What are the treatments for Raynaud's syndrome?

1. western medicine treatment

(1) General treatment: pay attention to cold and warmth, avoid emotional factors and avoid smoking. Prevent local trauma and avoid low temperature operation. Secondary patients should treat the primary disease as much as possible.

(2) drug therapy:

① α receptor blockers block norepinephrine and epinephrine and only block the receptor part of the vascular wall, resulting in α receptor blocking effect and vasodilation. Commonly used oral drugs are phenoxybenzamine, prazosin hydrochloride, indoleamine and tolazolin hydrochloride.

② Adrenergic nerve blockers can take Guanethidine, methyldopa and reserpine orally.

③ In vivo and in vitro experiments show that slow calcium channel antagonists can block calcium uptake by cells, reduce the contractility of smooth muscle, relax muscles and relieve arterial spasm. At the same time, the drug also has the effects of blocking α receptor and inhibiting the synthesis of thromboxane A2. Nifedipine can be used alone or in combination with anisodamine with good results. Or diltiazem (thiazine), taken orally.

④ Vascular smooth muscle relaxant acts directly on vascular smooth muscle, and nicotinic acid and inositol nicotinate are commonly taken orally.

⑤ Captopril, an angiotensin converting enzyme inhibitor, was taken orally, 25 ~ 50mg each time, three times a day, and the dosage was gradually increased.

⑥5- hydroxytryptamine antagonist is effective for vasospasm caused by cold. Ketoselin, 40 mg each time, 3 times a day.

⑦ Prostaglandin PG 1 and prostacyclin PG 12 can dilate blood vessels and inhibit platelet aggregation.

⑧ stanozole (Kanglilong) increases fibrinolytic activity and reduces blood viscosity. Oral administration, 2mg each time, 2 ~ 3 times/d.

Pet-name ruby estrogen is suitable for female patients with diseases caused by endocrine disorders.

(3) Local treatment: local application of 2% nitroglycerin ointment several times a day can relieve symptoms, but the effect lasts for a short time.

(4) Patients with induced vasodilation were exposed to 0℃ cold environment, and their hands were soaked in 43℃ hot water for 65438 00 minutes each time. The results of cold test showed that the temperature of extremity increased by 2.2℃ on average after treatment. The mechanism is that patients are exposed to cold environment again through conditioned reflex, and the blood vessels at the end of limbs no longer have excessive contraction reaction.

(5) Anesthesia treatment: brachial plexus block, waist and hip block, stellate ganglion block and thoracolumbar sympathetic nerve block.

(6) The patient with limb negative pressure treatment takes a seat and puts the affected limb into the negative pressure cabin. The pressure of upper limb treatment is -8.6 ~- 13.3 kPa, generally-10.6 kpa; Lower limb-10.6 ~- 17.3 kPa, generally-13.3kPa. Every day 1 time, every time 10 ~ 15 min,10. The principle of treatment is that negative pressure dilates the blood vessels of lower limbs, overcomes the contraction of vascular smooth muscle, and the arteries continue to dilate.

(7) Plasma exchange therapy can reduce plasma viscosity. 500ml blood is drawn every day, or 350 ~ 1000ml 1 ~ 2 times. In 1L, 2 ~ 2.5L artificial plasma can be used to replace the clearance. When the clearance is large, fresh plasma or albumin isotonic solution must be used. Weekly 1 time, 5 times in total, and the curative effect can last at least 6 weeks. If a blood cell separator is used, only the plasma is removed and the blood cells are kept, the curative effect is better.

(8) Surgical treatment

1. indications ① course of disease >: 3 years; ② Severe symptoms, which affect work and life; ③ Sufficient course of drug treatment is ineffective; ④ Immunological examination showed no abnormality.

2. Methods ① Sympathectomy. Upper thoracic sympathectomy can be considered for upper limb lesions; Lumbar sympathectomy can be done for lower extremity lesions. The curative effect can last for about 2 ~ 5 years. ② Microsympathetic nerve resection around metacarpal and digital arteries.

(9) Biofeedback therapy is a method to explore and amplify the unconscious or imperceptible biological information under normal circumstances, and convert it into signals through the recording and display system, so that patients can feel the changes of these functions, thus connecting some of their feelings with their physical functions and adjusting these functions to a certain extent.

Methods: ① The skin temperature was measured every 65,438 0.5 seconds with a thermometer connected to a light indicating system. When the skin temperature rises or stabilizes, the indicator system emits light, but it does not emit light when the skin temperature drops. In this way, the patient receives a visual stimulus reflecting the skin temperature. ② Self-control training, telling patients to take a deep breath and relax through recording, and then recalling pleasant and warm experiences, such as bathing in the warm sunshine and lying on the soft beach, where the surrounding waves gently beat the beach. Each treatment lasted 65438 0 hours. 1 month 3 times a week, 2 times a week in the second month, and 1 time in the third month. Instruct patients to do the same training at home every day 15 minutes. After treatment, when the patient entered the cold room at 3.3℃, the skin temperature could be kept at 265,438 0.4℃ (22.2 ~ 23℃ for normal people), and it dropped to 65,438 0.9℃ on average before treatment.

