【目的】观察加味痛泻要方治疗腹泻型肠易激综合征（diarrhea-predominant irritable bowel syndrome，IBS-D）肝郁脾虚证 患者的临床疗效。【方法】将60例IBS-D肝郁脾虚证患者随机分为治疗组和对照组，每组各30例。治疗组患者给予加味痛泻 要方治疗，对照组患者给予匹维溴铵片（得舒特）治疗，疗程为4周。观察2组患者治疗前后中医证候积分、肠易激综合征生 活质量量表（IBS-QOL）评分、汉密尔顿焦虑量表（HAMA）评分的变化情况，并根据IBS病情严重程度量表（IBS-SSS）积分的分 级情况评价2组患者的总体症状改善疗效，比较2组患者的腹痛、腹泻单项症状改善疗效和停药4周后的复发情况。【结果】 （1）总体症状改善疗效方面，治疗4周后，治疗组的总有效率为83.33%（25/30），对照组为43.33%（13/30），组间比较（χ2检 验），治疗组的总体症状改善疗效明显优于对照组（P＜0.01）。（2）单项症状改善疗效方面，治疗4周后，治疗组腹痛、腹泻症 状改善疗效的总有效率分别为80.00%（24/30）、90.00%（27/30），对照组分别为43.33%（13/30）、46.67%（14/30），组间比较 （χ2检验），治疗组的腹痛、腹泻症状改善疗效均明显优于对照组（P＜0.01）。（3）量表评分方面，治疗4周后，2组患者的中医 证候积分、IBS-QOL评分、HAMA评分均较治疗前明显降低（P＜0.05或P＜0.01），且治疗组的降低幅度均明显优于对照组 （P＜0.01）。（4）复发情况方面，停药4周后，治疗组的复发率为24.00%（6/25），明显低于对照组的61.54%（8/13），组间比 较，差异有统计学意义（P＜0.05）。【结论】加味痛泻要方治疗IBS-D肝郁脾虚证患者疗效确切，能有效改善患者的腹痛、腹 泻症状和中医证候积分，提高患者的生活质量，缓解患者的焦虑状态。

Objective To observe the clinical efficacy of Modified Tongxie Yaofang （Important Formula for Relieving Diarrhea with Pain）in the treatment of patients with diarrhea-predominant irritable bowel syndrome （IBS-D）with liver-depression and spleen-deficiency syndrome. Methods Sixty patients with IBS-D of liver depression and spleen deficiency type were randomly divided into treatment group and control group，30 patients in each group. The patients in the treatment group were given modified Tongxie Yaofang，and the patients in the control group were given Pivacurium Bromide Tablets（Dicetel）. Both groups were treated for a 4-week course of treatment. The changes of traditional Chinese medicine（TCM）syndrome scores，irritable bowel syndrome quality of life（IBS-QOL）scores， Hamilton Anxiety Scale（HAMA）scores of the two groups were observed before and ·临床研究· 广州中医药大学学报 Journal of Guangzhou University of Traditional Chinese Medicine 2024年3月第41卷第3期 562 March 2024，Vol. 41，No. 3 after the treatment. Moreover，the efficacy for overall symptomatic improvement in the two groups was evaluated according to the grading of irritable bowel syndrome symptom severity score（IBS-SSS）， and the efficacy for improving single symptom such as abdominal pain and diarrhea as well as the relapse after 4 weeks of drug cessation in the two groups were compared. Results（1）After 4 weeks of treatment， the total effective rate for overall symptomatic improvement in the treatment group was 83.33%（25/30），and that in the control group was 43.33%（13/30）. The intergroup comparison（tested by chi- square test） showed that the efficacy for overall symptomatic improvement in the treatment group was significantly superior to that in the control group（P＜0.01）. （2）After 4 weeks of treatment， the total effective rate for improving single symptom of abdominal pain and diarrhea in the treatment group was 80.00%（24/30），90.00%（27/30），and that in the control group was 43.33% （13/30），46.67%（14/30），respectively. The intergroup comparison（tested by chi-square test）showed that the efficacy for improving single symptom of abdominal pain and diarrhea in the treatment group was significantly superior to that in the control group（P＜0.01）.（3）After 4 weeks of treatment，the TCM syndrome scores，IBSQOL scores，and HAMA scores of patients in both groups were significantly decreased compared with those before treatment（P＜0.05 or P＜0.01），and the decrease in the treatment group was significantly superior to that in the control group（P＜0.01）.（4）After 4 weeks of drug withdrawal， the recurrence rate of the treatment group was 24.00%（6/25），which was significantly lower than that of the control group（61.54%，8/13），and the difference was statistically significant between the two groups（P＜0.05）. Conclusion Modified Tongxie Yaofang exerts certain effect in treating patients with IBS-D of liver depression and spleen deficiency type，and the decoction is effective on decreasing the scores of symptoms of abdominal pain and diarrhea as well as TCM syndrome scores， improving the quality of life of the patients，and alleviating the anxiety status of the patients.

R259.744

国家自然科学基金项目（编号：82104743）；国家中医药管理局丁氏内科黄文东基地李东垣“阴火”理论传承创新团队项目 （编号：2021LPTD-009）