基于“木郁达之”理论探讨慢性萎缩性胃炎辨治  

Study on the Differentiation and Treatment of Chronic Atrophic Gastritis Based on the Theory that"Mollify the Liver if it is Depressed"

作　　者：樊明智 王柏林 曹剑冰 王媛[1] 管文慧 刘维明[3] FAN Mingzhi;WANG Bolin;CAO Jianbing;WANG Yuan;GUAN Wenhui;LIU Weiming(Shandong University of Traditional Chinese Medicine,Jinan,Shandong,China,250014;Shandong Hospital of Traditional Chinese Medicine,Jinan,Shandong,China,250011;Jinan Traditional Chinese Medicine Hospital Affiliated to Shandong University of Traditional Chinese Medicine,Jinan,Shandong,China,250012)

机构地区：[1]山东中医药大学,山东济南250014 [2]山东省中医院,山东济南250011 [3]山东中医药大学附属济南市中医医院,山东济南250012

出　　处：《河南中医》2023年第10期1478-1482,共5页Henan Traditional Chinese Medicine

基　　金：山东省中医药科技项目(2020Z28)。

摘　　要：慢性萎缩性胃炎的发生主要与情志失调、脾胃虚弱、饮食不节、外侵袭等因素相关,诸因素或单独致病,或合而为病,病位在胃,但与肝密切相关,治疗应谨遵叶天士“忌刚用柔”之法则,顺应木性,把握木土乘克关系,从肝论治。肝气郁结者,治以疏肝和胃解郁,用柴胡疏肝散加减;肝胃郁热者,治以清肝泄热和胃,肝热清则胃得和,用左金丸加减;肝胃阴虚者,治以益胃生津、柔肝养阴,药用沙参、石斛、女贞子、麦冬等。胃络瘀阻者,治以活血化瘀,补肝养血,药用当归、白芍、桃仁等。同时,还应重视医学-心理-社会医学模式的应用,积极对患者进行心理疏导,二者相合,常有佳效。The occurrence of chronic atrophic gastritis(CAG)is mainly related to factors such as emotional imbalance,spleen-stomach weakness,improper diet,and external invasion,etc.These factors may cause the disease alone or in combination,with the disease located in the stomach but closely related to the liver.The treatment should strictly follow Ye Tianshi's principle of"avoiding hardness and u-sing softness",comply with the wooden nature,grasp the relationship between wood and earth,and treat it from the liver.For those with liver qi stagnation,the treatment should be to soothe the liver,harmonize the stomach and relieve depression,so Modified Bupleurum Liver-Soothing Powder is used.For those with liver and stomach heat stagnation,the treatment should be to clear the liver,relieve heat,and harmonize the stomach.If the liver heat is cleared,the stomach can be reconciled,so Modified Left Metal Pill is used.For liver-stomach yin deficiency,the treatment is to nourish the stomach and promote fluid production,emolliate the liver and nourish yin,and use medicinal herbs such as Shashen(Radix Adenophorae seu Glehniae),Shihu(Caulis Dendrobi),Nvzhenzi(FructusLigustri Lucidi),Maidong(Radix Ophiopogonis),etc.For gastric collateral stasis,the treatment is to promote blood circulation and remove stasis,tonify the liver and nourish blood,and use medicinal herbs such as Danggui(Radix Angelicae Sinensis),Baishao(Radix Paeoniae Alba),Taoren(Semen Persicae),etc.At the same time,attention should also be paid to the application of the medical-psychological-social medical model,and active psychological counseling should be provided to patients.The combination of the two often has good effects.

关 键 词：慢性萎缩性胃炎 木郁达之 疏肝法 清肝法 柔肝法 补肝法 

分 类 号：R259.733.2[医药卫生—中西医结合]