李乾构学术思想与临床经验总结及健脾降逆法辨治胃食管反流病脾虚气逆证的临床研究
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摘要
[研究目的]李乾构教授是第四批国家级名老中医学术经验继承指导老师,是补土学派的临床家,从医40余载,积累了丰富的临床经验,擅长治疗脾胃病。李乾构教授治疗脾胃病的学术思想和临床经验是非常宝贵的财富,全面系统地挖掘和继承这些学术思想和临床经验是该研究的目的；并重点学习李乾构教授治疗胃食管反流病的经验。
[研究方法和内容]通过跟随李乾构教授出门诊；整理李乾构教授医案；收集治疗验方、分析其用方思路；收集讲课资料、个人笔记、专题访谈、论文及著作；独立临床实践,进一步学习应用李乾构教授用药、用方和辨证的经验；通过中医古籍的检索以及对导师影响较大的名老中医学术思想的分析,完成李乾构教授学术渊源概述、学术思想和临床经验的整理与总结两部分研究工作。在门诊随机选取胃食管反流病患者60例,采用“健脾降逆方”加减与雷贝拉唑对照研究,比较临床疗效,检验跟师成果,完成临床研究部分工作。
[研究结果]
该研究分为三部分。包括李乾构教授学术渊源、李乾构教授学术思想和临床经验的整理与总结以及李乾构健脾降逆法辨治胃食管反流病脾虚气逆证的研究。
第一部分李乾构教授学术渊源
李乾构教授学术思想渊源主要来源于2个方面。一方面来源于《内经》、《伤寒论》、《金匮要略》等经典著作；另一方面来源于《脾胃论》的补土学说和关幼波的气血理论。最后形成了独具特色的重脾胃、重气血的学术思想。具体包含在以下几个方面：①提倡《黄帝内经》整体观,指出治病要因人、因时、因地制宜,坚持人与自然统一的“天人合一”论；②“邪之所凑,其气必虚”中医发病观；③“内伤脾胃,百病由生”的脾胃内伤理论；④“四季脾旺不受邪”的保胃气思想；⑤重视营卫气血,贯彻治疗脾胃病全过程的活血化痰治疗观。
第二部分李乾构教授学术思想和临床经验的整理与总结
(一)学术思想和临床经验
李乾构教授重要学术思想可以概括为“补脾胃、调气血”两个方面。脾胃为后天之本,气血生化之源,脾胃健,气血旺,营卫通,脏腑、四肢、百骸、九窍等全身器官组织得到濡养,“四季脾旺不受邪”；脾胃功能失调视为疾病发生的重要原因之一,脾胃失键,元气虚弱则是内伤外感疾病的主要成因。在临床实践中重视脾胃功能,治疗疾病抓住健运脾胃,调畅气机这一中心环节,临证内伤外感常用补益脾胃大法调治五脏。因此,李乾构教授临床经验可以概括为以下方面。在疾病发病原因中强调审证必求因,当在气血寻。辨证过程中,强调先辨病后辨证,抓主症与主证,重视体质辨证,重视舌诊。治疗过程中,立足脾胃,调畅中焦气机,健脾理气法贯穿脾胃病治疗始终；顾护中气,慎用寒凉药物等。
(二)疾病诊疗经验
1胃食管反流病：冠名胸痞,见解独到。认为该病病机为脾升胃降、肝升肺降的功能失调。胃气上逆、酸水泛溢而发病。治宜通过健脾疏肝,和顺胃气,来达到降逆制酸的目的。但临证要辨虚实寒热,随证用药有益于提高临床疗效,减少复发,但健脾疏肝、降逆制酸的治法、要贯穿治疗的始终。基本方用健脾降逆汤。
2幽门螺杆菌感染：根据中医“四季脾旺不受邪”、“邪之所凑,其气必虚”的理论,认为幽门螺杆菌感染作为外邪致病因素,它多在脾胃虚弱,正气不足的情况下才可以附着定植于胃黏膜,导致炎症反应,引起胃炎等疾病的发生。故从健脾清化立论,创健脾清化方。
3慢性胃痛：主张从虚论治、从气血论治和从肝脾论治慢性胃痛。
4功能性消化不良：认为本病病位在胃,与肝脾有关,病机特点是本虚标实,本虚指脾胃虚弱,标实为气滞、血瘀、痰湿、食积等郁滞中焦,气机不通。脾虚气滞为基本病机,且贯穿于本病的始终,临床以脾虚气滞证最为多见。治宜标本同治,以健脾理气法为基本治法,治疗要抓住健脾土,助中运；疏肝气,调气机；和胃气,理中焦三个要点,在健脾理气的基础上,随症(证)加减施治。
