老年人功能性消化不良的五脏论治
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摘要
我国逐渐进入老龄化社会,老年性疾病发生率也日益增长,病情多反复迁延,严重影响了老年人的生活质量。而脾胃病是常见的老年慢性疾病,其中功能性消化不良较为特殊,因其发病机制尚未明确,加上无明显器质性改变,西医治疗效果欠佳。老年人处于多器官功能渐衰阶段,在中医看来,此阶段素体虚弱,气血不足,脾失健运,证治常常交替复杂,在症状表现上各有不同,又因其易复发,成为脾胃病门诊的一大难题。中医学的两大理论强调整体观念,辩证论治,认为人体是以五脏为中心的有机整体,此病虽病位在脾胃,但与五脏密切相关。笔者认为从五脏角度辩治老年功能性消化不良是临床诊治的一大突破口。
With China having gradually entered an aging society,the incidence of geriatric diseases is increasing.Recurrence and prolonged course of the diseases are quite common,which seriously affects the quality of life in the elderly.Disorders involving the spleen and stomach are common chronic diseases in the elderly,and among them,functional dyspepsia is relatively special.Since its pathogenesis remains unclear,and no obvious organic changes are observed,the therapeutic effect of western medicine is barely satisfactory.The elderly are in decline of multiple organ function,so,in view of traditional Chinese medicine,this stage is characterized by weakness of body,deficiency of Qi and blood,abnormality of the spleen transportation and transformation,and alternation and complexity in syndrome differentiation and treatment.Because these diseases have diverse signs and symptoms and are of high incidence of recurrence,they become a major problem in the outpatient clinic.The two theories of traditional Chinese medicine emphasize the holistic concept and treatment based on syndrome differentiation,so the body is regarded as an organic whole centering on the Five Zangorgans.Although these diseases are located in the spleen and stomach,they are closely associated with the Five Zang-organs.We believe that treating functional dyspepsia from the view of the Five Zang-organs is a major breakthrough in the clinical diagnosis and treatment for the elderly.
With China having gradually entered an aging society,the incidence of geriatric diseases is increasing.Recurrence and prolonged course of the diseases are quite common,which seriously affects the quality of life in the elderly.Disorders involving the spleen and stomach are common chronic diseases in the elderly,and among them,functional dyspepsia is relatively special.Since its pathogenesis remains unclear,and no obvious organic changes are observed,the therapeutic effect of western medicine is barely satisfactory.The elderly are in decline of multiple organ function,so,in view of traditional Chinese medicine,this stage is characterized by weakness of body,deficiency of Qi and blood,abnormality of the spleen transportation and transformation,and alternation and complexity in syndrome differentiation and treatment.Because these diseases have diverse signs and symptoms and are of high incidence of recurrence,they become a major problem in the outpatient clinic.The two theories of traditional Chinese medicine emphasize the holistic concept and treatment based on syndrome differentiation,so the body is regarded as an organic whole centering on the Five Zangorgans.Although these diseases are located in the spleen and stomach,they are closely associated with the Five Zang-organs.We believe that treating functional dyspepsia from the view of the Five Zang-organs is a major breakthrough in the clinical diagnosis and treatment for the elderly.
引文
[1]冯美江,鲁翔.老年疾病与整合医学[J].中华临床医师杂志(电子版),2013,7(2):456-457.DOI:10.3877/cma.j.issn.1674-0785.2013.02.001.Feng MJ,Lu X.Geriatric diseases and integrated medicine[J].Chin J Clin(Electron Ed),2013,7(2):456-457.DOI:10.3877/cma.j.issn.1674-0785.2013.02.001.
[2]Tack J,Talley NJ.Functional dyspepsia-symptoms,definitions and validity of the RomeⅢcriteria[J].Nat Rev Gastroenterol Hepatol,2013,10(3):134-141.DOI:10.1038/nrgastro.2013.14.
[3]罗思明.老年人消化系统疾病的临床特点分析[J].当代医学,2015,21(21):41-42.DOI:10.3969/j.issn.1009-4393.2015.21.025.Luo SM.Analysis of clinical characteristics of digestive system diseases in the elderly[J].Contemp Med,2015,21(21):41-42.DOI:10.3969/j.issn.1009-4393.2015.21.025.
[4]陈凯佳.邓铁涛五脏相关理论研究的方法和思路探讨[J].中医研究,2006,19(4):46-48.DOI:10.3969/j.issn.1001-6910.2006.04.023.Chen KJ.Discussion on the methods and ideas of Five Zang related theoretical research by Deng Tietao[J].Res Tradit Chin Med,2006,19(4):46-48.DOI:10.3969/j.issn.1001-6910.2006.04.023.
