Chapter 6. Sores and Ulcers (Lecture-6hrs, SDL-3hrs)
Furuncles [Teaching Aim]
- Master the clinical manifestation,treatment and prevention of furuncles. [Teaching Content]
1.Concept: Definition and clinical manifestation of furuncles.
2.Etiology of furuncle is toxic-heat, orally taken medicine should be clear heat and remove toxin; Furuncle onset during summer and autumn is due to summer heat toxin, treatment method should be clear summer heat and remove toxins.
3.Based on general introduction, the localized management of furuncle is not to press and incision of abscess cavity exceeding the infected coverage. [Teaching Method]
Multimedia lecture. Boils [Teaching Aim]
- Master the syndrome differentiation and treatment of boils on face, hands and feet. [Teaching Content]
1.Concept: Definition, type of boils.
2.Boils on face:
(1) Concept: The characteristics and naming of boils on face and its differentiation with furuncles.
(2) Etiology and pathogenesis: Caused by fire heat toxin, insect bites or traumatic injury.
(3) Syndrome differentiation: Divided into early stage, middle stage and late stage. Improper treatmnt or loss of protection will lead to combination of boils and systemic pyogenic infection
(4) Treatment: Internal treatment is to clear away heat and dissolve toxin, using WuWeiXiaoDuYin and HuangLianJieDuTang; External treatment is done differently according to early stage, middle stage and late stage
3.Boils on hands or feet
(1) Concept: Indicates that boils happen on different part of body has different name. Complication of injuring tendons and bones may happen.
(2) Etiology and pathogenesis: Caused by fire toxin accumulating in Zang Fu organs or contamination of traumatic injury.
(3) Treatment: Syndrome differentiation and treatment of few commonly seen boils on hands or feet. [Teaching Method]
Multimedia lecture. Carbuncle [Teaching Aim]
- Master the differences of etiology, pathogenesis, syndrome differentiation and treatment between carbuncles on different part of body. [Teaching Content]
1.Concept: Definition and characteristics of carbuncles, cervical carbuncles, armpit carbuncles and carbuncles of popliteal fossa.
2.Etiology and pathogenesis: Caused by fire toxin with different disease location. Cervical carbuncle is due to wind fire on the upper energizer, armpit carbuncle is due to phlegm fire stagnating liver, carbuncle of popliteal fossa is due to damp-heat attacking the lower energizer.
3.Syndrome differentiation: Describe carbuncles according to early stage, middle stage and late stage.Describe carbuncles on different part of body according to different pathogenesis.
4.Treatment: Internally should clear heat and dissolve toxin. Prescribe NiuBangJieJiTang, ChaiHuQingGanTang and WuShenTang with BiXieShenShiTang. Externally managed according to general regularity based on stages. [Teaching Method]
Multimedia lecture. Headed carbuncle [Teaching Aim]
1. Master the Four stages（manifestations）of headed carbuncles.
2. Master the application of excess, deficiency, branch and root in syndrome differentiation and treatment.
3.Understand the prevention of sinking of carbuncle in old-aged people and severe chronic patient. [Teaching Content]
1. Concept: Definition, characteristics, onset and development of disease.
2. Etiology and pathogenesis: Exogenous factor is due to external contraction of wind-warmth and damp-heat toxin. Endogenous factor is due to emotional injury, Qi stagnation transformed into fire, over consumption of essence and Qi or fatty sweet diet, lead to toxin accumulated in Zang Fu organs
3. Syndrome differentiation: based on deficiency type and excess type.
4. Treatment: For excess pattern, harmonizing nutrient-Ying and expelling toxin, clear heat and drain dampness. For deficiency pattern, nourish Yin and clear fire, regulate and reinforcing Qi and blood. Localized management is done according to the early stage, middle stage and late stage of the disease. Be cautious with incision drainage and clearing necrotic tissue. [Teaching Method]
Multimedia lecture. Multiple abscesses [Teaching Aim]
- Master the characteristics, etiologies, syndrome differentiation and treatment of multiple abscesses [Teaching Content]
1. Concept: Definition,clinical characteristics
2. Etiology and pathogenesis: Happened due to sepsis diffusion in suppurative diseases, flow together with Qi and blood. Inducement of disease can be due to infection of summerheat-dampness, traumatic injury, over strained of tendon and vessel.
3. Syndrome differentiation: Describe common symptoms of multiple abscesses and the presentation of other different types of multiple abscesses, which are residual toxin, summerheat dampness, blood stasis and iliac fossa.
