Gangrene

Tuoju (gangrene of the extremities) is a chronic peripheral vascular disease affecting the ends of the limbs. In severe cases, the toes or fingers become gangrenous and slough off. It is also known as tuogu ju (bone-detaching gangrene). It typically affects the ends of the limbs, most often the lower extremities. Early symptoms may include coldness, sensitivity to cold, pallor, and numbness in the affected limb, sometimes accompanied by intermittent claudication. Pain may then become severe; over time, the affected toes or fingers may become necrotic and black, and may even slough off. It occurs most often in young and middle-aged men, older adults, and people with diabetes. In Western medicine, it corresponds to thromboangiitis obliterans, arteriosclerotic obliterans, and diabetic foot. In Traditional Chinese Medicine (TCM), this condition falls within the category of “ju” (deep-seated sores).

TCM Pattern Differentiation and Medication Reference

| Common Symptoms

Clinical Description:

The affected toe or finger is more comfortable when warm and sensitive to cold, with numbness, soreness, distension, and pain. Pain worsens with walking and eases somewhat with rest. The skin is pale and cool to the touch, and the dorsalis pedis pulse is weakened; the tongue is pale with a white, greasy coating, and the pulse is deep and fine.

In Plain Language:

  • The affected toe or finger feels better when warm and is sensitive to cold.
  • The affected area may feel numb.
  • There may be soreness, distension, and pain. The more you walk, the worse the pain; it eases after a short rest.
  • The skin looks pale and feels cool to the touch.
  • The pulse on the top of the foot is weaker and harder to feel.
  • The tongue is pale.
  • The tongue coating is white and greasy.
  • The pulse feels deep and fine.

| Treatment Approach

Clinical Description:

Warm yang, dispel cold, invigorate blood, and unblock the channels.

In Plain Language:

  • Support yang and dispel internal cold, with the aim of easing sensitivity to cold, cold limbs, soreness and weakness in the lower back and knees, or a heavy feeling in the body.
  • Promote the flow of blood and unblock the channels, with the aim of easing bruising, numbness, or pain.

| Related Formulas

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

Duhuo Jisheng Decoction

| Common Symptoms

Clinical Description:

Pain and distension in the affected toe or finger worsen, making it difficult to sleep at night and walk. The affected toe or finger is dark red or purplish, with discoloration worsening when the limb hangs down. The skin is cool and dry, muscles atrophy, and the dorsalis pedis pulse disappears. The tongue is dark red or has stasis spots, with a thin white coating; the pulse is wiry and choppy.

In Plain Language:

  • Soreness, distension, and pain in the affected toe or finger worsen and may make it difficult to sleep at night.
  • Walking becomes difficult, with heavy, labored steps.
  • The skin of the affected area becomes dark red or purplish, with the discoloration more pronounced when the limb hangs down.
  • The skin feels cool and dry to the touch.
  • Local muscles gradually become thinner from atrophy.
  • The pulse on the top of the foot disappears and can no longer be felt.
  • The tongue is dark red or has visible stasis spots or patches.
  • The tongue coating is thin and white.
  • The pulse feels taut like a stretched string or rough and hesitant.

| Treatment Approach

Clinical Description:

Invigorate blood, resolve stasis, unblock the channels, and relieve pain.

In Plain Language:

  • Promote blood flow and resolve stasis, with the aim of easing bruising, masses, or menstrual irregularities.
  • Unblock the channels and ease pain, with the aim of easing numbness, tingling pain, or painful obstruction.

| Related Formulas

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

| Common Symptoms

Clinical Description:

Severe pain in the affected limb, milder by day and worse at night; local swelling and purplish, darkened skin; lesions spread and infiltrate, then ulcerate and become necrotic, with unhealthy-looking tissue. There may also be fever, dry mouth, constipation, and dark urine. The tongue is red with a yellow, greasy coating, and the pulse is wiry and rapid.

In Plain Language:

  • The affected area may be severely painful, somewhat less so during the day and noticeably worse at night.
  • The local area may become visibly swollen.
  • The skin may become purplish and dark, with an abnormal appearance.
  • The skin lesions may spread and ooze into surrounding areas, increasing in extent.
  • The area may ulcerate and gradually become necrotic, with the wound appearing unhealthy.
  • The tissue in the wound may look dull and unhealthy.
  • There may be fever and dry mouth, with a strong desire to drink.
  • Constipation may occur, and the urine may appear reddish or yellowish.
  • The tongue may look red or bright red.
  • The tongue coating may be yellow and greasy, with a thick, sticky appearance.
  • The pulse feels taut like a stretched string and is rapid.

| Treatment Approach

Clinical Description:

Clear heat and drain dampness; invigorate blood and resolve stasis.

