四川中医

本文从理法方药角度结合中西对照探析陈实功辨证论治肠痈病的特色。通过对陈实功《外科正宗》肠痈篇的研读与感悟，并对照现代医学对阑尾炎的病理分型及并发症，对肠痈的病因病机、辨证施治及方药组成进行分析、阐述。陈实功根据发病机制将肠痈分为脓初未成、脓初已成、时时下脓及变证毒攻五脏，与现代医学阑尾炎及并发症的病理类型高度契合，认为其发病主要与血浊气壅、瘀血内积、湿生痰凝、毒攻脏腑有关，治法主要是清而下之，和而利之、和而导之、托而补之，分别给予大黄汤、活血散瘀汤、薏苡仁汤、排脓散、七贤散加减等治疗，并加以方药特点分析，临床应用效果甚佳。陈实功在治疗肠痈方面谨守病机，同时重视清热利湿化瘀，用药灵活，治疗效果较好，其学术观点值得后世医家借鉴推广。

Objective: To analyze the characteristics of Chen Shigong's syndrome differentiation in treating intestinal carbuncle from the perspective of theory, method, prescription and medicine combined with Chinese and Western comparison. [Methods] The etiology and pathogenesis of intestinal carbuncle, syndrome differentiation and prescription composition of intestinal carbuncle were analyzed and expounded through studying and understanding of intestinal carbuncle in Authentic Surgery by Chen Shigong and comparing with pathological classification and complications of appendicitis in modern medicine. [Results] According to the pathogenesis, Chen Shigong divided intestinal carbunge into initial abscess formation, initial abscess formation, constant abscess and change of syndrome and poison attack on the five viscera, which was highly consistent with the pathological types of appendicitis and complications in modern medicine. He believed that its incidence was mainly related to blood turbidity and qi obstructing, blood stasis, dampness and phlegm, poison attack on the zang fu organs, and the treatment was mainly to clear down, to benefit, to direct and to support. Rhubarb Decoction, Huoxue Powder Yu decoction, Coix seed decoction, puri powder and Qixian powder were respectively given treatment, and the characteristics of prescriptions were analyzed, and the clinical effect was very good. [Conclusion] Chen Shigong was careful to observe the pathogenesis of intestinal carbuncles and paid attention to clearing heat and removing dampness and removing blood stasis. His drug use was flexible and the therapeutic effect was good. His academic views were worthy of reference and promotion by later doctors.