田德禄教授治疗溃疡性结肠炎的经验

Professor Tian Delu′s Experience in Treating Ulcerative Colitis

溃疡性结肠炎(Ulcerative colitis,UC)为世界难治性疾病之一,临床易复发、难治愈。其归属中医学"久痢""休息痢"范畴,病机虚实夹杂,虚体表现在脾虚失于运化,实为湿热、寒湿、疫毒等邪气客于肠道,邪气与气血相搏结,大肠传导失司,脂络受伤,气血凝滞,瘀血内停,化腐成疡乃其核心病机。田德禄教授认为其可依照"内疡"辨治,病性属本虚标实,湿热寒湿毒邪为标实,脾之气阴两虚为本虚,久则损肝及肾,而瘀血贯穿始末。临证治疗中强调首辨虚实、脏腑同调,实者着重清热化湿、解毒化瘀,虚者重在益气养阴、健脾柔肝;并分期论治、抓住泻痢转化关键时期,"泻"在中焦宜分利脾胃之湿、"痢"在下焦宜调理脾肾之伤,若泻传痢,是脾传肾,谓之贼邪,难愈,若痢传泻,是肾传脾,谓之微邪,易瘳;另需补脾柔肝温肾,适度降低肠道敏感性,化瘀生肌,气血同调。田德禄教授并提出中医中药治疗本病的重点和优势均在于防复发,为临床辨证治疗及后续研究指明了方向。

Objective Ulcerative Colitis(UC)is one of the world′s refractory diseases,which is easy to relapse and difficult to cure.It belongs to the category of“long dysentery”and“rest dysentery”in traditional Chinese medicine.The pathogenesis is mixed with deficiency and excess.Traditional Chinese medicine believes that it is in line with the“resistant dysentery”,“rest dysentery”and other categories.The core pathogenesis is that spleen deficiency in transport,pathogenic factors aggressive intestines,entangled in Qi and blood,intestine conduction loss,intestinal mucosa injury,Qi and blood stagnation.Professor Tian Delu believes that the disease can be treated according to“internal ulcer”.UC belongs to the asthenia in origin and asthenia in superficiality by dampness,heat,cold and dampness.The disease is characterized by the deficiency of the spleen and the deficiency of Qi and Yin,and the blood stasis runs through the beginning and the end.In clinical treatment,we emphasize the first differentiation of deficiency and excess and the coherence of viscera.And treatment by stages,seize the critical period of diarrhea-dysentery conversion,“diarrhea”due to the middle-jiao,“dysentery”attributed to the lower-jiao,if diarrhea progress for dysentery,is spleen affect kidney,that is difficult to heal,if dysentery become to diarrhea,is kidney effect spleen,that is easy to heal.In addition,it is necessary to invigorate the spleen,soften the liver and warm the kidney,moderately reduce the intestinal sensitivity,remove blood stasis,and harmonize Qi and blood.It is pointed out that the focus and advantage of TCM treatment is to prevent recurrence,which points out the direction for clinical treatment and follow-up research.