溃疡性结肠炎-辨治方药功效特征与药理机制研究进展

Research progress on functional characteristics and pharmacological mechanisms of prescriptions in treatment of ulcerative colitis

溃疡性结肠炎(ulcerative colitis,UC)是以腹泻、黏液脓血便、腹痛为主要临床表现的反复发作、长期迁延的慢性非特异性肠道炎症性疾病。中医药治疗UC疗效整合、确切,具有多靶点系统调控、不良反应小等优势,其药理学特征表现为抗炎、调节免疫、改善肠道菌群、保护肠道黏膜屏障等作用。通过对大肠湿热、脾虚湿阻、脾肾阳虚、肝郁脾虚、瘀阻肠络、寒热错杂、热毒炽盛证7种临床常见证型,及清热化湿、调气行血,健脾益气、化湿止泻,健脾温肾、温阳化湿,疏肝理气、健脾和中,活血化瘀、理肠通络,温中补虚、清热化湿,清热解毒、凉血止痢7种治法所对应的临床优效16首经典名方、8个中成药品种的药理学特征、作用机制及临床适用范围进行综述,以期建立中医辨证理论指导下的优效方药治疗UC的药理学特征和临床疗效评价的科学体系,从源头促进中医药在UC临床中西医治疗领域的科学应用和创新发展。

Ulcerative colitis(UC) is a recurrent long-term delay chronic non-specific inflammatory bowel disease with the main clinical manifestations of diarrhea,mucous bloody stools,and abdominal pain and tenesmus.Classical prescriptions from traditional Chinese medicine(TCM) is effective in the treatment of UC,and it has the advantages of multi-target regulation and small toxic and side effects.Studies showed that several classical prescriptions from TCM could play a crucial role in the prevention and treatment of UC by regulating anti-inflammation,regulating immunity,regulating intestinal flora,and protecting intestinal mucosal barrier.Based on the systematic review of the common TCM syndrome types and main TCM rules of treatment,seven TCM syndrome types including large intestine damp-heat syndrome,spleen deficiency damp-obstruction syndrome,spleen and kidney yang deficiency syndrome,liver stagnation and spleen deficiency syndrome,blood stasis in the intestinal collateral syndrome,cold and heat mixed syndrome,excessive heat-poison syndrome in the diagnosis and treatment of UC in recent years were reviewed and summarized.From this,seven common rules of treatment were concluded under the guidance of TCM syndrome differentiation thinking,which include clearing away heat and dampness,regulating qi and blood;invigorating spleen and replenishing qi,removing dampness and stopping diarrhea,invigorating spleen and warming kidney,warming yang and removing dampness,soothing the liver and regulating qi,invigorating the spleen and the middle,promoting blood circulation by removing blood stasis,regulating intestine and dredging collaterals,warming the middle and tonifying deficiency,clearing away heat and eliminating dampeness,clearing heat and detoxicating,cooling blood and stopping diarrhea.At the same time,the pharmacological characteristics,mechanisms and clinical application of 16 classical prescriptions and four Chinese patent medicines are summarized,to establish a scientific system of pharmacologic characteristics and clinical efficacy evaluation of classical prescriptions and Chinese patent medicine for the treatment of UC under the guidance of TCM syndrome differentiation theory,and promote the rational application and innovative development of classical prescriptions and Chinese patent medicine in the field of clinical treatment of UC from the source.