蔡炳勤教授学术思想和治疗周围血管疾病经验整理与临床研究
|
摘要
(1)中文摘要
蔡炳勤教授从事中医外科临床、教学与科研工作40余年,有丰富的临床经验,建树颇丰,特别是在中医药治疗周围血管疾病方面,有很深的造诣。本人师从蔡炳勤老师三年,总结其治疗周围血管疾病学术思想和经验,同时对其临床经验进行临床研究。概述如下：
一、蔡炳勤教授主要学术思想
1、蔡炳勤教授强调中医外科以外治法为特色。蔡炳勤老师根据缺血性伤口的特点,总结了蚕食清创的系列疗法,改良了祛腐生肌膏制剂工艺。根据糖尿病足肌腱感染坏死是导致截肢的重要环节这一临床特点,提出早期“纵深切开、通畅引流、持续灌洗、祛腐生肌”的局部“祛腐生肌系列”处理原则。
2、蔡炳勤教授的中医手术观。蔡炳勤老师提出中医的“开刀”与西医有所不同,中医手术依据的也是中医的原则,用中医的思想指导手术,比如开刀主要是“祛邪”的手段,“祛邪”的同时,不能伤正,更注重局部和整体的关系,手术之后,中医还注重调整,进一步扶持正气,这些都是中医手术的独到之处。蔡炳勤老师提出要树立正确的中医手术观,强调手术是中医外科传统外治法之一。主张“治病先治人”。反对“一把刀”主义,强调“功夫在刀外”,注重中医外科围手术期治疗。
3、蔡炳勤教授提出专科建设是中医外科发展的突破口。蔡炳勤老师认为,从事中医外科工作,最大的困惑是外治法施展不足。针对中医治疗有优势的病种开设专科,先进技术与中医传统文化和治疗理念相结合,中医外科的发展就会有无穷的生命力。
4、蔡炳勤教授治疗周围血管疾病学术源流。蔡炳勤老师最先从治疗脉管炎取得丰硕成果,顺势成立周围血管专科,并且形成了自已的特色。疾病谱出现变化后,开始转入研究糖尿病足的中医外科治疗。从运用祛腐生肌膏治疗糖尿病足溃疡,到针对糖尿病足筋疽型,抗感染药物难以发挥局部疗效的难题,提出祛腐生肌系列疗法,并根据发生于足底组织坚韧部位高糖、多水的病灶,创立了中药“渴疽洗方”。并在长期的临床实践中,不断修正治疗方案,近期蔡炳勤老师根据糖尿病足筋疽型不同时期的发病特点,简化了祛腐生肌系列疗法,采用分急性感染期、好转缓解期、恢复期三个时期分期外治的方法,取得明显的临床疗效。
二、蔡炳勤教授治疗周围血管疾病学术思想和临床经验的整理与研究
1、蔡炳勤老师论活血化瘀药在周围血管外科的应用。
蔡炳勤老师认为,随着疾病谱的变化,继发性血管损害,纤维化病变逐渐增多,活血化瘀药物应用前景广阔。根据周围血管病血瘀证形成的共性,结合临床,提出活血化瘀药用法主要有三类：
(1)益气活血法：补气药与活血药联用,体现补必兼行的原则。
(2)活血化浊法：蔡炳勤老师认为血浊是病之始,血结是病之终,将性平力专的活血化瘀药与活血泄浊药合用,能防治高粘血症,降低胆固醇,防止动脉硬化斑块发生、发展的作用。
(3)温经通络法：蔡炳勤老师在临床上将破血逐瘀药与温经散寒药并用,以治疗血管病后期,顽固不愈,或涉及血管病变的其它疑难病症。
2、蔡炳勤老师论糖尿病足的治疗难点与对策。蔡炳勤老师认为治疗的难点和对策,主要表现在如何处理以下4关系：
(1)内科与外科：蔡炳勤老师认为,糖尿病足是全身性疾病在局部的表现,并非独立的外科疾病,在肢体未形成坏疽之时,应以内科治疗为主,严重的足坏疽感染,一般归属外科治疗。蔡炳勤老师认为应强化整体意识,正确认识局部与全身的因果关系,掌握降糖,抗炎,支持疗法等全身基础治疗。
(2)糖尿病足与糖尿病性动脉闭塞症：蔡炳勤老师认为,只有熟悉糖尿病足与闭塞性动脉硬化症不同的病理及临床特点,才能对一个糖尿病足坏疽患者,尤其是糖尿病性闭塞性动脉硬化症患者作出权衡判断,采取不同的治疗措施。
(3)降糖与抗菌：蔡炳勤老师认为,糖尿病足患者高血糖是始动环节,感染是贯穿始终的关键环节,坏疽、溃疡是终末环节,三个环节互为因果。
(4)“蚕食清创”与“扩创畅流”：蔡炳勤老师认为,只有在糖尿病足感染基本控制,或糖尿病性动脉硬化闭塞症慢性缺血期,病情相对稳定,坏疽较为局限的情况下应用,或在扩创畅流情况下穿插进行。
3、蔡炳勤老师分期辨治变应性血管炎经验。蔡炳勤老师对变应性血管炎的治疗有独到之处,他根据本病的发病特点,病证结合,分期治疗,疗效显著。急性期：蔡炳勤教授认为此期多为虚实夹杂之证,治疗应标本兼顾,内外并治,内调气血,外清湿热,自拟“五草汤”(茜草、紫草、仙鹤草、稀莶草、旱莲草)加减。慢性缓解期：蔡炳勤老师认为皮肤体表病损,病程迁延,日久耗伤正气,病机是虚实夹杂,虚多实少,表虚不固。治宜补虚固表,佐以清热利湿,予玉屏风散合“五草汤”加减。
4、蔡炳勤老师补虚立法治疗周围血管疾病经验。蔡炳勤老师认为,周围血管疾病的治疗,主要抓住疾病的基本病机,在治疗脱疽、股肿、臁疮等周围血管疾病中以补虚立法：以益气通阳法治疗脱疽、以益气化湿法治疗股肿、以益气活血法治疗臁疮,从而形成自已独特的治疗特色。
5、蔡炳勤老师分期外治糖尿病足筋疽型经验。蔡炳勤老师在总结分析各种中医外治法的基础上,根据糖尿病足筋疽不同时期的发病特点,在内科综合治疗的基础上,采用分急性感染期纵深切开、充分引[流、好转缓解期蚕食清创、持续灌注、恢复期祛腐生肌三个时期不同外治方法,能明显提高临床疗效。
三、糖尿病足筋疽型中医外治分期治疗临床疗效观察。
在总结蔡炳勤老师经验的基础上,结合文献调研及既往科学研究的成果,运用临床科研方法,客观评估糖尿病足筋疽中医外治分期治疗的临床疗效,研究表明,中医外治分期治疗组治愈23例,好转13例,无效4例,总有效率为90.0%；对照组治愈9例,好转7例,无效4例,总有效率为80.0%。两组疗效比较,差异有显著性意义(P<0.05)。说明糖尿病足筋疽型中医外治分期治疗,临床疗效确切,可操作性强、技术相对规范,是较好的中医外治糖尿病足筋疽型方案,值得推广应用。
Professor Cai Bingqin has engaged in clinical practice, teaching and research work in surgery of TCM for more than40years, and gained a lot in clinical experience, especially in the treatment of peripheral vascular diseases. Under the supervision of Prof. Cai for three years, Ii-ve summarized the academic thoughts and experience in the treatment of peripheral vascular diseases, and carried out clinical researches on his experience, and summarized as below:
1. Main academic thoughts of Prof. Cai
1.1Professor Cai Bingqin emphasis that external treatment is the key characteristic of TCM surgery. Based on the characteristics of ischemic wounds, he summarized a series of nibbled debridement therapy, improved preparation process of saprophytic muscle removing cream. According to the fact that tendon infection and necrosis of diabetic foot is the leading cause to amputation, he proposed management principles for local "cured rot myogenic series" as early "deep cut, smooth drainage, continuous irrigation, and remove rot myogenic"
1.2Professor Cai Bingqini-s surgical concept in Chinese medicine
