基于经验总结的便秘型溃疡性结肠炎探微

Exploration of Constipation Ulcerative Colitis Based on Experience Summary

溃疡性结肠炎(ulcerative colitis,UC)是一种以结直肠黏膜连续性、弥漫性炎症改变为特点的慢性非特异性肠道炎症性疾病,相比其腹泻、黏液脓血便等常见的症状而言,人们更容易忽视便秘这一较少见症状。国内外西医有关便秘型UC的研究虽少,但相关流行病学已经显示出人们对便秘和UC间关系的关注。便秘型UC的发病机制可能是通过肠神经系统改变、卡哈尔间质细胞减少、5-羟色胺增加、肛门直肠功能障碍、肠黏液屏障受损等影响结肠运动和肠内水分吸收功能,从而导致便秘,还可能涉及到肠道菌群及其代谢物失衡以及精神心理压力的影响。运动、增加液体摄入量及可溶性纤维、行为疗法可考虑用于治疗便秘型UC,一些治疗便秘的药物也可改善UC症状。导师李军祥教授从医30余年,系第七批全国老中医药专家学术经验继承工作指导老师,善治脾胃系病症,尤善治疗UC。李教授认为便秘型UC的基本病机是寒热错杂,湿热瘀阻,气滞阴虚血少兼夹。脾阳不足,水湿内停,湿郁化热,热久成毒,湿热毒邪与肠道气血相搏结,损伤肠道经络脂膜而致脓血;气虚气滞,无力推动,湿热瘀浊内阻肠道,久痢伤阴耗血,血虚肠燥,致大肠传导失司,糟粕停滞于肠道而便秘。治疗当以止黏液脓血为先,后可着重治疗便秘,提出清热化湿、凉血化瘀、温中健脾的治法,创立清肠温中方,附一则验案以证其疗效甚佳。该文通过结合国内外文献与李教授的临床经验探究便秘与UC的内在联系,并对李教授诊治便秘型UC经验进行拾掇,以期为该病的临床治疗提供一定参考。

Ulcerative colitis(UC)is a chronic nonspecific inflammatory disease of the intestine characterized by continuous,diffuse inflammatory changes in the mucosa of the colon.People are more likely to ignore the less common symptoms of constipation than common symptoms such as diarrhea and mucus and bloody stools.Although there are few studies on constipated UC in Western medicine at home and abroad,the relevant epidemiology has shown that people pay attention to constipation and UC.The pathogenesis of constipation-type UC may be through changes in the enteric nervous system,decreased interstitial cells of Cajal,increased 5-hydroxytryptamine,anorectal dysfunction,and impaired intestinal mucus barrier,which affect colonic motility and intestinal water absorption,resulting in constipation.It may also be involved in the imbalance of gut flora and its metabolites and the influence of mental and psychological stress.Exercise,increased fluid intake,and soluble fiber,behavioral therapy may be considered for the treatment of constipated UC,and some medications to treat constipation may also improve UC symptoms.The supervisor,Professor LI Junxiang,has been practicing medicine for more than 30 years,and is the seventh batch of national old Chinese medicine experts academic experience inheritance work guidance teacher,good at treating gastroenterology diseases,especially good at treating UC.Professor LI believes that the basic pathogenesis of constipation UC includes cold and heat mixing,dampness,heat and blood stasis blocking the operation of Qi and blood meridians,and Qi stagnation,Yin deficiency and less blood.The spleen Yang is insufficient,the water becomes dampness,the dampness becomes hot,and the heat becomes poisonous for a long time.Dampness,heat,and poison collide with intestinal Qi and blood,damaging the intestinal meridian lipids and causing mucus and blood.Qi deficiency and Qi stagnation result in the inability of the intestines to push feces out.Dampness,heat,and blood stasis impede bowel movement.Prolonged mucus and bloody stools lead to less blood and yin deficiency,which result in dryness of the intestines.The above combination leads to the dysfunction of the large intestine to transmit feces,and the feces accumulate in the intestines,resulting in constipation.Treatment should be to stop mucus and blood first,and then focus on the treatment of constipation.He proposed the treatment method of clearing heat and dampness,cooling blood and dissolving stasis,and warming the spleen,and founded the Qingchangwenzhong prescription.A test is attached to prove that it is very effective.This paper attempts to explore the intrinsic relationship between constipation and UC by combining domestic and foreign literature and Professor LI’s clinical experience,and to pick up Professor LI’s experience in diagnosing and treating constipation-type UC.In order to provide a certain reference for the clinical treatment of the disease.