陈康清治疗慢性结肠炎经验

Chen Kangqing's Experience of Treating Chronic Colitis

陈康清老师认为,脾肾虚致泄为慢性结肠炎主要病机。陈老师运用“态靶辨治”理论治疗慢性结肠炎,将慢性结肠炎分为炎症期、炎积癥瘕期、康复期三个阶段,将其发展的某一阶段的病理过程分为“郁火态、湿热态、癌毒态、阴火态”四种状态,辨证分为八种证型:脾胃虚弱,湿浊下迫肠腑型;脾阳虚夹寒,寒湿阻滞肠道型;脾虚中气下陷,气虚失司大肠型;肝郁脾湿,湿热留滞胃肠型;肝郁脾虚,气滞瘀堵大肠型;脾虚痰阻,水湿痰阻肠腑型;肾脾阳虚毒滞,阳虚毒滞大肠型;脾肾阴阳两虚,毒痰湿瘀互结留滞大肠型(寒热错杂)等。炎症期以“湿热态”“郁火态”为纲,辨证为脾胃虚弱,湿浊下迫肠腑型,治法为健脾利湿,通降谷道,以脏连丸为靶方;肝郁脾湿,湿热留滞胃肠型,治法为疏肝解郁,健脾利湿,通降谷道,以柴胡疏肝散为靶方;肝郁脾虚,气滞瘀堵大肠型,治法为疏肝化瘀,健脾化湿,通降肠腑,以大柴胡汤、大黄牡丹汤为靶方等。炎积癥瘕期以“癌毒态”为纲,如辨证为脾阳虚夹寒,寒湿阻滞肠道型,治法为温阳健脾,散寒祛浊,以附子理中丸为靶方;脾虚痰阻,水湿痰阻肠腑型,治法为健脾利湿,理气行滞,以二陈汤合参苓白术散为靶方;脾肾阴阳两虚,毒痰湿瘀互结留滞大肠型,治法为平调阴阳,化瘀理气行滞,以乌梅丸或半夏泻心汤合蛰虫丸为靶方等。此阶段脏腑气机虚弱加之有形之邪的复合态,如遇蒹加毒痰癌态,可加“半边莲配伍七叶一枝花”“蒲公英配伍山慈菇”药对清热解毒,消肿散结;痰瘀毒积态,选用“三棱配伍莪术、胆南星”“血竭配伍白附子”药对活血化瘀,化痰散郁。康复期以“阴火态”为纲,如辨证为肾脾阳虚毒滞,阳虚毒滞大肠型,治法为温肾健脾,散寒祛毒,利水消肿,以归脾汤、实脾饮为靶方;脾虚中气下陷,气虚失司大肠型,治法为补中益气,升阳祛毒,以补中益气汤、八珍汤为靶方等。此阶段脏腑功能虚弱,病邪渐除,根据临床症状及靶方加相应靶药,如遇蒹加气虚乏力,选用红参、西洋参等;如蒹加气滞食积选用调理气机之枳壳、陈皮、青皮等,消导开胃之薏苡仁、炒白术、焦山楂、焦神曲、焦麦芽等。陈老师还在辨证分型的基础上选择相应病因靶药、症靶药、标靶药。

