运用“三因制宜”理论指导慢性胃炎防治饮食干预探微
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摘要
"三因制宜"学说是中医的基本治则之一,是中医整体观念和辨证论治的具体体现。运用三因制宜学说指导慢性胃炎的防治,与现代医学中的个体化营养殊途同归。在前期饮食情况调查问卷分析的基础上,系统梳理了古代及近、现代文献中有关慢性胃炎常见主症("胃痛""痞满""吐酸")的常用方剂、药物以及食疗的方法,总结慢性胃炎饮食致病理论及饮食调治方案,在已经建立的慢性胃炎临床症状观察表和疗效评价体系的基础上,制定了中医三因制宜理论指导下与慢性胃炎疾病特征相契合的基于临床的慢性胃炎防治食疗干预方案,同时结合中医药三因制宜的理论,对慢性胃炎不同证候的临床患者,给予了综合三因制宜和中医辨证的饮食方。通过对患者定期随访,在临床上也初步看到了饮食干预方案在缓解患者临床症状、延缓疾病进展等方面的良好疗效。
The theory of the three categories of etiological factors is one of the basic principles in the treatment with TCM and it reflects the holistic idea and the syndrome differentiation for treatment in TCM. The application of this theory for the prevention and treatment of chronic gastritis is similar to the idea of individual treatment in modern medicine.On the base of the analysis on the diet questionnaire,the common formulas,drugs and dietary theories for gastric pain,gastric fullness and acid reflux in chronic gastritis recorded in the articles of ancient and modern time were collected systematically. The pathogenic theory and the dietary regimen for chronic gastritis were summarized. On the base of the observation form of the clinical symptoms of chronic gastritis and the assessment system of therapeutic effects,the dietary intervention regimen was set up in the guide of the theory of the three categories of etiological factors accordingly. Additionally,regarding the different symptoms of chronic gastritis,the corresponding dietary recipes were prepared according to the etiological factors and syndrome differentiation of TCM. Through the regular follow-up visit,it was found that dietary intervention was effective in relieving the clinical symptoms and retarding the progression of illness.
The theory of the three categories of etiological factors is one of the basic principles in the treatment with TCM and it reflects the holistic idea and the syndrome differentiation for treatment in TCM. The application of this theory for the prevention and treatment of chronic gastritis is similar to the idea of individual treatment in modern medicine.On the base of the analysis on the diet questionnaire,the common formulas,drugs and dietary theories for gastric pain,gastric fullness and acid reflux in chronic gastritis recorded in the articles of ancient and modern time were collected systematically. The pathogenic theory and the dietary regimen for chronic gastritis were summarized. On the base of the observation form of the clinical symptoms of chronic gastritis and the assessment system of therapeutic effects,the dietary intervention regimen was set up in the guide of the theory of the three categories of etiological factors accordingly. Additionally,regarding the different symptoms of chronic gastritis,the corresponding dietary recipes were prepared according to the etiological factors and syndrome differentiation of TCM. Through the regular follow-up visit,it was found that dietary intervention was effective in relieving the clinical symptoms and retarding the progression of illness.
引文
[1]中国中西医结合学会消化系统疾病专业委员会.慢性胃炎中西医结合诊疗共识意见(2011,天津)[J].中国中西医结合杂志,2012,32(6):738-743.
[2]房静远,刘文忠,李兆申,等.中国慢性胃炎共识意见[J].胃肠病学,2013,33(1):24-36.
[3]Wang F,Meng W,Wang B,et al. Helicobacter pylori-induced gastric inflammation and gastric cancer[J]. Cancer Lett,2014(345):196-202.
[4]Stefania Nobili,Lorenzo Bruno,Ida Landini,et al. Genomic and genetic alterations influence the progression of gastric cancer[J]. World J Gastroenterology,2011,17(3):290-299.
[5]王建国.影响慢性胃炎发展为胃癌的相关因素分析[J].海南医学,2015,26(18):2694-2696
[6]于婷婷,舒晓亮,雷涛,等.膳食因素对中国居民胃癌影响的Meta分析[J].实用癌症杂志,2016,31(9):1441-1444.
[7]盛志坚,熊琦,黄锦蓉.饮食及行为干预对慢性胃炎的影响[J].实用临床医学,2010,11(5):20.
[8]印会河.中医基础理论[M].上海:上海科学技术出版社,1984:137.
[9]龚雪妍.慢性胃炎发病与饮食的相关性研究[D].北京:北京中医药大学,2016.
