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Umbilical diseases refer to the umbilical cord disease caused by improper umbilical cord ligation,umbilical cord nursing or congenital umbilical hypoplasia,including umbilical wet,umbilical sores,umbilical cord blood,umbilical process and so on.The umbilicus for wet umbilical; swelling and heat pain or weeping for umbilical blood oozing sores;umbilical cord blood for umbilical; evagination for the umbilical hernia.The umbilical disease is equivalent to western medicine,omphalitis of newborn umbilical cord bleeding,umbilical hernia,etc.
Umbilical dampness,umbilical sore and umbilical cord blood are caused by improper treatment and improper nursing of newborn infants.Umbilical dampness is caused by infection of pathogenic water-dampness for a long period in the umbilical cord when the baby is bathing or it is infused in urine.The external pathogens invade the umbilicus,accumulating and transforming into heat;heat enters qi and blood,obstructed in the muscles,causing the umbilical cord red,swollen,hot,painful and even ulcerated,which is called umbilical sore.Umbilical cord blood is caused by improper ligation,blood oozing out,or fetal intrinsic heat forcing blood overflow outside the umbilical,or congenital deficiency and spleen failing to control blood.Umbilical hernia results from congenital umbilical incomplete closure,or infant excessive crying,or spleen qi deficiency,abdominal distension and dryness,hard stretching,and intestinal membrane bulging into the umbilicus.
There is a history of unclean treatment of umbilical cord after birth,or umbilical cord impregnated by water or urine or tearing umbilical scar.
If the umbilicus root is slightly reddish and there are swelling and education,it is umbilical dampness; if there is purulent secretion in the umbilical part,it is umbilical sore; if there is blood exudating from the umbilicus,it is umbilical cord blood; umbilicus is hemispherical or semi vesicular protuberance which returns with pressing,it is an umbilical hernia.
a.Differentiating common syndrome and deteriorated syndrome
The Common syndrome is marked by only umbilical exudation or red swollen surface with purulent secretion,and good general condition; deteriorated syndrome is marked by red swelling of the umbilicus with purulent or bloody secretion,accompanied by restlessness,even coma,and conclusions.
b.Differentiating mild and severe
The mild case is marked by less umbilical bleeding,good spirit,good sucking the breast and good sleep; a severe case is marked by more bleeding,restlessness or lassitude,refusal to breast,even hemoptysis and bloody stools.
The basic treatment principle is to astringe and consolidate essence,dispel pathogens and protect umbilicus.Mild cases can be treated by external treatment alone.Deteriorated and severe cases can be treated with internal and external combined therapy.Umbilical cord blood caused by improper umbilical ligation can be treated by relegation; for cases of fetal intrinsic heat causing frenetic movement of blood,treatment should be cooling blood and stopping bleeding; for cases of qi deficiency caused bleeding,it should be treated by reinforcing qi and arresting bleeding.
◆ Umbilical Dampness
Signs and Symptoms: lipid-water exudated from the wound surfac e a fter the umbilical ligation,wet maceration,or slightly red and swelling,red tongue with thin coating,and reddish finger venules hid in the wind pass.
Essentials: water exudated from the wound surface of the umbilicus,and wet maceration.
Treatment Principles: Astringe and consolidate essence,dispel pathogens and protect umbilicus.
Formula: Modified Lóng Gǔ Săn (Dragon’s Bone Powder,龙骨散) from Wondrous Lantern for Peering into the Origin and Development of Miscellaneous Diseases ( Zá Bìng Yuán Liú Xī Zhú ,杂病源流犀烛).
Medicinals: lóng gǔ (Os Draconis), kū fán (Alumen dehydrated).For external use by spreading it dry onto the umbilical part.
Modifications: For local red swelling and heat pain,treat it according to the umbilical sores.
◆ Umbilical Sore
Signs and Symptoms: red swelling and pain in the umbilicus,even erosions,purulent secretion,or aversion to cold with fever,crying,restlessness,dry mouth with a desire to drink,red lips and dry tongue,umbilical red swelling affecting the area around,coma and convulsions in severe cases; red tongue with yellow greasy coating,and purple finger venules present at the wind pass.
Essentials: red swelling and pain in the umbilicus,even erosions.
Treatment Principles: Clear heat,resolve toxins,dispel wind and remove pathogens.
Formula: Modified Xī Jiăo Xiāo Dú Yǐn (Rhinoceros Horn Toxin-Removing Beverage犀角消毒饮) from Golden Mirror of the Medical Tradition ( Yī Zōng Jīn Jiàn ,医宗金鉴).
Medicinals: jīn yín huā (Flos Lonicerae Japonicae), shuǐ niú jiăo (Cornu Bubali), fáng fēng (Radix Saposhnikoviae), jīng jiè (Herba Schizonepetae), niú bàng zǐ (Fructus Arctii), gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For constipation and yellow dry tongue coating,add dà huáng (Radix et Rhizoma Rhei) and zhǐ shí (Fructus Aurantii Immaturus); for exudation from the umbilicus mixed with blood,add sān qī (Radix et Rhizoma Notoginseng), zǐ căo (Radix Arnebiae) and qiàn căo (Radix et Rhizoma Rubiae);for symptoms accompanied by coma and convulsions,add quán xiē (Scorpio), gōu téng (Ramulus Uncariae Cum Uncis) and shí chāng pú (Rhizoma Acori Tatarinowii).
