What is Peripheral Neuropathy?

The disease can affect one nerve alone (single peripheral neuropathy), two or more nerves in multiple regions (multiple single peripheral neuropathy), or many nerves (multiple peripheral neuropathy) at the same time. Mainly affected by The damage may be axon (for example, seen in diabetes, Lyme disease, uremia or various poisonings), or myelin or Schwann cells (for example, seen in acute or chronic inflammatory multiple neuropathy, white matter dystrophy) Disease or Guillain-Barre syndrome). Small unmyelinated or myelinated fibers mainly cause loss of temperature and pain; large myelinated fibers cause impairment in movement or proprioception. Some neuropathies (for example, lead poisoning, dapsone poisoning, tick-borne disease, porphyria, Guillain-Barre syndrome) mainly involve motor fibers; others (for example, posterior root neuritis caused by cancer, leprosy , AIDS, diabetes, or chronic vitamin B6 poisoning) mainly affects the posterior root ganglia or sensory fibers and produces sensory symptoms. Occasionally, the cranial nerves can also be affected together (for example, Kyrgyzstan Lambert-Barre syndrome, Lyme disease, diabetes, diphtheria). Mastering specific ways of peripheral nerve damage can help clinicians determine the cause.

Peripheral neuropathy

Peripheral neuropathy is a syndrome formed by loss of sensation, muscle weakness and atrophy, decreased tendon reflexes, and vascular motor symptoms, alone or in any combination.

Introduction to peripheral neuropathy

Etiology of peripheral neuropathy

The most common cause of damage to a single nerve is trauma. Severe muscle activity or overstretching of joints can cause focal neuropathy, repetitive small injuries (for example, holding small tools often, or air hammer) Excessive vibration shock) can also produce focal neuropathy. Compression or entrapment paralysis usually affects superficial nerves (such as the ulnar nerve, radial nerve, and fibula nerve) and occurs at the osteoid process (For example, in lean or cachexia people and often when alcoholics are asleep or during anesthesia), or in narrow ducts (such as carpal tunnel syndrome). Compression paralysis can also be caused by tumors, bones Hyperplasia, plaster fixation, crutches, or long periods of restrained posture (such as gardening labor), etc. Intranerve hemorrhage, cold or radiation can cause neuropathy. Direct tumor invasion can also produce a single surrounding Neuropathy.

Multiple single neuropathies are usually secondary to collagen-vascular diseases (such as nodular polyarteritis, systemic lupus erythematosus, Sjogren's syndrome, rheumatoid arthritis), sarcomatoid disease, and metabolic diseases ( Such as diabetes, amyloidosis), or infectious diseases (such as Lyme disease, AIDS). Microorganisms can directly invade nerves and cause multiple single neuropathy (such as leprosy).

Polyneuropathy caused by acute febrile disease may be caused by a toxin (such as diphtheria) or by an autoimmune response (such as Guillain-Barre syndrome); polyneuropathy that sometimes occurs after immunization It may also be autoimmune.

Toxic substances generally cause multiple neuropathy, but sometimes they can also cause single neuropathy. They include turpentine, cyclohexyl barbiturate, barbiturate, chlorobutanol, sulfonamides, phenytoin sodium, furantoin , Vinblastine, heavy metals, carbon monoxide, tri-o-cresyl phosphate, phosphorodinitrophenol, many solvents, other industrial toxic substances, and certain AIDS drugs (such as zazitabine, didanoxine).

Nutritional deficiencies and metabolic diseases can cause multiple neuropathy. B vitamin deficiencies are common causes (such as seen in alcoholism, beriberi, malignant anemia, isoniazid vitamin B6 deficiency, malabsorption syndrome, and vomiting in pregnancy) Polyneuropathy can also be seen in hypothyroidism, porphyria, sarcoidosis, amyloidosis and uremia. Diabetes can cause sensorimotor distal polyneuropathy (most common), multiple single nerve Lesions and focal single neuropathy (such as involvement of the oculomotor or abductor nerve).

