徐鳳芹教授基于腦-腸軸理論運用經(jīng)方治療腸易激綜合征經(jīng)驗舉隅

郭曼萍 趙俊男 徐鳳芹

摘要 腸易激綜合征（IBS）是由中樞神經(jīng)系統(tǒng)和外周腸道系統(tǒng)功能障礙引起的疾病。抑郁、焦慮等應激相關的精神障礙往往與IBS等胃腸功能紊亂狀態(tài)并存。雖然IBS的發(fā)病機制尚未完全闡明，但腦-腸軸理論已經(jīng)成為IBS發(fā)病機制的研究熱點。徐鳳芹教授認為肝郁脾虛、腎陽虧虛、寒熱錯雜是IBS的主要中醫(yī)證候，中醫(yī)學上情志致病的病因學說在某種程度上與腦-腸軸學說對IBS發(fā)病機制的認識殊途同歸，肝、脾、腎對IBS發(fā)病機制的影響可能跟通過調節(jié)腦的生理功能進而作用于腸道有關。徐教授臨證經(jīng)驗豐富，擅用經(jīng)方治療內科雜病，本文試舉其辨治IBS臨床驗案1則，以見一斑。

關鍵詞 腦-腸軸;腸易激綜合征;烏梅丸;情志致病;寒熱錯雜;醫(yī)案; @ 徐鳳芹

Professor Xu Fengqin′s Experience in the Treatment of Irritable Bowel Syndrome with Classical Prescriptions Based on Brain-Gut Axis Theory

GUO Manping1，ZHAO Junnan2，XU Fengqin2

（1 School of Clinical Medicine，Beijing University of Chinese Medicine，Beijing 100091，China; 2 Institute of Geriatrics，Xiyuan Hospital，China Academy of Chinese Medical Sciences，Beijing 100091，China）

Abstract Irritable bowel syndrome（IBS） is a disease caused by dysfunction of the central nervous system and peripheral intestinal system.Stress-related mental disorders，such as depression and anxiety，often co-exist with gastrointestinal disorders such as IBS.Although the pathogenesis of IBS has not been fully elucidated，the brain-gut axis theory has become a research hotspot in the pathogenesis of IBS.Professor Xu Fengqin believes that liver depression and spleen deficiency，kidney yang deficiency，and cold-heat complex are the main traditional Chinese medicine（TCM） syndromes of IBS.The etiology of emotion in TCM is similar to the brain-gut axis theory in understanding the pathogenesis of IBS to some extent.The influence of the liver，spleen，and kidney on the pathogenesis of IBS may be related to the effect on the intestine by regulating the physiological function of the brain.Professor Xu has rich clinical experience and is good at treating internal miscellaneous diseases with classical prescriptions.

Keywords Brain-gut axis; Irritable bowel syndrome; Wumei Pills; Diseases caused by emotions; Cold-heat complex; Medical records; Xu Fengqin

中圖分類號：R249文獻標識碼：Bdoi：10.3969/j.issn.1673-7202.2022.10.017

腸易激綜合征（Irritable Bowel Syndrome，IBS）是一種常見的功能性胃腸道疾病，患病率為5%～10%[1]，其中不明原因的腹部不適或疼痛與排便習慣的改變有關，并具有排便障礙的特征[2]。羅馬Ⅳ標準常用于IBS的臨床診斷。IBS根據(jù)主要癥狀分為3個亞組：便秘型IBS（IBS-C）、腹瀉型IBS（IBS-D）和混合排便習慣的IBS（IBS-M）[3]。如果癥狀不明顯符合這3個類別，則診斷為不定型IBS（IBS-U）。西方國家以IBS-C多見，我國以IBS-D多見。IBS患者中90%會出現(xiàn)一般性抑郁障礙[4]。IBS的發(fā)病機制被認為是由于腸神經(jīng)系統(tǒng)（Enteric Nervous System，ENS）和中樞神經(jīng)系統(tǒng)（Central Nervous System，CNS）之間的雙向通信（稱為腦-腸軸）失調、腸運動障礙、免疫功能改變、內臟超敏反應和上皮屏障功能受損有關[5]。許多研究認為腦-腸軸失調在IBS的發(fā)病機制中起重要作用，腦-腸軸受到各種中樞神經(jīng)系統(tǒng)和腸道應激源的刺激?！?br>