摘要
慢性萎缩性胃炎是以腺体萎缩或肠化,部分伴有不典型增生为特征的慢性疾病。临床症状多见上腹部不适、疼痛、饱胀,可伴嗳气、反酸,病情易迁延反复,萎缩病理难以逆转,而且易合并肠上皮化生、异型增生及腺瘤等癌前病变。现代医学对此缺乏特异性有效的治疗方案,目前大多予根除幽门螺杆菌、抑酸护胃、促进胃动力等对症处理。中医学将慢性萎缩性胃炎归属为"胃痛""胃脘痛""痞满""嘈杂"等范畴。认为本病与胃、脾、肝关系密切,凡感受外邪、内伤饮食、情志失调以及禀赋不足均可导致本病的发生。韩树堂教授认为慢性萎缩性胃炎以胃气失和、脾失健运、胃阴损耗、胃络瘀阻为基本病机,虚实之间可以互相兼夹及转化,共同损伤脾胃,致使脾胃虚弱,气血津液亏虚,运化不能,从而产生气滞、痰凝、血瘀等各种病理产物,最终引起胃黏膜腺体萎缩及肠上皮化生。治疗多从脾胃健运,遇实证时泄阳明胃腑,佐以活血化瘀、行气止痛、软坚散结之法。遵循四诊合参,辨证论治,及时加减用药,扶正祛邪;同时借助内镜、病理等检查手段对胃黏膜萎缩程度实时评估,及时捕捉伴行的肠上皮化生等癌前病变痕迹,明确诊断,指导诊疗,所举案例亦获良效。韩树堂教授对慢性萎缩性胃炎的辨治有着系统完整的认识和丰富的临床经验,值得学习与推广。
Chronic atrophic gastritis is a chronic disease characterized by glandular atrophy or intestinal metaplasia,partially accompanied by atypical hyperplasia. Clinical symptoms are more common upper abdominal discomfort,pain,fullnesswith belching,acid regurgancy,noisy. Atrophy pathology is difficult to reverse,and easy to be combined with intestinal metaplasia,dysplasia and adenoma and other precancerous lesions. Modern medicine lacks specific and effective treatment for this disease. At present,most of the treatments are to eradicate Helicobacter pylori,inhibit acid and protect the stomach,and promote gastric motility. TCM classifies chronic atrophic gastritis as " stomachache", " epigastric pain" and " noisy". Chronic atrophic gastritis is closely related to the stomach,spleen and liver. Feeling exogenous pathogenic factors,irregular diet,emotional disorder and innate debilitating can lead to the occurrence of the disease. Professor HAN Shutang believes that the basic pathogenesis of chronic atrophic gastritis is imbalance of stomach Qi,spleendeficiency,the loss of stomach Yin and blood stasis in the stomach. Deficiency and dampness can be mixed and interchangeable,causing deficiency of spleen and stomach,deficiency of Qi,blood and body fluid,and inability to transport. Consequently,various pathological products,such as Qi stagnation,phlegm and blood stasis,eventually cause gastric mucosa glands atrophy and intestinal metaplasia. The treatment is protecting spleen and stomach,accompanied by invigorating blood circulation to remove blood stasis,promoting Qi circulation to relieve pain,resolving hard lump. Follow the four diagnosis and combination,syndrome differentiation and treatment,the prescriptions should be modified. At the same time,endoscopic and pathological examination methods are used to evaluate the extent of gastric mucosa atrophy in real time,capture the trace of precancerous lesions such as intestinal metaplasia,clarify the diagnosis and guide the diagnosis and treatment. Professor HAN has a systematic and complete understanding and rich clinical experience of the treatment of chronic atrophic gastritis,which is worthy of learning and promoting.
作者
周婉
韩树堂
ZHOU Wan;HAN Shutang(Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China;AffiliatedHospital of Nanjing TCM University,Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China)
出处
《实用中医内科杂志》
2020年第4期5-8,共4页
Journal of Practical Traditional Chinese Internal Medicine
基金
国家中医临床研究基地业务建设第二批科研专项计划(JDZX2015086)
江苏省研究生培养创新工程项目(SJLX15_00433)。
关键词
慢性萎缩性胃炎
胃痛
痞满
癌前病变
辨证分型
中医药治疗
韩树堂
经验
chronic atrophic gastritis
stomach pain
abdominal fullness
precancerous condition
syndrome differentiation type
treatment with traditional Chinese medicine
HAN Shutang
experience
