蔡炳勤辨证论治肝脓肿经验  

Experience of CAI Bing-Qin in Treating Liver Abscess

作　　者：王剑一 方扬 王珏钰 杨达钧 颜克秋 李格 田瑞 何军明[2] WANG Jian-Yi;FANG Yang;WANG Jue-Yu;YANG Da-Jun;YAN Ke-Qiu;LI Ge;TIAN Rui;HE Jun-Ming(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Guangdong Provincial Hospital of Traditional Chinese medicine,Guangzhou 510120 Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510405 [2]广东省中医院,广东广州510120

出　　处：《广州中医药大学学报》2021年第4期806-810,共5页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家中医药管理局科研项目“蔡炳勤全国名老中医药专家传承工作室”(编号:12BMGG02)。

摘　　要：总结蔡炳勤教授辨证论治肝脓肿经验。蔡炳勤教授认为肝脓肿属于中医“内痈”的范畴,可从内痈论治;该病多因外痈之内达、情志抑郁、饮食不节、大便秘结等因素,病邪郁于肝脏,血败肉腐,化而成脓。结合现代医学的病程分期,提出肝脓肿的中医分期辨证施治原则,拟分为初起期、成脓期、溃后期3期进行辨证治疗。初起期可采用清热解毒、疏肝理气、消肿散结等消法,临床常用柴胡清肝汤、化肝消毒汤、加味金铃子散等;成脓期可采用托法,配合使用现代医学的经皮经肝穿刺引流术或手术切开排脓等手段,使邪有出路;溃后期辨证以气阴两虚为主,治疗上可酌情采用补法,顾护胃气,同时更需关注大便的通畅与否。蔡炳勤教授认为肝痈为内痈,各期均需重视通便药物的使用,以使毒邪外泄,防内痈之在内溃破。The experience of Professor CAI Bing-Qin in treating liver abscess was summarized.Professor CAI Bing-Qin believes that liver abscess can be classified into the category of internal abscess,and can be differentiated and treated following the principles for internal abscess.Liver abscess usually develops from the inward movement of superficial abscess,emotional depression,improper diet,and constipation.The pathogens accumulate in the liver,which induces the blood and flesh becoming putrid,and then results into the formation of liver abscess.Based on the staging classification for liver abscess in the field of modern medicine,we put forward the principles of staging differentiation and treatment for liver abscess,and the treatment of liver abscess can be classified into the treatment for initial stage,the treatment for pyosis stage,and the treatment for post-pyosis stage.Treatment for the initial stage can be achieved by clearing heat and removing toxin,soothing liver and regulating qi,and alleviating swelling and dissipating nodulation with the usage of Chaihu Qinggan Decoction,Huagan Xiaodu Decoction,and modified Jinlingzi Powder.The treatment for pyosis stage can be achieved by expulsion method combined with percutaneous transhepatic drainage or abscess incision drainage.And the treatment for post-pyosis stage,which is predominated by the deficiency of both qi and yin,can be achieved by the usage of tonifying therapy if necessary and by protecting stomach qi,in particular to keep the defecation smoothing.Professor CAI Bing-Qin stresses that for liver abscess is one kinds of internal abscess,the medication of promoting defecation in various stages is needed to prevent the internal rupture of the liver abscess and the leakage of toxins.

关 键 词：肝脓肿 内痈 肝痈 分期辨证 消法 托法 补法 通便 中医药治疗 

分 类 号：R261[医药卫生—中医外科学]