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Article(id=1322923892272149354, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.06.046, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339234654, onlineDateStr=2026-10-30, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339234654, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339234654, creator=13701087609, updateTime=1793339234654, updator=13701087609, issue=Issue{id=1322923782029062261, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='6', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1749484800000', pubDateStr='2025-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339208371, creator='13701087609', updateTime=1793340556755, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929437859258468, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929437859258469, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=221, endPage=225, ext={EN=ArticleExt(id=1322923892465087339, articleId=1322923892272149354, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Qingre Lishi Decoction（清热利湿汤）Combined with Babaodan（八宝丹）in Treatment of Hemorrhoids with Dampness-Heat Pouring Down Syndrome and Its Influence on Inflammation and Immune Response, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the effect of Qingre Lishi Decoction（清热利湿汤）combined with Babaodan（八宝丹）in the treatment of hemorrhoids with dampness-heat pouring down syndrome and its influence on inflammation and immune response.

Methods

A hundred and two patients with hemorrhoids from June 2020 to April 2023 were selected as the research objects.The patients were divided into study group and control group by random number table method，with 51 cases in each group.The control group was given Babaodan，and the study group was given Qingre Lishi Decoction on the basis of the control group.The effect was evaluated after continuous treatment for 8 weeks in both groups.TCM symptom scores，improvement of main symptoms and clinical efficacy were compared between the two groups.Changes of inflammatory factors and immune response factors in peripheral blood were compared between the two groups.Adverse reactions of the two groups were recorded during treatment.

Results

The TCM syndrome scores of the main and secondary symptoms of two groups after treatment were lower than those before treatment（P<0.05），and the scores of the study group after treatment were lower than those of the control group（P<0.05）.The disappearance time of bleeding，anal swelling and anal pain in the study group were shorter than those in the control group（P<0.05）.The total effective rate of the study group was higher than that of the control group（P<0.05）.The serum levels of interferon-γ（IFN-γ），interleukin-4（IL-4）and interleukin-17（IL-17）in two groups after treatment were lower than those before treatment（P<0.05）.The levels of IFN-γ，IL-4 and IL-17 in the study group after treatment were lower than those of the control group（P<0.05）.The levels of immunoglobulin G（IgG），IgM，C3 and C4 in two groups after treatment were higher than those before treatment（P<0.05），and the levels of IgG，IgM，C3 and C4 in the study group after treatment were higher（P<0.05）.There were no obvious adverse reactions in both groups during treatment.

Conclusion

In the treatment of hemor-rhoids with dampness-heat pouring down syndrome，Qingre Lishi Decoction combined with Babaodan can enhance the therapeutic effect，reduce the levels of inflammatory factors and improve the immune response function，with good safety.

, authors=Shuling CHEN, Min LIN, Pang CHEN, Ruiping ZHENG, Shihan CHEN, authorsList=Shuling CHEN, Min LIN, Pang CHEN, Ruiping ZHENG, Shihan CHEN, authorCompany=null, correspAuthors=Min LIN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923894545462142, articleId=1322923892272149354, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=清热利湿汤联合八宝丹治疗湿热下注型痔疮效果及对炎症水平和免疫应答的影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

分析清热利湿汤联合八宝丹治疗湿热下注型痔疮的效果及对炎症水平和免疫应答的影响。

方法

选取2020年6月—2023年4月医院收治的102例湿热下注型痔疮患者，以随机数表法分为研究组、对照组，各51例。对照组给予八宝丹，研究组在对照组基础上给予清热利湿汤治疗，两组均持续治疗8周后评价效果。比较两组中医症状评分、主要症状改善情况及临床疗效，对比两组外周血炎症因子、免疫应答因子变化情况，记录两组治疗期间不良反应发生情况。

结果

两组治疗后的主症、次症中医证候评分均低于治疗前（P<0.05），研究组治疗后评分更低（P<0.05）。研究组出血消失时间、肛门肿胀消失时间、肛门疼痛消失时间均短于对照组（P<0.05）。研究组总有效率高于对照组（P<0.05）。两组治疗后血清干扰素γ（IFN-γ）、白细胞介素-4（IL-4）、白细胞介素-17（IL-17）均低于治疗前（P<0.05），研究组治疗后更低（P<0.05）。两组治疗后免疫球蛋白G（IgG）、IgM、C3、C4均高于治疗前（P<0.05），研究组治疗后的IgG、IgM、C3、C4均高于对照组（P<0.05）。两组治疗期间均未出现明显不良反应。

