韩丽君治疗肛周脓肿经验

Chief Physician HAN Lijun’s experience in treating perianal abscess

肛周脓肿是指直肠肛管周围软组织内或其周围间隙发生的急性化脓性感染并形成脓肿。常见的致病菌有大肠杆菌、金黄色葡萄球菌和绿脓杆菌,偶有厌氧性细菌和结核杆菌,常是多种病菌混合感染。本病病因众多,饮食不节,嗜食肥甘厚味,外感六淫邪气,脾、肺、肾三脏亏虚等均可致病。病机总以湿热内蕴、气血瘀滞、血败肉腐而成脓,日久可见气血耗伤,阴虚毒恋之象。山西中医药大学附属医院韩丽君主任医师认为本病病机可分为虚实两方面,实证为湿热下注引发肛痈;虚证为气血阴阳虚弱,毒邪滞留肛周。在治疗上,应注重扶正祛邪,提出补益气血、扶正散邪,使祛邪而不伤正的诊疗思路,以自拟“银芪合剂”加减治疗肛周脓肿,在临床上取得了良好的疗效。文章通过案例介绍韩丽君主任医师治疗肛周脓肿的经验,以期为临床提供参考。

Perianal abscess refers to the acute suppurative infection and abscess in or around the soft tissues around the rectum canal.The pathogenic bacteria commonly include escherichia coli,staphylococcus aureus and pseudomonas aeruginosa,and occasionally include anaerobic bacteria and tuberculosis bacteria.It is usually a mixed infection of multiple bacteria.There are many causes of this disease,such as improper diet,good appetite for fat,sweet and thick taste foods,exogenous infection of six pathogenic factors,and deficiency of the spleen,lungs and kidneys.Generally speaking,the pathogenesis is the accumulation of dampness and heat,the stagnation of Qi(气)and blood,pus turned from rotten blood and flesh,and the consumption of Qi and blood and Yin(阴)deficiency and poison accumulation can be seen for a long time.Chief Physician HAN Lijun from the Affiliated Hospital of Shanxi University of Traditional Chinese Medicine believes that the pathogenesis of this disease can be divided into two aspects:intangible lesion and corporeality lesion,that intangible lesion is anal carbuncle caused by dampness-heat diffusing downward,and that corporeality lesion refers to the retention of toxin around the anus caused by the weakness of Qi,blood,Yin and Yang(阳).In terms of its treatment,the method of strengthening healthy energy to remove pathogenic factors should be paid attention to,and the diagnosis and treatment ideas of supplementing Qi and blood,and strengthening healthy energy are put forward,so as to eliminate the pathogenic factors without harming the healthy energy.The Yinqi decoction(银芪合剂)was used to treat perianal abscess differentially,and had achieved good clinical effects.This article introduces Chief Physician HAN Lijun’s experience in treating perianal abscess through empirical case analyses,hoping to provide a reference for clinical practice.