肠易激综合征与体质的相关性研究
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摘要
目的：通过对2009年3月-2010年1月江苏省中医院消化科门诊及住院肠易激综合征(IBS)病例资料收集分析,初步探讨IBS患者与中医体质类型的相关性,进而总结出IBS的易感体质类型,为IBS的预防和治疗提供借鉴。
方法：采用问卷调查的方法,收集肠易激综合征患者247例,按中医体质量表分别判定为平和质、气虚质、阳虚质、阴虚质、痰湿质、湿热质、瘀血质、气郁质、特禀质等9种体质类型。采用Microsoft Excel建立数据库,使用SPSS13.0统计软件,分析肠易激综合征患者的性别、年龄、居住地、职业、病程、西医分型与中医体质类型的关系。
结果：
1、肠易激综合征患者中医体质类型出现的频率依次为气郁质(34.8%)>阳虚质(28.0%)>平和质(10.1%)>气虚质(8.9%)>湿热质(7.7%)>痰湿质(6.1%)>阴虚质(2.0%)>特禀质(1.6%)>瘀血质(0.8%)。
2、肠易激综合征西医分型与中医体质类型密切相关：腹泻型患者中体质出现频率分别为：阳虚质>气郁质>平和质>气虚质>痰湿质>湿热质>特禀质>瘀血质=阴虚质；便秘型患者中体质出现频率分别为：气郁质>湿热质>阳虚质>平和质=阴虚质>气虚质=特禀质>痰湿质=瘀血质；混合型患者中体质出现频率分别为：气郁质>阳虚质>平和质=气虚质>湿热质=特禀质>瘀血质=阴虚质=痰湿质；不定型患者中体质出现频率分别为：气郁质>平和质=气虚质=湿热质>阳虚质=阴虚质=瘀血质>痰湿质=特禀质。中医体质类型分布在不同IBS西医分型中的差别有统计学意义(P<0.05)。
3、未发现患者的性别、年龄、居住地、职业及病程与中医体质类型的相关性。
结论：
1、肠易激综合征与中医体质存在一定的相关性,多见于气郁质、阳虚质,与肠易激综合征的病机基本一致,即以肝郁脾虚,肝脾不和为主。
2、肠易激综合征分型与中医体质类型密切相关：腹泻型患者以阳虚质及气郁质为主；便秘型患者以气郁质及湿热质为主；混合型及不定型患者均以气郁质为主。
3、本研究启示肠易激综合征患者体质有一定的偏颇,因此通过调整体质,可以达到防治疾病的目的。
Objective:To analyze the distribution of TCM Constitution in irritable bowel syndrome patients who diagnosed and treated in Gastrointestinal Department of jiangsu provincial TCM Hospital from March 2009 to January 2010; explore the relationship between irritable bowel syndrome and TCM Constitution; summarized the popular tendency of IBS, and hence to provide a new ideas for the prevention and treatment of IBS.
Methods:By means of question investigations,247patients with irritable bowel syndrome are gathered. They are categorized into nine constitution types, namely, gentleness type, qi-deficiency type, yang-deficiency type, yin-deficiency type, phlegm-wet type, wetness-heat type, blood-stasis type, qi-depression type, and special inherited type. Data base was established, the relationship of TCM constitution with gender, age, residence, occupation, course of disease and IBS sub-types were analyzed by SPSS 13.0 statistical software.
Results:1.The frequency of TCM Constitution types in irritable bowel syndrome in descending order is:qi-depression type(34.8%)>yang-deficiency type(28.0%)>gentleness type(10.1%)>qi-deficiency type(8.9%)>wetness-heat type(7.7%)>phlegm-wet type(6.1%) >yin-deficiency type (2.0%)>special inherited type (1.6%)>blood-stasis type(0.8%).
2. IBS sub-types differences existed in the constitution in Chinese medicine of the patients with IBS. The frequency on the patients who suffered IBS diarrhea in descending order is: yang-deficiency type>qi-depression type>gentleness type>qi-deficiency type>phlegm-wet type>wetness-heat type>special inherited type>blood-stasis type=.yin-deficiency type. The frequency on the patients who suffered IBS constipation in descending order is:qi-depression type>wetness-heat type>yang-deficiency type>gentleness type=yin-deficiency type>qi-deficiency type-special inherited type>phlegm-wet type=blood-stasis type. The frequency on the patients who suffered IBS-Mixed in descending order is:qi-depression type>yang-deficiency type>gentleness type=qi-deficiency type>wetness-heat type=special inherited type>blood-stasis type=yin-deficiency type=phlegm-wet type. The frequency on the patients who suffered IBS-Unclassifiable in descending order is:qi-depression type>gentleness type=qi-deficiency type=wetness-heat type>yang-deficiency type=yin-deficiency type= blood-stasis type>phlegm-wet type=special inherited type. There was statistic difference between IBS sub-types differences and the constitution in Chinese medicine (P<0.05).
