Clinical observation on TCM fumigation and washing for treatment of diabetic peripheral neuropathy by self-made water-washing footbath

Lu Gan,Qing Liu,Liping Jin,Zheng Yuan,Youqiong Zhang

Department of Endocrinology,the First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine.

Introduction

According to the clinical symptoms and physical signs,diabetic peripheral neuropathy(DPN)should belong to the category of “arthromyodynia”, “atrophy”, and“pain” in traditional Chinese medicine (TCM).“prescriptions for universal relie” records that if the disease persists for a long time, "kidneys and genital atrophy, mouth and eyes dry, limbs pain” will appear."Danxi's experiential therapy" records that "legs and knees will be thin and joints will be aching pain" after patients get DPN.

Thirst is normally the initial symptom of DPN. The obstruction of phlegm and blood stasis is the key point.In the early stage, Qi and Yin deficiency and blood stasis are the main symptom.Then dryness-heat caused by Yin deficiency burns the Yin fluid, and the blood become sticky into blood stasis which block the tendon and vessel. Loss of Yin and consumption of Qi form Yin and Qi deficiency. Qi deficiency causes the Qi cannot follow the blood circulate smoothly,and so "no smooth causes pain" and damage the Yin of liver,leading to tendon and vessel loss nourishing. As a result, there is severe pain at the extremities. In the middle stage, spleen deficiency and phlegm stasis are the main symptoms. The spleen’ s function is to govern the movement of water-dampness. If too much fat and sweet diet are ingested, the function of spleen and stomach will be damaged and water-dampness can not move normally, resulting in the accumulation of phlegm ultimately.Phlegm blocks tendons and vessels,leading to the circulation of Qi and blood abstracted.So tendons and muscles loss the nutrition of Qi and blood, then the symptom of numbness and muscular atrophy will emerge. In the late stage, cardinal symptoms are the blockage of renal collaterals by phlegm,and then Qi and blood can’t reach to the limbs.In addition,the deficiency of Yin will damage the Yang,causing cold stagnation and blood stasis.Therefore,the symptoms will be followed: "the hands and feet is numb, the limb is cold like ice". Many doctors believe that DPN belongs to the TCM syndrome type of “root vacuity and tip repletion”. “root vacuity” means deficiency on both Qi and Yin and “tip repletion” is manifested as blood stasis. "Guideline for the Prevention and Treatment of Diabetes in TCM" points out that the main pathogenesis of DPN is based on Qi deficiency,Yin deficiency and Yang deficiency, which leads to the symptoms of blood stasis and phlegm turbidity. Especially, blood stasis is throughout the whole process of DPN. In clinical practice, deficiency and excess should be distinguished at first.The reason of deficiency on Qi,Yin and Yang should be found out,and the types of excess, including blood stasis and phlegm, should also be distinguished. Usually the reason is that the“excess”exists in the“deficiency”.In conclusion, DPN is caused by root vacuity but has symptoms of excess, intermingled deficiency and excess. The root vacuity is deficiency of Qi and blood,Yin and Yang, and the symptoms of excess is phlegm turbidity and blood stasis. They act on the occurrence and development of the disease together.

TCM foot bath is a commonly used method of TCM nursing.TCM believes that the DPN on the lower limbs of patients is because of Yin deficiency and dryness-heat, leading to the blood vessel congestion. Then tendons loss the nutrition of blood, which gives rise to the numbness and pain of limbs, even to swelling and ulceration.Herbs taken internally alone often fails to achieve the desired effect. Fumigation of TCM herbs is one of the external treatments in TCM therapy.Drugs are not absorbed by gastrointestinal tract,which can reduce the decomposition and destruction of drugs by metabolic pathways and reduce the side effects of drugs.At the same time,the drug acts directly on the skin, and through the skin absorption into the blood circulation, so it acts more quickly. Especially the foot and calf cuticle is thin, rich in blood vessels, nerves and muscles, and more conducive to drug transdermal absorption.

This article makes a comprehensive research and analysis on the clinical application of Chinese medicine fumigation and washing for treatment of DPN in the department of endocrinology in our hospital.

1 Patients and methods

1.1 Patients

Twenty patients with DPN from March 2018 to April 2018 were involved, including 10 female patients and 10 male patients. Clinical manifestations:6 cases of limbs numbness,5 cases of limbs pain, 4 cases of dark tongue, and 5 cases of fatigue.