◆ Umbilical Cord Blood
Signs and Symptoms: persistent blood effusion after umbilical ligation,or fever,red face and parched lips,red tongue,dry mouth,or lassitude,cold hands and feet,pale tongue with thin coating,and reddish finger venules.
Essentials: persistent blood effusion after umbilical ligation.
Treatment Principles: Stop bleeding by ligation again for improper ligation.Stop bleeding by clearing heat for internal exuberant fetus heat.Stop bleeding by boosting qi and warming yang for qi dysfunction in blood control.
Formula: Modified Qiàn Gēn Săn (Madder Powder,茜根散) from The Complete Works of[Zhang] Jing-yue/Yue ( Jǐng Yuè Quán Shū ,景岳全书) for internal exuberant fetus heat; Modified Guī Pí Tāng (Spleen-Restoring Decoction归脾汤) from Formulas to Aid the Living ( Jì Shēng Fāng ,济生方) for qi deficiency caused bleeding.
Medicinals: Qiàn Gēn Săn : qiàn căo (Radix et Rhizoma Rubiae), huáng qín (Radix Scutellariae), shēng dì huáng (Radix Rehmanniae), ē jiāo (Colla Corii Asini), cè băi yè (Cacumen Platycladi), gān căo (Radix et Rhizoma Glycyrrhizae).
Guī Pí Tāng : dăng shēn (Radix Codonopsis), huáng qí (Radix Astragali), bái zhú (Rhizoma Atractylodis Macrocephalae), fú shén (Sclerotium Poriae pararadicis), dāng guī (Radix Angelicae Sinensis), lóng yăn ròu (Arillus Longan), suān zăo rén (Semen Ziziphi Spinosae), yuăn zhì (Radix Polygalae), mù xiāng (Radix Aucklandiae), gān căo (Radix et Rhizoma Glycyrrhizae), shēng jiāng (Rhizoma Zingiberis Recens), dà zăo (Fructus Jujubae).
Modifications: For bloody urine,add dà jì (Herba Cirsii Japonici) and xiăo jì (Herba Cirsii); for bloody stools,add huái huā (Flos Sophorae) and dì yú (Radix Sanguisorbae); for cold body and limbs,add páo jiāng (Rhizoma Zingiberis Praeparatum).
◆ Umbilical Hernia
Signs and Symptoms: The umbilicus is in a hemispherical or cystic shape,empty,large,smooth and floating,as big as a walnut.It can be pushed back to the abdominal cavity with fingers.But coughing,crying and shouting can make it prominent.The umbilical skin is normal as usual,and there is no obvious changes in spirit and diet or other symptoms.
Essentials: The umbilicus is in a hemispherical or cystic shape,and especially when crying and holding breath.
Treatment Principles: External treatment by pressing the umbilical cord.Push the umbilical intestinal membrane into the abdomen,then place a smooth hard sheet wrapped with gauze and cotton to the navel,covered with gauze.Surgical treatment should be considered if the membrane is too large to be pushed back,accompanied by crying,or it is not healed when the patient has more than 2 years of age.
◆ Chinese Patent Medicines
1. Xiăo Ér Huà Dú Săn (Children’s Toxin-Resolving Powder,小儿化毒散) for umbilical sores.
2. Yún Nán Bái Yào (Yunnan White Medicinal Powder,云南白药) for umbilical cord blood.
3. Sān Qī Piàn (Radix Notoginseng Tablet,三七片) for umbilical cord blood.
◆ External Therapy
1. Jīn Huáng Săn (Golden Yellow Powder,金黄散) for umbilical sores.
2. Bīng Péng Săn (Ice Boron Powder,冰硼散) for umbilical dampness and umbilical sores.
3. Hăi Piāo Xiāo Săn (Cuttlebone Powder,海螵蛸散) for umbilical sores.
1.Neonatal omphalotomy must be conducted with an aseptic operation,and let the umbilical remnant fall naturally.
2.Keep the newborn umbilical cord clean,dry,and prevent infections; change diaper regularly and prevent urine from impregnating the umbilicus.
3.The underwear of the newborn should be soft to prevent the skin from scratching.
4.Closely observe the condition of the umbilical cord,provide treatment in time if exudation appears; if the umbilicus protrudes,properly feed and nurse to avoid crying and screaming.
5.If the umbilical sore has serious complications,it should be treated in time.
1.How to differentiate between physiological jaundice and pathological jaundice?
2.State the essentials in syndrome differentiation,treatment principles,and formulas to a syndrome of retention and fumigation of damp-heat.
3.What to do in the prevention and nursing of umbilical diseases?