3. No correlation is found between TCM Constitution types in irritable bowel syndrome and the patients'gender, age, residence, occupation and course of the disease.
Conclusion:
1. Irritable bowel syndrome is correlated with TCM Constitution types; abnormal constitution is common in qi-depression type, yang-deficiency type, which conforms to the pathogenesis of irritable bowel syndrome:liver stagnation and spleen deficiency.
2. IBS sub-types differences existed in the constitution in Chinese medicine of the patients with IBS. The biased constitution in the patients who suffered IBS diarrhea were yang-deficiency type and qi-depression type; the biased constitution in the patients who suffered IBS constipation were qi-depression type and wetness-heat type; the biased constitution in the patients who suffered IBS-Mixed and IBS-Unclassifiable were qi-depression type.
3. It is indicative by this study that the patients with irritable bowel syndrome have a certain bias TCM constitution. Therefore, by means of adjusting to the biased constitution, the effects of prevention and treatment of IBS can be attained.
方法：采用问卷调查的方法,收集肠易激综合征患者247例,按中医体质量表分别判定为平和质、气虚质、阳虚质、阴虚质、痰湿质、湿热质、瘀血质、气郁质、特禀质等9种体质类型。采用Microsoft Excel建立数据库,使用SPSS13.0统计软件,分析肠易激综合征患者的性别、年龄、居住地、职业、病程、西医分型与中医体质类型的关系。
结果：
1、肠易激综合征患者中医体质类型出现的频率依次为气郁质(34.8%)>阳虚质(28.0%)>平和质(10.1%)>气虚质(8.9%)>湿热质(7.7%)>痰湿质(6.1%)>阴虚质(2.0%)>特禀质(1.6%)>瘀血质(0.8%)。
2、肠易激综合征西医分型与中医体质类型密切相关：腹泻型患者中体质出现频率分别为：阳虚质>气郁质>平和质>气虚质>痰湿质>湿热质>特禀质>瘀血质=阴虚质；便秘型患者中体质出现频率分别为：气郁质>湿热质>阳虚质>平和质=阴虚质>气虚质=特禀质>痰湿质=瘀血质；混合型患者中体质出现频率分别为：气郁质>阳虚质>平和质=气虚质>湿热质=特禀质>瘀血质=阴虚质=痰湿质；不定型患者中体质出现频率分别为：气郁质>平和质=气虚质=湿热质>阳虚质=阴虚质=瘀血质>痰湿质=特禀质。中医体质类型分布在不同IBS西医分型中的差别有统计学意义(P<0.05)。
3、未发现患者的性别、年龄、居住地、职业及病程与中医体质类型的相关性。
结论：
1、肠易激综合征与中医体质存在一定的相关性,多见于气郁质、阳虚质,与肠易激综合征的病机基本一致,即以肝郁脾虚,肝脾不和为主。
2、肠易激综合征分型与中医体质类型密切相关：腹泻型患者以阳虚质及气郁质为主；便秘型患者以气郁质及湿热质为主；混合型及不定型患者均以气郁质为主。
3、本研究启示肠易激综合征患者体质有一定的偏颇,因此通过调整体质,可以达到防治疾病的目的。
Objective:To analyze the distribution of TCM Constitution in irritable bowel syndrome patients who diagnosed and treated in Gastrointestinal Department of jiangsu provincial TCM Hospital from March 2009 to January 2010; explore the relationship between irritable bowel syndrome and TCM Constitution; summarized the popular tendency of IBS, and hence to provide a new ideas for the prevention and treatment of IBS.
Methods:By means of question investigations,247patients with irritable bowel syndrome are gathered. They are categorized into nine constitution types, namely, gentleness type, qi-deficiency type, yang-deficiency type, yin-deficiency type, phlegm-wet type, wetness-heat type, blood-stasis type, qi-depression type, and special inherited type. Data base was established, the relationship of TCM constitution with gender, age, residence, occupation, course of disease and IBS sub-types were analyzed by SPSS 13.0 statistical software.
Results:1.The frequency of TCM Constitution types in irritable bowel syndrome in descending order is:qi-depression type(34.8%)>yang-deficiency type(28.0%)>gentleness type(10.1%)>qi-deficiency type(8.9%)>wetness-heat type(7.7%)>phlegm-wet type(6.1%) >yin-deficiency type (2.0%)>special inherited type (1.6%)>blood-stasis type(0.8%).
2. IBS sub-types differences existed in the constitution in Chinese medicine of the patients with IBS. The frequency on the patients who suffered IBS diarrhea in descending order is: yang-deficiency type>qi-depression type>gentleness type>qi-deficiency type>phlegm-wet type>wetness-heat type>special inherited type>blood-stasis type=.yin-deficiency type. The frequency on the patients who suffered IBS constipation in descending order is:qi-depression type>wetness-heat type>yang-deficiency type>gentleness type=yin-deficiency type>qi-deficiency type-special inherited type>phlegm-wet type=blood-stasis type. The frequency on the patients who suffered IBS-Mixed in descending order is:qi-depression type>yang-deficiency type>gentleness type=qi-deficiency type>wetness-heat type=special inherited type>blood-stasis type=yin-deficiency type=phlegm-wet type. The frequency on the patients who suffered IBS-Unclassifiable in descending order is:qi-depression type>gentleness type=qi-deficiency type=wetness-heat type>yang-deficiency type=yin-deficiency type= blood-stasis type>phlegm-wet type=special inherited type. There was statistic difference between IBS sub-types differences and the constitution in Chinese medicine (P<0.05).
