基于“肝与大肠相通”探讨功能性便秘的防治

Exploring the Prevention and Treatment of Functional Constipation on the Basis of"The Communication Between Liver and Large Intestine"

功能性便秘是临床常见的疾病,患病率呈上升趋势,病程长,病情迁延,常伴有情志异常。情志因素成为功能性便秘发病及复发的重要影响因素,情志异常致肝气郁结,气机疏泄失常,大肠腑气不通,从而引起功能性便秘的发生。然便秘日久,其本在脾虚,脾失健运,升清降浊失常,又脾病及肝,肝失疏泄,气机郁滞,出现情志焦虑、抑郁等。故“见肝之病,知肝传脾”不仅包含肝病传脾、实脾防传和脾病及肝、肝脾相互影响的内涵,还不应缺少“肝与大肠相通”的新内涵。现代医学认为肝脏和胃肠道在解剖学上及功能上存在内在联系,“肠-肝”轴学说可为“肝与大肠相通”提供客观的证据支持。文章尝试从中医理论、现代医学研究、临床应用等方面论述“肝与大肠相通”理论,及在其指导下运用“肝脾同调”法治疗功能性便秘。

Functional constipation is a common clinical disorder with an increasing prevalence,a long and prolonged course,and often accompanied by emotional abnormalities.Emotional factors have become an important influence on the onset and recurrence of functional constipation,emotional anomalies to liver qi stagnation,Qi mechanism drainage is not normal,the large intestine viscera qi does not pass,thus causing functional constipation occurs.However,constipation for a long time,its root in the spleen deficiency,spleen loss of healthy transportation,ascending clear and descending turbid disorder,and spleen disease and liver,liver loss of excretion,qi stagnation,emotional anxiety,depression and so on.Therefore,"when one sees a disease of the liver,one knows that the liver transmits to the spleen"not only includes the connotation of liver disease transmitting to the spleen,the prevention of transmission by the actual spleen,spleen disease and liver,and the interaction between the liver and the spleen,but should not lack the new connotation of"the liver and the large intestine are connected".Western medicine believes that the liver and the gastrointestinal tract are intrinsically linked anatomically and functionally,and that the"intestinal-liver"axis provides objective evidence to support the idea that the liver is connected to the large intestine.This article attempts to discuss the theory of"the liver is connected with the large intestine"from the aspects of traditional Chinese medicine theory,modern medical research,and clinical application,and the treatment of functional constipation with the method of"the liver and the spleen are adjusted together"under the guidance of this theory.