建中补脾、活血理气法治疗慢性萎缩性胃炎临床探讨
摘要
慢性萎缩性胃炎是临床常见病、多发病,并与胃癌发生有密切联系。现代医学研究发现,本病的发病与HP感染、局部胃黏膜免疫反应增强及血液流变学改变等因素有关。其病理变化与胃黏膜缺血、缺氧有密切关联。本病病程长,病理机制复杂,治疗难度较大,随着医疗技术的普及,近年来检出率有所提高,对其认识也有所深入,但是治疗尚无重大突破。
祖国医学认为本病多因饮食不节、情志所伤、劳役过度或禀赋不足等所致。饮食不节、过食生冷则寒积胃中;嗜食辛辣肥甘、酗酒,湿热内生;情志不遂、恚怒忧思,致气郁伤肝,横逆犯胃;劳倦过度,饥饱失宜,病后体弱,禀赋不足等致脾胃虚弱。多种病因丛集,损伤脾胃,寒、热、湿、食、痰、饮、瘀等诸多病理产物内生,导致脾胃虚弱、气滞血瘀而发为本病。
根据本病的病史及临床表现,结合胃镜下黏膜相改变(胃黏膜苍白、黏膜变薄、腺体减少及黏膜下血管透见等),我们认为CAG与祖国医学脾胃虚弱兼胃络瘀血的病理机制特点相符。
本文主要探讨了以建中益胃、活血理气法为基本大法组方用药治疗慢性萎缩性胃炎的理论基础,评价该法治疗慢性萎缩性胃炎的临床疗效,探索中医药治疗慢性萎缩性胃炎的新思路。
第一部分介绍了现代医学对慢性萎缩性胃炎发病情况、病因病机、病理组织学改变、相关临床及实验研究和治疗等方面的研究进展。
第二部分介绍了祖国医学对本病的相关认识,包括病名、病因病机、辨证分型治疗等方面。
第三部分对典型病例及组方进行了讨论。
最后讨论了以建中补脾、活血理气为基本大法组方用药治疗CAG的理论基础,并探讨了存在的问题。
CAG is common, and there is close contact of gastric cancer. Modern medical research found that it is close contact of HP infection, the local mucosal immune responses to enhance and Hemorrheology change.As the popularity of medical technology, the detection rate has increased in recent years, its depth also recognize,however, no major breakthrough in treatment.
In Traditional Chinese Medicine it due to that diet many, the emotional injury, Excessive laboror a lack of endowment. A variety of Pathological factors injury piwei, Cause piweixuruo and qizhixueyu , and last Cause disease.
Modern research found that pathological changes of CAG is closely to gastric mucosal ischemia and hypoxia.Pale mucosa, mucosal thinning, reduction and submucosal glands of vascular permeability,is closely to piweixuruo andweiluoyuxue of traditional Chinese medicine.
This article discusses the Theoretical foundation of treatment by yiqijianpi huoxuehuayufa. Evaluate the treatment of chronic atrophic gastritis of the clinical efficacy, Explorate the new ideas of Chinese medicine to treat chronic atrophic gastritis.
The first part discusses of the incidence, Etiology and Pathogenesis, Histopathological changes, Clinical and Experimental Research and Treatment of CAG.
The second part presents that the disease, Etiology and Pathogenesis pathogenesis, the treatment of CAG of traditional Chinese medicine.
the third part Analysis the Theoretical foundation of treatment by jianzhongbupi huoxueliqi discusses the Prescription and typical cases.
Finally sum up the theoretical basis of this Law, and discussed the existing problems.