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[6]王凤仪.王道坤教授调五脏以安脾胃的治病观[J].西部中医药,2017,30(1):31-33.DOI:10.3969/j.issn.1004-6852.2017.01.011.Wang FY.The view of treating the spleen and stomach by conditioning Five Zang of Professor Wang Daokun[J].Western Chin Med,2017,30(1):31-33.DOI:10.3969/j.issn.1004-6852.2017.01.011.
[7]刘晶,李峰,唐旭东,等.功能性消化不良中医辨证及辨证标准的现代临床文献研究[J].世界中医药,2015,10(1):56-59.DOI:10.3969/j.issn.1673-7202.2015.01.014.Liu J,Li F,Tang XD,et al.Study on modern clinical literature of TCM syndrome differentiation and syndrome differentiation standard of functional dyspepsia[J].World Tradit Chin Med,2015,10(1):56-59.DOI:10.3969/j.issn.1673-7202.2015.01.014.
[8]郭先文,黄丹,左国文,等.精神心理因素与老年功能性消化不良研究进展[J].临床荟萃,2014,29(6):717-719.DOI:10.3969/j.issn.1004-583X.2014.06.040.Guo XW,Huang D,Zuo GW,et al.The progress of research on mental and psychological factors and functional dyspepsia in the elderly[J].Clin Highlights,2014,29(6):717-719.DOI:10.3969/j.issn.1004-583X.2014.06.040.
[9]李晶,赵莉娟,崔长虹,等.老年脾胃病诊治心得[J].世界中西医结合杂志,2012,7(12):1064-1065.DOI:10.3969/j.issn.1673-6613.2012.12.019.Li J,Zhao LJ,Cui CH,et al.Diagnosis and treatment of senile spleen and stomach disease[J].World J Integr Chin Western Med,2012,7(12):1064-1065.DOI:10.3969/j.issn.1673-6613.2012.12.019.
[10]张佩江.《脾胃论》学术思想初探[J].河南中医,2009,29(9):856-857.Zhang PJ.A tentative study on the academic thoughts of spleen and stomach theory[J].Henan Tradit Chin Med,2009,29(9):6 856-857.
[11]李朝辉.柏树纲教授治疗功能性消化不良的经验总结[D].辽宁中医药大学,2016.Li CH.A summary of experience in the treatment of functional dyspepsia by Professor Bo Shugang[D].Liaoning Univ Tradit Chin Med,2016.
[12]厉启芳,陈汉文,张丽,等.孙冰运用寒热并用法治疗脾胃病经验[J].山东中医药大学学报,2017,41(2):158-160.Li QF,Chen HW,Zhang L,et al.Sun Bing's experience in treating spleen and stomach disease with cold and fever usage[J].J Shandong Univ Tradit Chin Med,2017,41(2):158-160.
[13]赵霞.辨证分型治疗功能性消化不良40例[J].陕西中医,2006,26(9):1051-1052.DOI:10.3969/j.issn.1000-7369.2006.09.018.Zhao X.Treatment of 40 cases of functional dyspepsia with syndrome differentiation and separation[J].Shaanxi Tradit Chin Med,2006,26(9):1051-1052.DOI:10.3969/j.issn.1000-7369.2006.09.018.
[14]苏锐.功能性消化不良辨证分型与Hp感染关系的探讨[J].现代中西医结合杂志,2002,11(6):482-483.DOI:10.3969/j.issn.1008-8849.2002.06.003.Su R.Discussion on the relationship between functional dyspepsia syndrome differentiation and Hp infection[J].J Mod Integr Chin Western Med,2002,11(6):482-483.DOI:10.3969/j.issn.1008-8849.2002.06.003.
[15]Kindt S,Caenepeel P,Arts J,et al.Characteristics and determinants of long-term outcome in acute onset functional dyspepsia patients[J].Gastroenterology,2006,130(4):A134-A135.
[16]王美峰,林琳,张红杰,等.功能性消化不良患者焦虑、抑郁状况与生活质量的相关性研究[J].南京医科大学学报(自然科学版),2008,28(12):1677-1679.Wang MF,Lin L,Zhang HJ,et al.Study on the correlation between anxiety,depression and quality of life in patients with functional dyspepsia[J].J Nanjing Med Univ(Nat Sci Ed),2008,28(12):1677-1679.
[17]冯英,赵永锋.功能性消化不良患者的抑郁和焦虑调查分析[J].中华临床医学杂志,2005,6(5):23-24.Feng Y,Zhao YF.Investigation and analysis of depression and anxiety in patients with functional dyspepsia[J].Chin J Clin Med,2005,6(5):23-24.
[18]徐蕾,黄穗平.五脏相关学说论治功能性消化不良[J].辽宁中医杂志,2011,38(2):250-251.Xu L,Huang SP.On the treatment of functional dyspepsia by Five Zang related theories[J].Liaoning J Tradit Chin Med,2011,38(2):250-251.
