张小萍从脾胃气化论治肠易激综合征

Zhang Xiao-ping′s Experience of Treating Irritable Bowel Syndrome Based on Spleen and Stomach Qi Movement

张小萍教授认为,肠易激综合征临床症状虽有腹泻型、便秘型、混合型及不定型之分,病因有情志失调、外感六淫、饮食所伤之别,然其致病之本皆为脾胃虚弱。遂秉持"治病必求于本"的原则进行辨证论治,提出了"脾胃气化学说",以脾胃气化为核心,统论外感内伤疾病,采用调升降、理出入、适纳化、宜燥湿等法施治。张老师提出"健脾必先开胃",针对脾胃虚弱导致纳化失常的肠易激综合征患者,多在参苓白术散基础上少佐炒谷芽、焦山楂等消食之品。针对外感六淫导致气机出入无序的肠易激综合征患者,张老师常用攻补兼施之法施治。其中,攻法依据外感、内生病邪的特性采取祛风散寒、化痰行瘀、宣卫和营等法伐其有余,补法以调理脾胃为要而采用益气和胃、调和营卫等法益气生源,临证时常用桂枝-白芍、生姜-大枣、怀山药-紫苏梗等药对。张老师认为,苦温燥湿之品并非治疗腹泻型肠易激综合征的最佳选择,甘温之品虽具温燥却有甘缓,组方配伍时无须顾虑燥化伤阴,常选用黄芪、党参、茯苓、甘草等甘温药物振奋脾阳,温而不燥,中正和缓,运化水湿。

According to Professor Zhang Xiao-ping,although the clinical symptoms of irritable bowel syndrome(IBS)can be divided into diarrhea type,constipation type,mixed type and atypical type,the etiology can include emotional disorders,six exogenous factors and food injuries,but the cause of the disease is deficiency of the spleen and stomach.Therefore,according to the principle that"treating disease should focus on the root",he has put forward"theory of spleen and stomach qi movement",which centers on spleen-stomach qi movement,takes such measures as regulating the ascending and descending;regulating the exiting and entering;proper absorption;drying dampness to treat any externally or internally contracted disease.Professor Zhang has put forward"invigorating the spleen must first harmonize the stomach".For those with IBS who suffer from weak spleen and stomach and lead to abnormal absorption,he often uses Ginseng and Poria and White Atractylodes Powder combined with fried Guya(Fructus Setariae Germinatus),scorch-fried Shanzha(Fructus Crataegi),to help digestion.For the patients with IBS who have disorder of qi movement caused by exogenous six pathogens,Professor Zhang often uses the method of both attack and supplement.Among them,according to the characteristics of exogenous and internal pathogenic factors,the attack methods include dispelling wind,dispersing cold,resolving phlegm,removing blood stasis,dispersing defense qi and harmonizing nutrient qi.Supplementing method include regulating the spleen and stomach by nourishing qi and harmonizing the stomach,regulating nutrient-defense qi.In clinical practice,such drug-pairs as Guizhi(Ramulus Cinnamomi)-Baishao(Radix Paeoniae Alba),Shengjiang(Rhizoma Zingiberis Recens)-Dazao(Fructus Jujubae),Huaishanyao(Rhizoma Dioscoreae)-Zisugeng(Caulis Perillae),etc.According to him,it is not the best choice to treat diarrhea type IBS with bitter,warm and dry dampness drugs.Although sweet-warm drugs can warm and dry,they are also sweet and mild.It is not necessary to worry about dryness harming yin in the combination of prescriptions.Some sweet-warm drugs such as Huangqi(Radix Astragali),Dangshen(Radix Codonopsis),Fuling(Poria),Gancao(Radix et Rhizoma Glycyrrhizae),etc.to invigorate spleen yang and remove water dampness with their nature of being warm without dry.