结论

清热利湿汤联合八宝丹治疗湿热下注型痔疮可增强治疗效果，降低炎症因子水平，改善免疫应答功能，且安全性良好。

, authors=陈淑玲, 林敏, 陈雱, 郑锐平, 陈世涵, authorsList=陈淑玲, 林敏, 陈雱, 郑锐平, 陈世涵, authorCompany=null, correspAuthors=林敏, authorNote=

陈淑玲（1993-），女，福建福安人，医师，硕士，研究方向：内科疾病及肛肠疾病的中西医结合临床。

, correspAuthorsNote=
林敏（1979-），男，福建莆田人，副主任医师，硕士，研究方向：内科疾病及肛肠疾病的中西医结合临床。E-mail：。
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陈淑玲（1993-），女，福建福安人，医师，硕士，研究方向：内科疾病及肛肠疾病的中西医结合临床。

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陈淑玲（1993-），女，福建福安人，医师，硕士，研究方向：内科疾病及肛肠疾病的中西医结合临床。

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Role of interleukin-17 in the pathogenesis of perianal abscess and anal fistula：a clinical study on 50 patients with perianal abscess［J］. ANZ J Surg，2019，89（3）：244-247., articleTitle=Role of interleukin-17 in the pathogenesis of perianal abscess and anal fistula：a clinical study on 50 patients with perianal abscess, refAbstract=null), Reference(id=1322923911993766865, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, doi=null, pmid=null, pmcid=null, year=2021, volume=17, issue=1, pageStart=98, pageEnd=105, url=null, language=null, rfNumber=［24］, rfOrder=23, authorNames=VELASCO-MEDINA A A, GARCÍA-LEÓN ML, VELÁZQUEZSÁMANO G, journalName=Hum Vaccin Immunother, refType=null, unstructuredReference=VELASCO-MEDINA A A，GARCÍA-LEÓN ML，VELÁZQUEZSÁMANO G，et al. The cellular and humoral immune response to influenza vaccination is comparable in asthmatic and healthy subjects［J］. 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JOral Biol Craniofac Res，2020，10（4）：665-669., articleTitle=Evaluation of serum immunoglobulin（IgG，IgM，IgA）in potentially malignant disorders of oral cavity-a case control study, refAbstract=null), Reference(id=1322923912379642835, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, doi=null, pmid=null, pmcid=null, year=2020, volume=20, issue=19, pageStart=3695, pageEnd=3698，3677, url=null, language=null, rfNumber=［26］, rfOrder=25, authorNames=孙嘉伟, 刘欣, 马媛媛, journalName=现代生物医学进展, refType=null, unstructuredReference=孙嘉伟，刘欣，马媛媛，等. 龙血竭胶囊合九华膏对环状混合痔术后患者创面愈合、血清炎性因子和免疫功能的影响［J］. 现代生物医学进展，2020，20（19）：3695-3698，3677., articleTitle=龙血竭胶囊合九华膏对环状混合痔术后患者创面愈合、血清炎性因子和免疫功能的影响, refAbstract=null), Reference(id=1322923912488694740, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, doi=null, pmid=null, pmcid=null, year=2021, volume=16, issue=5, pageStart=95, pageEnd=99, url=null, language=null, rfNumber=［27］, rfOrder=26, authorNames=陈凯迪, 严建, journalName=中国药物经济学, refType=null, unstructuredReference=陈凯迪，严建. 参茋槐榆汤治疗痔疮患者的临床疗效及对中医证候的影响［J］. 中国药物经济学，2021，16（5）：95-99., articleTitle=参茋槐榆汤治疗痔疮患者的临床疗效及对中医证候的影响, refAbstract=null)], funds=[Fund(id=1322923906176267192, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, awardId=2022J011515, language=CN, fundingSource=福建省自然科学基金项目(2022J011515), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322923894943921023, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, xref=null, ext=[AuthorCompanyExt(id=1322923894964892544, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, companyId=1322923894943921023, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Ningde Mindong Hospital，Fuan 355000，Fujian，China), AuthorCompanyExt(id=1322923894990058369, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, companyId=1322923894943921023, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=宁德市闽东医院，福建 福安 355000)])], figs=[ArticleFig(id=1322923903470941100, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数性别/（例）年龄/（岁，±s）体质量指数/（kg/m2，±s）痔疮病程/（年，±s）痔疮严重程度/（例）
男女Ⅰ度Ⅱ度
对照组51302141.59±7.3823.27±1.984.32±0.762031
研究组51213043.37±7.1423.59±1.734.53±0.811734
t/χ2值3.1761.2380.8691.3500.382
P值0.0750.2190.3870.1800.537
), ArticleFig(id=1322923903550632877, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=CN, label=表1, caption=

