李乾构运用四君子汤加减治疗慢性萎缩性胃炎经验

LI Qiangou′s Experience on Treating Chronic Atrophic Gastritis with Sijunzi Decoction(四君子汤)

《太平惠民和剂局方》首载四君子汤方,其组方主要包括人参、白术、茯苓、甘草四味中药,功用为健脾益气、调理脾胃气机,常被各方医家用来治疗慢性胃病,其中人参可补脾益肺,白术功专补益脾气,与人参同用可增强健脾之效,与茯苓同用可加强除湿之功,甘草补虚,还可调和诸药,李乾构教授认为此方为治疗慢性萎缩性胃炎的基本方。李乾构教授从医五十余载,对治疗慢性萎缩性胃炎、胃食管反流病及功能性消化不良等脾胃系疾病有着丰富的临床经验。慢性萎缩性胃炎多由于人体情志失调、饮食不节等原因,导致脾胃升降失常,此病病程长,逐渐消耗人体正气,故李教授认为脾气虚弱为性萎缩性胃炎的主要发病机理,兼以气滞、血瘀、痰湿为患,临床以补脾理气为治疗的根本大法,结合患者实际情况,以四君子汤为基础方进行化裁用以辨证施治,并取得良好的疗效。《脾胃论》曾云:“治脾可以安五脏”,《金匮要略》亦云:“四季脾旺而不受邪”,均可表明脾胃之气对于健康的重要性。该文通过总结李乾构教授针对不同病证下四君子汤的变化应用,浅析性萎缩性胃炎的病因病机及用药规律。

The prescription of Sijunzi Decoction(四君子汤),first published in Taiping Huimin Heju Jufang,mainly consists of Renshen(Radix Et Rhizoma Ginseng),Baizhu(Rhizoma Atractylodis Macrocephalae),Fuling(Poria)and Gancao(Radix Et Rhizoma Glycyrrhizae).Its function is to strengthen spleen and Qi and regulate Qi movement of spleen and stomach.It is often used by doctors to treat chronic stomach diseases.Among them,Renshen(Radix Et Rhizoma Ginseng)can strengthen spleen and nourish lung.Baizhu(Rhizoma Atractylodis Macrocephalae)is specially used to strengthen spleen and can enhance the effect of Renshen(Radix Et Rhizoma Ginseng)strengthening spleen and the function of eliminating dampness of Fuling(Poria).Gancao(Radix Et Rhizoma Glycyrrhizae)can tonify deficiency and also can reconcile various drugs.Professor LI Qiangou believes that this formula is the basic formula for the treatment of chronic atrophic gastritis(CAG).Professor LI Qiangou has been a doctor for more than 50 years and has rich clinical experience in the treatment of spleen and stomach diseases such as CAG,gastroesophageal reflux disease and functional dyspepsia.CAG often leads to Qi abnormal rise and fall of spleen and stomach due to human emotional disorders,improper diet and other reasons.The disease has a long course and gradually consumes the healthy Qi of the human body.Therefore,Professor LI believes that spleen Qi deficiency is the main pathogenesis of CAG,which is also suffering from Qi stagnation,blood stasis and phlegm-dampness.Clinically,strengthening spleen and regulating Qi is the fundamental method of treatment,combined with the actual situation of patients.Based on Sijunzi Decoction,the prescription is modified based on syndrome differentiation and has achieved good curative effect.Piweilun once said that“treating spleen can calm the five Zang organs”,and Synopsis of the Golden Chamber also said that“the spleen is prosperous in four seasons without evils”,which can show the Qi importance of spleen and stomach for health.This paper summarized Professor LI Qiangou′s application of Sijunzi Decoction under different diseases and syndromes and analyzed the etiology,pathogenesis and medication law of CAG.