祖国医学认为本病多因饮食不节、情志所伤、劳役过度或禀赋不足等所致。饮食不节、过食生冷则寒积胃中;嗜食辛辣肥甘、酗酒,湿热内生;情志不遂、恚怒忧思,致气郁伤肝,横逆犯胃;劳倦过度,饥饱失宜,病后体弱,禀赋不足等致脾胃虚弱。多种病因丛集,损伤脾胃,寒、热、湿、食、痰、饮、瘀等诸多病理产物内生,导致脾胃虚弱、气滞血瘀而发为本病。
根据本病的病史及临床表现,结合胃镜下黏膜相改变(胃黏膜苍白、黏膜变薄、腺体减少及黏膜下血管透见等),我们认为CAG与祖国医学脾胃虚弱兼胃络瘀血的病理机制特点相符。
本文主要探讨了以建中益胃、活血理气法为基本大法组方用药治疗慢性萎缩性胃炎的理论基础,评价该法治疗慢性萎缩性胃炎的临床疗效,探索中医药治疗慢性萎缩性胃炎的新思路。
第一部分介绍了现代医学对慢性萎缩性胃炎发病情况、病因病机、病理组织学改变、相关临床及实验研究和治疗等方面的研究进展。
第二部分介绍了祖国医学对本病的相关认识,包括病名、病因病机、辨证分型治疗等方面。
第三部分对典型病例及组方进行了讨论。
最后讨论了以建中补脾、活血理气为基本大法组方用药治疗CAG的理论基础,并探讨了存在的问题。
CAG is common, and there is close contact of gastric cancer. Modern medical research found that it is close contact of HP infection, the local mucosal immune responses to enhance and Hemorrheology change.As the popularity of medical technology, the detection rate has increased in recent years, its depth also recognize,however, no major breakthrough in treatment.
In Traditional Chinese Medicine it due to that diet many, the emotional injury, Excessive laboror a lack of endowment. A variety of Pathological factors injury piwei, Cause piweixuruo and qizhixueyu , and last Cause disease.
Modern research found that pathological changes of CAG is closely to gastric mucosal ischemia and hypoxia.Pale mucosa, mucosal thinning, reduction and submucosal glands of vascular permeability,is closely to piweixuruo andweiluoyuxue of traditional Chinese medicine.
This article discusses the Theoretical foundation of treatment by yiqijianpi huoxuehuayufa. Evaluate the treatment of chronic atrophic gastritis of the clinical efficacy, Explorate the new ideas of Chinese medicine to treat chronic atrophic gastritis.
The first part discusses of the incidence, Etiology and Pathogenesis, Histopathological changes, Clinical and Experimental Research and Treatment of CAG.
The second part presents that the disease, Etiology and Pathogenesis pathogenesis, the treatment of CAG of traditional Chinese medicine.
the third part Analysis the Theoretical foundation of treatment by jianzhongbupi huoxueliqi discusses the Prescription and typical cases.
Finally sum up the theoretical basis of this Law, and discussed the existing problems.
引文
[1]Warren JR and Marshall BJ.unidentified curved bacillion gastric epithelium active chronic gastritis.Lancet,1983,Ⅰ:1273-1275.
[2]吴春燕,郭晓钟等.慢性胃炎与幽门螺杆菌感染研究进展[M].胃炎研究进展,85-89.
[3]林三仁.幽门螺杆菌感染与胃黏膜炎症[M].胃炎临床研究进展,60-63.
[4]马文莲等.胃癌致病因素探讨[J].滨州医学院学报,2002,25(6).
[5]胡品津,曾志荣,林汉良.幽门螺杆菌的根除与萎缩性胃炎形成和逆转的动物实验研究[J].中华消化杂,2000,20:155.
[6]Kuipers EJ,Uyterlinde AM,Pena AS,etal.Long term sequelae of Helicobacter pylori gastritis.Lancet,1995,345:1525-1528.
[7]Strickland,J.,T.J.Dull,D.D.Sleeter,and H.F.Noller.1981.Gene Organization and Primary structure of a ribosomal IFA operon from A Chronic atrophic gastritis coli.J.Mol.Biol.148:107-127.
