基于“伏邪理论”探讨中医药抗溃疡性结肠炎复发的诊疗策略

Exploration of the Diagnosis and Treatment Strategies of Traditional Chinese Medicine in Preventing Recurrence of Ulcerative Colitis Based on“the Theory of Hidden Pathogens”

溃疡性结肠炎(ulcerative colitis,UC)是一种病因尚未阐明的好发于直肠和结肠的慢性炎症性疾病,目前尚无确切有效的治疗方法,其具有周期性、反复发作等发病特点,此与中医学“伏邪理论”认识趋同。该文试从中医“伏邪理论”入手,回顾相关典籍,结合本团队的临床经验,对UC的中医发病机制进行重新探讨。认为湿热、瘀血是伏邪的重要组成部分,脾虚是伏邪产生的基础,而伏邪所致的肠络受损是UC发生的病理基础,因此临证遣方用药时谨遵扶正祛邪、透邪外出的治疗总纲,提出清热利湿是祛除伏邪的首要治则,健脾温中为重要保障,理气活血是主要方式,而顾护胃气则需贯穿治疗始终,由此创立的清肠温中方具有明显的临床疗效,并能有效防治UC的复发。该文分别从“伏邪理论”源流、伏邪在UC发病中的特点及在诊疗中的应用等探讨了中医药抗UC复发的诊疗策略,并附本团队防治UC复发的经验,以期对该病的临床治疗有所裨益。

Ulcerative colitis(UC)is a chronic inflammatory disease that has not yet been elucidated and is prone to occur in the rectum and colon.Currently,there is no effective treatment method.UC has the characteristics of periodicity and recurrent attacks,which are consistent with the“the theory of hidden pathogens”in traditional Chinese medicine.This article focuses on the“the theory of hidden pathogens”,reviews relevant literature,and combines the clinical experience of our team to re explore the pathogenesis of UC in traditional Chinese medicine.We believe that damp-heat and blood stasis are important components of hidden pathogens,spleen deficiency is the basis for its occurrence,and the damage of intestinal collaterals caused by it is the pathological basis for the occurrence of UC.Therefore,we strictly adhere to the overall treatment principle of“strengthening the body and dispelling pathogenic factors,and penetrating pathogenic factors to go out”in clinical treatment.We propose that“clearing heat and promoting dampness is the primary treatment principle for dispelling latent pathogens,strengthening the spleen and warming the middle is an important guarantee,regulating Qi and promoting blood circulation is the main method,and caring for stomach Qi needs to be integrated throughout the treatment”.The Qingchang Wenzhong Decoction(清肠温中方)established from this has significant clinical efficacy and can effectively prevent and treat the recurrence of UC.This article explores the diagnosis and treatment strategies of Traditional Chinese medicine for preventing UC recurrence from the perspective of the origin and development of the“hidden pathogens”,its characteristics in the pathogenesis of UC,and its application in the diagnosis and treatment of UC.The experience of our team in preventing and treating UC recurrence is also attached,with the aim of providing some insights into the clinical treatment of this disease.