两组湿热下注型痔疮患者临床资料比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数性别/（例）年龄/（岁，±s）体质量指数/（kg/m2，±s）痔疮病程/（年，±s）痔疮严重程度/（例）
男女Ⅰ度Ⅱ度
对照组51302141.59±7.3823.27±1.984.32±0.762031
研究组51213043.37±7.1423.59±1.734.53±0.811734
t/χ2值3.1761.2380.8691.3500.382
P值0.0750.2190.3870.1800.537
), ArticleFig(id=1322923903621936046, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主症
便血鲜红、量较多肛门肿物外脱并可自行缩回肛门伴灼热、肿胀、疼痛感便干或溏小便短赤
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组513.58±0.611.31±0.24a3.84±0.641.42±0.23a2.41±0.381.02±0.17a2.32±0.331.11±0.19a2.46±0.421.17±0.21a
研究组513.64±0.571.18±0.21a3.93±0.681.25±0.19a2.35±0.360.91±0.15a2.27±0.310.93±0.17a2.39±0.381.02±0.19a
t值0.5132.9110.6884.0690.8193.4650.7895.0420.8833.783
P值0.6090.0040.4930.0000.4150.0010.4320.0000.3800.000
), ArticleFig(id=1322923903705822127, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=CN, label=表2, caption=

两组湿热下注型痔疮患者中医证候评分（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主症
便血鲜红、量较多肛门肿物外脱并可自行缩回肛门伴灼热、肿胀、疼痛感便干或溏小便短赤
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组513.58±0.611.31±0.24a3.84±0.641.42±0.23a2.41±0.381.02±0.17a2.32±0.331.11±0.19a2.46±0.421.17±0.21a
研究组513.64±0.571.18±0.21a3.93±0.681.25±0.19a2.35±0.360.91±0.15a2.27±0.310.93±0.17a2.39±0.381.02±0.19a
t值0.5132.9110.6884.0690.8193.4650.7895.0420.8833.783
P值0.6090.0040.4930.0000.4150.0010.4320.0000.3800.000
), ArticleFig(id=1322923903798096816, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数出血消失时间肛门肿胀消失时间肛门疼痛消失时间
对照组516.17±1.214.64±0.824.19±0.76
研究组514.98±1.05a3.91±0.73a3.52±0.58a
t值5.3054.7495.005
P值0.0000.0000.000
), ArticleFig(id=1322923903865205681, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=CN, label=表3, caption=

两组湿热下注型痔疮患者症状改善情况（±s）

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组别例数出血消失时间肛门肿胀消失时间肛门疼痛消失时间
对照组516.17±1.214.64±0.824.19±0.76
研究组514.98±1.05a3.91±0.73a3.52±0.58a
t值5.3054.7495.005
P值0.0000.0000.000
), ArticleFig(id=1322923903944897458, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
对照组5128（54.90）11（21.57）12（23.53）39（76.47）
研究组5138（74.51）10（19.61）3（5.88）48（94.12）
χ2值6.331
P值0.012
), ArticleFig(id=1322923904007812019, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=CN, label=表4, caption=

两组湿热下注型痔疮患者临床疗效

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
对照组5128（54.90）11（21.57）12（23.53）39（76.47）
研究组5138（74.51）10（19.61）3（5.88）48（94.12）
χ2值6.331
P值0.012
), ArticleFig(id=1322923904100086708, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数IFN-γIL-4IL-17
治疗前治疗后治疗前治疗后治疗前治疗后
对照组512.87±0.411.86±0.32a1.88±0.241.03±0.19a13.04±2.6710.12±1.83a
研究组512.92±0.431.65±0.28a1.91±0.210.92±0.17a13.25±2.489.01±1.62a
t值0.6013.5270.6723.0810.4143.243
P值0.5490.0010.5030.0030.6800.002
), ArticleFig(id=1322923904200750005, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=CN, label=表5, caption=

