基于“土中泻木”理论论治肝郁脾虚型腹泻型肠易激综合征疗效观察及机制探讨

Discussion on Curative Effect and Mechanism of Treating Diarrhea Predominant Irritable Bowel Syndrome with Liver-Stagnation and Spleen-Deficiency Based on"Purging Wood from Earth"

目的观察运用“土中泻木”理论治疗肝郁脾虚型腹泻型肠易激综合征的临床疗效,并探讨其作用机制。方法本研究选取2017年1月至2018年12月于山东中医药大学附属医院脾胃病科门诊及住院的符合纳入标准的60例患者作为研究对象,随机分为观察组30例、对照组30例。观察组给予加味理肠饮口服,对照组给予匹维溴铵(得舒特)口服,4周1个疗程。观察治疗前后2组患者焦虑抑郁量表评分[Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)]、肛门直肠测压动力学指标[肛门括约肌静息压力(ARP)、直肠静息压力(RRP)、直肠初始感觉及最大耐受阈值]、临床疗效及随访后的复发率。结果治疗后,2组中医证候积分较治疗前显著降低(P<0.05~0.01),观察组优于对照组(P<0.05~0.01);临床总有效率观察组优于对照组(P<0.05);2组患者焦虑抑郁量表评分均较治疗前显著降低(P<0.05~0.01),观察组优于对照组(P<0.05);2组ARP、RRP、直肠初始感觉及最大耐受阈值与治疗前相比有显著性差异(P<0.05),2组比较无显著性差异(P>0.05)。结论加味理肠饮治疗肝郁脾虚型腹泻型肠易激综合征疗效确切,且复发率较低。其作用机制可能与调节胃肠道动力、降低直肠敏感性有关。

OBJECTIVE To observe the clinical effect of treating diarrhea predominant irritable bowel syndrome(IBS)with liver-stagnation and spleen-deficiency based on"purging wood from earth"and to discuss its mechanism.METHODS 60 patients from January,2017 to December,2018 in the Spleen-Stomach Department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine were enrolled in the case group.They were divided into the observation group and the control group with 30 cases each.The observation group was given modified Lichang Drink while the control group was given pinaverium bromide(Dicetel).The course lasted four weeks.Patients'indexes in these aspects were observed before and after the treatment:Scores of anxiety-depression scale[Zung self-rating anxiety scale(SAS)and self-rating depression scale(SDS)],indexes of anorectal manometry dynamics[anal sphincter resting pressure(ARP),rectal resting pressure(RRP),initial rectal sensation and maximum tolerance threshold],clinical effects and recurrence rate after follow-up.RESULTS After treatment,scores of TCM syndrome in the two groups significantly decreased compared with those before treatment(P<0.05,P<0.01)and the observation group was better than those in the control group(P<0.05,P<0.01).The total recovery rate in the observation group was higher than that in the control group(P<0.05).Patients in the two groups had significant lower scores of anxiety-depression scale than before(P<0.05,P<0.01)and the observation group was better(P<0.05).There was significant difference in ARP,RRP,initial rectal sensation and maximum tolerance threshold in both groups before and after treatment(P<0.05)but no significant difference between two groups(P>0.05).CONCLUSION Modified Lichang Drink shows obvious curative effect in treating diarrhea predominant with liver-stagnation and spleen-deficiency and the recurrence is low,which might function through regulating gastrointestinal motility and decreasing rectal sensitivity.