从气从痰论治顽固性胃食管反流病

胃食管反流病多因饮食不节、七情失和、素体禀赋虚弱等原因,导致脾胃受损,土壅木郁,肝胃不和,胃失和降,胃气上逆,出现反酸、烧心、嗳气、胃胀等症状。其发生与肝、脾、胃密切相关,气机逆乱,胃失和降是其基本病机。由于本病病程较长,病情易反复发作,易成为顽固性胃食管反流病。而顽固性胃食管反流病多为本虚标实之证,本虚是指因疾病反复发作所导致的脾胃虚弱,标实是指由于脾胃虚弱、脾失健运、土壅木郁、气机不畅所导致的痰湿、气滞、热郁、血瘀等实邪。最后结局是痰气郁(瘀)交阻,脾胃升降失司,胃气上逆,从而引起反酸烧心反复发作,缠绵难愈。纵观核心病机,乃"气郁"、"痰阻"导致的胃失和降、胃气上逆。治疗顽固性胃食管反流病时宜"从气而治""从痰而治"。

Treatment of Refractory Gastroesophageal Reflux Disease from Qi and Phlegm

For the reason of immoderate diet,estrangement of seven emotions,natural weakness,etc,gastroesophageal reflux disease(GERD)always results in damage of spleen and stomach,which influences liver,causes stagnation of liver-qi,incoordination between liver and stomach,failure of descending of stomach-qi,then stomach-qi rises adversely,and leads to acid regurgitation,heartburn,eructation,gaseous distention and so on.This is closely related to liver,spleen,stomach,the basic pathological mechanism is disturbance of activity of qi and failure of descending of stomach-qi.On account of long course of disease and is easy to recur,GERD can develop into refractory GERD.Refractory GERD is mostly deficient in nature and excess in superficiality.Deficiency in nature means damage of spleen and stomach causing by recurrence,excess in superficiality means excess evil such as phlegm-dampness,qi stagnation,hot depression and blood stasis,causing by damage of spleen and stomach,dysfunction of the spleen in transport,depression of liver and the irregular flow of the liver-qi.In the end,phlegm and qi obstructed,making failure of uprising and descending of spleen and stomach,causing recurrent acid regurgitation and heartburn,becoming a protracted disease.Taking a wide view,key pathological mechanism is failure of descending and adverse rise of stomach-qi causing by qi stagnation and phlegm obstruction.Refractory GERD treatment should be considered from qi and phlegm.