[19]周建法.老年人胃病临床特点与预防[J].黑龙江医学,2004,28(4):296.DOI:10.3969/j.issn.1004-5775.2004.04.032.Zhou JF.Clinical characteristics and prevention of gastric disease in the elderly[J].Heilongjiang Med,2004,28(4):296.DOI:10.3969/j.issn.1004-5775.2004.04.032.
[20]吴整军,钱妍.中医对老年病的认识及治疗[J].中华老年多器官疾病杂志,2008,7(3):254-256.DOI:10.3969/j.issn.1671-5403.2008.03.028.Wu ZJ,Qiian Y.Cognition and treatment of geriatric diseases in traditional Chinese medicine[J].Chin J Mult Organ Dis Elderly,2008,7(3):254-256.DOI:10.3969/j.issn.1671-5403.2008.03.028.
[21]梁光宇,吴绪祥.赵树森主任医师抗衰老学术思想简介[J].中华中医药学刊,2007,25(8):1556-1557.DOI:10.3969/j.issn.1673-7717.2007.08.006.Liang GY,Wu XX.Brief introduction of Chief Physician Zhao Shusen's academic thoughts on antiaging[J].Chin Arch Tradit Chin Med,2007,25(8):1556-1557.DOI:10.3969/j.issn.1673-7717.2007.08.006.
[22]马青,单兆伟,王晓华.单兆伟教授从肺论治脾胃病[J].吉林中医药,2016,36(6):557-559.Ma Q,Shan ZW,Wang XH.The theory of the treatment on spleen and stomach disease from lung by Professor Shan Zhaowei[J].Jilin Tradit Chin Med,2016,36(6):557-559.
[2]Tack J,Talley NJ.Functional dyspepsia-symptoms,definitions and validity of the RomeⅢcriteria[J].Nat Rev Gastroenterol Hepatol,2013,10(3):134-141.DOI:10.1038/nrgastro.2013.14.
[3]罗思明.老年人消化系统疾病的临床特点分析[J].当代医学,2015,21(21):41-42.DOI:10.3969/j.issn.1009-4393.2015.21.025.Luo SM.Analysis of clinical characteristics of digestive system diseases in the elderly[J].Contemp Med,2015,21(21):41-42.DOI:10.3969/j.issn.1009-4393.2015.21.025.
[4]陈凯佳.邓铁涛五脏相关理论研究的方法和思路探讨[J].中医研究,2006,19(4):46-48.DOI:10.3969/j.issn.1001-6910.2006.04.023.Chen KJ.Discussion on the methods and ideas of Five Zang related theoretical research by Deng Tietao[J].Res Tradit Chin Med,2006,19(4):46-48.DOI:10.3969/j.issn.1001-6910.2006.04.023.
[5]李振华,李郑生.中医脾胃病学[M].北京:科学出版社,2012:24.Li ZH,Li ZS.Spleen and Stomach Disease in Traditional Chinese Medicine[M].Beijing:Science Press,2012:24.
[6]王凤仪.王道坤教授调五脏以安脾胃的治病观[J].西部中医药,2017,30(1):31-33.DOI:10.3969/j.issn.1004-6852.2017.01.011.Wang FY.The view of treating the spleen and stomach by conditioning Five Zang of Professor Wang Daokun[J].Western Chin Med,2017,30(1):31-33.DOI:10.3969/j.issn.1004-6852.2017.01.011.
[7]刘晶,李峰,唐旭东,等.功能性消化不良中医辨证及辨证标准的现代临床文献研究[J].世界中医药,2015,10(1):56-59.DOI:10.3969/j.issn.1673-7202.2015.01.014.Liu J,Li F,Tang XD,et al.Study on modern clinical literature of TCM syndrome differentiation and syndrome differentiation standard of functional dyspepsia[J].World Tradit Chin Med,2015,10(1):56-59.DOI:10.3969/j.issn.1673-7202.2015.01.014.
[8]郭先文,黄丹,左国文,等.精神心理因素与老年功能性消化不良研究进展[J].临床荟萃,2014,29(6):717-719.DOI:10.3969/j.issn.1004-583X.2014.06.040.Guo XW,Huang D,Zuo GW,et al.The progress of research on mental and psychological factors and functional dyspepsia in the elderly[J].Clin Highlights,2014,29(6):717-719.DOI:10.3969/j.issn.1004-583X.2014.06.040.
[9]李晶,赵莉娟,崔长虹,等.老年脾胃病诊治心得[J].世界中西医结合杂志,2012,7(12):1064-1065.DOI:10.3969/j.issn.1673-6613.2012.12.019.Li J,Zhao LJ,Cui CH,et al.Diagnosis and treatment of senile spleen and stomach disease[J].World J Integr Chin Western Med,2012,7(12):1064-1065.DOI:10.3969/j.issn.1673-6613.2012.12.019.
