Common in young and middle-aged women and usually affecting the upper limbs but less involving the lower one, this disease is due to over excitement or cold stimulus an manifested as symmetrical and paroxysmal sudden pallor of the finger or toe followed by light purple, hectic and sensation of pain and numbness.

Etiology and Pathogenesis

failure of the tendons to be nourished by blood due to insufficiency of the liver-Yin resulting from stagnation of the liver qi results in numbness and spas of the limbs. deficiency of qi and blood due to stagnation of qi and shortage of blood leads to pale fingers. Absence of enough heat due to Yang-deficiency of the spleen and kidney is responsible for very cold hands and feet. Accumulation of cold, Yin pathogen, in the channels causes grayish purple extremities of he limbs. Blood stasis is due to stagnation of qi, obstruction is due to blood stasis, and pain is due to obstruction. Inability of the tendons and vessels to be nourished due to stagnation of qi and blood brings about withered skin, myophagism and even ulcer. In short, insufficiency of the liver-Yin, yang-deficiency of the spleen and kidney and stagnation of qi and blood are the original causes of this disease, while exogenous cold, the external pathogenic factor.

Clinical Manifestations

After sudden anger or rage, the skin of fingers or toes symmetrically and paroxysmally becomes pale, greyish purple and finally hectic and then returns to normal, which is accompanied by cold, numbness and dysesthesia of the finger which are relieved by warmth but aggravated by cold, and distending thin smaller pointed extremity of the limb wit dry skin and myophagism or superficial small ulcers in severe cases, with the arterial pulse of the affected limb being normal.

Type and Treatment

1. Internal Treatment

(1) Type of Yin-Cold

Main Symptoms: Cold extremities whose color is changed symmetrically by cold, thin white tongue coating, and deep thready pulse.

Therapeutic Method: warming the channels to disperse cold, promoting blood circulation t remove obstruction form the vessels.

Prescription: Danggui Sini Tang (Decoction with Chinese Angelica for Restoring Yang).

Ingredients:

Danggui Radix Angelicae Sinensis

Shaoyao radix Paeoniae

Guizhi Ramulus Cinnamomi

Xixin Herba Asari

Zhigancao Radix Glycyrrhizae Preparata

Tongcao Medulla Tetrapanacis

Dazao Fructus Jujubae

Administration: Decocted in water twice for the decoction, which is taken warm in the morning and evening, 1 dose daily.

Modification: In case of severe cold, the herbs added are Shufuzi Radix Aconiti Lateralis Preparata, Paijiang Rhizoma Zingiberis Preparata. For contracture, the herbs added are Gouteng Ramulus Uncariae Cum Uncis, Quanxie Scorpio.

(2) Type of Stagnation:

Main Symptoms: Symmetrical color change in the extremity of the limb occurring after mental depression or excitement, which is accompanied by distension and stabbing pain, ecchymosis on the tongue, and deep taut uneven pulse.

Therapeutic Method: Soothing the liver and promoting the flow of the liver-qi, removing blood stasis from the vessels.

Prescription: Modified Care-Free Decoction.

Ingredients:

Radix Bupleuri

Baishao radix Paeoniae Alba

Poria

Baizhu Rhizoma Atractylodis Macrocephalae

Danggui Radix Angelicae Sinesis

Bohe Herba Menthae

Zhigancao radix Glycyrrhizae Preparata

Weijiang Rhizoma Zingiberis Preparata

Taoren Semen Persicae

Honghua Flos Carthami

Jixueteng Caulis Spatholobi

Guizhi Ramulus Cinnamomi

Dilong Lumbricus

Tubiechong Eupolyphaga seu Stelephaga

Administration: Decocted in water twice for the decoction, which is taken warm in the morning and evening, 1 dose daily.

(3) Type of Deficiency of Both Qi and Blood

Main Symptoms: Pale and num affected limb with abnormal color, superficial ulcer and pale granulation which grows slowly, light red tongue, and thready weak pulse.

Therapeutic Method: Reinforcing qi, nourishing blood, promoting blood circulation and removing blood stasis in the vessels.

Prescription: Modified Renshen Yangrong Tang (Ginseng Decoction for Nourishing Blood).

Ingredients:

Renshen Radix Ginseng

Baizhu Rhizoma Atractylodis Macrocephalae

Poria

Baishao Radix Paeoniae Alba

Chenpi Pericarpium Citri Reticulatae

Yuanzhi Radix Polygalae

Rougui Cortex Cinnamomi

Danggui Radix Angelicae Sinensis

Shudi Radix Rehmanniae Preparata

Huangqi Radix Astragali

Gancao Radix Glycyrrhizae

Administration: decocted in water twice for the decoction, which is taken warm in the morning and evening, 1 dose daily.

Modification: If the upper limbs are affected, the herb omitted is Rougui Cortex Cinnamomi; the herb added is Guizhi Ramulus Cinnamomi.

If the lower limbs are affected, the herb added is Niuxi Radix Cyathulae.

For insufficiency of the liver-yin, the herb added are Shanyurou Fructus Corni, Nuzhenzi Fructus Ligustri Lucidi.