谢晶日教授运用调肝通胃法论治慢性萎缩性胃炎经验探析_李昊天.pdf

浙江中医药大学学报2023年2月第47卷第2期JOURNAL OF ZHEJIANG CHINESE MEDICAL UNIVERSITY VOL.47NO.2 Feb.2023国医传承谢晶日教授运用调肝通胃法论治慢性萎缩性胃炎经验探析李昊天1谢晶日2孙志文21.黑龙江中医药大学哈尔滨1500402.黑龙江中医药大学附属第一医院摘要：目的总结谢晶日教授运用调肝通胃法论治慢性萎缩性胃炎的经验，以期说明调肝通胃法的立法依据及临床应用思路。方法通过跟随谢教授门诊抄方，对门诊医案进行收集、整理和分析，查阅中医典籍和现代慢性萎缩性胃炎相关的临床研究文献，从患病特点、临床治法、处方用药特点几方面总结谢教授论治慢性萎缩性胃炎的经验，并附医案一则加以佐证。结果谢教授认为，慢性萎缩性胃炎患者有以下三个特点：情志不遂而伤正、饮食不慎而伤脾胃、病程日久生痰瘀。针对以上的病机特点，谢教授确立调肝三法和通胃祛邪的治疗思路，其中调肝三法从气不升发、气机郁结、气郁化火三个角度，治以疏肝散郁、破气调肝、清肝泻火三种方法；通胃祛邪则是从消导的思路化除食积、痰瘀邪气，从补益脾胃的角度扶正固本，以此达到胃气通降，邪气不存的效果。验案中患者因饮食而发病，伴有情志不遂，结合舌脉，谢教授辨证分析为肝郁化火、脾虚湿蕴证，治疗以调肝清热、通胃扶正为法，获得较好的疗效。结论谢教授运用调肝通胃法论治慢性萎缩性胃炎，根据不同症状特点灵活变通用药，取得了较好的临床疗效。谢教授的经验从临床实践出发，为中医药治疗慢性萎缩性胃炎扩展了新的思路。关键词：慢性萎缩性胃炎；调肝通胃法；肝脾论；辨证论治；中医药；名医经验；谢晶日中图分类号：R256文献标志码：A文章编号：1005-5509（2023）02-0161-06DOI:10.16466/j.issn1005-5509.2023.02.009Analysis of Professor XIE Jingris Experience in Treating Chronic Atrophic Gastritis by Regulating the Liver and Promoting theStomach LI Haotian1，XIE Jingri2，SUN Zhiwen21.Heilongjiang University of Chinese Medicine，Harbin(150040)，China；2.FirstAffiliated Hospital of Heilongjiang University of Chinese MedicineAbstract:ObjectiveTo summarize Professor XIE Jingris experience in treating chronic atrophic gastritis(CAG)with the method ofregulating the liver and promoting the stomach，in order to explain the treatment basis and clinical application idea of regulating theliver and promoting the stomach method.MethodsThrough following Professor XIEs prescriptions in outpatient clinic，outpatientmedical cases were collected，collated and analyzed，traditional Chinese medicine classics and modern clinical research literaturerelated to CAG were consulted，and Professor XIEs experience in treating CAG was summarized from the aspects of diseasecharacteristics，clinical treatment methods and characteristics of prescription medication，and one medical case was listed as evidence.ResultsProfessor XIE believes that patients with CAG have the following three characteristics：bad mood leading to damage of healthyQi，careless diet injuring the spleen and stomach，long term illness producing phlegm and blood stasis.In view of the abovepathogenesis characteristics，Professor XIE proposes the three methods of regulating the liver and promoting the stomach and removingpathogenic factors.Among them，the three methods of regulating the liver include regulating the liver and dispersing depression，breaking Qi and regulating the liver，clearing the liver and eliminating fire from the perspectives of Qi failing in rising