六磨汤加减治疗肠道疾病研究进展

Research Progress of Modified Liumo Decoction(六磨汤加减)in the Treatment of Intestinal Diseases

六磨汤首载于《世医得效方》,主破气宽中通便,是治疗气秘的经典效方,现代基础及临床研究的不断发展拓展了六磨汤加减治疗肠道疾病的范围。文章在对近5年有关六磨汤加减治疗肠道疾病的文献进行总结归纳的基础上,分别从中医对六磨汤的认识、六磨汤的现代药理研究、临床报道、基础实验研究及网络药理学研究5个方面加以论述,总结该方治疗多类型便秘、便秘型肠易激综合征(IBS-C)、肠梗阻等多种肠道疾病的研究进展,以探讨六磨汤加减治疗肠道疾病的相关作用机制和临床优势病种。目前,基础实验主要侧重于六磨汤对慢传输型便秘(STC)的研究,主要的作用机制包括降低结肠肌间神经丛内一氧化氮合成酶(NOS)阳性表达水平、减少血清一氧化氮(NO)生成、与结肠肌电生理变化密切相关、减少水通道蛋白的表达、调整肠道菌群以及抑制结肠中水分的重吸收等。总结临床研究发现,六磨汤加减在治疗多类型便秘、IBS-C、肠梗阻、术后肠道功能紊乱等多种肠病方面颇有疗效,其可能主要通过抑制白细胞介素-6(IL-6)、白细胞介素-8(IL-8)等炎症因子的表达产生抗菌抗炎效果,通过影响血清5-羟色胺(5-HT)、血管活性肠多肽(VIP)、乙酰胆碱(ACh)、乙酰胆碱酯酶(AChE)等神经递质的水平以促进胃排空,增强肠蠕动,从而发挥降低患者中医证候评分,缓解焦虑、抑郁等不良情绪,提高生活质量,提高治疗总有效率以及降低复发率等作用。

Liumo Decoction(六磨汤)was first published in the Effective Prescription of world Medicine,breaking Qi,relieving epigastric distention and relaxing bowels.It is a classic effective prescription for the treatment of Qi mystery,the continuous development of modern basic and clinical research has expanded the scope of Modified Liumo Decoction for the treatment of intestinal diseases.On the basis of summarizing the literature on the treatment of intestinal diseases by Liumo Decoction in the past five years,this paper discusses the understanding of Liumo Decoction in traditional Chinese medicine,clinical reports,modern pharmacological research of Liumo Decoction,basic experimental research and network pharmacological research,and summarizes the research progress of this prescription in the treatment of multiple types of constipation,constipated irritable bowel syndrome(IBS-C),intestinal obstruction and other intestinal diseases,in order to explore the relevant mechanism of Liumo Decoction in the treatment of intestinal diseases and its clinical advantages.At present,the basic experiments mainly focus on the research of slow transit constipation(STC),the mechanism of action mainly includes:reducing the positive expression level of nitric oxide synthase(NOS)in the colonic myenteric plexus,reducing the production of serum nitric oxide(NO),closely related to the colonic myoelectric physiology,reducing the expression of aquaporin,adjusting the intestinal flora,and inhibiting the reabsorption of water in the colon.Through summarizing of clinical studies found that Liumo Decoction was effective in the treatment of multiple types of constipation,IBS-C,intestinal obstruction,postoperative intestinal dysfunction and other intestinal diseases.It may produce antibacterial and anti-inflammatory effects mainly by inhibiting the expression of inflammatory factors such as IL-6 and IL-8,and promote gastric emptying and enhance intestinal motility by affecting the levels of serum 5-HT,VIP,ACh,AChE and other neurotransmitters,it can alleviate anxiety and depression,improve the quality of life,improve the total effective rate of treatment and reduce the recurrence rate.