小建中汤治疗消化性溃疡评述

A Commentary Treating Peptic Ulcer with Minor Center-Fortifying Decoction

小建中汤主要用于治疗伤寒腹中急痛和虚劳里急等症,而消化性溃疡的典型表现为腹部疼痛,在病症上二者明显相似;在病机上,小建中汤证为阴阳两虚、寒热错杂,偏于阳虚为主,消化性溃疡为胃之气机阻滞或脉络失养,致胃失和降,不通则痛,失荣亦痛,发病日久则可见虚实夹杂证。因此,在病机上二者具有共同性,这也是小建中汤能用于治疗消化性溃疡的原因。现代医家运用小建中汤治疗消化性溃疡注重中西医合用,在治疗周期上符合诊疗共识,疗效评价机制在不断丰富,基础组方在小建中汤基础上结合现代医学认识予以加减。但是目前研究存在:(1)研究设计尚待进一步规范;(2)缺乏大样本、多中心的研究;(3)相关的作用机制阐发研究缺乏。可在目前研究基础上,有针对性地开展下一步工作:(1)依据专家共识、诊疗规范等详细设计研究方案;(2)开展小建中汤在改善消化性溃疡方面的生化、蛋白组学等方面的研究;(3)开展大样本的临床研究。

Minor Center-Fortifying Decoction is mainly used in the treatment of abdominal pain due to typhoid fever,and abdominal pain due to compulsive disease,while the typical manifestation of peptic ulcer is abdominal pain,so the two are obviously similar in symptoms.In terms of pathogenesis,Minor Center-Fortifying Decoction syndrome is characterized by deficiency of both yin and yang,cold and heat in complexity,with yang deficiency as the main symptom.Peptic ulcer is caused by qi stagnation of the stomach or loss of nourishment of vessels,resulting in disharmony and descending of the stomach,pain due to obstruction,and pain due to loss of nutrient.After a long time,the syndrome of intermingled deficiency and excess can be seen.Therefore,both of them have common pathogenesis,which is also the reason why Minor Center-Fortifying Decoction can be used to treat peptic ulcer.Modern doctors use Minor Center-Fortifying Decoction to treat peptic ulcer,pay attention to the combination of traditional Chinese and Western medicine,accord with the consensus of diagnosis and treatment in the treatment cycle,the curative effect evaluation mechanism is constantly enriched,and the basic formulas are added and subtracted on the basis of Minor Center-Fortifying Decoction combined with modern medical knowledge.However,the current research has the following problems:(1)Research design needs to be further standardized;(2)It lacks of large sample and multi-center research;(3)It lacks of relevant mechanism elucidation research.Therefore,on the basis of the current research,we can carry out the next researches:(1)Diagnosis and treatment standards and other detailed research program should be designed according to the expert consensus;(2)The biochemical and proteomic research of Minor Center-Fortifying Decoction in improving peptic ulcer should be carried out;(3)The large sample clinical research should be carried out.