1.2 Inclusion criteria

(1) Diabetes patients who meet the WHO diagnostic criteria, not restricted by the type of diabetes, age, sex, duration of disease, glycemic control, and ethnicity; (2) Electromyography shows peripheral sensory or motor nerve conduction disorders.

1.3 Exclusion criteria

(1) Exclude other diseases that can cause peripheral neuropathy; (2) Severe heart, liver and kidney dysfunction; (3) Combined with Other serious complications of diabetes, such as proliferative retinitis, ketoacidosis, etc; (4) More than 3 times of diabetes coma; (5) Combined with other serious diseases, such as malignant tumors,cerebrovascular accidents, etc; (6) Combined with hemorrhagic disorders or skin infections; (7) Pregnant and lactating women; (8) Uncooperative or mentally disturbed;(9)The skin is damaged or not healed.

1.4 Rejection criteria

Those who met the inclusion criteria were enrolled,but didn’t initiate treatment for various reasons.

1.5 Shedding standard

(1) If the treatment is not prescribed according to various reasons, it is impossible to judge the curative effect; (2) Incomplete data affect the efficacy or safety judgment; (3) Those who fall out naturally during observation and are lost to follow- up; (4) Subjects with poor compliance, serious adverse reactions,complications, and should not continue to receive treatment;(5)Self-exit.

1.6 Methods

From March 2018 to April 2018, a total of 20 patients with DPN were treated in our hospital and they were divided into control group (10 cases) and treatment group (10 cases).The control group used conventional wooden barrels for foot bath, and the treatment group used self-made water-washing footbath with herbs fumigation instead. The two groups were both treated for 20 days. After 20 days, the differences in the changes of some symptoms and signs before and after treatment, diabetic neuropathy scale and the objective indexes of electromyography were observed and compared between the two groups. The self-made water- washing footbath is shown in figure 1. The patients can use self-made water-washing footbath for herbs fumigation and washing. The footbath has two layers.The first layer has mesh and the second layer is used for filling with drug liquid of fumigation. The patient’s foot can be placed in the first layer for fumigation, so that it can have medicinal effects and also avoid scald. Until the temperature of the drug liquid is appropriate (temperature with 38 ~ 42 ° C),and then patients can put feet in the second layer for soaking, two times respectively in the morning and evening, 30 minutes per time, 20 days for a course of treatment. 2 Precautions Precautions for fumigation and washing with traditional Chinese medicine are as follows: (1) Strictly control the water temperature to avoid scalding feet; (2)Avoid stepping on the edge of the footbath with both feet to prevent slipping;(3) Pay attention to the situation of exposed skin during fumigation, adjust the indoor temperature in time, and ensure the appropriate treatment environment.

2 Percutaneous

Precautions for fumigation and washing with traditional Chinese medicine are as follows:

(1)Strictly control the water temperature to avoid scalding fee;

(2) Avoid stepping on the edge of the footbath with both feet to prevent slipping;

(3) Pay attention to the situation of exposed skin during fumigation, adjust the indoor temperature in time,and ensure the appropriate treatment

Environment[1];

(4) Children and the elderly should be treated under the care of family members to avoid unnecessary accidents;

(5) The functional exercise during the period of treatment by traditional Chinese medicine fumigation and washing should be step by step,and can’t be too hasty[2].

(6) The damaged parts of the skin cannot be fumigated and washed with traditional Chinese medicine.

3 Evaluation criteria

3.1 The efficacy evaluation is carried out according to the standards formulated by the“Chinese medicine therapeutic schedule for 95 diseases in 22 specialties” issued by the Medical State Administration of Traditional Chinese Medicine of China in 2010.The clinical effect was judged comprehensively by clinical syndrome reduction rate and electromyography test results:Inefficacy: No improvement in symptoms. No change in electromyography;

Effective: Symptoms were significantly improved.Tendon reflexe were partially recovered, and electromyography test results showed some improvement;

Obvious effect: Symptoms disappeared. Achilles tendon and knee reflex were basically normal,and electromyography test results showed significant improvement.

3.2 Patient tolerance: Investigate the patient's discomfort such as scald and observe the patient's blood pressure.

4 Results

According to the inclusion criteria and exclusion criteria, a total of 20 patients with DPN were involved in our study from March 2018 to April 2018.There are 10 patients in the treatment group and control group respectively. Patients in the treatment group showed significant improvement compared with patients in the control group, and the control group has higher scald rate (Table 1).So based on the experimental study we found thatthe TCM fumigation and washing treatment for patients with DPN has a certain effect in the treatment period. And to some extent the self- made waterwashing footbath can reduce the risk of scald for patients with DPN.

