太阴病(脾阳虚证)“欲解时”与脾和小肠结构变化的关系

Experiment research of the recovery of Taiyin disease(syndrome of deficiency of spleen yang) and the structural changes of spleen and small intestine

目的:探究太阴病(脾阳虚证)"欲解时"的组织病理学基础,观察"四逆辈"代表方剂理中汤的治疗作用。方法:大承气汤室温灌胃法建立脾阳虚大鼠模型;制作脾、小肠组织石蜡切片,光镜下观察造模及理中汤子时和午时干预6d、12d后大鼠脾、小肠组织。结果:造模结束,模型组脾小梁静脉明显扩张充血,小肠黏膜上皮细胞渗出明显,间质层可见大量淋巴细胞。理中汤干预6d,模型组脾脏可见充血,子时、午时干预组虽不及模型组严重,但二者未见明显区别;模型组小肠渗出仍较多,子时干预组渗出消失,间质层淋巴细胞减少明显,午时干预组仍可见少量渗出,间质层淋巴细胞数目减少不明显。干预12d,模型组大鼠脾脏轻微充血,干预组大鼠脾脏未见充血;模型组小肠间质层仍有少量淋巴细胞,子时、午时干预组渗出均消失,间质层淋巴细胞数目恢复正常。结论:脾小梁静脉充血、小肠黏膜上皮渗出可能为太阴病的病理变化,理中汤能有效促进脾阳虚大鼠的恢复,且在太阴病"欲解时"中心时段干预更好。

Objective： To explore histopathological basis of the recovery of Taiyin disease（syndrome of deficiency of spleen yang）, and to observe the therapeutic effect of Lizhong Decoction, a representative Decoction of ‘Sini generation＇. Methods： The rat model of syndrome of deficiency of spleen yang was established with Dachengqi Decoction by gavage at room temperature. Then, the paraffin section of the spleen and small intestine tissues were made to observe the effect of Lizhong Decoction after 6-day and 12-day intervention at 11 p.m. to 1 a.m. and 11 a.m. to 1 p.m. by the light microscope, respectively. Results： After molding, there were obvious dilation and hyperaemia of the spleen trabecular veins, obvious exudation of small intestinal mucosal epithelial cells, and a large number of lymphocytes in stroma layer in the model group. After 6-day Lizhong Decoction intervention, the hyperaemia was seen in spleen of the model group. The hyperaemia in the 6-day intervention groups was not as seriously as that in the model group, but there were no significantly difference between them. The exudation of small intestine was still large in the model group, but disappeared in the midnight group, and significantly decreased in the noon group. And, the lymphocytes in the mesenchymal layer in the the midnight group were decreased, but the reduction was not obvious in the the noon group. After 12-day intervention, slight hyperaemia of the spleen was found in the model group, while disappeared in the intervention groups. A small number of lymphocytes in the mesenchymal layer were found in the model group, but both of the lymphocytes and exudation disappeared in intervention groups. Conclusion： The venous hyperaemia of spleen trabecula veins and exudation of small intestinal mucosal epithelial cells may be the pathological changes of Taiyin disease. Lizhong Decoction could effectively promote the recovery of model rats with Taiyin disease（syndrome of deficiency of spleen yang）, and play better intervention effective at midnight than noon.