谢晶日基于“胆胃相关论”治疗慢性胆囊炎合并胆汁返流性胃炎的经验浅析

XIE Jingri's Treatment of Chronic Cholecystitis with Bile Reflux Gastritis Based on Theory of“Gallbladder and Stomach Being Related”

慢性胆囊炎是我国高发疾病,是中医治疗的优势病种。研究表明,慢性胆囊炎与胆汁返流性胃炎重叠发病率较高,二者具有显著相关性。谢师提出“胆胃相关论”,认为胆胃生理上互用为荣,病理上损则俱损,故需从中医整体观念出发,胆胃同治。本病核心病机为邪犯肝胆,郁而化火;胆腑气逆,胆邪逆胃;脾胃素虚,胆胃失和;即始动环节期、加速环节期,形成环节期三个病理阶段。三者环环相扣,互为因果,故提出以疏肝利胆通腑兼以健脾和胃为治疗本病的总纲,在治疗上采用分期辨治,始动环节期,治宜清肝利胆以解少阳之邪;加速环节期,治宜通腑降逆以和胆胃之气;形成环节期,治宜健脾和胃以复中焦之衡,其疗效确切,以资借鉴。

Chronic cholecystitis is a high-incidence disease in our country,and it is the dominant disease treated by traditional Chinese medicine.Studies have shown that the overlapping incidence of chronic cholecystitis and bile reflux gastritis is highly correlated.Professor XIE has put forward the“theory of gallbladder and stomach being related”and believes that gallbladder and stomach could interact with each other physiologically,and the pathological damage would cause all damage.Therefore,it is necessary to start from the overall concept of traditional Chinese medicine and treat the gallbladder and stomach simultaneously.The core pathogenesis of this disease is evils invading liver and gallbladder and turning into fire;gallbladder Qi counterflow and attacking stomach;spleen and stomach deficiency,disharmony between gallbladder and stomach.That is the three stages including the initial stage,the accelerated stage and the formation stage of the pathogenesis.They are interlinked and interact as both cause and effect.Therefore,it is proposed that the general plan for treating this disease is to soothe liver,dredge gallbladder and strengthen spleen and stomach.In terms of treatment,syndrome differentiation and treatment by stages should be adopted.In the initial stage,the treatment should be clearing liver and dredging gallbladder to relieve the pathogenic factors of Shaoyang.During the accelerated stage,it is necessary to regulate the flow of Qi through the bowels and lower the adverse reactions in order to harmonize Qi of gallbladder and stomach.During the formation stage,it is advisable to strengthen spleen and stomach to restore the balance of the middle Jiao.Its curative effect is accurate and it can be used for reference.