从痈疡论治溃疡性结肠炎

Treatment of ulcerative colitis from carbuncle

溃疡性结肠炎(UC)致病原因复杂,究其本源,脾胃虚弱,湿邪内生,蕴久成毒,毒侵肠络,血败肉腐,痈疡内生为基本病机。临床上根据UC特点可从“痈疡”分期论治,活动期以“消”为主,湿热毒邪盛者予黄连、黄芩、败酱草等苦寒清消,脓多者予黄柏、苍术、薏苡仁等燥湿排脓以消之,便血多者予地榆、马齿苋、大血藤、茜草、白头翁等药凉血活血以消之,后期仍有腹痛、里急后重者予木香、当归、白芍、丹参等药调气和血以“托”之,缓解期脾胃虚弱者予参苓白术散健脾渗湿,日久累及肾阳者予四神丸健脾温肾以“补”之。在此基础上随症加减用药,同时配合自拟“青赤散”灌肠方,直达病所,内外兼治,可有效诱导缓解并维持治疗。

The pathogenic causes of ulcerative colitis(UC)are complex.The basic pathogenesis is the weakness of spleen and stomach,endogenous dampness,long-lasting toxin,toxin invading intestinal collaterals,blood corruption and carbuncle endogenesis.According to the characteristics of UC,it can be treated by stages from“carbuncle”,and the main pathogenesis is“elimination”in the active period.The patients with dampness-heat and toxin pathogen are treated with Coptis chinensis,Scutellaria baicalensis,Patrinia villosa and so on,and the patients with excessive pus are treated with Cortex Phellodendri,RhizomaAtractylodis,Coix Seed and so on,and the patients with excessive hematochezia are treated with Sanguisorba officinalis,Portulaca oleracea,Caulis Spatholobi,madder,Pulsatilla chinensis and other herbs to cool blood and promote blood circulation.In the later stage,there are still abdominal pain and tenesmus,the herbs such as common aucklandia root,Angelica,paeony,salvia miltiorrhiza are used to regulate qi and blood to“support”.In the patients with weak spleen and stomach in the remission stage,Shenling Baizhu Powder is used to strengthen spleen and infiltrate dampness.In the patients with chronic kidney yang involvement,Sishen Pill is used to strengthen spleen and warm kidney to“fill”.On this basis,the drugs are added and subtracted according to the symptoms.At the same time,the self-drafted Qingchi San enema prescription is used to directly reach the disease site and treat both inside and outside.It can effectively induse remission and maintain treatment.