基于脑-肠轴论治肝郁脾虚型腹泻型肠易激综合征的研究进展  

A review on the treatment of diarrhea-type irritable bowel syndrome with liver depression and spleen deficiency based on brain-gut axis

作　　者：李小燕 卢雨蓓[2] 董洪克 周一婷 LI Xiaoyan;LU Yubei;DONG Hongke;ZHOU Yiting

机构地区：[1]甘肃中医药大学,甘肃兰州730000 [2]甘肃省中医院,甘肃兰州730050

出　　处：《中医临床研究》2023年第21期97-101,共5页Clinical Journal Of Chinese Medicine

摘　　要：肠易激综合征是临床比较常见的功能紊乱性肠病之一,最新罗马IV诊断标准中将本病依据排便异常时的粪便性状再细分为4种亚型,其中以腹泻型最常见,其临床发病率亦最高。腹泻型肠易激综合征(Diarrhea-type Irritable Bowel Syndrome,IBS-D),本病病位在肠,与肝、脾、胃、肾等脏腑功能失调有关,尤其与肝、脾密切相关,肝郁脾虚证是其最常见的中医分型,亦是本病发生的关键病机。目前对于IBS-D的病因及其发病机制尚未完全明确,大多数认为与胃肠动力紊乱、幽门螺杆菌感染、内脏敏感性改变、胃肠激素等密切相关。近些年来,越来越多的学者重视其病因及其发病机制的研究,随着研究进一步深入,其中脑-肠轴学说成为热点方向。对于IBS-D,中医学在病因、发病机制方面与现代脑-肠轴学说有异曲同工之处。因此基于本病肝郁脾虚之病机,治疗多从疏肝解郁、健脾止泻方面着手,中医学治疗IBS-D从疏肝健脾调神论治,而现代医学脑-肠轴学说被证实与肝郁脾虚型IBS-D诸多方面存在类似之处,基于脑-肠轴理论为临床治疗肝郁脾虚型IBS-D提出了新的方向。文章基于中医基础理论结合现代医学脑-肠轴学说,总结肝郁脾虚型IBS-D的诊疗进展。Irritable bowel syndrome is one of the most common functional bowel disorders in clinic.The latest Rome IV diagnostic criteria subdivides the disease into four subtypes based on the fecal characteristics of abnormal bowel movements,among which diarrhea-type is the most common and has the highest clinical incidence.For diarrheal-type irritable bowel syndrome,the location of the disease is in the intestine,and is related to the dysfunction of the liver,spleen,stomach,kidney and other viscera,especially the liver and spleen.The syndrome of liver depression and spleen deficiency is the most common TCM type of the disease,and is also the core and pathogenesis of the disease.At present,the etiology and pathogenesis of diarrhea-type irritable bowel syndrome have not been fully defined,and most believe that it is closely related to gastrointestinal motility disorders,Helicobacter pylori infection,visceral sensitivity changes,gastrointestinal hormones,etc.In recent years,more and more scholars pay attention to the study of its etiology and pathogenesis,and with further research,brain-gut axis theory has become a hot direction.For diarrhea-type irritable bowel syndrome,TCM has similarity with the modern theory of the brain-gut axis in terms of etiology and pathogenesis.Therefore,based on the mechanism of liver depression and spleen deficiency in this disease,the treatment mainly starts from soothing liver depression,strengthening spleen and preventing diarrhea.The treatment of diarrheal-type irritable bowel syndrome in TCM is based on soothing the liver,strengthening the spleen and regulating the spirit while the brain-gut axis theory in modern medicine has been proved to be similar to the diarrheal-type irritable bowel syndrome of liver depression and spleen deficiency in many aspects.Based on the brain-intestinal axis theory,a new direction is proposed for the clinical treatment of diarrheal-type irritable bowel syndrome of liver depression and spleen deficiency.The author summarizes the diagnosis and treatment progress

关 键 词：肠易激综合征 腹泻型 肝郁脾虚型 脑-肠轴 

分 类 号：R256.3[医药卫生—中医内科学]