蔡炳勤从肝论治腹部外科“术后应激证”的思路  

Cai Bingqin's Thoughts on the Treatment of“Postoperative Stress Syndrome”in Abdominal Surgery from the Perspective of Liver

作　　者：程洁 卢思丽 王佳敏 熊子慧 何军明[2] CHENG Jie;LU Sili;WANG Jiamin;XIONG Zihui;HE Junming(The Second Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Dept.of General Surgery,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120 Guangdong,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]广东省中医院大外科,广东广州510120

出　　处：《广州中医药大学学报》2025年第2期483-487,共5页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省国际科技合作项目(编号:2022A05050065);广东省中医院中医学术流派传承工作室建设项目——“岭南疡科流派传承工作室”(编号:中医二院[2013]233号)。

摘　　要：因手术创伤引起的术后应激症状,目前西医治疗缺乏主动干预以促进机体功能恢复的方法。蔡炳勤教授通过对患者腹部外科术后应激症状如汗出异常、睡眠障碍、情志改变、胃肠功能障碍等的病因病机分析,提出围手术期“术后应激证”这一概念。蔡炳勤教授认为,手术刺激作为引起术后应激的重要病因,可致机体应激过度,引起一系列影响患者康复的症状。肝在术后应激状态中,通过对气机、血液和情志的调节,起着防卫与适应作用,患者表现的汗出异常、睡眠障碍、情志改变等与肝主情志、藏魂、主疏泄有关,而纳差、腹胀、便秘等胃肠功能障碍表现则属肝脾不调。治疗上,蔡教授提出从肝论治的原则,采用疏肝解郁、温运气机之法,常选四逆散为基本方,使肝气升发条达,疏泄功能正常,气血调和,血脉通畅;佐以健脾化湿、益气固表之法调整机体脏腑功能紊乱,恢复气血阴阳平衡。“术后应激证”的提出,可为中医药在围手术期的运用提供一个较好的切入点,是对现有快速康复外科体系的一种有益补充。Postoperative stress symptoms are caused by surgical trauma,and now still lack active intervention methods to promote the recovery of body function in the field of western medicine.Professor Cai Bingqin analyzed the etiology and pathogenesis of stress symptoms after abdominal surgery,which usually manifested as abnormal sweating,sleep disorders,emotional disorders,and gastrointestinal dysfunction,and then put forward the concept of postoperative stress syndrome for the perioperative period.Professor Cai Bingqin believes that surgical stimulation,as the important etiological factor responsible for postoperative stress symptoms,can cause excessive stress in the body,which results in a series of symptoms affecting the recovery of patients.Liver plays a defensive and adaptive role in postoperative stress by regulating qi movement,blood circulation and emotions.The symptoms of abnormal sweating,sleep disorders and emotional disorders are related with the function of the liver in governing emotions,housing the ethereal soul,and ensuring the free movement of qi,while the gastrointestinal dysfunction manifestations of poor appetite,abdominal distention and constipation are due to the disharmony of liver and spleen.For the treatment of postoperative stress syndrome,Professor Cai proposes the principle of treating disease from the perspective of liver,and the methods of soothing liver and alleviating depression,and warming and activating qi movement are adopted.Sini San(Sini Powder for Soothing Liver and Regulating Qi)is commonly used as the basic prescription to ensure the normal function of liver and to ensure the free movement of qi,and then the harmony of qi and blood and the unobstruction of blood vessels will be achieved.Additionally,the assistance of therapy for invigorating spleen to dissolve dampness,and replenishing qi to consolidate superficies can adjust zang-fu organs’dysfunction,and will restore the balance of qi-blood and yin-yang.The proposal of“postoperative stress syndrome”will provide an approach t

关 键 词：术后应激证 从肝论治 汗出异常 睡眠障碍 情志异常 胃肠功能障碍 疏肝运脾 四逆散 蔡炳勤 

分 类 号：R269.19[医药卫生—中西医结合]