浅析中医外科明清三大流派辨治脱疽之异同

Analysis on the Similarities and Differences of Three Schools of Surgery of Traditional Chinese Medicine in the Treatment of Gangrene of Digit in Ming and Qing Dynasties

中医外科明清三大流派关于脱疽的辨治各具特色,正宗派认为其发病与寒湿、情志、饮食、房劳、外伤、药邪、误治等有关,全生派认为与气血亏虚、寒凝阻络有关,心得派认为与饮食、房劳及消渴等有关。内治方面,正宗派体现了“治疮全赖脾土”及整体观,全生派体现了阴阳辨治、因人制宜、阳和通腠及以消为贵,心得派提出“外疡实从内出论”,注重扶正及标本兼顾。外治方面,正宗派有膏药、油膏、箍围、掺药、结扎、切割、针灸、浸渍及熏法,全生派反对滥用针刀,酌情使用切割法,心得派提倡灸法,慎用切割。三大流派均指出脱疽病位在手足且疼痛剧烈,病情复杂,症状重,疗效及预后不佳。

For the syndrome differentiation and treatment of gangrene of digit,the three major schools of surgery of traditional Chinese medicine in Ming and Qing Dynasties have their own characteristics.The orthodox school thinks it is related to cold and damp pathogen,emotions,diet,sexual overstrain,trauma,abuse of medicine,fault of therapist,etc.The life-saving school believes that the asthenia of qi and blood and the cold coagulation and stagnation causing blood stasis is in connection with the disease.The experience school thinks it is associated with diet,sexual overstrain and diabetes,etc.In terms of internal therapeutic methods,the orthodox school reflects the“therapeutic methods of sore depends entirely on the spleen”theory and the concept of holism.The life-saving school points out the syndrome differentiation of yin-yang,the individuality-concerned therapeutic method,the harmonious yang qi makes unobstructed,and the thinking of abatement is precious.The experience school embodies the“external sore is actually caused by endogenous problems”idea,and pays great attention to considering both branch and root while strengthening healthy qi.in terms of external therapy,the orthodox school proposed the plaster,ointment,hoop,doping,ligation,incision,acupuncture,impregnation method,fumigation.The life-saving school opposes to the abuse of needle and knife,but use incision appreciate,the experience school advocates moxibustion and using the incision cautiously.The three academic schools all agreed that the locations of gangrene of digit are hands and feet,the pain is intense,the pathogenesis is complex,the symptoms of it are severe,and the treatment resulted in poor effect and prognosis.