3. No correlation is found between TCM Constitution types in irritable bowel syndrome and the patients'gender, age, residence, occupation and course of the disease.
Conclusion:
1. Irritable bowel syndrome is correlated with TCM Constitution types; abnormal constitution is common in qi-depression type, yang-deficiency type, which conforms to the pathogenesis of irritable bowel syndrome:liver stagnation and spleen deficiency.
2. IBS sub-types differences existed in the constitution in Chinese medicine of the patients with IBS. The biased constitution in the patients who suffered IBS diarrhea were yang-deficiency type and qi-depression type; the biased constitution in the patients who suffered IBS constipation were qi-depression type and wetness-heat type; the biased constitution in the patients who suffered IBS-Mixed and IBS-Unclassifiable were qi-depression type.
3. It is indicative by this study that the patients with irritable bowel syndrome have a certain bias TCM constitution. Therefore, by means of adjusting to the biased constitution, the effects of prevention and treatment of IBS can be attained.
引文
[1]Moore Comunications, Inc. Break through in Patient Care for Irritable Bowel Syndrome [symposium update] [M].Fort Laude rule, Fla:GlaxowellCome,2000.
[2]王伟岸,钱家鸣,潘国宗.肠易激综合征的发病机制[J].胃肠病学和肝病学杂志,2001,10(6)：99.
[3]Garakani,Amir,Win,et al. Co morbidity of Irritable Bowel Syndrome in Psychiatric Patients:A Review. American journal of Therapeutics[J].2003,10(1):61.
[4]Go roll AH,Mulley jr. A. Primary Care Medicine [M].4 the d Philadelphia:LIPP in cot Williams & Wilkins, 2000,485.
[5]Da Poigny,Michel,Bell anger, et al. Irritable bowel syndrome In France:a conunon, debilitating and costly disorder [J]. European journal of Gastroenterology&Hepatology,2004,16(10):995.
[6]潘国宗,鲁素彩,柯美云,等.北京地区肠易激综合征的流行病学研究：一个整群、分层随机的调查[J].中华流行病学杂志,2000,21：26.
[7]熊理守,陈惠新,许岸高等.广东省社区人群肠易激综合征的流行病学研究[J].中华医学杂志,2004,84(4)：278-281.
[8]Hung in AP, Whorwell PJ, Tack J, et al. The prevalence, patterns and impact of irritable bowel syndrome:an international survey of 40,000 subjects[J].Aliment Pharmacology Ther,2003,17:643-650.
[9]Schnrich S, Dembski R, Resch, et al. Analyzing the Content of outcome measures in clinical trials on irritable bowel syndrome using the international classification of functioning, disability and health as a reference [J]. Rehabilitation (Stuttg),2006,45:172-180.
[10]Longstreth GF, Thompson WG, Chey WD, et al.Functional bowel disorders[J]. Gastroenterology, 2006,130:1480-1491.
[11]Drossman DA, CoraZZiariE, DelvauxM, Spiller RC.et al. RomeⅢ:The functional gastrointestinal disorders[M].Third Edition(KS).Alien Press,Inc,2006,492.
[12]BorowiecAM, FedorakRN. The role of probiotics in management of irritable bowel syndrome [J]. Curr Gastroenterol Rep,2007,9 (5):393-400.
[13]CremonC,GarganoL,Morselli-Labate AM, et al.Mucosal immune activation in irritable bowel syndrome: gender-dependence and association with digestive symptom. AmJGastroenterol.2009,104(2):392-400.
[14]CamilleriM,GormanH. Intestinal permeability and irritable bowel syndrome.Neurogastroenterol Motil.2007,19(7),545-552.
[15]BarbaraqwdngB, Stanghellini V, et al.Mast cell-dependent excitation of visceral-nociceptive sensory neurons inneurons in irritable bowel syndrome.Gastroenterology.2007,132(1):26-37.
[16]PataC, ErdalME, DericiE, et al.Serotonin transporter gene polymorphism in irritable bowel syndrome. Am[J].Gastroenterol.2002,97(7):178-184.
[17]Yeo A, Boyd P, Lumsden S, et al.Association between a functional Poly-morphs in the serotonin transporter gene and diarrhea predominant irritable bowel syndrome in women.Gut.2004,53(10):1452-1458.
