【摘要】 [目的]探讨院方归龙汤加味治疗消渴脱疽的作用及其相关机制。[方法]查阅分析古今相关文献,并结合临床实践,基于陈实功的《外科正宗》一书中治疗阴疽的四法"疏稼土、通地脉、助根本、回阳气",对消渴脱疽的病因病机及院方归龙汤加味治疗消渴脱疽进行分析,并列举验案一则加以佐证。[结果]根据文献研究及实践经验,笔者认为消渴脱疽的病机为阳气亏虚、气血失养、经脉闭阻,故临床上遵从陈实功的阴疽治疗四法"疏稼土、通地脉、助根本、回阳气",在归龙汤基础上进行加减:加白术、陈皮健脾益气、燥湿利水,此为疏稼土;加黄芪补气升阳、通脉行滞、敛疮生肌,此为助根本;加附子助阳行气,此为回阳气。所举验案,诊断为消渴脱疽,证属阳虚血瘀,符合归龙汤加味方之病机,治之而获良效。[结论]归龙汤加味充分体现了《外科正宗》中脱疽治疗四法,治疗消渴脱疽临床疗效良好,值得临床推广应用。更多还原

【Abstract】 [Objective] To investigate the clinical effect and correlative mechanism of flavored Guilong Decoction in treatment of Xiaoke gangrene.[Methods]By analyzing and referring to the pertinent information in ancient and modern literature and combining with clinic practice, the four methods of treating gangrene derived from CHEN Shigong’s works "Waike Zhengzong" were discussed, which were "dredging the soil, connecting the local vein,helping the fundamental and restoring Yang Qi". And a valid case was listed for support. [Results] According to literature research and practical experience, it is believed that the mechanism of Xiaoke gangrene is deficiency of Yang Qi, deficiency of Qi and blood, and obstruction of meridians.According to the four methods of treating Xiaoke gangrene derived from "Waike Zhengzong", the mechanism and pathogenesis of flavored Guilong Decoction can be well interpreted, Atractylodes macrocephala, Pericarpium Citri Reticulatae is added to invigorate spleen and replenish Qi, eliminate dampness and promote diuresis, that is dredging the soil; Radix Astragali is added to invigorate Qi and promote Yang, regulate pulse and stagnation, heal the sores and engender flesh, which is helping the fundamental; Aconitum carmichaeli is added to support Yang to promote Qi, which is restoring Yang Qi. According to the clinical practice, flavored Guilong Decoction achieves better curative effect in the treatment of Xiaoke gangrene. The case was diagnosed with Xiaoke gangrene, and was differentiated as Yang deficiency and blood stasis, coincided with the pathogenesis of Guilong Decoction. The patient achieved good results after treatment. [Conclusion]Flavored Guilong Decoction fully reflects the four methods of "Waike Zhengzong" in treatment of Xiaoke gangrene, and has a good clinical effects, and it is worthy of clinical application.更多还原