基于“上下交损，当治其中”探讨溃疡性结肠炎肠外表现的中医病机

Exploring the Pathogenesis of Extraintestinal Manifestations in Ulcerative Colitis Based on “Treatment of Simultaneous Upper and Lower Diseases Focusing on Spleen and Stomach”

摘要: 溃疡性结肠炎(Ulcerative Colitis, UC)除肠道主症外，常伴有多系统肠外表现，其病机复杂，中医诊疗尚缺乏统一认识。本文依据“上下交损，当治其中”理论，系统阐述UC肠外表现的中医病机与治则。脾胃居于中焦，为气机升降之枢、气血生化之源，脾虚失运则湿浊内生，枢机不利，导致清气不升、浊阴不降，病邪上犯下迫，累及四肢九窍、关节皮肤、肝胆目睛等，形成“上下交损”之候。UC肠外表现虽部位各异，然其根本在于中焦脾胃功能失常，气血化生不足，营卫失调，络脉失养，加之湿热瘀毒等循经走窜，内外合邪，发为诸症。故治疗当以调治中焦为核心，健脾益气、运湿和胃以复其枢转之职，兼顾上下，使五脏得安，肠外之症自除。本文从“中焦–五脏”整体观出发，以期为UC肠外表现的中医辨治提供理论依据与临证思路。

Abstract: Ulcerative colitis (UC) is characterized not only by primary intestinal symptoms but also by frequent extraintestinal manifestations affecting multiple systems. Its pathogenesis is complex, and there remains a lack of unified understanding in traditional Chinese medicine (TCM) diagnosis and treatment. This paper systematically elaborates on the TCM pathogenesis and therapeutic principles for extraintestinal manifestations of UC based on the theory that “when both upper and lower parts are damaged, the middle must be treated”. The spleen and stomach reside in the middle jiao, serving as the pivot for qi movement and the source of qi and blood generation. When spleen deficiency impairs transportation and transformation, dampness and turbidity accumulate internally, disrupting the pivotal function. This leads to impaired ascension of clear qi and descent of turbid yin, allowing pathogenic factors to invade upward and press downward. Consequently, the limbs, orifices, joints, skin, liver, gallbladder, and eyes become affected, manifesting as “damage to both upper and lower parts”. Although extraintestinal manifestations of UC vary in location, their root cause lies in dysfunction of the middle jiao spleen and stomach, resulting in insufficient qi and blood generation, disharmony between nutritive and defensive qi, and inadequate nourishment of collaterals. Compounded by pathogenic factors like damp-heat and stasis-toxin traversing meridians, internal and external pathogens converge to manifest various symptoms. Therefore, treatment should focus on regulating the middle jiao—strengthening the spleen and boosting qi, transforming dampness and harmonizing the stomach to restore its pivotal function. This approach addresses both upper and lower aspects, ensuring the five zang organs function harmoniously, thereby naturally resolving extraintestinal manifestations. This article adopts a holistic perspective of the “middle jiao-five zang organs” to provide theoretical foundations and clinical reasoning for TCM diagnosis and treatment of extraintestinal manifestations in UC.