《温病条辨》承气汤类方治疗癌症阿片类相关性便秘的证机析要OA

[Objective]To explore the theoretical basis and innovative applications of Chengqi Decoctions in the treatment of opioid-induced constipation(OIC).[Methods]Based on the records of Systematic Differentiation of Warm Diseases and the essence of WU Tang's methods,the pathological characteristics of the four syndrome types(Qi,fire,blood and water)presented in OIC were analyzed.It explained the mechanisms of action of Xuanbai Chengqi Decoction,Daochi Chengqi Decoction,Zengye Chengqi Decoction,and Xinjia Huanglong Decoction in responding to different syndromes,and combined with clinical case study to demonstrate their practical applications.[Results]This study clarifies the core pathogenesis of the four OIC syndrome types:the Qi syndrome is caused by the pungent and penetrating nature of opioids disturbing Qi movement,leading to Qi disorder,internal generation of dry-heat,and dysfunction of intestinal transmission;the fire syndrome is resulted from opioids'dry-heat nature exacerbating excessive Yang-heat,which disturbs the tri-Jiao,consumes body fluids and scorches the intestines;the blood syndrome is due to long-term retention of cancer toxin combined with opioids'dry-warm property,resulting in consumption of essence and blood as well as intestinal dryness;the water syndrome is caused by impaired blood circulation leading to fluid retention,which binds with dregs of food and static blood to obstruct the intestines.Corresponding therapeutic results:Xuanbai Chengqi Decoction is used for Qi syndrome to regulate Qi movement and clear dry-heat;Daochi Chengqi Decoction is applied for fire syndrome to clear heat and relieve stagnation,replenish body fluids and unblock the intestines;Zengye Chengqi Decoction is adopted for blood syndrome to nourish blood,moisten stool and promote purgation simultaneously;Xinjia Huanglong Decoction is employed for water syndrome to resolve water and blood stasis as well as strengthen healthy Qi to relieve constipation.The patient in the clinical case with postoperative gastric cancer(Ⅳ stage)OIC was differentiated as water syndrome constipation,and the pathogenesis was"binding of water and blood stasis,deficiency of healthy Qi".The patient's constipation and accompanying symptoms were significantly relieved,after treated with modified Xinjia Huanglong Decoction,following the therapeutic principle of"expelling water to unblock the fu-organs,strengthening healthy Qi to relieve constipation".[Conclusion]Establishing a cross-progressive pathogenesis evolution system for OIC based on the four syndromes of"Qi-fire-blood-fluid"can not only provides a feasible theory-practice integrated approach for the traditional Chinese medicine(TCM)diagnosis and treatment of OIC,but also offers referential insights for the modern disease-adaptation research of classical prescriptions for warm-heat diseases.In the future,large-sample clinical verification can be further carried out to deepen the modern pharmacological research on its mechanism of action,so as to promote the innovative development of classic TCM theory in the diagnosis and treatment of cancer pain complications.