Raynaud's disease

　　The etiology of Raynaud's syndrome is still not entirely clear. Cold stimulation, emotional hormones, or mental stress are the main triggering factors. Other causes include infection, fatigue, and so on. Since the condition often worsens during the menstrual period and improves during pregnancy, some believe that the syndrome may be related to gonadal function.

　　1, Pneumothorax

　　It is a common complication with an incidence of 95%. This is because artificial pneumothorax is artificially created during surgery to allow the operation to proceed. Although the air in the pleural cavity is supposed to be drained at the end of the surgery, it is very difficult to completely drain it. The remaining air in the pleural cavity is generally not much, and no special treatment is needed. Patients may feel some chest tightness, which usually disappears after 1-2 days. The air is completely absorbed within 3-5 days. In some patients with more pneumothorax, fine needle aspiration of the gas can be performed on the first or second day after surgery. In extremely rare cases, if the pleura has pre-existing lesions causing adhesions, which may rupture the lung during surgery, a drainage tube needs to be placed in surgery or postoperatively for a few days until the wound closes, and then it can be removed. The treatment is not complicated.

　　2, Horner's syndrome

　　It is a severe complication characterized by slight ptosis of the eyelid on the affected side and constriction of the pupil (which does not affect vision). There have been reports in foreign literature, but after technical innovation, we have not encountered a single case in 600 cases of sympathectomy surgery.

　　Patients often experience a sudden change in finger skin color to pale after exposure to cold or emotional excitement, followed by bluish discoloration. Attacks usually start from the tips of the fingers and then spread to the entire finger, even the palm, accompanied by local coldness, numbness, tingling, and decreased sensation. After several minutes, the skin gradually turns red, warms up, and a burning-like sensation of swelling occurs before the skin color returns to normal. Warm drinks or alcohol, and warming the limbs, often alleviate the attack. Generally, after the cold stimulus is removed, the skin color changes from pale, bluish, to red, and returns to normal in about 15-30 minutes. A few patients may start with bluish discoloration without a pale stage, or turn red directly after paleness, without bluish discoloration. During attacks, the radial artery pulse does not weaken, and during the interattack period, except for slightly cooler finger skin temperature and slightly paler skin color, there are no other symptoms.

　　The onset of the disease usually occurs in the fingers, but it can also affect the toes, and occasionally the ears and nose. Symptomatic attacks are symmetric, which is another important feature of Raynaud's syndrome. For example, the ring and little fingers are often the first to be affected, followed by the index and middle fingers. The thumb is rarely affected due to its rich blood supply. The degree and extent of skin color change in both hands are the same, and a few patients may initially have unilateral attacks, which later become bilateral.

　　The course of the disease generally progresses slowly, with a few patients experiencing rapid progression, frequent attacks, severe symptoms, and swelling of the fingers (toes). Each attack lasts for more than 1 hour, can be triggered by a slight drop in environmental temperature or slight excitement, and severe cases may not disappear even in warm seasons. The tips of the fingers (toes) may show nutritional changes, such as deformed and brittle nails, atrophy of the nail bed, thinning of the skin, disappearance of wrinkles, and occasional ulcers or gangrene at the tip of the nails, but the radial artery remains unweakened.

　　1. Clarify the cause

　　Secondary cases should try to control the primary disease as much as possible.

　　2. General Prevention and Treatment Measures

　　Prevent cold and keep warm, try to avoid exposure to cold air or contact with cold water and cold objects; avoid various injuries; drink a small amount of alcohol to increase blood circulation, do not smoke to avoid nicotine stimulating vasoconstriction; patients who are easily excited or impulsive should be comforted more to relieve mental concerns or appropriately use tranquilizing drugs.

　　Firstly, Laboratory Examinations

　　Antinuclear antibodies, rheumatoid factor immunoglobulin electrophoresis, complement values, anti-natural DNA antibodies, cold agglutinins, and Combs' test, among other indicators of systemic connective tissue diseases, should be routine examinations.

