浅谈仲景胃食管反流病诊治思路

文章信息/Info

• Title:浅谈仲景胃食管反流病诊治思路

• 卷期:2024年22卷14期

• 作者:王媛媛 李镇*

• 南京中医药大学第二附属医院脾胃病科 江苏南京 210017

• Author(s):Yuanyuan Wang , Zhen Li*

• The Second Affiliated Hospital of Nanjing University of Chinese Medicine,Department of Gastroenterology，JiangSu Province，210017

• 关键词胃食管反流病，伤寒论，金匮要略

• Keywords: Gastroesophageal reflux disease，Treatise on Febrile Diseases，Synopsis of Golden Chamber

• 摘要:通过对《伤寒论》、《金匮要略》中关于胃食管反流病相关条文的研读，归纳出胃食管反流病的临床证型分为：肝胃不和证、寒热错杂证、痰气交阻证、肝郁化火证、水饮内停证、脾虚痰壅证、胃虚有热证、脾胃虚寒证、阴虚内热证。对每种证型的方药结合自己的临床体会进行分析，最后通过典型临床案例举隅，浅析经方治疗胃食管病的思路。                                                                                                                                                                                

• AbstractBased on the study of the relevant articles on gastroesophageal reflux disease in Treatise on Febrile Diseases and Synopsis of Golden Chamber, the clinical syndrome types of gastroesophageal reflux disease are summarized as follows: disharmony between liver and stomach, cold and heat mixed, phlegm and qi obstructing, liver stagnation and fire transforming, water retention inside, spleen deficiency and phlegm stagnation, stomach deficiency and heat, spleen stomach deficiency and cold, yin deficiency and internal heat. Analyze the prescriptions and drugs of each syndrome type in combination with their own clinical experience, and finally analyze the idea of treating gastroesophageal disease with classical prescriptions through typical clinical cases.

  胃食管反流病主要表现为胸骨后烧灼感、胸痛、反酸、嗳气、咽部作堵、恶心、反胃、咳嗽、口苦等症状，发病率较高，部分症状难以缓解，中药治疗该病有独到优势。有学者认为本病病机特点以 “逆”“热” “郁”为主，有虚实之分，实有气、热、痰、郁、湿、瘀，虚以脾胃虚寒、胃阴不足为主[1]，我认为临床寒热虚实夹杂之况更为常见。