周德丽教授治疗慢性萎缩性胃炎学术经验研究
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摘要
理论溯源：
周德丽教授长期从事中西医结合治疗慢性萎缩性胃炎的研究,认为慢性萎缩性胃炎属于中医学脾胃病中“胃脘痛”、“痞满”、“嘈杂”、“吞酸”等范畴,其病位在胃,病因主要为饮食不节、七情失和、脾胃虚弱、外邪侵袭等。现代医学认为病因主要为感染因素(Hp感染、其他细菌、病毒感染)、胆汁返流、胃黏膜微循环的改变、血管活性因子的改变、黏膜营养因子缺乏、宿主的遗传因素、免疫因素、神经精神因素。
学术经验：
周德丽教授在理论上强调人以胃气为本,治诸病不离脾胃。治脾胃须遵循其相反相成的特性,重视胃与脾、肝、胆的关系,在大量文献研究的基础上,结合长期的临床实践,将慢性萎缩胃炎病机特点概括脾胃气虚为其本,肝胆湿热为其标,气血郁滞为其病机关键。在临床上治疗当标本兼顾,调理脾胃功能气机升降失常是主要矛盾。治脾胃之虚损,调肝胆脾胃之气机。治疗本病既要体现注重调补脾胃之虚损,又需调理肝气以畅运气机,活血消痞；在宏观与微观辨证相结合的基础上,以扶正祛邪为基本原则,确立调气活血、清热滋阴,解毒除湿的治疗方法。这是阻断和逆转萎缩性胃炎癌前病变的关键。慢病缓治,从源头做起,治疗上推崇吴鞠通治温热病之“中焦如衡”观点,用药轻灵,补而不滋腻,清而不虚寒太过,令其和平,以和为贵。并根据此学术观点,创制了胃复康方治疗慢性萎缩性胃炎,经长期临床应用,疗效显著。临证时主张中西结合、辫证与辫病相结合；重视舌脉在脾胃病中的诊治作用,初步将本病分为脾胃气阴虚,肝胆湿热型和脾虚肝郁气滞型两个大的证型施治；倡导饮食及生活调养、注重情志调摄,防治结合。
临床研究：
通过胃复康颗粒治疗慢性萎缩性胃炎的临床研究,发现该方能显著改善慢性萎缩性胃炎患者的胃脘痞满、胃脘疼痛、嗳气、口干等临床症状、胃镜下胃粘膜征象,抑制或杀灭Hp,对萎缩性胃炎的肠化生和异型增生有一定的逆转和较好的治疗作用,从而达到降低或阻断萎缩性胃炎的癌变可能。其较好的疗效可能与增强机体免疫,保护胃粘膜,改善胃粘膜微循环,抗菌消炎,杀灭Hp,调节胃肠运动功能,促进胃动力,解痉止痛有关。
Review:
Professor Zhou Deli, who has been studied Chronic atrophic Gastritis (CAG) with TCM and west medicine theory for a long time considers that chronic gastritis belong to "weiwantong","piman""caoza","fansuan" and so on in Traditional Chinese Medicine. Pathogenic location of Chronic Atrophic Gastritis (CAG) is stomach. It is mainly caused by improper diet, disharmony of emotion, weakness of taste, and invasion of pathogenic factors. While in Western medicine it is regarded as causing mainly by Infectious Factors (Hp infection, other bacteria and virus infection), biliary reflux, the changes of gastric mucosa microcirculation, the change of vasoactive factors, deficiency of mucous membrane trophic factors, genetic factors of host cell, immunological factors, neuropsychological factors.
Academic experiences:
People is based on the function of stomach-qi. And regulating the spleen and stomach is inevitable in treatment theoretically. We should follow their both opposite and complementary characters, pay attention to the relationships between the spleen, liver and gallbladder. Basing on the theories and clinical practice, and sum up the mechanism of CAG as follow: the origin is qi-deficiency of spleen and stomach, the urgency symptoms are about damp-heat of liver and gallbladder, and The key of pathogenesis is stagnation of qi and blood stagnation. In the clinical treatment, we should address both symptoms and root causes, adjust the function of spleen and stomach, and the lifting of qi. Treating the weakness of spleen and stomach, we should regulate the qi of liver, gallbladder, spleen and stomach. In the clinical treatment, we should emphasize conditioning of the weakness of spleen and stomach, adjust qi of liver so as to open qi and eliminate blood swelling, basic on macroscopic and microsmic aspect, As the basic principle of supporting healthy qi and dispelling pathogenic factors, establishing a treatment of promoting qi and blood circulation, clearing fire away and nourishing yin, removing toxicity and dampness. This is the key to interrupt and reverse atrophic gastritis's precancerous lesion. Followed the Wu jutong's theory on "the balanced middle Jiao " treatment of seasonal febrile disease. Treatment must search for the primary cause of disease, and for the chronic disease should be treated slowly. Furthermore using little dosage can keep reestablishing harmony and equilibrium by invigoration and heat-clearing. Basic on the theory, she has founded a stomach Rehabilitation Treatment to treat CAG and its effect is remarkable. When treating patients she always pays attention to combine Chinese medicine with west medicine, and syndrome differentiation with disease identification, and observe the tongue condition. She divides CAG into two syndrome patterns for clinical treatment, and also pays attent ion to recuperation of diet and daily life, regulate the emotions, and integration of prevention and treatment.
Clinical Research:
Weifukan granule can improve the symptoms of the patients of CAG, gastroscopy, kill Hp, treat and reverse IM and ATP, so it can be lower or hinder the occurrence of cancer. It may take effect in such ways: improving the immunity and blood circulation, defending the stomach, killing Hp, regulating themovement of stomach,killing the pain.
