从肺论治反流性食管炎经验探析

An analysis of the experience in treating reflux esophagitis from lung

反流性食管炎是临床常见的消化系统疾病之一,发病机制多样,以反酸、嗳气、胸骨后灼痛等为主要临床特征,亦可表现为咳嗽、哮喘、咽喉不适、口腔糜烂等食管外刺激症状,内镜下可见食管黏膜破损,影响患者的生活质量。现代医学在治疗上目前存在治疗药物单一、病情易反复等问题。其对应中医病名为“吐酸”“梅核气”“呕吐”等。随着社会经济的发展与社会环境的变化,人们生活节奏加快,压力增加、情绪焦虑、高脂饮食等因素都使反流性食管炎发病率逐年上升,影响患者健康和生活质量。董筠教授长期从事中西医结合论治反流性食管炎工作,认为本病病程迁延,反复难愈,发展至疾病后期常可见虚实夹杂证。本病病机在胃气上逆,但“非独胃也”,董筠教授以气机升降理论为基础,重视肺脏在反流性食管炎发病中的作用,治疗上强调肺、肝、胃同治,着重恢复脏腑气机运转,临证常采用肃降肺气、清泻肺热、调理气机升降等方法。文章通过临床医案收集、汇总与分析,再结合董筠教授的临证配伍用药规律,得出以下常用药物:杏仁、桔梗、枇杷叶、桑叶、紫苏子、全瓜蒌等,从而使反流性食管炎患者脏腑协调,气机通畅,阴阳平和,临床疗效显著。文章附典型案例1则,分享董教授论治反流性食管炎的经验。

Reflux esophagitis is one of the common clinical digestive diseases,the pathogenesis is diverse,affecting the Rquality of life of patients.The main clinical features are acid regurgitation,belching and retrosternal burning pain.It can also be characterized by cough,asthma,throat discomfort,oral erosion and other extraesophageal irritation symptoms.Esophageal mucosal damage can be seen under endoscope.Modern medicine currently has the treatment of single treatment drugs,the disease is easy to recur.Its corresponding TCM diseases are called spitting acid,neurosis pharynx,vomiting and so on.With the development of social economy and the change of social environment,people’s pace of life has accelerated,and factors such as increased stress,emotional anxiety,and high-fat diet have increased the incidence of reflux esophagitis year by year,affecting the health and quality of life of patients.Professor DONG Jun has long been engaged in the treatment of reflux esophagitis by integrating TCM and Western medicine,and believes that the course of the disease is prolonged,repeated and difficult to heal,and mixed evidence can often be seen in the later stage of the disease.The pathogenesis of this disease is reversed in stomach Qi(气),but not only stomach,Professor DONG Jun based on the theory of Qi movement lifting,attaches importance to the role of lungs in the pathogenesis of reflux esophagitis,emphasizes the treatment of lungs,liver and stomach,focuses on restoring the operation of internal organs Qi,often uses methods such as suppressing lung Qi,clearing lung fever,regulating Qi movement lifting,etc.Through clinical medical case collection,summary and analysis,and then combined with Professor DONG Jun’s clinical evidence matching drug rules,the following commonly used drugs were obtained:Xingren(Semen Armeniacae Amarum),Jiegeng(Radix Platycodonis),Pipaye(Folium Eriobotryae),Sangye(Folium Mori),Zisuzi(Fructus Perillae),Quan Gualou(Fructus Trichosanthis),etc.,so that the internal organs of patients with reflux esophagitis are coordinated,the Qi movement is smooth,the Yin(阴)and Yang(阳)are peaceful,and the clinical effect is remarkable.One typical case is attached to share the experience of the professor in treating reflux esophagitis.