沈舒文症位多维调治慢性溃疡性结肠炎经验

Shen Shuwen′s Multi-dimensional Method in Treatment of Chronic Ulcerative Colitis

慢性溃疡性结肠炎的基本病机在于湿热偏盛、正气亏虚,邪损正、正恋邪贯穿于病程始终,反复发作,缠绵难愈,治疗当从症位变化多维调治,根据疾病分期的病理状态选择用药,疾病症状及发生传变多与湿热、寒湿、肝络失和、脾虚及肾、寒热错杂等有关。故治湿热脓血便以清化湿热、清热凉血为法;治寒湿白冻便以温运脾阳、化寒湿、导肠滞为法;肝络失和腹痛当以柔肝行气、化瘀止痛为法;脾虚及肾之泄泻久泻当以温运脾肾、化湿止泻为法;寒热错杂以调衡并用、温脾清肠为法。临证常用药物可以分为治脓血便、导滞通腑、柔肝行气、厚肠收涩、健脾补气、益气托疮生肌6组经验用药,各组药物互相配伍,多维调治疾病。

The basic pathogenesis of chronic ulcerative colitis lies in the prevalence of Dampness and Heat as well as the deficiency of Zheng Qi.The evil factors damage the Zheng Qi while the Zheng Qi is convolved throughout the course of the disease.With repeated attacks and lingering evil factors,the disease is difficult to be healed.The treatment should be multi-dimensional adjustment based on the changes of the symptom,and medication should be carried out according to the pathological state of the disease stage.The disease symptoms and the occurrence of transmission are mostly related to Dampness and Heat,Cold and Dampness,Liver collateral disharmony,Spleen deficiency injuring Kidney as well as mixed conditions of Cold and Heat,etc.Therefore,the treatment of bloody purulent stool with Dampness-Heat syndrome should focus on clearing and removing Dampness-Heat as well as clearing Heat to cool the blood;The treatment of Cold-dampness typed white freezing stool should focus on warming and encouraging the Spleen Yang,to dissolve Cold and Dampness to remove the intestinal stagnation of the stool;The treatment of abdominal pain with Liver collateral disharmony should focus on softening and promoting the Liver Qi to dissolve blood stasis and relieve pain;The treatment of prolonged diarrhea with Spleen deficiency induced kidney deficiency should focus on warming the Spleen and Kidney to dissolve Dampness and stop diarrhea;The treatment of mixed conditions of Cold and Heat should focus on corresponding methods of warming the Spleen and clearing the intestine Heat.The commonly used drugs for clinical syndrome can be divided into 6 groups of empirical prescriptions:treating bloody purulent stool,guiding stagnation and dredging the intestines,softening and promoting the Liver Qi,strengthening the intestine in astringency,tonifying the Spleen Qi as well as invigorating Qi to resolving sores and supporting wound healing.