单兆伟基于温病学说从气血辨治溃疡性结肠炎  

Professor SHAN Zhaowei’s experience in treating ulcerative colitis based on the theory of epidemic febrile disease

作　　者：杨玥 徐艺[1] YANG Yue

机构地区：[1]南京中医药大学附属医院,江苏南京210029

出　　处：《中医临床研究》2023年第5期144-146,共3页Clinical Journal Of Chinese Medicine

基　　金：国家中医药管理局单兆伟全国名中医传承工作室(国中医药办人教函发[2018]119号)。

摘　　要：溃疡性结肠炎多发作与缓解交替出现,是世界卫生组织公认的难治性疾病。单兆伟教授认为该病活动期多为热毒炽盛伤及气分,阻滞肠腑,致气机不通,伤及营血,熏灼肠络,血败肉腐成脓疡,进而可见腹痛腹泻、黏液脓血便。单教授基于温病学说从气血角度辨治溃疡性结肠炎活动期,提出了“气血双清”的治疗原则。气血双清法原见于治疗温热疫毒之法,施以清热泻火凉血之品以清透气分表里之热毒,通泄三焦之火邪。此法与血热作祟所致的溃疡性结肠炎活动期病机相吻合,临床遣以古方白头翁汤加减,以达清气化湿、凉血止痢之功,依据肝郁脾虚、脾肾亏虚等不同的兼夹证候随证加减,疗效显著。溃疡性结肠炎病程迁延,后期与肝、脾、肾密切相关,治疗上还应注重调达肝气、温肾健脾,故临证辨治时应根据实际需求加以创新,不局限于固有思维,异病同治,从不同的角度分析能开拓思路,治则治法不是固定不变的,面对古方更应活学活用,顺应疾病谱的变化,结合经典古方今用,才能更好地为临床服务。文章另附验案1则,对单兆伟教授经验详细论述。Ulcerative colitis occurs alternately between episodes and remissions.It is a refractory disease recognized by World Health Organization.Professor SHAN Zhaowei believes that the active period is mostly due to the flaming heat and toxin,which damages the Qi(气),blocks the intestines,and causes Qi impassability,blood injury,burned intestines,and abscess after blood and flesh rot,and then appears abdominal pain,diarrhea,mucus pus and bloody stools.Based on the theory of epidemic febrile disease,Professor SHAN treated active ulcerative colitis from the aspects of Qi and blood,and put forward the therapeutic principle of“Qi and blood both cleared”.The Qi and blood both cleared therapy comes from the method of treating warm-heat and pestilent toxin.Chinese materia medica of clearing heat and fire,cooling blood were used for the purpose of clearing heat-toxicity in Qifen(气分),and exterior and interior,and eliminating fire pathogen by purgation in Sanjiao(三焦).This method is consistent with the pathogenesis of active stage of ulcerative colitis caused by blood heat.The Baitouweng decoction(白头翁汤)with addition and subtraction is used clinically,With the function of clearing Qi and dissolving dampness,cooling blood and stopping diarrhea,according to different symptoms such as liver depression and spleen deficiency,spleen and kidney deficiency,etc.,the effect is remarkable.The course of ulcerative colitis is prolonged,and it is closely related to the liver,spleen and kidney in the later stage,and the treatment should also pay attention to regulating liver Qi,warming the kidney and strengthening the spleen.Therefore,the identification and treatment should be innovated according to actual needs,not limited to inherent thinking,different diseases with same treatment,analysis from different angles can open up ideas.The treatment method is not fixed,ancient remedies should be more active learning,conform to the changes in the disease spectrum,combined with classic prescription for new,in order to better serve t

关 键 词：溃疡性结肠炎 温病学说 气血辨治 

分 类 号：R574.62[医药卫生—消化系统]