逍遥散联合神阙穴艾条灸治疗...效及对患者肠道微生物的影响_张贵玉.pdf

Hainan Med J,Jul.2023,Vol.34,No.13海南医学2023年7月第34卷第13期逍遥散联合神阙穴艾条灸治疗肝郁脾虚型肠易激综合征的疗效及对患者肠道微生物的影响张贵玉1，赵庆华2，常秦征3，张欢欢31.开封市祥符区中医院内二科，河南开封475100；2.开封市中医院肝胆脾胃科，河南开封475000；3.河南中医药大学第三附属医院针灸科，河南郑州450000【摘要】目的观察逍遥散联合神阙穴艾条灸治疗肝郁脾虚型肠易激综合征(IBS)的疗效，并探讨其对患者肠道微生物的影响。方法按照随机数表法将开封市祥符区中医院2020年1月至2022年8月收治的104例肝郁脾虚型IBS患者分为联合组和对照组各52例。两组患者均给予西医基础治疗，对照组患者在此基础上采用神阙穴艾条灸治疗，联合组患者则在此基础上采用逍遥散治疗，均持续治疗4周。比较两组患者的临床疗效、临床症状改善情况、炎症指标白细胞介素-1(IL-1)、IL-6、单核细胞趋化蛋白-1(MCP-1)和肠道微生物(双歧杆菌、肠杆菌、乳杆菌、肠球菌)的变化及复发情况。结果联合组患者的治疗总有效率为94.23%，明显高于对照组的80.77%，差异有统计学意义(P0.05)；联合组患者治疗4周后的腹痛程度、腹痛频率、腹胀程度、排便满意度、对生活的影响评分分别为(21.354.21)分、(18.632.41)分、(15.433.52)分、(18.532.35)分、(20.144.32)分，明显低于对照组的(28.325.63)分、(23.242.80)分、(18.153.81)分、(24.152.58)分、(26.585.04)分，差异均有统计学意义(P0.05)；联合组患者治疗4周后的血清IL-1、IL-6、MCP-1水平分别为(12.311.80)pg/mL、(10.212.14)ng/L、(186.8518.24)ng/L，明显低于对照组的(15.142.05)pg/mL、(13.582.30)ng/L、(201.5321.58)ng/L，差异均有统计学意义(P0.05)；联合组患者治疗4周后的肠球菌、肠杆菌含量分别为(6.850.83)CFU/g、(7.430.65)CFU/g，明显低于对照组的(7.350.95)CFU/g、(8.010.73)CFU/g，乳杆菌、双歧杆菌含量分别为(8.241.04)CFU/g、(7.811.12)CFU/g，明显高于对照组的(7.550.95)CFU/g、(7.131.05)CFU/g，差异均有统计学意义(P0.05)；治疗后3个月随访结果显示，联合组患者复发率为3.85%，明显低于对照组的15.38%，差异有统计学意义(P0.05)。结论逍遥散联合神阙穴艾条灸治疗肝郁脾虚型IBS疗效确切，其能有效抑制炎症反应，调节肠道微生态失衡，缓解临床症状，降低复发风险。【关键词】肠易激综合征；肝郁脾虚型；逍遥散；神阙；艾条灸；炎症因子；肠道微生物【中图分类号】R442.8【文献标识码】A【文章编号】10036350（2023）13184105Efficacy of Xiaoyao Powder combined with moxibustion at Shen Que point in patients with irritable bowelsyndrome of liver-depression and spleen-deficiency type and its effect on intestinal microorganisms.ZHANGGui-yu1,ZHAO Qing-hua2,CHANG Qin-zheng3,ZHANG Huan-huan3.1.Second Department of Internal Medicine,Traditional Chinese Medicine Hospital of Xiangfu District of Kaifeng,Kaifeng 475100,Henan,CHINA;2.Department ofHepatobiliary Spleen and Stomach,Kaifeng Traditional Chinese Medicine Hospital,Kaifeng 475000,Henan,CHINA;3.Department of Acupuncture and Moxibustion,Third Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,Henan,CHINA【Abstract】ObjectiveTo investigate the efficacy of Xiaoyao Powder combined with moxibustion at ShenQue point in patients with irritable bowel syndrome(IBS)of liver-depression and spleen-deficiency type and to investi-gate its effect on intestinal microorganisms according to the principles of a prospective randomized controlled trial.MethodsAccording to the random number table method,104 patients with IBS of liver-depression and spleen-defi-ciency type admitted to Traditional Chinese Medicine Hospital of Xiangfu District of Kaifeng