Prof. Cai proposed that "cut" in Chinese medicine is different from that of Western medicine operations, the operation should be directed under the principles of TCM, such as surgery are mainly means of "eliminating the pathogenic factors", we can not hurt the human vitals while "dispelling the evil", and should pay more emphasis on the relationship between local and global. TCM also focuses on adapting and further fostering human vitals after the surgery. These are the unique of TCM operations. The correct opinions of TCM surgery should be established, TCM surgery is one of external treatment representative for "treatment human first but not disorders." He opposed to be just "a knife" as a surgical doctor, and emphasized that "Kung Fu of a surgeon is outside the scalpel", focusing on perioperative surgical treatment of TCM.
1.3Prof. Cai put forward that the subject construction is the breakthrough of TCM surgery development, and the biggest confusion is the insufficient of external treatment of TCM. Specialized department establishment according to TCM treatment advantages, combining advanced technology and the Chinese traditional culture and the treatment concept, and the combination of the development of traditional Chinese medicine surgery will be infinite vitality.
1.4Academic origins of Prof. Caii-s treatment of peripheral vascular disease.
Prof. Caii s achievement was first gained from the treatment of vasculitis, and then he established peripheral vascular department, and formed their own characteristics. He turned to research on the surgical treatment of diabetic foot after the change of disease spectrum.
He put forward the series therapy of saprophytic muscle removing starting from using saprophytic muscle removing cream in the treatment of diabetes foot ulcer, and for diabetes foot muscle to jaundice type, anti-infection drugsi-difficulties in local wound, and founded the Traditional Chinese Medicine "Ke-ju washing formula". He kept correcting treatment in the long period of clinical practice, and simplified saprophytic muscle removing series therapy recently. He treated diabetic foot according to clinical characteristics of three different period, and achieved significant clinical effect.
2. Research and arrangement of Prof. Caii-s academic thoughts and clinical experience of treatments of peripheral vascular disease
2.1Prof. Caij s theory of applications of blood-activating and stasis-dissolving drugs in Peripheral vascular surgery
Prof. Cai thinks, with the change of the disease patterns, secondary vascular impairment, fibrosis lesions increases gradually, for activating blood circulation and eliminating stasis drugs broad prospect of application. According to common of the formation of the blood stasis syndrome in the vascular disease, classified them into three types:
2.1.1therapy of supplementing qi and activating blood circulation: combined drugs of activating blood circulation and supplementing qi, stands for the principle that activating must be used along with tonifying.
2.1.2Promoting blood change chaotic:Cai thinks blood disease is the beginning of turbidity, blood is ill and end, and the only force sex flat and promoting blood circulation to remove blood stasis drugs discharge turbidity medicine share, prevention and cure high sticky hematic disease, lower cholesterol, prevent arteriosclerosis plaque occurrence and development.
2.1.3Warm the meridians:Cai will be using warm drugs that expelling blood stasis and scatter cold medicine, and to treat diseases of later phase, stubborn unhealed, or other vascular disease involving difficult cases.
2.2Prof. Caii s opinion on difficulties and countermeasures of the treatment of diabetic foot. Cai believes that the difficulties and treatment strategies lie in how to deal with the following four relations:
2.2.1Medical and surgical:diabetes foot is systemic disease-s local expression, and not an independent surgical disease, which should be treated with internal medical treatment firstly before gangrene, while serious infection of foot gangrene should be treated surgically. One should enhance the concept of overall consciousness, the correct understanding of local and systemic causality, master hypoglycemic, anti-inflammatory, support therapy all over the body such as the foundation treatment.
