婴幼儿腹泻的中西医结合病因病理及疗法进一步探讨

我们于1958年开始组织中西医力量,对腹泻的病因病理、辨证分型治疗及疗效机理进行了中西医结合临床研究。兹综合二十二年来实践探讨如下。病因病理凡脾胃功能失调,以腹泻为主要症状而不夹脓血者,祖国医学称为泄泻。婴幼儿泄泻的病因主要由于感受外邪、内伤乳食或脾胃虚弱引起。小儿感受暑湿时邪,蕴郁肠胃,以致水湿滞留而为下利。乳食不节也可损伤脾胃而致泄泻。但外邪与伤食均属于外因,

英文摘要:

It is held in traditional Chinese medicine that diarrhoea is caused by"disorders of spleen and stomach function"(脾胃失调) and"gathering and brewing of water and dampness in the body"(水湿内生).Experiments and research of modern medicine have shown that disturbances of enteric function(excessive secretion or malabsorption)which lead to water retention in intestine are the cause of infectious diarrhoea.This has created the condition for a further investigation of pathogeny and pathology by means of TCM-WM,and offered scientific evidence for the theory of TCM. Following the combined method of TCM-WM,diarrhoea was divided into 3 types,namely,"Waigan"(外感,affection due to exogenous pathogenic factors,i.e,infectious diarrhoea),"Shangshi"(伤食,indigestion caused by improper diet or over eating,i.e.food factor simply)and"Pixu"(脾虚,deficiency in the spleen,i.e.prolonged enteritis),which were treated with"Ge Gen Qin Lian Tang"(葛根芩连汤),"Bao He Wan"(保和丸)and"Shen Ling Bai Zhu San"(参苓白术散)respectively.In 1958-1978,these drugs were applied to 961 inpatients with diarrhoea.The total curative rate was 92.3%.Time of stoppage of diarrhoea and subsidence of feverwas shortened for 1-2 days as compared with the WM group.Thus,there was a significant difference between them. Waigan type was seen more often clinically.According to our analysis,the main pathogens were E.coli.and Rotavirus.All cases of the bactreial diarrhoea were resistant to antibiotics in common use.Furthermore,it is recognized today that the pathogenesis of E.cell diarrhoea is an increase in enteric secretion due to the enterotoxin produced by the bacteria.As it is by no means induced by intestinal inflammation,there is no point in using antibiotics to diminish inflammation.As for viral diarrhoea, the use of antibiotic drugs is of no avail at all.Therefore,it would be appropriate to apply traditional Chinese medicine to treat infectious diarrhoea.When dehydration occurred,an addition of fluid therapy will elevate the therapeutic effect. According to the experimental research of berberine on animals abroad,it was made clear that the mechanism of stoppage of diarrhoea was due to the inhibition of intestinal secretions by berberine.It was also proved in our experiment with the ligation of rabbit’s intestine that the toxin of E.coil isolated locally had manifested a phenomenon of increasing intestinal secreticn.Since the effect of"Ge Gen Qin Lian Tang"in the inhibition of bacteria is not strong,and the main component(berberine)of the decoction has been proved to possess a function of inhibiting intestinal secretion,the therapeutic mechanism of stopping diarrhoea with the given decoction is related to the function of inhibiting secretion. Recently,there is a global tendency to investigate ways to inhibit intestinal secretion with respect to therapeutic drugs for bacterial diarrhoea,keeping an eye on the exploration of traditional Chinese medicine and pharmacology.As the treatment of diarrhoea with Chinese medicine(if necessary,combined with fluid therapy)is distinguished for its high therapeutic effect,low side-effect,convenience and economy,it is highiy regarded in overseas countries,and is going to be included in WHO’s relevant program. For the moment,the use of ORS(Oral Rehydration Salts)to treat diarrhoea dehydration is being recommended by WHO and has remarkable therapeutic effect.We deem it possible to further elevate the therapeutic effect by using TCM in conjunction with ORS,which will be more appropriate for grassroot units,and is being experimented and summarized.

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