谢晓华运用补托法辅助治疗迁延型阑尾周围脓肿经验

XIE Xiao-Hua’s Experience in Treating Prolonged Periappendiceal Abscess with Tonification and Expulsion Method

迁延型阑尾周围脓肿的西医治疗以抗生素和腹膜外引流为主,但单纯西医治疗的效果不甚理想。谢晓华教授认为,迁延型阑尾周围脓肿可归属于中医学的“肠痈”“流注”范畴,病机特点为本虚标实,脾气虚弱为本,热毒腐肉为标;病证特点为半阴半阳证。治疗迁延型阑尾周围脓肿以补托法为原则,以益气托毒为基本治法,辅助腹膜外引流,可获显效。运用补托法治疗迁延型阑尾周围脓肿时需分期施治。引流期以健脾益气托毒为法,补益气血,和营生肌,托毒外出,方选托里消毒散加减;拔管期采用补益气血、养阴生肌之法,方药可选内补黄芪汤加减。日常调护需注意健脾护胃、补益扶正。

The western medical treatment of persistent periappendiceal abscesses is based on antibiotics and extraperitoneal drainage,but the effect of pure western medical treatment is not satisfactory.In the view of Professor XIE Xiao-Hua,persistent periappendiceal abscesses can be attributed to the category of“intestinal abscess”and“multiple abscesses”in traditional Chinese medicine,and the pathogenesis is characterized by deficiency in the origin and excess in the superficiality,deficiency in the origin manifests as the weakness of spleen qi,and excess in the superficiality manifests as the accumulation of heat-toxin and flesh becoming putrid.The symptoms of persistent periappendiceal abscesses are characterized by half-yin and half-yang syndrome.The treatment of persistent periappendiceal abscesses is based on the principle of tonification and expulsion method,with the basic therapy of replenishing qi and expelling toxin,assisted by extraperitoneal drainage,which can achieve significant results.Professor XIE advocates that persistent periappendiceal abscesses should be treated by stages.In the drainage period,the method of strengthening the spleen,replenishing qi and expelling toxin can be used to replenish qi and blood,regulate nutritive phase and promote granulation,and expulse toxin,and the formula for the treatment is modified Tuoli Xiaodu Powder.In the extubating period,the method of replenishing qi and blood,nurturing yin and promoting granulation is adopted,and the formula of modified Neibu Huangqi Decoction can be chosen.Moreover,daily care should pay attention to strengthening the spleen and protecting the stomach,tonifying and supporting healthy qi.