刘启泉从胆论治腹泻型肠易激综合征

Liu Qiquan′s Treatment of Diarrhea-Predominant Irrita Blebowel Syndrome from Gallbladder Theory

腹泻型肠易激综合征(diarrhea-predominant irrita blebowel syndrome, IBS-D)发病的本质是气血运行失调,情志饮食刺激是重要诱因。气机病变取决于胆,胆作为枢纽,通过调节气机升降影响周身气血的运行,影响情志和消化。IBS-D气机郁滞明显,腹痛较为严重,有泻后痛减特点者,常伴有脾虚的表现,重在疏肝利胆,理气止泻。IBS-D湿热明显者,为气滞津停,水液运行不畅,聚而生湿,日久郁而生热,凝炼成痰,痰留脾胃,则食少纳呆、脘闷不舒,临证应清胆化痰,除湿止泻。IBS-D伴有上消化道症状者,当注意调和胆胃,止痛止泻。IBS-D患者常合并焦虑抑郁等神志异常的表现,是因心胆气虚,胆失决断,神不内守,故应补胆安神,温肾止泻。

The essence of diarrhea-predominant irrita blebowel syndrome(IBS-D) is the imbalance of qi and blood, and emotional and dietary stimulation is an important inducement.The pathological changes of qi movement depend on the gallbladder.As a hub, the gallbladder affects the movement of qi and blood, emotion and digestion by adjusting the rise and fall of qi movement.IBS-D qi stagnation is obvious, abdominal pain is more serious, and those with the characteristics of reducing pain after diarrhea are often accompanied by the performance of spleen deficiency, focusing on soothing the liver and gallbladder, regulating qi and stopping diarrhea.IBS-D patients with obvious damp and heat are characterized by stagnation of qi and fluid, poor operation of water and fluid, accumulation and dampness, depression and heat for a long time, condensing into phlegm, phlegm left in the spleen and stomach, which causes anorexia, stuffy and uncomfortable in stomach.In the clinical syndrome, we should clear the gallbladder, remove phlegm, remove dampness and stop diarrhea.IBS-D patients with upper gastrointestinal symptoms should pay attention to regulating gallbladder and stomach, relieving pain and diarrhea.IBS-D patients are often complicated with mental abnormalities such as anxiety and depression, which is due to deficiency of heart and gallbladder qi, loss of decision-making and lack of internal defense, so they should be treated by replenishing the gallbladder, calming the nerves, warming the kidney and stoping diarrhea.