from January 2020 to Au-gust 2022 were divided into combined group and control group,with 52 cases in each group.Both groups were given ba-sic treatment of western medicine.On this basis,the control group was treated with moxibustion at Shen Que point,andthe combined group was treated with Xiaoyao Powder combined with moxibustion at Shen Que point.Both groups weretreated for 4 weeks.The clinical efficacy,improvement of clinical symptoms,changes of inflammatory indexes interleu-kin-1(IL-1),IL-6,monocyte chemoattractant protein-1(MCP-1),intestinal microorganisms(Bifidobacterium,En-terobacter,Lactobacillus,Enterococcus),and recurrence were compared between the two groups.ResultsThe total ef-fective rate of the combined group was 94.23%,significantly higher than 80.77%of the control group(P2周；患者均知情，签订知情同意书；依从性高，配合本研究。(4)排除标准：既往有腹部或直肠手术史者；造血、肾、肝功能严重异常者；患有严重精神疾病；慢性非特异性溃疡型结肠炎者；由微生物感染等其他因素引起的腹泻。按照随机数表法将104例患者分为联合组和对照组，每组52例。两组患者的一般资料比较差异均无统计学意义(P0.05)，具有可比性，见表1。本研究经本院医学伦理委员会审核通过(批号：XFZYY202301)。1.2治疗方法两组患者均给予蒙脱石散(国药准字H20074198，生产厂家：杭州康恩贝特制药，规格：每袋含蒙脱石3 g)，温水冲服，1袋/次，3次/d。同时嘱咐患者低盐、低脂、高纤维饮食，避免刺激性食物及生冷海鲜，并规律作息，保持精神放松。sion,satisfaction with defecation,and impact on life were(21.354.21)points,(18.632.41)points,(15.433.52)points,(18.532.35)points,(20.144.32)points in the combined group,significantly lower than(28.325.63)points,(23.242.80)points,(18.153.81)points,(24.152.58)points,(26.585.04)points in the control group(P0.05).After 4 weeks oftreatment,the serum IL-1,IL-6,and MCP-1 levels were(12.311.80)pg/mL,(10.212.14)ng/L,(186.8518.24)ng/Lin the combined group,significantly lower than(15.142.05)pg/mL,(13.582.30)ng/L,(201.5321.58)ng/L in thecontrol group(P0.05).After 4 weeks of treatment,Enterococci and Enterobacteria levels were(6.850.83)CFU/g,(7.430.65)CFU/g in the combined group,significantly lower than(7.350.95)CFU/g,(8.010.73)CFU/g in the con-trol group(P0.05).Follow-up at 3 months after treatment showed that the recurrence rate in the combined group wassignificantly lower than that in the control group(3.85%vs 15.38%,P0.05).ConclusionThe efficacy of Xiaoyao Pow-der combined with moxibustion at Shen Que point in treating IBS of liver-depression and spleen-deficiency type is definite,which can effectively suppress inflammatory response,regulate the intestinal microecological imbalance,alleviate clinicalsymptoms,and reduce the risk of recurrence.