and Qi stagnationproducing fire；promoting the stomach and removing pathogenic factors follows the idea of helping digestion and removing accumulation，in order to eliminate the accumulation of food，phlegm and stasis evil；tonifying the spleen and stomach so as to strengthen thefoundation，achieve the effect of clearing stomach Qi and removing pathogen.The medical case mentioned in the article was caused bydiet，accompanied by emotional distress.Professor XIE analyzed the case as liver depression transforming fire，spleen deficiency anddampness accumulation syndrome according to the syndrome differentiation of tongue and pulse.The method of regulating the liver andclearing heat，and promoting the stomach and strengthening the body was used to achieve good curative effect.ConclusionProfessorXIE treats CAG with the method of regulating the liver and promoting the stomach，and makes flexible drug use according to thecharacteristics of different symptoms，and achieves good clinical efficacy.Professor XIEs experience from the clinical practice，extendsa new idea for the TCM treatment of CAG.Key words：chronic atrophic gastritis；method of regulating the liver and promoting the stomach；liver and spleen theory；syndromedifferentiation and treatment；traditional Chinese medicine；experience of famous doctor；XIE Jingri基金项目：国家中医药管理局全国名老中医药专家传承工作室建设项目（国中医药人教发201642号）；黑龙江省博士后资助项目（LBH-Z20194）；黑龙江省中医药管理局项目（ZHY2022-146）Fundprojects：ConstructionProjectofNationalFamousOldTCMExpertsInheritanceStudioofNationalTCMAdministration(G.TCM.R.J.F.201642)；Postdoctoral Project of Heilongjiang Province(LBH-Z20194)；Project of Heilongjiang TraditionalChinese Medicine Administration(ZHY2022-146)通信作者：孙志文，E-mail：161浙江中医药大学学报2023年2月第47卷第2期慢 性 萎 缩 性 胃 炎（chronic atrophic gastritis，CAG）是多种致病因素导致的临床常见的消化系统疾病，其病理特征是胃黏膜上皮固有腺体的减少，伴或不伴有肠化生、异型增生。2016年一项研究显示，该病胃镜检出率为22.43%1。CAG是胃癌前病变的一种2，患者确诊后5年内胃癌的年发病率为0.1%3。患者往往缺乏特异性临床表现，以胃脘部胀满或者疼痛等消化系统相关症状为主。西医目前多以抑制胃酸、保护胃黏膜为主要治疗手段，亦有部分患者合并幽门螺杆菌感染，则需联合抗菌药物治疗，虽然具有一定的临床疗效，但也存在幽门螺杆菌耐药、病情反复的一些弊端4。中医药治疗胃癌前病变的研究已经进行了30余年，在改善患者不适、延缓或者逆转黏膜病变方面获得了较好的效果5。谢晶日教授系黑龙江中医药大学博士及博士后导师，全国第五、六批名老中医药专家学术经验继承工作指导教师，国家脾胃病重点专科带头人，黑龙江省第二批名中医，黑龙江省德艺双馨名中医，享受国务院特殊津贴专家，从事临床工作40余年，临床经验丰富，擅长运用中医、中西医结合的方法治疗消化病及其他内科疾病。谢教授在多年临床实践中总结出的“肝脾论”学术思想，在治疗消化系统疾病方面有着很好的指导意义。笔者有幸侍诊左右，感触颇深，遂撰写本文，拟从临床实践的角度来分析谢教授论治CAG的经验。1立法依据CAG患病三大特点现代研究发现，CAG的发病与幽门螺杆菌感染、年龄、身体质量指数、精神因素以及不良的饮食习惯相关6。中医认为CAG属于“胃脘痛”“痞满”“嘈杂”等范畴，其发病多与情志、饮食、外邪感染相关7。谢教授在临床实践中，发现很多CAG患者都有以下三个特点：情志不遂而伤正、饮食不慎而伤脾胃、病程日久生痰瘀。1.1情志不遂而伤正情志不遂而伤正，即情志方面的问题会导致人体气机运行失调。现今工作生活压力较大，路理杰等8研究显示，CAG患者病