谢晶日调畅气机抑酸通腑辨治胃食管反流

XIE Jingri(谢晶日) Adjusting Qi Dynamic and Acid Suppression and Chathartic's Experience in Treating Gastroesophageal Reflux

谢晶日教授认为胃食管反流病(GERD)是情志不遂、饮食不节、素患胆病、脾胃虚弱,气机升降失调,病位在胃与食管,与肝胆脾胃密切相关。治疗从调畅肝气出发,选方灵活、用药审慎、巧设药对、着重整体;活用左金丸,灵活调整黄连和吴茱萸比例,谢师认为左金丸乃辛开苦降,寒热并用之典范,不单局限于肝火证,适用于一切中焦寒热错杂。临证尤注意顾护胃气,常用舒缓平和之品,木香、草豆蔻等香燥之品尤为慎重;调畅气机为主,抑酸为辅,巧设"四石"组合(海螵蛸、海蛤壳、煅瓦楞子、浙贝母)制酸止痛;兼顾上下,畅通腑气;便秘较轻用焦槟榔替代槟榔,大黄与诸药一起煎煮,便秘较重大黄代茶饮,增强通便功效。饮食调护,重视情志因素,嘱患者改变生活方式,清淡饮食,勿过饱,戒除辛辣油腻,好转后仍要注意饮食情志调护,预防复发。

Professor XIE Jingri thinks the basic mechanism of the disease is affect-mind dissatisfaction,improper diet,gallbladder disease, weakness of the spleen and the stomach,qi dynamic lifting disorders,sick in the stomach and esophagus,it is closely related to Liver spleen and stomach.The key of treatment from adjust Qi dynamic set out,choose prescriptions flexible, use the medicine caution,set up the ＂Yaodui＂ ,focus on the whole;make flexible use of Zuojin pill,adjusting the proportion of huanglian and wuzhuyu,he thinks that the Znojin pill is the model of open bitter drop and fever,don＇t just apply to the liver-fire diease but also to all middle burner cold and warm confusion.Especially pay attention to the stomach in the healing process,the drug often relieve and pease,the fiery drug like muxiang caodoukou must be careful;give priority to adjusting qi dynamic,complementary with acid-inhibitory drug, clever set up the group ＂Sishi＂ - ＂Haipiaoxiao, zhaigeke, duanwalengzi, zhebeimu＂ to control acid and relieve pain;in the meantime,bowel-relaxing; On the one hand, when constipation is lighter, he often uses jiaobinlang instead of binlang, dahuang boil with other drug, On the other hand, when constipation is heavier,he take dahuang as tea,to promote the efficacy of purge.Changes in eating habits and pay attention to the modern factors.Light diet and don＇t be too full, kick the spicy greasy.Better still pay attention to the diet of modern after regulating ,prevent recurrence.