【作者】 陆宇平；

【导师】 王长洪；

【作者基本信息】 中国人民解放军军医进修学院 ， 中西医结合临床， 2009， 博士

【摘要】 溃疡性结肠炎(ulcerative colitis,UC)是一种慢性非特异性结肠炎症,属临床难治性疾病之一。导师王长洪教授诊治UC具有丰富的临床经验。为继承和发展名老中医的临证经验,弘扬传统中医学,本文从理论研究、临床研究及实验研究三个方面系统总结了导师治疗UC的学术经验。在理论研究方面,首先总结了历代关于本病的病因病机,治法方药,进而回顾了董建华教授在“泄泻”、“痢疾”病的诊治经验,提出温清并用是董老治疗UC的重要大法,导师正是通过对此法的总结与应用,提出了临床治疗UC的理、法、方、药。导师认为,本病的病因病机在于脾虚是发病基础,热毒内蕴是发病的条件,瘀血阻络是病理产物,针对上述的病因病机,确立了益气健脾、清热解毒、化瘀通络的治疗大法,强调温清两法在治疗不同阶段的UC时具有同样重要的价值。疾病初期,虽应祛除邪实,但亦应顾护脾胃,健脾固本之法贯穿于治疗的始终;在疾病的后期,虽病邪已弱,正虚也日渐明显,故补脾的同时亦应投以清热解毒活血之品,以防疾病反复。并以黄芪30g、肉桂10g、炮姜10g、败酱草20g、白头翁15g、黄连10g、青黛3g、苦参15g、白术15g、苍术15g、川芎10g、丹参15g、炙甘草10g组成治疗UC的基本方剂。在临床研究方面,通过对40例UC患者的临床观察发现,口服益气健脾、清热解毒、化瘀通络的中药在综合疗效、肠黏膜病变疗效、症状疗效方面均优于应用艾迪莎的西药对照组(P＜0.05),在主要临床症状及肠镜下黏膜病变的改善方面,尤其是减轻腹泻、里急后重感症状、促进肠黏膜糜烂、溃疡愈合上疗效更为突出(P＜0.01),进而证明了导师组方的有效性。在实验研究方面,益气健脾、清热解毒、化瘀通络方剂可明显改善三硝基苯磺酸造成大鼠UC模型的临床及病理变化。在与生理盐水组的比较中发现,本方在缓解临床症状,减轻肉眼及镜下的组织学损伤方面都具有明显的效果(P＜0.05,P＜0.01);在与SAsP组的比较中发现,本方在减轻大鼠体重下降,改善大便性状,降低疾病活动指数方面疗效明显(P＜0.05),在与益气健脾组的比较中发现,本方在减轻体重下降、降低疾病活动指数及减少溃疡面积方面具有统计学意义(P＜0.05),并可减轻镜下的病变深度及隐窝破坏的组织学损伤。再次从动物实验的角度论证导师组方的科学性和有效性。更多还原

【Abstract】 Ulcerative Colitis(UC) is a kind of non-specificity chronic inflammatory disease of colon.It is consider as a refractoriness digestive disease.Professor Wang Changhong achieved a great deal of experience in the treatment of UC. This article summary systematically on advisor’ academic experience from theory research,clinical research and experimental research.On theory research,the researcher summarized on the origin and pathogenesis of a disease and therapeutic methods on history,and reviews the clinical experience of professor Dong Jianhua in treatment of diarrhea.Warm and clear is the main method of Dong Jianhua in treatment of UC.Based on this theory,Professor Wang Changhong considers that the pathogenic foundation is spleen asthenia,the pathogenic condition is heat and toxicants,and the pathology product is blood-stasis.According to this thought,advisor treats UC with the method of strengthening the spleen and supplementing Qi,clearing away heat and toxicants resolving blood-stasis and unblocking collaterals.In each pathological phases of UC,Professor Wang Changhong uses the method of eliminating the evil in the initial stage,and at the same time,the method of invigorating the spleen is also used.In the later stage,the method of invigorating the spleen is important, the method for eliminating damp or blood stasis also be used.Advisor created the foundation prescription which is composed of Radix Astragali 30g,Radix Astragali10g,Rhizoma Zingiberis Preparata10g,white flower patrinia harb20g, Radix Pulsatillae15g,Rhizoma Coptidis10g,Indigo Naturalis10g,Radix Sophorae Flavescentis15g,Rhizoma Atractylodis Macrocephalae15g,Rhizoma Atracylodis15g,Rhizoma Chuanxiong10g,Radix Salviae Miltiorrhiae15g,Radix Glycyrrhizae preparata10g. On clinical research,forty patients with UC were randomly divided into tow groups.Twenty patients in the Chinese herb group were give Chinese herb medicine of strengthening the spleen and supplementing Qi,clearing away heat and toxicant resolving blood-stasis and unblocking collaterals.Twenty patients in the Western medicine group were treated with Etiasa.Then the curative effect was observed.The comprehensive clinical efficacy,the mucosal diseased efficacy and the clinical efficacy on symptoms of the Chinese herb medicinal group was better than that of the Western medicine group(P＜0.05).Compared with the Western medicine group,the improvement of the main symptoms(diarrhea,tenesmus) and the mucosal diseases(erosion,ulcer) before and after treatment were statistically significant(P＜0.01).The prescription of Professor Wang Changhong in treatment of UC is effective on the clinic.On experimental research,the prescription can effectively improve the symptom and pathological change of TNBS-induced UC rats.The effect of synthetic group to improve the clinical symptoms and to lighten the injury of naked eye and histology is better than that of Sodium Chloride group(P＜0.05,P＜0.01).The effect of synthetic group to improve the clinical symptoms such as the weight degression,diarrhea and to decrease the disease active index is also better than that of SASP group(P＜0.05).Compared with the Yiqijianpi group, the effect of synthetic group to improve the clinical symptoms such as the weight degression,to decrease the disease active index and to contract ulcer area is statistically significant(P＜0.05).The rationality and validity of the prescription is also being proved from the experimental research.更多还原