《外科正宗》辨治肠痈病探析  

An Analysis of Differentiation and Treatment of Intestinal Carbuncle in Orthodox Manual of External Medicine

作　　者：马钰婷 郭修田[1] MA Yuting;GUO Xiutian(Shanghai Municipal Hospital of Traditional Chinese Medicien Affilated to Shanghai University of Traditional Chinese Medicine,Shanghai,China,200071)

机构地区：[1]上海中医药大学附属市中医医院,上海200071

出　　处：《河南中医》2023年第10期1513-1517,共5页Henan Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(81873308);上海市卫生健康委员会科研项目(202140158);上海市进一步加快中医药传承创新发展三年行动计划——中医非药物疗法示范中心建设项目[ZY(2021-2023)-0204];上海中医药大学产业发展中心医养结合科创项目(YYKZ-2021-01-140);上海市中医医院未来计划项目(WLJH2021ZY-GZS003);上海市中医医院未来计划传承人才项目(WLJH2021ZY-MZY024)。

摘　　要：陈实功《外科正宗》认为,肠痈病机为湿热、瘀血流聚肠道,其根据患者腹痛、腹胀、溃脓等症状,将肠痈分为初期、成脓期、溃脓期、迁延期4期,分期进行辨证论治。初期腹痛轻微,因湿热瘀血壅遏于局部,经脉不通,不通则痛,治“宜下之”,用大黄汤攻下瘀血,瘀血祛则正安,然大黄汤药力峻猛,对于体虚脉细者,以活血散瘀汤和利之。“腹中疼痛,胀满不食,便淋刺痛者”为脓肿渐成,陈实功主张以薏苡仁汤“和而导之”,另用熏蒸法、针刺法排脓。“已溃时时下脓,腹痛不止,饮食无味者,宜托而补之”,脓成破溃,正气耗损,此期邪实正虚,治以牡丹皮汤、排脓散、七贤散等。肠痈积袭日久,正虚邪恋,进展至迁延期,在当时被视为“不治证”,现代用氨基水杨酸制剂、激素、免疫抑制剂、生物制剂、干细胞疗法等治疗。针对前3个时期,陈实功先后采用消、托、补三法,进一步明确了中医外科内治法在肠痈病中的运用。According to Chen Shigong's Orthodox Manual of External Medicine,the pathogenesis of intestinal carbuncle is dampness-heat and blood stasis accumulated in the intestines.Based on the symptoms of abdominal pain,abdominal distension and ulceration,in-testinal carbuncle can be divided into four stages:the initial stage,pyogenic stage,purulent stage and prolonged stage,so dfferentiation and treatment by stages treatment is adopted.In the early stage,the abdominal pain is mild,and due to dampness,heat,and blood stasis suppressed locally,the meridians are blocked,leading to pain.Chen Shigong believed that"it is appropriate to use purgative method",so Rhubarb Decoction is adopted to remove blood stasis and reinforce the healthy qi.However,the power of Rhubarb Decoction is fierce,and for those with weak body and thin pulse,Decoction for Promoting Blood Circulation and Removing Stasis can be used to harmo-nize."Abdominal pain,fullness,poor appetite,dribbling urination with stabbing pain"means that the abscess has gradually become,so Chen Shigong advocated using Semen Coicis Decoction for harmonizing and guiding it.Besides,fumigation method,and acupuncture method can also be used to discharge pus."When intestinal carbuncle has always pus,more abdominal pain,poor appetite,expulsion method can be used for tonifying.At this time,the healthy qi is injured,with excessive pathogens and deficient healthy qi,so Cortex Moutan Decoction,Pus-Discharging Powder,Seven Xian Powder can be adopted.When intestinal carbuncle accumulates for a long time,the healthy qi is deficient and pathogens linger,it progresses into the prolonged stage.At that time,it was regarded as"incurable syn-drome".Modern medicine uses amino salicylic acid preparations,hormones,immunosuppressants,biological agents,stem cell therapy to treat it.In view of the first three stages,Chen Shigong successively adopted the three methods:resolving method,expulsion method,and tonifying method,which has further clarified the application of TCM surgical internal treatment in in

关 键 词：肠痈 《外科正宗》 陈实功 分期辨治 消法 托法 补法 

分 类 号：R261[医药卫生—中医外科学]