刘启泉治疗腹泻型肠易激综合征用药特点
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摘要
刘启泉认为"肝脾失调、心神失养"为腹泻型肠易激综合征主要病机,以"调和肝脾、养心安神、解郁理肠、宣肺达表"为治疗大法,在治疗中运用调气、安神、化湿、补虚、宣肺等方法,疗效显著。腹泻型肠易激综合征初期,多为肝失疏泄,肝气郁结,横逆犯脾,继而导致脾失健运,湿邪阻滞,气机不升,通降不利,在治疗此类患者时,以调理气机、抑肝扶脾为原则,避免应用温燥之品,谨慎运用开破之药。用药上常选用荔枝核、预知子、柴胡、延胡索等理气之药。治疗久病之累及心神患者时,多选用养心安神之药,诸如夜交藤、合欢花、炒酸枣仁等,亦喜用芳香之品,如藿香、佩兰、茵陈、紫苏叶,以达芳香化湿,宣畅气机之效。泄泻日久,病程迁延,患者体质减弱,逢天气变化或冷暖不适时易感受外邪,而致肺气郁闭失宣,治疗此类患者不可一味以脾胃论治,在基本治疗的基础上,可运用"逆流挽舟"法,加用荆芥、桑叶、苏叶等清宣肺气之药,清开肺气则会达到较好效果。
Liu Qi-quan believes that the main pathogenesis of irritable bowel syndrome of diarrhea type is liver-spleen disorder and mental disorder. The principle treatments of it include"harmonizing liver and spleen,nourishing heart and tranquilizing mind,relieving depression and regulating intestine". In clinical practice,the methods of regulating qi,calming mind,removing dampness,tonifying deficiency,and dispersing lung qi are used,and the effect is remarkable. In the early stage of irritable bowel syndrome of diarrhea type,liver failure in catharsis,liver-qi depression and transgression of the spleen,lead to spleen dysfunction,damp pathogen blockade,qi stagnation and unfavorable ventilation. In the treatment of such patients,the principle of regulating qi movement,inhibiting liver and strengthening the spleen should be taken,while warming and drying products should be avoided,and the use of cracking drugs should be cautious. The drugs for regulating qi,such as Lizhihe( Semen Litchi),Yuzhizi( Fructus Akebiae),Chaihu( Radix Bupleuri),Yanhusuo( Rhizoma Corydalis),etc. are often used. In the treatment of patients suffering from chronic illness,the medicines of nourishing heart and tranquilizing mind,such as Yejiaoteng( Caulis Polygoni Multiflori),Hehuanhua( Flos Albiziae),fried Suanzaoren( Semen Ziziphi Spinosae),etc. are often chosen. Aromatic products,such as Huoxiang( Herba Agastachis),Yinchen( Herba Artemisiae Scopariae) and Zisuye( Folium Perillae) can also be used to achieve the effect of aromatizing dampness and ventilating qi. For patients with prolonged diarrhea,prolonged course of disease,weakened physique,vulnerable to exogenous pathogens when weather changes or cold or warm discomfort,and lung qi depression and loss of circulation,they should not be blindly treated based on the spleen and stomach,on the basis of basic treatment,the method of"counter-current boat pulling"can be adopted,and other drugs to clear lung qi such as Jingjie( Herba Schizonepetae),Sangye( Folium Mori) and Suye( Folium Perillae) can be added to achieve better efficacy.
Liu Qi-quan believes that the main pathogenesis of irritable bowel syndrome of diarrhea type is liver-spleen disorder and mental disorder. The principle treatments of it include"harmonizing liver and spleen,nourishing heart and tranquilizing mind,relieving depression and regulating intestine". In clinical practice,the methods of regulating qi,calming mind,removing dampness,tonifying deficiency,and dispersing lung qi are used,and the effect is remarkable. In the early stage of irritable bowel syndrome of diarrhea type,liver failure in catharsis,liver-qi depression and transgression of the spleen,lead to spleen dysfunction,damp pathogen blockade,qi stagnation and unfavorable ventilation. In the treatment of such patients,the principle of regulating qi movement,inhibiting liver and strengthening the spleen should be taken,while warming and drying products should be avoided,and the use of cracking drugs should be cautious. The drugs for regulating qi,such as Lizhihe( Semen Litchi),Yuzhizi( Fructus Akebiae),Chaihu( Radix Bupleuri),Yanhusuo( Rhizoma Corydalis),etc. are often used. In the treatment of patients suffering from chronic illness,the medicines of nourishing heart and tranquilizing mind,such as Yejiaoteng( Caulis Polygoni Multiflori),Hehuanhua( Flos Albiziae),fried Suanzaoren( Semen Ziziphi Spinosae),etc. are often chosen. Aromatic products,such as Huoxiang( Herba Agastachis),Yinchen( Herba Artemisiae Scopariae) and Zisuye( Folium Perillae) can also be used to achieve the effect of aromatizing dampness and ventilating qi. For patients with prolonged diarrhea,prolonged course of disease,weakened physique,vulnerable to exogenous pathogens when weather changes or cold or warm discomfort,and lung qi depression and loss of circulation,they should not be blindly treated based on the spleen and stomach,on the basis of basic treatment,the method of"counter-current boat pulling"can be adopted,and other drugs to clear lung qi such as Jingjie( Herba Schizonepetae),Sangye( Folium Mori) and Suye( Folium Perillae) can be added to achieve better efficacy.
引文
[1]中华中医药学会脾胃病分会.肠易激综合征中医诊疗专家共识意见(2017)[J].中医杂志,2017,58(18):1615-1620.
[2] CELEBI S,ACIK Y,DEVECI SE,et al. Epidemiological features of irritable bowel syndrome in a Turkish urban so-ciety[J]. J Gastroenterol Hepatol,2004,19(7):738-743.
[3]邓建春.中医治疗腹泻型肠易激综合征研究进展[J].北方药学,2016,13(2):130-131.
[4]于红菲.谢晶日教授治疗腹泻型肠易激综合征用药规律的研究[D].哈尔滨:黑龙江中医药大学,2017.
[5]成亚亚.柴芍调肝方治疗肝郁脾虚型肠易激综合征临床研究[D].石家庄:河北医科大学,2015.
[6]刘启泉,石芳,张娜娜,等.从“心为噫”论治慢性萎缩性胃炎嗳气[J].中医杂志,2017,58(6):520-522.
[7]刘启泉,王志坤.刘启泉胃病临证录[M].北京:人民军医出版社,2013:89,103.
[8]张纨.刘启泉医案医话集[M].北京:中国医药科技出版社,2016:86.
[2] CELEBI S,ACIK Y,DEVECI SE,et al. Epidemiological features of irritable bowel syndrome in a Turkish urban so-ciety[J]. J Gastroenterol Hepatol,2004,19(7):738-743.
[3]邓建春.中医治疗腹泻型肠易激综合征研究进展[J].北方药学,2016,13(2):130-131.
[4]于红菲.谢晶日教授治疗腹泻型肠易激综合征用药规律的研究[D].哈尔滨:黑龙江中医药大学,2017.
[5]成亚亚.柴芍调肝方治疗肝郁脾虚型肠易激综合征临床研究[D].石家庄:河北医科大学,2015.
[6]刘启泉,石芳,张娜娜,等.从“心为噫”论治慢性萎缩性胃炎嗳气[J].中医杂志,2017,58(6):520-522.
[7]刘启泉,王志坤.刘启泉胃病临证录[M].北京:人民军医出版社,2013:89,103.
[8]张纨.刘启泉医案医话集[M].北京:中国医药科技出版社,2016:86.