4. Treatment:
(1) Internal treatment: Clear nutrient-Ying and detoxify for residual toxin caused multiple abscesses, clear summerheat and resolve dampness for summerheat dampness multiple abscesses, activate blood and unblock collaterals for blood stasis type multiple abscesses, clear heat and resolve dampness for multiple abscesses on iliac fossa. Treatment for suppuration is written in general introduction.
(2) External treatment: Management is done according to general regularity.
5. Method of prevention: Actively treating primary infections. [Teaching Method]
Self-study. Erysipelas [Teaching Aim]
- Master the characteristics of erysipelas and differential diagnosis with cellulitis.
- Familiar with the prevention and treatment of erysipelas at lower limb. [Teaching Content]
1. Concept: Definition and characteristics of erysipelas and its differential diagnosis with cellulitis.
2. Etiology and pathogenesis: Often caused by blood heat and fire toxin. Happening on face, it is caused by pathogenic wind and fire toxin while on lower limbs, it is caused by pathogenic dampness and fire toxin.
3. Syndrome differentiation: Besides local symptoms of redness, swelling, warm and pain, it is also accompanied by obvious whole body symptoms. Erysipelas of different part has different syndrome characteristics.
4. Treatment: Internal therapeutic principles are cool blood and clear heat, detoxify and resolve blood stasis. External treatment is mainly topical application. Lower limbs erysipelas can be treated by stone needling.
5. Prevention: Treating local infections on foot first for lower limbs erysipelas. [Teaching Method]
Multimedia lecture. Suppurative Parotitis [Teaching Aim]
1.Master differential diagnosis of suppurative parotitis, mumps and cervical carbuncles.
2.Understand that suppurative parotitis is pyogenic infection of parotid glands and its prevention. [Teaching Content]
1. Concept: Definition and characteristics of suppurative parotitis
2. Etiology and pathogenesis: Caused by residual toxin after infection of Shang Han and warm diseases such as WenBing.
3. Syndrome differentiation: In early stage, there is swelling between mandibular joint, difficulty in mouth opening. There is redness, fluctuations during fibrosis stage. Late incision will cause pus to break out from oral cavity, accompanied by obvious sign and symptoms. In severe case, there is sinking of toxic Qi.
4. Differential diagnosis: Differ from mumps and cervical carbuncles.
5. Treatment: Internal treatment should clear heat and detoxify; External treatment is done according to early stage, middle stage and late stage. [Teaching Method]
Multimedia lecture. Scrofula [Teaching Aim]
1.Master the definition and clinical features of scrofula.
2.Acquainted with differential diagnosis of scrofula. [Teaching Content]
1. Concept: Definition and clinical characteristics.
2. Etiology and pathogenesis: Etiology is Qi stagnation and phlegm congealing. Whole body pathological changes are internal heat with Yin deficiency, finally convert into consumptive disease due to Qi and blood deficiency.
3. Syndrome differentiation: Describe according to early, middle and late stage.
4. Differential diagnosis: Should be differ from cervical carbuncles,cervical carcinoma with cachexia and spinal nucleus.
5. Treatment:
(1) Internal treatment: Divided into early, middle and late stage.
(2) Local management: Before pus formation, treat according to Yin syndrome. After pus formation, draw pus and resolve putridity. [Teaching Method]
Multimedia lecture. Bed sores [Teaching Aim]
- Master the prevention of bed sores. [Teaching Content]
1. Concept: Definition, characteristics and predilection sites.
2. Etiology and pathogenesis: Caused by prolonged continuously pressure applied on certain part of body, blockage of Qi and blood stasis, leading to necrosis of intracutaneous.
3. Syndrome differentiation: Localized symptoms of bed sores
4. Treatment
(1) Whole body treatment: Treat according to Qi stagnation and blood stasis, toxic accumulation and ulceration, dual deficiency of Qi and blood.
(2) Local management: In early stage, apply topically HongLing decoction. After pus formation, clear necrotic cells, incise abscess cavity and drain pus, control infection, draw pus and resolve putridity, promote regeneration and close wound.
5.Prevention and care management: Remain the cleanliness and dryness of compressed part, massage regularly, turn over body and prevent compression. [Teaching Method]
Multimedia lecture. Sinus [Teaching Aim]
- Understand the etiology, diagnosis and treatment of sinus. [Teaching Content]
1. Concept: Definition and characteristics.
2. Etiology and pathogenesis: Happen due to surgical injury, foreign body remained in the body or the excitation of necrotic tissue on deep tissue, pus forms and breaks.
3. Diagnosis: A small sore found locally, often have some purulent fluid discharge.
4. Treatment: External therapy is the main treatment. [Teaching Method]
Self-study.