5功能性便秘：认为本病病位在大肠,而与脾胃关系最为密切。治便秘离不开辨证,并要随症(证)加减,因临床上少见冷秘、热秘、气秘,多数便秘患者为虚实夹杂证,虚以脾虚,大肠津液不足最多,实以气滞血瘀、热结肠燥常见,故治疗常健脾滋阴为主,辅以调理气血、润燥通便,应用四君子汤加减治疗便秘。
6慢性萎缩性胃炎：该病病位在胃,与肝脾有密切关系。本病初起在气,久病则由气及血,渐致气虚血瘀,胃络痹阻。李乾构教授认为慢性萎缩性胃炎证候虽杂,总不离“虚”和“瘀”二字。慢性萎缩性胃炎当从气虚血瘀论治。
7口腔溃疡从“火”论治：认为临证要紧紧抓住一个“火”字。分清虚火与实火。实火多见心脾火盛,药用大黄泻心汤合泻黄散加减：虚火多为心肾阴虚,虚火上炎。药用知柏地黄汤合增液汤加减。
8善于从脾论治久咳：李乾构教授善于从脾论治久咳。肺与脾在病理上亦相互影响,如脾失健运,水湿不化,聚而生痰成饮,多影响肺的宣发和肃降功能。所以补益脾气是治疗久咳肺虚的重要法则。
第三部分李乾构健脾降逆法辨治胃食管反流病脾虚气逆证的研究
目的：观察健脾降逆法治疗胃食管反流病脾虚气逆证的疗效。
方法：60例患者随机分为中药组和雷贝拉唑西药组,分别采用随证加减的健脾降逆方及雷贝拉唑治疗。疗程4周,随访1个月。重点观察患者症状频率变化及生活质量变化。
结果：治疗前后症状发作频率积分统计结果提示中药组疗效优于西药组,组间差异显著,有统计学意义(P<0.01),且停药1月后中药组较西药组疗效稳定。治疗4周结束后,两种治疗均能改善生活质量积分,但中药组在改善活力,总体健康方面优于西药组,且疗效可持续至停药1个月。
结论：应用健脾降逆法随证加减治疗胃食管反流病,具有较好的疗效,且能够较持久的改善患者生活质量。
目的：观察健脾降逆法治疗胃食管反流病脾虚气逆证的疗效。方法：60例患者随机分为中药组和雷贝拉唑西药组,分别采用随证加减的健脾降逆方及雷贝拉唑治疗。疗程4周,随访1个月。重点观察患者症状频率变化及生活质量变化。结果：治疗前后症状发作频率积分统计结果提示中药组疗效优于西药组,组间差异显著,有统计学意义(P<0.01),且停药1月后中药组较西药组疗效稳定。治疗4周结束后,两种治疗均能改善生活质量积分,但中药组在改善活力,总体健康方面优于西药组,且疗效可持续至停药1个月。结论：应用健脾降逆法随证加减治疗胃食管反流病,具有较好的疗效,且能够较持久的改善患者生活质量。
[Objectives] As a clinician of spleen-tonifying school and a fourth batch tutor of the program of Inheriting National Distinguished TCM Doctors' Experience, Professor Li Qiangou has engaged in the medical work for over 40 years with abundant knowledge being accumulated and is good at treating spleen-stomach diseases. He has academic ideas and clinical experiences being very valuable in spleen-stomach diseases. The objectives of the study are to excavate and inherit these academic ideas and clinical experiences; And focus on learning the experience from Professor Li Qiangou for the treatment of gastroesophageal reflux disease (GERD).
