胃食管反流病中医辨治探析

探讨“常法与变法”在胃食管反流病(GERD)中的具体临床应用。GERD致病原因复杂,其基本病机为脾虚失运为本,肝郁气逆为标,二者互相影响,治疗时常需兼顾常法与变法。常法有四,即辨证为湿热蕴结证时,选用温胆汤合菖蒲郁金汤加减以清热化湿开窍; 辨为脾虚气滞证时,用香砂六君子汤合平胃散加减以健脾燥湿行气; 邪气弥漫,辨为湿阻三焦证时,则用三仁汤加减以宣通三焦利湿; 中年女性,辨为肝郁气逆证时,选用柴胡加龙骨牡蛎汤加减以疏肝和胃降逆。在此基础上随症加减,有是症,用是药。中医学强调整体观念,故以通心阳、清心火、调肺气、滋肾阴为治疗之变法,且注重患者自身调护,以减少复发,提高临床疗效。

Discussion on treatment of gastroesophageal reflux disease by traditional Chinese medicine

Investigating the clinical application of “routine method and variant method ” in gastroesophageal reflux disease(GERD).The pathogenesis of GERD is complex.The basic pathogenesis of GERD is spleen deficiency and dysfunction,and liver qi stagnation.Both of them affect each other.The treatment often needs to take into account the conventional and modified methods.There are four common methods,that is,when syndrome differentiation is damp-heat accumulation,Wendan decoction and Changpu Yujin decoction are used to clear heat and remove dampness.When the syndrome of spleen deficiency and qi stagnation is identified,Xiangsha Liujunzi decoction combined with Pingwei powder is used for invigorating spleen,drying dampness and promoting qi; when the evil is diffuse and is identified as dampness obstructing Sanjiao,Sanren decoction is used to remove dampness.Middle-aged women,when identified as liver qi depression,choose Chaihu Longgu Muli decoction to soothe liver and stomach.On this basis,the dialectical addition and subtraction of drugs.Traditional Chinese medicine emphasizes the holistic concept,so it takes tongxinyang,clearing heart fire,regulating lung qi,nourishing kidney yin as the treatment methods,and pays attention to the patient's own care,in order to reduce recurrence and improve clinical efficacy.