《外科正宗》脏毒治疗经验撷菁

张燕宾 郁懿 李华转

【摘 要】 明代著名外科医家陈实功所著《外科正宗》一书在总结前人经验的基础上，结合自己的临床经验，对外科疾病进行了系统的阐述。他在诊治“脏毒”上的特色学术思想和临床经验对现代医家具有指导作用。病因上，脏毒多与感受外邪、过食醇酒厚味，劳倦过度，平素性情急暴，为痨虫所伤等因素相关。病机上，脏毒有外发与内发之别，外发者实热蕴藉肛周，属阳;内发者湿热或痰热流注，更兼阴虚，属阴。治疗上分初起期、肿痛期、溃脓期、溃后期，初起宜用轻剂解散，成肿宜下之，已溃宜养血健脾兼渗湿，溃后宜滋肾气、补脾胃。因时制宜，攻补兼施，治病求本，非常值得后世学习。

【关键词】 外科正宗;肛痈;辨证

【中图分类号】R256.39   【文献标志码】 A    【文章编号】1007-8517（2020）10-0097-03

Abstract：The book “authentic surgery”， written by Chen Shigong， a famous surgeon in Ming Dynasty， systematically expounds the surgical diseases on the basis of summing up the previous experience and combining his own clinical experience. His characteristic academic thought and clinical experience in the diagnosis and treatment of “perianal abscess” have a guiding role for modern doctors. In terms of etiology， visceral toxin is related to the factors such as feeling external evils， eating too much alcohol， being tired， being in a normal temper， and being injured by tuberculosis. On the pathogenesis， there is a difference between the external and internal visceral toxins. The external ones have excess heat， which is accumulated around the anus and belongs to Yang. The internal ones have damp heat or phlegm heat flow， which is also Yin deficiency and belongs to Yin. The treatment can be divided into initial stage， swelling stage， purulent stage and later stage of purulence. At the beginning of the treatment， light agent should be used to dissolve the swelling. After the treatment， kidney qi and spleen stomach should be invigorated. Its worth learning today that we should take measures according to the situation， attack and supplement simultaneously， and treat diseases for the root.

Keywords：Authentic Surgical;Perianal Abscess;Dialectical

《外科正宗》對中医外科学的发展起到了至关重要的作用，全书详细阐述了明代以前的外科疾病的内治外治法，以及作者结合临床经验总结的大量方药、针灸选穴，该书图文并茂，后世称赞其为“列证最详，论治最精”，书中许多关于外科疾病的中医治疗方法在如今用于临床依然卓著成效。《外科正宗》提及多种肛痈类疾病，例如“脏毒”“臀痈”“悬痈”。

“脏毒”一词在多本著作中有不同的解释，《医学入门》卷五曰：“自内伤得着曰脏毒，积久乃来，所以色暗，多在粪后，自小肠血分来也。”《三因极一病证方论》卷十五曰：“肠风脏毒，自属滞下门。脏毒，即是脏中积毒。”《血证论》卷四曰：“脏毒者，肛门肿硬，疼痛流血与痔漏相似。……