周正华治疗功能性消化不良经验  

Zhou Zheng-hua′s Experience of Treating Functional Dyspepsia

作　　者：赵帅 周正华[1] ZHAO Shuai;ZHOU Zheng-hua(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin,China,300381)

机构地区：[1]天津中医药大学第一附属医院,国家中医针灸临床医学研究中心,天津300381

出　　处：《河南中医》2022年第2期214-218,共5页Henan Traditional Chinese Medicine

摘　　要：肝胃不和为功能性消化不良(functional dyspepsia,FD)主要病机之一,周正华发现,肝胃不和证存在多种亚型,病机遵循"气郁→攻冲→化火→伤阴→成瘀"五步演变过程。初始阶段病机为肝气郁结,木不疏土,秉持"见肝之病,知肝传脾,当先实脾"的既病防变原则,先以四君子汤健脾助运;肝气郁结进一步发展,出现肝气逆乱,疏泄太过,肝气攻冲,治宜散郁调气,方选四逆散合上下左右汤加减;肝气闭郁不疏,日久火象渐现,出现气郁化火,气火同病,方选化肝煎合温胆汤加减;肝热脾寒证,方选柴胡桂枝干姜汤;肝气聚而化火,损伤肝脏气分,阳亢火盛煎灼血分,热熬血浓,运行不畅,以致脉络瘀滞,瘀血内阻,火损营阴,治以柔肝益胃,养阴安神,方选养阴二味合玉女煎加减。对FD日久未愈伴瘀血阻滞明显者,根据不同病机所致的瘀血,治法亦有区分。每个阶段可独立存在,亦可相兼致病,需把握主病机,了解疾病的病性,病势及预后,方可对证施药。Liver-stomach disharmony is one of the main pathogenesis of functional dyspepsia(FD).Zhou Zheng-hua has found that there are many subtypes of liver-stomach disharmony,and the pathogenesis follows the five-step evolution process of"depression→attacking thoroughfare vessel(TV)→transforming into fire→damaging yin→forming blood stasis".In the initial stage,the pathogenesis is stagnation of liver qi,wood failing to disperse earth.Adhering to the principle of controlling development of existing disease,because"liver diseases may affect the function of the spleen,strengthening the spleen is the most important".At this stage,Four Gentlemen Decoction can be used to strengthen the spleen and help transport.When the stagnation of liver qi develops further,the disorder of liver qi occurs,the dispersing is too much,the attack of liver qi is too strong,the treatment should focus on regulating qi,so Frigid Extremities Powder combined with Modified Upper-Lower and Right-Left Decoction can be used.Long-time stagnation of liver qi may transform into fire,make qi and fire have same disease,so Liver-Resolving Decoction combined with Modified Gallbladder-Warming Decoction can be used.For liver heat and spleen cold syndrome,Bupleurum and Cinnamon Twig and Dried Ginger Decoction can be used to warm cold in middle energizer and clear heat in the reverting meridian.If liver qi accumulates and transforms into fire,damaging liver qi aspect,Yang hyperactivity and excessive fire will burn blood aspect,blood will become thick and fail to move smoothly,resulting in blocked collaterals,blood stasis,and fire damaging nutrient yin,so the treatment is to soften the liver,benefit the stomach,nourish yin and calm the mind,and Yin-Nourishing and Two-Ingredient Decoction combined with Modified Jade Lady Decoction can be used.For patients with FD who have not healed for a long time but combined with obvious blood stasis,the treatment methods are also differentiated according to blood stasis caused by different pathogenesis.Each stage can exist

关 键 词：功能性消化不良 肝胃不和 健脾解郁法 调逆行气法 清火止痛法 柔肝益胃法 化瘀活络法 周正华 

分 类 号：R249.2[医药卫生—中医临床基础]