[8]Irvine K,Muraoka A,Shoda R,Yamato S,Umeda N.PCA in the gastric mucosa:A molecular Profile of the mouse gastric Parietal cell Proc.Natl.Acad.Sci.U.S.A.98,13687-13692.
[9]杨耀芳,蔡钦朝,王钦茂等.细胞免疫学新探(下卷)[M].南京:南京大学出版社,1993:219.
[10]Mills,J.C.,Syder,A.J.,Hong,C.V.Guruge,J.L.,Raaii,F.,Gordon,J.I.evidence of GCAincreased generation in adaptirecyto Protection.Gastroenterology,1994,106-132.
[11]Strickland,E.M.,K.Oien,A.El-Nujumi,D.Gillen,A.Wirz,S.Oahill,C.Williams,J.E.S.Ardill,and K.E.L.McColl.1997.Lymphocyte in the control of gastric acid Secretion gastrin release and blood flow Gastroenterology,1994,106:A52.
[12]林峰克.慢性萎缩性胃炎相关性疾病.中国免疫学杂志[J],1990,5(5):308.
[13]Atherton,J.C.,Falkow,S.,Peek,R.M.Jr.(2001).Prostaglandins.diversity within the gastric niehe of human host.Proc.Nat1.Acad.Sci.U.S.A.98:14625-14630.
[14]iemela S.Characteristics oNf reflux gatritis duodenogastric reflux:Cor relations among Bile acid pattern,mucus secretion,and mucosal damage scand.J Gastroentreoll,1987,72:349.
[15]郑芝田主编.胃肠病学(第三版).人民卫生出版社[M],2000:312-313.
[16]Varis L.Fiorucci S,Distrutti E,Chiorean M,Santucci L,Heredity factor in incidence of Chronic atrophic gastritis Gastroentreoll 1997,72:349.
[17]刘海峰,刘为纹,房殿春,等.胃癌变中细胞凋亡及其与bcl-2蛋白表达关系的研究.中华消化内镜杂志[J],2000,17(2):41.
[18]鲁香风,赵凤志,等.3种方剂水兰液对实验性胃炎大鼠血清胃泌素水平、G细胞密度及胃壁黏膜PGE_2凡含量的影响.中国中药杂志[J],1995,20(6):361-64.
[19]危北海.胃安素治疗慢性萎缩性胃炎的临床与实验研究.华人消化杂志[J],1998,6(2):114-117。
[20]张喜奎.胃萎灵治疗慢性萎缩性胃炎的实验研究.中国中医药科技[J],2000:7(2):81-82。
[21]徐叔云,卞如濂,陈修.药理实验方法学.第2版.人民卫生出版社[M],1991:723.
[22]徐文静.金实治疗慢性萎缩性胃炎经验.辽宁中医学院学报[J],2005,7(5):470
[23]周学文.慢性萎缩性胃炎中医证治旨要.中医药学刊[J],2002,20(5):955-9571
[24]赵霞.余绍源教授辨治慢性萎缩性胃炎经验.四川中医[J],2004,22(4):19-21
[25]陈英.中药防治慢性萎缩性胃炎癌前病变100例[J].光明中医2005,20(5):52
[26]张聪,陈明.自拟舒胃汤治疗慢性萎缩性胃炎36例[J].辽宁中医学院学报,2004,6(5):381
[27]姚保泰,王磊,王洪京,等.萎缩康冲剂治疗萎缩性胃炎癌前病变的临床与实验研究[J].中医杂志,1999,40(11):673
[28]王汝新,牛华珍.温阳补肾活血法治疗慢性萎缩性胃炎180例观察[J].实用中医内科杂志,2000,16(11):11
[29]樊东香,宋思峰,胡家才.芪夏连棱汤治疗慢性萎缩性胃炎癌前病变临床研究[J].中国中西医结合脾胃杂志,2000,8(4):204-206
[30]祁宏,等.萎胃康治疗慢性萎缩性胃炎的疗效及对血液流变学的影像[J].中国中西医结合急救杂志,2004,11(1):42-44
[31]王钢,等.养阴活血法治疗慢性萎缩性胃炎84例[J].陕西中医,2004,25(1):4
[32]阚士宁,陈如芳,龙战生,等.荣胃煎治疗萎缩性胃炎癌前病变49例疗效分析[J].中医杂志,1999,40(10):601
[33]代二庆,等.善胃Ⅰ-Ⅲ号方治疗慢性萎缩性胃炎胃癌前病变的临床研究[J].中医药学刊,2004,22(4):606
[34]周衍.老年萎缩性胃炎的辨证施治[J].南京中医药大学学报,1996,12(2):39.
