芍药汤及其加减方治疗溃疡性结肠炎的研究进展

Shaoyaotang and Its Modified Formulas in Treatment of Ulcerative Colitis:A Review

芍药汤由黄连、黄芩、大黄、白芍、当归、木香、槟榔、肉桂,甘草构成。因其具有清热利湿、调气活血功效,后世医家皆推此方为治疗湿热泄痢之主方。现代临床应用中,除芍药汤原方,其加减方亦用于溃疡性结肠炎治疗,并可与其他方剂(痛泄要方、白头翁汤、参苓白术散等)、西药(美沙拉嗪、柳氮磺吡啶、英夫利昔单抗等)、中医针刺或艾灸等特色疗法联用。临床疗效结果显示芍药汤及其加减方能明显降低梅奥内镜(Mayo)评分、结肠黏膜病变(Baron)评分、中医证候积分等疾病评分,改善患者肠道症状效果显著且不良反应少。实验药理学研究显示芍药汤可通过抑制肿瘤坏死因子-α(TNF-α)、核转录因子-κB(NF-κB)、白细胞介素-1β(IL-1β)等促炎因子表达,上调白细胞介素-10(IL-10)等抑炎因子来减轻炎症反应;可通过调节炎症信号通路,阻断连环反应,减少细胞凋亡;可通过调节免疫轴平衡、调节免疫蛋白修复异常免疫屏障;可调节肠道菌群平衡、促进肠上皮细胞再生、改善黏膜通透性,从而恢复肠道内环境平衡以达到治疗溃疡性结肠炎的效果;其药物单体黄芩苷、芍药苷、黄连素等可起到抗炎、抗菌、调节代谢等作用。该文就芍药汤治疗溃疡性结肠炎的临床和基础研究进展进行系统综述。

Shaoyaotang is composed of Cptidis Rhizoma,Scutellariae Radix,Rhei Radix et Rhizoma,Paeoniae Radix Alba,Angelicae Sinensis Radix,Aucklandiae Radix,Arecae Semen,Cinnamomi Cortex and Glycyrrhizae Radix et Rhizoma,with the functions of clearing away heat,eliminating dampness,regulating Qi and activating blood.Thus,it is proposed as the main formula for the treatment of dampness-heat dysentery by later generations of doctors.In modern clinical application,in addition to original Shaoyaotang,its modified formulas are also used for the treatment of ulcerative colitis,and can be used in combination with other prescriptions(such as Tongxie Yaofang,Pulsatilla Soup,Shenling Baizhu San),western medicine(such as mesalazine,sulfasalazine,Infliximab),traditional Chinese medicine(TCM)acupuncture or moxibustion and other characteristic therapies.Clinical efficacy results indicate that Shaoyaotang and its modified formulas can significantly lower Mayo Endoscopic Score(MES),Baron score,TCM syndrome score and other disease scores,and improve patients’intestinal symptoms,with few side effects.Experimental pharmacological studies reveal that Shaoyaotang can inhibit tumor necrosis factor-α(TNF-α),nuclear transcription factor-κB(NF-κB),interleukin-1β(IL-1β)and other pro-inflammatory factors to up regulate the expression of anti-inflammatory factors such as interleukin-10(IL-10),thereby reducing the inflammatory response.The formula could also reduce apoptosis by regulating inflammatory signaling pathway and blocking the chain reaction,and repair abnormal immune barrier by balancing immune axis and regulating immune proteins.Additionally,it could adjust the balance of intestinal flora,promote intestinal epithelial cell regeneration and improve mucosal permeability,so as to restore the balance of intestinal environment and thus treat ulcerative colitis.Its monomers baicalin,paeoniflorin,and berberine have anti-inflammatory,antibacterial,metabolism-regulating and other effects.This paper systematically reviewed the clinical and basic research progress of Shaoyaotang in the treatment of ulcerative colitis.