[Approaches And Contents] The collating and summarizing work is completed through the following approaches:following Professor Li Qiangou in his clinic work; collating his medical cases; collecting his treatment prescriptions and analyzing his prescription ideas; collecting his lecturing materials, personal notes, special interviews, papers and books; carrying out independent clinical practices so as to further study and adopt his experience in drugs, prescriptions and dialectical methods; indexing of ancient Chinese medicine literature; and analyzing academic ideas which have a large impact on him.60 patients were randomly selected from outpatient and ward, which were respectively subject to spleen-strengthening and counter-flowing stomach Qi-lowering prescription (which is added or subtracted) as well as rabeprazole and compare the clinical effect. And complete clinical study.
[Results]
The study results is divided into three parts:an overview of Professor Li Qiangou's academic origins; collation & summary of his academic ideas and clinical experiences; and a study of his syndrome differentiation based treatment of GERD due to counterflowing stomach Qi and spleen deficiencies, whereas he invigorates the spleen and lowers the conterflowing stomach Qi.
Part 1:Professor Li Qiangou's academic origins
Professor Li Qiangou's academic origins mainly come from two aspects. One aspect comes from some classic works such as "The Yel low Emperor's Inner Canon", "Treatise on Febrile Diseases", "Synopsis of Prescriptions of the Gold Chamber", etc. The other aspect comes from spleen-tonifying doctrine of "Piwei Lun" and Guan youbo's "Qi and Blood". Finally he forms the unique academic ideas attaching importance to the spleen, stomach, Qi, and Blood. to take actions that suit local circumstances It specifically includes the following aspects:①Advocating the integrity concept of "The Yellow Emperor's Inner Canon", which points out that treatment should differentiate from different person, time and local circumstances, and he insists on the theory "Harmony between man and nature".②Pathogenesis of Chinese medicine theory:"Qi deficiency will be provoked by approach of any pathogenic factors. "③Internal injury of spleen and stomach theory:"Internal injury of spleen and stomach will cause diseases. "④The thought of Protection for stomach Qi:"One will be free from diseases throughout an entire year as long as his spleen functions well."⑤Attach importance on Yin, Wei, Qi, Blood and carry through the treatment concept " Activating blood circulation and resolving phlegm" in the whole process for spleen & stomach treatment.
Part 2:Collation/Summary of Professor Li Qiangou's Academic Ideas & Clinical Experiences
Section 1:Academic Idea and Clinical Experiences
Professor Li Qiangou's academic Ideas and clinical experiences can be summarized into two aspects "fortifying spleen and stomach & adjusting Qi and blood". Spleen and stomach are acquired foundation and the source of Qi and blood. All body organs such as zang-fu viscera, limbs, hundred skeleton, nine orifices, etc. can get foster if healthy state of the spleen, stomach, Qi, Blood, Ying, and Wei is kept. One will be free from diseases throughout an entire year as long as his spleen functions well. The function disorders of spleen and stomach is one of key reasons for disease occurrence. Deficient cold of spleen & stomach and weak primordial qi are main causes for endogenous and exogenous diseases. He attaches importance on spleen and stomach function in his clinical practices. And focus on the important stage for strengthening spleen and stomach to regulate Qi smooth. Strengthening spleen and stomach is commonly used for treatment of internal organs.
So Professor Li Qiangou's clinical experiences can be summarized into follows. In syndrome differentiation, the cause shall be found in Qi and Blood. During the diagnosis first is syndrome differentiation and then dialectical treatment in which attention is paid to main symptoms. Constitution-specific syndrome differentiation and tongue diagnosis are also important. Good at treatment of chronic and incurable diseases based on the spleen and stomach. Regulate Qi movement of the Middle-Jiao based on spleen and stomach during the treatment. The principle to strengthen spleen and regulate Qi shall be in the entire course of treating stomach-spleen diseases. Middle-Jiao Qi should be cared and protected, and it is necessary to be cautious in the use of drugs of cool or cold nature so as to avoid stomach injuries.
