风药在腹泻型肠易激综合征中的应用

Application of wind-drugs in the treatment of diarrhea-predominant irritable bowel syndrome

腹泻型肠易激综合征是临床上最常见的疾病,以慢性、反复发作的腹痛或腹部不适为主要特征,常伴有排便习惯改变,而又缺乏器质性疾病解释的临床症状。现代医学认为,腹泻型肠易激综合征的病理生理学机制尚未明确,仅仅知道其作用机制与内脏敏感性、肠道运动异常、肠道感染及肠道炎症、精神神经因素、免疫因素、自主神经功能障碍、肠道微生物失调、肠渗透性等有关。中医理论目前认为,本病发病的基础是脾虚湿盛,但以肝郁为标,脾虚为本,肝郁脾虚相互影响,互为因果,为病机关键之所在;肠风内扰则为本病发病之关键。本病久则脾阳日亏,可累及肾阳,肾阳命门火衰,无以暖脾胃之土,故水谷精微不化而泄泻愈重。目前西医的治疗效果欠佳,运用中医药治疗取得了一定成功,尤其风药的运用更是有举足轻重的作用。风药味薄、气轻,具有升发、疏散、走窜的特性,有调脾胃之气机、升提脾中之阳、醒脾化湿及疏肝利胆等功效,而药理研究表明,风药能抗过敏、调节免疫、抗炎、调节胃肠蠕动、抑菌及镇痛,故临床上若疗效不佳,可根据患者出现的症状加用风药。在临床用药中,诸多医家推崇风药用在治疗腹泻型肠易激综合征中,其疗效显著。

Diarrhea-predominant irritable bowel syndrome(IBS-D)is the most common disease in clinical practice,characterized by chronic,recurrent abdominal pain or discomfort,often accompanied by changed bowel habits,and lack of clinical symptoms explained by organic diseases.Modern medicine believes that the pathophysiological mechanism of IBS-D is not clear,only knowing that its mechanism is related to visceral sensitivity,abnormal intestinal movement,intestinal infection and inflammation,psychoneurotic factors,immune factors,autonomic nervous dysfunction,intestinal microbial imbalance,intestinal permeability,etc..At present,most of the traditional Chinese medicine theories believe that the basis of the disease is spleen deficiency and dampness,but with liver depression as the symptom,spleen deficiency as the basis,liver depression and spleen deficiency are mutual influence,mutual causation,and the key to the pathogenesis;intestinal wind internal disturbance is the key to the pathogenesis of the disease.The long course causes spleen Yang(阳)deficiency,can involve kidney Yang,fire failure of Mingmen(命门)kidney Yang causes the spleen and stomach deficiency,so the water and valley are not changed and diarrhea is more serious.At present,the effect of western medicine is not good,and the use of traditional Chinese medicine can achieve a certain success,especially the use of wind-drugs is more important.Wind-drugs are thin and light,with the characteristics of ascending,evacuating and moving,and the functions of regulating Qi(气)movement of the spleen and stomach,lifting Yang in the spleen,strengthening the spleen and relieving the dampness,soothing the liver and gallbladder,etc..Pharmacological studies in modern Western medicine show that wind-medicine has the functions of anti-allergy,immune regulation,anti-inflammatory,gastrointestinal peristalsis,bacteriostasis and analgesia,so if the clinical effect is not good,wind-drugs can be added according to the symptoms of patients.Because of its remarkable curative effect,it is recommended by many physicians in clinical medicine for the treatment of IBS-D.