[18]CamilleriM, CarlsonP, ZinsmeisterAR, et al. Mitochondrial DNA and gastro-intestinal motor and sensory functions in health and functional gastro-intestinal disorders. Am[J].Physiol Gastrointest Liver Physiol.2009,296(3):G510-G516.
[19]RokaR,WittmannT,BuenoL,et al.Altered protease signaling in the gut:a novel path physiological factor in irritable bowel syndrome.Neurogastro-enterolMotil.2008,20(8),853-856.
[20]CenaeN,Andrews CN,Holzhausen M,et al. Role for protease activity in visceral pain in irritable bowel syndrome[J].Clin Invest.2007,117(3):636-647.
[21]LiebregtsT, AdamB, Bredack C,et al.Immune activation in patients with irritable bowel syndrome. Gastroenterology 2007,132(3):913-920.
[22]DinanTqQuigleyEM, AllllledSM et al.Hypothalamic pituitary-gut axis dysregulation in irritable bowel syndrome:plasma cytokines as a potential biomarker?Gastroenterology2006,130(2):304-11.
[23]张海燕,吴萍,李延青等,肠易激综合征患者的免疫学机制探讨[J].胃肠病学和肝病学杂志.2006,15(3)：285-287.
[24]Morris-Yates A, Talley NJ, Boyce PM, Nandurkar S, Andrews G. Evidence of a genetic contribution to functional bowel disorder. Am[J].Gastroenterol 1998,93:1311-1317.
[25]Levy RL, Jones KR, Whitehead WE, Feld SI, Talley NJ, Corey LA. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology[J]. Gastroenterology 2001,121:799-804.
[26]朱爱芳,孟繁立,李延青.肠易激综合征患者的心理治疗与护理[J].中华护理志,2003,38(9)：690-692.
[27]RuigomezA, RodriguezLA, Johansson S,et al.Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome[J]. Maturities,2003,44(2):133-140.
[28]Houghton LA, Jackson NA, Whorwhell PJ, et al.Do male sex hormones protect from irritable bowel syndrome[J] Am J Gastroenterology,2000,95(9):2296-2300.
[29]黄翌,赵长鹰.肠易激综合征从情致论治探讨[J].山东中医杂志,2004,23(10)：379.
[30]汪静凤,刘煜.抑肝扶脾化痰祛瘀法治疗肠道易激综合征36例[J].南京中医药大学学报(自然科学版),2000,16(4)：2501.
[31]周福生,程宏辉,祝淑贞.心胃相关理论及临床应用[J].浙江中医学院学报,2004,28(2)：7.
[32]霍清萍.从肠易激综合征脑肠轴学说谈肝郁脾虚病理机制[J].中国中西医结合消化杂志,2005,13(5)：318-320.
[33]胡品津.从脑肠互动的高度认识肠易激综合征[J].中华消化杂志,2003,23(5)：261-262.
[34]吴至久.疏肝健脾法治疗肠易激综合征肝郁脾虚型临床研究[J].中华中医药学刊,2009,27(5)：1041—1043.
[35]张正利,蔡淦.肠易激综合征中医论治溯源[J].中国中医基础医学杂志,2001,07(07)：48.
[36]李国霞“胃强脾弱”考辨.上海中医药大学学报,2000,14(1)：13.
[37]TalleyNJ, Dennis EH, Schettler-Duncan VA, et al. Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea. Am J Gastroenterol,2003,98(11):2454-2459.
[38]龙艳芹,候晓华.肠易激综合征患者临床症状特点分析,胃肠病学,2007,12(1)：23-26.
[39]高峰,王景杰,黄裕新,等.肠易激综合症16例胃肠运动功能临床探讨[J].陕西医学杂志,2007,8(8)： 1903-1905.
[40]陶琳,柯美云,王智凤.小肠细菌过度生长与功能性胃肠疾病的关系[J].中国中西医结合消化杂志,2005,13(2)：122-123.
[41]王琦.中医体质学[M].人民卫生出版社,北京：2005,2.
[42]匡调元.论辨证与辨体质[J].中国中医基础医学杂志,2002,8(2)：1.
[43]孙广仁.中医基础理论[M].北京：中国中医药出版社,2003,202.
[44]王琦.东方生命科学的架构[J].中医药通报,2004,3(5)：3.
[45]朱燕波,王琦,折笠秀树.中医体质表的信度和效度评价[J].中国行为医学科学,2007,1(7)：651-654.
[46]鲁明源.体制学说—中医预防医学研究的切入点[J].山东中医,2003,(3)：54.
[47]中华医学会消化病学分会胃肠动力学组.肠易激综合征诊断和治疗的共识意见[J].中华消化杂志,2008,28：38.
[48]BengtsonMB, RnningT, VatnMH, et al Irritable bowel syndrome in twins:genes and environment [J]. Gut, 2006,55 (12):1754-1759.
[49]Locke GR 3rd, ZinsmeisterAR, Talley NJ,et al.Familial association in adults with functional gastrointestinal disorders[J].Mayo Chin Proc,2000,75(9):907-912.