Section 2:Diagnostic and therapeutic experiences
1. GERD (gastroesophageal reflux disease):It is called Xiong Pi in TCM. In it, Professor Li Qiangou has unique insights that the pathogenesis is in abnormal movements of the spleen, stomach, liver and lung. Its cause lies on flooding gastric juice due to counterflowing stomach Qi. The treatment is to regulate liver Qi and harmonize stomach Qi so as to downbear the counterf low and restrain gas tric juice. On the other hand, deficiency and excess, and cold and heat shall be differentiated for specific case to improve clinical effectiveness and reduce recurrence. The principles of regulating liver, harmonizing stomach, subduing the counterflow and restraining gastric juice shall be implemented through the entire course of the treatment. The basic formula is spleen-invigorating & counterflow-downbearing Decoction.
2. Helicobacter pylori infection:According to TCM theories such as the concept that one will be free from diseases throughout an entire year as long as his spleen functions well and that Qi deficiency will be provoked by approach of any pathogenic factors, he thinks Hp, as a pathogenic factor, can adhere to the gastric mucosa to cause gastritis or other diseases only when the spleen and stomach are weak and vital Qi is deficient. From such perspectives, the rule to fortify spleen and promote digestion shall be abided by so as to establish the spleen-fortifying digestion-promoting formula.
3. Chronic stomach pain:Advocate the treatment of the chronic stomach pain from deficiency, blood, Qi, liver and spleen.
4. Functional dyspepsia:Professor Li Qiangou thinks that the location of the disease is in the stomach and is related to the liver and spleen. The pathogenesis is characterized by deficiency in origin and excess in superficiality. Deficiency in origin means that the spleen and stomach are weak, and excess in superficiality means that the middle-Jiao is stagnated including Qi stagnation, blood stasis, phlegm dampness, and food stagnation. Also, Qi movement is not smooth. The spleen deficiency and Qi stagnation are the basic pathogenesis which is through the entire course of the disease. Clinically, the syndrome of the spleen deficiency and Qi stagnation is often seen. The appropriate treatment method is to remove deficiency in origin and excess in superficiality at the same time, while the main principle is to regulate Qi and strengthen spleen. Three key points are:First is to pay attention to the spleen and help the middle-Jiao Qi movement; second is to dredge liver Qi and regulate Qi activity; and third is to regulate the middle-Jiao. On the basis of strengthening spleen and regulating Qi, addition and subtraction of the prescription are adopted according to changes of the disease conditions.
5. Functional constipation:Professor Li Qiangou thinks that the location of the disease is in the large intestine, and is closely related to the spleen and stomach. Constipation needs syndrome differentiation, while addition and subtraction of the prescription are adopted according to changes of the disease conditions. Clinically, constipation due to interior cold, heat and disorder of Qi is not frequently seen. In most cases, patients with constipation are characterized by syndrome of intermingled deficiency and excess. The deficiency is mainly the spleen deficiency with insufficient fluid in the large intestine, while the excess mainly includes Qi stagnation, blood stasis, heat accumulation, and intestine dryness. The main treatment method is to strengthen spleen and nourish Yin, which is supplemented by regulating Qi and blood plus moistening dryness for relaxing bowels. So, Four Gentlemen Decoction is used to treat constipation through addition and subtraction.
6. Chronic atrophic gastritis:The location of the disease patients is in the stomach, and is closely related to the liver and spleen. At the beginning, it originates from Qi, and a time later, involves in blood gradually resulting in Qi deficiency and blood stasis in stomach collaterals. Professor Li Qiangou thinks that chronic atrophic gastritis is a complex disease, but it is always related to deficiency and stasis. So, it should be treated from the theory of Qi deficiency and blood stasis.
7. Treatment of oral ulcers from fire:Professor Li Qiangou thinks that the clinical practice should pay attention to fire. Deficient fire or excess fire should be identified. Excess fire is often in the heart and spleen, so the drug should be the Rhubarb Xiexin Decoction with Xie Huang San which is added or subtracted. Deficient fire flaring-up is often in the heart and kidney, so the Zhibai Dihuang Decoction with Zeng Ye Tang which is added or subtracted.
