基于“脾苦湿,急食苦以燥之”理论治疗腹泻型肠易激综合征的经验  

Experience in the treatment of diarrhea-type irritable bowel syndrome based on the theory of“The spleen suffers from dampness and can be relieved by taking bitter medicinal for dryness”

作　　者：张波 刘财堂[1] 周晓凤 ZHANG Bo;LIU Caitang;ZHOU Xiaofeng

机构地区：[1]临沂市中医医院,山东临沂276002

出　　处：《中医临床研究》2023年第36期98-102,共5页Clinical Journal Of Chinese Medicine

摘　　要：文章介绍徐晓梅主任医师辨治腹泻型肠易激综合征(Diarrhea-type Irritable Bowel Syndrome,IBS-D)的经验。徐师指出肠易激综合征(Irritable Bowel Syndrome,IBS)的病因和发病机制目前尚未完全明确,多倾向于肠道动力异常、内脏高敏感、肠道感染、肠道微生态失衡、精神心理异常、脑-肠轴调节异常、遗传因素、饮食因素和性别等多种因素共同作用的结果。此外,临床中还应重视肠漏与IBS的关系。IBS的临床症状主要与肠道功能紊乱相关,临床有四个亚型,其中以腹泻型最为常见。根据IBS-D的临床特点,中医可将其归为慢性泄泻之属,虽然泄泻病因病机复杂,五脏皆可致泄,但泄泻之本无不由脾胃。本病以脾虚为发病之本,湿为发病之要,基本病机为脾虚湿盛。治疗上西医多着眼于调节肠道功能紊乱及抗焦虑等方面,但仍有很多患者病情得不到改善。因此,临床在辨治IBS-D时,徐师强调中西互参,紧跟现代研究,虽然其病因病机复杂,但根在脾虚湿盛,注重五脏相关,强调安神定志,善于紧抓主证,辨证结合辨病。基于《素问•脏气法时论篇》中“脾苦湿,急食苦以燥之”等理论,结合现代医学研究,徐师自拟调中安肠汤加减,以健脾燥湿,疏肝调神,升清降浊,补泻兼施,寒热平调,进而达到健脾和胃、安肠止泻的作用,效果显著。This paper introduces the experience of Chief physician XU Xiaomei in differentiating and treating diarrhea-type irritable bowel syndrome.Professor XU points out that the etiology and pathogenesis of IBS have not yet been fully defined,and it tends to be the result of multiple factors such as intestinal motility abnormalities,visceral hypersensitivity,intestinal infection,intestinal microecological imbalance,mental and psychological abnormalities,brain-intestinal axis adjustment abnormalities,genetic factors,dietary factors and gender.In addition,clinical attention should also be paid to the relationship between intestinal leakage and irritable bowel syndrome.The clinical symptoms of IBS are mainly related to intestinal dysfunction,and there are four clinical subtypes,of which diarrhea-type IBS is the most common.According to the clinical characteristics of diarrhea-type irritable bowel syndrome,traditional Chinese medicine can classify it as chronic diarrhea.Although the etiology and pathogenesis of diarrhea are complex,the five organs can cause diarrhea,but the origin of all diarrhea is from the spleen and stomach.The basic cause of this disease is the deficiency of the spleen,and a very important factor is the abundance of the dampness.Therefore,the most basic pathogenesis is the combination of the deficiency of the spleen and the abundance of the dampness.As for the treatment,Western medicine focuses on regulating intestinal dysfunction and anti-anxiety,but there are still many patients whose symptoms and conditions are not ameliorated.Therefore,in the clinical differentiation and treatment of diarrhea-type irritable bowel syndrome,Professor XU emphasizes the mutual reference between traditional Chinese medicine and Western medicine and closely follows modern research;although the etiology and pathogenesis are complex,the root is spleen deficiency and dampness,attention should be given to the correlation between the five viscera and emphasizing calming the mind and making determination.XU’s treatment is goo

关 键 词：腹泻型肠易激综合征 脾虚湿盛 临床经验 

分 类 号：R256.3[医药卫生—中医内科学]