2. Chinese medicine treatment

(1) syndrome differentiation and treatment:

① Blood deficiency and cold coagulation:

Main symptoms: cold limbs, chills, pale or reddish complexion, which are immediately caused by cold or emotional stimulation. It is obviously aggravated in winter and lightened in summer, with pale tongue, thin and white tongue coating and thin pulse.

Treatment: nourishing blood and dispelling cold, warming channels and removing blood stasis.

Prescription: Jiawei Danggui Sini Decoction.

Cinnamomum cassia twig10g, Asari 3g, Angelica sinensis10g, Paeonia lactiflora15g, medulla tetrapanacis 6g, five Chinese dates, peach kernel10g, turmeric10g and licorice 6g.

Addition and subtraction: For patients with severe internal cold, add 3 grams of Evodia rutaecarpa and 3 slices of ginger to warm the middle warmer and dispel cold to relieve pain.

② Yang deficiency and cold coagulation:

Symptoms: cold limbs, pale face, frequent attacks, especially in winter, pale face, aversion to cold and warmth, clear urine, thirst, pale tongue, white fur, slow or heavy pulse.

Treatment: Warming yang, dispelling cold and guiding stagnation.

Prescription: Yanghe decoction is flavored.

Radix Rehmanniae Preparata 15g, Colla Cornu Cervi 10g, Charcoal Ginger 10g, Cinnamomum cassia 4g, Herba Ephedrae 5g, Semen Sinapis Albae 10g, Radix Codonopsis 10g, Herba Epimedii10g; Asarum 3g.

Addition and subtraction: For patients with obvious pain, frankincense 10g, myrrh 10g, Spatholobus suberectus 30g and Salvia miltiorrhiza 30g can be added to remove blood stasis and relieve pain.

③ Qi deficiency and blood stasis:

Symptoms: Intermittent attack, pale fingers (toes), gradually turning green, accompanied by numbness and tingling, mild warmth, white tongue coating, red tongue and weak pulse.

Treatment: Yiqi Wenyang, Huoxue Tongluo.

Prescription: Huangqi Guizhi Wuwu Decoction.

Astragalus root 30g. Ramulus Cinnamomi 10g, Radix Paeoniae Alba 12g, 3 slices of ginger, 5 jujubes, Radix Angelicae Sinensis 10g, and Lumbricus 10g.

Addition and subtraction: if the finger (toe) is swollen and the tongue is purple and dark with ecchymosis, add 30g of Salvia miltiorrhiza, 65438+ 00g of myrrh and 2 centipedes.

(4) at the end of the four relegation:

Symptoms: persistent attack, dry skin, desquamation, atrophy or thickening of the affected limb, longitudinal bending and deformation of the nail, emaciation of the finger pad, decalcification of the distal phalanx, fingertip ulcer extending under the nail, separating the nail from the nail bed, causing severe pain and even gangrene of the extremity. The tongue is purple and dull, with ecchymosis on the edge of the tongue and heavy pulse.

Treatment: Yiqi Yangxue, Huayu Tongluo.

Prescription: Shiquan Dabu Decoction and Dahuangchong Pill.

Codonopsis pilosula 10g, Poria cocos 15g, Atractylodes macrocephala 10g, Glycyrrhrizae Radix 6g, Radix Rehmanniae 15g, Radix Paeoniae Alba 12g, Radix Angelicae Sinensis 10g, Rhizoma Chuanxiong 10g and Radix Astragali 30g. Turmeric 10g, safflower 10g.

Addition and subtraction: add frankincense, myrrh 10g, corydalis yanhusuo 10g and Spatholobus suberectus 30g. If the ulcer does not heal for a long time, it can be applied externally with products such as Shengji Yuhong ointment.

⑤ Heat toxin due to blood stasis:

Symptoms: Blood stasis turns into heat for a long time, and accumulated heat produces poison, resulting in mild superficial ulcers on fingers or toes and even local gangrene. Finger (toe) fever, redness, swelling and pain, red tongue, yellow greasy fur and astringent pulse.

Treatment: clearing heat and cooling blood, removing blood stasis and dredging collaterals. 20g of honeysuckle, 0/0g of angelica sinensis/kloc-0, 2g of radix scrophulariae/kloc-0, 6g of licorice, 30g of dandelion, 0g of viola yedoensis/kloc-0, 0g of forsythia suspensa12g.