8. Be good at treatment of chronic cough from spleen:Professor Li Qiangou is good at treatment of chronic cough from spleen. Lung and spleen interact on pathology. In case of dysfunction of spleen in transportation and loss of water, then gather phlegm into drink. It'11 mostly affect pulmonary dispersing and descending function of lung. So it is an important formula to fortify spleen Qi for treatment of chronic cough and lung deficiency.
Part 3:Study of his treatment of GERD by invigorating the spleen and lowering the counter-flowing stomach Qi
Objectives:To observe the effect of the treatment for GERD due to spleen deficiency and counter-flowing Qi by invigorating the spleen to remove the phlegm and subduing this counter-flowing Qi.
Methods:60 patients were randomly divided into TCM drug group and rabeprazole group, which were respectively subject to Liver-dredging & spleen-strengthening prescription (which is added or subtracted) as well as rabeprazole in the treatment. The treatment course is 4 weeks with the 1 month follow-up. Changes of the symptom frequency and quality of life with patients were mainly observed.
Results:Seen from the statistic scores result for symptomatic seizures frequency before and after treatment, it shows that TCM group has better treatment effect than western medicine group. And there is a distinct difference between groups, which has statistical significance (P<0.01). Furthermore TCM group has more stable treatment effect than western medicine group after one month's drug withdrawal. After 4 weeks of treatment, two treatments can improve the scores of the symptom frequency and quality of life with patients. On the other hand, in improving vitality and overall health, TCM drug group is better than western medicine group, and the effect can be maintained 1 month after drug withdrawal.
Conclusion:There is a good effect with the treatment for GERD by dredging liver and strengthening spleen, which can maintain a more lasting improvement in quality of life for patients.
Objectives:To observe the effect of the treatment for GERD due to spleen deficiency and counter-flowing Qi by invigorating the spleen to remove the phlegm and subduing this counter-flowing Qi. Methods:60 patients were randomly divided into TCM drug group and rabeprazole group, which were respectively subject to Liver-dredging & spleen-strengthening prescription (which is added or subtracted) as well as rabeprazole in the treatment. The treatment course is 4 weeks with the 1 month follow-up. Changes of the symptom frequency and quality of life with patients were mainly observed. Results: Seen from the statistic scores result for symptomatic seizures frequency before and after treatment, it shows that TCM group has better treatment effect than western medicine group. And there is a distinct difference between groups, which has statistical significance (P<0.01). Furthermore TCM group has more stable treatment effect than western medicine group after one month's drug withdrawal. After 4 weeks of treatment, two treatments can improve the scores of the symptom frequency and quality of life with patients. On the other hand, in improving vitality and overall health, TCM drug group is better than western medicine group, and the effect can be maintained 1 month after drug withdrawal. Conclusion:There is a good effect with the treatment for GERD by dredging liver and strengthening spleen, which can maintain a more lasting improvement in quality of life for patients.