两组湿热下注型痔疮患者炎症因子变化（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数IFN-γIL-4IL-17
治疗前治疗后治疗前治疗后治疗前治疗后
对照组512.87±0.411.86±0.32a1.88±0.241.03±0.19a13.04±2.6710.12±1.83a
研究组512.92±0.431.65±0.28a1.91±0.210.92±0.17a13.25±2.489.01±1.62a
t值0.6013.5270.6723.0810.4143.243
P值0.5490.0010.5030.0030.6800.002
), ArticleFig(id=1322923904293024694, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数IgG/（g/L）IgM/（g/L）C3/（mg/L）C4/（mg/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组5111.89±2.0114.94±2.46a1.19±0.211.42±0.28a1.17±0.151.35±0.19a0.65±0.140.83±0.15a
研究组5112.03±1.9616.35±2.72a1.23±0.241.55±0.26a1.21±0.181.48±0.22a0.67±0.120.92±0.17a
t值0.3562.7460.8962.4301.2193.1940.7752.835
P值0.7220.0070.3730.0170.2260.0020.4400.006
), ArticleFig(id=1322923905979134903, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923892272149354, language=CN, label=表6, caption=

两组湿热下注型痔疮患者免疫应答因子变化（±s）

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组别例数IgG/（g/L）IgM/（g/L）C3/（mg/L）C4/（mg/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组5111.89±2.0114.94±2.46a1.19±0.211.42±0.28a1.17±0.151.35±0.19a0.65±0.140.83±0.15a
研究组5112.03±1.9616.35±2.72a1.23±0.241.55±0.26a1.21±0.181.48±0.22a0.67±0.120.92±0.17a
t值0.3562.7460.8962.4301.2193.1940.7752.835
P值0.7220.0070.3730.0170.2260.0020.4400.006
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清热利湿汤联合八宝丹治疗湿热下注型痔疮效果及对炎症水平和免疫应答的影响
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陈淑玲 , 林敏 , 陈雱 , 郑锐平 , 陈世涵
中华中医药学刊 | 省级项目平台 2025,43(6): 221-225
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中华中医药学刊 |省级项目平台 2025 , 43 (6) : 221 -225
清热利湿汤联合八宝丹治疗湿热下注型痔疮效果及对炎症水平和免疫应答的影响
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陈淑玲, 林敏 , 陈雱, 郑锐平, 陈世涵
作者信息
  • 宁德市闽东医院，福建 福安 355000
通讯作者:
林敏（1979-），男，福建莆田人，副主任医师，硕士，研究方向：内科疾病及肛肠疾病的中西医结合临床。E-mail：。
作者简介:

陈淑玲（1993-），女，福建福安人，医师，硕士，研究方向：内科疾病及肛肠疾病的中西医结合临床。

Effect of Qingre Lishi Decoction（清热利湿汤）Combined with Babaodan（八宝丹）in Treatment of Hemorrhoids with Dampness-Heat Pouring Down Syndrome and Its Influence on Inflammation and Immune Response
Shuling CHEN, Min LIN , Pang CHEN, Ruiping ZHENG, Shihan CHEN
Affiliations
  • Ningde Mindong Hospital，Fuan 355000，Fujian，China
出版时间: 2025-06-10 doi: 10.13193/j.issn.1673-7717.2025.06.046
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摘要
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目的

分析清热利湿汤联合八宝丹治疗湿热下注型痔疮的效果及对炎症水平和免疫应答的影响。

方法

选取2020年6月—2023年4月医院收治的102例湿热下注型痔疮患者，以随机数表法分为研究组、对照组，各51例。对照组给予八宝丹，研究组在对照组基础上给予清热利湿汤治疗，两组均持续治疗8周后评价效果。比较两组中医症状评分、主要症状改善情况及临床疗效，对比两组外周血炎症因子、免疫应答因子变化情况，记录两组治疗期间不良反应发生情况。

结果

两组治疗后的主症、次症中医证候评分均低于治疗前（P<0.05），研究组治疗后评分更低（P<0.05）。研究组出血消失时间、肛门肿胀消失时间、肛门疼痛消失时间均短于对照组（P<0.05）。研究组总有效率高于对照组（P<0.05）。两组治疗后血清干扰素γ（IFN-γ）、白细胞介素-4（IL-4）、白细胞介素-17（IL-17）均低于治疗前（P<0.05），研究组治疗后更低（P<0.05）。两组治疗后免疫球蛋白G（IgG）、IgM、C3、C4均高于治疗前（P<0.05），研究组治疗后的IgG、IgM、C3、C4均高于对照组（P<0.05）。两组治疗期间均未出现明显不良反应。

结论

清热利湿汤联合八宝丹治疗湿热下注型痔疮可增强治疗效果，降低炎症因子水平，改善免疫应答功能，且安全性良好。

痔疮  /  湿热下注型  /  清热利湿汤  /  八宝丹  /  效果  /  炎症  /  免疫应答
Objective

To analyze the effect of Qingre Lishi Decoction（清热利湿汤）combined with Babaodan（八宝丹）in the treatment of hemorrhoids with dampness-heat pouring down syndrome and its influence on inflammation and immune response.

