二参三草汤治疗慢性萎缩性胃炎脾虚湿热证的临床研究
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摘要
目的与意义：萎缩性胃炎是一种慢性胃炎,是消化内科常见病、多发病。伴中度以上肠化或异型增生,显示较高的变成胃癌的趋向,因此治疗本病,防止癌变是已成为消化系统研究重点之一。西医对本病病因尚未清楚,关于治疗方案尚缺乏公认的特效方法,而许多研究证实中医药对本病,具有较好的治疗效果,毒副作用相对较少,可防止其发展,甚至逆转萎缩等优点。导师单兆伟教授从医50余年,在脾胃病理论、临床和科研方面均取得了令人瞩目的成果。对慢性萎缩性胃炎的诊治方面,结合中医和现代医学,制造出独步的经验方-二参三草汤,尤有创新。
研究方法：观察从2009年9月到2012年3月期间求诊于单兆伟教授的患者,包括门诊和住院病人,并确诊为萎缩性胃炎者。符合于中医脾虚湿热证诊断标准者,随机入选,共104例。给予二参三草汤(太子参,黄芪,炒白术,紫丹参,薏苡仁,仙鹤草,白花蛇舌草,甘草),每日1剂,水煎服,共两个疗程,6月。
研究结果:观察104例(男54例,女50例)患者治疗前后疗效,病理总有效率为75.9%,萎缩、肠化及异型增生均有显著性差异(P<0.05)。53例幽门螺杆菌感染者,治疗后转阴者20例,表示有统计学意义(P<0.05)。临床证候方面,各症状治疗前后均有明显的改善,临床证候总积分比较t=17.84,P<0.01。提示导师的二参三草汤对萎缩性胃炎脾虚湿热证患者有明显的效果。
结论意义:单教授认为萎缩性胃炎脾虚湿热证是以脾虚为本,湿热为标,治疗应健脾益气,清热祛湿。通过6月的临床试验,二参三草汤可明显改CAG脾虚湿热证患者的痞满、胃痛等各项临床症状；病理上亦有改善或逆转萎缩性胃炎的效果。这说明导师对本病的理论和临床实践是确切、可靠的。并在观察期间未发现中药引起的严重不良反应的报告。本文应用导师的二参三草汤治疗萎缩性胃炎脾虚湿热证,在临床方面提供试验依据。再加上初步得研究导师对本病的学术经验,为全世界CAG患者有一些帮助。
Objective:The chronic atrophic gastritis, a sort of chronic gastritis, is a common, frequent disease in an internal digestive medicine department. If it comes with medium or high level of intestinal metaplasia or dysplasia, it shows a strong tendency to turn into gastric cancer. So regarding the cure for this disease, gastric carcinoma prevention has already become an important point of the research activities in the Division of Digestive Disease, both in Western and traditional Chinese medicine. Western medicine has not found a correct cause of CAG, and there is no officially recognized treatment for it. Professor Shan has more than50years of experiences in Chinese medicine. He has achieved a remarkable outcome in spleen and stomach disease theory, research, and clinical practice. To treat and diagnose chronic atrophic gastritis, he combined Chinese medicine with modern medicine, and created a leading-edge experiential herbal decoction-ErshenSancao decoction.
Method:From the patients coming to Professor Shan's office from2009to2012who were diagnosed with chronic atrophic gastritis, we selected104examples which match up with the Chinese diagnosis standard of spleen deficiency damp heat syndrome. We prescribed them Professor Shan's ErshenSancaotang (Taizishen, Huangqi, Chaobaizhu, Danshen, Yiyiren, Xianhecao, Sheshecao, Gancao), then adjusted medication dose (boiling in water, twice a day) according to their symptoms for six months.
Result:Observing the results before and after treatment for104examples (male54, female50), we found the effective ratio in gastro scope is75.9%, and atrophy, intestinal metaplasia and dysplasia all showed significant difference (P<0.05).53Helicobacter pylori-infected patients, also show statistical difference (P<0.05). According to the result, the effective ratio of clinical symptoms showed remarkable difference (t=17.84, P<0.01). This explains that Proressor Shan's ErshenSancaotang is very effective to the patients of chronic atrophic gastritis spleen deficiency damp heat syndrome.
Conclusion:According to the6month's research, ErshenSancaotang can ease the clinical symptoms such as stomachache, gas, bloating exta, and also can improve gastro scope signs. And there was no serious untoward effect was reported, which means that this treatment is safe for at least6months. This thesis analyzes and provides clinical evidences for Professor Shan's ErshenSancaotang treatment. We hope that it can help reduce pain in CAG patients all over the world.