[研究方法和内容]通过跟随李乾构教授出门诊；整理李乾构教授医案；收集治疗验方、分析其用方思路；收集讲课资料、个人笔记、专题访谈、论文及著作；独立临床实践,进一步学习应用李乾构教授用药、用方和辨证的经验；通过中医古籍的检索以及对导师影响较大的名老中医学术思想的分析,完成李乾构教授学术渊源概述、学术思想和临床经验的整理与总结两部分研究工作。在门诊随机选取胃食管反流病患者60例,采用“健脾降逆方”加减与雷贝拉唑对照研究,比较临床疗效,检验跟师成果,完成临床研究部分工作。
[研究结果]
该研究分为三部分。包括李乾构教授学术渊源、李乾构教授学术思想和临床经验的整理与总结以及李乾构健脾降逆法辨治胃食管反流病脾虚气逆证的研究。
第一部分李乾构教授学术渊源
李乾构教授学术思想渊源主要来源于2个方面。一方面来源于《内经》、《伤寒论》、《金匮要略》等经典著作；另一方面来源于《脾胃论》的补土学说和关幼波的气血理论。最后形成了独具特色的重脾胃、重气血的学术思想。具体包含在以下几个方面：①提倡《黄帝内经》整体观,指出治病要因人、因时、因地制宜,坚持人与自然统一的“天人合一”论；②“邪之所凑,其气必虚”中医发病观；③“内伤脾胃,百病由生”的脾胃内伤理论；④“四季脾旺不受邪”的保胃气思想；⑤重视营卫气血,贯彻治疗脾胃病全过程的活血化痰治疗观。
第二部分李乾构教授学术思想和临床经验的整理与总结
(一)学术思想和临床经验
李乾构教授重要学术思想可以概括为“补脾胃、调气血”两个方面。脾胃为后天之本,气血生化之源,脾胃健,气血旺,营卫通,脏腑、四肢、百骸、九窍等全身器官组织得到濡养,“四季脾旺不受邪”；脾胃功能失调视为疾病发生的重要原因之一,脾胃失键,元气虚弱则是内伤外感疾病的主要成因。在临床实践中重视脾胃功能,治疗疾病抓住健运脾胃,调畅气机这一中心环节,临证内伤外感常用补益脾胃大法调治五脏。因此,李乾构教授临床经验可以概括为以下方面。在疾病发病原因中强调审证必求因,当在气血寻。辨证过程中,强调先辨病后辨证,抓主症与主证,重视体质辨证,重视舌诊。治疗过程中,立足脾胃,调畅中焦气机,健脾理气法贯穿脾胃病治疗始终；顾护中气,慎用寒凉药物等。
(二)疾病诊疗经验
1胃食管反流病：冠名胸痞,见解独到。认为该病病机为脾升胃降、肝升肺降的功能失调。胃气上逆、酸水泛溢而发病。治宜通过健脾疏肝,和顺胃气,来达到降逆制酸的目的。但临证要辨虚实寒热,随证用药有益于提高临床疗效,减少复发,但健脾疏肝、降逆制酸的治法、要贯穿治疗的始终。基本方用健脾降逆汤。
2幽门螺杆菌感染：根据中医“四季脾旺不受邪”、“邪之所凑,其气必虚”的理论,认为幽门螺杆菌感染作为外邪致病因素,它多在脾胃虚弱,正气不足的情况下才可以附着定植于胃黏膜,导致炎症反应,引起胃炎等疾病的发生。故从健脾清化立论,创健脾清化方。
3慢性胃痛：主张从虚论治、从气血论治和从肝脾论治慢性胃痛。
4功能性消化不良：认为本病病位在胃,与肝脾有关,病机特点是本虚标实,本虚指脾胃虚弱,标实为气滞、血瘀、痰湿、食积等郁滞中焦,气机不通。脾虚气滞为基本病机,且贯穿于本病的始终,临床以脾虚气滞证最为多见。治宜标本同治,以健脾理气法为基本治法,治疗要抓住健脾土,助中运；疏肝气,调气机；和胃气,理中焦三个要点,在健脾理气的基础上,随症(证)加减施治。
5功能性便秘：认为本病病位在大肠,而与脾胃关系最为密切。治便秘离不开辨证,并要随症(证)加减,因临床上少见冷秘、热秘、气秘,多数便秘患者为虚实夹杂证,虚以脾虚,大肠津液不足最多,实以气滞血瘀、热结肠燥常见,故治疗常健脾滋阴为主,辅以调理气血、润燥通便,应用四君子汤加减治疗便秘。
6慢性萎缩性胃炎：该病病位在胃,与肝脾有密切关系。本病初起在气,久病则由气及血,渐致气虚血瘀,胃络痹阻。李乾构教授认为慢性萎缩性胃炎证候虽杂,总不离“虚”和“瘀”二字。慢性萎缩性胃炎当从气虚血瘀论治。
7口腔溃疡从“火”论治：认为临证要紧紧抓住一个“火”字。分清虚火与实火。实火多见心脾火盛,药用大黄泻心汤合泻黄散加减：虚火多为心肾阴虚,虚火上炎。药用知柏地黄汤合增液汤加减。
8善于从脾论治久咳：李乾构教授善于从脾论治久咳。肺与脾在病理上亦相互影响,如脾失健运,水湿不化,聚而生痰成饮,多影响肺的宣发和肃降功能。所以补益脾气是治疗久咳肺虚的重要法则。
第三部分李乾构健脾降逆法辨治胃食管反流病脾虚气逆证的研究
目的：观察健脾降逆法治疗胃食管反流病脾虚气逆证的疗效。
方法：60例患者随机分为中药组和雷贝拉唑西药组,分别采用随证加减的健脾降逆方及雷贝拉唑治疗。疗程4周,随访1个月。重点观察患者症状频率变化及生活质量变化。
结果：治疗前后症状发作频率积分统计结果提示中药组疗效优于西药组,组间差异显著,有统计学意义(P<0.01),且停药1月后中药组较西药组疗效稳定。治疗4周结束后,两种治疗均能改善生活质量积分,但中药组在改善活力,总体健康方面优于西药组,且疗效可持续至停药1个月。
结论：应用健脾降逆法随证加减治疗胃食管反流病,具有较好的疗效,且能够较持久的改善患者生活质量。
