基于“脏腑别通”理论从肝论治放射性肠炎

Treatment of radioactive enteritis based on the theory of“Zangfu extraordinary connection”

放射性肠炎是腹部及盆腔恶性肿瘤在放射治疗后产生的常见肠道并发症,目前西医治疗效果欠佳,极大地影响患者的生活质量。现基于“脏腑别通”理论,从阴阳属性、五行生克、经络循行角度出发,相应于西医“肝-肠轴”学说,阐明肝与大肠气血相通、疾病互传、互治互用的病机基础,并根据放射性肠炎不同时期的症状表现,总结出急性放射性肠炎湿热为盛、慢性放射性肠炎血虚为主、气机失和贯穿始终的病理特点,提出选方用药时应结合患者症状斟酌损益,重视清热利湿、益阴养血、理气解郁等调肝之法的应用。若肝未受邪,则先安其地;既已受邪,则复其升降疏泄之道、濡养固藏之职,从而助肠腑肃降排泄功能恢复,促进疾病向愈,以期对后续放射性肠炎的中医治则治法有所启迪。

Radiation enteritis is a common intestinal complication arising from abdominal and pelvic malignancies after radiation therapy,which is currently poorly treated by western medicine and greatly affects the quality of life of patients.In this paper,based on the theory of“Zangfu extraordinary connection”,from the perspective of yin and yang properties,generation-inhibition of five elements,and meridian circulation,and in accordance with the western medicine“liver-intestine axis”theory,we clarify the pathological mechanism basis that liver and large intestine are connected with each other in terms of qi and blood,disease transmission and mutual treatment.Moreover,according to the symptoms of radiation enteritis in different periods,we summarized the pathological characteristics of acute radiation enteritis with damp-heat,chronic radiation enteritis with blood deficiency and loss of qi harmony throughout.Therefore,we propose that the treatment should be combined with the patient’s symptoms,the application of liver regulating methods such as clearing heat and dampness,benefiting yin and nourishing blood,regulating qi and relieving depression.If the liver has not been affected,it should be settled first.Since it has been affected,then it should restore its function of lifting and draining,moistening and retaining,thus helping the intestinal bowels to restore its function of purging and excreting,promoting the healing of the disease,in order to supplement and enlighten the subsequent Chinese medicine treatment of radiation enteritis.