THROMBOPHLEBITIS OF THE SUPERFICIAL VEINS
3. THROMBOPHLEBITIS OF THE SUPERFICIAL VEINS GENERAL CONSIDERATION
Superficial thrombophlebitis may occur spontaneously, as in pregnant or postpartum women or in individuals with varicose veins or thromboangiitis obliterans; or it may be associated with trauma, as in the case of a blow to the leg or following intravenous therapy with irritating solutions. In the migratory or recurrent form,
thromboangiitis should be suspected. It may also be a manifestation of abdominal
malignancy such as carcinoma of the pancreas or may be its earliest sign. The long
saphenous vein is most often involved. Superficial thrombophlebitis may be associat-
ed with occult deep vein thrombosis in about 20% of cases. Pulmonary emboli are
infrequent but do occur.
Short-term plastic venous catheterization of superficial arm veins is now in
routine use. The catheter should be observed daily for signs of local inflammation.
It should be removed if a local reaction develops in the vein and in any case it should be removed in 48 hours. If further intravenous therapy is necessary, a new catheter may be inserted in a new vein. Serious septic complications can occur if these rules are not followed. The steel intravenous needles with the anchoring flange (butterfly needle) is less likely to be associated with phlebitis and infection than the plastic.
According to the symptoms, the condition is termed vascular Bi, caused by a relative excess of the pathogenic heat factors.
The patients usually experience a dull pain in the region of the involved vein. Local findings consist of induration, redness and tenderness along the course of a vein. The process may be localized, or it may involve most of the long saphenous
vein and its tributaries. The inflammatory reaction generally subsides in 1 or 2 weeks; a firm cord may remain for a much longer period. Edema of the extremity and deep calf tenderness are absent unless deep thrombophlebitis has also developed. If chills and high fever develop, septic thrombophlebitis exists.
Essentials of diagnosis:
? Induration, redness and tenderness along a superficial vein.
? No significant swelling of the extremity.（6.24）
I. Treatment in Western medicine.
If the process is well localized and not near the saphenofemoral junction. Local heat and bed rest with the leg elevated are usually effective in limiting thrombosis. Phenylbutazone(Butazolidin), 100rag orally 3 times daily for 5 days, may aid in the resolution of the inflammatory process but is contraindicated in individuals with peptic ulcer.
If the process is very extensive or is progressing upward toward the saphenofemoral junction, or if it is in the proximity of saphenofemoral junction initially, ligation and division of the saphenous vein at the saphenofemoral junction is indicated. The inflammatory process usually regresses following this procedure, though removal of the involved segment of vein (stripping) may result in a more rapid recovery.
Anticoagulation therapy is indicated if there is a rapid progress and extension into the deep system.
Septic thrombophlebitis requires excision of the involved vein up to its junction with an uninvolved vein in order to help the continued seeding of the blood with bacteria.
II. Treatment in traditional Chinese medicine.
Vascular Bi is a blockage syndrome characterized mainly by the symptoms of
the blood vessels. The chief manifestations are irregular fever, burning sensation of the skin, pain of the muscles of the joints and erythematous rash, redness and
tenderness along the course of a vein, rapid pulse and yellow coating of the tongue.
A. Si Miao Yun An Tang Jia Jian.
Honeysuckle flower 40g
Weeping forsythia (fruit) 40g
Root of Zhejiang figwort 30g
Chinese angelica 30g
Chinese goldthread 12g
Chinese violet 30g
Unpeeled root of herbaceous peony 30g
Root-bark of peony 12g
Root of red rooted salvia 30g
Fresh or dried rehmannia 30g
Buffalo horn 30g
Decoction and dosage. Put all the above herbs together to be simmered twice and then the broth of each mixed, half of the mixed broth each time, twice a day. Six doses are prescribed.
B. Rumex madaio Makino. Fresh leaves of rumex madaio makino are smashed for application on the affected region, 3 times daily, each 60 grams.
The above herb therapies are very effective for this condition.