谢晶日教授运用调肝通胃法论治慢性萎缩性胃炎经验探析

Analysis of Professor XIE Jingri’s Experience in Treating Chronic Atrophic Gastritis by Regulating the Liver and Promoting the Stomach

[目的]总结谢晶日教授运用调肝通胃法论治慢性萎缩性胃炎的经验,以期说明调肝通胃法的立法依据及临床应用思路。[方法]通过跟随谢教授门诊抄方,对门诊医案进行收集、整理和分析,查阅中医典籍和现代慢性萎缩性胃炎相关的临床研究文献,从患病特点、临床治法、处方用药特点几方面总结谢教授论治慢性萎缩性胃炎的经验,并附医案一则加以佐证。[结果]谢教授认为,慢性萎缩性胃炎患者有以下三个特点:情志不遂而伤正、饮食不慎而伤脾胃、病程日久生痰瘀。针对以上的病机特点,谢教授确立调肝三法和通胃祛邪的治疗思路,其中调肝三法从气不升发、气机郁结、气郁化火三个角度,治以疏肝散郁、破气调肝、清肝泻火三种方法;通胃祛邪则是从消导的思路化除食积、痰瘀邪气,从补益脾胃的角度扶正固本,以此达到胃气通降,邪气不存的效果。验案中患者因饮食而发病,伴有情志不遂,结合舌脉,谢教授辨证分析为肝郁化火、脾虚湿蕴证,治疗以调肝清热、通胃扶正为法,获得较好的疗效。[结论]谢教授运用调肝通胃法论治慢性萎缩性胃炎,根据不同症状特点灵活变通用药,取得了较好的临床疗效。谢教授的经验从临床实践出发,为中医药治疗慢性萎缩性胃炎扩展了新的思路。

[Objective] To summarize Professor XIE Jingri’s experience in treating chronic atrophic gastritis(CAG) with the method of regulating the liver and promoting the stomach, in order to explain the treatment basis and clinical application idea of regulating the liver and promoting the stomach method. [Methods] Through following Professor XIE’s prescriptions in outpatient clinic, outpatient medical cases were collected, collated and analyzed, traditional Chinese medicine classics and modern clinical research literature related to CAG were consulted, and Professor XIE’s experience in treating CAG was summarized from the aspects of disease characteristics, clinical treatment methods and characteristics of prescription medication, and one medical case was listed as evidence.[Results] Professor XIE believes that patients with CAG have the following three characteristics: bad mood leading to damage of healthy Qi, careless diet injuring the spleen and stomach, long term illness producing phlegm and blood stasis. In view of the above pathogenesis characteristics, Professor XIE proposes the three methods of regulating the liver and promoting the stomach and removing pathogenic factors. Among them, the three methods of regulating the liver include regulating the liver and dispersing depression,breaking Qi and regulating the liver, clearing the liver and eliminating fire from the perspectives of Qi failing in rising and Qi stagnation producing fire;promoting the stomach and removing pathogenic factors follows the idea of helping digestion and removing accumulation,in order to eliminate the accumulation of food, phlegm and stasis evil;tonifying the spleen and stomach so as to strengthen the foundation, achieve the effect of clearing stomach Qi and removing pathogen. The medical case mentioned in the article was caused by diet, accompanied by emotional distress. Professor XIE analyzed the case as liver depression transforming fire, spleen deficiency and dampness accumulation syndrome according to the syndrome differentiation of tongue and pulse. The method of regulating the liver and clearing heat, and promoting the stomach and strengthening the body was used to achieve good curative effect. [Conclusion] Professor XIE treats CAG with the method of regulating the liver and promoting the stomach, and makes flexible drug use according to the characteristics of different symptoms, and achieves good clinical efficacy. Professor XIE’s experience from the clinical practice, extends a new idea for the TCM treatment of CAG.