【Key words】Irritable bowel syndrome;Liver-depression and spleen-deficiency;Xiaoyao Powder;Shen Quepoint;Moxibustion;Inflammatory factors;Intestinal microorganism表1两组患者的一般资料比较例(%)，x-sTable 1Comparison of general information between the two groups n(%),x-s组别联合组对照组2/t值P值例数5252男性21(40.38)18(34.62)女性31(59.62)34(65.38)0.3690.543年龄(岁)45.345.3046.525.811.0820.282BMI(kg/m2)120.430.8220.570.850.8550.395轻度11(21.15)14(26.92)重度41(78.85)38(73.08)0.4740.491性别病情程度1.2.1对照组该组患者同时采用神阙穴艾条灸治疗，点燃艾条一端并对准神阙穴，距离皮肤23 cm，局部有温热感为宜，施灸约15 min，1次/d，以皮肤红晕为度。1.2.2联合组该组患者同时采用逍遥散+神阙穴艾条灸(方法同对照组)。逍遥散组成：柴胡20 g，茯1842Hainan Med J,Jul.2023,Vol.34,No.13海南医学2023年7月第34卷第13期苓20 g，白芍20 g，当归20 g，白术20 g，炙甘草8 g，煨姜10 g，薄荷10 g，煎煮成汁400 mL，分早晚两次饭后半小时服完。气虚加黄芪30 g，党参30 g；便溏加扁豆10 g，芡实10 g；肝火重加栀子10 g，黄芩10 g；疼痛明显加砂仁10 g，丹参10 g，延胡索10 g。两组均持续治疗4周。1.3观察指标与评价方法(1)疗效8：腹痛即泻，泻后痛减，急怒易燥，自觉胸中憋闷，按照无、轻、中、重依次取0、2分、4分、6分，两肋胀满，纳呆，常伴呕恶，按照无、轻、中、重依次取0、1分、2分、3分，两者之和为总分，根据治疗前后总分变化评估疗效，总分降低95%、70%94%、30%69%、30%分别为痊愈、显效、有效、无效，其中痊愈、显效、有效纳入总有效。(2)临床症状改善情况：治疗前、治疗4周后采用IBS症状严重程度量表(IBS-SSS)评估，涉及腹痛频率、腹痛程度、排便满意度、腹胀程度、对生活的影响5个项目，每项分值范围为0100分，分值越高表明症状越严重。(3)炎症指标：治疗前、治疗4周后采集静脉血3 mL，3 000 r/min，离心10 min，取上清液，置于低温环境待检。单核细胞趋化蛋白-1(MCP-1)、白细胞介素-1(IL-1)、IL-6以酶联免疫吸附法测定。(4)肠道微生物：治疗前、治疗4周后取新鲜粪便5 g，应用光冈法进行培养，双歧杆菌、肠杆菌、乳杆菌以厌氧培养基培养，肠球菌以氧培养基培养。取3个平板以上菌落平均数，计算每克标本中菌含量。(5)复发情况：治疗后3个月进行电话随访，若出现IBS症状，则为复发。1.4统计学方法应用SPSS22.0统计软件分析数据。计量资料符合正态分布，以均数标准差(x-s)表示，组间比较采用t 检验，计数资料比较采用2检验。以P0.05为差异有统计学意义。2结果2.1两组患者的临床疗效比较联合组患者的治疗总有效率为94.23%，明显高于对照组的80.77%，差异有统计学意义(2=4.308，P=0.0380.05)，见表2。2.2两组患者治疗前后的临床症状改善情况比较与治疗前比较，两组患者治疗4周后的腹痛频率、腹痛程度、排便满意度、腹胀程度、对生活的影响评分明显降低，且联合组明显低于对照组，差异均有统计学意义(P0.05)，见表3。表2两组患者的临床疗效比较(例)Table 2Comparison of clinical efficacy between the two groups(n)组别联合组对照组例数5252痊愈115显效2823有效1014无效310总有效率(%)94.2380.77表3两组患者治疗前后的临床症状改善情况比较(x-s，分)Table 3Comparison of clinical symptom improvement between the two groups before and after treatment(x-s,points)时间治疗前治疗4周后组别联合组对照组t值P值联合组对照组t值P值例数52525252腹痛程度78.548.3276.218.851.3830.17021.354.21a28.325.63a7.1500.001腹痛频率64.326.2565.316.040.8210.41318.632.41a23.242.80a8.9980.001腹胀程度56.324.6355.854.570.5210.60415.433.52a18.153.81a3.7810.001排便满意度61.246.1062.536.471.0460.29818.532.35a24.152.58a11.6130.001对生活的影响73.507.3574.117.430.4210.67520.144.32a26.585.04a6.9960.001注：与本组治疗前比较，aP0.05。Note:Compared with that in the same group before treatment,aP0.05.2.3两组患者治疗前后的炎症指标比较与对照组比较，联合组患者治疗4周后的血清IL-1、IL-6、MCP-1水平下降趋势更为明显，差异均有统计学意义(P0.05)，见表4。2.4两组患者治疗前后的肠道微生物联合组患者治疗4周后的肠球菌、肠杆菌含量明显低于对照组，乳杆菌、双歧杆菌含量明显高于对照组，差异均有统计学意义(P0.05)，见表5。2.5两组患者的复发情况比较治疗后3个月电话随访，两组均无失访病例。结果显示，联合组复发2例，对照组复发8例。联合组复发率为3.85%，明显低于对照组的 15.38%，差异有统计学意义(2=3.983，P=0.046)。