　　Secondly, Special Examinations

　　1. Cold Provocation Test

　　After the fingers are exposed to cold and the temperature drops, use a photoplethysmography (PPG) to record the time required for the finger circulation to return to normal, which serves as a simple, reliable, and non-invasive method to estimate the condition of the finger circulation. During the test, the patient should sit quietly in the room (room temperature 26±2℃) for 30 minutes, record the finger circulation waveform with PPG, then immerse both hands in ice water for 1 minute, dry them immediately, and then record the finger circulation every minute for a total of 5 minutes. Normal people's finger circulation recovers to baseline within 0 to 2 minutes, while the finger circulation of Raynaud's syndrome patients takes significantly longer (more than 5 minutes) to return to normal. Normal people's finger artery waves are bidirectional, i.e., they have a main peak wave and a secondary wave, while the artery waves of Raynaud's syndrome patients are unidirectional, with low, dull, and flat wave peaks, even disappearing. This test method can also be used to evaluate the effectiveness of treatment; if the patient's symptoms improve after taking medication, the time for finger circulation recovery will be shortened.

　　2. Measurement of Finger Humidity Recovery Time

　　After the fingers are cooled and the temperature drops, use a thermistor probe to measure the time required for the fingers to recover to normal temperature. This is used to estimate the blood flow in the fingers and provides objective evidence for the diagnosis of Raynaud's phenomenon. 95% of normal people's finger temperature recovers to baseline within 15 minutes, while the vast majority of Raynaud's syndrome patients require more than 20 minutes for their finger temperature to return to normal. This test can also be used to estimate the effectiveness of treatment.

　　3. Finger Arteriography

　　If necessary, perform upper limb arteriography to understand the condition of the finger arteries, which is helpful in determining the diagnosis of Raynaud's syndrome and can also show whether there are organic lesions in the arteries. Arteriography is not only a traumatic examination method but also complex, therefore, it is not suitable as a routine examination.

　　In special examinations, the conduction velocity of upper limb nerves is measured to detect the existence of carpal tunnel syndrome, and hand X-ray films are helpful in identifying rheumatoid arthritis and finger calcification.

　　1. Diet Therapy for Raynaud's Disease

　　Astragalus and Ramulus Cinnamomi Decoction with modification for treatment.

　　The composition of the prescription is Astragalus 75g, Ramulus Cinnamomi 20g, Radix Paeoniae Alba 20g, Rhizoma Zingiberis Recens 5 slices, Fructus Jujubae 12 pieces, Draconis 15g, Salvia Miltiorrhiza 20g, Carthamus Tinctorius 10g, Glycyrrhiza uralensis 10g, decocted for oral administration.

　　2. Foods Good for Raynaud's Disease

　　Drink a small amount of alcohol.

　　3. Foods to Avoid for Raynaud's Disease

　　Quit smoking.

　　Drug Therapy:

　　1. Prazosin

　　Also known as tolazoline, taken orally 25-50mg each time, four to six times a day, after meals. For those with severe local pain and ulceration, the dose can be increased to 50-100mg each time. Intramuscular, intravenous, or intra-arterial injection dosage is 25-50mg each time, two to four times a day. Some patients may experience side effects such as hot flashes, fainting, dizziness, headache, nausea, vomiting, and chicken skin.

　　2. Reserpine

　　Because it has the effects of depleting dopamine and serotonin. It is a drug with a long history of treatment for Raynaud's phenomenon and good efficacy. The oral dose varies greatly. Kontos reported that taking 1mg/d for a course of 1-3 years can reduce the frequency and severity of symptoms.

　　3. Nifedipine

　　Nifedipine is a calcium channel blocker that inhibits the formation of action potentials and smooth muscle contraction by reducing the calcium storage capacity or calcium binding ability at the calcium storage site on the muscle cell membrane, thereby dilating the blood vessels. Taken orally 20mg, three times a day, for a course of 2 weeks to 3 months, clinical studies have shown that it can significantly improve the clinical symptoms of moderate to severe Raynaud's syndrome.

　　4. Guanethidine

　　It has a similar effect to reserpine, taken orally 5-10mg each time, three times a day. It can also be used in combination with phenoxybenzamine (phonoxy-benzamine), with a daily dose of 10-30mg. About 80% of patients are effective.

　　5. Methyldopa

　　The daily dose is 1-2g, and most patients can receive the effect of preventing the onset of Raynaud's syndrome. Attention should be paid to blood pressure when taking the medicine.