苏云教授从“燥-津-阴-虚”病理网络论治血热肠燥型肛裂的理论与实践  

Professor SU Yun’s theory and practice in the diagnosis and treatment of the blood-heat with intestinal dryness syndrome of anal fissure based on the pathological network of Zao-Jin-Yin-Xu

作　　者：王寅先 刘小倩 张娟 王怡君 王泓雨 苏云 WANG Yinxian

机构地区：[1]山西中医药大学,山西太原030024 [2]山西中医药大学附属医院,山西太原030024

出　　处：《中医临床研究》2024年第26期73-77,共5页Clinical Journal Of Chinese Medicine

基　　金：山西省中医药管理局2024初预算强省科研项目(2024ZYYB012)。

摘　　要：肛裂是指肛管皮肤全层呈放射状纵行裂开并在局部形成感染性溃疡的一种肛周疾病,其临床特点为可因排便引起肛门周期性疼痛、便血以及便秘等。中医学对“肛裂”没有明确记载,但有“裂肛痔”“脉痔”等名称记录,目前临床根据病因病机对其采取不同的证候分型。其中,在血热肠燥型肛裂发病机制的探讨中,苏云教授创新性提出“燥-津-阴-虚”病理网络,并从此论治,认为此病发病与“脾-胃”“肺-大肠”这两对表里脏腑有密切关系,是燥热阴虚所致疾病。具体来说,饮食不节等导致患者脾胃气血燥热,热邪顺血脉下传至肠道,煎灼肠内阴津而使燥屎内结,循行全身,炙烤娇脏则使肺津亏耗,加之脾胃燥热阴亏,脾土无以滋润肺金,又因肺主皮毛且与大肠相表里,遂肺津枯竭且生化乏源,导致肠道肌肤驰张失利,故燥屎下排费力,努挣时易发为肛裂,外邪趁机侵袭则发而为患。在临床诊治过程中,苏师遵循“调整阴阳,标本同治”的治疗原则,从脏腑阴阳生理功能及其相互联系的角度出发,注重调节“脾-胃”“肺-大肠”两对脏腑之阴,创新性提出“清热滋阴,润燥养津”的治疗方法,并自拟“润燥去裂汤”以治之,临床应用效果颇佳。研究结合一则医案,从此病的病因病机、治则治法、对症用药等方面阐述苏教授治疗血热肠燥型肛裂的理论与实践,吾辈见贤思齐,共学习之。Anal fissure refers to a perianal disease in which the entire layer of the anal skin radiates longitudinally and forms an infectious ulcer locally.Its clinical characteristics include periodic pain,rectal bleeding,and constipation caused by defecation.There is no clear record of anal fissure in traditional Chinese medicine,but there are records of names such as Liegang Zhi(裂肛痔)and Mai Zhi(脉痔).Currently,there are different syndrome types in clinical practice based on their etiology and pathogenesis.Among them,in terms of the exploration of the pathogenesis of the blood-heat with intestinal dryness syndrome of anal fissure,Professor SU Yun innovatively proposed the Zao(燥)-Jin(津)-Yin(阴)-Xu(虚)pathological network to treat this disease.The professor believes that the onset of this disease is closely related to the two pairs of internal organs,spleen-stomach and lung-large intestine,and this disease is caused by internal dryness-heat and Yin deficiency.Specifically,improper diet causes dryness and heat Qi and blood in the spleen and stomach.The heat evil transmites down the blood vessels to the intestines,burning Yin and fluid in the intestines and causing dry feces to accumulate inside.The heat evil circulates the whole body,and bake delicate viscera throughout the whole body,causing lung and fluid loss.In addition,the spleen and stomach are dry and hot with Yin deficiency,can not be able to nourish the lung.Additionally,due to the fact that the lungs govern skin and hair,and the lungs and the large intestine are mutually exterior and interior,the lung fluid is exhausted,and the biochemical sources is depleted,causing the failure of intestinal skin relaxation.Therefore,the dry excretion fails,and the anal fissure is easy to occure when trying to defecate,and the external evil takes the opportunity to invade.In the clinical diagnosis and treatment process of this disease,following the treatment principles of regulating Yin and Yang(阳),and treating both principal and secondary aspects of disease,Prof

关 键 词：燥-津-阴-虚 血热肠燥 肛裂 

分 类 号：R256.39[医药卫生—中医内科学]