[35]乔樵.慢性萎缩性胃炎癌前病变的中医证治[J].浙江中医学院学报,1997,21(6):7.
[36]王文仲.软坚散结慢性萎缩性胃炎伴胃黏膜异型增生及肠化生的对比观察[J].中医杂志,1994,35(8):477.
[37]百福金.活血化瘀为主治疗萎缩性胃炎30例[J].北京中医学院学报,1993,16(1):48.
[38]张玉,林庚金,金惠铭,等.慢性萎缩性胃炎黏膜血流量的研究[J].中华消化内镜杂志,1997,14(2):101-102.
[39]侯冬梅,刘勤社,郭安阳.慢性萎缩性胃炎中医证型与血液流变学的关系[J].中国中西医结合脾胃杂志,1997,5(1)14-16.
[40]杨容青.调和气血法治疗慢性萎缩性胃炎思考[J].辽宁中医杂志,2005,32(6):551-552.
[41].陈泽民等.60例慢性萎缩性胃炎的辨证分型和疗效观察.武汉医学院学报[J],1981:10(3):78
[42].陈泰庆等.中西医结合治疗慢性萎缩性胃炎140例报告.中西医结合杂志[J],1983:3(4):221
[43].李世俊等.养胃冲剂治疗慢性萎缩性胃炎临床观察.中医杂志[J],1986:(11):30
[44].龙祖宏等.龙祖宏治疗脾胃病举隅.辽宁中医杂志[J],1984:(9):42
[45].李恩复等.中医中药治愈慢性萎缩性胃炎31例总结.山东中医学院学报[J],1985:9(2):43
[46].许建华.复胃汤治疗慢性萎缩性胃炎60例 陕西中医[J],1987:8(1):302
[47].张真如.中医杂志,1980:(11)19
[48].乔樵.慢性萎缩性胃炎癌前病变的中医证治.浙江中医学院学报[J],1997:21(6)
[49].王陵等.中西医结合杂志,1981:1(2):80
[50].周孜.慢性萎缩性胃炎中医治法与中成药复方运用的探讨.中成药研究[J]1987:(11):21
[51].周兰等.慢性萎缩性胃炎中医辨证施治的研究.中医杂志[J],1986:(6):26
[52].陈云芝等.萎缩性胃炎的中医辨证施治.陕西中医[J],1985:(11):488
[53].张继泽.“胃炎灵”冲剂治疗中虚气滞型慢性浅谈.江苏中医杂志[J],1982:3(6):1
[54].苗世举.活血化瘀汤治疗慢性萎缩性胃炎50例小结.中西医结合杂志[J],1986:(5):267
[55].赵汉鸣.辨证治疗萎缩性胃炎50例临床和病理观察.中医杂志[J],1985:(3):9
[2]吴春燕,郭晓钟等.慢性胃炎与幽门螺杆菌感染研究进展[M].胃炎研究进展,85-89.
[3]林三仁.幽门螺杆菌感染与胃黏膜炎症[M].胃炎临床研究进展,60-63.
[4]马文莲等.胃癌致病因素探讨[J].滨州医学院学报,2002,25(6).
[5]胡品津,曾志荣,林汉良.幽门螺杆菌的根除与萎缩性胃炎形成和逆转的动物实验研究[J].中华消化杂,2000,20:155.
