谢晶日运用“肝脾同调”治疗胃食管反流病经验探析

Experience of XIE Jingri Treating Gastroesophageal Reflux Disease with “Regulating Spleen and Liver Simultaneously”

目的浅析谢晶日教授临床运用“肝脾同调”治疗胃食管反流病(GERD)的经验。方法文章分别从GERD的发病病因,关键病机,辨证要点及药物应用上探析谢晶日教授治疗GERD的经验及用药规律,并列举典型案例1则。结果谢晶日教授结合当下社会背景,认为导致GERD发生的病因主要为情志失调和饮食不节,同时与脾胃虚弱和外邪犯胃相关。病机关键在于中焦气机失调,气逆于上。本病为本虚标实之证,脾虚不运为发病之本,肝郁气逆为致病之标,同时与肺胃气机失调、痰气郁阻相关。在治疗上谢晶日教授倡导“肝脾同调”,以“肝郁”为切入点,以疏肝健脾,抑酸和胃降逆为治疗大法。同时四诊合参,精准辨证,根据兼症灵活加减用药,方可获得好的临床疗效。结论谢晶日教授以“肝脾同调”为指导思想,通过精准辨证,灵活加减治疗GERD,临床疗效确切,能够有效改善GERD患者的相关临床症状,值得学习和借鉴。

Objective A brief analysis of Professor XIE Jingri′s clinical application experience of“regulating spleen and liver simultaneously”on treating gastroesophageal reflux disease(GERD).Methods The current study analyzed Professor XIE Jingri′s experience on treating GERD and medication rules from the etiology,key pathogenesis,key points of syndrome differentiation and drug application of GERD,and illustrated one typical case.Results Based on the current social background,Professor XIE Jingri reckons that the main causes of GERD are emotional disorders and improper diet,and it is also associated with deficiency of spleen and stomach and invasion of external evils to the stomach.The key to the pathogenesis lies in the imbalance of Qi activity in middle-Jiao and reversed flow of Qi to the upside.This disease is a symptom of deficient root and excessive superficial,deficiency of spleen is the root of this disease and stagnation of liver Qi is the symptom of the disease.Furthermore,it is also associated with the imbalance of lung and stomach Qi activity and stagnation of phlegm and Qi.The principle of treatment takes Professor XIE Jingri′s experience of“regulating spleen and liver simultaneously”as the starting point and soothing liver and invigorating spleen,suppressing acid and reducing the adverse effects of stomach as the treatment methods.Meanwhile,the combination of four diagnoses,the precise differentiation of symptoms and signs,and the flexible addition and reduction of medication based on concurrent symptoms can achieve satisfactory clinical effects.Conclusion Under the guiding principle of“regulating spleen and liver simultaneously”,Professor XIE Jingri applies precise differentiation of syndromes and signs,treats GERD using flexible addition and subtraction of medication,and achieves a definite clinical effect.This treatment can effectively improve the relevant clinical symptoms of GERD patients and it is worthy of learning and applying for reference.