徐健众主任中医师治疗久泻的经验总结

Chief Physician XU Jianzhong’s experience in treating chronic diarrhea

慢性腹泻是消化系统常见疾病之一,属于中医“久泄”范畴,具有长期反复发作的特点,影响患者身心的健康。西医治疗该病的方法单一,效果欠佳。徐健众主任中医师从医30余年,治疗久泄具有丰富的临床经验。徐师认为久泻核心病机为五脏失和,浊邪内生,其中五脏失和为之本,脾虚为五脏失和的核心,而心、肝、肺、肾导致的久泄多发生在脾虚的基础之上;浊邪内生为之标,其中又以湿邪最为常见,并且影响疾病的发展,部分可合并“阳虚”“气郁”“血瘀”“食滞”等,虚实夹杂、寒热并见。治疗上以安五脏,祛浊邪为主,安五脏以健脾助运为要,从健脾益气、恢复中焦升降功能、消食和胃三个方面入手,可灵活配合使用疏肝、宣降肺气、安神、补肾等方法。祛浊邪以化湿为首要,以薛生白的祛湿四法(宣湿、燥湿、化湿、渗湿)为法,以四君子汤、参苓白术散、资生丸等为基础方加减,同时灵活配合使用治泻九法,临床效果显著。部分慢性腹泻为器质性疾病导致,因此徐师重视通过肠镜等检查排除器质性疾病。此外,因慢性腹泻易反复,徐师重视巩固治疗及调护。

Chronic diarrhea is one of the common diseases of digestive system.It belongs to the category of long diarrhea in TCM.It has the characteristics of long-term recurrence,affecting the physical and mental health of patients.The treatment of the disease in Western medicine is simplex and ineffective.Chief Physician XU Jianzhong has practiced medicine for more than thirty years,and has rich clinical experience in treating chronic diarrhea.Mr.XU believes that the core pathogenesis of chronic diarrhea isC the disharmony of internal organs,and endogenous turbid pathogen.Disharmony of internal organs is the root cause,and spleen deficiency is the core of disharmony of internal organs,while chronic diarrhea caused by heart,liver,lung,and kidney dysfunction mostly occurred on the basis of spleen deficiency.Endogenous turbid pathogen is superficial syndrome,among which dampness is the most common and affects the progess of diseases.Some patients may also have Yang(阳)deficiency,Qi(气)stagnation,blood stasis,food stagnation and other syndroms,with mixed deficiency and excess,cold and heat.The main treatment method is to restore the normal function of internal organs and dispel turbid pathogen.In order to restore the normal function of internal organs,invigorating spleen to enhance the function of transportation is regarded as the main means,and it can start from three aspects of invigorating spleen and Qi,restoring function of middle energizer,and promoting digestion,flexibly supplemented by methods such as soothing liver,decending Qi of lung,calming the mind and tonifying the kidney.In terms of dispelling turbid pathogens,it is important to remove dampness,and four methods of removing dampness(dispersing dampness,drying dampness,removing dampness,and seeping dampness)of XUE Shengbai,a TCM master in the Qing Dynasty,are taken as the treatment methods.The Sijunzi decoction(四君子汤),Shenling Baizhu San(参苓白术散),Zisheng Wan(资生丸)are often used as basic prescriptions,flexibly supplemented by the nine methods of treating diarrhea,with good effects in clinical practice.Some chronic diarrhea is caused by organic diseases,so Mr.XU attaches importance to excluding organic diseases by colonoscopy and other inspection.In addition,because chronic diarrhea is easy to relapse,Mr.XU also attaches importance to consolidating the curative effect and nursing of patients.