中医“通补-序贯法”分期治疗溃疡性结肠炎思路探究  

Exploration of the“Tong-Bu Sequential Method”for Staged Treatment of Ulcerative Colitis in Traditional Chinese Medicine

作　　者：王蔷 刘世举[2] 刘俊红[2] 梁薇 李天天 商云飞 范瑶媛 Wang Qiang;Liu Shiju;Liu Junhong;Liang Wei;Li Tiantian;Shang Yunfei;Fan Yaoyuan(Henan University of Chinese Medicine,Henan,Zhengzhou 450003,China)

机构地区：[1]河南中医药大学,河南郑州450003 [2]河南中医药大学第三附属医院,河南郑州450003

出　　处：《中国中医急症》2024年第8期1382-1386,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：2022年度河南省中医药拔尖人才培养项目专项课题(2022ZYBJ20);河南省中医药拔尖人才(豫卫中医函[2021]15号)。

摘　　要：溃疡性结肠炎属中医学“肠澼”“痢疾”“肠痈”范畴,其核心病机为脾虚湿盛、本虚标实,脾虚为本,浊毒为标,病因病机复杂,常发作期与缓解期反复交替发作,迁延难愈。笔者根据“腑以通为用”的生理特性,提出“通补-序贯法”分期治疗溃疡性结肠炎。“通”以祛除体内湿、热、毒、瘀等实邪为要,“补”以扶助正气祛邪外出为本,使机体气机升降复常,脏腑真元通畅,邪祛正复。临证用药时西医分期与中医辨证相结合,先辨分期,再明虚实主次,后定通补之侧重。发作期以邪实壅盛、脾虚湿盛为主要病机,通补兼施;缓解期以脾肾亏虚、正虚邪恋为主,以补兼通。通补法贯通全程,通勿伤正,补而勿壅。形成“序贯通补,急缓分治”的诊疗思路,临床取得较好疗效。Ulcerative colitis falls under the categories of“intestinal purgation”“dysentery”and“intestinal carbuncle”in Traditional Chinese Medicine(TCM).Its core pathogenesis revolves around spleen deficiency and abundant dampness,where deficiency of the spleen is fundamental,and turbid toxicity is the superficial manifestation.Due to complex etiology and pathogenesis,it often presents with alternating episodes of exacerbation and remission,making it difficult to resolve.Based on the physiological characteristic of“Fu functions best when unobstructed”,we propose the“Tong-Bu Sequential Method”for staged treatment of ulcerative colitis.The“Tong”aspect focuses on eliminating real evils such as dampness,heat,toxins,and stasis,while the“Bu”component aims to reinforce vital energy to expel evils,restoring the normal circulation of qi and the true essence of the organs.In clinical practice,we combine western medical staging with TCM pattern identification,prioritizing the identification of stage,then clarifying the balance between deficiency and excess,before determining the emphasis on Tong or Bu.During the exacerbation phase,the primary pathogenesis is the predominance of evil and abundance of spleen dampness,thus employing both Tong and Bu.In the remission phase,deficiency of the spleen and kidney with lingering evil takes precedence,hence focusing on Bu with concurrent Tong.The Tong-Bu method is applied throughout,ensuring that Tong does not harm the vital energy,and Bu does not cause stagnation.This leads to a diagnostic and therapeutic concept of“sequential Tong-Bu,treating acute and chronic stages separately”,achieving favorable clinical outcomes.

关 键 词：溃疡性结肠炎 通补法 分期论治 

分 类 号：R574.62[医药卫生—消化系统]