吴门医派气机升降学说在胃食管反流病中的应用

Application of the Theory of Ascending and Descending of Qi Movement of Master Wu′s Medical School to Gastroesophageal Reflux Disease

胃食管反流病病位在食管,属胃所主。情志不遂,肝气郁结,横逆犯胃,导致肝(胆)胃不和或肝脾不和;气郁日久,化火生热,胃热上泛食管,发展为肝胃郁热证、胆热犯胃证。治当平肝扶胃,采用抑木扶土法,以"苦辛泄降,少佐酸味"为遣药原则,采用《金匮要略》半夏厚朴汤化裁治疗。脾不升清,胃(浊)气挟热上逆,发为胃食管反流病。故调和阴阳,祛其寒热偏盛,使脾升胃降,气机调畅,应为胃食管反流病治疗思路之一。吴门医家对脾胃升降失常的治疗各具特色,薛己治脾,以升为主,遵循李东垣"大升阳气"之法,以补中益气汤、调中益气汤、升阳益胃汤补脾之虚,升下陷之清阳;叶天士调胃,以降为先,遵循张仲景"急下存阴"法,创立"胃阴学说"。胃食管反流病与肺脏有一定关联,肺主肃降,助胃使浊阴下降,肺胃不和,胃气上逆也是胃食管反流病的病机之一。当降肺降胃,用药以"轻剂清降,以及苦辛寒开肺"为原则。吴门医家着眼于全身气机升降平衡,论证了脾升胃降和肝升肺降对维持脾胃正常生理功能的作用,在胃食管反流病的升降治法中既疏肝肃肺,又善补胃阴,调和脾阳胃阴。

Gastroesophageal reflux disease is located in the esophagus,which belongs to the stomach.Emotional frustration,stagnation of liver qi and invasion of stomach lead to disharmony between liver(gallbladder)and stomach,or disharmony between liver and spleen;qi stagnation lasts for a long time,and changes into fire and heat,and stomach heat spreads up to esophagus,which develops into syndrome of liver-stomach stagnant heat and gallbladder Heat invading stomach.The treatment should focus on cooling liver and supporting stomach,regard"dispersing stagnation and purging heat with bitter and pungent medicinals"as medication principle.Modified Pinellia and Officinal Magnolia Bark Decoction in Synopsis of Golden Chamber can be adopted.If the spleen does not ascend smoothly,stomach(turbid)qi combined with heat rises up,gastroesophageal reflux disease will easily occur.Therefore,harmonizing yin and yang,removing excessive cold and heat to ascend spleen and descend stomach and make qi movement smooth becomes one of principles of treating gastroesophageal reflux disease.Master Wu′s medical school doctors have their own characteristics in the treatment of spleen-stomach ascending and descending disorders.Xue Ji treated the spleen disease mainly by ascending,following Li Dong-yuan′s method of"greatly increasing yang qi".He used Center-Supplementing and Qi-Boosting Decoction,Center-Regulating and Qi-Boosting Decoction,Yang-Raising and Stomach-Boosting Decoction to nourish the deficiency of spleen and elevate the collapsed lucid yang.Ye Tian-shi adjusted the stomach and established the theory of stomach yin by descending first following Zhang Zhong-jing′s method of"emergent purgation to preserve yin".Gastroesophageal reflux disease is associated with the lung.The lung governs keeping lung-qi pure and descendant,while supporting stomach can help reduce turbid yin.Disharmony between the lung and stomach,stomach qi ascending counterflow is also one of the pathogenesis of gastroesophageal reflux disease.The treatment should focus on descending lung qi and stomach qi.""Clearing and descending with light medicinal,and regulating lung with bitter and pungent and cold medicinal"can be regarded as the medication principle.Master Wu′s medical school doctors focused on the balance of qi movement in the whole body,and demonstrated the role of spleen qi ascending and stomach qi descending,and liver qi ascending and lung qi descending in maintaining the normal physiological function of spleen and stomach.In the ascending and descending treatment of gastroesophageal reflux disease,it not only soothes the liver and disperses lungs,but also is good at tonifying stomach yin and harmonizing spleen yang and stomach yin.