基于“肠结–疳积”理论畲药验方承气汤联合内镜治疗复杂肠梗阻的理论与实践——附两种术式应用分析

The Theory and Practice of She Ethnic Medicine Empirical Formula Chengqi Decoction Combined with Endoscopic Treatment for Complex Intestinal Obstruction Based on the “Intestinal Binding-Ganji” Theory—An Analysis of the Application of Two Endoscopic Procedures

摘要: 目的：基于中医“肠结”理论与畲医“疳积”理论的融合创新，构建“肠结辨病位、疳积辨病因”的统一病机框架，并系统阐释在该理论指导下畲药验方承气汤联合内镜治疗肠梗阻的理论基础与实践路径。方法：通过理论分析法，整合中医经典理论与畲医学术思想，在广泛回顾国内外中西医结合治疗肠梗阻研究现状的基础上，提出“破结攻积”协同治疗策略；结合本团队前期已发表的临床研究证据(MBO 54例、AIO 50例)，分析两种内镜术式在该框架下的应用定位与操作要点。结果：“肠结–疳积”理论实现了对MBO与AIO病机的统一阐释——肠结为标(梗阻状态)，疳积为本(积滞成因)；据此构建的“破结攻积”策略以内镜技术直接解除机械梗阻，以畲药验方承气汤序贯给药促进肠道功能恢复，形成“器械攻积 + 药物化积”的协同治疗模式。前期临床验证表明，该方案在MBO中总有效率为96.4%，AIO中总有效率为96.0%，均显著优于单纯内镜治疗(P < 0.05)，并能有效缩短住院时间、加速功能恢复。结论：基于“肠结–疳积”理论的畲药验方承气汤联合内镜治疗肠梗阻，理论框架清晰，临床实践有效，为不同病因肠梗阻的中西医结合治疗提供了统一的理论依据和实践方案，值得进一步推广与研究。

Abstract: Objective: Based on the integrated innovation of the Traditional Chinese Medicine (TCM) “Intestinal Knot” theory and the She ethnic medicine “Ganji” theory, to establish a unified pathogenic framework of “Intestinal Knot for disease location and Ganji for disease etiology”, and to systematically elucidate the theoretical basis and practical pathways of She ethnic medicine Chengqi Decoction combined with endoscopic techniques in the treatment of intestinal obstruction under this theoretical guidance. Methods: Through theoretical analysis, integrating classic TCM theories with She ethnic medical thoughts and extensive literature review, the “Pojie Gongji” (breaking the obstruction and attacking the accumulation) synergistic treatment strategy was proposed. Combined with our team’s previously published clinical research evidence (54 cases of MBO, 50 cases of AIO), the application positioning and operational key points of two endoscopic procedures within this framework were analyzed. Results: The “Intestinal Knot-Ganji” theory achieved a unified interpretation of the pathogenesis of MBO and AIO—Intestinal Knot represents the manifestation (obstruction state), while Ganji represents the root cause (accumulation-stasis). Based on this, the “Pojie Gongji” strategy was constructed, in which endoscopic techniques directly relieve mechanical obstruction, and She ethnic medicine Chengqi Decoction is administered sequentially to promote the recovery of intestinal function, forming a synergistic treatment model of “instrument-based accumulation attacking + medication-based accumulation resolving”. Previous clinical validation demonstrated that this regimen achieved a total effective rate of 96.4% in MBO and 96.0% in AIO, both significantly superior to endoscopic treatment alone (P < 0.05), and effectively shortened hospitalization duration and accelerated functional recovery. Conclusion: The treatment of intestinal obstruction with She ethnic medicine Chengqi Decoction combined with endoscopic techniques based on the “Intestinal Knot-Ganji” theory has a clear theoretical framework and proven clinical efficacy, providing a unified theoretical basis and practical protocol for the integrated traditional Chinese and Western medicine treatment of intestinal obstruction of different etiologies, warranting further promotion and research.