曾意荣应用消肿方加减治疗全膝关节置换术后下肢肿胀经验

ZENG Yi-Rong’s Experience in Treating Lower Limb Swelling After Total Knee Arthroplasty with Modified Xiaozhong Formula

全膝关节置换(TKA)术后肢体肿胀可归属中医“痹证”范畴。曾意荣教授认为,行TKA术的患者多为老年人,肝肾不足,气血亏虚,加之手术带来的创伤,瘀血阻滞经络贯穿病程始终;TKA术后下肢肿胀患者的病机以气滞血瘀、痰瘀互结、气虚血瘀、肝肾亏虚为特点;其治疗用药基于防己黄芪汤合桃红四物汤加减,自拟消肿方治疗TKA术后下肢肿胀。自拟消肿方由当归、熟地黄、赤芍、川芎、桃仁、红花、防己、黄芪、甘草、白术、牛膝、醋三棱、醋莪术等13味药组成。治疗TKA术后下肢肿胀时,可基于TKA术后下肢肿胀的主要证型(气滞血瘀型、痰瘀互结型、气虚血瘀型),运用消肿方加减治疗。

Lower limb swelling after total knee arthroplasty(TKA)can be classified as“blockage syndrome”in the field of traditional Chinese medicine. In the opinions of Professor ZENG Yi-Rong,most patients undergoing TKA are elderly and they are insufficient in the liver,kidney,qi and blood,and then the surgery bring about the trauma, which results in blood stasis blocking the meridians throughout the course of disease. Therefore,Professor ZENG Yi-Rong believes that the pathogenesis of the patients with lower limb swelling after TKA is characterized by qi stagnation and blood stasis,phlegm blended with blood stasis,qi deficiency and blood stasis,and insufficiency of both liver and kidney. Professor ZENG Yi-Rong’s treatment was based on the modified usage of Fangji Huangqi Decoction plus Taohong Siwu Decoction, and he established a self-prescribed Xiaozhong Formula to reduce the swelling of the lower limbs after TKA. The formula consists of 13 herbs, and they are Angelicae Sinensis Radix, Rehmanniae Radix Praeparata, Paeoniae Rubra Radix, Chuanxiong Rhizoma,Persicae Semen, Carthami Flos, Stephaniae Tetrandrae Radix, Astragali Radix, Glycyrrhizae Radix et Rhizoma, Atractylodis Macrocephalae Rhizoma, Achyranthis Bidentatae Radix, vinegar-prepared Sparganii Rhizoma,and vinegar-prepared Curcumae Rhizoma. Professor ZENG Yi-Rong advocates that for the treatment of the swelling of the lower limbs after TKA,the modified medication of Xiaozhong Formula can be adopted for the main syndrome types of qi stagnation and blood stasis type,phlegm blended with blood stasis type,qi deficiency and blood stasis type in the post-TKA patients with lower limb swelling.