[50]KanazawaM, EndoY, WhiteheadWE,et al.Patients and non consulters with irritable bowel syndrome reporting a parental history of bowel problem shave more impaired psychological distress[J].Dig Dis Sic 2004, 49(6):1046-1053.
[51]Chan g FY, LuCL. Irritable bowel syndrome in the 21st century:Perspectives from Asia or South-east Asia.Gastroenterol Hepatol 2007,22:4～12.
[52]RuigomezA, RodriguezLA, Johansson S,et al.Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome [J].Maturities,2003,44(2):133-140?
[53]Houghton LA, Jackson NA, Whorwhell PJ,et al.Domale sex hormones protect from irritable bowel syndrome[J] Am J Gastroenterology,2000,95(9):2296-2300.
[54]少萍.论七情致病的内在因素[J].中国医药学报,2002,17(6)：333.
[55]刘谦民,齐欣,郭全平,等.肠易激综合症与性格关系的探讨[J].中华内科杂志,2003,42(9)：602-604.
[56]张志雄,熊汉华,侯晓华.肠易激综合征患者心理评价[J].胃肠病学和肝病学杂志,2004,13(4)：396-399.
[57]Sugaya N,Nomura S.Relationship between cognitive appraisals of symptoms and negative mood for subtypes of irritable bowel syndrome[J].Bio Psycho Social Medicine,2008,2:9-15.
[58]吴正祥,解丽,张开光,等.功能性消化不良者心理因素与食管动力的关系[J].中国临床保健杂志,2007,10(5)：456-458.
[59]杨永红.肠易激综合征的病因探讨.医学综述,2004,10(1)：61-63.
[60]陆敏,沈洪.肠易激综合征中西医结合研究.中国临床医生,2005,33(4)：21-23.
[61]白浩,杨毅军.肠易激综合征和心理疾患.胃肠病学杂志,2000,9(2)：134-137.
[62]刘长灵.中医体质学现代研究进展[J].浙江中医药大学学报,2009,1(33)：138-139.
[63]周福生.肠易激综合征与体质的相关性研究[J].中医药学刊,2005,8(23)：1359-1361.
[64]王玉珍.谈中医体质学在临床的应用[J].中国航天医药杂志,2002,4(6)：79.
[65]宋明林.痛泻药方合甘麦大枣汤治疗肠易激综合征203例临床观察[J].河北中医,2007,29(8)：721-722.
[66]王国耀.痛泻要方加味治疗肠易激综合征76例[J].实用中医药杂志,2004,20(2)：68.
[67]陈维强,杨海泉.柴胡疏肝散加味治疗肠易激综合征61例疗效观察[J].新中医,2003,35(8)： 37.
[68]严付红.调肝扶脾益肾汤治疗腹泻型肠易激综合征38例[J].河南中医,2006,26(1)：59-60.
[69]袁雪晶,汪受传.论体质学说在中医儿科临床的应用[J].中医儿科杂志,2009,5(1)：11-14.
[70]Walker EA, Roy-Byrne PP, Katon WJ. Irritable bowel syndrome and psychiatric illness[J].Am J Psychiatry, 1990,147 (5):565-572.
[71]CruzRuizMA, OrtlzHerreraRB, Mufiiz JuradoD,et al.Association of depression and anxiety in patients with irritable bowel syndrome[J].Rev Gastroenterol Mex,2007,72(1):29-33.
[72]贾波,李晓红,梁显.白术茯苓汤对脾虚大鼠胃肠激素的影响.成都中医药大学学报,2001,24(4)：47.
[73]谢仁广.肠易激综合征辨治方法探讨.陕西中医,1999,20(9)：404-405.
[74]沈芸.蔡淦教授从肝脾论治肠易激综合征临床经验拾零.新中医,2002,34(4)：12-13.
[75]杨桦.疏肝理气配合心理疗法治疗肠易激综合征[J].云南中医学院学报,2000,23(4)：18-20.
[76]潘相学,谢建群.疏肝饮治疗肠易激综合征的临床疗效观察[J].上海中医药大学学报,2006,20(4)：48-50.
[77]何高潮,汪翠萍.调肝益脾法治疗腹泻型肠易激综合征56例[J].四川中医,2005(1)：50-51.
[78]石瑁,汪崇文,范可.中药痛泻药方治疗肠易激综合征疗效的荟萃分析[J].世界华人消化杂志,2007,15(17)：1934-1939.
[79]朱兆承.黄连逍遥汤治疗肠易激综合征32例.实用中医药杂志,2001,17(9)：18.
[80]申亚东,张锋.加味逍遥散治疗腹泻型肠易激综合征85例.河南中医药学刊,2000,15(6)：37-38.
[81]石君杰.疏肝健脾法治疗束缚应激肠易激综合征大鼠的实验研究.现代中西医结合杂志,2005,(6)：12.
[82]陈元鸿,叶文桃,曾运红,等.肠易激综合征患者的心理社会因素调查[J].预防医学论坛,2005,11(3)：271-272.
