基于“厚肠理论”探讨腹泻型肠易激综合征病机特点及辨治策略
冯旭静 , 曹金宇 , 黄文贞 , 张澳 , 张诗杰 , 丁康
长春中医药大学学报 ›› 2026, Vol. 42 ›› Issue (9) : 1020 -1024.
基于“厚肠理论”探讨腹泻型肠易激综合征病机特点及辨治策略
Exploration of the pathogenesis characteristics and treatment based on syndrome differentiation strategies of diarrhea-predominant irritable bowel syndrome based on the intestine-strengthening theory
腹泻型肠易激综合征(IBS-D)是一种高发的功能性肠道疾病,病势缠绵,易反复,严重影响患者生活质量。“厚肠”为“益肠”之意,即恢复肠壁“脂膏”厚度与固涩功能。本文基于“厚肠理论”探讨IBS-D病机特点,认为其病位虽在肠,但核心病机与脾、肝、肾失调密切相关,即“脏病致薄”。脾失健运,肠薄失濡为发病之始;肝郁犯脾,肠薄失固为发病之渐;肾阳衰微,肠薄失温为发病之重;寒热错杂、肠薄失约,使肠道黏膜屏障薄弱、运化固涩功能减退为发病之末。治疗上应辨病位、明寒热虚实,通过“厚中焦、调肝脾、暖命门、燮寒热”分层辨治策略,恢复肠壁“脂膏”厚度与固涩功能,达到“薄者渐厚,泄者自实”,为临床防治IBS-D提供新思路。
Diarrhea-predominant irritable bowel syndrome (IBS-D) is a highly prevalent functional bowel disorder characterized by persistent symptoms, and recurrent course, which seriously affects the quality of life of patients. "Intestine-nourishing" refers to "benefiting the intestines", meaning restoring the thickness of the "fatty layer" of the intestinal wall. and its astringent function. Based on the"intestine-strengthening theory", this article explores the pathogenic characteristics of IBS-D. It posits that although the disease is located in the intestines, its core pathogenesis is closely related to the imbalance of the spleen, liver, and kidneys, that is, "visceral disorders leading to intestinal thinning". The onset of the disease begins with the spleen's failure of transportation and transformation, with the intestines being thin and lacking nourishment; The gradual development of the disease is marked by liver depression invading the spleen leading to intestinal thinning and loss of consolidation; The severity of the disease is characterized by the decline of kidney yang, with the intestines lacking sufficient warming and nourishment; The final stage of the disease is characterized by cold-heat complex disorder, and intestinal thinning with impaired restraint, which results in a weakened intestinal mucosal barrier and a decline in the intestine's transportation-consolidation functions. The treatment should focus on identifying the location of the disease, distinguishing cold-heat and deficiency- excess patterns, and adopting a stratified treatment strategy of "strengthening the middle jiao, regulating the liver and spleen, warming the life gate, and harmonizing cold-heat" to restore the thickness and astringent function of the "fatty layer" of the intestinal wall, achieving the goal of "thinning gradually thickens, and loose gradually solidifies", providing new ideas for the clinical prevention and treatment of IBS-D.
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