周围血管疾病(peripheral vascular disease,PVD)病理因素以血热、湿热、血瘀、气虚为主.初期,以湿热外邪为主,此期病程较短,正气充足,正邪交争明显,宜用金黄散外敷,箍束邪毒,同时佐以辛散之品或灸法,透达体内之邪,热毒较重者用金银花、紫花地丁;肢体肿胀、气机郁结者用柴胡、郁金等宣散之品.PVD进展期,湿、热、瘀蕴结于内,正邪交争激烈,在拔毒排脓的同时加扶助正气药物,用生肌玉红膏、通络生肌膏、朱红膏纱条联合围刺法,给邪出路,促邪外出,防止疾病传变.PVD后期,久病气血凝滞,或湿邪蕴结,日久化湿生寒,用温阳散瘀散、回阳生肌膏、温阳扶正外洗药、股肿洗剂等温阳益气,活血通络,扶正补托,托邪外出,使寒性病邪局限而散于外.箍围法不只是"围",也在局限邪毒同时促进正气来复,以生肌长肉.

箍围法是中医外治法之一.通过箍集围聚,收束疮毒作用,达到清热消肿,散瘀定痛的目的.通过分析近10余年相关文献,显示箍围法不再局限于外用膏粉剂的使用,也包括凝胶软膏等不同剂型、针刺、负压引流等应用技术.临床文献显示,箍围法在其优势病种——外周血管疾病中变形及应用,可视为中医传统外治方法的延伸应用.

目的：探讨负压封闭引流技术配合点状植皮在治疗糖尿病足中的效果。方法：选取糖尿病性足坏疽患者58例，应用负压封闭引流技术配合点状植皮术治疗，观察创面愈合率和创面愈合时间等指标。结果：58例创面愈合时间12~83 d，平均32.4 d；临床痊愈49例，显效3例，有效4例，无效3例，创面愈合率88.4%，总有效率为94.8%。结论：负压封闭引流技术配合点状植皮术治疗糖尿病性足，对坏疽创面有良好的促愈作用。

笔者应用复方黄柏液外敷治疗下肢慢性溃疡30例,取得一定疗效,现报道如下. 1 临床资料 1.1 一般资料 所有病例均为天津市中医药大学第一附属医院住院和门诊患者,共60例,随机分为2组.治疗组30例:男17例,女13例;年龄35～75岁,平均年龄53.4岁;病程30 ～60 d;其中下肢静脉曲张性溃疡13例,外伤性溃疡17例;对照组30例:男16例,女14例;年龄33～74岁,平均年龄50.36岁;病程31～64d;其中下肢静脉曲张性溃疡16例,外伤性溃疡14例.2组患者年龄、性别、平均病程等一般资料经统计学处理无显著性差异(P＞0.05),具有可比性.

随着糖尿病发病率的提高,其慢性并发症逐渐对糖尿病患者的健康和生活质量构成严重威胁,在全球2.5亿糖尿病患者中是糖尿病足的患病率达6％～20％,其中有15％会发生足溃疡或坏疽严重者造成截肢.根据既往临床中西医外治对照研究文章所见,综合中医治疗有效率约为84.6％,西医治疗的有效率为55.8％.

[Objective] To explore the pathogenesis mechanism of macroangiopathy in diabetic patients trough observing the expression of TGF-β1 and CTGF in rats with experimental diabetic macroangiopathy and decide the target in preventing and treating the macroangiopathy in patients with diabetes through observing the preventing effect of TCM.[Methods] Among eighty male SD rats seventy were induced with diabetes(DM).They were divided into 5 groups: model group(n=14),high,medium and low dose of traditional Chinese medicine groups(n=14),melbine group(n=14).All rats in these six groups were giving with ordinary feed for 12 weeks.After that,arteria cruralis was obtained and the site and change of expression of CTGF and TGF-β1 in which were observed.[Results] TGF-β1 was mainly expressed in the cytoplasm.It is strong positive in model group.In Chinese medicine intervention groups the expression of TGF-β1 was declined obviously(P<0.01).Melbine has influence on the expression of TGF-β1,but the comparison with high dose of traditional Chinese medicine group has significant difference(P<0.05).A large of brown-1yellow material with strong positive reaction(CTGF) could be seen in cytochylema in submucosa of blood vessels of model group.But the CTGF expression was all significantly lowered in cell of blood vessels in drug intervention groups(P<0.01).The difference of expression between high dose group and Western medicine control group was statistically different.[Conclusion] 1)The onset of diabetic angiopathy may be concerned with fibrosis.2)Modified Taohe Chengqi Decoction can reduce the expression of Fibrosis factor TGF-β1 and CTGF in rats with experimental diabetic macroangiopathy.It can improve macroangiopathy in DM and has a dose-1dependent relationship.