Methods

A hundred and two patients with hemorrhoids from June 2020 to April 2023 were selected as the research objects.The patients were divided into study group and control group by random number table method，with 51 cases in each group.The control group was given Babaodan，and the study group was given Qingre Lishi Decoction on the basis of the control group.The effect was evaluated after continuous treatment for 8 weeks in both groups.TCM symptom scores，improvement of main symptoms and clinical efficacy were compared between the two groups.Changes of inflammatory factors and immune response factors in peripheral blood were compared between the two groups.Adverse reactions of the two groups were recorded during treatment.

Results

The TCM syndrome scores of the main and secondary symptoms of two groups after treatment were lower than those before treatment（P<0.05），and the scores of the study group after treatment were lower than those of the control group（P<0.05）.The disappearance time of bleeding，anal swelling and anal pain in the study group were shorter than those in the control group（P<0.05）.The total effective rate of the study group was higher than that of the control group（P<0.05）.The serum levels of interferon-γ（IFN-γ），interleukin-4（IL-4）and interleukin-17（IL-17）in two groups after treatment were lower than those before treatment（P<0.05）.The levels of IFN-γ，IL-4 and IL-17 in the study group after treatment were lower than those of the control group（P<0.05）.The levels of immunoglobulin G（IgG），IgM，C3 and C4 in two groups after treatment were higher than those before treatment（P<0.05），and the levels of IgG，IgM，C3 and C4 in the study group after treatment were higher（P<0.05）.There were no obvious adverse reactions in both groups during treatment.

Conclusion

In the treatment of hemor-rhoids with dampness-heat pouring down syndrome，Qingre Lishi Decoction combined with Babaodan can enhance the therapeutic effect，reduce the levels of inflammatory factors and improve the immune response function，with good safety.

