影像学辅助“以通为补”法治疗慢性腹泻验案举隅

Illustrative Cases of Imaging-Assisted “Tonifying by Unblocking” Method in Treating Chronic Diarrhea

摘要: 慢性腹泻是临床常见的消化系统疾病，其病机多以脾虚湿盛为基础，常兼夹气滞、食积、瘀血等标实，形成虚实夹杂的复杂局面。“以通为补”法针对此类病机，主张运用理气、化湿、消导、活血等祛邪之法，疏通肠道壅滞，从而恢复脾胃运化功能，达到“通即是补”的疗效。然而，该法在临床具体运用中仍存在一定局限。为此，岳妍教授提出结合现代医学影像学结果辅助中医辨证，实现宏观辨证与微观形态的相互参照。影像学所见如肠腔积气、粪便滞留、肠壁水肿、黏膜强化或糜烂等表现，可直观对应中医的气滞、食积、湿热及瘀毒等病理要素。这不仅使抽象病机“可视化”，有助于提高患者对“通法”治疗逻辑的理解与接受度，也能辅助判断病邪性质，为“以通为补”法的精准运用——包括治法选择与时机把握——提供客观依据。文章结合一则典型案例，进一步阐述该整合模式的临床价值。

Abstract: Chronic diarrhea is a common clinical digestive system disease. Its pathogenesis is typically based on spleen deficiency with dampness abundance, often accompanied by intermingled excess manifestations such as Qi stagnation, food retention, and blood stasis, forming a complex situation of deficiency complicated by excess. The “Tonifying by Unblocking” method addresses this pathogenesis by advocating the use of therapeutic approaches that dispel pathogens, such as regulating Qi, resolving dampness, promoting digestion, and invigorating blood circulation, to clear intestinal stagnation. This restores the transportation and transformation functions of the spleen and stomach, achieving the therapeutic effect of “unblocking constitutes tonifying”. However, there are still certain limitations in the clinical application of this method. Therefore, Professor Yue Yan proposed integrating modern medical imaging results to assist TCM pattern differentiation, enabling cross-referencing between macro-pattern differentiation and micro-morphology. Imaging findings such as intestinal gas accumulation, fecal retention, intestinal wall edema, mucosal enhancement, or erosions can intuitively correspond to TCM pathological elements like Qi stagnation, food retention, damp-heat, and stagnant toxin. This not only makes the abstract pathogenesis “visualizable”, helping to improve patients’ understanding and acceptance of the treatment logic behind the “unblocking method”, but also assists in determining the nature of the pathogenic factors. It provides an objective basis for the precise application of the “Tonifying by Unblocking” method, including the selection of treatment principles and the timing of intervention. This article further elaborates on the clinical value of this integrated model through a typical case study.