[10]苏泽琦,李培彩,郭强,等.慢性胃炎中医证候演变规律研究[J].北京中医药大学学报,2015,38(11):762-766.
[11]贾春霞,杜月光. 210例杭州市拱宸桥地区慢性胃炎胃脘痛患者中医证候分析[J].浙江中医杂志,2014,49(4):288-289.
[12]杨幼新,袁红霞,代二庆,等.慢性萎缩性胃炎癌前病变病理演变与中医证型的相关性[J].天津中医药大学学报,2006,25(4):207-209.
[13]陈瑶,张学智.张学智教授治疗慢性萎缩性胃炎经验[J].时珍国医国药,2015(6):1502-1503.
[14]王龙华,朱辰辰,王晓迪,等.慢性胃炎中医病机演变规律浅析[J].辽宁中医杂志,2014(11):2327-2329.
[15]唐·孙思邈.备急千金要方[M].太原:山西科技出版社,2011.
[16]Mupphy G,Pfeiffer R,Camargo MC,et al. Meta analysis shows that prevalence of Epstein-Barr virus-positive gastric cancer differs based on sex and anatomic location[J]. Gastroenterology,2009,137(3):824-833.
[17]Arzumanya N,Reish M,Feitelson MA,et al. Pathogenic mechanisms in HBV and HCV-associated hepatocellular carcinoma[J]. Nat Rev Cancer,2013,13(2):123-135.
[18]Chen W,Zheng RZ,Badde PD,et al. Cancer statistics in China,2015[J]. CA Cancer J Clin,2016,66(2):115-132.
[19]Wang R,Zhang MG,Chen XZ,et al. Risk population of Helicobacter-pylori infection among Han and Tibetan ethnicities in western China:a cross-sectional,longitudinal epidemiological study[J].Lancet,2016,388(Suppl 1):S17.
[20]李玉玲,胡学军,钟子劭,等.广州地区慢性胃炎中医证型分析[J].中华中医药杂志,2015(3):821-823.
[21]孟繁忠.老年人慢性胃炎临床特点调查分析[J].中国疗养医学,2012,21(7):647-648.
[22]张声生.慢性胃炎中医证候学临床研究[D].北京:北京中医药大学,2005.
[23]朱飞叶,王丽,石灯汉,等.慢性胃炎中医证候归类的流行病学研究[J].世界中西医结合杂志,2008,3(2):95-98.
[24]陈自明.妇人大全良方[M].北京:人民卫生出版社,1985.
[25]崔软凡,李培硕.仁斋直指方论[M].贵州:贵州科技出版社,2008.
[26]姚星,修宗昌. 423例慢性胃炎患者的中医证型与中医体质相关性研究及思考[J].辽宁中医杂志,2013(2):283-284.
[27]吴晋兰,陈长春,沈一山,等.慢性胃炎不同证候与体质的相关性研究[J].中华中医药学刊,2010(9):1876-1878.
[28]林平,林煜,黄铭涵,等.慢性萎缩性胃炎中医体质分布特点[J].中医药临床杂志,2017(1):71-75.
[29]Corrae P. Helicobacter pylori and gastric carcino-genesis[J]. Am J Surg Pathol,1995(19):S37-S43.
[30]中华医学会消化病学分会.中国慢性胃炎共识意见[J].中华消化杂志,2012,33(1):5-16.
[31]Weck MN,Brenner H. Prevalence of chronic atrophic gastritis in different parts of the world[J]. Cancer Epidemiol Biomarkers Prev,2006,15(6):1083-1094.
[32]Vinceza Conteduca,Domenico Sansonno,Gianfranco Lauletta,et al.Hpylori infection and gastric cancer:State of the art[J]. International Journal of Oncology,2003(42):5-18.
[33]苏泽琦,于春月,张文君,等.国医大师路志正治疗慢性萎缩性胃炎临证经验[J].现代中医临床,2017,24(3):34-36.
[2]房静远,刘文忠,李兆申,等.中国慢性胃炎共识意见[J].胃肠病学,2013,33(1):24-36.
[3]Wang F,Meng W,Wang B,et al. Helicobacter pylori-induced gastric inflammation and gastric cancer[J]. Cancer Lett,2014(345):196-202.
[4]Stefania Nobili,Lorenzo Bruno,Ida Landini,et al. Genomic and genetic alterations influence the progression of gastric cancer[J]. World J Gastroenterology,2011,17(3):290-299.