[83]刘爱萍,辛丽.肠易激综合征心理行为的调护[J].齐鲁护理杂志,1998,4(4)：68.
[84]曹中昌.心理治疗肠易激综合征的疗效观察[J].中国肛肠病杂志,1997,17(1)：23.
[85]Creed F, Fernandes L, Guthrie E, et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology,2003,124(2):303-317.
[86]曾莉,李春婷.慢性肠病中医治疗.南京：江苏科学技术出版社,2005,(9)：265-279.
[87]朱良如,侯晓华.胃肠感觉过敏在胃肠功能性疾病中的作用[J].中国实用内科杂志,2001,2(10)：557.
[88]Ehlin AG,Montgomery SM,Ekbom A, et al. Prevalence of gastrointestinal diseases in two British national birth cohorts.Gut,2003,52(8):1117-1121.
[2]王伟岸,钱家鸣,潘国宗.肠易激综合征的发病机制[J].胃肠病学和肝病学杂志,2001,10(6)：99.
[3]Garakani,Amir,Win,et al. Co morbidity of Irritable Bowel Syndrome in Psychiatric Patients:A Review. American journal of Therapeutics[J].2003,10(1):61.
[4]Go roll AH,Mulley jr. A. Primary Care Medicine [M].4 the d Philadelphia:LIPP in cot Williams & Wilkins, 2000,485.
[5]Da Poigny,Michel,Bell anger, et al. Irritable bowel syndrome In France:a conunon, debilitating and costly disorder [J]. European journal of Gastroenterology&Hepatology,2004,16(10):995.
[6]潘国宗,鲁素彩,柯美云,等.北京地区肠易激综合征的流行病学研究：一个整群、分层随机的调查[J].中华流行病学杂志,2000,21：26.
[7]熊理守,陈惠新,许岸高等.广东省社区人群肠易激综合征的流行病学研究[J].中华医学杂志,2004,84(4)：278-281.
[8]Hung in AP, Whorwell PJ, Tack J, et al. The prevalence, patterns and impact of irritable bowel syndrome:an international survey of 40,000 subjects[J].Aliment Pharmacology Ther,2003,17:643-650.
[9]Schnrich S, Dembski R, Resch, et al. Analyzing the Content of outcome measures in clinical trials on irritable bowel syndrome using the international classification of functioning, disability and health as a reference [J]. Rehabilitation (Stuttg),2006,45:172-180.
[10]Longstreth GF, Thompson WG, Chey WD, et al.Functional bowel disorders[J]. Gastroenterology, 2006,130:1480-1491.
[11]Drossman DA, CoraZZiariE, DelvauxM, Spiller RC.et al. RomeⅢ:The functional gastrointestinal disorders[M].Third Edition(KS).Alien Press,Inc,2006,492.
[12]BorowiecAM, FedorakRN. The role of probiotics in management of irritable bowel syndrome [J]. Curr Gastroenterol Rep,2007,9 (5):393-400.
[13]CremonC,GarganoL,Morselli-Labate AM, et al.Mucosal immune activation in irritable bowel syndrome: gender-dependence and association with digestive symptom. AmJGastroenterol.2009,104(2):392-400.
[14]CamilleriM,GormanH. Intestinal permeability and irritable bowel syndrome.Neurogastroenterol Motil.2007,19(7),545-552.
[15]BarbaraqwdngB, Stanghellini V, et al.Mast cell-dependent excitation of visceral-nociceptive sensory neurons inneurons in irritable bowel syndrome.Gastroenterology.2007,132(1):26-37.
[16]PataC, ErdalME, DericiE, et al.Serotonin transporter gene polymorphism in irritable bowel syndrome. Am[J].Gastroenterol.2002,97(7):178-184.
[17]Yeo A, Boyd P, Lumsden S, et al.Association between a functional Poly-morphs in the serotonin transporter gene and diarrhea predominant irritable bowel syndrome in women.Gut.2004,53(10):1452-1458.
[18]CamilleriM, CarlsonP, ZinsmeisterAR, et al. Mitochondrial DNA and gastro-intestinal motor and sensory functions in health and functional gastro-intestinal disorders. Am[J].Physiol Gastrointest Liver Physiol.2009,296(3):G510-G516.
[19]RokaR,WittmannT,BuenoL,et al.Altered protease signaling in the gut:a novel path physiological factor in irritable bowel syndrome.Neurogastro-enterolMotil.2008,20(8),853-856.
[20]CenaeN,Andrews CN,Holzhausen M,et al. Role for protease activity in visceral pain in irritable bowel syndrome[J].Clin Invest.2007,117(3):636-647.
[21]LiebregtsT, AdamB, Bredack C,et al.Immune activation in patients with irritable bowel syndrome. Gastroenterology 2007,132(3):913-920.
[22]DinanTqQuigleyEM, AllllledSM et al.Hypothalamic pituitary-gut axis dysregulation in irritable bowel syndrome:plasma cytokines as a potential biomarker?Gastroenterology2006,130(2):304-11.
