Superficial thrombophlebitis is a clinically frequent and common disease. Both men and women can suffer from the disease, but it is more common in young adults. Superficial thrombophlebitis can occur in various parts of the body, usually in the limbs, followed by the chest and abdominal wall, and a few show migrating attacks. The clinical characteristics are: sudden redness, swelling, burning, pain or tenderness along the course of the superficial vein, and the appearance of cords or induration. After the acute stage, the cords become hardened and local skin pigmentation occurs.

Superficial thrombophlebitis belongs to the categories of blood paralysis, pulse paralysis, swelling and blood stasis in traditional Chinese medicine. During the onset of the disease, the superficial vein becomes a hard cord and there may be spontaneous pain. Tenderness or traction pain, generally called "pulse paralysis"; sudden redness, swelling, burning, and pain along the course of the superficial vein and its surrounding tissues. After the redness, swelling and pain subside, hard cord-like objects may be palpable locally. Those accompanied by pigmentation, or mild heat and mild pain, which are complicated by varicose veins, are often called "evil veins"; those without a history of varicose veins can be called "blood stasis". "Elbow Reserve Emergency Prescription": "Drug veins disease, sudden red veins like earthworms appear in the body." "The skin and flesh are swollen, narrow, red and painful".

Due to differences in etiology, pathology, and clinical characteristics, superficial thrombophlebitis of the limbs, chest and abdominal wall is also called benign superficial thrombophlebitis. Intermittent and recurrent superficial thrombophlebitis is called migrating superficial thrombophlebitis.

1. Benign superficial thrombophlebitis

(1) Causes and pathogenesis

Superficial thrombophlebitis of the limbs can be caused by different reasons. For example: ① Intravenous injection of irritating or hypertonic solutions, such as hypertonic glucose, erythromycin, streptomycin, organic iodine, etc., can stimulate the intima of superficial veins, cause damage to the vein wall, rapid thrombosis, and There is an obvious inflammatory reaction. ② Repeated intubation in the vein for more than 24 hours and continuous infusion can often cause direct damage to the superficial vein wall, formation of thrombus, and rapid inflammatory reaction. ③ When varicose veins occur in the lower limbs, due to severe deformation of the vein wall and venous blood stasis, the skin in the boot area is susceptible to chronic infection due to nutritional changes, causing the varicose veins to suffer hypoxia and inflammatory damage, leading to superficial thrombophlebitis.

Superficial thrombophlebitis of the thoracoabdominal wall is more common in women who are obese and lack physical exercise. The cause was once attributed to oral contraceptives, but there is no sufficient evidence. Since the upper limbs are stretched due to sudden force, the disease is often induced, so it is believed that the onset is related to the venous traction injury when the anterior chest wall and upper abdominal wall are stressed. Damage to the intima of the veins will cause thrombosis and cause an inflammatory reaction in the blood vessel wall.

(2) Pathological changes

Superficial thrombophlebitis starts with extensive thrombosis of the entire superficial vein, which quickly leads to an inflammatory reaction of the entire superficial vein wall, and even involves the veins. There is exudate in the surrounding tissues, so the local manifestations of the affected vein include pain, swelling, and a cord-like object with a relatively flexible texture and tenderness. One week later, as the inflammation subsides and the exudate is absorbed, painless hard cords and local pigmentation remain, indicating that the thrombus has undergone the process of organization and recanalization. In this process blood circulation under new conditions can be re-established. Sometimes acute inflammation can be replaced by a chronic inflammatory state, with fibrotic changes in the thrombosed veins. There may be long-term tenderness in and around the affected blood vessels. There is a tendency for recurrence or multiple attacks, which can cause mild cellulitis in the tissues around the veins, and the formation of induration and pigmentation on the skin. Around the induration, one or several superficial vein branches with thrombosis can be palpable. Superficial thrombophlebitis of the thoracoabdominal wall usually affects one side, often involving the thoracic and epigastric veins, lateral thoracic veins and superior epigastric veins.

