基于肠道黏液屏障探讨“厚肠理论”的生物学内涵及其在溃疡性结肠炎诊治中的应用  

Discussion on the biological connotation of“theory of thicken intestine”based on intestinal mucus barrier and its application in the diagnosis and treatment of ulcerative colitis

作　　者：邢韵淇 李军祥[1] 张文基 韩海啸[1] 孙中美 袁亚利 毛堂友 XING Yunqi;LI Junxiang;ZHANG Wenji;HAN Haixiao;SUN Zhongmei;YUAN Yali;MAO Tangyou(Department of Gastroenterology,Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China)

机构地区：[1]北京中医药大学东方医院消化科,北京100078

出　　处：《中国医药导报》2023年第5期128-132,共5页China Medical Herald

基　　金：国家自然科学基金青年科学基金资助项目(81903990)。

摘　　要：“厚肠”作为一种中医治法,多次出现于本草类医籍及方书中,主要关联肠澼、泄泻、下利、滞下等肠道疾病,但由于多数医家对“厚肠”的理解较为模糊,笼统地将其称为增强肠道的功能,阻碍“厚肠理论”的进一步发展。直至清代,邹润安等医家对“厚肠”的理解才逐渐精确,认为肠道中存在一层固有的“脂膜”或“脂膏”,具有“护导滓秽使下行”的功效;而湿热或者其他原因导致“脂膜”或“脂膏”变薄,则是“肠垢”“肠澼”发生的关键病机,这与现代医学中肠道黏液屏障受损是溃疡性结肠炎的关键病机相耦合。因此,在治疗上,针对肠道脂膜渐薄的不同病机,采用相应的治疗方法,使“消铄之源绝,而薄者厚矣”,达到“厚肠”的目的,最终治疗溃疡性结肠炎,这与现代医学的重塑黏液屏障功能治疗溃疡性结肠炎具有异曲同工之妙。本文通过挖掘中医经典古籍,对“厚肠理论”进行了溯源和延伸,并从肠道黏液屏障入手,深入探讨其生物学内涵,以期为临床治疗溃疡性结肠炎提供新的思路和方法。As a traditional Chinese medicine treatment method,“thicken intestine”appears many times in herbal medical related books and prescriptions,which mainly associated with intestinal diseases,such as bowel,diarrhoea,diuresis,and dysentery.However,due to the vague understanding of“thicken intestine”by most physician,it is generally called enhancing the function of intestine,which hindered the further development of the theory.It is not until the Qing Dynasty that some doctors gradually accurately understood the“thicken intestine”and believed that there is an inherent layer of“lipid membrane”or“ointment”in the intestine,which has the function of“protecting and guiding waste and making it go down”.The thinning of“lipid membrane”or“ointment”caused by damp heat or other reasons is the key pathogenesis of“putrid stool”and“bowel”,which is coupled with the damage of intestinal mucus barrier in modern medicine,the key pathogenesis of ulcerative colitis.Therefore,the corresponding treatment methods based on different pathogenesis of intestinal lipid membrane thinning should be adopted to“eliminate the source of damage,and the thin is thick”,so as to achieve the purpose of“thicken intestine”and finally treat ulcerative colitis,which is similar to the treatment of ulcerative colitis by reconstruction of mucus barrier function in modern medicine.By excavating the classic ancient books of traditional Chinese medicine,this paper traces and extendes the meaning of“theory of thicken intestine”,and deeply discusses its biological connotation from the perspective of intestinal mucus barrier,in order to provide new ideas and methods for the clinical treatment of ulcerative colitis.

关 键 词：厚肠理论 溃疡性结肠炎 肠道黏液屏障 生物学内涵 

分 类 号：R256.3[医药卫生—中医内科学]