2.2.2Diabetes foot and diabetic arterial occlusion disease:Cai thinks, only familiar with the different pathological and clinical characteristics of diabetes foot and occlusive atherosclerosis, can different treatment measures be taken on a diabetes foot gangrene patients, especially diabetic occlusive artery sclerosis patients.
2.2.3Glucose-lowering and antimicrobiology:Cai thinks that high blood glucose is initiating linkfor diabetes foot, the infection is the key link of throughout the disease history, gangrene, ulcer is terminal link, three links are cause and effect mutually.
2.2.4"Nibbled debridement" and "debridement and drainage":Cai thinks that only when infection of diabetic foot is basically controlled, or diabetic atherosclerosis block disease is in chronic ischemic phase, latively stable condition, and gangrene is in relatively limited circumstances, should the former treatment be applied.
2.3Caio-s experience on staging differentiation for allergic vasculitis. Prof. Caii-s treatment experience of allergic vasculitis's has the originality, according to the pathogenesis of this disease he characteristics, disease and syndrome union, staging treatment, and got significant clinical effect. The acute phase:Cai thinks that disease of this period is mingled with excess and deficiency syndromes, and should be treated wi th consideration of the root cause and symptoms of the disease, by both internal and external treatment, managing qi and blood, and clear humid using self-made "five grass decoction". In chronic remission period, Cai thinks skin surface damage and long course hurt vital qi, pathogenesis is deficiency complicated with excess, asthenia complicated with sthenia. Treatment should be tonify deficiency and body surface, combined with heat and dampness expelling, using Yupinfeng Powder with "five grass decoction ".
2.4Caii s experience of tonifying principle for peripheralvascular disease. Cai believes that the treatment of peripheral vascular disease is mainly to seize the basic pathogenesis of the disease; use tonifying method for the treatment of anthrax, boils and other peripheral vascular disease; use Supplementing Qi and Activating Yang method for anthrax treatment, thus formed his own unique treatment characteristics.
2.5Cai; s experience of staging treatment for diabetic foot gangrene tendons. Prof. Cai analyzed tendons of diabetic foot gangrene according to the clinical characteristics of different periods, based on the comprehensive medical treatment, he adapted a serie external treatment in three different periods, including deep incision and adequate drainage in acute phase of infection, nibbled debridement and continuous infusion in resolving stage, remove saprophytic muscle in recovery stage, and improved the clinical effect significantly.
3. Clinical effects observation of TCM external treatment by stage for diabetic foot muscle gangrene
Clinical observations to prove the clinical effects of TCM external treatment by stage for diabetic foot muscle gangrene were performed, based on the experience summary of Prof. Cai, and literature review. Results showed23cases cured,13improved, and4ineffective in treatment group, with total effective rate of90.0%; while9cured,7improved and4ineffective in control group, with total effective rate of80.0%. Comparison of two groups showed significant difference (P<0.05). Conclusion:TCM external treatment by stage for diabetic foot muscle gangrene is a good TCM treatment plan, and should be generalized for its exact clinical effectiveness, good maneuverability, and relative standard operation techniques.
蔡炳勤教授从事中医外科临床、教学与科研工作40余年,有丰富的临床经验,建树颇丰,特别是在中医药治疗周围血管疾病方面,有很深的造诣。本人师从蔡炳勤老师三年,总结其治疗周围血管疾病学术思想和经验,同时对其临床经验进行临床研究。概述如下：
一、蔡炳勤教授主要学术思想
1、蔡炳勤教授强调中医外科以外治法为特色。蔡炳勤老师根据缺血性伤口的特点,总结了蚕食清创的系列疗法,改良了祛腐生肌膏制剂工艺。根据糖尿病足肌腱感染坏死是导致截肢的重要环节这一临床特点,提出早期“纵深切开、通畅引流、持续灌洗、祛腐生肌”的局部“祛腐生肌系列”处理原则。
2、蔡炳勤教授的中医手术观。蔡炳勤老师提出中医的“开刀”与西医有所不同,中医手术依据的也是中医的原则,用中医的思想指导手术,比如开刀主要是“祛邪”的手段,“祛邪”的同时,不能伤正,更注重局部和整体的关系,手术之后,中医还注重调整,进一步扶持正气,这些都是中医手术的独到之处。蔡炳勤老师提出要树立正确的中医手术观,强调手术是中医外科传统外治法之一。主张“治病先治人”。反对“一把刀”主义,强调“功夫在刀外”,注重中医外科围手术期治疗。
3、蔡炳勤教授提出专科建设是中医外科发展的突破口。蔡炳勤老师认为,从事中医外科工作,最大的困惑是外治法施展不足。针对中医治疗有优势的病种开设专科,先进技术与中医传统文化和治疗理念相结合,中医外科的发展就会有无穷的生命力。
