六经辨治脓毒症急性胃肠功能损伤

Preliminary study on six-meridian differentiation and treatment of acute gastrointestine functional injury in sepsis

胃肠道是脓毒症首先累及的器官,同时胃肠道功能损伤也可加重或诱发脓毒症.探讨脓毒症急性胃肠功能损伤(AGI)的临床症状与中医六经病的关系,认为AGI疾病分级符合六经传变规律,临床上可采用六经辨证理论进行治疗.按六经病提纲,脓毒症AGIⅠ级辨少阳阳明同病;AGIⅡ级辨太阴阳明同病;AGIⅢ级辨太阴病;AGIⅣ级辨少阴病、厥阴病.总结此类患者的临床治疗经验,认为AGIⅠ级患者常给予通腑泻热治疗;AGIⅡ级患者则寒温并用;AGIⅢ级患者在温脾汤基础上,佐以宣肺、行气、泄水利尿药物;AGIⅣ级患者可在温脾汤基础上合用乌梅丸加减治疗.同时附验案3则,对患者均采用了六经辨证疗法,获得较好疗效.

Gastrointestinal tract is the first organ involved in sepsis,and at the same time the injury of gastrointestinal tract function can aggravate or induce sepsis.This article explores the relationship between the clinical symptoms of septic acute gastrointestinal function injury(AGI)and traditional Chinese medicine(TCM)six-meridian diseases.It is believed that the septic AGI disease classification is in accordance with the law of six-meridian transmission,and the six-meridian syndrome differentiation theory can be used in clinical treatment.According to the outline of six-meridian diseases,the gradation of sepsis AGI syndrome differentiation is as follows:the same diseases of Shaoyang and Yangming are identified in grade Ⅰ,the same diseases of Taiyin and Yangming are in grade Ⅱ,Taiyin disease in grade Ⅲ and Shaoyin and Jueyin diseases in septic AGI grade Ⅳ.The clinical experiences in treatment of sepsis AGI disease are summarized in this article,Tongfuxiere(free the bowels and discharge heat)recipe is often used in treatment of septic AGI grade Ⅰ patients,grade Ⅱ patients are treated with drug having cold and warm characteristics,septic AGI Ⅲ patients are treated with Wenpi(warming spleen)decoction,supplemented with drugs for dispersing lung,promoting Qi,releasing water and dieresis and septic AGI Ⅳ patients can be treated with modified Wumei(dark plum)pill on the basis of Wenpi decoction.In the mean time,three patients with septic AGI disease treated by syndrome differentiation of six-meridians and achieving relatively good therapeutic results are described in this paper.