从“阑门湿热”论治末端回肠炎  

Treatment of distal ileitis from“damp-heat of diaphragm gate”

作　　者：叶涛 徐陆周[1] YE Tao;XU Luzhou

机构地区：[1]南京中医药大学附属医院,江苏南京210000

出　　处：《中医临床研究》2024年第36期16-19,共4页Clinical Journal Of Chinese Medicine

基　　金：第五批全国中医临床优秀人才研修项目(国中医药人教函[2022]1号)(2022FTj12-6);江苏省中医消化病医学创新中心(苏卫科教[2022]15号)(CXZX202208)。

摘　　要：末端回肠炎是一种发生于回肠末端的炎症性疾病,以腹痛和腹泻为主要表现,目前,末端回肠炎的机制尚不完全清楚,主要发病机制可能与“结肠-回肠反流”有关,回肠末端的异常蠕动和回盲瓣畸形导致结肠内容物反流至回肠末端,大量菌群在回肠末端滋生,诱发免疫反应,从而导致腹泻症状。大肠为传道之官,容纳秽浊之物,故多有湿热邪气停留,虽有邪而不易发病。小肠属火,湿热邪气至小肠则受火而为病,发为末端回肠炎。阑门是大肠与小肠的连接处,湿热之邪返入小肠,也多集中于阑门处。因此末端回肠炎以“阑门湿热”为病机特征,表现为兼具泄泻和痢疾的特点,又以“邪滞阑门”为发病关键,表现为易反复发作,经久不愈。在治疗过程中不应单纯以泄泻或痢疾之法治之,应兼顾治泻与治痢,急性期以肠痈之法治之,以“行气导滞,攻积泄热”为基本治疗思路;慢性期可在止泻和理气的基础上,加用黄芩、黄连、黄柏等苦寒之品去湿热积滞,并结合患者具体症状随证加减,注重“运脾理气、清热消滞”。Distal ileitis is an inflammatory disease occurring at the end of the ileum,and it is mainly characterized by abdominal pain and diarrhea.At present,the mechanism of distal ileitis is not completely clear,and the main pathogenesis may be related to“colo-ileal reflux”:Abnormal peristalsis at the end of the ileum and malformation of the ileocecal valve cause the colon contents to regress to the end of the ileum,where a large number of bacteria proliferate and induce an immune response,resulting in diarrhea symptoms.This paper interprets this mechanism from the perspective of traditional Chinese medicine,considering the large intestine as the official channel for conveying filthy things,where damp-heat pathogens often reside but do not easily cause disease.The small intestine is attributed to fire property,and when damp-heat pathogens reach the small intestine,they become a disease,manifesting as distal ileitis.The diaphragm gate is the connection between the large intestine and the small intestine,where damp-heat pathogens return to the small intestine and are mostly concentrated at the diaphragm gate.Therefore,this paper proposes that the distal ileitis is characterized by“dampness and heat of the diaphragm gate”as the pathogenesis,which is characterized by both diarrhea and dysentery,and takes“pathogen stagnation at diaphragm gate”as the key to the onset,which is easy to repeat and long-lasting.On this basis,this paper further points out that in the treatment of distal ileitis,it should not be treated simply with the methods of treating diarrhea or dysentery,but should take into account both of them:in the acute phase,it can be treated with the method of treating intestinal abscesses,with“regulating qi to guide stagnation and attacking accumulation to relieve heat”as the basic treatment idea;in the chronic phase,on the basis of stopping diarrhea and regulating qi,bitter and cold medicinals such as Scutellaria baicalensis,Coptis chinensis,and Phellodendron amurense can be added to remove damp-heat

关 键 词：末端回肠炎 泄泻 湿热 

分 类 号：R516.1[医药卫生—内科学]