4、蔡炳勤教授治疗周围血管疾病学术源流。蔡炳勤老师最先从治疗脉管炎取得丰硕成果,顺势成立周围血管专科,并且形成了自已的特色。疾病谱出现变化后,开始转入研究糖尿病足的中医外科治疗。从运用祛腐生肌膏治疗糖尿病足溃疡,到针对糖尿病足筋疽型,抗感染药物难以发挥局部疗效的难题,提出祛腐生肌系列疗法,并根据发生于足底组织坚韧部位高糖、多水的病灶,创立了中药“渴疽洗方”。并在长期的临床实践中,不断修正治疗方案,近期蔡炳勤老师根据糖尿病足筋疽型不同时期的发病特点,简化了祛腐生肌系列疗法,采用分急性感染期、好转缓解期、恢复期三个时期分期外治的方法,取得明显的临床疗效。
二、蔡炳勤教授治疗周围血管疾病学术思想和临床经验的整理与研究
1、蔡炳勤老师论活血化瘀药在周围血管外科的应用。
蔡炳勤老师认为,随着疾病谱的变化,继发性血管损害,纤维化病变逐渐增多,活血化瘀药物应用前景广阔。根据周围血管病血瘀证形成的共性,结合临床,提出活血化瘀药用法主要有三类：
(1)益气活血法：补气药与活血药联用,体现补必兼行的原则。
(2)活血化浊法：蔡炳勤老师认为血浊是病之始,血结是病之终,将性平力专的活血化瘀药与活血泄浊药合用,能防治高粘血症,降低胆固醇,防止动脉硬化斑块发生、发展的作用。
(3)温经通络法：蔡炳勤老师在临床上将破血逐瘀药与温经散寒药并用,以治疗血管病后期,顽固不愈,或涉及血管病变的其它疑难病症。
2、蔡炳勤老师论糖尿病足的治疗难点与对策。蔡炳勤老师认为治疗的难点和对策,主要表现在如何处理以下4关系：
(1)内科与外科：蔡炳勤老师认为,糖尿病足是全身性疾病在局部的表现,并非独立的外科疾病,在肢体未形成坏疽之时,应以内科治疗为主,严重的足坏疽感染,一般归属外科治疗。蔡炳勤老师认为应强化整体意识,正确认识局部与全身的因果关系,掌握降糖,抗炎,支持疗法等全身基础治疗。
(2)糖尿病足与糖尿病性动脉闭塞症：蔡炳勤老师认为,只有熟悉糖尿病足与闭塞性动脉硬化症不同的病理及临床特点,才能对一个糖尿病足坏疽患者,尤其是糖尿病性闭塞性动脉硬化症患者作出权衡判断,采取不同的治疗措施。
(3)降糖与抗菌：蔡炳勤老师认为,糖尿病足患者高血糖是始动环节,感染是贯穿始终的关键环节,坏疽、溃疡是终末环节,三个环节互为因果。
(4)“蚕食清创”与“扩创畅流”：蔡炳勤老师认为,只有在糖尿病足感染基本控制,或糖尿病性动脉硬化闭塞症慢性缺血期,病情相对稳定,坏疽较为局限的情况下应用,或在扩创畅流情况下穿插进行。
3、蔡炳勤老师分期辨治变应性血管炎经验。蔡炳勤老师对变应性血管炎的治疗有独到之处,他根据本病的发病特点,病证结合,分期治疗,疗效显著。急性期：蔡炳勤教授认为此期多为虚实夹杂之证,治疗应标本兼顾,内外并治,内调气血,外清湿热,自拟“五草汤”(茜草、紫草、仙鹤草、稀莶草、旱莲草)加减。慢性缓解期：蔡炳勤老师认为皮肤体表病损,病程迁延,日久耗伤正气,病机是虚实夹杂,虚多实少,表虚不固。治宜补虚固表,佐以清热利湿,予玉屏风散合“五草汤”加减。
4、蔡炳勤老师补虚立法治疗周围血管疾病经验。蔡炳勤老师认为,周围血管疾病的治疗,主要抓住疾病的基本病机,在治疗脱疽、股肿、臁疮等周围血管疾病中以补虚立法：以益气通阳法治疗脱疽、以益气化湿法治疗股肿、以益气活血法治疗臁疮,从而形成自已独特的治疗特色。
5、蔡炳勤老师分期外治糖尿病足筋疽型经验。蔡炳勤老师在总结分析各种中医外治法的基础上,根据糖尿病足筋疽不同时期的发病特点,在内科综合治疗的基础上,采用分急性感染期纵深切开、充分引[流、好转缓解期蚕食清创、持续灌注、恢复期祛腐生肌三个时期不同外治方法,能明显提高临床疗效。
三、糖尿病足筋疽型中医外治分期治疗临床疗效观察。
在总结蔡炳勤老师经验的基础上,结合文献调研及既往科学研究的成果,运用临床科研方法,客观评估糖尿病足筋疽中医外治分期治疗的临床疗效,研究表明,中医外治分期治疗组治愈23例,好转13例,无效4例,总有效率为90.0%；对照组治愈9例,好转7例,无效4例,总有效率为80.0%。两组疗效比较,差异有显著性意义(P<0.05)。说明糖尿病足筋疽型中医外治分期治疗,临床疗效确切,可操作性强、技术相对规范,是较好的中医外治糖尿病足筋疽型方案,值得推广应用。
Professor Cai Bingqin has engaged in clinical practice, teaching and research work in surgery of TCM for more than40years, and gained a lot in clinical experience, especially in the treatment of peripheral vascular diseases. Under the supervision of Prof. Cai for three years, Ii-ve summarized the academic thoughts and experience in the treatment of peripheral vascular diseases, and carried out clinical researches on his experience, and summarized as below:
1. Main academic thoughts of Prof. Cai
1.1Professor Cai Bingqin emphasis that external treatment is the key characteristic of TCM surgery. Based on the characteristics of ischemic wounds, he summarized a series of nibbled debridement therapy, improved preparation process of saprophytic muscle removing cream. According to the fact that tendon infection and necrosis of diabetic foot is the leading cause to amputation, he proposed management principles for local "cured rot myogenic series" as early "deep cut, smooth drainage, continuous irrigation, and remove rot myogenic"
1.2Professor Cai Bingqini-s surgical concept in Chinese medicine
Prof. Cai proposed that "cut" in Chinese medicine is different from that of Western medicine operations, the operation should be directed under the principles of TCM, such as surgery are mainly means of "eliminating the pathogenic factors", we can not hurt the human vitals while "dispelling the evil", and should pay more emphasis on the relationship between local and global. TCM also focuses on adapting and further fostering human vitals after the surgery. These are the unique of TCM operations. The correct opinions of TCM surgery should be established, TCM surgery is one of external treatment representative for "treatment human first but not disorders." He opposed to be just "a knife" as a surgical doctor, and emphasized that "Kung Fu of a surgeon is outside the scalpel", focusing on perioperative surgical treatment of TCM.
1.3Prof. Cai put forward that the subject construction is the breakthrough of TCM surgery development, and the biggest confusion is the insufficient of external treatment of TCM. Specialized department establishment according to TCM treatment advantages, combining advanced technology and the Chinese traditional culture and the treatment concept, and the combination of the development of traditional Chinese medicine surgery will be infinite vitality.