表4两组患者治疗前后的炎症指标比较(x-s)Table 4Comparison of inflammatory indicators between the twogroups before and after treatment(x-s)时间治疗前治疗4周后组别联合组对照组t值P值联合组对照组t值P值例数52525252IL-1(pg/mL)21.252.5320.822.480.8750.38412.311.80a15.142.05a7.4810.001IL-6(ng/L)25.345.2524.535.180.7920.43010.212.14a13.582.30a7.7350.001MCP-1(ng/L)313.5331.45308.2830.230.8680.388186.8518.24a201.5321.58a3.7460.001注：与本组治疗前比较，aP0.05。Note:Compared with that in the same group before treatment,aP0.05.1843海南医学2023年7月第34卷第13期Hainan Med J,Jul.2023,Vol.34,No.133讨论中医学认为，IBS虚实夹杂，肝郁、脾虚之间相互影响及转化，医方考 中记载“泻责之脾，痛则之肝，肝责之实，脾责之虚，脾虚肝实，故令痛泻”，张氏医通 补充道“脉虚则胃虚，二肠失其上源而为泄泻矣”，明确阐明本病机制9。外邪入侵脾胃，累及肝肾，脏腑功能失调，寒热之邪入肺，湿邪善缠脾土，伤及脾胃，加重病情，最终导致脾虚，脾运化失常致清浊难分，情志失调致肝郁，肝火犯胃则伤脾，升降失调，肠腑传导失司，进而泄泻10。脾虚肝郁是其主要病机，辨证求因论治，为促进胃肠传导功能恢复正常，须坚持以健脾疏肝、升清固肠为主要方法。本研究发现，逍遥散联合神阙穴艾条灸治疗肝郁脾虚型IBS效果显著，能有效减轻患者临床症状。IBS神阙穴艾条灸为中医非药物治疗法，“神阙者，神之所舍其中也，脐居正中，如门之阙，神通先天”(会元针灸学)，刺激此穴可激发诸经百脉经络之气，并连接五脏六腑、输布全身，有效调节机体神经-内分泌-免疫机制11。逍遥散中柴胡为君药，善疏肝解郁；白芍、当归合而为臣，前者善养血柔肝、敛阴止痛，后者为肝郁血虚之要药，能缓解行气止痛，两者相配养血柔肝；配以白术、茯苓健脾益气，以防肝气亢逆、升发太过；薄荷疏肝行气，能解肝经之羁热，炙甘草补中益气，缓解止痛，有襄赞之效；兼以煨姜温胃和中，全方配伍得当，既补肝体，又助肝用，通补兼施，标本共治，彰显治疗之功。现代医学中，逍遥散具有止泻、抗炎抗菌、解痉止痛、增强免疫功能、调节微循环等多种作用，能针对IBS不同临床症状，从多途径多靶点发挥功效，故能取得满意疗效12。已有相关研究证实，IBS患者促炎/抗炎细胞因子比例失衡且持续存在，导致局部肠组织损伤，是引起腹痛、腹泻等症状的关键因素13。王建刚等14报道，IBS患者血清MCP-1水平明显高于健康人群，其作为趋化因子，可诱导其他炎症介质释放，加重炎症反应，导致肠道炎性损伤，加重病情。本研究发现，联合组治疗4 周后血清 IL-1、IL-6、MCP-1 水平低于对照组，究其原因可能与逍遥散中柴胡、白术等等多味中药具有良好抗炎作用，能有效抑制炎症因子表达有关。此外，有研究指出，肠道慢性、低级别炎症形成和维持与IBS患者肠道菌群紊乱有着密切关联15。已有相关研究证实，IBS患者体内结肠菌群中益生菌/致病菌菌群比例失衡，即益生菌含量减少，致病菌含量增多，导致IBS肠黏膜免疫激活，进一步说明两者之间相互影响及转化16-17。本研究结果表明，联合组患者治疗4周后肠球菌、肠杆菌含量低于对照组，乳杆菌、双歧杆菌含量高于对照组，说明逍遥散联合神阙穴艾条灸治疗肝郁脾虚型IBS能有效纠正肠道微生态失衡，促进肠运动功能恢复。这可能与逍遥散中白芍、炙甘草等均有抗病原微生物作用有关。此外，联合组患者复发率低于对照组，究其原因，逍遥散具有抗炎抗菌、抗病毒、抗氧化、改善免疫功能等作用，可通过多方面增强机体抗病力，进而促进疾病转归，降低复发风险。综上所述，逍遥散联合神阙穴艾条灸治疗肝郁脾虚型IBS可调节肠道微生态失衡，减轻机体炎症状态，经由多途径提高治疗效果，促进临床症状消退，减少复发。参考文献1 Altomare A,Di Rosa C,Imperia E,et al.Diarrhea predominant-irrita-ble bowel syndrome(IBS-D)effects of different nutritional patternson Intestinal dysbiosis and Symptoms J.Nutrients,2021,13(5):1506.2 Bai TT,Yang X,Sun HW,et al.Study on the mechanism of tradition-al Chinese medicine-mediated aquaporin treatment of diarrhea typeirritable bowel syndrome J.Modern Journal of Integrated Tradition-al Chinese and Western Medicine,2021,30(26):2955-2960.白婷婷,杨欣,孙宏文,等.中医药介导水通道蛋白治疗腹泻型肠易激综合征的机制研究J.现代中西医结合杂志,2021,30(26):2955-2960.3Ni MC,Zhang H,Zhu JY,et al.Effect of Anchang Decoction onsymptoms,signs and quality of life of diarrhea irritable bowel syn-drome patients with liver depression and spleen deficiency syndromeJ.Chinese Journal of Integrated Traditional and Western Medicineon Digestion,2022,30(1):6-10.