Cardiovascular

Lian Chuang (Chronic Ulcer of the Lower Extremities)

By Fornia ⋅ December 18, 2009 ⋅  Print This Post ⋅ Post a comment

Lian Chuang (臁疮) is so named because lian refers to the tibialis bone, commonly known as the shin, while chuang means ulcer. The ulcers are usually seen on the lower one-third (1/3) of the shin, either on the medial or lateral side. Especially on the medial side, where there are less nerves and blood vessels, which makes it hard for healing to take place and wounds to close up. The issue here is that the ulcer does not heal, or if it does heal, there will be a relapse (复发).

This usually happens to people who stand or walk for long durations at one go. It also happens secondary to what in known in TCM as jinliu (筋瘤) — literally “tendon tumor” but known today as varicose veins.

Herbal treatment would require pattern diagnosis. The two main pattern types include the hot type (related more to inflammation) and the cold type (more closely linked with ischemia).

1. Hot Type: This is when the body’s immune system is still working hard enough for signs of heat to show. Often happening after the varicose veins have burst open, there may be other signs of heat, like in the stool and urine, from the pulse and tongue.
2. Cold Type: This is often seen when enough time has lapsed and the wound doesn’t heal too well. The skin around does not seem to afford sufficient circulation, and may even turn dark and thicken. By this time, there is often some manifestation of local edema. Of course, the person is also likely to feel tired and worn down. There are signs of both qi deficiency and blood stasis.

Treatment:

For both, the ermiao san (二妙散) formula is used. In addition diuretics are very important. However, the hot type for sure would require heat clearers as well, while the cold type could do with tonics. The textbook gives the following recommendations:

1. Hot Type: ermiao san (二妙散) and wushen tang (五神汤). Additional heat clearers can be thrown in, e.g. chishao (赤芍) and danshen (丹参). And diuretics too, if needed, e.g. fuling (茯苓) and zexie (泽泻).
2. Cold Type: simiao san (四妙散) and buyang huanwu tang (补阳还五汤) are recommended as base formulas to build upon.

Source:

• 中国中医药出版社, 外科学, p. 291-2

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