溃疡性结肠炎(UC)是一种慢性非特异性肠道炎症性疾病.中医认为UC发病之本为脾胃虚弱,病理产物包括湿热、瘀血、热毒等,日久则脾肾渐损,肠腑湿热,终成虚实并见、寒热错杂之病,临证时当以寒热并用法治之,可取得较好疗效.该文主要论述寒热并用法在溃疡性结肠炎中的应用.

目的:探讨国医大师李佃贵治疗幽门螺杆菌(Hp)阳性慢性萎缩性胃炎(CAG)的用药规律及经验,为临床治疗提供用药参考.方法:纳入国医大师李佃贵门诊就诊的Hp阳性CAG患者,从医案资料中搜集患者的基本信息和首诊处方,采用古今医案云平台的统计分析、关联分析、聚类分析等方法进行分析.结果:筛选的110首门诊病例处方涉及中药共128味,总频数为2871;中药四气以寒、温药物最多,五味以苦、辛为主,归经多归于肝脾两经;符合强关联规则的药对有"黄芩-黄连""茯苓-白术""当归-白芍"等15组;频数居前15位的中药形成6个聚类群组,其中黄芩、黄连、茯苓、三七粉、白术、白花蛇舌草、茵陈、半枝莲、半边莲为核心用药.结论:国医大师李佃贵治疗Hp阳性CAG"苦寒并用、肝脾同调",将清热燥湿泄、活血祛瘀解毒、健脾柔肝扶正三大治法贯穿始终.

Ulcerative colitis (UC) is a chronic and immune-mediated inflammatory disorder characterized by abdominal pain, diarrhoea, and haematochezia. The goal of clinical therapy for UC is mucosal healing, accomplished by regenerating and repairing the intestinal epithelium. Paeoniflorin (PF) is a natural ingredient extracted from Paeonia lactiflora that has significant anti-inflammatory and immunoregulatory efficacy. In this study, we investigated how PF could regulate the renewal and differentiation of intestinal stem cells (ISCs) to improve the regeneration and repair of the intestinal epithelium in UC. Our experimental results showed that PF significantly alleviated colitis induced by dextran sulfate sodium (DSS) and ameliorated intestinal mucosal injury by regulating the renewal and differentiation of ISCs. The mechanism by which PF regulates ISCs was confirmed to be through PI3K-AKT-mTOR signalling. In vitro, we found that PF not only improved the growth of TNF-α-induced colon organoids but also increased the expression of genes and proteins related to the differentiation and regeneration of ISCs. Furthermore, PF promoted the repair ability of lipopolysaccharide (LPS)-induced IEC-6 cells. The mechanism by which PF regulates ISCs was further confirmed and was consistent with the in vivo results. Overall, these findings demonstrate that PF accelerates epithelial regeneration and repair by promoting the renewal and differentiation of ISCs, suggesting that PF treatment may be beneficial to mucosal healing in UC patients.

总结李佃贵基于浊毒理论从脾胃防治结直肠腺瘤进展为结直肠癌的经验.李佃贵认为脾胃失和、功能异常,痰、湿、瘀、滞、虚等相继产生,损伤肠络,导致腺瘤发生.各种病理产物胶着日久,化为浊毒之邪.浊毒伏匿是促进腺瘤进展为腺癌的关键.治疗当以调脾胃、化浊毒为大法,分别予行气畅中除浊毒、活血理脾消浊毒、化痰运脾涤浊毒、扶正益中散浊毒等治法阻断腺瘤进展,以降低其癌变率,临床疗效显著.附医案2则以佐证.

Objective:To explore the potential mechanism of Tianshui Dichang Decoction in the treatment of ulcerative colitis through network pharmacology and experimental verification.Methods:The active components and targets of Tianshui Dichang Decoction were screened by TCMSP. The related targets of ulcerative colitis were screened by OMIM, GeneCard and TTD databases, and the effective component targets of Tianshui Dichang Decoction were intersected with the potential targets of ulcerative colitis. The PPI network was constructed by STRING database to screen the core targets, and the "Chinese materia medica-disease-active components-target" network was constructed by Cytoscape 3.8.0 software. GO function and KEGG pathway enrichment analysis were carried out using Metascape database. 48 mice were divided into control group, model group, mesalazine group (0.3 g/kg) and Tianshui Dichang Decoction low-, medium-, and high-dosage groups (7.5,15 and 30 g/kg) according to random number table method, with 8 mice in each group. Except the control group, the ulcerative colitis model was established in other groups. After 7 days of intervention with corresponding drugs, the disease activity index (DAI) was scored, the pathological changes of colon were observed by HE staining, and the expressions of IL-6, STAT3mRNA and protein in colon tissue were detected by PCR and Western blot methods.Results:Totally 127 active components in Tianshui Dichang Decoction and 560 targets of ulcerative colitis were obtained. 89 intersecting targets of Tianshui Dichang Decoction and ulcerative colitis were obtained, and the core targets included IL6, TNF, IL1B, AKT1, TP53, VEGFA, JUN, PTGS2, CXCL8, CCL2, STAT3, MMP9 and so on. Oxidative stress response, lipopolysaccharide metabolism, bacterial response, signal transduction and other biological processes were mainly involved, mainly through the cancer pathway, IL17, TNF, MAPK and other signal pathways to play a role in the treatment of ulcerative colitis. The results of experimental verification showed that the DAI score, the expressions of IL-6 and STAT3 protein in colon tissue of Tianshui Dichang Decoction medium- and high-dosage groups.decreased ( P<0.05). The levels of IL-6 and STAT3 mRNA in colon tissue decreased in the Tianshui Dichang Decoction low-, medium- and high-dosage groups.groups ( P<0.05). Conclusion:Tianshui Dichang Decoction has a certain therapeutic effect on UC through component-multitarget-signal pathway, and its mechanism is related to regulating IL-6/STAT3 signal pathway and inhibiting intestinal mucosal inflammation.

介绍刘建平教授治疗溃疡性结肠炎(UC)的经验.刘教授认为,UC为本虚标实之证,脾虚为发病之本,随着病情的发展,湿、热、浊、毒并存,为发病之标,久之脾肾两虚.在治疗上应肝脾同调、气血共治,清温并用、内外兼顾,使阴阳平衡,气机升降有常,气血运行有序,脏腑功能协调,则病情得以控制.并附验案1则,以资佐证.