周德丽教授长期从事中西医结合治疗慢性萎缩性胃炎的研究,认为慢性萎缩性胃炎属于中医学脾胃病中“胃脘痛”、“痞满”、“嘈杂”、“吞酸”等范畴,其病位在胃,病因主要为饮食不节、七情失和、脾胃虚弱、外邪侵袭等。现代医学认为病因主要为感染因素(Hp感染、其他细菌、病毒感染)、胆汁返流、胃黏膜微循环的改变、血管活性因子的改变、黏膜营养因子缺乏、宿主的遗传因素、免疫因素、神经精神因素。
学术经验：
周德丽教授在理论上强调人以胃气为本,治诸病不离脾胃。治脾胃须遵循其相反相成的特性,重视胃与脾、肝、胆的关系,在大量文献研究的基础上,结合长期的临床实践,将慢性萎缩胃炎病机特点概括脾胃气虚为其本,肝胆湿热为其标,气血郁滞为其病机关键。在临床上治疗当标本兼顾,调理脾胃功能气机升降失常是主要矛盾。治脾胃之虚损,调肝胆脾胃之气机。治疗本病既要体现注重调补脾胃之虚损,又需调理肝气以畅运气机,活血消痞；在宏观与微观辨证相结合的基础上,以扶正祛邪为基本原则,确立调气活血、清热滋阴,解毒除湿的治疗方法。这是阻断和逆转萎缩性胃炎癌前病变的关键。慢病缓治,从源头做起,治疗上推崇吴鞠通治温热病之“中焦如衡”观点,用药轻灵,补而不滋腻,清而不虚寒太过,令其和平,以和为贵。并根据此学术观点,创制了胃复康方治疗慢性萎缩性胃炎,经长期临床应用,疗效显著。临证时主张中西结合、辫证与辫病相结合；重视舌脉在脾胃病中的诊治作用,初步将本病分为脾胃气阴虚,肝胆湿热型和脾虚肝郁气滞型两个大的证型施治；倡导饮食及生活调养、注重情志调摄,防治结合。
临床研究：
通过胃复康颗粒治疗慢性萎缩性胃炎的临床研究,发现该方能显著改善慢性萎缩性胃炎患者的胃脘痞满、胃脘疼痛、嗳气、口干等临床症状、胃镜下胃粘膜征象,抑制或杀灭Hp,对萎缩性胃炎的肠化生和异型增生有一定的逆转和较好的治疗作用,从而达到降低或阻断萎缩性胃炎的癌变可能。其较好的疗效可能与增强机体免疫,保护胃粘膜,改善胃粘膜微循环,抗菌消炎,杀灭Hp,调节胃肠运动功能,促进胃动力,解痉止痛有关。
Review:
Professor Zhou Deli, who has been studied Chronic atrophic Gastritis (CAG) with TCM and west medicine theory for a long time considers that chronic gastritis belong to "weiwantong","piman""caoza","fansuan" and so on in Traditional Chinese Medicine. Pathogenic location of Chronic Atrophic Gastritis (CAG) is stomach. It is mainly caused by improper diet, disharmony of emotion, weakness of taste, and invasion of pathogenic factors. While in Western medicine it is regarded as causing mainly by Infectious Factors (Hp infection, other bacteria and virus infection), biliary reflux, the changes of gastric mucosa microcirculation, the change of vasoactive factors, deficiency of mucous membrane trophic factors, genetic factors of host cell, immunological factors, neuropsychological factors.
Academic experiences:
People is based on the function of stomach-qi. And regulating the spleen and stomach is inevitable in treatment theoretically. We should follow their both opposite and complementary characters, pay attention to the relationships between the spleen, liver and gallbladder. Basing on the theories and clinical practice, and sum up the mechanism of CAG as follow: the origin is qi-deficiency of spleen and stomach, the urgency symptoms are about damp-heat of liver and gallbladder, and The key of pathogenesis is stagnation of qi and blood stagnation. In the clinical treatment, we should address both symptoms and root causes, adjust the function of spleen and stomach, and the lifting of qi. Treating the weakness of spleen and stomach, we should regulate the qi of liver, gallbladder, spleen and stomach. In the clinical treatment, we should emphasize conditioning of the weakness of spleen and stomach, adjust qi of liver so as to open qi and eliminate blood swelling, basic on macroscopic and microsmic aspect, As the basic principle of supporting healthy qi and dispelling pathogenic factors, establishing a treatment of promoting qi and blood circulation, clearing fire away and nourishing yin, removing toxicity and dampness. This is the key to interrupt and reverse atrophic gastritis's precancerous lesion. Followed the Wu jutong's theory on "the balanced middle Jiao " treatment of seasonal febrile disease. Treatment must search for the primary cause of disease, and for the chronic disease should be treated slowly. Furthermore using little dosage can keep reestablishing harmony and equilibrium by invigoration and heat-clearing. Basic on the theory, she has founded a stomach Rehabilitation Treatment to treat CAG and its effect is remarkable. When treating patients she always pays attention to combine Chinese medicine with west medicine, and syndrome differentiation with disease identification, and observe the tongue condition. She divides CAG into two syndrome patterns for clinical treatment, and also pays attent ion to recuperation of diet and daily life, regulate the emotions, and integration of prevention and treatment.
Clinical Research:
Weifukan granule can improve the symptoms of the patients of CAG, gastroscopy, kill Hp, treat and reverse IM and ATP, so it can be lower or hinder the occurrence of cancer. It may take effect in such ways: improving the immunity and blood circulation, defending the stomach, killing Hp, regulating themovement of stomach,killing the pain.
引文
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