[6]Kuipers EJ,Uyterlinde AM,Pena AS,etal.Long term sequelae of Helicobacter pylori gastritis.Lancet,1995,345:1525-1528.
[7]Strickland,J.,T.J.Dull,D.D.Sleeter,and H.F.Noller.1981.Gene Organization and Primary structure of a ribosomal IFA operon from A Chronic atrophic gastritis coli.J.Mol.Biol.148:107-127.
[8]Irvine K,Muraoka A,Shoda R,Yamato S,Umeda N.PCA in the gastric mucosa:A molecular Profile of the mouse gastric Parietal cell Proc.Natl.Acad.Sci.U.S.A.98,13687-13692.
[9]杨耀芳,蔡钦朝,王钦茂等.细胞免疫学新探(下卷)[M].南京:南京大学出版社,1993:219.
[10]Mills,J.C.,Syder,A.J.,Hong,C.V.Guruge,J.L.,Raaii,F.,Gordon,J.I.evidence of GCAincreased generation in adaptirecyto Protection.Gastroenterology,1994,106-132.
[11]Strickland,E.M.,K.Oien,A.El-Nujumi,D.Gillen,A.Wirz,S.Oahill,C.Williams,J.E.S.Ardill,and K.E.L.McColl.1997.Lymphocyte in the control of gastric acid Secretion gastrin release and blood flow Gastroenterology,1994,106:A52.
[12]林峰克.慢性萎缩性胃炎相关性疾病.中国免疫学杂志[J],1990,5(5):308.
[13]Atherton,J.C.,Falkow,S.,Peek,R.M.Jr.(2001).Prostaglandins.diversity within the gastric niehe of human host.Proc.Nat1.Acad.Sci.U.S.A.98:14625-14630.
[14]iemela S.Characteristics oNf reflux gatritis duodenogastric reflux:Cor relations among Bile acid pattern,mucus secretion,and mucosal damage scand.J Gastroentreoll,1987,72:349.
[15]郑芝田主编.胃肠病学(第三版).人民卫生出版社[M],2000:312-313.
[16]Varis L.Fiorucci S,Distrutti E,Chiorean M,Santucci L,Heredity factor in incidence of Chronic atrophic gastritis Gastroentreoll 1997,72:349.
[17]刘海峰,刘为纹,房殿春,等.胃癌变中细胞凋亡及其与bcl-2蛋白表达关系的研究.中华消化内镜杂志[J],2000,17(2):41.
[18]鲁香风,赵凤志,等.3种方剂水兰液对实验性胃炎大鼠血清胃泌素水平、G细胞密度及胃壁黏膜PGE_2凡含量的影响.中国中药杂志[J],1995,20(6):361-64.
[19]危北海.胃安素治疗慢性萎缩性胃炎的临床与实验研究.华人消化杂志[J],1998,6(2):114-117。
[20]张喜奎.胃萎灵治疗慢性萎缩性胃炎的实验研究.中国中医药科技[J],2000:7(2):81-82。
[21]徐叔云,卞如濂,陈修.药理实验方法学.第2版.人民卫生出版社[M],1991:723.
