基于“胃心相关”理论探讨胃食管反流病相关性胸痛中医内涵及发病机制

Discussion on traditional Chinese medicine connotation and pathogenesis of gastroesophageal reflux disease⁃related chest pain based on the theory of“relevance of stomach and heart”

胃食管反流病相关性胸痛是胃食管反流病食管症状中最重要的不典型症状,以“胃心相关”理论为指导探讨其中医内涵和发病机制,将胃食管反流病相关性胸痛病名为“食心痛”,其病机是胃失和降、胸络痹阻,病位在食管和胃,痛在食管和心。辨证可分肝气犯胃、痰浊痹阻、瘀血阻络、胸阳不振4种证候类型。胸阳不振证是最常见的临床分型,病机是气机升降乖戾、浊阴上逆、痰气痹阻。临证以通阳宣痹、降气化痰为主,以枳实薤白桂枝汤为基础方随证加减。现代研究认为,异常酸反流、食管-心脏反射通路、脑肠轴等重要发病机制均体现“胃心相关”理论。

Among all atypical gastroesophageal reflux disease(GERD)-related symptoms,chest pain is the most important one.The theory of“relevance of stomach and heart”can guide the discussion on traditional Chinese medicine connotation and pathogenesis of GERD⁃related chest pain.We named GERD⁃related chest pain as“alimentary epigastralgia”.Its pathological mechanism is failure of gastric qi to descend,combined with obstruction of thoracic collaterals.The disease location is the esophagus and stomach,resulting in pain in esophagus and heart.The syndrome can be divided into four types:liver qi affecting the stomach,phlegm dampness obstructing,stagnant blood obstructing the collaterals,and inactivity of thoracic yang.The commonest clinical subtype is inactivity of thoracic yang,which is caused by disordered qi activity,ascending of turbid yin,and obstruction due to phlegm and qi.In clinical practice,the main therapeutic principle is to diffuse blockage and free yang and descend qi to resolve phlegm,and the basic formula is Zhishi Xiebai Guizhi Decoction,with variations according to the Journal of Beijing University of Traditional Chinese Medicine symptoms.Modern research suggests that abnormal acid reflux,the esophagus⁃heart reflex pathway,the brain⁃gut axis,and other important pathogeneses all reflect the theory of“relevance of stomach and heart”.