Thrombo-occlusive angiitis, commonly known as angiitis, is a chronic, periodically worsening condition involving obstruction of medium and small arteries and veins throughout the body, primarily affecting young adults aged 20–40, mostly males. Main features include coldness, numbness, followed by pain in the extremities, necrosis, ulcers, and severe cases may lead to loss of toes (fingers). Without timely treatment, disability may result, affecting daily life and work, even threatening life. Patients must quit smoking, avoid cold exposure, especially after walking or working in cold, damp environments—dry affected limbs thoroughly, wear warm clothing and socks, avoid trauma, and perform limb function exercises to improve local circulation. Diet should be easy to digest and rich in calories. This condition corresponds to TCM categories such as “gangrene” and “loss of ten fingers.” Internal causes mainly involve spleen qi deficiency and liver-kidney insufficiency; external factors include invasion by cold-damp, and long-term smoking is also a contributing factor. The disease often arises from spleen-kidney yang deficiency with external cold-damp invasion causing stagnation of cold-damp in meridians, or emotional injury leading to internal heat accumulating in organs and invading the vessels, resulting in blocked meridians and poor blood and qi circulation.
Common clinical syndromes include:
① Vascular stasis syndrome: Affected limb skin appears dark purple, more severe in lower limbs; ecchymosis on toe tips; intense pain in all five toes, worse at night, preventing sleep; pale skin, muscle atrophy, absence of dorsalis pedis pulse; tongue purple-dark or with ecchymoses, thin white coating, deep, fine, wiry pulse.
② Toxic heat syndrome: Fever, thirst, dry stool, yellow urine; skin of limbs dark red and swollen, possibly turning purplish-black; necrosis and ulceration appear, discharging pus or foul-smelling bloody exudate, exposed tendons and bones, severe pain; red tongue, yellow thick coating, fine rapid pulse.
③ Yang deficiency with cold coagulation syndrome: Cold aversion, cold limbs, pain in affected limb, intermittent claudication, warmth relieves symptoms; skin pale, cold, dry; pale tongue, white greasy coating, deep, fine, slow pulse.
④ Qi and blood deficiency syndrome: Pale, emaciated appearance, fatigue, spontaneous sweating with exertion, mild or no pain in affected limb, muscle and skin wasting, chronic non-healing ulcers, cold skin, pale tongue, white coating, deep, fine, weak pulse.
One, Recommended Western Medications
1. Vasodilators:
(1) Tolazoline: 25–50mg per dose, oral three times daily.
(2) Nicotinic acid: 50mg per dose, oral three times daily.
(3) Papaverine: 30mg per dose, oral or subcutaneous injection three times daily.
(4) 2.5% Magnesium sulfate: Freshly prepared 100ml, intravenous infusion once daily, 15 sessions constitute one course, with a 2-week interval between courses.
2. Dextran 40 Injection: 500ml per dose, intravenous infusion once or twice daily, 10–14 days per course.
3. Antibiotics: For secondary infections in toe ulcers or gangrene.
4. Other:
(1) Fluid replacement: Intravenous fluids for severe cases to correct electrolyte imbalance.
(2) Vitamin supplementation.
(3) For severe pain: 2% procaine 20ml can be used for femoral artery block; alternatively, 1g procaine added to 100ml of 5% glucose injection, intravenous infusion once daily. Other analgesics may also be used.
Two, Recommended Chinese Patent Medicines
1. Vascular Stasis Syndrome:
(1) Antithrombotic Bao Rong Capsules: 10 capsules per dose, once daily, taken with warm water after meals.
(2) Mao Dongqing Capsules: 3 capsules per dose, three times daily, taken with warm water.
(3) Mao Dongqing Injection: Intramuscular injection, 2ml per dose, once or twice daily.
(4) Xue Fu Zhu Yu Pills: 1 pill per dose, twice daily, taken with warm water.
(5) Fuchun Tablets: 4–8 tablets per dose, three times daily, taken with warm water.
2. Toxic Heat Syndrome:
(1) Mailingning Injection: Intravenous infusion, adult dose 10–20ml, diluted in 5%–10% glucose injection or 0.9% sodium chloride injection (250–500ml), once daily, 10–14 days per course. Depending on condition, up to 3–4 courses may be used, with 5–7 day intervals between courses. In severe cases, two consecutive courses may be administered if necessary.
(2) Tongsai Mai Tablets: 10 tablets per dose, three times daily, taken with warm water.
(3) Qingxue Neixiao Pills: 6g per dose, 2–3 times daily, taken with warm water.
3. Yang Deficiency with Cold Coagulation Syndrome:
(1) Yanghe Pills: 2 pills per dose, 2–3 times daily, taken with warm water.
(2) Yougui Pills: 9g per dose, 2–3 times daily, taken with warm water.
4. Qi and Blood Deficiency Syndrome:
(1) Bazi Pill (Decoction, Syrup, Granules): Large honey pill, 1 pill per dose, or water honey pill 6g per dose, twice daily; concentrated pills 8 pills per dose, 2–3 times daily, taken with warm water. Decoction paste: 15–20g per dose, twice daily. Granules: 1 packet per dose, twice daily, dissolved in hot water.
(2) Ren Shen Yangrong Pills: 1 pill per dose, twice daily, taken with warm water.<Angiitis>