Add or subtract: if the affected skin is cyanotic, add Cortex Moutan 10g, Lumbricus 10g, Radix Paeoniae Rubra 12g and Flos Lonicerae 30g. Patients with blood stasis and heat toxin should not only take the products of clearing heat and cooling blood, removing blood stasis and dredging collaterals, but also pay attention to the local medication and protection of the affected area. Wash the affected area with Flos Lonicerae, Herba Taraxaci, Herba Violae, Radix Paeoniae Rubra and Cortex Phellodendri, and apply Ruyi Huangjin Powder or Sanhuang Plaster externally. Avoid spicy, greasy and sweet food.

(2) Comprehensive management:

① Chinese patent medicines: Compound Danshen Tablets, Shenrong Pills, Jiawei Xiaoyao Pills, Hanshibi Granules and Acanthopanax Senticosus Tablets.

② Unilateral:

A. Ilex pubescens tablets, 5 tablets each time, 3 times a day, taken orally.

B. Ilex pubescens injection is 2ml~4ml each time, intramuscular injection, twice a day.

C. Danshen tablets, 5 tablets each time, 3 times a day, taken orally.

D. Sichong Pill: Scolopendra, Scorpio, Eupolyphaga Seu Steleophaga and Lumbricus are equally divided, ground into fine powder and watered into pills, 3g each time, 2-3 times a day. Has effect in promoting blood circulation, dredge collaterals, relieving spasm and relieving pain.

E. Tongmai 'an Pill: Flos Daturae 1 .5g, Radix Salviae Miltiorrhizae 60g, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Radix Paeoniae Rubra, Amber15g, Cinnabar1g, Semen Ziziphi Spinosae and Chicken Blood 30g, all of which are ground into fine powder and refined pills, 9g each time, twice a day. Has effect in promoting blood circulation, relieve pain, and tranquilizing.

F. Huoxue Tongmai tablets: Salvia miltiorrhiza180g, Paeonia Rubra, Smilax glabra 90g, Angelica sinensis 60g, Lonicera japonica11~ 30g, all of which are ground into fine powder and made into 0.3g tablets, 20 tablets each time, taken orally for 2-3 times, with the functions of promoting blood circulation, removing blood stasis, dredging collaterals and relieving swelling.

G. add 20 ml ~ 30 ml of salvia miltiorrhiza injection into 200 ml ~ 300 ml of 5% glucose or physiological saline, and drip intravenously, 65438 0 times/d. ..

③ Acupuncture therapy.

A. Needle selection: Hegu, Baxie, Shousanli, Waiguan, Feng Ba, Sanyinjiao, Zusanli and Juegu; Zhongwan, Guanyuan, Pishu and Shenshu. Both groups were treated with acupoint rotation and warm acupuncture. 65438+ 0 times every other day, 7-9 strong moxibustion each time.

B. Moxibustion points: a. Dazhui, Zhiyang, Mingmen, Shangwan and Zhongwan; B Zusanli, Shu Ge, Pishu, Shu Wei and Shenshu. Choose 2 acupoints at point A and/kloc-0 moxibustion points at point B each time. Every other day 1 time, 7 ~ 9 strong moxibustion each time.

C. acupoint injection of drugs:

Acupoints: Quchi, Chise, Waiguan and Neiguan are selected for the upper limbs, and Zusanli, Sanyinjiao, Juegu and Xue Hai are selected for the lower limbs.

Medicine: Danshen injection 2ml.

Treatment: Take 2 acupoints of the affected limb and inject them in turn, 1 time per day, 30 times for 1 course of treatment.

D. triangular needle, essentials: 3 ~ 5 drops of blood are stabbed at the fingertips of hands and feet.

Syndrome differentiation: bleed 3 ~ 5ml from elbow vein, gently prick the back of hand until congestion; If it happens in the foot, take 5 ~ 10 ml of collateral blood and stab it in Wally, then gently prick the foot until it is congested or slightly bleeding. Every 2 ~ 3 days 1 time, 5 ~ 7 times as 1 course of treatment, with 5 days' rest between courses.

E. After scalp acupuncture takes the frontoparietal region, the insertion of l/3 and posterior oblique region of temporal parietal region (corresponding parts on both sides) is slightly reduced. The posterior l/3 of the frontoparietal belt should be penetrated from front to back, and the posterior parietal temporal belt should be penetrated along the belt. When acupuncture is performed, patients are required to take a deep breath and hold their breath, and at the same time, patients are allowed to rub and massage their affected limbs. If the cold gets worse, it should be induced by cold water or ice to the period before acupuncture, and then acupuncture can ensure and consolidate the curative effect. Needle insertion lasts for 3 ~ 5 minutes each time, and needles can be inserted at intervals for 24 hours. 1 time/d.

F ear points: ear hot spots, cardiovascular, subcortical, sympathetic, heart, lung, greater occipital nerve points, right liver, left spleen and finger points. Every 3 ~ 5 days 1 time, 5 times for 1 course of treatment.

