Thromboangiitis obliterans—commonly known as Buerger disease—is a rare, inflammatory, occlusive vascular disorder that primarily affects small- and medium-sized arteries and veins in the extremities. Characterized by segmental inflammation, thrombosis, and vasospasm, it typically presents in young to middle-aged male smokers with symptoms including coldness, numbness, and pain in the fingers or toes; intermittent claudication (pain during walking that resolves with rest); progressing to severe, persistent rest pain—often worse at night—and ultimately tissue necrosis, non-healing ulcers, and, in advanced cases, limb amputation.
The disease is strongly and uniquely associated with tobacco use. According to the *Expert Consensus on Integrated Traditional Chinese and Western Medicine for Thromboangiitis Obliterans*, published by the Chinese Society of Integrated Traditional Chinese and Western Medicine’s Peripheral Vascular Disease Committee, tobacco exposure is the single most well-established environmental trigger. Notably, many affected individuals begin smoking during adolescence—often before age 15—and exhibit a long history of heavy tobacco consumption. While the precise pathogenesis remains incompletely understood, current evidence points to an immune-mediated inflammatory process, potentially involving autoimmune mechanisms, that drives endothelial injury, mural inflammation, and recurrent thrombus formation within affected vessels.
This tight link to smoking has earned Buerger disease the grim moniker “the smoker’s nightmare.” Unlike atherosclerosis—which often develops later in life and involves multiple risk factors—Buerger disease disproportionately strikes otherwise healthy young men whose disease trajectory is directly tied to continued tobacco exposure. Once diagnosed, lifelong, absolute tobacco abstinence—including avoidance of secondhand smoke—is the only intervention proven to halt disease progression and reduce the risk of amputation. For many patients, this requirement represents both a profound behavioral challenge and a pivotal turning point in clinical outcomes.
Medical management focuses on three core objectives: suppressing vascular inflammation, reducing vasospasm, and improving microcirculatory perfusion. Pharmacologic strategies aim to modulate oxidative stress, inhibit pro-inflammatory signaling pathways (including JAK-STAT1), and attenuate platelet aggregation and thrombus formation. Daphnetin—a bioactive compound derived from *Daphne odora*—has demonstrated therapeutic potential in this context. Clinical guidelines and pharmacologic studies indicate that daphnetin capsules exert antioxidant, anti-inflammatory, and vasodilatory effects, improve hemorheology, and inhibit HMGB1 release induced by lipopolysaccharide (LPS) in vitro. These properties support its use as an adjunctive therapy in early-stage thromboangiitis obliterans, as well as in other occlusive vascular conditions such as diabetic foot syndrome, where microvascular dysfunction and chronic inflammation play central roles.
While pharmacotherapy can help stabilize disease and alleviate symptoms, definitive disease control hinges on cessation of all tobacco products. In selected cases, surgical or endovascular revascularization may be considered—but only after confirmed tobacco abstinence and in carefully evaluated patients without active distal inflammation. Multidisciplinary care—including vascular medicine, smoking cessation counseling, wound management, and rehabilitation—is essential to prevent progression and preserve limb function. As emphasized in current consensus statements, tobacco cessation remains the sole intervention capable of altering the natural history of Buerger disease. Early recognition, prompt intervention, and unwavering adherence to abstinence offer the best chance to avoid irreversible tissue loss and maintain quality of life.