基于伏邪理论探讨溃疡性结肠炎病机特点研究

Study on Exploring the Pathogenic Characteristics of Ulcerative Colitis Based on the Theory of Latent Pathogens

摘要: 文章以溃疡性结肠炎(Ulcerative Colitis, UC)的病机特点为研究对象，采用理论分析方法，基于中医伏邪理论系统探讨其内在病机规律。近年来，我国UC发病率显著上升，达(1.77~3.14)/10万，其反复发作、缠绵难愈的特点导致西医治疗存在复发率高、不良反应多等局限，中医学将其归为“肠澼”、“久痢”等范畴，伏邪理论为理解该病病机提供了独特视角。研究揭示了UC“本虚标实”、“正虚邪伏”的本质特征，明确脾虚湿困是该病伏邪形成的始动因素，内外合邪为伏邪引动的关键条件，湿性黏滞致病程缠绵，脏络受损使病机深入并易生变证。进一步从现代生物学角度探析，组织驻留记忆CD4⁺ T细胞(CD4⁺ TRM)的免疫记忆功能及细胞外基质异常重塑可能分别是伏邪潜藏、瘀毒损络的微观物质基础。基于此，提出了透邪外出、气血同治、微环境调节等治疗策略，为降低UC复发率、改善远期预后提供了新的思路。本研究为中医药在溃疡性结肠炎的防治领域提供了理论支撑与实践指导，具有可资借鉴的学术价值。

Abstract: This study focuses on the pathological characteristics of Ulcerative Colitis (UC), employing theoretical analysis to systematically explore its intrinsic pathogenic patterns based on the traditional Chinese medicine theory of latent pathogens. In recent years, the incidence of UC in China has risen significantly, reaching 1.77~3.14 per 100,000 individuals. Characterized by recurrent attacks and a prolonged, refractory course, UC presents limitations in Western medical treatment, such as high relapse rates and numerous adverse reactions. In traditional Chinese medicine, UC is categorized under “Chang Pi” (intestinal flux) or “chronic dysentery”, and the theory of latent pathogens provides a unique perspective for understanding its pathogenesis. The research reveals the essential features of UC as “deficiency in origin and excess in manifestation” and “deficiency of healthy qi with lingering pathogens”. It clarifies that spleen deficiency with dampness encumbrance is the initiating factor in the formation of latent pathogens in UC, while the confluence of internal and external pathogens serves as the key condition for triggering latent pathogens. The sticky and stagnant nature of dampness leads to a protracted disease course, and damage to the visceral collaterals allows the pathology to deepen and easily give rise to complicated syndromes. Further exploration from a modern biological perspective suggests that the immune memory function of CD4⁺ tissue-resident memory T cells (CD4⁺ TRM) and the aberrant remodeling of the extracellular matrix may serve as the microscopic material basis for the harboring of pathogens and damage due to static blood and toxins, respectively. Based on this, therapeutic strategies such as eliminating the harbored pathogen, simultaneous treatment of both qi and blood, and microenvironment regulation offer new insights for reducing the recurrence rate of UC and improving long-term prognosis. This study provides theoretical support and practical guidance for the prevention and treatment of ulcerative colitis in traditional Chinese medicine, offering academic value for reference.