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1.湖南中医药大学,长沙 410208
2.湖南中医药大学 第一附属医院,长沙 410007
3.湖南医药学院,湖南 怀化 418000
Received:29 April 2022,
Published Online:16 May 2022,
Published:20 July 2022
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余炼,宾东华,尹园缘等.从“培土生金,肺合大肠”角度探析参苓白术散防治炎性肠病思路[J].中国实验方剂学杂志,2022,28(14):186-193.
YU Lian,BIN Donghua,YIN Yuanyuan,et al.Shenling Baizhusan in Prevention and Treatment of Inflammatory Bowel Disease Based on Theory of "Reinforcing Earth to Generate Metal and Associating Lung with Large Intestine"[J].Chinese Journal of Experimental Traditional Medical Formulae,2022,28(14):186-193.
余炼,宾东华,尹园缘等.从“培土生金,肺合大肠”角度探析参苓白术散防治炎性肠病思路[J].中国实验方剂学杂志,2022,28(14):186-193. DOI: 10.13422/j.cnki.syfjx.20221491.
YU Lian,BIN Donghua,YIN Yuanyuan,et al.Shenling Baizhusan in Prevention and Treatment of Inflammatory Bowel Disease Based on Theory of "Reinforcing Earth to Generate Metal and Associating Lung with Large Intestine"[J].Chinese Journal of Experimental Traditional Medical Formulae,2022,28(14):186-193. DOI: 10.13422/j.cnki.syfjx.20221491.
炎性肠病(IBD)最常见的表现形式是克罗恩病和溃疡性结肠炎,IBD的全球发病率呈上升趋势,中医药在治疗本病上具有一定优势。中医将IBD多依据临床症状而命名,多归属“休息痢”“久痢”“泄泻”“痢疾”“肠澼”等范畴,认为IBD病机以脾虚湿盛贯穿疾病发展始终,肺与大肠相合,肺脾气机联动,肺脾气虚,湿热内蕴,瘀血阻络发为本病,从“肺合大肠”角度认为肺肠气机失衡,肺肠津液代谢失常,肺肠营阴受损是IBD发生的主要机制;结合IBD慢性、复发性、弥漫性的主要发病特点和主要临床表现进行分析认为IBD的发生均与“肺肠”密切相关,在治疗思路上可补脾益肺、从肺治肠,一方面补脾祛湿,另一方面补母益子而调肠。参苓白术散为治疗IBD常用经典用方,主为益气健脾,渗湿止泻,更有“培土生金”之功,通过“培土生金”增强肺的功能反过来达到调节肠道的作用,促进IBD恢复。该文重点阐述参苓白术散通过健脾益肺达到调节肠道机制,结合现代研究分析其可能作用机制与调节炎症因子水平、调节免疫、黏膜修复改善屏障功能、肠道菌群等多个环节发挥治疗IBD作用,为IBD的辨治过程中重视肺-脾-大肠轴调治和后续开展实验研究提供新的思路。
The most common manifestations of inflammatory bowel disease (IBD) are Crohn's disease and ulcerative colitis, and the global incidence of IBD is on the rise. Traditional Chinese medicine (TCM) is advantageous in the treatment of IBD. IBD, with TCM names based on clinical symptoms, mostly belongs to recurrent dysentery, long dysentery, diarrhea, dysentery, bowel, and other categories. In TCM pathogenesis of IBD, spleen deficiency and exuberant dampness predominate in the whole course of the disease. Since the lung is associated with the large intestine and the lung Qi and spleen Qi are interconnected, the lung Qi and spleen Qi are deficient and the dampness and heat accumulate internally, which caused collateral obstruction by stagnant blood and the development of IBD. From the perspective of "associating lung with large intestine",it is believed that the main mechanism of IBD is the Qi imbalance and abnormal metabolism of fluids in the lung and the intestine,and the nutrient-Yin injury of the lung and the intestine. According to the chronic, recurrent, and diffuse pathogenesis characteristics and main clinical manifestations of IBD, IBD is closely related to the lung and the intestine. In terms of therapeutic principles, IBD can be treated by tonifying the spleen and replenishing the lung, which highlights the treatment of the intestine from the lung. To be specific, in time of tonifying the spleen and removing dampness, the intestine is regulated by tonifying the spleen and replenishing the lung. Shenling Baizhusan, a commonly used classical prescription for IBD, is mainly potent in replenishing Qi, invigorating the spleen, draining dampness, checking diarrhea, and especially "reinforcing earth to generate metal". It can enhance the function of the lung through "reinforcing earth to generate metal", which in turn regulates the intestine and promote the improvement of IBD. The present study clarified the mechanism of Shenling Baizhusan in regulating the intestine by tonifying the spleen and replenishing the lung. On the basis of modern research, its therapeutic effect on IBD was achieved through multiple links, such as regulation of the level of inflammatory factors, immunoregulation, barrier function improvement via mucosal repair, and intestinal flora. The findings of this study are expected to provide new ideas for the regulation of the lung-spleen-large intestine axis in the syndrome differentiation and treatment of IBD and subsequent experimental research.
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