[10]张佩江.《脾胃论》学术思想初探[J].河南中医,2009,29(9):856-857.Zhang PJ.A tentative study on the academic thoughts of spleen and stomach theory[J].Henan Tradit Chin Med,2009,29(9):6 856-857.
[11]李朝辉.柏树纲教授治疗功能性消化不良的经验总结[D].辽宁中医药大学,2016.Li CH.A summary of experience in the treatment of functional dyspepsia by Professor Bo Shugang[D].Liaoning Univ Tradit Chin Med,2016.
[12]厉启芳,陈汉文,张丽,等.孙冰运用寒热并用法治疗脾胃病经验[J].山东中医药大学学报,2017,41(2):158-160.Li QF,Chen HW,Zhang L,et al.Sun Bing's experience in treating spleen and stomach disease with cold and fever usage[J].J Shandong Univ Tradit Chin Med,2017,41(2):158-160.
[13]赵霞.辨证分型治疗功能性消化不良40例[J].陕西中医,2006,26(9):1051-1052.DOI:10.3969/j.issn.1000-7369.2006.09.018.Zhao X.Treatment of 40 cases of functional dyspepsia with syndrome differentiation and separation[J].Shaanxi Tradit Chin Med,2006,26(9):1051-1052.DOI:10.3969/j.issn.1000-7369.2006.09.018.
[14]苏锐.功能性消化不良辨证分型与Hp感染关系的探讨[J].现代中西医结合杂志,2002,11(6):482-483.DOI:10.3969/j.issn.1008-8849.2002.06.003.Su R.Discussion on the relationship between functional dyspepsia syndrome differentiation and Hp infection[J].J Mod Integr Chin Western Med,2002,11(6):482-483.DOI:10.3969/j.issn.1008-8849.2002.06.003.
[15]Kindt S,Caenepeel P,Arts J,et al.Characteristics and determinants of long-term outcome in acute onset functional dyspepsia patients[J].Gastroenterology,2006,130(4):A134-A135.
[16]王美峰,林琳,张红杰,等.功能性消化不良患者焦虑、抑郁状况与生活质量的相关性研究[J].南京医科大学学报(自然科学版),2008,28(12):1677-1679.Wang MF,Lin L,Zhang HJ,et al.Study on the correlation between anxiety,depression and quality of life in patients with functional dyspepsia[J].J Nanjing Med Univ(Nat Sci Ed),2008,28(12):1677-1679.
[17]冯英,赵永锋.功能性消化不良患者的抑郁和焦虑调查分析[J].中华临床医学杂志,2005,6(5):23-24.Feng Y,Zhao YF.Investigation and analysis of depression and anxiety in patients with functional dyspepsia[J].Chin J Clin Med,2005,6(5):23-24.
[18]徐蕾,黄穗平.五脏相关学说论治功能性消化不良[J].辽宁中医杂志,2011,38(2):250-251.Xu L,Huang SP.On the treatment of functional dyspepsia by Five Zang related theories[J].Liaoning J Tradit Chin Med,2011,38(2):250-251.
[19]周建法.老年人胃病临床特点与预防[J].黑龙江医学,2004,28(4):296.DOI:10.3969/j.issn.1004-5775.2004.04.032.Zhou JF.Clinical characteristics and prevention of gastric disease in the elderly[J].Heilongjiang Med,2004,28(4):296.DOI:10.3969/j.issn.1004-5775.2004.04.032.
[20]吴整军,钱妍.中医对老年病的认识及治疗[J].中华老年多器官疾病杂志,2008,7(3):254-256.DOI:10.3969/j.issn.1671-5403.2008.03.028.Wu ZJ,Qiian Y.Cognition and treatment of geriatric diseases in traditional Chinese medicine[J].Chin J Mult Organ Dis Elderly,2008,7(3):254-256.DOI:10.3969/j.issn.1671-5403.2008.03.028.
[21]梁光宇,吴绪祥.赵树森主任医师抗衰老学术思想简介[J].中华中医药学刊,2007,25(8):1556-1557.DOI:10.3969/j.issn.1673-7717.2007.08.006.Liang GY,Wu XX.Brief introduction of Chief Physician Zhao Shusen's academic thoughts on antiaging[J].Chin Arch Tradit Chin Med,2007,25(8):1556-1557.DOI:10.3969/j.issn.1673-7717.2007.08.006.
[22]马青,单兆伟,王晓华.单兆伟教授从肺论治脾胃病[J].吉林中医药,2016,36(6):557-559.Ma Q,Shan ZW,Wang XH.The theory of the treatment on spleen and stomach disease from lung by Professor Shan Zhaowei[J].Jilin Tradit Chin Med,2016,36(6):557-559.
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