1.4Academic origins of Prof. Caii-s treatment of peripheral vascular disease.
Prof. Caii s achievement was first gained from the treatment of vasculitis, and then he established peripheral vascular department, and formed their own characteristics. He turned to research on the surgical treatment of diabetic foot after the change of disease spectrum.
He put forward the series therapy of saprophytic muscle removing starting from using saprophytic muscle removing cream in the treatment of diabetes foot ulcer, and for diabetes foot muscle to jaundice type, anti-infection drugsi-difficulties in local wound, and founded the Traditional Chinese Medicine "Ke-ju washing formula". He kept correcting treatment in the long period of clinical practice, and simplified saprophytic muscle removing series therapy recently. He treated diabetic foot according to clinical characteristics of three different period, and achieved significant clinical effect.
2. Research and arrangement of Prof. Caii-s academic thoughts and clinical experience of treatments of peripheral vascular disease
2.1Prof. Caij s theory of applications of blood-activating and stasis-dissolving drugs in Peripheral vascular surgery
Prof. Cai thinks, with the change of the disease patterns, secondary vascular impairment, fibrosis lesions increases gradually, for activating blood circulation and eliminating stasis drugs broad prospect of application. According to common of the formation of the blood stasis syndrome in the vascular disease, classified them into three types:
2.1.1therapy of supplementing qi and activating blood circulation: combined drugs of activating blood circulation and supplementing qi, stands for the principle that activating must be used along with tonifying.
2.1.2Promoting blood change chaotic:Cai thinks blood disease is the beginning of turbidity, blood is ill and end, and the only force sex flat and promoting blood circulation to remove blood stasis drugs discharge turbidity medicine share, prevention and cure high sticky hematic disease, lower cholesterol, prevent arteriosclerosis plaque occurrence and development.
2.1.3Warm the meridians:Cai will be using warm drugs that expelling blood stasis and scatter cold medicine, and to treat diseases of later phase, stubborn unhealed, or other vascular disease involving difficult cases.
2.2Prof. Caii s opinion on difficulties and countermeasures of the treatment of diabetic foot. Cai believes that the difficulties and treatment strategies lie in how to deal with the following four relations:
2.2.1Medical and surgical:diabetes foot is systemic disease-s local expression, and not an independent surgical disease, which should be treated with internal medical treatment firstly before gangrene, while serious infection of foot gangrene should be treated surgically. One should enhance the concept of overall consciousness, the correct understanding of local and systemic causality, master hypoglycemic, anti-inflammatory, support therapy all over the body such as the foundation treatment.
2.2.2Diabetes foot and diabetic arterial occlusion disease:Cai thinks, only familiar with the different pathological and clinical characteristics of diabetes foot and occlusive atherosclerosis, can different treatment measures be taken on a diabetes foot gangrene patients, especially diabetic occlusive artery sclerosis patients.
2.2.3Glucose-lowering and antimicrobiology:Cai thinks that high blood glucose is initiating linkfor diabetes foot, the infection is the key link of throughout the disease history, gangrene, ulcer is terminal link, three links are cause and effect mutually.
2.2.4"Nibbled debridement" and "debridement and drainage":Cai thinks that only when infection of diabetic foot is basically controlled, or diabetic atherosclerosis block disease is in chronic ischemic phase, latively stable condition, and gangrene is in relatively limited circumstances, should the former treatment be applied.
2.3Caio-s experience on staging differentiation for allergic vasculitis. Prof. Caii-s treatment experience of allergic vasculitis's has the originality, according to the pathogenesis of this disease he characteristics, disease and syndrome union, staging treatment, and got significant clinical effect. The acute phase:Cai thinks that disease of this period is mingled with excess and deficiency syndromes, and should be treated wi th consideration of the root cause and symptoms of the disease, by both internal and external treatment, managing qi and blood, and clear humid using self-made "five grass decoction". In chronic remission period, Cai thinks skin surface damage and long course hurt vital qi, pathogenesis is deficiency complicated with excess, asthenia complicated with sthenia. Treatment should be tonify deficiency and body surface, combined with heat and dampness expelling, using Yupinfeng Powder with "five grass decoction ".
2.4Caii s experience of tonifying principle for peripheralvascular disease. Cai believes that the treatment of peripheral vascular disease is mainly to seize the basic pathogenesis of the disease; use tonifying method for the treatment of anthrax, boils and other peripheral vascular disease; use Supplementing Qi and Activating Yang method for anthrax treatment, thus formed his own unique treatment characteristics.
2.5Cai; s experience of staging treatment for diabetic foot gangrene tendons. Prof. Cai analyzed tendons of diabetic foot gangrene according to the clinical characteristics of different periods, based on the comprehensive medical treatment, he adapted a serie external treatment in three different periods, including deep incision and adequate drainage in acute phase of infection, nibbled debridement and continuous infusion in resolving stage, remove saprophytic muscle in recovery stage, and improved the clinical effect significantly.
3. Clinical effects observation of TCM external treatment by stage for diabetic foot muscle gangrene
Clinical observations to prove the clinical effects of TCM external treatment by stage for diabetic foot muscle gangrene were performed, based on the experience summary of Prof. Cai, and literature review. Results showed23cases cured,13improved, and4ineffective in treatment group, with total effective rate of90.0%; while9cured,7improved and4ineffective in control group, with total effective rate of80.0%. Comparison of two groups showed significant difference (P<0.05). Conclusion:TCM external treatment by stage for diabetic foot muscle gangrene is a good TCM treatment plan, and should be generalized for its exact clinical effectiveness, good maneuverability, and relative standard operation techniques.