hemorrhoids  /  dampness-heat pouring down syndrome  /  Qingre Lishi Decoction（清热利湿汤）  /  Babaodan（八宝丹）  /  effect  /  inflammation  /  immune response
陈淑玲, 林敏, 陈雱, 郑锐平, 陈世涵. 清热利湿汤联合八宝丹治疗湿热下注型痔疮效果及对炎症水平和免疫应答的影响. 中华中医药学刊, 2025 , 43 (6) : 221 -225 . DOI: 10.13193/j.issn.1673-7717.2025.06.046
Shuling CHEN, Min LIN, Pang CHEN, Ruiping ZHENG, Shihan CHEN. Effect of Qingre Lishi Decoction（清热利湿汤）Combined with Babaodan（八宝丹）in Treatment of Hemorrhoids with Dampness-Heat Pouring Down Syndrome and Its Influence on Inflammation and Immune Response[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (6) : 221 -225 . DOI: 10.13193/j.issn.1673-7717.2025.06.046
正文
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痔疮是最常见的肛门直肠疾病，是由肛垫移位或病理性肥大引起的局部血管结构扩张，肛门直肠黏膜下血管网的静脉功能不全和扩张导致的痔疮增生[1-2]。痔疮在普通人群中的患病率高达40%左右，在中老年人群中发病率最高[3]。痔疮患者最常表现为复发性慢性直肠出血、痔核脱出，在血栓形成或裂隙的情况下，痔疮患者会经历极度疼痛，不仅会降低患者生活质量还可能导致贫血[4]。目前临床针对痔疮主要包括保守治疗、外科手术治疗，外科手术虽可根除病源，但具有一定创伤性，术后并发症发生风险高，且手术具有各种禁忌证和繁琐的术后护理，大多数痔疮患者较难接受此种疗法，多数轻症患者会首选保守治疗[5]。高锰酸钾溶液熏蒸坐浴是临床治疗痔疮的常用方法，可控制感染、改善患者临床症状，但长期疗效不甚理想。
痔疮包括湿热下注型、气滞血瘀型等多种证型，笔者临床工作中发现湿热下注型较为常见。《东垣十书》显示治痔应以清热、祛风、燥湿为主，湿热下注型痔疮多因湿热蕴积或下注大肠，气血凝滞，肛周经脉受伤而下血，治疗应以清热燥湿为主要原则[6-7]。八宝丹是临床常用的中成药制剂，具有清利湿热、活血解毒、去黄止痛之功，目前多用于治疗湿热蕴结、湿热下注型疾病中，但其单药临床疗效有限。目前研究[8-9]指出，炎症反应与免疫应答功能失调与痔疮发生、发展关系密切。基于痔疮证型、病机、辨证施治，笔者采用清热利湿汤联合八宝丹用于湿热下注型痔疮可进一步提升治疗效果，改善患者炎症水平及免疫应答功能。
1　临床资料
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1.1　一般资料
选取2020年6月—2023年4月医院收治的102例湿热下注型痔疮患者，以随机数表法分为研究组、对照组，各51例。两组临床资料可比（P>0.05），见表1。研究经医院伦理委员会审批。
1.2　诊断标准
1.2.1　西医诊断标准
符合《中国痔病诊疗指南（2020）》[10]中内痔诊断标准：主要表现为便时出血，便后自行停止出血，排便时痔脱出、便后自行还纳。
1.2.2　中医诊断标准
参照《中医肛肠科常见病诊疗指南》[11]，辨证湿热下注；主症：便血鲜红、量较多，肛门肿物外脱并可自行缩回；次症：肛门伴灼热、肿胀、疼痛感，便干或溏，小便短赤；舌脉：舌质红，舌苔黄腻，脉浮数。
1.3　纳入标准
①符合诊断标准；②年龄>18岁；③研究知情同意。
1.4　排除标准
①伴肛门、直肠疾病手术史；②伴传染性疾病、血液系统疾病；③重要脏器功能障碍；④伴肛瘘、肛裂、肛管直肠占位等其他肛周疾病；⑤伴药物滥用史、药物过敏史；⑥伴其他肛周皮肤病；⑦有排便障碍者；⑧妊娠或哺乳者；⑨自然失访。
1.5　治疗方法
对照组口服八宝丹胶囊（厦门中药厂有限公司，国药准字Z10940006，规格：0.3 g/粒）0.6 g/次，3次/d；睡前坐浴高锰酸钾（国药准字H22026515，吉林省东盟制药有限公司）溶液，10 g高锰酸溶于约5 L开水熏蒸患处10 min，水温合适后坐浴10 min，擦干涂抹马应龙痔疮膏（马应龙药业集团股份有限公司，国药准字Z42021920），1次/d。
研究组在对照组基础上口服清热利湿汤：方剂组成：黄柏10 g，黄芩10 g，鱼腥草10 g，生地黄10 g，白藓皮10 g，苦参10 g，金银花8 g，黄连8 g，白芷8 g，大黄8 g，泽泻8 g，赤芍5 g，鸡血藤5 g，白术5 g，茯苓5 g，山药5 g，炙甘草3 g。上述药物1剂/d，煎熬滤至200 mL药汁，早晚各口服100 mL。