<正>周围神经病变是糖尿病常见并发症之一,其病理改变主要表现于糖尿病广泛的微血管病变、供血障碍影响神经组织本身和神经滋养血管。笔者采用针药结合治疗糖尿病周围神经病变,效果显著。

<正>褥疮是局部软组织持续受压,导致组织、细胞缺血、缺氧坏死后引起的皮肤缺损,是很多长期卧床患者常见的并发症,给患者造成很大痛苦。

<正>下肢慢性缺血性疾病包括动脉硬化性闭塞症、血栓闭塞性脉管炎及大动脉炎,糖尿病足等。主要以动脉硬化性闭塞症为主[1],如果误治或治疗不当,就会造成患者痛苦加重,甚至肢体残缺的可能。因此,深入研究下肢慢性缺血性疾病的诊治,是目前临床医疗的重要课题。现就缺血性疾病的治疗方法作

<正>皮肤溃疡是外科疾病中常见的并发症,特别是一些溃疡经久不愈、反复加重,令患者非常痛苦,也是临床医生治疗棘手的问题。笔者采用点状植皮、外敷生肌象皮膏的方法治疗较大面积及较难愈合的感染性创面,使之伤口愈合时间显著缩短。1一般资料选择我院2005年9月～2007年5月收治的患者共126例,男性85例,女性41例;年龄34～81岁,平均62.5岁;下肢慢性溃

<正>下肢深静脉血栓形成(DVT)是血管外科临床常见的静脉回流障碍性疾病。但因治疗效果不理想,尤其是治疗不及时,常出现一些严重的并发症和后遗症。本科于2003年8月—2006年10月共收治患者82例,现报道如下。

Objective To investigate the therapeutic effect of transplantation of mononuclear cell in autologous bone marrow with the herbal medicine for lower limb ischemia with various causes Methods Patients were treated with colony stimulating factors to make their marrow in an active condition of accrementition before the operation. During the operation,blood marrow samples were taken to abstract mononuclear cells,then injected into the lumen of distal artery and muscle of the ischemic limbs.After the operation,the soreness,temperature, intermittent lameness ,score of the ulcer raw surface circumstance and the fluctuation of ankle-brachial index(ABI) were observed. Results After treatment,the feeling of soreness and the temperature,distance of the angina cruris and the capability of agglutination were improved;but the ABI was not obviously advanced in a short time. Conclusion The investigation suggests that transplantation of mononuclear cell in autologous bone marrow with herbal medicine can quickly ameliorate the feeling of soreness and low temperature, promoting healing and local blood circulation for a longer term.

To explore the correlation of syndrome differentiation in TCM with pathologic change of amputated sample in diabetic foot.Patients with diabetic foot were divided into stagant deficiency of both qi and blood type,blood stssis in collaterals type,stagnant heat in collaterals type,heat toxin in collaterals type and stagnant deficiency of both qi and yin type according to syndrome differentiation in TCM.Pathologic picture was observed on amputated limbs.thirteen cases were mainly of stagnant heat in collaterals type,heat toxin in collaterals type and stagnant deficiency of both qi and yin type.The main pathologic changes of amputated artery were manifested as a chronic inflammation in its peripheral vessels or in full thickness in the former.The stagnant heat in collaterals type were mainly as calaification of middle membrane,atrophy,degeration and necriosis of smooth muscle,obvious increase of collagenous fiber.The inflammatory changes were alleviated more obviously than the former.The stagnant deficiency of both qi and yin type were mainly as calcification of middle membrane,decrease of smooth muscle,obvious increase of collagenous fiber.[Conclusion]Syndrome differentiation has certain correlation with pathologic changes of diabetic foot.

我院近2年来收治的急性动脉栓塞病人,通过临床症状及肢体血管检查,早期明确诊断后,行动脉血栓取栓术,并应用活血化瘀、通脉止痛中药治疗,取得了较好疗效.

目的:探讨糖尿病足坏疽中医辨证分型、分度与创面致病菌有否相关性.验证辨证分型内治加丹黄消炎液外治对创面抑菌及促愈效果.方法:对140例不同分型、分度的糖尿病足坏疽创面分泌物做细菌学调查及相关性分析;对178例感染性糖尿病足坏疽进行中药内外辨治,判定疗效.结果:糖尿病足坏疽中医辨证分型、分度与创面致病菌有一定相关性;内外合治对足坏疽临床总有效率为85.39%.结论:中医辨证内外合治可从抑菌、消炎及改善局部微环境等诸方面促进糖尿病足坏疽创面愈合.

急性主髂动脉闭塞是外科危急重症,可引发多器官功能障碍,对患者威胁很大,国外报道其死亡率为 30%～ 50%.我们采用中西医结合方法治疗本病效果较好,现介绍如下.