引文
1.出自《中华医典CD-ROM》(湖南电子音像出版社出版ISBN 7-900352-22-8/R·10)
2.贾文华.中医治疗糖尿病性肢端坏疽的临床观察.中医杂志,1996；37(6)：552
3.朱章志,熊曼琪.益气养阴活血通脉法为主治疗糖尿病足的体会.中国中医药报,1996；11(1)：35
4.邢光明,糖尿病坏疽验案二则.新中医,1992；(9)：21
5.张恒龙.中西医结合治疗糖尿病坏疽9例.山东中医学院学报,1988；12 (2)：101
6.牛志世,郭根,宋相文.中西医结合治疗糖尿病足57例.中国中西医结合杂志,1994；14(2)：120
7.胡涤非.重症糖尿病足坏疽.湖南中医杂志,1996；12(6)：38
8.黄学阳,王巧萍,谭志健.脱疽中血栓闭塞性脉管炎与糖尿病足的证治异同.广州中医药大学学报,2004；21(1)：60～61
9.李昌祁,孙贵民,主编.糖尿病最新防治进展.北京,中国医药科技出版社,1994：141
10.Gavin LA, Stess RM, Golds tone J Prevention and treatment of foot problems in diabetes mellitus acomprehens ive program [clinical conference] [see comments] West J Med 1993; 158(1):47-55
11.林丽香.糖尿病性神经病变.福建医药杂志,1986；(4)：35
12.沈钰如.长期糖基化终末产物与糖尿病并发症.国外医学.内分泌分册,1995；15 (2)86
13. Kozak GP. Clinical diabets mellitus Canada W B Savnders Compary 1981; 215
14. Joseph WS Trestment of lower extremity infections in diabetics. Drugs,1991; 42:984
15. D. T. Williams, J. R. Hilton, K. G. Harding. Diagnosing Foot Infection in Diabetes.Clinical Infectious Diseases,2004; 39:S83-6
16.Sim DS, Cavanagh, Ulbrech JS. Risk factors in the diabetic foot recognition and management. Phys Ther,1988; 68:1887
17.唐祖宣,王云恒,高华林,等.30例消渴脱疽治疗前后的微循环变化和临床疗效观察.上海中医药杂志,1987；(9)：8～9
18.郭赛珊,梁晓音,殷风华,等.糖尿病患者小腿血流量测定及活血化瘀法治疗对其影响的观察.中西医结合杂志,1990,10(11)：664～666
19.曹烨民,王义成.奚氏糖尿病足筋疽的提出对糖尿病足诊治的意义 甘肃中医学院学报,1999,16(2)：5～7
20.奚九一,赵兆琳.糖尿病足肌腱变性坏死症(筋疽)的临床研究.上海中医药杂志,1996；(5)：1
21.范冠杰,吕仁和.分期辨证为主治疗糖尿病足及其对下肢动脉超声多普勒血流动力学变化的影响 中国中西医结合杂志,1999；19(9)：520-523
22.谢文秀,屈国云,伍汉文,等.糖尿病足16例中西医结合治疗分析.中西医结合杂志,1990；10 (9) ：554
23.钟志贵 足浸泡方治疗糖尿病足 中医杂志,1998；39(3)：171
24.刘建英,兰信永.五黄油治疗糖尿病足10例报告.江西医药,1989；(6)：118
25.李翠兰,王清玲.糖尿病肢端溃疡的非手术疗法.山东医药,1995；35(23)：11
26.宋宪,王建利,林伯杰,等.蝮蛇抗栓酶、山莨菪碱治疗糖尿病足30例.临床荟萃,1996；11(12)：555
27.刘树国,刘来平,张传芳,等.糖尿病足的防治进展.临床荟萃,1997；12(23)：1072
28.张万能.中药煎液浸泡治疗糖尿病性趾端坏死20例.浙江中医杂志,1990；25(3)：176
29.杨孝先,宋晓明.中药酒浸剂为主外敷治疗糖尿病坏疽.长春中医学院学报,1996；12(5)：41
30.李仕明,朱西娥,史国珍等.糖尿病肢端坏疽的综合治疗.中华医学杂志,1997；74(6)358～360
31.中华医学会糖尿病学会全国第一届糖尿病足专业学术会议纪要.中国糖尿病杂志,1996；4(1)：60
32.顾明君.局部应用苯妥英钠治疗糖尿病下肢溃疡.全国第一届糖尿病足学术会议论文摘要汇编,北京,1995：55
33.萧建中,杨兆军,赵庆莉,等.糖尿病及并发足坏疽与p 3-AR基因Arg64突变.中日友好医院学报,1997；11(4)：296
34.唐兰,朱西娥,费淑霞,等.糖尿病神经病变与足坏疽关系的探讨.中国糖尿病杂志,1997；5(1)：48
35. Flynn MD, Boolell M,Tooke JE, et al. The effect of insulin infusion on capillary blood flow in the diabetic neuropathic foot Diabet-med,1992; 9(7):630-634
36.范冠杰,吕仁和.糖尿病足的分期辨治及对患者微循环的影响.中医杂志,1998；39 (7)：421～424
37.王四清,宋秀玲,孙衍龙,等.胰岛素外敷治疗糖尿病患者软组织感染的护理.实用护理杂志,1996；12(3)：113
38.奚九一.糖尿病足肌腱变性坏死症(筋疽)的临床研究.上海中医药杂志,1996；5：1-4
39.奚九一,赵兆琳,吴伟达,等.对糖尿病足诊治的几点新看法.中国实用外科杂志,1998；18(9)：565-567
4U. WHU. World Diabetes Day:too many people are losing lower limbs unnecessarily to diabetes.2005,11,11, GENEVA, Joint News Release WHO/IDF
41. IDF. Experts warn that diabetic foot complications threaten healthcare resources worldwide.2005,11,14, Salvador de Bahia, Brazil
