蔡炳勤教授以温通为核心治疗腹部术后炎性肠梗阻经验总结
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摘要
炎性肠梗阻是指肠壁受到损伤或炎症刺激后,导致肠功能紊乱,肠蠕动消失,以致肠内容物不能正常通行而引起肠梗阻,以腹部术后常见。蔡炳勤教授在治疗腹部外科术后炎性肠梗阻方面有独到见解。蔡教授认为外科术后患者多虚、多瘀,术后炎性肠梗阻非燥屎内结之承气汤证,主因中阳不足,常予温中通下法,提出以温通为核心的中医整体辨证论治学术思想。温通法临床应用包括厚朴温中汤合四磨汤加减内服、大黄附子汤保留灌肠、电针足三里、吴茱萸外熨、情绪心理疏导、艾灸及叩齿等多方位、多角度的综合治疗,对温通法具体应用进行介绍,并结合临床病例加以阐述。
Inflammatory intestinal obstruction refers to intestinal dysfunction and disappearance of intestinal peristalsis after intestinal wall injury or inflammation stimulation, resulting in intestinal obstruction caused by intestinal contents not being able to pass normally, which is common after abdominal surgery.Professor Cai Bingqin has unique views on the treatment of inflammatory intestinal obstruction after abdominal surgery.Professor Cai believes that the patients after surgery are deficient and stasis-prone, and the inflammatory intestinal obstruction after surgery is not the syndrome of Chengqi Decoction with dry excrement and internal knot.He think that the main cause of postoperative inflammatory intestinal obstruction is the deficiency of Zhongyang. He often uses the method of warming the middle and dredging the lower part. He puts forward the academic thought of TCM syndrome differentiation and treatment with warmly dredging method as the core. Clinical application of Wentong method includes Houpu Wenzhong Decoction and Simo Decoction plus or minus oral administration, Dahuang Fuzi Decoction retention enema, electro-acupuncture bilateral Zusanli, rutaecarpa rutaecarpa external ironing, emotional psychological counseling, moxibustion and toothtapping, and other multi-directional and multi-angle comprehensive treatment, as well as introducing the application of warmly dreging method, which are elaborated with clinical cases.
Inflammatory intestinal obstruction refers to intestinal dysfunction and disappearance of intestinal peristalsis after intestinal wall injury or inflammation stimulation, resulting in intestinal obstruction caused by intestinal contents not being able to pass normally, which is common after abdominal surgery.Professor Cai Bingqin has unique views on the treatment of inflammatory intestinal obstruction after abdominal surgery.Professor Cai believes that the patients after surgery are deficient and stasis-prone, and the inflammatory intestinal obstruction after surgery is not the syndrome of Chengqi Decoction with dry excrement and internal knot.He think that the main cause of postoperative inflammatory intestinal obstruction is the deficiency of Zhongyang. He often uses the method of warming the middle and dredging the lower part. He puts forward the academic thought of TCM syndrome differentiation and treatment with warmly dredging method as the core. Clinical application of Wentong method includes Houpu Wenzhong Decoction and Simo Decoction plus or minus oral administration, Dahuang Fuzi Decoction retention enema, electro-acupuncture bilateral Zusanli, rutaecarpa rutaecarpa external ironing, emotional psychological counseling, moxibustion and toothtapping, and other multi-directional and multi-angle comprehensive treatment, as well as introducing the application of warmly dreging method, which are elaborated with clinical cases.
引文
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[12] 沈展涛,钟小生,何军明,等.吴茱萸热敷促进肝部分切除术后胃肠功能恢复的临床研究[J].江苏中医药,2014,46(2):40-41.
[13] 张崇富.论道教叩齿的仪式内涵[J].四川大学学报(哲学社会科学版),2013(4):113-121.
[14] 蒋著椿,罗春艳.“通法”辨证思维在术后早期炎性肠梗阻的应用及对PCT的影响[J].中国中医急症,2017,26(3):547-549.
[2] 刘昉.幼幼新书[M].白极,校注.北京:中国医药科技出版社,2011:206.
[3] 周建功.中西医结合治疗腹部手术后麻痹性肠梗阻疗效分析[J].现代医药卫生,2017,33(6):871-873.
[4] 叶天士.临证指南医案[M].苏礼,焦振廉,张琳叶,等,整理.北京:人民卫生出版社,2006:199.
[5] 高士栻.医学真传[M].宋咏梅,李圣兰,点校.天津:天津科学技术出版社,2000:256.
[6] 段世锋,刘彩霞.厚朴温中汤加味治疗脾胃虚寒型慢性胃炎43例[J].西部中医药,2016,29(8):98-99.
[7] 黄蓓.四磨汤加减联合普济痔疮栓对混合痔术后疗效及康复进程的影响[J].四川中医,2016,34(7):169-171.
[8] 马相民.四磨汤口服液促进腹部手术后胃肠功能恢复的疗效观察[J].北方药学,2015,12(9):29.
[9] 王齐兵,易芳,彭绪东,等.生大黄保留灌肠对重症急性胰腺炎患者炎症因子的影响[J].中国中医急症,2016,25(3):517-519.
[10] 张仲景.金匮要略[M].何任,何若苹,整理.北京:人民卫生出版社,2005:72.
[11] 吴静芳,魏星,裘华森.电针治疗大鼠腹部术后肠麻痹实验研究[J].浙江中西医结合杂志,2014,24(8):675-677.
[12] 沈展涛,钟小生,何军明,等.吴茱萸热敷促进肝部分切除术后胃肠功能恢复的临床研究[J].江苏中医药,2014,46(2):40-41.
[13] 张崇富.论道教叩齿的仪式内涵[J].四川大学学报(哲学社会科学版),2013(4):113-121.
[14] 蒋著椿,罗春艳.“通法”辨证思维在术后早期炎性肠梗阻的应用及对PCT的影响[J].中国中医急症,2017,26(3):547-549.