倪梦嗔,张慧,朱君仪,等.安肠汤治疗对肝郁脾虚证腹泻型肠易激综合征患者症状体征及生活质量的影响J.中国中西医结合消化杂志,2022,30(1):6-10.4Feng CY,Pan JD,Zhu FF,et al.Clinical effect of moxibustion atShenque point combined with warm acupuncture and moxibustion onprimary dysmenorrhea and its influence on immune function J.Ma-ternal and Child Health Care of China,2021,36(6):1448-1450.冯春燕,潘建娣,诸飞飞,等.艾灸神阙穴结合温针灸治疗原发性痛经的临床效果及对免疫功能的影响J.中国妇幼保健,2021,36(6):1448-1450.5 Wu HM,Zheng H,Qin SM,et al.Mechanism of the liver spleen defi-ciency syndrome of diarrhea-predominant irritable bowel caused byintestinal flora-bile acid metabolism axis imbalance J.China Jour-nal of Traditional Chinese Medicine and Pharmacy,2022,37(6):表5两组患者治疗前后的肠道微生物比较(x-s，CFU/g)Table 5Comparison of gut microbiota between the two groups beforeand after treatment(x-s,CFU/g)时间治疗前治疗4周后组别联合组对照组t值P值联合组对照组t值P值例数52525252肠球菌8.231.248.121.220.4560.6496.850.83a7.350.95a2.8580.005肠杆菌9.520.859.380.830.8500.3977.430.65a8.010.73a4.2790.001乳杆菌5.750.815.830.820.5010.6188.241.04a7.550.95a3.5320.001注：与本组治疗前比较，aP0.05。Note:Compared with that in the same group before treatment,aP0.05.双歧杆菌5.830.925.750.900.4480.6557.811.12a7.131.05a3.1940.0021844Hainan Med J,Jul.2023,Vol.34,No.13海南医学2023年7月第34卷第13期3123-3127.吴皓萌,郑欢,秦书敏,等.从肠道菌群-胆汁酸代谢轴失调探讨腹泻型肠易激综合征肝郁脾虚的机制J.中华中医药杂志,2022,37(6):3123-3127.6 Oka P,Parr H,Barberio B,et al.Global prevalence of irritable bowelsyndrome according to Rome or criteria a systematic reviewand meta-analysis J.Lancet Gastroenterol Hepatol,2020,5(10):908-917.7 Ministry of Health of the Peoples Republic of China.Guiding princi-ples for clinical research of new traditional Chinese medicine(Trial)M.Beijing:China Pharmaceutical Science and Technology Press,2002:112-113.中华人民共和国卫生部.中药新药临床研究指导原则(试行)M.北京:中国医药科技出版社,2002:112-113.8National Administation of Traditional Chinese Medidne.Criteria fordiagnosis and curative effect of traditional Chinese medicine M.Beijing:China Traditional Chinese Medicine Press,2016:132-133.国家中医药管理局医政司.中医病症诊断疗效标准M.北京:中国中医药出版社,2016:132-133.9 Yang YL,Chen M,Zhou YN,et al.Research progress on the relation-ship between substance P and diarrhea irritable bowel syndrome ofliver depression and spleen deficiency and the regulation of tradition-al Chinese medicine J.Chinese Archives of Traditional ChineseMedicine,2021,39(9):82-85.杨焱麟,陈敏,周彦妮,等.P物质与肝郁脾虚型腹泻型肠易激综合征关系及中医药调控的研究进展J.