42.王巧萍,黄学阳.脱疽的古文献综述.中医研究,2004；17(1)：57-60
43.林毅,蔡炳勤.专科专病中医临床诊治丛书-外科专病中医临床诊治.人民卫生出版社,2000年10月第1版：189-190
44. Benjamin A, Lipsky. Medical Treatment of Diabetic Foot Infections. Clinical Infectious Diseases,2004; 39:S104-14
45.王嘉桔.糖尿病肢体动脉闭塞症(DLAO)的发病概况及研究进展.中国中西医结合外科杂志,2003;9(6)： 415-416
46.张东萍,奚九一.奚九一教授诊治糖尿病足筋疽的经验.中华现代中西医结合,2004;1(3)：131-133
47.韩永斌,张德宪;徐筱玮；中医外治糖尿病足研究近况.山东中医杂志,2005；24(10)：637-639
48.王建春,傅强,林鸿国,等.蔡炳勤教授分期外治糖尿病足筋疽型的经验.陕西中医,2009;30(6)： 704-705
49.李仕明.糖尿病足(肢端坏疽)检查方法及诊断标准(草案)[J].中国糖尿病杂志,1996；4 (2)： 126
50. Wanger FW. The dysvascular foot:a system for diagnosis and treatment[J]. Foot and ankle,1981; 2:64-122.
51.董砚虚,钱国荣.糖尿病及其并发症当代治疗[M].济南：山东科技出版社,1994：25.
52.国家中医药管理局.中医病症诊断疗效标准[S].南京：南京大学出版社,1994：53.
53.黄学阳,王巧萍,谭志健,等.脱疽中血栓闭塞性脉管炎与糖尿病足的证治异同.广州中医药大学学报,2004；21(1)：60-62.
54.蔡炳勤,王建春.糖尿病足的治疗难点与对策[J].新中医,2004；36(6)：34.
55.蔡炳勤,郭智涛.糖尿病足的临床特点及中西医结合治疗：——附50例分析.中国中西医结合外科杂志,1999,5(2)：74-77
56.蔡炳勤,郭智涛,王建春.祛腐生肌膏促进糖尿病足溃疡愈合作用的临床研究.‘中国中医药信息杂志,2000；7(8)：49-50
57.谭志健,蔡炳勤,陈志强,等.祛腐生肌膏治疗感染性体表溃疡的临床与实验研究.中国中西医结合外科杂志,1999；5(3)；140-142
58.王建春,蔡炳勤,曾晔.祛腐生肌系列局部治疗糖尿病足的临床研究.中医外治杂志,2001；10(6)：6-7
59.王建春,刘明、林鸿国,等.渴疽洗方足浴治疗糖尿病足筋疽型60例疗效观察.广州中医药大学学报,2009；26(4)：343-346
60.乔传卓,张汉明,宓鹤鸣.根茎类生药·大黄·生药学[M].上海：上海同济大学出版社,1995：184.
61李仲兴,王秀华,赵建宏,等.乌梅对308株临床菌株的抑菌效果[J].中国中医药信息杂志,2007：14(11)：41-42.
62.石壁,狄莹,何有节,等.蹂质的药理活性[J].中草药,1998;23 (7)：487-490.
2.贾文华.中医治疗糖尿病性肢端坏疽的临床观察.中医杂志,1996；37(6)：552
3.朱章志,熊曼琪.益气养阴活血通脉法为主治疗糖尿病足的体会.中国中医药报,1996；11(1)：35
4.邢光明,糖尿病坏疽验案二则.新中医,1992；(9)：21
5.张恒龙.中西医结合治疗糖尿病坏疽9例.山东中医学院学报,1988；12 (2)：101
6.牛志世,郭根,宋相文.中西医结合治疗糖尿病足57例.中国中西医结合杂志,1994；14(2)：120
7.胡涤非.重症糖尿病足坏疽.湖南中医杂志,1996；12(6)：38
8.黄学阳,王巧萍,谭志健.脱疽中血栓闭塞性脉管炎与糖尿病足的证治异同.广州中医药大学学报,2004；21(1)：60～61
9.李昌祁,孙贵民,主编.糖尿病最新防治进展.北京,中国医药科技出版社,1994：141
10.Gavin LA, Stess RM, Golds tone J Prevention and treatment of foot problems in diabetes mellitus acomprehens ive program [clinical conference] [see comments] West J Med 1993; 158(1):47-55
11.林丽香.糖尿病性神经病变.福建医药杂志,1986；(4)：35
12.沈钰如.长期糖基化终末产物与糖尿病并发症.国外医学.内分泌分册,1995；15 (2)86
13. Kozak GP. Clinical diabets mellitus Canada W B Savnders Compary 1981; 215
14. Joseph WS Trestment of lower extremity infections in diabetics. Drugs,1991; 42:984
15. D. T. Williams, J. R. Hilton, K. G. Harding. Diagnosing Foot Infection in Diabetes.Clinical Infectious Diseases,2004; 39:S83-6
16.Sim DS, Cavanagh, Ulbrech JS. Risk factors in the diabetic foot recognition and management. Phys Ther,1988; 68:1887
17.唐祖宣,王云恒,高华林,等.30例消渴脱疽治疗前后的微循环变化和临床疗效观察.上海中医药杂志,1987；(9)：8～9
18.郭赛珊,梁晓音,殷风华,等.糖尿病患者小腿血流量测定及活血化瘀法治疗对其影响的观察.中西医结合杂志,1990,10(11)：664～666
19.曹烨民,王义成.奚氏糖尿病足筋疽的提出对糖尿病足诊治的意义 甘肃中医学院学报,1999,16(2)：5～7
20.奚九一,赵兆琳.糖尿病足肌腱变性坏死症(筋疽)的临床研究.上海中医药杂志,1996；(5)：1
21.范冠杰,吕仁和.分期辨证为主治疗糖尿病足及其对下肢动脉超声多普勒血流动力学变化的影响 中国中西医结合杂志,1999；19(9)：520-523
