大腸激躁症之中醫辨證與治療文獻探討

Literature Review of Traditional Chinese Medicine Pattern Identification and Treatment Administration in Irritable Bowel Syndrome

大腸激躁症（Irritable bowel syndrome, IBS）是種常見的慢性且易復發腸道排便混亂的疾病，臨床疾病型態可以分為便秘型（Constipation type,IBS-C）、腹瀉型（Diarrhea type, IBS-D）、混合型（Mixed type, IBS-M）。IBS確切的致病機轉尚不明確，其病位雖在大腸，但主因是情志不暢、肝氣鬱滯，進而橫逆犯脾，使脾失運健，濕濁內生，體內津液代謝失衡致使大腸功能混亂。臟腑辨證中主要與肝、脾、腎密切相關，也有其他醫家提出從肺論治。肝鬱脾虛、脾腎陽虛、寒熱錯雜等為IBS-D常見之症型，常用方有痛瀉要方或合用四君子湯、參苓白朮散等（肝鬱脾虛型）、四神丸加味（脾腎陽虛）、烏梅丸（寒熱錯雜型）等方；IBS-C病人則常見脾胃陰虛、腸燥陰虛等證型，常用方有麻子仁丸、五仁丸、增液湯等方，供臨床上隨證加減應用。名老印會河教授臨床上常用戊己丸治療肝火犯胃而下迫大腸之IBS-D病人；隗繼武教授則應用經方柴胡桂枝湯治療肝鬱脾虛，久而化火或成瘀之IBS-D病患。本文整合近年IBS之文獻，有助於臨床上參考應用。

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with high prevalence in Taiwan. IBS has three clinical phenotype: (1) diarrhea type (IBS-D) (2) Constipation type (IBS-C) (3) Mixed type (IBS-M).The pathogenesis of IBS is still unclear, but it is believed to be related to stress, braingut interaction, and gut immune activation. As per the perspective of traditional Chinese medicine (TCM), it believes the functional balance between liver and spleen is key in diagnosis and treatment while the ill location of IBS is in the colon. The obstruction of ＂chi＂ of liver flow inhibits the functions of spleen. Altered intestinal permeability is the cause of diarrhea or constipation. The major clinical phenotype of IBS is liver stagnation and spleen deficiency type.TCM believes IBS starts with liver stagnation and spleen deficiency and then develops different symptom with times goes by. There are many drug used on IBS-D patients such as ＂TongxieYaofang＂, ＂Sishen wan＂ ,＂powder of ShenlingBaizhu＂. ＂Maziren wan＂, ＂Wurenwan＂, and ＂Zengyen tang＂ are usually used in IBS-C.. Some TCM doctor may use different drugs. Professor Yin Huihe treated IBS-D patients with ＂TongxieYaofang＂ or Wuji wan., while Professor Wei Jiwu used ＂ChaihuGuizhi tang＂. In conclusion, TCM has developed complete theories and all kinds of diagnosis of TCM which could provide patients more customized treatment.