(3) Causes and pathogenesis of traditional Chinese medicine

Poor emotions, stagnation of liver qi, dampness and heat in the liver and gallbladder. Or trauma, poisoning, or trauma to the meridians, qi and blood stasis, or blood transfusion, transfusion, damage to the meridians can lead to poor circulation of qi and blood, qi stagnation, blood stasis, and blockage of the arteries, leading to this disease.

(4) Medical history

Superficial thrombophlebitis of the limbs often has a history of recent blood transfusion, infusion, or venous injury. It is more common in young adults, or there is a history of varicose veins in the lower limbs, but it is not related to Season and gender are irrelevant. The typical history of superficial thrombophlebitis of the thoracoabdominal wall is that after pulling forcefully with the right or left hand, one side of the chest wall suddenly feels pain of varying degrees. Raising your arms, coughing, taking deep breaths, and inadvertently putting pressure on the affected area can aggravate the pain.

(5) Clinical manifestations

The patient early found that the affected limb had red and hot areas, accompanied by tenderness. The pain worsened when the affected part was traction. When the great saphenous vein was involved, it may Causes a saphenous neuritis reaction, causing neuralgia in the nerve distribution area. Sometimes the neuralgia can continue for a period of time after the venous lesions disappear. During examination, a 1cm wide red line of varying lengths can be seen in the superficial vein, and the local skin temperature increases. , a soft cord-like mass is touched under the skin, which is a thrombosed vein. The redness and heat of the skin indicate periphlebitis and exudation. The lesion can extend to the proximal end of the vein and even spread to its branches. Because the deep vein is unobstructed, it rarely causes redness and swelling of the limbs. As the lesion subsides, skin redness, heat and local tenderness gradually disappear. The brown pigmentation is left behind, and the cord-like mass in the vein can still be palpable for weeks, sometimes permanently. In some cases, chronic inflammation may remain after the acute phase, and there may be persistent tenderness near the vein. Diseased veins are often difficult to palpate due to fibrosis. Occasionally recanalization occurs, so the disappearance of local cords can only be judged based on the remaining pigmentation to determine that the vein has experienced superficial thrombophlebitis, but the pigmentation can also gradually disappear.

Superficial thrombophlebitis of the thoracoabdominal wall is mostly unilateral, with 1 to 2 superficial veins often involved. Typical clinical manifestations are: when lifting or moving the upper limbs, you suddenly feel pain in the chest and abdominal wall on one side, the affected veins are slightly red, swollen, tender, and the blood vessels become tough, and cord-like objects can be palpated, and some appear as silver crosses or beads. It is soft at first and gradually hardens, with a diameter of about 3 to 5 mm. Depending on the different directions of the involved veins, they may appear tortuous or straight, and may be slightly adherent to the skin. When the upper arm is abducted or raised high, the skin depression covering the diseased superficial vein can be seen as a shallow groove, and the cord-like thing is more obvious and bow-string-like.

The systemic reaction of benign thrombophlebitis is relatively mild, with at most an increase in body temperature or a mild increase in white blood cells. The disease has a tendency to relapse, and the relapsed lesions may occur in the original vein or other veins, and the affected areas show signs of chronic inflammation. Varicose veins of the lower limbs are complicated by superficial thrombophlebitis. In some cases, the thrombus spreads to the confluence of the saphenous and femoral veins, which may involve deep veins and be complicated by pulmonary embolism. This should be taken seriously.

(6) Diagnostic criteria

Benign thrombophlebitis occurs in the lower limbs. It is usually red, swollen, hot and painful along the veins. When the redness and swelling gradually subside, a brown color appears. Represented in the form of a bar, the cord can be touched beneath it. When it occurs on the chest, abdominal wall and upper limbs, cord-like hard objects can often be touched at the painful area. Combined with the history of blood transfusion, transfusion, trauma, and traction injury, the diagnosis can be made.

