基于黄元御“水寒土湿木郁”理论探讨功能性便秘的诊治及其肠道微生态的改变  

Discussion on Diagnosis and Treatment of Functional Constipation and Changes in Intestinal Microecology Based on Huang Yuanyu′s Theory of“Cold Water,Damp Soil,and Depressive Wood”

作　　者：吴锋[1] 祝珊珊 肖秋平[1] 林丽珠[1] 曾于恒 吴小云[1] WU Feng;ZHU Shan-shan;XIAO Qiu-ping;LIN li-zhu;ZENG Yu-heng;WU Xiao-yun(Xiamen hospital of TCM,Xiamen Fujian 361009;Xiamen Medical College,Xiamen Fujian 361000)

机构地区：[1]厦门市中医院,福建厦门361009 [2]厦门医学院,福建厦门361000

出　　处：《世界中西医结合杂志》2024年第9期1839-1845,1851,共8页World Journal of Integrated Traditional and Western Medicine

基　　金：2020年厦门市医疗卫生指导性项目(3502Z20209129)。

摘　　要：目的基于黄元御“水寒土湿木郁”理论探讨功能性便秘(Functional constipation,FC)的诊治,采用高通量测序技术探讨肉苁蓉汤对“水寒土湿木郁”型FC患者肠道微生态的影响。方法选取2020年9月—2022年1月期间厦门市中医院肛肠科便秘门诊收治的“水寒土湿木郁”型慢性FC患者60例,采用随机数字表法分为对照组和治疗组,每组各30例。治疗组采用肉苁蓉汤,对照组口服聚乙二醇4000,疗程均为5周。其中肉苁蓉汤组20例,聚乙二醇组18例,分别采集两组患者治疗前后的自然排出的粪便(10.00±5.00)g,立即置于液氮中冷冻,再放入-80℃冰箱中保存,采用MagPure Soil DNA LQ Ki试剂,采用高通量测序技术分析菌群的变化,进行Alpha多样性指数分析,并分别使用Chao、Shannon及Simpson指数计算肠道菌群丰度和菌群多样性;采用LefSe技术分析治疗前后粪便样本中菌群组成中的差异性菌属。结果两组患者疗程结束后水寒土湿木郁证候量化积分,差异有统计学意义(P<0.05);两组患者疗程结束3个月后水寒土湿木郁证候量化积分,差异有统计学意义(P<0.05)。表明肉苁蓉汤组的疗效优于聚乙二醇组。稀释曲线表明测序数据量合理,基本能覆盖样本中所有的细菌种类;治疗后FC患者肠道菌群的Chno1指数高于治疗前,Shannon指数和Simpson指数均低于治疗前,但三者治疗前后的差异无统计学意义(P>0.05);门水平上各组肠道菌群中相对分布较高的菌属有Bacteroidota、Cyanobacteria、Campilobacterota、Deferribacterota;属水平上,各组肠道菌群中相对分布较高的菌属有Bacteroidota、Parabacteroides、Eubacterium_eligens_group、Alistipes、Lachnoclostridium。结论肉苁蓉汤治疗“水寒土湿木郁”型便秘可以取得中远期的疗效,可以增加肠道有益菌,改善肠道微生态。Objective Based on Huang Yuanyu′s theory of“cold water,damp soil,and depressive wood”,this study explores the diagnosis and treatment of functional constipation(FC)and investigates the impact of Cistanche decoction on the intestinal microecology of FC patients classified under the“cold water,damp soil,and depressive wood”type,using high-throughput sequencing technology.Methods A total of 60 chronic FC patients with the“cold water,damp soil,and depressive wood”type were selected from the Constipation Clinic of the Anorectal Department at Xiamen Hospital of Traditional Chinese Medicine between September 2020 and January 2022.They were selected as the research objects and were divided into a control group and a treatment group according to the random number table method,with 30 patients in each group.The treatment group received Cistanche decoction,while the control group received oral PEG 4000,with both treatment courses lasting for five weeks.Fecal samples(10.00±5.00 g)were collected from 20 patients in the Cistanche decoction group and 18 patients in the PEG 4000 group,both before and after treatment.These samples were immediately frozen in liquid nitrogen and stored at-80℃.The MagPure Soil DNA LQ Kit was used to analyze changes in intestinal microecology through high-throughput sequencing.Alpha diversity indices were analyzed using Chao,Shannon,and Simpson indices used to calculate the abundance and diversity of the intestinal microbiota.LefSe technology was used to identify differential bacterial genera in the fecal samples before and after treatment.Results After the treatment period,there was a statistically significant difference in the quantitative scores of“cold water,damp soil,and depressive wood”symptoms between the two groups.Three months after treatment,the difference in these quantitative scores remained statistically significant.The results indicated that the treatment group demonstrated superior efficacy compared to the control group.The dilution curve indicated that the sequenc

关 键 词：黄元御 《四圣心源》 肉苁蓉汤 功能性便秘 微生态 

分 类 号：R256.35[医药卫生—中医内科学]