Multiple neuropathy caused by malignant tumors may be secondary to monoclonal gamma globulinopathy (multiple myeloma, lymphoma), or amyloid invasion into the nerve, or nutritional deficiencies, or as a manifestation of paracancerous syndrome.

Peripheral neuropathy

Wallerian degeneration, axonal degeneration, neuron degeneration, segmental demyelination

Peripheral neuropathy Wallerian degeneration

Refers to a series of changes in the distal nerve fibers after the nerve fibers are broken by various trauma. The axon on the distal end of the stump can only survive for a few days because it does not receive the nutritional support of the soma, and it will soon degenerate and disintegrate. The debris was cleared by phagocytosis of Schwann cells and macrophages. The axons and myelin sheaths on the proximal end of the stump can have the same changes, but stop after only 1-2 Langfei knots are destroyed.

Peripheral neuropathy axis mutation

Poisoning or dystrophy, axonal degeneration, and secondary demyelinating all develop from the distal to the proximal (dying back).

Peripheral neuropathy neuron degeneration

The axon and myelin sheath secondary to neuron cell body degeneration and necrosis is called neuronopathy.

Peripheral neuropathy segmental demyelinating

The myelin sheath is destroyed and the axon remains relatively intact. Pathologically, the peripheral and proximal nerves were irregularly segmented and demyelinated, and Schwann cells proliferated and engulfed myelin fragments.

Peripheral neuropathy complications

Nutritional deficiencies and metabolic diseases can cause multiple neuropathy. B vitamin deficiencies are common causes (such as seen in alcoholism, beriberi, malignant anemia, isoniazid vitamin B6 deficiency, malabsorption syndrome, and vomiting in pregnancy) Polyneuropathy can also be seen in hypothyroidism, porphyria, sarcoidosis, amyloidosis, and uremia. Diabetes can cause sensorimotor distal polyneuropathy (most common), multiple single nerves Lesions and focal single neuropathy (such as involvement of the oculomotor or abductor nerve).

Clinical manifestations of peripheral neuropathy

In clinical peripheral neuropathy, the most commonly involved are the femoral, sciatic, median, radial, ulnar, sural, and lateral femoral cutaneous nerves. Early symptoms are mainly sensory disorders, but electrophysiological examinations often involve motor and sensory nerves. Clinical symmetry pain and paresthesia, lower limb symptoms are more common than upper limbs. There are abnormal numbness, ant walking, insect crawling, fever, and electric shock, and they often reach the knee from the distal toe, and the patient has socks and gloves. Patients with severe sensory disorders may develop arthropathy and ulcers in the lower extremities. The pain was stinging, burning, and drilling pain. It seemed to be painful in the deep part of the bone marrow. Sometimes the pain was severe, such as amputation. Sometimes there are tactile allergies, and even the pressure of the quilt cannot be tolerated. The quilt must be supported. When the motor nerves are tired in time, muscle strength often decreases to varying degrees, and in the later stage, there is dystrophic muscular atrophy. Peripheral neuropathy can be bilateral, unilateral, symmetrical, or asymmetric, but bilateral symmetry is more common.

In terms of physical signs of peripheral neuropathy: Achilles tendon reflexes, knee tendon reflexes are weakened or disappeared; Vibration sensation is weakened or disappeared; Position sensation is weakened or disappeared, especially deep sensation decline.

Treatment and experimental examination of peripheral neuropathy

Western medicine treatment of peripheral neuropathy

Etiology treatment: Those who cause poisoning should immediately prevent the poison from entering the human body and escape from the poisoning environment and toxic substances. Those who are caused by drugs should, in principle, stop taking them as soon as possible. In short, measures should be taken to remove the cause.

