张金波教授治疗慢性萎缩性胃炎伴肠上皮化生经验

Professor ZHANG Jinbo’s experience in treating chronic atrophic gastritis with intestinal metaplasia

慢性萎缩性胃炎伴肠上皮化生作为与胃癌关联性较高的癌前病变,由于其发病机制不明,故而现代医学并没有疗效好或特效的治疗方式。张金波教授在“玄府气液”学说的基础上,在长期的临床治疗中总结出“玄府-胃络-胃腠”系统,认为“万物尽皆有之”的玄府是胃络之门户,胃络通过玄府的开阖来控制脾胃气血津液的输布,进而影响胃黏膜的正常生理功能。张金波教授认为慢性萎缩性胃炎伴肠上皮化生可归于“积聚”的范畴,主要病因是玄府密塞导致气血津液无法输布至胃中各处所致,迁延日久则代谢难处而营养难至,胃之肌腠失养逐渐萎缩,代谢秽浊沉积成肠上皮化生。故在治疗上以“开玄扩络”为主,恢复胃腠气液流通为先,再以“中正”治法——调平中焦病理状态,使气血平和、清浊自分。用药上,张教授在活用辛味药开通密塞之玄府的基础上配伍补虚药、活血药、祛痰药对症治疗,常用药物组合为柴胡-枳实-姜半夏、肉桂-酒大黄。

Chronic atrophic gastritis with intestinal metaplasia is a precancerous lesion with a relatively high correlation with gastric cancer.Because of its unknown pathogenesis,there is no effective or specific treatment method in modern medicine.Based on the theory of Qi(气)and liquid in Xuanfu(玄府),Professor ZHANG Jinbo summarizes the Xuanfu-stomach collaterals-Weicou(胃腠)system in long-term clinical practice,and believes that Xuanfu is the gateway of stomach collaterals,and that stomach collaterals controls the distribution of Qi,blood,and body fluids in the spleen and stomach through the opening and closing of Xuanfu,thereby affecting the normal physiological function of gastric mucosa.Professor ZHANG Jinbo believes that chronic atrophic gastritis with intestinal metaplasia can be classified into the category of accumulation,and that the main cause is closed Xuanfu,whichCleadsto the inability of Qi,blood and body fulid to be transported to all parts of the stomach.If it lasts for a long time,metabolism is difficult to carry out and nutrition is difficult to reach the stomach.The muscular striae of the stomach gradually atrophies due to malnutrition,and the metabolic turbidity deposits and turns into intestinal epithelial metaplasia.Therefore,the main treatment method is opening Xuanfu and expanding the collaterals,restoring the circulation of Qi and body liquid in Weicou first,and then the Zhongzheng(中正)treatment method of regulating the pathological state of middle energizer is used to obtain a peaceful state of Qi and blood,and the purpose of clear and turbid go their separate ways.In terms of medication,on the basis of pungent medicines for opening closed Xuanfu,Professor ZHANG compatibly uses reinforcing medicines,blood-activating medicines and expectorant medicines for symptomatic treatment;the common used combined medicines are Chaihu(Radix Bupleuri)-Zhishi(Fructus Aurantii Immaturus)-Jiang Banxia(Rhizoma Pinelliae Preparatum)and Rougui(Cortex Cinnamomi)-Jiu Dahuang(Wine-Radix et Rhizoma Rhei).