【目的】分析腹泻型肠易激综合征 （IBS-D） 重叠功能性消化不良 （FD） 的中医证素分布规律，探讨IBS-D重叠FD的中医 证候特征。 【方法】通过临床调查收集IBS-D、FD和IBS-D重叠FD （简称重叠组） 各50例患者的临床资料，运用证素辨证学方 法分析其中医证素，并采用频数分析、关联规则分析以及聚类分析归纳其中医证候和证素特征。 【结果】（1） 频数分析结果显 示：重叠组以情志异常为主要诱发或加重因素，其次为饮食不节。主要证候是腹泻、腹胀、胃脘痞满、腹痛和食后痞胀。 舌色多为舌淡、舌淡红、舌暗或舌红，舌体大多胖大或有齿痕，舌苔以薄白或白为主；最常见的脉象是脉滑、脉弦、脉沉 和脉细。病位证素主要是脾、胃、小肠和肝，病性证素主要是气滞、湿、气虚和阳虚。 （2） 关联规则分析结果显示：中医证 候方面，腹胀和腹泻的支持度最高，为70.00%；病位证素方面，脾和胃的支持度最高，为80.00%；病性证素方面，湿和气 滞、气虚和气滞两组的支持度最高，均为36.00%。 （3） 聚类分析结果显示：中医证候方面，共聚为4类，分别为脾虚湿滞证、 脾虚气滞证、脾阳虚证和脾气虚证的主要表现；证候和证素组合方面，共聚为5类，分别为肝郁脾虚证和肠道湿滞证表现、 食滞胃脘证表现、脾虚气滞证表现、苔腻以及胃失和降、胃气上逆表现。 【结论】IBS-D重叠FD的主要病位在脾，与胃、肝 和小肠密切相关，主要证候是脾虚湿滞证和肝郁脾虚证、肠道湿滞证。气滞与湿阻是重叠病机的关键，病性表现为虚实夹 杂，疾病后期可出现痰湿、食积、血瘀等病理产物。

Objective To investigate the distribution of traditional Chinese medicine （TCM） syndrome elements in the patients with diarrhea-predominant irritable bowel syndrome （IBS-D） overlapping functional dyspepsia （FD） ， and to explore the characteristics of TCM syndromes in IBS-D overlapping FD. Methods Clinical investigation was performed for collecting the clinical data of patients with IBS-D，FD and IBS-D overlapping FD （overlapping group），50 cases for each disease. The TCM syndrome elements were analyzed by syndrome-element dialectical methods，and the characteristics of TCM syndromes and syndrome types were summarized by frequency analysis，association rule analysis and cluster analysis. Results （1） The results of frequency analysis showed that emotional disorder was the main inducing or aggravating factor in the overlapping group，followed by improper diet. The primary syndromes in the overlapping group were diarrhea，abdominal distension，epigastric fullness，abdominal pain and postprandial fullness；the tongue color was usually pale，pale red，dark or red，the tongue body was usually enlarged or tooth-marked，and the tongue coating was usually thin white or white；slippery pulse，wiry pulse，deep pulse and thin pulse were the common pulses. The diseases-location syndrome elements mainly involved spleen，stomach，small intestine and liver，and the disease-nature syndrome elements mainly involved qi stagnation，dampness，qi deficiency and yang deficiency. （2） The results of association rule analysis showed that the combination of abdominal distension and diarrhea had the highest support （accounting for 70.00%） associated with TCM syndromes，the combination of spleen and stomach had the highest support （accounting for 80.00%） associated with diseases-location syndrome elements， the two combinations of dampness and qi stagnation，qi deficiency and qi stagnation had the highest support （both accounting for 36.00%） associated with disease-nature syndrome elements. （3）The results of cluster analysis showed that TCM syndromes in the overlapping group were clustered into four categories of syndrome manifestations，namely spleen deficiency and dampness stagnation syndrome，spleen deficiency and qi stagnation syndrome，spleen yang deficiency syndrome and spleen qi deficiency syndrome；the combinations of syndromes and syndrome elements were clustered into five categories，namely manifestations of liver depression and spleen deficiency syndrome combined with intestinal dampness stagnation syndrome，manifestations of food stagnation in the stomach syndrome，manifestations of spleen deficiency and qi stagnation syndrome，manifestation of greasy coating，and manifestations of stomach qi failing to descend and rebellious stomach qi syndrome. Conclusion IBS-D overlapping FD usually affects the spleen，and is closely related to the disorders of the stomach，liver and small intestine. The main syndromes of IBS-D overlapping FD are spleen deficiency and dampness stagnation syndrome，and liver stagnation and spleen deficiency combined with intestinal dampness stagnation syndrome. Qi stagnation and dampness stagnation contribute to the key pathogenesis of IBS-D overlapping FD. IBS-D overlapping FD is characterized by the mixture of deficiency and excess， with the presence of pathological products such as phlegm-dampness， food accumulation and blood stasis in the later stage.

R256.34；R259.744

国家中医药管理局2023年度中医证候全国重点实验室项目 （编号：QZ2023ZZ18）；广东省中医院临床研究专项 （1010专项）（编号： YN10101907）；广东省中医药科学院“优秀青年人才青苗计划”项目 （编号：SZ2022QN08）；东莞市卫健局“黄绍刚东莞市名中医 传承工作室”建设项目 （东卫涵·号[2021]·134号）