祝肇刚从虚论治食管裂孔疝经验

Experience of ZHU Zhaogang Treating Esophageal Hiatal Hernia by Reinforcing Deficiency

食管裂孔疝(esophageal hiatal hernia,EHH)是指腹腔内脏器或组织,主要指胃经膈食管裂孔持续或暂时性进入胸腔所致的疾病。该病临床表现缺乏特异性,多归属于中医“吞酸”“胃痞”“噎膈”等范畴,目前西医药物治疗手段有限,疗效欠佳,且易反复发作,长期影响患者的生活质量。祝肇刚先生从事中医临床五十余载,在中医药治疗脾胃病方面经验丰富,见解独到,祝师认为食管裂孔疝为本虚标实之证,脾气亏虚,不主肌肉为发病之本,胃失和降,气机上逆为致病之标,情志不遂,肝失疏泄常为病进之因。治疗上强调治病求本,从虚论治,针对病机,提出健脾益气扶正为主,佐以和胃降逆的治疗大法,以加味补中益气汤为基础方,随证加减应用,同时结合饮食与起居调护,常常获得满意的疗效。文章通过总结祝肇刚先生从虚论治食管裂孔疝的经验,以期为该病的临床治疗提供新的思路。

Esophageal hiatal hernia(EHH)is a disease that abdominal organs and tissues penetrate into thoracic cavity temporarily or continuously through hiatus esophageus of diaphragm.EHH lacks specific clinical manifestations and mostly belongs to the category of“acid regurgitation”,“stuffiness of stomach”and“dysphagia”in traditional Chinese medicine.At present,the treatment methods in modern medicine are not only limited and few effective,but also easy to relapse,which affects the quality of life of patients for a long time.Professor ZHU Zhaogang has been engaged in clinical practice of TCM for more than fifty years and has extensive experience and unique opinions in treating spleen and stomach diseases.He believes that EHH belongs to TCM syndrome of deficiency in origin and excess in superficiality.Spleen deficiency which makes muscle weakness is defined as basic pathogenesis while abnormal rising of stomach Qi is the superficial cause and not liver freely distributing is often a factor in the progression of the disease.Professor ZHU emphasizes the treatment should focus on the essence of the disease,which means treating EHH by reinforcing deficiency,and puts forward the treatment method of strengthening spleen,supplementing Qi and strengthening the body,with the treatment of harmonizing the stomach and descending the adverse.The Modified Buzhong Yiqi Decoction(加味补中益气汤)is the basic prescription which often be modified according to clinical symptoms and combined with diet and daily care to achieve satisfactory curative effect.This article summarized professor ZHU Zhaogang′s experience on treating EHH by reinforcing deficiency in order to provide new ideas for the clinical treatment of this disease.