郑雪平治疗高位肛瘘经验

Zheng Xue-ping's Experience of Treating High Anal Fistula

郑雪平教授认为,肛瘘与肛周脓肿是一个疾病的两个阶段,其发病不离“湿、热、虚、瘀”:一因肛门为足太阳经所主,足太阳经为多血少气之经,又因肛门为消化道之末端,湿邪属阴,易袭阴位,湿热结聚于肛门,热壅血瘀而成痈,破溃后脓水淋漓继发成漏。二因肺脾气虚抑或是肺肾阴虚,湿热乘虚流注肛门,久则穿肠透穴为漏,若病程较长则气血损耗,无力托毒外出,湿热留恋,疮孔难敛。三因病久必有脉络损伤,瘀血阻络,“因虚致瘀,因瘀致虚”,虚与瘀相互联系、相互转化,以致疮孔难以愈合。郑教授认为,肛漏是湿热蕴结,血涩不通,败坏肌肉所致,故封堵之法不可取,当“疏导肌间感染”,对经肛括约肌间切开术术式进行改良,形成括约肌间切开术。术后创面湿热蕴结,气血运行不畅,瘀血阻滞,应使用清热解毒、散结消瘀之品熏洗坐浴,浴后拭干创面予乌蔹莓膏外涂。脾虚腹泻是高位肛瘘复发的危险因素之一,且术后正气亏虚,因此要注意顾护脾胃之气,扶正固本。

Professor Zheng Xue-ping believes that anal fistula and perianal abscess are two stages of the same disease,and their onset results from"dampness,heat,deficiency,and stasis":Firstly,the anus is dominated by the foot greater yang meridian,which has more blood and less qi.Besides,the anus is the end of the digestive tract,where dampness belongs to yin and is prone to attacking the yin position.Dampness and heat accumulate in the anus,causing heat to accumulate in the blood,resulting in carbuncle.After rupture,the pus drips profusely,leading to leakage.Secondly,due to the deficiency of lung and spleen qi or the deficiency of lung and kidney yin,dampness and heat flow into the anus.If the disease lasts for a long time,penetrating the intestines and acupoints can lead to leakage.If the course of the disease is long,the qi and blood may be depleted,and the patient may not be able to carry toxins out.The dampness and heat linger,making it difficult to collect the sores.Thirdly,if the leakage lasts for a long time,there will inevitably be damage to the veins,and blood stasis blocking the collaterals."Deficiency leads to blood stasis,while blood stasis leads to deficiency."The connection and transformation between deficiency and blood stasis make it difficult for the ulcer to heal.Professor Zheng must use palpation when he is in clinical practice,and puts forward the method of"first solid then virtual thread-hanging"and"directional thread-hanging".He believes that anal leakage is caused by dampness-heat and phlegm for a long time,blood stagnation,and muscle deterioration,so the method of blocking is not advisable.The treatment should be based on"dredging intramuscular infection",and the method of transanal sphincter interincision should be improved to form a sphincter interincision.After surgery,the wound surface may accumulate dampness and heat,resulting in poor circulation of qi and blood,and blockage of blood stasis.Therefore,it is recommended to use products that clear heat,detoxify,disperse nodules,and eliminate blood stasis to fumigate and through the sitz bath.After the bath,the wound surface should be wiped dry and applied externally with Cayratia Japonica Berry Paste.Spleen deficiency causing diarrhea is one of the risk factors for recurrence of high anal fistula,and there is a deficiency of healthy qi after surgery.Therefore,special attention should be paid to protecting the qi of the spleen and stomach,and strengthening the foundation.