Splenic Rupture

　　Splenic rupture is divided into traumatic rupture and spontaneous rupture. Traumatic rupture is caused by external violence; spontaneous rupture is caused by pathological enlargement of the spleen due to reasons such as severe coughing, sneezing, or sudden change in body position.

　　The spleen is the most easily damaged organ among abdominal viscera, accounting for nearly 20% to 40% of various abdominal injuries. The spleen with pathological changes (such as portal hypertension, schistosomiasis, malaria, lymphoma, etc.) is more prone to injury and rupture. Patients with splenic rupture are prone to complications such as hemorrhagic shock and secondary infection.

　　The clinical manifestations of splenic rupture are characterized by internal hemorrhage and the stimulation of the peritoneum by blood, and they are often closely related to the amount and speed of bleeding. A large amount of bleeding and rapid speed can quickly lead to hypovolemic shock, with a critical condition; a small amount of bleeding and slow speed results in mild symptoms, with only mild pain in the upper left abdomen and no other obvious signs, making it difficult to diagnose. With the passage of time, as the amount of bleeding increases, the symptoms of pre-shock stage appear, followed by shock. Abdominal pain may occur due to the stimulation of the peritoneum by blood, initially in the upper left abdomen, gradually involving the entire abdomen, but still most prominent in the upper left abdomen. At the same time, there may be abdominal tenderness, rebound pain, and muscle tension in the abdomen. Sometimes, due to the stimulation of the left diaphragm by blood, there may be radiation pain in the left shoulder, which is exacerbated during deep breathing, known as the Kehr sign. Laboratory examination shows progressive decrease in red blood cells, hemoglobin, and hematocrit, indicating internal hemorrhage.

　　To prevent splenic rupture, attention should be paid to safety, avoid外伤, people with pathologically enlarged spleen should avoid strenuous exercise as much as possible, abdominal trauma patients should be vigilant about splenic rupture, early detection and prevention of shock, and adhere to the principle of trying to preserve the spleen during treatment.

　　Since the condition of splenic rupture is serious, it is important to make a quick diagnosis and rescue, so the examination for patients with splenic rupture is very important.

　　1, Abdominal lavage

　　This is an invasive examination that cannot specifically locate the damaged organ, nor can it indicate the extent of the injury. There are also a few false-positive or false-negative results, which must be analyzed in combination with clinical and other examination results.

　　2, Ultrasound

　　This is a non-invasive examination that is commonly used, and it can show broken spleen, large subcapsular hematoma of the spleen, and blood accumulation in the abdominal cavity.

　　3, CT examination

　　CT examination can clearly show the shape of the spleen and has a high accuracy in diagnosing splenic parenchymal rupture or subcapsular hematoma.

　　4, Radioisotope scanning

　　Techniques such as 99mTc colloidal sulfur scanning or gamma photography can be used to diagnose splenic injury, which is a safe method.

　　5, Selective abdominal aortic angiography

　　This is an invasive examination with complex operation and certain risks, but it has a high accuracy in diagnosing splenic rupture, showing the location of the damaged splenic artery and parenchyma, and is only used for closed injuries with stable conditions and other methods unable to make a clear diagnosis.

　　Patients with mild splenic rupture or those who have had splenectomy after surgery, in addition to general treatment, can also relieve the condition through dietary therapy.

　　1, Yam tastes sweet and has a balanced nature, entering the spleen, lung, and kidney meridians. It can tonify Qi and strengthen the spleen, nourish yin and benefit the lung, and补肾固精. It is suitable for people with spleen Qi deficiency, insufficient food intake and loose stools, and chronic diarrhea. People with excessive dampness and Qi stagnation with abdominal distension should avoid eating it.

　　2, Red dates (Jujube) taste sweet and have a warm nature, entering the spleen and stomach meridians. They can tonify the spleen and stomach, nourish blood and calm the mind. They are suitable for people with spleen and stomach weakness, insufficient food intake and loose stools, and fatigue. People with Qi stagnation, damp-heat, and constipation should avoid eating them.

　　3, Honey tastes sweet and has a balanced nature, entering the spleen, lung, and large intestine meridians. It can tonify the spleen to relieve emergency, moisten the lung to relieve cough, and moisten the intestines to relieve constipation. It is suitable for people with spleen and stomach weakness and stomachache, dryness of the intestines and bowels with constipation, and is used in recent times for peptic ulcers. People with dampness, damp-heat syndrome, abdominal distension, vomiting, and loose stools should avoid eating it; it is not suitable to eat with scallions and lettuce.