中华中医药学刊,2021,39(9):82-85.10 Huo YL,Mao JY,Hou ZL,et al.Curative effect observation of Wen-jing Tongluo Hot Ointment combined with Tongxie Yaofang on diar-rhea-type irritable bowel syndrome of liver depression and spleen de-ficiency J.China Journal of Traditional Chinese Medicine and Phar-macy,2021,36(9):5689-5692.霍永利,毛竞宇,侯姿蕾,等.温经通络中药热膏摩联合痛泻药方治疗肝郁脾虚证腹泻型肠易激综合征疗效观察J.中华中医药杂志,2021,36(9):5689-5692.11 Huang JC,Mao YL,Pei QQ,et al.Effect of moxibustion at Shenque(CV8),oral administration Jisheng Shenqi Pill and Western medicineon the efficacy and immune function of chronic kidney disease stage34 J.Tianjin Journal of Traditional Chinese Medicine,2021,38(8):1041-1045.黄积仓,毛亚兰,裴强强,等.艾灸神阙穴(CV8)、济生肾气丸联合西药对慢性肾脏病34期疗效及免疫功能的影响J.天津中医药,2021,38(8):1041-1045.12 Liu LL,Wang JJ,Su J,et al.Clinical efficacy of modified Xiaoyaopowder in treatment of patients with liver depression and spleen defi-ciency-type leucorrhea and its effects on vaginal flora and inflamma-tory factors J.Medical&Pharmaceutical Journal of Chinese Peo-ples Liberation Army,2022,34(5):123-125.刘莉莉,王娟娟,苏静,等.逍遥散加减治疗肝郁脾虚型带下病效果及对患者阴道菌群、炎性因子的影响J.解放军医药杂志,2022,34(5):123-125.13 Gandhi A,Shah A,Jones MP,et al.Methane positive small intestinalbacterial overgrowth in inflammatory bowel disease and irritablebowel syndrome A systematic review and meta-analysis J.Gut Mi-crobes,2021,13(1):193-198.14 Wang JG,Hu YT,Yang LY,et al.Study on the correlation between se-rum zonulin and monocyte chemoattractant protein-1 levels in pa-tients with irritable bowel syndrome and the intestinal flora,inflam-matory reaction and severity of gastrointestinal symptoms J.AnhuiMedical and Pharmaceutical Journal,2022,26(5):937-941.王建刚,胡宜涛,杨兰艳,等.肠易激综合征病人血清连蛋白、单核细胞趋化蛋白-1水平与肠道菌群、炎症反应及胃肠症状严重程度的相关性J.安徽医药,2022,26(5):937-941.15 Zhang YX,Zhao R,Lv SR,et al.Effects of modified Qiwei BaizhuPowder with umbilical moxibustion on intestinal flora and inflamma-tory factors of patients with diarrhea-predominant irritable bowel syn-drome of spleen-stomach deficiency J.Hebei Journal of TraditionalChinese Medicine,2021,43(12):2046-2051.张艳霞,赵蓉,吕双然,等.七味白术散加味联合脐灸对腹泻型肠易激综合征脾胃虚弱证患者肠道菌群及炎症指标的影响J.河北中医,2021,43(12):2046-2051.16 Li Q,Tian FL,Guo ZY,et al.Effect of Fus subcutaneous needling onvisceral sensitivity,gastrointestinal motility,intestinal flora and intes-tinal mucosal barrier function in mild and moderate irritable bowelsyndrome with diarrhea J.Chinese General Practice,2021,24(9):1111-1115.李旗,田福玲,郭振宇,等.浮针疗法对轻中度腹泻型肠易激综合征患者内脏敏感性、胃肠动力、肠道菌群及肠黏膜屏障功能的影响研究J.中国全科医学,2021,24(9):1111-1115.17 Zhao MM.Clinical observation on the effect of Anchang Zhixie de-coction in treating diarrhea type irri