基于“玄府”理论辨治妇科恶性肿瘤术后相关下肢淋巴水肿  

The treatment of lower limb lymphedema in postoperative gynecological malignant tumor based on the theory of Xuanfu

作　　者：谭心悦 邹玺[2] TAN Xinyue

机构地区：[1]南京中医药大学,江苏南京210029 [2]南京中医药大学附属医院,江苏南京210029

出　　处：《中医临床研究》2025年第1期106-111,共6页Clinical Journal Of Chinese Medicine

基　　金：江苏省卫健委项目(ZD2022070);江苏省中医院高峰学术人才项目(y2021 rc19);江苏省医学重点实验室(ZDXYS202208);江苏省研究生科研与实践创新计划(SJCX23_0775)。

摘　　要：下肢淋巴水肿是妇科恶性肿瘤手术后常见并发症之一,患者轻则出现感觉异常,重则演变为功能障碍,本病具有迁延不愈及进行性加重的特点,对患者身心可造成严重不良影响,西医治疗总以改善症状为主,短期内可减轻水肿,然而长期疗效欠佳。玄府理论萌发于《黄帝内经》,经后世医家不断阐释发挥,内涵日益丰富。玄府结构与西医淋巴循环系统相似,玄府理论对人体气液运行的病理认识与炎症反应、脂肪增生、纤维化等本病现代医学发病机制有相通之处,因此从玄府角度认识妇科恶性肿瘤术后下肢淋巴水肿客观合理且具科学性。基于玄府理论,可将下肢淋巴水肿病变过程概括为玄府郁闭,气液失通,郁而化热,终致痰瘀胶结,玄府空虚,虚实夹杂,水肿顽固难消。治疗上当顺玄府之性,立开玄之法,条畅气液流行,除湿浊痰瘀,以消水肿之患。按不同病程阶段,具体治法可分为理气利水开玄、清透火热开玄、祛痰活血开玄、扶正补虚开玄。风药辛散宣通之特性与本病玄府郁闭之基本病机尤为契合,故本病治疗应善伍以风药,根据病证灵活选择药物,常有增效的作用。文章附临床验案一则,为临床论治本病提供新思路。Lymphoedema of the lower extremities is one of the common complications after surgery for gynecological malignancies.Minor cases present with sensory abnormalities,while severe ones evolve into functional disorders.This disease is characterized by persistence and progressive aggravation,exerting serious adverse impacts on the physical and mental well-being of patients.Western medical treatments mainly aim at alleviating symptoms,but the long-term efficacy is suboptimal.The theory of Xuanfu(玄府)originated in Huangdi Neijing(《黄帝内经》)and has been continuously expounded and developed by subsequent physicians,with its connotation becoming increasingly enriched.The structure of Xuanfu is similar to that of the lymphatic circulation system in Western medicine.The understanding of the physiology and pathology of Qi(气)and fluid circulation in the human body in the theory of Xuanfu shares similarities with the pathogenesis of modern medicine such as inflammatory responses,adipose hyperplasia,and fibrosis.Therefore,it is objectively reasonable and scientific to recognize lymphedema of the lower extremities after gynecological malignancy surgery from the perspective of Xuanfu.Based on the theory of Xuanfu,the pathological process of lymphedema of the lower extremities can be summarized as follows:blockage of Xuanfu,impairment of Qi and fluid circulation,stagnation transforming into heat,and eventually,the intermingling of phlegm and stasis,as well as deficiency and excess in Xuanfu,resulting in stubborn and persistent edema.In treatment,it is necessary to comply with the nature of Xuanfu and establish the method of opening Xuanfu,regulate the circulation of Qi and fluid,remove dampness,turbidity,phlegm,and stasis,thereby eliminate edema.Specific treatment methods based on different disease courses are classified as follows:regulating Qi and promoting diuresis to open Xuanfu,clearing and permeating heat to open Xuanfu,eliminating phlegm and activating blood circulation to open Xuanfu,and reinforcing and tonify

关 键 词：妇科恶性肿瘤 下肢淋巴水肿 玄府 风药 

分 类 号：R73[医药卫生—肿瘤]