[23]张海燕,吴萍,李延青等,肠易激综合征患者的免疫学机制探讨[J].胃肠病学和肝病学杂志.2006,15(3)：285-287.
[24]Morris-Yates A, Talley NJ, Boyce PM, Nandurkar S, Andrews G. Evidence of a genetic contribution to functional bowel disorder. Am[J].Gastroenterol 1998,93:1311-1317.
[25]Levy RL, Jones KR, Whitehead WE, Feld SI, Talley NJ, Corey LA. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology[J]. Gastroenterology 2001,121:799-804.
[26]朱爱芳,孟繁立,李延青.肠易激综合征患者的心理治疗与护理[J].中华护理志,2003,38(9)：690-692.
[27]RuigomezA, RodriguezLA, Johansson S,et al.Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome[J]. Maturities,2003,44(2):133-140.
[28]Houghton LA, Jackson NA, Whorwhell PJ, et al.Do male sex hormones protect from irritable bowel syndrome[J] Am J Gastroenterology,2000,95(9):2296-2300.
[29]黄翌,赵长鹰.肠易激综合征从情致论治探讨[J].山东中医杂志,2004,23(10)：379.
[30]汪静凤,刘煜.抑肝扶脾化痰祛瘀法治疗肠道易激综合征36例[J].南京中医药大学学报(自然科学版),2000,16(4)：2501.
[31]周福生,程宏辉,祝淑贞.心胃相关理论及临床应用[J].浙江中医学院学报,2004,28(2)：7.
[32]霍清萍.从肠易激综合征脑肠轴学说谈肝郁脾虚病理机制[J].中国中西医结合消化杂志,2005,13(5)：318-320.
[33]胡品津.从脑肠互动的高度认识肠易激综合征[J].中华消化杂志,2003,23(5)：261-262.
[34]吴至久.疏肝健脾法治疗肠易激综合征肝郁脾虚型临床研究[J].中华中医药学刊,2009,27(5)：1041—1043.
[35]张正利,蔡淦.肠易激综合征中医论治溯源[J].中国中医基础医学杂志,2001,07(07)：48.
[36]李国霞“胃强脾弱”考辨.上海中医药大学学报,2000,14(1)：13.
[37]TalleyNJ, Dennis EH, Schettler-Duncan VA, et al. Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea. Am J Gastroenterol,2003,98(11):2454-2459.
[38]龙艳芹,候晓华.肠易激综合征患者临床症状特点分析,胃肠病学,2007,12(1)：23-26.
[39]高峰,王景杰,黄裕新,等.肠易激综合症16例胃肠运动功能临床探讨[J].陕西医学杂志,2007,8(8)： 1903-1905.
[40]陶琳,柯美云,王智凤.小肠细菌过度生长与功能性胃肠疾病的关系[J].中国中西医结合消化杂志,2005,13(2)：122-123.
[41]王琦.中医体质学[M].人民卫生出版社,北京：2005,2.
[42]匡调元.论辨证与辨体质[J].中国中医基础医学杂志,2002,8(2)：1.
[43]孙广仁.中医基础理论[M].北京：中国中医药出版社,2003,202.
[44]王琦.东方生命科学的架构[J].中医药通报,2004,3(5)：3.
[45]朱燕波,王琦,折笠秀树.中医体质表的信度和效度评价[J].中国行为医学科学,2007,1(7)：651-654.
[46]鲁明源.体制学说—中医预防医学研究的切入点[J].山东中医,2003,(3)：54.
[47]中华医学会消化病学分会胃肠动力学组.肠易激综合征诊断和治疗的共识意见[J].中华消化杂志,2008,28：38.
[48]BengtsonMB, RnningT, VatnMH, et al Irritable bowel syndrome in twins:genes and environment [J]. Gut, 2006,55 (12):1754-1759.
[49]Locke GR 3rd, ZinsmeisterAR, Talley NJ,et al.Familial association in adults with functional gastrointestinal disorders[J].Mayo Chin Proc,2000,75(9):907-912.
[50]KanazawaM, EndoY, WhiteheadWE,et al.Patients and non consulters with irritable bowel syndrome reporting a parental history of bowel problem shave more impaired psychological distress[J].Dig Dis Sic 2004, 49(6):1046-1053.
[51]Chan g FY, LuCL. Irritable bowel syndrome in the 21st century:Perspectives from Asia or South-east Asia.Gastroenterol Hepatol 2007,22:4～12.
[52]RuigomezA, RodriguezLA, Johansson S,et al.Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome [J].Maturities,2003,44(2):133-140?
[53]Houghton LA, Jackson NA, Whorwhell PJ,et al.Domale sex hormones protect from irritable bowel syndrome[J] Am J Gastroenterology,2000,95(9):2296-2300.
[54]少萍.论七情致病的内在因素[J].中国医药学报,2002,17(6)：333.