General treatment: bed rest in the acute phase should be used for polyneuritis caused by various reasons, large doses of B vitamins, vitB1, B6, B12, severe cases using ATP, coenzyme A. Those with obvious pain use analgesics and sedatives, such as carbamazepine. Adrenocortical hormones such as prednisone, dexamethasone, or hydrocortisone can be used for inflammatory demyelinating lesions. Can also use the vasodilator niacin (50-100mg / time), 5-10mg / dipazol.

Enhance nursing: Keep your limbs functional and turn over frequently to prevent bedsores and lung infections.

Recovery period: functional exercise, acupuncture, massage, physical therapy.

Prevention of peripheral neuropathy

Related drugs: Vitamin B1, Vitamin B6, Adenosine triphosphate, Coenzyme A, Nicotinic acid

TCM treatment of peripheral neuropathy

Peripheral neuritis belongs to the category of "pulse paralysis" in Chinese medicine.

Pulse paralysis is characterized by insufficient righteousness, mixed with six kinky, invading blood veins, causing blood clots, and obstruction of the blood vessels. The main characteristics are limb pain, irritable skin, dark or pale skin, weak pulse or no pulse. A kind of disease certificate. The disease can occur all year round, but it is more common in summer due to damp and hot, and it is more common in winter due to cold or dampness or yang deficiency. The age of onset is mostly young, followed by old age, and young usually does not have the disease, and the difference is small.

Mai Bi was first seen in the "Inner Canon of the Yellow Emperor". Later, medical records such as "Golden Chronicles" have records of blood paralysis. Blood gas obstruction is related to meridian obstruction, so blood obstruction is similar to pulse obstruction. Although later generations of medical books deal with those who suffer from pulse paralysis, they are not officially listed as a disease type, and they lack a systematic discussion on the etiology, pathogenesis, and dialectical treatment. From clinical practice, it is not uncommon for Mai Bi to be a disease, so it is listed as one of the diseases. Those with blood stasis as the main disease syndrome should belong to this disease.

Symptom classification:

Symptoms of Wind-cold-resistance-collateral syndrome: sore limbs, sore joints, sore joints, bruising skin or veins, heavy fatigue throughout the body, chills, fever, no sweat or sweating, pale red tongue, thin white fur, and tight pulses or Floating. The main points of diagnosis are limb pain, bruising skin, chills, and fever.

Governing Law: Qufengsanhan, dehumidification Tongluo.

Liyang Deficiency Syndrome

Symptoms: numbness, coldness, or pain in the affected limb or extremities, local skin temperature decreases and pale or bruising, flushing, exacerbation in cold or winter, decrease in temperature, or limb pain, convulsions after action, calm After the remission, the pulse of Liyang pulse or Taixi pulse was weak, or the migratory strip-shaped mass of the affected limb was present, the tongue was pale and white, and the pulse was thin. The main points of diagnosis are the soreness of the affected limb, coldness, pale skin or bruising.

Governing Law: Wenyang disperses cold, decondenses Xuanbi.

Symptoms of cold coagulation and blood stasis syndrome: The affected limb is cold, numb, and has more pain, heavier day and night, pale or flushed skin, purple blood stasis, and even dry skin, desquamation, cracking, shedding of hairs, and less or no sweat. (Toe) The nails are thick, brittle, deformed, muscle atrophy, numbness, pulsation of Liyang vein or Taixi pulse disappears, the tongue is purple and white, and the veins are heavy. The main points of diagnosis are the pain of the affected limb, discoloration of the skin, muscle atrophy, and disappearance of the pulse of the Puyang or Taixi pulses.

Governing Law: Wenjing Sanhan, Huoxue Tongbi.

Symptoms of qi qi stagnation and blood stasis syndrome: When the emotion is agitated or a little active, the skin of the limb is pale or bruising, flushing, the limb is full, and the chest is full and painful, too rested, dull, irregular stool, and the limbs are long. Swelling pain, purple skin redness, or hot flashes in the afternoon, irregular menstruation, abdominal pain and blood clots, purple stasis of the tongue, thin white or yellow fur, and astringent pulse strings. The main points of diagnosis are based on the pain of the affected limb, pale skin, bruising, and flushing, and the onset or aggravation of emotional or a little activity.