Figure 1.The sketch map of self-made water-washing footbath

Table 1.The effective rate and scald number of the two groups

5 Discussion

With the development of society,TCM,as the traditional method of treating diseases in China, has a leading position in current medicine. Drug fumigation and washing treatment is one of the important methods in TCM [3], which also has a certain therapeutic effect in many other diseases [4]. This article mainly research and analysis of the application of TCM fumigation and washing on the treatment of DPN.In this article, TCM fumigation and washing was used on the base of the basic treatment of diabetes and it does not affect other therapies. The TCM fumigation and washing is a method of boiling the medicine into decoction, then fuming and washing,drip washing or dipping bath on the skin or the affected part while the decoction still hot [5]. TCM fumigation forms the liquid into medicine mist, and acts by fumigating both lower limbs directly. This conforms to the principle of pore absorption in drug administration. The drug properties of the TCM decoction is mild and can be added or reduced according to the patient's symptom differentiation,which conforms to the thoughts of “diagnosis and treatment based on an overall analys is of the illness and the patient'scondition”in TCM. Because soaking feet with TCM decoction can not only bring patients with various degrees of comfort and pleasure feeling,but also improve symptoms and of patients with DPN, reduce patients’ discomfort, and assist and support medical effects. For those reasons, it is very popular with patients. DPN usually starts from the extremities of both lower limbs with the sensory disturbance until to the unbearable pain, which often leads patients to pain and suffering. In addition, DPN often induces injuries, infections and pedopathy, so it is meaningful and important to give such specialized nursing care to patients with DPN. Currently, common plastic or wooden barrels are used for fumigation and washing of feet with TCM in clinical practice. For example,a medical footbath published in Chinese patent document CN205019388U has the following disadvantages: 1. Due to the limb feeling disorder of diabetic patients, it is not possible to accurately know whether the medicine is too hot or not, which is easy to cause scald; 2. When patients use plastic or wooden basins to wash their feet, they are not fully treated by fumigation.If patients place their feet on the edge of the basin for fumigation, they slip easily; 3. If the water temperature is not tested properly in the process of fumigation and washing, the feet will be scalded, thus increasing the risk of diabetic feet; 4. When it is necessary to fumigate and wash the lower legs of the patient, it cannot have a well- sealed effect. Besides, it cannot flexibly adjust the height of the footbath according to the length of the patient's leg. Therefore,the purpose of self-made water-washing footbath is to overcome the defects in the existing technology and provide a kind of water-washing footbath that can avoid the scald on the feet of patients with limb sensory disorders to reduce the risk of diabetic foot and decrease the infection rate at the same time.

In order to achieve the above purpose, the self- made water-washing footbath includes a barrel body at the lower part and a barrel cover at the upper part, and the barrel cover can be clasped on the barrel body separately.Two holes are arranged on the barrel cover so that the user's legs can pass through the holes and enter into the barrel body.The barrel body can be separately provided with a supporting mesh,and the water level in the barrel body is below the supporting mesh. When using the water-washing footbath for treatment, the supporting mesh is set in the barrel body.When the fumigation soup pours into the barrel body, the user's feet can be fumigated on the supporting meshto avoid scalding.Moreover, the height of the wash barrel can be flexibly adjusted according to the length of the patient's legs.After fumigation, waiting for the water temperature to 38 -42 ° C, the supporting mesh can be directly pulled to the side of the barrel body, then patients can place feet into the water for soaking. It’s a simple operation which can eliminate the patient's fear and increase the patient's participation,so as to improve the compliance of patients, especially for the elderly. On the basis of foot soaking effect, it also increases the fumigation effect, which speeds up the recovery process of patients and avoids scald and other accidents.It has made great innovations in adjuvant therapy and nursing operation, and has high promotion and use value. In conclusion, selfmade water-washing footbath is more suitable for patients with DPN than common wooden barrels.Although our study has proved that DPN can be treated through TCM fumigation and washing by self- made water-washing footbath which has important theoretical significance in the field of combined therapy of Chinese and Western medicine.However, further research is necessary, such as water temperature adjustment, enlarged samples,population promotion, quality control questionnaire optimization,different climates and races,etc.

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