基于重症病例及现代病理生理机制的四妙勇安汤方证条文内涵解读及其治疗糖尿病足伴感染、脓毒症、动脉硬化性闭塞症等急危重症体会  

Interpretation of connotation of Simiao Yong′an Decoction based on severe cases and modern pathophysiological mechanisms and experience in treating diabetic foot with infection,sepsis,and arteriosclerosis obliterans in critical care medicine

作　　者：熊兴江[1] XIONG Xing-jiang(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《中国中药杂志》2025年第1期267-272,共6页China Journal of Chinese Materia Medica

基　　金：中央高水平中医医院临床研究和成果转化能力提升项目——医疗机构制剂研发与新药转化专项(HLCMHPP2023081);临床科研一体化人才专项(CZ30981);京津冀基础研究合作专项(J230037);中国中医药科技发展中心(国家中医药管理局人才交流中心)联合攻关项目(CXZH202301)。

摘　　要：四妙勇安汤出自《验方新编》,该方具有清热解毒,活血止痛功效,主治热毒炽盛之脱疽,临床表现为患肢暗红微肿,皮温灼热,溃烂腐臭,疼痛剧烈,或见发热口渴,舌质红,脉数。现今临床多将该方用于血管闭塞性脉管炎、下肢动脉硬化闭塞性溃疡、下肢血管支架成形术后支架内再狭窄、深脓疱病、深静脉血栓、糖尿病性下肢动脉硬化闭塞症、糖尿病足溃疡、急性膝关节炎、下肢静脉曲张、冠心病、经皮冠状动脉介入(PCI)术后、脓毒症、痛风、肿瘤、小儿慢性扁桃体炎等疾病的治疗。研究发现,糖尿病足伴感染、脓毒症、动脉硬化性闭塞症、血管闭塞性脉管炎等,属中医学“脱骨疽”范畴。四妙勇安汤为古代治疗“脱骨疽”的专病专方。四妙勇安汤的方证指征,(1)疾病方面,可用于动脉硬化性闭塞症、血管闭塞性脉管炎、糖尿病足、深脓疱病等。(2)症状方面,指征包括手指、足趾部位黯红,发黑,微肿,灼热,溃烂腐臭,甚则脚趾脱落,手脚腐烂坍陷,剧烈疼痛,难以忍受;皮肤溃烂蔓延,脓水淋漓,淋巴结肿大增生;伴见口干,口渴,烦躁,小便黄,大便干;舌暗红,苔薄白,脉弦数。(3)方证加减规律方面,针对合并顽固性低血压时,笔者用四妙勇安汤加大剂量黄芪以益气、扶正、托毒,常能达到升血压、抗炎作用。(4)合方规律方面,该方常与四妙丸、桂枝茯苓丸合方。大剂量用药是该方取效的关键。中西医结合疗法在糖尿病足伴感染、脓毒症、感染性休克、动脉硬化性闭塞症、血管闭塞性脉管炎的治疗中具有重要作用。Simiao Yong′an Decoction is derived from the New Compilation of Proved Prescriptions(Yan Fang Xin Bian).This formula has the effects of clearing heat and detoxifying as well as activating blood and relieving pain.It is mainly used to treat gangrene caused by excessive heat toxin and with the clinical manifestations including dark red and slightly swollen limbs,scorching skin,ulceration and odor,severe pain,occasional fever,thirst,red tongue,and rapid pulse.Nowadays,Simiao Yong′an Decoction is mostly used in the treatment of thromboangitis obliterans,ulcers in arteriosclerosis obliterans of lower limbs,stent restenosis after angioplasty of lower limbs,ecthyma,deep venous thrombosis,diabetic arteriosclerosis obliterans of lower limbs,diabetic foot ulcer,acute knee arthritis,varicose veins of lower limbs,coronary heart disease,post percutaneous coronary intervention(PCI),sepsis,gout,tumor,chronic tonsillitis in children,and other diseases.It has been identified that diabetic foot with infection,sepsis,arteriosclerosis obliterans,and thromboangitis obliterans belong to the category of gangrene in traditional Chinese medicine(TCM),and Simiao Yong′an Decoction is an ancient specialized prescription for treating this disease.The diseases that can be treated by Simiao Yong′an Decoction include arteriosclerosis obliterans,thromboangitis obliterans,diabetic foot,and ecthyma.The symptoms that can be treated by Simiao Yong′an Decoction include dark red,blackened,slightly swollen,burning,ulceration,and odor in the fingers and toes,and toes falling off,hands and feet decaying and collapsing,severe and unbearable pain in some cases.Furthermore,this formula is effective for skin ulceration spreading,pus dripping,swollen and proliferating lymph nodes.These symptoms are always accompanied by dry mouth,thirst,irritability,yellow urine,and dry stool.The TCM symptoms include red tongue,thin and white tongue coating,and wiry and rapid pulse.In the case with the complication of refractory hypotension,large dosage of Astragali

关 键 词：四妙勇安汤 糖尿病足伴感染 动脉硬化性闭塞症 血管闭塞性脉管炎 急危重症 

分 类 号：R259[医药卫生—中西医结合]