腹泻型肠易激综合征(脾虚湿热证)治疗经验探析

Experience in Treating Diarrhea-predominant Irritable Bowel Syndrome(Syndrome of Spleen Deficiency and Damp-Heat)

腹泻型肠易激综合征的发病率日益升高,对患者及医疗系统造成沉重负担。西医治疗本病具有难根治、易复发、全身症状改变不明显等局限性,而祖国医学整体观念、辨证论治的指导思想对于本病治疗具有独特优势。孙志广教授行医三十余年,对治疗腹泻型肠易激综合征一病颇有心得,在临证过程中发现本病多以脾虚为本,并见湿热,二者互为因果,导致疾病有迁延难愈、胶着难解、反复发作、难以根治的特点。治疗上,孙教授认为健脾益气法与清热利湿法应同施同用,并以酸甘药物缓腹泻型肠易激综合征之疼痛,因此形成了“健脾为本,固护中焦”“清热利湿,升清止泻”“酸甘化阴,缓急止痛”的治疗法则。参苓白术散、葛根芩连汤和芍药甘草汤是孙教授治疗本病证的常用底方。本研究对孙教授治疗腹泻型肠易激综合征(脾虚湿热证)的经验进行总结分析,并举验案一则,以期为该病的治疗提供参考借鉴。

The incidence of diarrhea-predominant irritable bowel syndrome(IBS-D)is increasing,resulting in heavy burden on patients and the medical system.But the treatment of this disease with Western medicine has limitations such as difficult to cure,easy to relapse,and little improvement in systemic symptoms,while Chinese medicine has unique advantages for this disease with its guideline of overall concept and holistic diagnosis and treatment.Professor Sun Zhiguang has been engaging in medical work for more than 30 years and has a lot of experience in treating IBS-D.In the course of his practice,he found that the disease is mostly based on the syndrome of spleen deficiency and damp-heat,both of which are mutually causal,resulting in the disease is difficult to be cured.In treatment,professor Sun believes that the method of strengthening the spleen and benefiting the Qi should be used together with the method of clearing heat and relieving dampness,and that sour and sweet herbs can be used to ease the pain of IBS-D.Therefore,the treatment rules of“strengthening the spleen and protecting the middle energizer”,“clearing heat and relieving dampness,promoting clearing and stopping diarrhea”,and“sour and sweet herbs to nourish Yin and ease the pain”were developed.Shenling baizhu decoction,gegen qinlian decoction and shaoyao gancao decoction are the common formulas used by professor Sun in treating this disease.The article summarizes and analyzes Professor Sun Zhiguang′s experience in treating IBS-D(syndrome of spleen deficiency and damp-heat)and presents a clinical case to provide reference for the treatment of this disease.