《伤寒杂病论》方辨治腹泻型肠易激综合征的启示

Enlightenment from the prescriptions in Shanghan Zabing Lun differentiating and treating irritable bowel syndrome

目的:在《伤寒杂病论》中寻找肠易激综合征(IBS)常见的脾虚湿阻证、肝郁脾虚证、脾肾阳虚证、脾胃湿热证、肝郁气滞证等5型的辨治依据,以期为现代中医辨治IBS提供启示。方法:腹泻型IBS大致归属于中医学"泄泻"、"腹痛"等疾病范畴。参考《伤寒杂病论》辨治"下利"、"腹痛"等疾病的思路,针对病机确立治疗大法,寻得治疗主方。结果:腹泻型IBS常见证型可选的《伤寒杂病论》方分别为:脾虚湿滞证可选黄芪建中汤;肝郁脾虚证可选芍药甘草汤;脾肾阳虚证可选金匮肾气丸;脾胃湿热证可选葛根黄芩黄连汤;肝郁气滞证可选四逆散。结论:《伤寒杂病论》对现代辨治IBS的启示:①《伤寒杂病论》为IBS相似病证提供了治疗法则。②IBS辨证研究当借助于《伤寒杂病论》。

Objective： Searching the basis of syndrome differentiation and treatment about syndrome of dampness stagnancy due to spleen deficiency, syndrome of stagnation of liver qi and spleen deficiency, syndrome of deficiency of spleen yang and kidney yang, syndrome of dampness-heat of spleen and stomach, syndrome of stagnation of liver qi from Shanghan Zabing Lun, which would provide the enlightenment for modem traditional Chinese medicine. Methods： IBS-D generally belonged to the disease category of ＇distension＇, ＇abdominal pain＇. Refering to the method of syndrome differentiating and treating ＇diarrheic＇, ＇abdominal pain＇ of Shanghan Zabing Lun, aiming at the pathogenesis and establishing treatment, which would find out the main prescription. Results： Common types of syndrome of IBS-D could choose the prescription in Shanghan Zabing Lun respectively： dampness stagnancy due to spleen deficiency could choose Huangqi Jianzhong Decoction; Syndrome of stagnation of liver qi and spleen deficiency could choose Shaoyao Gancao Decoction; Syndrome of stagnation of liver qi and spleen deficiency could choose Shenqi Pills; Syndrome of dampness-heat of spleen and stomach could choose Gegen Qinlian Decoction; Syndrome of stagnation of liver qi could choose Sini Powder. Conclusion： Enlightenment of syndrome differentiating and treating IBS from Shanghan Zabing Lun： （~）Shanghan Zabing Lun provides rule to discuss about similar disease and syndrome with IBS; （~）Syndrome differentiation research of IBS ought to have the aid of at Shanghan Zabing Lun.