[5]王建国.影响慢性胃炎发展为胃癌的相关因素分析[J].海南医学,2015,26(18):2694-2696
[6]于婷婷,舒晓亮,雷涛,等.膳食因素对中国居民胃癌影响的Meta分析[J].实用癌症杂志,2016,31(9):1441-1444.
[7]盛志坚,熊琦,黄锦蓉.饮食及行为干预对慢性胃炎的影响[J].实用临床医学,2010,11(5):20.
[8]印会河.中医基础理论[M].上海:上海科学技术出版社,1984:137.
[9]龚雪妍.慢性胃炎发病与饮食的相关性研究[D].北京:北京中医药大学,2016.
[10]苏泽琦,李培彩,郭强,等.慢性胃炎中医证候演变规律研究[J].北京中医药大学学报,2015,38(11):762-766.
[11]贾春霞,杜月光. 210例杭州市拱宸桥地区慢性胃炎胃脘痛患者中医证候分析[J].浙江中医杂志,2014,49(4):288-289.
[12]杨幼新,袁红霞,代二庆,等.慢性萎缩性胃炎癌前病变病理演变与中医证型的相关性[J].天津中医药大学学报,2006,25(4):207-209.
[13]陈瑶,张学智.张学智教授治疗慢性萎缩性胃炎经验[J].时珍国医国药,2015(6):1502-1503.
[14]王龙华,朱辰辰,王晓迪,等.慢性胃炎中医病机演变规律浅析[J].辽宁中医杂志,2014(11):2327-2329.
[15]唐·孙思邈.备急千金要方[M].太原:山西科技出版社,2011.
[16]Mupphy G,Pfeiffer R,Camargo MC,et al. Meta analysis shows that prevalence of Epstein-Barr virus-positive gastric cancer differs based on sex and anatomic location[J]. Gastroenterology,2009,137(3):824-833.
[17]Arzumanya N,Reish M,Feitelson MA,et al. Pathogenic mechanisms in HBV and HCV-associated hepatocellular carcinoma[J]. Nat Rev Cancer,2013,13(2):123-135.
[18]Chen W,Zheng RZ,Badde PD,et al. Cancer statistics in China,2015[J]. CA Cancer J Clin,2016,66(2):115-132.
[19]Wang R,Zhang MG,Chen XZ,et al. Risk population of Helicobacter-pylori infection among Han and Tibetan ethnicities in western China:a cross-sectional,longitudinal epidemiological study[J].Lancet,2016,388(Suppl 1):S17.
[20]李玉玲,胡学军,钟子劭,等.广州地区慢性胃炎中医证型分析[J].中华中医药杂志,2015(3):821-823.
[21]孟繁忠.老年人慢性胃炎临床特点调查分析[J].中国疗养医学,2012,21(7):647-648.
[22]张声生.慢性胃炎中医证候学临床研究[D].北京:北京中医药大学,2005.
[23]朱飞叶,王丽,石灯汉,等.慢性胃炎中医证候归类的流行病学研究[J].世界中西医结合杂志,2008,3(2):95-98.
[24]陈自明.妇人大全良方[M].北京:人民卫生出版社,1985.
[25]崔软凡,李培硕.仁斋直指方论[M].贵州:贵州科技出版社,2008.
[26]姚星,修宗昌. 423例慢性胃炎患者的中医证型与中医体质相关性研究及思考[J].辽宁中医杂志,2013(2):283-284.
[27]吴晋兰,陈长春,沈一山,等.慢性胃炎不同证候与体质的相关性研究[J].中华中医药学刊,2010(9):1876-1878.
[28]林平,林煜,黄铭涵,等.慢性萎缩性胃炎中医体质分布特点[J].中医药临床杂志,2017(1):71-75.
[29]Corrae P. Helicobacter pylori and gastric carcino-genesis[J]. Am J Surg Pathol,1995(19):S37-S43.
[30]中华医学会消化病学分会.中国慢性胃炎共识意见[J].中华消化杂志,2012,33(1):5-16.
[31]Weck MN,Brenner H. Prevalence of chronic atrophic gastritis in different parts of the world[J]. Cancer Epidemiol Biomarkers Prev,2006,15(6):1083-1094.
[32]Vinceza Conteduca,Domenico Sansonno,Gianfranco Lauletta,et al.Hpylori infection and gastric cancer:State of the art[J]. International Journal of Oncology,2003(42):5-18.
[33]苏泽琦,于春月,张文君,等.国医大师路志正治疗慢性萎缩性胃炎临证经验[J].现代中医临床,2017,24(3):34-36.