两组治疗8周评价效果。
1.6　观察指标
1.6.1　中医证候评分
评估患者治疗前后中医证候评分，主症每项0～6分；次症每项0～4分；分数越高病情越严重。
1.6.2　症状改善情况
统计患者出血消失时间、肛门肿胀消失时间、肛门疼痛消失时间。
1.6.3　临床疗效
①显效：治疗后症状改善或消失，痔核消失或萎缩变小，肛镜显示痔黏膜正常或轻微充血，中医证候评分降低≥70%；②有效：治疗后症状减轻，痔核缩小、轻微脱垂，肛镜显示痔黏膜充血，中医证候评分降低≥30%且<70%；④无效：未达上述标准[12]。总有效率＝显效率+有效率。
1.6.4　炎症因子
患者治疗前后采集空腹静脉血，离心分离收集血清，酶联免疫吸附法测定干扰素γ（interferon-γ，IFN-γ）、白细胞介素-4（interleukin-4，IL-4）、白细胞介素-17（interleukin-17，IL-17），试剂盒购自上海酶联生物科技有限公司。
1.6.5　免疫应答
治疗前后，空腹抽取患者静脉血5mL，散射比浊法测定免疫球蛋白G（Immunoglobulin G，IgG）、免疫球蛋白M（Immunoglobulin M，IgM）及补体C3、C4，试剂盒购自上海康朗生物科技有限公司。
1.6.6　安全性
统计患者治疗期间恶心、呕吐、口干等不良反应。
1.7　统计学分析
数据处理采用SPSS 23.0统计软件，计量资料以（）表示，t检验；计数资料以构成比或率（%）表示，χ2 检验。P<0.05差异有统计学意义。
2　结果
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2.1　中医证候评分
两组治疗后的主症、次症中医证候评分均低于治疗前（P<0.05），研究组治疗后评分更低（P<0.05）。见表2。
2.2　症状改善情况
研究组出血消失时间、肛门肿胀消失时间、肛门疼痛消失时间均短于对照组（P<0.05）。见表3。
2.3　疗效
研究组总有效率高于对照组（P<0.05）。见表4。
2.4　炎症因子
两组治疗后IFN-γ、IL-4、IL-17均低于治疗前（P<0.05），研究组治疗后更低（P<0.05）。见表5。
2.5　免疫应答功能
两组治疗后IgG、IgM、C3、C4均高于治疗前（P<0.05），研究组治疗后更高（P<0.05）。见表6。
2.6　安全性
两组未出现明显不良反应。
3　讨论
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痔疮的形成与肛门周围血管的异常扩张有关，正常情况下肛门周围的静脉血管会通过肛门内外的连接来保持血液循环的平衡，当血管扩张或变形时，会导致血液在静脉血管中滞留，从而形成痔疮；便秘和长时间的排便努力也是痔疮形成的重要因素之一，长时间的排便努力会增加肛门周围的压力，使血液难以流动，进一步导致血管扩张和痔疮形成；肠道炎症和肠道感染也可导致痔疮的发生，炎症和感染会引起肛门周围组织的充血和水肿，增加了痔疮形成的风险；遗传因素和生活习惯也对痔疮的形成起到一定的影响，血管弹性较差者易出现血管扩张和痔疮，长时间久坐、饮食不规律、缺乏运动等不良生活习惯也可能增加患病风险。中医认为目前多数痔疮因内湿而发，饮食不节致饮食积滞，久而化湿、化热，湿热蕴积，湿性趋下，下先受之，阻滞经络、气血凝滞，致魄门筋脉纵横，经络阻隔交错，长此以往肛门直肠出现血瘀脓肿，且经脉受伤致血下[13-15]。此外，湿热下注大肠可导致肠道气机不畅，经络阻滞，瘀血聚集肛周，亦可发为湿热下注型痔疮。
本研究显示，研究组治疗后的中医证候评分低于对照组，研究组出血消失时间、肛门肿胀消失时间、肛门疼痛消失时间均短于对照组，研究组总有效率高于对照组，提示清热利湿汤联合八宝丹治疗湿热下注型痔疮可改善患者临床症状，增强临床疗效。本研究中的清热利湿汤由黄柏、鱼腥草、炙甘草等多种药材精制而成，扣清热利湿辨证论治要点，方中黄柏清热燥湿、善于清除下焦湿热，黄芩清热燥湿、泻火解毒，鱼腥草清热解毒，生地黄凉血止血，白藓皮清热燥湿，苦参清热燥湿、凉血止血，金银花清热解毒、消炎退肿，黄连清热燥湿，白芷祛风燥湿、消肿止痛，大黄泻热通便、凉血止血，泽泻利尿化湿，赤芍清热凉血、散瘀止痛，鸡血藤舒筋活络、活血补血，白术祛湿健脾，茯苓健脾利湿，山药健脾益胃，炙甘草补脾益气、调和诸药，共奏清热利湿、消肿止痛之功。现代药理研究指出，癸酰乙醛鱼腥草素可抑制金黄色葡萄球菌、致病杆菌等致病菌活性[16]；苦参总碱具有抗炎、镇痛、促进黏膜修复等功效[17]；金银花富含多糖、绿原酸等活性成分，具有抑制病原体感染、消炎退肿、扩张血管等药理作用[18]；多糖作为茯苓中重要的活性物质之一，具有调节机体免疫功能、抗炎、抗氧化等多种药理活性[19]。
