慢性萎缩性胃炎以脾虚血瘀论治探析

Preliminary Study on Treatment of Chronic Atrophic Gastritis with Spleen Deficiency and Blood Stasis

慢性萎缩性胃炎(chronic atrophic gastritis, CAG)是临床中常见的一种消化系统难治性疾病,且该病具有一定的癌变趋势。因其以"胃黏膜萎缩→肠上皮化生→异型增生→胃癌"的疾病演变过程,已被明确定为癌前疾病。积极干预治疗是阻断炎癌转变的重要手段,对胃癌防治具有重要意义。该病属于中医学中"胃痞""胃脘痛"等范畴,其发生发展是复杂的渐变过程,病机复杂多变,虚实兼夹,临床中多以脾胃虚弱,胃络瘀阻为常见,主要的病位在胃,和肝脾的关系最为密切。故提出"脾虚血瘀"为其基本病机,脾虚为本,血瘀为标,本虚标实相互交织,最终形成虚实夹杂之证。针对该病机,治以"扶正补脾,祛瘀生新",并注重肝脾(胃)同调。通过从脾虚血瘀病机论治慢性萎缩性胃炎,展现中医药辨证施治的巨大优势,以期为中医药治疗本病提供更多的思路与方法。

Chronic atrophic gastritis(CAG) is a common digestive system disease in clinic, and it is also a refractory disease. It has a certain tendency of canceration. Nowadays, most of the mathematicians at home and abroad agree with the development model of "chronic gastritis-atrophy of gastric mucosa-metaplasia of intestinal epithelium-dysplasia-gastric cancer". CAG has been clearly identified as a precancerous disease. Active intervention for this disease is an important means to block the transformation of inflammation and cancer, which is of great significance to the prevention and treatment of gastric cancer. This disease belongs to the category of "stomach fullness" and "stomach pain" in traditional Chinese medicine. Traditional Chinese medicine believes that the occurrence and development of this disease is a complex gradual process. The pathogenesis is complex and changeable, with deficiency and excess. In clinic, deficiency of spleen and stomach and stagnation of stomach collaterals are common. The main location of the disease is the stomach, which is most closely related to liver and spleen. Therefore, it is proposed that "spleen deficiency and blood stasis" is its basic pathogenesis. Spleen deficiency is the foundation and blood stasis is the pathological product, and spleen deficiency and blood stasis are intertwined to form the syndrome of deficiency and excess. In view of the pathogenesis, the treatment should be "strengthening spleen, removing blood stasis and generating tissue regeneration", and pay attention to the concordance of liver and spleen(stomach). In this paper, through the treatment of CAG from the pathogenesis of spleen deficiency and blood stasis, it showed great advantages of TCM syndrome differentiation, in order to provide more ideas and methods for TCM treatment of this disease.