张维骏教授运用加味救土通肠汤治疗阿片类药物相关性便秘经验  

Professor Zhang Weijun′s experience in treating opioid-induced constipation with Modified Jiutu Tongchang Decoction

作　　者：任宏秀 武传玲 李旭辉 张维骏 Ren Hongxiu;Wu Chuanling;Li Xuhui;Zhang Weijun(Shanxi University of Chinese Medicine,Jinzhong Shanxi 030619)

机构地区：[1]山西中医药大学,山西晋中030619

出　　处：《山西中医药大学学报》2024年第12期1369-1373,1378,共6页Journal of Shanxi University of Chinese Medicine

基　　金：山西省中医药管理局科研课题项目(2022ZYYC260);2020年度山西教育厅项目(2020W100);2021年山西省高等学校人文社会科学重点研究基地项目(20210107);傅山文化研究中心。

摘　　要：阿片类药物相关性便秘(OIC)可归属于中医学“便秘”范畴,病机多为本虚标实。基于脾胃升降失调,大肠传导失常导致糟粕内停的基本病机,张维骏教授结合陈士铎《辨证录》所载方剂救土通肠汤,专方化裁创制加味救土通肠汤,由玄参、生地黄、麦冬、当归、厚朴、麸炒枳壳、升麻、火麻仁、郁李仁、肉苁蓉、山药、炙甘草组成,行滋养脾阴、通肠润燥方义,调整阴阳,以达安脾阴而益脾气,润脾燥而治脾约之效。并在此方基础上,结合癌症后期正虚邪胜的特点,分为脾虚气陷、气机阻滞、湿热下注、气阴两虚、阳虚寒凝5种证型施治,充分体现中医在辨证论治指导下遣方用药的特色,并取得肯定的疗效。Opioid-induced constipation(OIC)can be classified as“constipation”in Chinese medicine,and the pathogenesis of the disease is mostly based on the deficiency in origin and excess in superficiality.Based on the basic pathogenesis of abnormal ascending and descending of spleen and stomach and accumulated waste materials due to dysfunction of the large intestine,Professor Zhang Weijun combines the formula of Jiutu Tongchang Decoction in Bianzheng Lu by Chen Shiduo,and creates a special formula called Modified Jiutu Tongchang Decoction,which is composed of Xuanshen,Shengdihuang,Maidong,Danggui,Houpo,Zhiqiao fried with bran,Shengma,Huomaren,Yuliren,Roucongrong,Shanyao and Prepared Gancao.The formula is designed to nourish the spleen-Yin,clear the intestine and moisten the dryness.Through adjusting Yin and Yang,the formula aims to promote the spleen-Qi by tranquilizing the spleen-Yin,and treat the splenic constipation by moistening the spleen dryness.On the basis of this formula and the characteristics of deficient healthy-Qi and exuberant pathogenic factors in the late stage of cancer,the constipation is divided into five syndrome types for treatment:spleen deficiency and Qi collapse,obstruction of Qi activity,downward flow of damp-heat,deficiency of both Qi and Yin,and Yang deficiency and cold coagulation.It fully reflects the characteristics of TCM prescription and medication under the guidance of syndrome differentiation and treatment,and has achieved positive therapeutic effects.

关 键 词：便秘 阿片类药物 辨证录 救土通肠汤 

分 类 号：R256.35[医药卫生—中医内科学]