IFN-γ主要由活化的T淋巴细胞和自然杀伤细胞产生，痔疮的形成与炎症反应密切相关，包括炎性细胞浸润、炎性因子的释放等，IFN-γ能够抑制炎症细胞的活化和炎症因子的产生，从而减轻炎症反应，缓解痔疮症状；痔疮发作时直肠周围组织受到损伤，IFN-γ能够促进纤维母细胞的增殖和胶原蛋白的合成，加速组织修复过程；IFN-γ还能够促进血管生成和新生血管的稳定，有利于痔疮组织的血液循环和营养供应；FN-γ能够调节免疫细胞的功能，增强免疫应答，提高机体对痔疮病原微生物的抵抗能力[20]。IL-4是一种由T细胞和其他免疫细胞产生的细胞因子，主要参与调节免疫反应和抗炎作用，在痔疮患者中，IL-4的表达水平升高，可能是为了抑制炎症反应和促进组织修复，IL-4可以抑制炎症介质的产生，减轻炎症反应；此外，IL-4还可以促进巨噬细胞的活化和分化，增强巨噬细胞对病原体的吞噬和杀伤能力，从而帮助清除病原体和减轻炎症反应[21]。IL-17是一种由T细胞产生的细胞因子，它主要参与调节炎症反应和免疫应答，在痔疮患者中，IL-17的表达水平升高，IL-17可以促进炎症介质的产生，增加炎症反应，激活多种炎症细胞，增强机体炎症反应和吞噬能力；IL-17还可促进血管生成和组织纤维化，从而加重痔疮的炎症和组织损伤[22-23]。IL-4和IL-17在痔疮中的炎症反应机制中起着相互作用的调节作用，IL-4可抑制IL-17的产生和炎症反应，减轻炎症损伤，而IL-17则可增强IL-4的作用，增加炎症反应和免疫应答，这两种细胞因子的平衡调节对于痔疮的发展和进展具有重要意义。本研究显示研究组治疗后的IFN-γ、IL-4、IL-17低于对照组，提示清热利湿汤联合八宝丹治疗湿热下注型痔疮可降低炎症因子水平，研究组疗效更佳可能与此作用机制有关。
补体C3和C4参与了痔疮免疫及炎症反应的启动，可被激活并形成活化补体，这些活化的补体分子可吸引和激活中性粒细胞和单核细胞等其他免疫细胞；其次补体C3和C4也参与了痔疮炎症反应的调节，一方面可通过与其他免疫细胞表面的受体结合，调节免疫细胞的活化和功能，另一方面还可与炎症介质相互作用，调节炎症反应的程度和持续时间；补体C3和C4还参与了痔疮组织的修复和再生过程，可促进炎症后的组织修复，促进血管生成和纤维组织形成，有助于痔疮的愈合[24]。IgG可增强免疫细胞抗感染能力，IgG可识别和结合痔疮引起的病原体或炎症介质，通过与这些分子结合，形成免疫复合物，有助于清除病原体和炎症介质，减轻痔疮的症状；IgG还可激活其他免疫细胞参与免疫应答，当IgG与病原体结合后，它可与免疫细胞表面的受体结合，激活的免疫细胞会释放细胞因子和化学介质，进一步增强免疫应答，促进痔疮的治愈；IgG还具有调节免疫应答的功能，可与其他免疫球蛋白和细胞因子相互作用，调节免疫细胞的活性和功能，这种调节作用有助于平衡炎症反应，防止过度的免疫反应导致组织损伤[25]。IgM可通过多种途径参与痔疮的发生和发展，IgM可与病原体或其他外来抗原结合，触发免疫应答；IgM可通过激活免疫细胞，如巨噬细胞和淋巴细胞，增强炎症反应和免疫细胞的活性；IgM还可参与血管生成和修复过程，对痔疮组织的修复和再生起到一定的作用[26-27]。本研究显示研究组治疗后的IgG、IgM、C3、C4高于对照组，提示清热利湿汤联合八宝丹治疗湿热下注型痔疮可改善免疫应答功能，笔者认为可能与以下原因有关：清热利湿汤联合八宝丹治疗湿热下注型痔疮可促进肛门黏膜修复，提高局部新陈代谢，通过抗炎、抗氧化等药物活性促进炎症物质吸收，进而改善其免疫应答功能。
综上所述，清热利湿汤联合八宝丹治疗湿热下注型痔疮可增强治疗效果，安全性良好，其机制可能与降低炎症因子水平、改善免疫应答功能有关。后期仍需开展更多临床与基础研究探讨清热利湿汤在湿热下注型痔疮中的具体作用机制。
基金
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  • 福建省自然科学基金项目(2022J011515)
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2025年第43卷第6期
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doi: 10.13193/j.issn.1673-7717.2025.06.046
  • 首发时间：2026-10-30
  • 出版时间：2025-06-10
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福建省自然科学基金项目(2022J011515)
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    宁德市闽东医院，福建 福安 355000

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林敏（1979-），男，福建莆田人，副主任医师，硕士，研究方向：内科疾病及肛肠疾病的中西医结合临床。E-mail：。
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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