[22]徐文静.金实治疗慢性萎缩性胃炎经验.辽宁中医学院学报[J],2005,7(5):470
[23]周学文.慢性萎缩性胃炎中医证治旨要.中医药学刊[J],2002,20(5):955-9571
[24]赵霞.余绍源教授辨治慢性萎缩性胃炎经验.四川中医[J],2004,22(4):19-21
[25]陈英.中药防治慢性萎缩性胃炎癌前病变100例[J].光明中医2005,20(5):52
[26]张聪,陈明.自拟舒胃汤治疗慢性萎缩性胃炎36例[J].辽宁中医学院学报,2004,6(5):381
[27]姚保泰,王磊,王洪京,等.萎缩康冲剂治疗萎缩性胃炎癌前病变的临床与实验研究[J].中医杂志,1999,40(11):673
[28]王汝新,牛华珍.温阳补肾活血法治疗慢性萎缩性胃炎180例观察[J].实用中医内科杂志,2000,16(11):11
[29]樊东香,宋思峰,胡家才.芪夏连棱汤治疗慢性萎缩性胃炎癌前病变临床研究[J].中国中西医结合脾胃杂志,2000,8(4):204-206
[30]祁宏,等.萎胃康治疗慢性萎缩性胃炎的疗效及对血液流变学的影像[J].中国中西医结合急救杂志,2004,11(1):42-44
[31]王钢,等.养阴活血法治疗慢性萎缩性胃炎84例[J].陕西中医,2004,25(1):4
[32]阚士宁,陈如芳,龙战生,等.荣胃煎治疗萎缩性胃炎癌前病变49例疗效分析[J].中医杂志,1999,40(10):601
[33]代二庆,等.善胃Ⅰ-Ⅲ号方治疗慢性萎缩性胃炎胃癌前病变的临床研究[J].中医药学刊,2004,22(4):606
[34]周衍.老年萎缩性胃炎的辨证施治[J].南京中医药大学学报,1996,12(2):39.
[35]乔樵.慢性萎缩性胃炎癌前病变的中医证治[J].浙江中医学院学报,1997,21(6):7.
[36]王文仲.软坚散结慢性萎缩性胃炎伴胃黏膜异型增生及肠化生的对比观察[J].中医杂志,1994,35(8):477.
[37]百福金.活血化瘀为主治疗萎缩性胃炎30例[J].北京中医学院学报,1993,16(1):48.
[38]张玉,林庚金,金惠铭,等.慢性萎缩性胃炎黏膜血流量的研究[J].中华消化内镜杂志,1997,14(2):101-102.
[39]侯冬梅,刘勤社,郭安阳.慢性萎缩性胃炎中医证型与血液流变学的关系[J].中国中西医结合脾胃杂志,1997,5(1)14-16.
[40]杨容青.调和气血法治疗慢性萎缩性胃炎思考[J].辽宁中医杂志,2005,32(6):551-552.
[41].陈泽民等.60例慢性萎缩性胃炎的辨证分型和疗效观察.武汉医学院学报[J],1981:10(3):78
[42].陈泰庆等.中西医结合治疗慢性萎缩性胃炎140例报告.中西医结合杂志[J],1983:3(4):221
[43].李世俊等.养胃冲剂治疗慢性萎缩性胃炎临床观察.中医杂志[J],1986:(11):30
[44].龙祖宏等.龙祖宏治疗脾胃病举隅.辽宁中医杂志[J],1984:(9):42
[45].李恩复等.中医中药治愈慢性萎缩性胃炎31例总结.山东中医学院学报[J],1985:9(2):43
[46].许建华.复胃汤治疗慢性萎缩性胃炎60例 陕西中医[J],1987:8(1):302
[47].张真如.中医杂志,1980:(11)19
[48].乔樵.慢性萎缩性胃炎癌前病变的中医证治.浙江中医学院学报[J],1997:21(6)
[49].王陵等.中西医结合杂志,1981:1(2):80
[50].周孜.慢性萎缩性胃炎中医治法与中成药复方运用的探讨.中成药研究[J]1987:(11):21
[51].周兰等.慢性萎缩性胃炎中医辨证施治的研究.中医杂志[J],1986:(6):26
[52].陈云芝等.萎缩性胃炎的中医辨证施治.陕西中医[J],1985:(11):488
[53].张继泽.“胃炎灵”冲剂治疗中虚气滞型慢性浅谈.江苏中医杂志[J],1982:3(6):1
[54].苗世举.活血化瘀汤治疗慢性萎缩性胃炎50例小结.中西医结合杂志[J],1986:(5):267
[55].赵汉鸣.辨证治疗萎缩性胃炎50例临床和病理观察.中医杂志[J],1985:(3):9