In Plain Language:

  • Clear internal heat and promote the elimination of dampness, with the aim of easing fever, thirst, a heavy feeling in the body, or difficulty urinating.
  • Promote blood flow and resolve stasis, with the aim of easing pain, bruising, or menstrual irregularities.

| Related Formulas

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

| Common Symptoms

Clinical Description:

The skin is dry, body hair is lost, and the toenails or fingernails become thickened and deformed. Muscles atrophy, and the toes or fingers develop dry gangrene. There may be dry mouth and thirst, constipation, and dark urine. The tongue is red with a yellow coating, and the pulse is wiry, fine, and rapid.

In Plain Language:

  • The skin is very dry, fine body hair may fall out, and the fingernails or toenails may thicken and become deformed. Local muscles gradually waste away, and the fingers or toes develop dry gangrene.
  • The mouth feels dry and there is a desire to drink; bowel movements may be constipated and difficult, and the urine may look reddish or yellowish.
  • The tongue is red.
  • The tongue coating is yellow.
  • The pulse feels taut, fine, and rapid.

| Treatment Approach

Clinical Description:

Clear heat and resolve toxins; nourish yin and invigorate blood.

In Plain Language:

  • Clear internal heat and resolve toxins, with the aim of easing fever, sore or swollen throat, or red, swollen sores.
  • Nourish yin fluids and promote blood flow, with the aim of easing dry mouth and throat, low energy, or pain and bruising.

| Related Formulas

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

| Common Symptoms

Clinical Description:

After a prolonged course, the wound remains unhealed after necrotic tissue sloughs off, and the granulation tissue is dark red or pale and unhealthy-looking. There may be fatigue, thirst without a desire to drink, a dull complexion, weight loss, and heat in the palms, soles, and chest. The tongue is pale with a red tip and little coating; the pulse is fine and weak.

In Plain Language:

  • After necrotic tissue sloughs off, the wound remains unhealed and does not close.
  • New granulation tissue looks dark red or pale and unhealthy, with little sign of vitality.
  • You may feel tired and weak, with little energy.
  • You may feel thirsty but not want to drink much.
  • The complexion may look dull.
  • Weight may decrease, with noticeable thinning.
  • The palms, soles, and chest may feel warm.
  • The tongue is generally pale, with a red tip.
  • There is very little tongue coating.
  • The pulse is fine and weak.

| Treatment Approach

Clinical Description:

Supplement qi and nourish yin.

In Plain Language:

  • Support the body’s qi, with the aim of easing weakness, shortness of breath, or fatigue.
  • Nourish yin fluids, with the aim of easing dry mouth and throat, restlessness, night sweats, or a feeling of internal heat.

| Related Formulas

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

Shengmai San

References

  1. Vijayakumar A，Tiwari R，Kumar Prabhuswamy V. Thromboangiitis Obliterans（Buerger’s Disease）—Current Practices[J]. In J Inflam，2013：156905.
  2. Gao Jie, Zhang Ya, Fu Chenfei. Clinical Observation of 72 Cases of Lower-Extremity Arteriosclerosis Obliterans Treated with Alprostadil Combined with Kangmai Injection[J]. Heilongjiang Science and Technology Information, 2015(30): 77-78.
  3. Yang Wenyan. Recent Advances in Integrated Chinese and Western Medicine Nursing for Diabetic Foot[J]. Chinese Journal of Geriatric Care, 2014(6): 101-103.
  4. Jia Xiuqing, Sun Ximing. Application of Ruyi Jinhuang Powder for External Use in the Nursing Care of Diabetic Foot Ulcers[J]. Journal of Clinical and Experimental Medicine, 2010(10): 786-787.
  5. Zhu Xiaojuan, Zhang Didi, Yao Jing, et al. Nursing Care of 28 Patients with Diabetic Foot and the Damp-Heat Toxin Pattern Treated with External Application of Shengji Yuhong Ointment[C]//Proceedings of the 14th National Conference on TCM Diabetes. 2012.