Evaluation Of Curative Effect In Buerger's Disease Above The Second Stage By Combined Treatment Of TCM And Western Medicine

Purpose: The purpose of this study was to review the curative effect of two different combined treatments of traditional Chinese medicine and western medicine for thromboangiitis obliterans (TAO) above the second stage.Method:57 patients(4 females and 53 males) above the second stage of TAO was divided into 2 groups, and one group was received treatments in vascular surgery department (The Group A) and the other in Chinese medicine surgery department (The Group B), TCM hospital of HuBei Province between July 1996 and Match 2007.31 patients (29 males and 2 females) is in the Group A, 22 of which were in the second stage, 6 were in grade 1 of the third stage, 2 were in grade 2 of the third stage, and lwere in grade 3 of the third stage. 26 patients (24 male and 2 females) were in the Group B, 21 of which were in the second stage, 3 were in grade 1 of the third stage, 2 were in grade 2 of the third stage. Anticoagulant drug as well as Pimobendane and thrombolytic drugs were used in both groups. The A group were determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs, which were divided into four types (acute stage, deferment and active stage, improve and convalescence stage, stable and metabolic stage). After acute stage, different types of arterialization operation were used to all patients of the A group. The B group were determination of treatment based in pathogenesis by 4 types(asthenia cold; sluggish; pyretic toxicity; deficiency of both QI and blood ), according to the classic view of TCM theory, to go with debriding and change of dressing.Results: The patients of the group A received treatment for 74 days on average in hospital.2 patients received high amputation because of the serious oedema-induced the increased ischemic symptom after operation and one of them was dead suddenly with ambiguous reasons after one month of high amputation. 2 patients had to be high amputated owning to the increased ischemic symptom. Pain disappeared basically in 25 patients and easement in 3 patients. Remission rate of pain was 80.6%, Ulcer or wound of gangrene of limbs by veno-arterialization operation healed in 18 patients including mummification necrosis autotomied in 5 patients of the third stage. 3 patients healed basically that the surface of wound had been scabbed with no secretion. The wound of 4 patients with high amputation healed well. Intention rate was 100%. The process of the ulcer healing spent 73.6 days on average. 8 patients in the second stage healed well, 7 of which were excellence and 5 were improvement, 2 were invalid and one dead. Clinical recovery rate was 32.3% and total effective rate was 83.9%. 27 patients of the group A were followed up 8.4 years on average, 12 of which were cured (44.4%), 7 showed excellence(25.9%), 5 improved (18.5%), 3 invalid(11.1%), and including 2 suffered amputation of middle-inferior leg and mid-inferior thigh respectively due to relapse after operations, effective rate was 88.8%. The treatment time of the 26 patients in the group B was 88.5 days on average in hospital. 2 patients of the third stage received high amputation because of increased ischemic symptom. And mummification necrosis autotomied in 7 patients. Pain relieved in different degree in 17 patients and 3 had no relief of pain. Remission rate of pain was 65.4%. 2 patients of the second stage were cured, 13 patients showed excellence, 4 improved, and 2 ineffective while 2 patients in third stage improved, 3 invalid. Clinical cure rate was 7.7% and total effective rate was 80.7%. 22 patients of the group B were followed up 6.8 years on average, 3 of which were cured (13.6%), 3 showed excellence (13.6%), 8 improved (36.4%), 8 invalid including 2 relapsed and ischemic symptom increased, 3 suffered high amputation. Total effective rate was 63.3%. There were not significant difference on the effective rate in the near future between the group A and B by statistic test (p＜0.05), while the group A have an advantage in cure rate, intention rate, remission rate of pain (p＜0.05). The group A also have more advantage in cure rate, intention rate in prostecdtive efficacy than B (p＜0.05).Conclusion: Eliminating pathogen is first and blood circulation against stasis is not the major method when we treat TAO patients. On the premise of strict operation indication, Vein-arterialization could be considered as an effective method to treat TAO. The combined treatment of traditional Chinese medicine and western medicine to TAO should be a synthesis therapy within direction and selection including surgery, medicine, Chinese herbs, living habit etc, after we recognized the different developmental stage of pathological changes. 【Descriptor】: Thromboangiitis obliterans, Determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs, Activating blood circulation to dissipate blood stasis, Arterialization...