　　4, Chicken meat tastes sweet and has a warm nature, entering the spleen and stomach meridians. It can tonify the middle and boost the Qi, and replenish essence and marrow. It is suitable for people with weakness of the spleen and stomach, fatigue, lack of appetite, and chronic diarrhea. People with实证, heat syndrome, boils, and measles should avoid eating it.

　　5, The rabbit meat tastes sweet and has a cool nature. It can tonify the middle and boost the Qi, cool the blood and detoxify. It is suitable for people with spleen deficiency and insufficient food intake, blood heat with hematochezia, stomach heat with vomiting and regurgitation, and intestinal dryness with constipation. People with deficiency-cold and diarrhea should avoid eating it.

　　Traditional Chinese medicine treatment of spleen rupture focuses on invigorating Qi and securing the loose, and active measures should be taken for severe cases; for mild cases or postoperative treatment, focus on smoothing Qi and blood circulation, invigorating Qi and nourishing blood.

　　1. Qi Detached with Blood

　　Treatment Method: Invigorate Qi, secure the loose and return Yang.

　　Prescription: urgently administer 9g Renshen in Duxiren Decoction. Then use modified Renshen Yangrong Decoction. 6g Renshen, 3g Gancao, 9g Danggui, 9g Baishao, 9g Shudihuang, 3g Roudoukou, 6g Daizao, 9g Huangqi, 9g Baizhu, 9g Fuling, 9g Wuweizi, 9g Yuanzhi, 9g Jupi, 3g Shengjiang; if there is uncontrolled bleeding, add Xianhecao, Oujie, Cebepi to stop bleeding; if there is spontaneous sweating, cold skin, weak breathing, add Fuzi, Ganjiang to warm Yang; if there is palpitations and insufficient sleep, add Longyanrou, Yuanzhi, Suanzaoren to nourish the heart and calm the mind.

　　2. Syndrome of Internal Obstruction by Blood Stasis

　　Treatment Method: Remove blood stasis and unblock the meridians.

　　Prescription: modified Xuanfu Hua Decoction. 9g Xuanfu Hua, 9g Xinfeng, 6g Cong. You can also add Yujin, Taoren, Xuanhu, Guizhi to enhance the effect of smoothing Qi and activating blood circulation; if there is severe blood stasis, you can use modified Fuyuan Huoxue Decoction. 9g Chaihu, 9g Gualou Gen, 9g Danggui, 6g Honghua, 6g Gancao, 3g Chuanshanjie, 6g Dahuang, 6g Taoren to activate blood circulation and unblock the meridians.

　　3. Liver Qi Stagnation

　　Treatment Method: Soothe the liver and Qi.

　　Prescription: modified Chaihu Shugan Powder. 9g Chaihu, 9g Zhizi, 9g Shaoyao, 6g Gancao, 9g Xiangfu, 9g Chuanxiong. For those with severe pain in the ribs, add Qingpi, Chuanlianzi, Yujin to enhance the effect of smoothing Qi and relieving pain; if there are symptoms of Qi stagnation transforming into fire, such as pain in the ribs, restlessness, dry mouth and bitter taste, jaundice, constipation, red tongue with yellow fur, wiry and rapid pulse, remove Chuanxiong and add Danpi, Shanzha, Huanglian, Chuanlianzi, Xuanhu to clear the liver and Qi, activate blood circulation and relieve pain; if there is residual blood stasis after injury, add Danggui, Taoren, Honghua to enhance the effect of activating blood circulation and removing blood stasis.

　　4. Deficiency of Qi and Blood

　　Treatment Method: Invigorate Qi and nourish blood.

　　Prescription: modified Baizhen Decoction. 9g Dangshen, 9g Baizhu, 9g Fuling, 6g Zhigancao, 9g Chuanxiong, 9g Danggui, 9g Shudihuang, 9g Baishao, 3g Shengjiang, 6g Daizao. For those with chronic injury and insufficient Qi and blood, and residual blood stasis, add Taoren, Honghua, Yujin, etc., to promote blood circulation and unblock the meridians; for those with restlessness and heat in the heart due to blood deficiency and Yin, add Stir-fried Zhizi, Suanzaoren to clear heat and calm the mind.