从五脏气机升降辨治胃食管反流  

Discussion on Gastroesophageal Reflux Disease from the Qi Rise and Fall of Five-zang Organs

作　　者：刘金萍 吕冠华[2] LIU Jinping;LYU Guanhu(Liaoning university of Traditional Chinese Medicine：1.The 2016 Level Digestible Direction of Graduate School;Affiliated Second Hospital,Spleen and Stomach Department,Shenyang 110032,China)

机构地区：[1]辽宁中医药大学研究生学院,沈阳110032 [2]辽宁中医药大学附属二院脾胃肝胆科,沈阳110032

出　　处：《实用中医内科杂志》2018年第9期4-6,共3页Journal of Practical Traditional Chinese Internal Medicine

摘　　要：胃食管反流属"反酸""呕吐""呃逆"等范畴,为气机升降失调,病在胃,与五脏关系密切,五脏气机升降异常均可致胃失和降、胃气上逆,应和胃降逆,辅以疏肝、健脾、宣肺、补肾、养心之法,标本同治。肝失疏泄,胃失和降:肝胃同居中焦,升降相依,相互为用,肝气疏泄升发之性可促进胃气之和降,情绪畅达,则不易发病,治疗疏肝气以降胃气之柴胡疏肝散。脾不升清,胃不降浊:脾胃互为表里,一升一降,关系密切,脾气虚弱,无力布散水谷精微时易导致病理产物瘀滞中焦,加重胃气阻滞导致胃失和降,治以健脾益气和胃降逆,六君子汤或香砂六君子汤化裁。肺气不宣,胃气不降:全身气机通过肺的运动维持动态平衡,调节肺气的宣发肃降功能对于通降胃气可起到提壶揭盖之功。肾失摄纳,胃失和降:胃为水谷之海,肾为气之根,肾火不暖胃土则致胃气虚寒,治疗以和胃降逆,酌加枸杞、山药、杜仲等补肾之品,以达到补先天以养后天的功效。火不暖土,心胃同病:心胃毗邻,心为气血之大主,脾胃乃气血化生之源,心气亢盛,心火上炎而不能下降以暖胃土,水谷不化,胃气失于和降临床上可借鉴"调心以治胃"的辨证思路。Gastroesophageal reflux is a category of ＂antacids＂, ＂vomiting＂ and ＂hiccups＂, caused by the imbalance of the air lift and fall in the stomach, and it is closely related to the five viscera, and abnormal rise and fall of the five internal organs can lead to gastric disharmony and fall. Stomach Qi inversion should be treated by adjust the stomach Qi, soothing liver and strengthening spleen, nourishing kidney and ventilating lungand nourishing heart in order tosimultaneous treatment of principal and subordinate symptoms, liver dysfunction and stomach Qi rising： Both are in the middle energizer, rise and fall dependent, mutually serving,liver Qi dredge uplift of the nature can promote the sum and fall of stomach Qi. Good humor prevents illness and should be treated by treatment of liver Qi to lower stomach Qi of chai hu shugan powder. Spleen not clear,stomach not cloudy： the spleen and stomach are the exterior and interior and the two are closely related in rise and all.Dysfunction of the spleen in transport lead to the pathological product stays in the middle energizer up to aggravate stasis of stomach Qi, that should be treated by strengthening the spleen and stomach of liu junzi or xiangsha liujunzi. Lung can not governing diffusion, stomach Qi failing to descend： the whole body ventilator maintains its dynamic balance through the movement of the lungs, to regulate the function of lung Qi, it can improve the function of pull down the stomach Qi. Renal failure is taken, stomach Qi failing to descend： The stomach is the sea of water and cereal, the kidney is the basis of Qi, kidney fire does not warm the stomach soil causes stomach Qi deficiency cold should be treated by harmonizing stomach and lowering adverse Qi, Use kidney-tonifying therapy such as the fruit of Chinese wolfberry, Chinese yam, tu-chung, in order to nourished innate. Fire is not warm earth, heart and stomach are sick together： heart stomach adjacent to each other, heart main Qi and blood, spleen and stomach are the source of

关 键 词：胃食管反流 反酸 呕吐 呃逆 气机升降 肝失疏泄 胃气不降 柴胡疏肝散 脾不升清 六君子汤 香砂六君子汤 肺气不宣 肾失摄纳 火不暖土 心胃同病 中医药治疗 

分 类 号：R259[医药卫生—中西医结合]