2. Migratory thrombophlebitis

Migrating thrombophlebitis refers to superficial phlebitis that repeatedly attacks various parts of the body.

(1) Etiology and pathology

There are many theories about the cause of this disease, but none of them is universally accepted. Some people have suggested that infection is the cause of the disease, but bacteria can rarely be cultured in the diseased vein wall or thrombus. It has also been suggested that it is related to increased coagulation of blood, especially increased fibrinogen. Currently, it is clinically closely related to two diseases. First, it is often the surface recurrence of visceral cancer. And many scholars have recognized that this disease is an early manifestation of potential visceral cancer. The location of the primary cancer involves the stomach, pancreas, gallbladder, prostate and other organs, and is particularly closely related to cancer in the body and tail of the pancreas. Second, it is closely related to thromboangiitis obliterans. According to current clinical reports, 30% to 50% of patients with migratory superficial phlebitis in the early stage of thromboangiitis obliterans, and given that most of the patients with this disease are young adults. Male patients who initially present with migrating superficial thrombophlebitis often develop thromboangiitis obliterans later on. Therefore, the disease is considered to be thromboangiitis obliterans, a clinical manifestation of the active stage of the disease throughout the course of the disease. , may be related to autoimmunity.

The pathogenesis and pathology: The disease mainly invades small and medium-sized superficial veins, with histological morphology of thrombosis and inflammatory reaction in the vein wall. There is fibroblast infiltration under the intima of the blood vessel, accompanied by secondary thrombosis. The lumen blocked by thrombus can be recanalized due to organization. The vein wall may have connective tissue proliferation and inflammatory infiltration, and occasionally giant cells. There is little inflammatory reaction in the tissue near the diseased blood vessel, and there is no panniculitis.

(2) Causes and Pathogenesis of Traditional Chinese Medicine

External invasion of damp-heat evil, or stasis of cold-dampness, long-term stagnation of heat, resulting in sluggish circulation of qi and blood, and damp-heat congestion staying in the meridians. To. It may be caused by the injuries caused by the seven emotions, such as emotional discomfort, qi stagnation and blood stasis, blockage of the arteries, persistent stagnation, and blockage of the meridians.

(3) Clinical manifestations

Migratory thrombophlebitis is more common in superficial phlebitis of the lower legs and feet, and is less common in the thighs and upper limbs

See you. The symptoms of the attack are not significantly different from those of general superficial thrombophlebitis. Since all small and medium-sized superficial veins are affected by the disease, although there may be thrombosis and blockage in the lumen, it will not cause venous blood disorders, and swelling of the entire limb is rare. The clinical manifestations are often the sudden appearance of mostly scattered red nodules in an area near the superficial veins of the limbs or trunk, which are painful and tender and stick to the surrounding inflammatory skin. The lesions are linear in appearance and generally short. , occasionally the diseased vein segment can be about 30cm long. The diseased vein is touched by a hard cord-like object, which can appear in batches. Therefore, the disease has just appeared in some parts and has subsided in other parts. The characteristics of this disease are: nodules It subsides quickly, and most of them only last 7 to 18 days. After that, the cords gradually become less obvious and eventually disappear, leaving local brown pigmentation. The nodules do not suppurate or necrosis, and there is no edema in the affected limbs. Reactions such as low fever, increased white blood cells, and accelerated erythrocyte sedimentation rate may occur throughout the body. After each nodule subsides, there will be an interval of several weeks or years. The superficial veins in other parts of the body may react similarly, with repeated attacks. After a long-term illness, the remaining pigmentation and cords can be found all over the body.

(4) Diagnostic criteria: Based on the characteristics of recurrence and migration of superficial thrombophlebitis, the diagnosis is not difficult.

Treatment: Wear Weilun elastic stockings to control the progression of the disease, protect the legs, and promote blood circulation