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10.中醫治療脫疽之會診病例(Case Study of Conference Diagnosis on TCM Treatment of Gangrene)

作者: 林高士、王麗香、林健蓉、黃怡嘉、蔡運寧 雜誌期刊發表時日期: 2008-08-15

  期刊內容描述

摘要
54歲男性,因糖尿病合併週邊動脈阻塞,在右足外傷後發展成蜂窩組織炎,引發化膿潰爛,經足趾截肢後傷口化膿減緩,但週圍持續有壞死性脂肪、筋膜形成;且因血循不良而四肢冰冷。外科使用抗生素控制感染,並嘗試重建下肢循環,然而靜脈繞道手術失敗;另以高壓氧治療,及真空抽吸器處理患處,使感染不致蔓延、傷口進入癒合階段,但持續壞死性筋膜炎,須不斷進行清創,使傷口復原停滯;另外血循不良亦使生肌長肉雪上加霜,患處深可見骨,形成復原瓶頸。以中醫觀點,為「厥」合併「外傷」後引起「發」與「脫疽」之證。會診後,辨其證為全身陽虛寒凝、脈痺痰阻;局部溼熱壅滯、腐肉成膿。治療策略以溫陽通脈、養陰生肌,並清熱利溼、化痰通絡;使用陽和湯合三妙散化裁。治療後二天內手足冰冷即改善,數日後瘡面紅活,肉芽組織生長良好、壞死性筋膜炎日見減緩,於十二天後順利進行植皮,成功保存餘留肢體、縮短住院時間。本會診病例說明在正確辨證求因、審因論治之原則下,中醫對於血循不良合併感染後傷口難癒之棘手病症,亦有迅捷之效。

Abstract

A 54 year old male suffered from diabetes and obstruction of peripheral arteries. His right foot developed cellulitis after trauma, and further became suppurated and ulcerated. After toe amputation, suppuration was slowed down, but necrotic fat tissues and fascia keep developing with cold limbs due to poor circulation. Antibiotic is used to control infection, and circulation of lower limbs is reconstructed. However, the bypass operation failed. Hyperbaric oxygen therapy is applied with vacuuming on infection site to prevent spreading and healing of the wound. However, stubborn necrotic fascia holds back healing of the wound, and malcirculation prevents growth of new muscles. From TCM’s point of view, this belongs to “carbuncle” and “gangrene” caused by “syncope” and “trauma”. After consultation, the diagnosis is overall yang deficiency with cold stagnation and obstruction of vessels with phlegm, and there is obstruction of dampness and heat locally. The treatment strategy is to warm up Yang to improve circulation, to nourish yin to facilitate muscle growth, and to clear dampness and heat to dissolve phlegm. Modified Yang He Decoction with San Miao Powder is prescribed. Within two days, there is improvement of cold hands and feet. A few days later, it shows excellent tissue growth and improved necrotic fasciitis. Skin-grafting is performed after 12 days, remaining limb is preserved successfully, and hospitalization is shortened. This conference diagnosis explains that traditional Chinese medicine works wonders on mal-circulation combined with infection when correct diagnosis and proper treatment plan are in place.





 


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