基于“郁生百病”思想从“气郁”论治胃食管反流病

Discussion on Treatment of Gastroesophageal Reflux Disease from"Qi Depression"Based on the Theory of"All Diseases are Born from Qi Depression"

以“郁生百病”的观点为基础,明确指出“百病气为先”,强调疾病的产生总是“气郁”所致“,气郁”是发病的基础,进而从“气郁致酸”角度探析胃食管反流病的病因病机:气郁由肝生,是“木郁”所致“;气”特指“木气“”气郁”既是“肝郁”;肝郁不舒,克伐胃土,胃气不降反升,遂作酸;气郁乃诸证形成之根本“,气郁为先”,日久易生它变。久生兼证:或生热化火,或聚湿化痰,或脾虚土弱,或瘀结阻络“;气郁”贯穿疾病全过程。故临证时宜以“行气解郁”为立法之本,以疏肝健脾、和胃降逆为基本治则,将升降并用、肝胃同治、肝脾同调为遣药原则;采用柴胡疏肝散、乌贝散合四君子汤等方剂加减治疗,并应根据兼证辨证施治,随证灵活加用清热、祛湿、化痰、补中、活血等治法;同时注重精神、饮食、生活习惯的调摄。

On the foundation of the outlook of"depression producing all kinds of diseases",the article clearly points out"Qi is the first cause of all kinds of diseases",and emphasizes that the occurrence of disease is always caused by"Qi depression"which is the foundation of the disease,and then discusses the cause and the pathogenesis of gastroesophageal reflux disease(GERD)from the angle of"Qi depression leading to acid formation":Qi depression produced by liver is caused by"wood depression";"Qi"refers specifically to"wood Qi","Qi depression"is"liver depression";liver depression attacking stomach and earth,stomach Qi doesn't fall but rises,causing it to form acid;Qi depression is the root of the formation of different syndromes,"Qi depression is the first",easily transforming into other changes with the passing of time.Transforming into the complication in the course of time:or producing heat and transforming fire,or gathering dampness and resolving phlegm,or spleen deficiency and weak earth,or blood stasis obstructing the collateral;"Qi depression"is throughout the disease.Hence,"promoting Qi circulation and resolving depression"should be adopted as the foundation of treating the disease in clinic,adopting soothing liver and invigorating spleen,harmonizing the stomach and downbearing the counterflow as the basic therapeutic principles,choosing raising and downbearing simultaneously,treating liver and stomach concurrently,regulating liver and spleen simultaneously as the principles of prescribing herbs;Chaihu Shugan powder,Wubei powder and Sijunzi decoction are modified and applied,therapeutic methods such as clearing heat,removing dampness,resolving phlegm,tonifying the middle-jiao,promoting blood circulation should be added flexibly in accordance with the syndromes according to syndrome differentiation and treatment of the complications;meanwhile,the regulation of spirit,diet and living habits should be stressed.