目的：观察健脾降逆法治疗胃食管反流病脾虚气逆证的疗效。方法：60例患者随机分为中药组和雷贝拉唑西药组,分别采用随证加减的健脾降逆方及雷贝拉唑治疗。疗程4周,随访1个月。重点观察患者症状频率变化及生活质量变化。结果：治疗前后症状发作频率积分统计结果提示中药组疗效优于西药组,组间差异显著,有统计学意义(P<0.01),且停药1月后中药组较西药组疗效稳定。治疗4周结束后,两种治疗均能改善生活质量积分,但中药组在改善活力,总体健康方面优于西药组,且疗效可持续至停药1个月。结论：应用健脾降逆法随证加减治疗胃食管反流病,具有较好的疗效,且能够较持久的改善患者生活质量。
[Objectives] As a clinician of spleen-tonifying school and a fourth batch tutor of the program of Inheriting National Distinguished TCM Doctors' Experience, Professor Li Qiangou has engaged in the medical work for over 40 years with abundant knowledge being accumulated and is good at treating spleen-stomach diseases. He has academic ideas and clinical experiences being very valuable in spleen-stomach diseases. The objectives of the study are to excavate and inherit these academic ideas and clinical experiences; And focus on learning the experience from Professor Li Qiangou for the treatment of gastroesophageal reflux disease (GERD).
[Approaches And Contents] The collating and summarizing work is completed through the following approaches:following Professor Li Qiangou in his clinic work; collating his medical cases; collecting his treatment prescriptions and analyzing his prescription ideas; collecting his lecturing materials, personal notes, special interviews, papers and books; carrying out independent clinical practices so as to further study and adopt his experience in drugs, prescriptions and dialectical methods; indexing of ancient Chinese medicine literature; and analyzing academic ideas which have a large impact on him.60 patients were randomly selected from outpatient and ward, which were respectively subject to spleen-strengthening and counter-flowing stomach Qi-lowering prescription (which is added or subtracted) as well as rabeprazole and compare the clinical effect. And complete clinical study.
[Results]
The study results is divided into three parts:an overview of Professor Li Qiangou's academic origins; collation & summary of his academic ideas and clinical experiences; and a study of his syndrome differentiation based treatment of GERD due to counterflowing stomach Qi and spleen deficiencies, whereas he invigorates the spleen and lowers the conterflowing stomach Qi.
