从阳论治老年反流性食管炎

Treatment of Reflux Esophagitis in the Elderly from Yang

肾阳为人身阳气的根本,是胃消熟水谷的前提。肾为胃之关,肾阳充足则胃中火力强盛,胃的消熟和脾的化生功能强健,纳运相宜;肾阳不足则炉火不旺,不足以助中焦脾胃腐熟水谷。老年人肾阳虚弱,不能温暖中焦脾胃,致水谷长时间停滞于胃脘,积郁而生酸。脾胃是人体气机升降之关键,脾胃阳气虚弱,导致气机升降失宜,胃腑失于和降,不能降浊,故形成反流,并伴有嗳腐、腹满、便秘等胃肠动力不足的症状。对于老年反流性食管炎的治疗,应以温肾健脾和胃为主,对于肾阳虚的老年患者,轻证可用八味丸调补肾中阳气,以助胃降逆,若虚寒之相较重,可用右归丸加淫羊藿、巴戟天、补骨脂等温肾阳、补精髓。温补肾阳的同时也要注意培补脾胃阳气,培补脾胃当首推李东垣之法,用辛甘升浮之品升脾养胃,再佐以疏肝、降逆、消食之品,通过扶正以祛邪。

Kidney yang is the source of body yang,and the premise of stomach digestion.Kidney is the key organ to stomach.If kidney yang is sufficient,the stomach will have strong firepower.The digestion and maturation of stomach and the generation of spleen will be strong and appropriate.If the kidney yang is not enough,the fire will not be prosperous.It is not enough to help the spleen and stomach to ripen.If the kidney yang of the elderly is weak,it will not warm the spleen and stomach,which will cause the water and grain to stagnate in the stomach for a long time,and accumulate depression and produce acid.The spleen and stomach are key to the rise and fall of qi.The weakness of yang qi in the spleen and stomach leads to the improper rise and fall of qi,the loss of harmony in the stomach and viscera,the inability to reduce turbidity,the formation of reflux,accompanied by belching,fullness of stomach,constipation and other symptoms of gastrointestinal motility deficiency.For the treatment of geriatric reflux esophagitis in the elderly,we should mainly warm the kidney and strengthen the spleen and stomach.For the ones with slight kidney yang deficiency,Eight-Ingredient Pill can be used to regulate the yang qi in the kidney,so as to help the stomach to reduce the adverse.If the deficiency cold is more serious,Right-Restoring Pill can be combined with Yinyanghuo(Herba Epimedii),Baijitian(Radix Morindae Officinalis)and Buguzhi(Fructus Psoraleae)to warm kidney yang and nourish essence.At the same time,we should also pay attention to the nourishment of yang qi of spleen and stomach.In terms of this,Li Dong-yuan’s method should be first advocated,which is to raise the spleen and stomach qi with products with pungent,sweet and floating properties,combined with the products of soothing the liver,reducing adverse reactions and digesting food,so as to strengthen healthy qi and remove pathogens.