基于气、血、水探讨经方治疗慢性胃炎思路

Study on Treating Chronic Gastritis with Classical FormulasBased on Qi and Blood and Water Aspects

慢性胃炎病因复杂,病程迁延,常见气血水相兼为病,可从气分、水分、血分进行论治。气分证治:气机通畅对脾胃运化尤为关键,无论胃出现气分实证或虚证均能导致胃降浊失常,通降不畅,气滞者宜行,方用四逆散加减;气虚夹滞者应通补并用,方用厚朴半夏生姜人参汤化裁;寒化者宜温,方用理中丸;热化者宜清,方用白虎汤或大黄黄连泻心汤。水分证治:湿化证和燥化证是水分证基本证型,湿化者宜治胃中水饮,方用小半夏汤类方;燥化者宜养阴润燥,方用苓芍术甘汤、麻子仁丸。血分证治:“初病在气,久病入络”,慢性胃炎后期可见血瘀证、血虚证、出血证等,血瘀证宜行气活血,方用枳实芍药散加减;血虚证宜益气养血,方用小建中汤加减;出血属热灼血络者宜清热凉血,予三黄泻心汤加减,属脾不摄血者宜温脾摄血,予黄土汤加减。

Chronic gastritis has a complex etiology and a prolonged course.It often involves disturbances in qi,blood,and water,with qi flow being particularly crucial for spleen-stomach function.Whether the stomach manifests an excess or deficiency in the qi aspect,it can lead to disrupted descending functions and impaired digestion.Qi stagnation should be treated by promoting movement,using Modified Frigid Extremities Decoction.For qi deficiency with stagnation,both tonifying and dredging treatments are necessary,so Modified Officinal Magnolia Bark and Pinellia and Fresh Ginger and Ginseng Decoction can be used.Cold transformation is treated with warming,using Center-Regulating Pill,while heat transformation requires clearing,with formulas like White Tiger Decoction,or Rhubarb and Coptis Heart-Draining Decoction.The basic water-related patterns are dampness and dryness.Dampness should be treated by resolving water retention in the stomach,using formulas like Minor Pinellia Decoction.Dryness should be treated by nourishing yin and moistening dryness,using formulas such as Poria and Peony and Atractylodes Macrocephala and Licorice Decoction,Cannabis Fruit Pill."At the onset,the illness affects qi;over time,it enters the channels and collaterals."In chronic gastritis,as the disease progresses,blood-related patterns such as blood stasis,blood deficiency,and bleeding may appear.Blood stasis should be treated by invigorating qi and blood with Modified Immature Bitter Orange and Peony Powder.Blood deficiency should be addressed by tonifying qi and blood with Modified Minor Center-Fortifying Decoction.For bleeding due to heat scorching the blood vessels,the treatment should focus on clearing heat and cooling blood,so Modified Three Yellows Heart-Draining Decoction can be used.For bleeding due to spleen failing to hold blood requires warming the spleen and stopping bleeding with Modified Yellow Earth Decoction.