④ Massage therapy: The patient takes the sitting position, and the doctor takes Quchi, Neiguan, Waiguan, Shaofu, Laogong, thenar, Houxi, Qian Gu and Zhongzun: 65,438+0 min, and takes the entrance, Gu Shan, Sanjian and Erjian, slapping the patient's palm and back for 5min, and shaking his hands twice with the wrist as the axis, and applying the shaking method. 2 times in hand, ending the treatment. 10 times yes. 1 course, rest 1 day, and perform the next 1 course.

(5) fumigation therapy:

A. Huoxue Zhitong Powder: 65,438+/-00g of Spermatum speranskiae tuberculatae, Radix Clematidis, Cortex Acanthopanacis, Rhizoma Corydalis, Radix Cyathulae, Carthami Flos, Radix Angelicae Sinensis, Olibanum, Myrrha, Rhizoma Smilacis Glabrae, Curcuma Rhizome, Notopterygii Rhizoma, Zanthoxylum bungeanum, Radix Angelicae Dahuricae, Cortex Erythrinae and lignum sappan, respectively, decocted in water and smoked. It is suitable for qi deficiency and blood stasis syndrome and four-terminal disgrace syndrome.

B) Huiyang Zhitong Lotion: 30g of Caulis et Folium Gaultheriae Yunnanensis, 65438 05g of Radix Angelicae Sinensis, Radix Paeoniae Rubra, Fructus Zanthoxyli and Lignum sappan, 65438 00g of Rhizoma Arisaematis, Rhizoma Pinelliae, Radix Aconiti Kusnezoffii, Radix Cyathulae, Radix Angelicae Dahuricae and Cortex Erythrinae, decocted in water, smoked and washed. Suitable for yang deficiency and cold coagulation.

C. For patients without ulcer and gangrene, the affected limbs can be fumigated and washed with traditional Chinese medicines, such as Caulis et Folium Gaultheriae Yunnanensis, Fructus Toosendan, Cortex Erythrinae, Radix Clematidis, Radix Cyathulae, Notopterygii Rhizoma, Radix Angelicae Dahuricae, Lignum sappan, Cortex Acanthopanacis, Carthami Flos, Rhizoma Polygoni Cuspidati, Fructus Zanthoxyli, Olibanum and Myrrha. The decoction can be used for fumigation and washing affected limbs, and has the effects of promoting blood circulation and relieving pain.

D for patients with ulcer and gangrene, pay attention to debridement and dressing change, 1 ~ 2 days 1 time. It can be used as Shengji Yuhong ointment (used by people who don't shut up for a long time) and Yangyin Shengji powder.

3. Care about:

(1) nursing problems: the finger skin is pale and numb when it is cold or emotional; Pain; Skin sclerosis and gangrene.

(2) Nursing objectives: ① Avoid cold stimulation and bad mood, and reduce attacks. ② Relieve pain, numbness and discomfort. ③ Prevent the deterioration of skin lesions.

(3) Nursing measures:

① Avoid all kinds of inducing factors, keep warm in winter, prevent local exposure of limbs to cold environment, and keep the ward temperature between 22 ~ 23℃. Prohibit vasoconstrictors and B receptor blockers to avoid trauma. Actively encourage smoking cessation, because nicotine can constrict blood vessels, affect blood circulation, and actively treat various diseases that cause blood vessel damage. Keep the skin clean and the ward should be disinfected regularly.

2 avoid irritating diet, avoid cold, spicy and thick products.

③ Do psychological nursing well, explain the relationship between mental factors and diseases to patients, avoid mental stress and emotional excitement, and maintain a good mood.

④ Observe the skin blood circulation of patients' toes. When symptoms such as pallor, pain and numbness appear, you can soak in warm water to strengthen massage. If necessary, apply nitroglycerin ointment to the toes locally, and keep it for 65438±0h hours each time before drying. ..

⑤ When the patient has local ulcer or gangrene, pay attention to the cleanliness of the skin, and cooperate with fumigation and external application of drugs when necessary. If fever, aversion to cold, general pain and other systemic symptoms occur at the same time, symptomatic treatment should be taken in time to control infection. Avoid drooping and hyperactivity of the affected limb.

⑥ If there is pain during the attack, local rubbing can relieve the pain or stop the attack.

⑦ Actively treat various diseases that cause Raynaud's phenomenon, such as systemic lupus erythematosus and dermatomyositis.

⑧ Conduct outdoor activities properly, and pay attention to protecting exposed parts.

(2) Prognosis

Raynaud's disease has a good prognosis, and can be completely cured by avoiding cold stimulation and emotional excitement, smoking, drugs and surgical treatment. Raynaud's sign depends on the therapeutic effect and prognosis of the primary disease. Raynaud's syndrome's general prognosis caused by autoimmune rheumatism is poor.