黄健玲治疗盆腔脓肿经验

Huang Jian-ling's Experience in Treating Pelvic Abscess

盆腔脓肿急性期起病急骤,发展迅速,病情危重,黄健玲教授认为要迅速控制感染,应中医综合治疗、中西医结合救治。急性盆腔脓肿发病初期,中医治疗宜清热解毒为主,药量要大,甚至可日夜分服2~3剂,同时黄健玲教授认为,急性盆腔炎初起还会出现腹胀,大便不通,甚或呕吐而不能食等因热壅阳明而腑气不通的症状,故临证时通腑泻热、使邪有出路是治疗本病的重要环节,其多在清热解毒的基础上酌加泻热通腑的药品,急性盆腔脓肿发病中期为湿热瘀结之证,治宜清热利湿为主,佐以活血化瘀,急性盆腔脓肿发病后期为气阴两虚之证,治疗以活血化瘀,益气养阴为主,佐以清热利湿。慢性盆腔脓肿病变的主要矛盾和瘀、虚、塞,多是湿邪与瘀滞共存,黄教授在辨证立法的思路上,以活血化瘀消瘕为治疗大法。无论病情急慢,黄教授均提倡多途径综合用药。

Acute pelvic abscess has abrupt onset,rapid development,disease severity,so Professor Huang Jian-ling thinks that TCM comprehensive treatment,or combined therapy of traditional Chinese and Western medicine should be used to control infection rapidly. At early stage of acute pelvic abscess,TCM treatment should focus on expel toxin by cooling; the dose should be large,even 2 or 3 agents can be taken day and night. At the same time,the symptoms of excessive heat in yangming meridian leading to blocked fu qi such as abdominal fullness,constipation,even poor appetite due to vomiting,therefore,purgating fu-organs to eliminate heat is the key to drive pathogen out; the drugs for purgating fu-organs to eliminate heat should be properly added based on expelling toxin by cooling. At middle stage,acute pelvic abscess is manifested as syndrome of damp-heat and blood stasis,so treatment should focus on eliminating dampness by cooling accompanied by promoting blood circulation by removing blood stasis. At late stage,acute pelvic abscess is manifested as syndrome of qi-yin deficiency,so treatment should focus on promoting blood circulation by removing blood stasis,supplementing qi and nourishing yin,accompanied by eliminating dampness by cooling. The primary conflicts of chronic pelvic abscess are blood stasis,deficiency and blocking,accompanied by dampness and stagnation. Based on syndrome differentiation,Professor Huang adopts the therapy of promoting blood circulation by removing blood stasis to remove abdominal mass. Regardless of acute or chronic condition,Professor Huang advocates integrated treatment in many ways.