徐陆周从湿热瘀滞病机论治溃疡性结肠炎的经验

XU Luzhou’s experience in treating ulcerative colitis from the pathogenesis of damp-heat stasis

溃疡性结肠炎是一种非特异性肠道炎症性疾病,该病通常被认为与遗传易感、环境变化、感染、肠黏膜免疫异常等因素有关,是常见的消化系统疑难病。患者临床表现为持续或反复发作的腹痛、腹泻、黏液脓血便,可伴有皮肤、黏膜、关节、眼、肝胆等肠外表现。临床维持症状缓解较难实现,大多数患者因饮食不慎或者劳累、受凉等极易复发,导致病程漫长,迁延难治。南京中医药大学附属医院徐陆周主任认为脾虚是发病的基础,感受外邪、饮食不洁是溃疡性结肠炎的发病诱因,湿热瘀滞为该病的主要病机,病位在大肠,常涉及脾、肾、肝、肺,总以“祛邪导滞、清肠化湿、健脾益气”为治疗原则。在治疗上,徐主任主张要依据疾病的不同分期随证施治,以清肠化湿、祛邪导滞、凉血活血,健脾温肾之法治疗溃疡性结肠炎,主张在5-氨基水杨酸治疗的基础上结合中药口服及灌肠治疗,发挥中医药点面结合的治疗优势,可达到快速诱导缓解、长期维持缓解,促进黏膜及组织学愈合的目标。文章通过案例,介绍徐主任治疗溃疡性结肠炎的成功经验,以期为临床提供参考。

Ulcerative colitis is a nonspecific inflammatory disease of the intestine,which is generally thought to be related to genetic predisposition,environmental changes,infection,intestinal mucosal immune abnormalities,and other factors,and is a common digestive system.The clinical manifestations of patients are persistent or recurrent abdominal pain,diarrhea,mucopurulent and bloody stools,which may be accompanied by extraintestinal manifestations such as skin,mucous membranes,joints,eyes,hepatobiliary and so on.Clinical maintenance and remission are difficult to achieve,and most patients are prone to recurrence due to careless diet,fatigue,cold,etc.,resulting in a long course of disease and prolongation and refractory treatment.Director XU Luzhou of the Affiliated Hospital of Nanjing University of Chinese Medicine believes that spleen deficiency is the basis of the disease,exopathogen and unclean diet are the causes of ulcerative colitis,stagnant dampness-heat is the main pathogenesis,the disease is located in the large intestine,often involving the spleen,kidney,liver,lungs,take strengthening vital Qi(气)and removing stagnation,clearing intestinal and eliminating dampness,strengthening the spleen and replenishing Qi as the principle of treatment.In terms of treatment,Director XU advocated that ulcerative colitis should be treated according to the different stages of the disease,and ulcerative colitis should be treated by strengthening vital Qi and removing food stagnation,clearing intestinal and eliminating dampness,blood cooling and promoting,invigorating spleen and warming kidney.Dr.XU advocates combining oral and enema therapy with 5-aminosalicylic acid to develop the therapeutic advantages of Chinese medicine,which can achieve rapid symptom relief,long-term maintenance effect,and promote mucosal and histological healing.This paper introduces Director XU’s successful experience in the treatment of ulcerative colitis through cases,in order to provide clinical reference.