[55]刘谦民,齐欣,郭全平,等.肠易激综合症与性格关系的探讨[J].中华内科杂志,2003,42(9)：602-604.
[56]张志雄,熊汉华,侯晓华.肠易激综合征患者心理评价[J].胃肠病学和肝病学杂志,2004,13(4)：396-399.
[57]Sugaya N,Nomura S.Relationship between cognitive appraisals of symptoms and negative mood for subtypes of irritable bowel syndrome[J].Bio Psycho Social Medicine,2008,2:9-15.
[58]吴正祥,解丽,张开光,等.功能性消化不良者心理因素与食管动力的关系[J].中国临床保健杂志,2007,10(5)：456-458.
[59]杨永红.肠易激综合征的病因探讨.医学综述,2004,10(1)：61-63.
[60]陆敏,沈洪.肠易激综合征中西医结合研究.中国临床医生,2005,33(4)：21-23.
[61]白浩,杨毅军.肠易激综合征和心理疾患.胃肠病学杂志,2000,9(2)：134-137.
[62]刘长灵.中医体质学现代研究进展[J].浙江中医药大学学报,2009,1(33)：138-139.
[63]周福生.肠易激综合征与体质的相关性研究[J].中医药学刊,2005,8(23)：1359-1361.
[64]王玉珍.谈中医体质学在临床的应用[J].中国航天医药杂志,2002,4(6)：79.
[65]宋明林.痛泻药方合甘麦大枣汤治疗肠易激综合征203例临床观察[J].河北中医,2007,29(8)：721-722.
[66]王国耀.痛泻要方加味治疗肠易激综合征76例[J].实用中医药杂志,2004,20(2)：68.
[67]陈维强,杨海泉.柴胡疏肝散加味治疗肠易激综合征61例疗效观察[J].新中医,2003,35(8)： 37.
[68]严付红.调肝扶脾益肾汤治疗腹泻型肠易激综合征38例[J].河南中医,2006,26(1)：59-60.
[69]袁雪晶,汪受传.论体质学说在中医儿科临床的应用[J].中医儿科杂志,2009,5(1)：11-14.
[70]Walker EA, Roy-Byrne PP, Katon WJ. Irritable bowel syndrome and psychiatric illness[J].Am J Psychiatry, 1990,147 (5):565-572.
[71]CruzRuizMA, OrtlzHerreraRB, Mufiiz JuradoD,et al.Association of depression and anxiety in patients with irritable bowel syndrome[J].Rev Gastroenterol Mex,2007,72(1):29-33.
[72]贾波,李晓红,梁显.白术茯苓汤对脾虚大鼠胃肠激素的影响.成都中医药大学学报,2001,24(4)：47.
[73]谢仁广.肠易激综合征辨治方法探讨.陕西中医,1999,20(9)：404-405.
[74]沈芸.蔡淦教授从肝脾论治肠易激综合征临床经验拾零.新中医,2002,34(4)：12-13.
[75]杨桦.疏肝理气配合心理疗法治疗肠易激综合征[J].云南中医学院学报,2000,23(4)：18-20.
[76]潘相学,谢建群.疏肝饮治疗肠易激综合征的临床疗效观察[J].上海中医药大学学报,2006,20(4)：48-50.
[77]何高潮,汪翠萍.调肝益脾法治疗腹泻型肠易激综合征56例[J].四川中医,2005(1)：50-51.
[78]石瑁,汪崇文,范可.中药痛泻药方治疗肠易激综合征疗效的荟萃分析[J].世界华人消化杂志,2007,15(17)：1934-1939.
[79]朱兆承.黄连逍遥汤治疗肠易激综合征32例.实用中医药杂志,2001,17(9)：18.
[80]申亚东,张锋.加味逍遥散治疗腹泻型肠易激综合征85例.河南中医药学刊,2000,15(6)：37-38.
[81]石君杰.疏肝健脾法治疗束缚应激肠易激综合征大鼠的实验研究.现代中西医结合杂志,2005,(6)：12.
[82]陈元鸿,叶文桃,曾运红,等.肠易激综合征患者的心理社会因素调查[J].预防医学论坛,2005,11(3)：271-272.
[83]刘爱萍,辛丽.肠易激综合征心理行为的调护[J].齐鲁护理杂志,1998,4(4)：68.
[84]曹中昌.心理治疗肠易激综合征的疗效观察[J].中国肛肠病杂志,1997,17(1)：23.
[85]Creed F, Fernandes L, Guthrie E, et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology,2003,124(2):303-317.
[86]曾莉,李春婷.慢性肠病中医治疗.南京：江苏科学技术出版社,2005,(9)：265-279.
[87]朱良如,侯晓华.胃肠感觉过敏在胃肠功能性疾病中的作用[J].中国实用内科杂志,2001,2(10)：557.
[88]Ehlin AG,Montgomery SM,Ekbom A, et al. Prevalence of gastrointestinal diseases in two British national birth cohorts.Gut,2003,52(8):1117-1121.