Governing Law: Shugan Qi, Huoxue Sanyu.

Damp and heat stasis syndrome; affected limbs are cold and hot, heavy, weak, swollen and painful, red veins of the affected area are hot and burning, or there are cords and strips, which are painful, or the extremities are festering and yellow. Water, body heat, thirst, do not want to drink, chest tightness, appetite, yellow and red urine, yellow greasy tongue coating, slippery pulse. The main points of diagnosis are based on the cold and hot of the affected limb, the redness and burning of the veins, or the flowing yellow water of the extremities.

Governing method: clearing away heat and dampness, promoting blood circulation and removing blood stasis.

Symptoms of phlegm, turbidity, and stasis: swelling, numbness, pain, coldness, dull skin or sclerosis, dizziness, heavy chest tightness, dullness, spitting, spitting, prolonged illness and physical appearance Not thin, fat tongue dark, or see ecchymosis, white greasy fur, heavy pulse. Swelling of the affected limb, numbness, pain, dull skin, not thin shape, fat tongue, dark fur and white greasy are the main points of diagnosis.

Governing Law: Expelling phlegm and dissolving knots, promoting blood circulation and removing blood stasis.

Syndromes of internal heat of yin and yin deficiency: sore limbs, burning joints, flushing of skin, low or nocturnal hot flushes, night sweats, dizziness, tinnitus, insomnia, visual impairment, dry mouth, dry tongue, red tongue, less moss, and thin pulses. Based on the soreness of the limbs, burning of the joints, flushing of the skin color, low fever, red tongue and less moss as the basis of differentiation.

Governing law: nourishing yin and clearing heat, promoting blood circulation and numbness.

Symptoms of deficiency of qi and blood: sore limbs, numbness, pain, pale skin, muscle atrophy, dry and desquamated skin, or reddish wounds, prolonged non-healing, chlorosis, weight loss, Sweat, weakness in the limbs, dizziness, dizziness, palpitations, shortness of breath, pale tongue, thin white fur, and weak pulses. The main points of diagnosis are the soreness and pain of the limbs, muscle atrophy, dry and desquamated skin, chlorosis, and swelling of the extremities.

Governing Law: Yiqi Yangxue, Huoxue Tongbi.

Symptoms of deficiency of spleen and kidney yang: cold limbs, tenderness of waist and knees, coldness of hands and feet, dull skin or bruising, ecchymosis, atrophy or thickening of skin, chills, fatigue, pale, low food, Thin stools, more urination, pale tongue, thin white fur, weak pulses or weak pulses. The main points of diagnosis are cold pain, dark skin and chills.

Method of treatment: warming the spleen and kidney, dispersing cold and promoting blood circulation.

Peripheral neuropathy unilateral prescription

Wang's Analgesic Tablets

Composition: confidential formula in the hospital

Usage: 3-4 times a day, 6 tablets at a time, orally, three months as a course of treatment

Efficacy: 460 cases were observed, 386 cases were markedly effective, 60 cases were effective, 14 cases were ineffective, and the total effective rate was above 95%.

Other measures of peripheral neuropathy

In order to ensure the strict implementation of long-term treatment and obtain better results, do a good job of patient publicity, including introduction of basic knowledge of treatment, qualitative self-test of urine glucose, living arrangements and follow-up inspections.

Usually strengthen exercise (mainly Tai Chi), avoid anger or excessive depression, eliminate mental states such as tension and excitement, maintain a comfortable and open mood, and emotional stability. The diet should be nutritious and light, avoid thick flavor, especially tobacco and alcohol. There is a regular life and regular affairs to avoid further loss of righteousness.