谢晶日教授辨治溃疡性结肠炎经验

Professor XIE Jingri’s Experience in Treating Ulcerative Colitis

[目的]分析总结全国名老中医谢晶日教授临证辨治溃疡性结肠炎的经验。[方法]通过跟随门诊学习,整理并分析医案,翻阅古籍资料,从谢师对溃疡性结肠炎病机的认识,临证分析辨证及用药等方面,分析其临床治疗经验,并举医案一则加以证明。[结果]谢师认为,溃疡性结肠炎多由饮食、起居、情志等因素导致,其病位在大肠,与脾胃,肝、肾相关。发病根本原因是脾虚,证候要素以脾虚湿盛、湿热、寒湿、阴虚、阳虚、气滞、血瘀为主,活动期以邪实为主,缓解期以正虚为主,提出以寒、热、虚、实为纲辨治,热者以湿热蕴结为实,以阴亏热稽为虚;寒者以寒湿内停为实,以脾肾阳脱为虚。拟定了清肠燥湿、养阴泄热,化湿温中、升阳固脱,健脾疏肝、扶正固本,调气和血、化瘀敛疡的治疗法则,其中健脾疏肝、调和气血的治法应用于患者的全程治疗。所举医案患者病情反复发作10余年,为痢疾之脾肾阳虚证,以温补脾肾、固涩止泻为治则,治疗后诸症好转,恢复正常。[结论]谢师以寒、热、虚、实为纲,辅以健脾疏肝、调气和血治疗溃疡性结肠炎,思路清晰,疗效显著,具有重要的临床实用价值。

[Objective]To analyze and summarize the experience of Professor XIE Jingri,a famous old Chinese medicine doctor,in the diagnosis and treatment of ulcerative colitis(UC).[Methods]The clinical treatment experience of UC was analyzed from the aspects of understanding of the pathogenesis of UC,syndrome differentiation and medication,etc.by following the outpatient department,sorting out and analyzing medical records and reading ancient books.And the article cited a medical case to prove it.[Results]Professor XIE believes that the etiology is mainly caused by diet,daily life,mood and other factors,and the disease is located in the large intestine,related to spleen and stomach,liver and kidney.The basic cause of the disease is spleen deficiency,and the main factors of syndrome are dampness of spleen deficiency,dampness and heat,cold and dampness,Yin deficiency,Yang deficiency,Qi stagnation and blood stasis.According to the characteristics of the disease,it is considered that the main syndromes of the disease are excess pathogen in the active stage,and deficiency of positive Qi in the remission stage.It is put forward to distinguish and treat cold,heat,deficiency and excess.For the heat type,the excess is due to the accumulation of damp-heat,and the deficiency is due to Yin deficiency and heat retention.For the cold type,the stagnation of cold-dampness in the interior is the excess,and the collapse of spleen and kidney Yang is the deficiency.It is mainly used to clear the intestine and dry the dampness,nourish Yin and dissipate heat;remove dampness and warm the interior,and elevate Yang to cure prostration;invigorate the spleen and liver,strengthen the foundation;regulate Qi and harmonize blood,remove stasis and convergent ulcer.Among them,the methods of invigorating the spleen and regulating the liver,regulating Qi and harmonizing blood are applied to the whole treatment of UC patients.The case mentioned was that the patient suffered from repeated attacks of dysentery with deficiency of spleen and kidney Yang syndrome for more than 10 years.The therapeutic principles were warming and tonifying the spleen and kidney,astringing and relieving diarrhea.After treatment,the symptoms were relieved and he returned to normal.[Conclusion]Professor XIE takes cold,heat,deficiency and excess as the outline,supplemented by invigorating the spleen,soothing the liver,regulating Qi and harmonizing blood in the treatment of UC.With clear thinking and significant curative effect,this method has important clinical and practical value.