Chief physician Chen Kangqing believes that spleen and kidney deficiency leading to diarrhea is the main pathogenesis of chronic colitis.Professor Chen uses the theory of"differentiation and treatment of state targets"to treat chronic colitis.Chronic colitis is divided into three stages:inflammation stage,inflammation accumulation and abdominal mass stage,and rehabilitation stage.The pathological process of a certain stage of its development is divided into four states:"stagnated fire state,dampness-heat state,cancer toxicity state,and yin fire state".The syndrome differentiation is divided into eight types:spleen and stomach weakness,dampness and turbidity forcing the intestines and viscera type;spleen yang deficiency mixed with cold,cold dampness blocking intestinal type;spleen deficiency,sinking of middle energizer qi,and qi deficiency failing to control the large intestine type;liver stagnation and spleen dampness,dampness-heat retention in the gastrointestinal tract type;liver stagnation and spleen deficiency,qi stagnation and blood stasis blocking the large intestine type;spleen deficiency and phlegm obstruction,water dampness and phlegm obstruction in the large intestine type;kidney-spleen yang deficiency and toxin stagnation,yang deficiency and toxin stagnation in the large intestine type;spleen-kidney yin and yang deficiency,toxin and phlegm and dampness and blood stasis stagnation in the large intestine type(cold and heat in complexity),etc.The inflammation stage is characterized by"dampness-heat state"and"stagnated fire state".For those diagnosed with spleen and stomach weakness,dampness and turbidity forcing the intestines and viscera,the treatment is to invigorate the spleen and eliminate dampness,promote the flow of descending grains,and choose Zanglian Pill as the target formula.For liver stagnation and spleen dampness,dampness-heat retention in the gastrointestinal tract type,the treatment is to soothe the liver and relieve stagnation,invigorate the spleen and eliminate dampness,promote the descending of the grain channel,and use Bupleurum Liver-Soothing Powder as the target formula.For liver stagnation and spleen deficiency,qi stagnation and blood stasis blocking the large intestine type,the treatment is to soothe the liver and remove blood stasis,invigorate the spleen and eliminate dampness,promote and dredge intestines,so Major Bupleurum Decoction,Rhubarb and Peony Decoction,etc.can be used as the target formulas.The stage of inflammation accumulation and abdominal mass stage is based on the principle of"cancer toxicity".If the syndrome differentiation is spleen yang deficiency mixed with cold,cold dampness blocking intestinal type,the treatment is to warm yang and invigorate the spleen,dispel cold and remove turbidity,and use Aconite Middle-Regulating Pills as the target formula.For spleen deficiency and phlegm obstruction,water dampness and phlegm obstruction in the large intestine type,the treatment is to invigorate the spleen and eliminate dampness,regulate qi and promote stagnation.The target formula is Two Matured Substances Decoction combined with Ginseng and Poria and White Atractylodes Powder.For kidney-spleen yang deficiency and toxin stagnation,yang deficiency and toxin stagnation in the large intestine type,the treatment is to regulate yin and yang,remove blood stasis,regulate qi and promote stagnation.The target formula is Mume Pill,or Pinellia Heart-Draining Decoction combined with Eupolyphaga seu Steleophaga Pill.At this stage,there is a complex state of weakened internal organs and qi,combined with visible pathogens.If encountering the toxic phlegm and cancerous state combined with abdominal mass,"Banbianlian(Herba Lobeliae Chinensis)-Qiyeyizhihua(Rhizoma Paridis)","Pugongying(Herba Taraxaci)-Shancigu(Pseudobulbus Cremastrae seu Pleiones)pairs can be added to clear heat and detoxify,reduce swelling and disperse nodules.For phlegm,blood stasis,and toxin accumulation,"Sanleng(Rhizoma Spargani)-Ezhu(Rhizoma Curcumae)-Dannanxing(Rhizoma Arisaematis cum Bile)","Xuejie(Sanguis Draconis)-Baifuzi(Rhizoma Typhoni)"pairs can be used to promote blood circulation,remove blood stasis,and disperse phlegm and depression.The rehabilitation stage is based on the principle of"yin fire state".If the syndrome is diagnosed as kidney spleen yang deficiency and toxin stagnation,and yang deficiency and toxin stagnation in the large intestine type,the treatment is to warm the kidney and invigorate the spleen,dispel cold and remove toxins,promote diuresis and reduce swelling,with Spleen-Restoring Decoction and Decoction for Reinforcing the Spleen as the target formulas.For spleen deficiency,sinking of middle energizer qi,and qi deficiency failing to control the large intestine type,the treatment is to tonify the middle energizer qi,raise yang and eliminate toxins,with Center-Supplementing and Qi-Boosting Decoction and Eight-Gem Decoction,etc.as target formulas.At this stage,the function of zang-fu organs is weak and the pathogenic factors are gradually eliminated.According to clinical symptoms and target formulas,corresponding target drugs should be added.If there is qi deficiency and fatigue,Hongshen(Radix et Rhizoma Ginseng Rubra),Xiyangshen(Radix Panacis Quinquefoli),etc.can be added.For abdominal mass combined with qi stagnation and food accumulation,Zhiqiao(Fructus Auranti),Chenpi(Pericarpium Citri Reticulatae),Qingpi(Pericarpium Citri Reticulatae Viride),etc.can be added to regulate qi movement,while Yiyiren(Semen Coicis),stir-fried Baizhu(Rhizoma Atractylodis Macrocephalae),baked Shanzha(Fructus Crataegi)and Shenqu(Massa Fermentata Medicinalis)and Maiya(Fructus Hordei Germinatus),etc.can be added to help digestion.Professor Chen also selects corresponding etiological target drugs,symptomatic target drugs,and targeted drugs based on syndrome differentiation and typing.