半夏泻心汤治疗嗜酸细胞性胃肠炎体会

CJI (Traditional Chinese Medicine) - - 中国中医药信息杂志 -

吴秋霞河南中医药大学第二附属医院,河南 郑州 450002摘要:嗜酸细胞性胃肠炎(eosinophilic gastroenteritis,EG)最常见的表现是腹痛和腹泻,糖皮质激素是目前治疗的常用药物,但不良反应较大。仲景名方半夏泻心汤多用于治疗多种胃肠道疾病。本文介绍以半夏泻心汤联合芍药甘草汤加减治疗以腹痛为主的EG,以及半夏泻心汤联合葛根芩连汤加减治疗以腹泻为主的EG,均获得满意疗效。关键词:嗜酸细胞性胃肠炎;半夏泻心汤;芍药甘草汤;葛根芩连汤;中医疗法

DOI:10.3969/j.issn.1005-5304.2018.04.025

中图分类号:R259.733.5 文献标识码:A 文章编号:1005-5304(2018)04-0118-02

Experience in Treating Eosinophilic Gastroenteritis with Banxia Xiexin Decoction

WU Qiu-xia

The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450002, China

Abstract: The most common manifestations of eosinophilic gastroenteritis (EG) are abdominal pain and diarrhea. Glucocorticoid is currently used in the treatment for EG, but the adverse reactions are relatively large. Banxia Xiexin Decoction is the famous Zhongjing prescription can be used to treat many kinds of gastrointestinal diseases. This article introduced. Banxia Xiexin Decoction combined with Shaoyao Gancao Decoction in the treatment of abdominal pain predominant based EG, as well as Banxia Xiexin Decoction combined with Gegen Qinlian Decoction in treating diarrhea predominant based EG have achieved satisfactory efficacy.

Keywords: eosinophilic gastroenteritis; Banxia Xiexin Decoction; Shaoyao Gancao Decoction; Gegen Qinlian Decoction; TCM therapy

嗜酸细胞性胃肠炎(eosinophilic gastroenteritis, EG)是以胃肠道组织嗜酸性粒细胞异常浸润为特征的胃肠道疾病,主要表现为恶心、呕吐、腹胀、腹痛、腹泻等,年龄特征不明显,发病部位可涉及从食管到直肠,发病机制尚不完全明确。一般认为EG是源于体内外过敏原所致的全身或局部变态反应。西医治疗多采用糖皮质激素,但不良反应较大。迄今中医药对该病的诊治鲜有报道。笔者以半夏泻心汤合芍药甘草汤加减治疗以腹痛为主的 EG、合葛根芩连汤加减治疗以腹泻为主的EG,临床效果较好,兹报道如下。典型病例

案例1:患者,男,41 岁,2015 年 4 月 15 日就诊。半月前,患者无明显诱因出现腹部疼痛,以中上腹部为主,呈胀痛、隐痛,发作无明显规律,伴口干苦、腹胀、纳差,舌红,苔薄黄,脉弦细。无发热、腹泻,无恶心呕吐。曾经抑酸及促进胃动力治疗后,症状无明显改善,1 d 前症状加重。既往有慢性丙型肝炎病史,无过敏史。现上腹部压痛。查血常规示:白细胞总数 10.9×109/L,嗜酸性粒细胞计数 3.48×

109/L(32%)。二便正常。血清学检查:肝、肾功正常,寄生虫全套、肿瘤标志物、自身免疫抗体均阴性,红细胞沉降率、C反应蛋白均正常。胸片及腹部彩超未见明显异常。胃镜示:胃窦、十二指肠黏膜充血、红斑、点状糜烂,内镜下黏膜活检提示较多量嗜酸性粒细胞浸润。肠镜示:横结肠黏膜散在充血、水肿,浅表小溃疡形成;内镜下黏膜活检提示黏膜炎症、较多量嗜酸性粒细胞浸润。西医诊断:嗜酸细胞性胃肠炎。中医诊断:腹痛,辨证为肝脾不调、寒热错杂。治以清肝和胃、缓急止痛。方以半夏泻心汤合芍药甘草汤加减:法半夏12 g,人参 9 g,黄连 9 g,黄芩 9 g,炙甘草 15 g,麸炒白芍 30 g,干姜 6 g,延胡索 12 g,枳壳 12 g,大枣 5枚。水煎服,每日1剂。服药3剂

后,患者腹痛、腹胀、口干苦明显缓解,1 周后复查白细胞总数7.9×109/L,嗜酸性粒细胞计数2.1×109/L

(26%)。守方继服 3 周后完全缓解。守方继服 8 周后,复查血常规、白细胞总数、嗜酸粒细胞计数及百分数均正常,胃肠镜未见明显异常。随访1年无复发。

案例2:患者,女,58 岁,2016 年 10 月 20 日就

Newspapers in Chinese (Simplified)

Newspapers from China

© PressReader. All rights reserved.