基于“肝为五脏之贼”探讨治肝法在腹泻型肠易激综合征辨治中的应用  

The application of liver treatment method in the differentiation and treatment of diarrhea irritable bowel syndrome based on ‘The liver is the thief of the five Zang-organs’

作　　者：叶艋玮 陆为民[1] 郑浩 YE Mengwei;LU Weimin;ZHENG Hao

机构地区：[1]南京中医药大学附属医院,江苏南京210029

出　　处：《中医临床研究》2024年第30期39-43,共5页Clinical Journal Of Chinese Medicine

基　　金：国家中医药管理局“国医大师徐景藩学术经验传承研究室”建设项目(国中医药人教发[2010]59号)。

摘　　要：腹泻型肠易激综合征(Diarrhea irritable bowel syndrome,IBS-D)是一种功能性肠病,临床主要表现为胃肠道的应激反应,并伴有反复发作的腹痛、大便性状和排便习惯的改变,目前IBS-D的病因尚未明确,公认的危险因素有社会心理因素、生活环境及不良习惯、内分泌功能紊乱等,其发病机制多与胃肠道运动异常、内脏高敏感、心理因素等相关。根据临床表现的不同,其隶属于中医学“泄泻”“腹痛”等范畴,根据病机又可分为肝郁脾虚证、脾虚湿盛证、脾肾阳虚证、脾胃湿热证、寒热错杂证。黄元御在《四圣心源》中提出“故风木者,五脏之贼,百病之长”,认为木气郁滞则百病生,由此提出“肝为五脏之贼”理论。肝为五脏之贼,余脏阴阳失和多为肝所累,肝木为病是IBS-D重要的发病机制,文章以“肝为五脏之贼”理论为基础,探析IBS-D辨证论治,其不同证型虽病机不一,但都有肝贼他脏之因,肝受邪则他脏失于安和,故临证应重视“肝木为病”这一发病机制,临床兼以治肝法可起到加强疗效的作用,根据证型的不同常可有以下治法:肝郁脾虚为木郁土滞,治以疏肝;脾虚湿胜即为湿土不运,兼以平肝;脾肾阳虚为水土湿寒,兼以温肝;脾胃湿热可成中土湿热,兼以清肝;寒热错杂,治以敛肝。Diarrheal irritable bowel syndrome(IBS) is a functional bowel disease mainly characterized by gastrointestinal stress, accompanied by recurrent abdominal pain, changes in stool characteristics and defecation habits. At present, the etiology of diarrheal IBS is not clear, and the recognized risk factors include psychosocial factors, living environment and bad habits, endocrine dysfunction, etc. Its pathogenesis is mainly related to abnormal gastrointestinal motility, visceral hypersensitivity and psychological factors. According to its different clinical manifestations, it belongs to the categories of ‘diarrhea' and ‘abdominal pain' in traditional Chinese medicine. According to its pathogenesis, it can be divided into liver-stagnation and spleen-deficiency syndrome, spleen deficiency and dampness excess syndrome, spleen-kidney Yang( 阳) deficiency syndrome, spleen-stomach damp-heat syndrome, and intermingled cold and heat syndrome. HUANG Yuanyu put forward in Sisheng Xinyuan(《四圣心源》) that ‘The wind-wood is the thief of the five Zang-organs and the root of of all diseases', and thought that the stagnation of Qi( 气) of wood led to all diseases, so he put forward the theory of ‘The liver is the thief of the five Zang-organs'. The liver is the thief of the five Zang-organs, and the Yin( 阴) and Yang disharmony of the remaining Zang-organs is mostly affected by the liver. The liver disease is an important pathogenesis of diarrheatype IBS. Based on the theory of ‘The liver is the thief of the five Zang-organs', this article analyzes the syndrome differentiation and treatment of diarrhea-type IBS. Although the pathogenesis of different syndrome types is different, they all have the causes of liver thief affecting other organs. When the liver is affected by evil, other organs will be invlolbed. Therefore, clinical syndrome should pay attention to the pathogenesis of ‘liver wood disease', and liver treatment method can play a role in strengthening the curative effect. According to different types

关 键 词：“肝为五脏之贼” 治肝法 肠易激综合征 辨证论治 

分 类 号：R256.3[医药卫生—中医内科学]