22.谢文秀,屈国云,伍汉文,等.糖尿病足16例中西医结合治疗分析.中西医结合杂志,1990；10 (9) ：554
23.钟志贵 足浸泡方治疗糖尿病足 中医杂志,1998；39(3)：171
24.刘建英,兰信永.五黄油治疗糖尿病足10例报告.江西医药,1989；(6)：118
25.李翠兰,王清玲.糖尿病肢端溃疡的非手术疗法.山东医药,1995；35(23)：11
26.宋宪,王建利,林伯杰,等.蝮蛇抗栓酶、山莨菪碱治疗糖尿病足30例.临床荟萃,1996；11(12)：555
27.刘树国,刘来平,张传芳,等.糖尿病足的防治进展.临床荟萃,1997；12(23)：1072
28.张万能.中药煎液浸泡治疗糖尿病性趾端坏死20例.浙江中医杂志,1990；25(3)：176
29.杨孝先,宋晓明.中药酒浸剂为主外敷治疗糖尿病坏疽.长春中医学院学报,1996；12(5)：41
30.李仕明,朱西娥,史国珍等.糖尿病肢端坏疽的综合治疗.中华医学杂志,1997；74(6)358～360
31.中华医学会糖尿病学会全国第一届糖尿病足专业学术会议纪要.中国糖尿病杂志,1996；4(1)：60
32.顾明君.局部应用苯妥英钠治疗糖尿病下肢溃疡.全国第一届糖尿病足学术会议论文摘要汇编,北京,1995：55
33.萧建中,杨兆军,赵庆莉,等.糖尿病及并发足坏疽与p 3-AR基因Arg64突变.中日友好医院学报,1997；11(4)：296
34.唐兰,朱西娥,费淑霞,等.糖尿病神经病变与足坏疽关系的探讨.中国糖尿病杂志,1997；5(1)：48
35. Flynn MD, Boolell M,Tooke JE, et al. The effect of insulin infusion on capillary blood flow in the diabetic neuropathic foot Diabet-med,1992; 9(7):630-634
36.范冠杰,吕仁和.糖尿病足的分期辨治及对患者微循环的影响.中医杂志,1998；39 (7)：421～424
37.王四清,宋秀玲,孙衍龙,等.胰岛素外敷治疗糖尿病患者软组织感染的护理.实用护理杂志,1996；12(3)：113
38.奚九一.糖尿病足肌腱变性坏死症(筋疽)的临床研究.上海中医药杂志,1996；5：1-4
39.奚九一,赵兆琳,吴伟达,等.对糖尿病足诊治的几点新看法.中国实用外科杂志,1998；18(9)：565-567
4U. WHU. World Diabetes Day:too many people are losing lower limbs unnecessarily to diabetes.2005,11,11, GENEVA, Joint News Release WHO/IDF
41. IDF. Experts warn that diabetic foot complications threaten healthcare resources worldwide.2005,11,14, Salvador de Bahia, Brazil
42.王巧萍,黄学阳.脱疽的古文献综述.中医研究,2004；17(1)：57-60
43.林毅,蔡炳勤.专科专病中医临床诊治丛书-外科专病中医临床诊治.人民卫生出版社,2000年10月第1版：189-190
44. Benjamin A, Lipsky. Medical Treatment of Diabetic Foot Infections. Clinical Infectious Diseases,2004; 39:S104-14
45.王嘉桔.糖尿病肢体动脉闭塞症(DLAO)的发病概况及研究进展.中国中西医结合外科杂志,2003;9(6)： 415-416
46.张东萍,奚九一.奚九一教授诊治糖尿病足筋疽的经验.中华现代中西医结合,2004;1(3)：131-133
47.韩永斌,张德宪;徐筱玮；中医外治糖尿病足研究近况.山东中医杂志,2005；24(10)：637-639
48.王建春,傅强,林鸿国,等.蔡炳勤教授分期外治糖尿病足筋疽型的经验.陕西中医,2009;30(6)： 704-705
49.李仕明.糖尿病足(肢端坏疽)检查方法及诊断标准(草案)[J].中国糖尿病杂志,1996；4 (2)： 126
50. Wanger FW. The dysvascular foot:a system for diagnosis and treatment[J]. Foot and ankle,1981; 2:64-122.
51.董砚虚,钱国荣.糖尿病及其并发症当代治疗[M].济南：山东科技出版社,1994：25.
52.国家中医药管理局.中医病症诊断疗效标准[S].南京：南京大学出版社,1994：53.
53.黄学阳,王巧萍,谭志健,等.脱疽中血栓闭塞性脉管炎与糖尿病足的证治异同.广州中医药大学学报,2004；21(1)：60-62.
54.蔡炳勤,王建春.糖尿病足的治疗难点与对策[J].新中医,2004；36(6)：34.
55.蔡炳勤,郭智涛.糖尿病足的临床特点及中西医结合治疗：——附50例分析.中国中西医结合外科杂志,1999,5(2)：74-77
56.蔡炳勤,郭智涛,王建春.祛腐生肌膏促进糖尿病足溃疡愈合作用的临床研究.‘中国中医药信息杂志,2000；7(8)：49-50
57.谭志健,蔡炳勤,陈志强,等.祛腐生肌膏治疗感染性体表溃疡的临床与实验研究.中国中西医结合外科杂志,1999；5(3)；140-142
58.王建春,蔡炳勤,曾晔.祛腐生肌系列局部治疗糖尿病足的临床研究.中医外治杂志,2001；10(6)：6-7
59.王建春,刘明、林鸿国,等.渴疽洗方足浴治疗糖尿病足筋疽型60例疗效观察.广州中医药大学学报,2009；26(4)：343-346
60.乔传卓,张汉明,宓鹤鸣.根茎类生药·大黄·生药学[M].上海：上海同济大学出版社,1995：184.
61李仲兴,王秀华,赵建宏,等.乌梅对308株临床菌株的抑菌效果[J].中国中医药信息杂志,2007：14(11)：41-42.
62.石壁,狄莹,何有节,等.蹂质的药理活性[J].中草药,1998;23 (7)：487-490.