研究方法：观察从2009年9月到2012年3月期间求诊于单兆伟教授的患者,包括门诊和住院病人,并确诊为萎缩性胃炎者。符合于中医脾虚湿热证诊断标准者,随机入选,共104例。给予二参三草汤(太子参,黄芪,炒白术,紫丹参,薏苡仁,仙鹤草,白花蛇舌草,甘草),每日1剂,水煎服,共两个疗程,6月。
研究结果:观察104例(男54例,女50例)患者治疗前后疗效,病理总有效率为75.9%,萎缩、肠化及异型增生均有显著性差异(P<0.05)。53例幽门螺杆菌感染者,治疗后转阴者20例,表示有统计学意义(P<0.05)。临床证候方面,各症状治疗前后均有明显的改善,临床证候总积分比较t=17.84,P<0.01。提示导师的二参三草汤对萎缩性胃炎脾虚湿热证患者有明显的效果。
结论意义:单教授认为萎缩性胃炎脾虚湿热证是以脾虚为本,湿热为标,治疗应健脾益气,清热祛湿。通过6月的临床试验,二参三草汤可明显改CAG脾虚湿热证患者的痞满、胃痛等各项临床症状；病理上亦有改善或逆转萎缩性胃炎的效果。这说明导师对本病的理论和临床实践是确切、可靠的。并在观察期间未发现中药引起的严重不良反应的报告。本文应用导师的二参三草汤治疗萎缩性胃炎脾虚湿热证,在临床方面提供试验依据。再加上初步得研究导师对本病的学术经验,为全世界CAG患者有一些帮助。
Objective:The chronic atrophic gastritis, a sort of chronic gastritis, is a common, frequent disease in an internal digestive medicine department. If it comes with medium or high level of intestinal metaplasia or dysplasia, it shows a strong tendency to turn into gastric cancer. So regarding the cure for this disease, gastric carcinoma prevention has already become an important point of the research activities in the Division of Digestive Disease, both in Western and traditional Chinese medicine. Western medicine has not found a correct cause of CAG, and there is no officially recognized treatment for it. Professor Shan has more than50years of experiences in Chinese medicine. He has achieved a remarkable outcome in spleen and stomach disease theory, research, and clinical practice. To treat and diagnose chronic atrophic gastritis, he combined Chinese medicine with modern medicine, and created a leading-edge experiential herbal decoction-ErshenSancao decoction.
Method:From the patients coming to Professor Shan's office from2009to2012who were diagnosed with chronic atrophic gastritis, we selected104examples which match up with the Chinese diagnosis standard of spleen deficiency damp heat syndrome. We prescribed them Professor Shan's ErshenSancaotang (Taizishen, Huangqi, Chaobaizhu, Danshen, Yiyiren, Xianhecao, Sheshecao, Gancao), then adjusted medication dose (boiling in water, twice a day) according to their symptoms for six months.
Result:Observing the results before and after treatment for104examples (male54, female50), we found the effective ratio in gastro scope is75.9%, and atrophy, intestinal metaplasia and dysplasia all showed significant difference (P<0.05).53Helicobacter pylori-infected patients, also show statistical difference (P<0.05). According to the result, the effective ratio of clinical symptoms showed remarkable difference (t=17.84, P<0.01). This explains that Proressor Shan's ErshenSancaotang is very effective to the patients of chronic atrophic gastritis spleen deficiency damp heat syndrome.
Conclusion:According to the6month's research, ErshenSancaotang can ease the clinical symptoms such as stomachache, gas, bloating exta, and also can improve gastro scope signs. And there was no serious untoward effect was reported, which means that this treatment is safe for at least6months. This thesis analyzes and provides clinical evidences for Professor Shan's ErshenSancaotang treatment. We hope that it can help reduce pain in CAG patients all over the world.
引文
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[3]中华中医药学会脾胃病分会。慢性萎缩性胃炎中医诊疗共识意见[J]。中医杂志,2010,51(8)：749-753.
[4]黄蓝洋.中医治疗慢性萎缩性胃炎临床近况.实用中医内科杂志[J],2005,19(3):202.
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[6]杨国平,李敏,孙益,肖伟军,郑红斌.百名名中医慢性萎缩性胃炎临床经验资料的计算机分析研究[J],2008,14(1)：62-63.
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