Part 1:Professor Li Qiangou's academic origins
Professor Li Qiangou's academic origins mainly come from two aspects. One aspect comes from some classic works such as "The Yel low Emperor's Inner Canon", "Treatise on Febrile Diseases", "Synopsis of Prescriptions of the Gold Chamber", etc. The other aspect comes from spleen-tonifying doctrine of "Piwei Lun" and Guan youbo's "Qi and Blood". Finally he forms the unique academic ideas attaching importance to the spleen, stomach, Qi, and Blood. to take actions that suit local circumstances It specifically includes the following aspects:①Advocating the integrity concept of "The Yellow Emperor's Inner Canon", which points out that treatment should differentiate from different person, time and local circumstances, and he insists on the theory "Harmony between man and nature".②Pathogenesis of Chinese medicine theory:"Qi deficiency will be provoked by approach of any pathogenic factors. "③Internal injury of spleen and stomach theory:"Internal injury of spleen and stomach will cause diseases. "④The thought of Protection for stomach Qi:"One will be free from diseases throughout an entire year as long as his spleen functions well."⑤Attach importance on Yin, Wei, Qi, Blood and carry through the treatment concept " Activating blood circulation and resolving phlegm" in the whole process for spleen & stomach treatment.
Part 2:Collation/Summary of Professor Li Qiangou's Academic Ideas & Clinical Experiences
Section 1:Academic Idea and Clinical Experiences
Professor Li Qiangou's academic Ideas and clinical experiences can be summarized into two aspects "fortifying spleen and stomach & adjusting Qi and blood". Spleen and stomach are acquired foundation and the source of Qi and blood. All body organs such as zang-fu viscera, limbs, hundred skeleton, nine orifices, etc. can get foster if healthy state of the spleen, stomach, Qi, Blood, Ying, and Wei is kept. One will be free from diseases throughout an entire year as long as his spleen functions well. The function disorders of spleen and stomach is one of key reasons for disease occurrence. Deficient cold of spleen & stomach and weak primordial qi are main causes for endogenous and exogenous diseases. He attaches importance on spleen and stomach function in his clinical practices. And focus on the important stage for strengthening spleen and stomach to regulate Qi smooth. Strengthening spleen and stomach is commonly used for treatment of internal organs.
So Professor Li Qiangou's clinical experiences can be summarized into follows. In syndrome differentiation, the cause shall be found in Qi and Blood. During the diagnosis first is syndrome differentiation and then dialectical treatment in which attention is paid to main symptoms. Constitution-specific syndrome differentiation and tongue diagnosis are also important. Good at treatment of chronic and incurable diseases based on the spleen and stomach. Regulate Qi movement of the Middle-Jiao based on spleen and stomach during the treatment. The principle to strengthen spleen and regulate Qi shall be in the entire course of treating stomach-spleen diseases. Middle-Jiao Qi should be cared and protected, and it is necessary to be cautious in the use of drugs of cool or cold nature so as to avoid stomach injuries.
Section 2:Diagnostic and therapeutic experiences
1. GERD (gastroesophageal reflux disease):It is called Xiong Pi in TCM. In it, Professor Li Qiangou has unique insights that the pathogenesis is in abnormal movements of the spleen, stomach, liver and lung. Its cause lies on flooding gastric juice due to counterflowing stomach Qi. The treatment is to regulate liver Qi and harmonize stomach Qi so as to downbear the counterf low and restrain gas tric juice. On the other hand, deficiency and excess, and cold and heat shall be differentiated for specific case to improve clinical effectiveness and reduce recurrence. The principles of regulating liver, harmonizing stomach, subduing the counterflow and restraining gastric juice shall be implemented through the entire course of the treatment. The basic formula is spleen-invigorating & counterflow-downbearing Decoction.
2. Helicobacter pylori infection:According to TCM theories such as the concept that one will be free from diseases throughout an entire year as long as his spleen functions well and that Qi deficiency will be provoked by approach of any pathogenic factors, he thinks Hp, as a pathogenic factor, can adhere to the gastric mucosa to cause gastritis or other diseases only when the spleen and stomach are weak and vital Qi is deficient. From such perspectives, the rule to fortify spleen and promote digestion shall be abided by so as to establish the spleen-fortifying digestion-promoting formula.
3. Chronic stomach pain:Advocate the treatment of the chronic stomach pain from deficiency, blood, Qi, liver and spleen.
4. Functional dyspepsia:Professor Li Qiangou thinks that the location of the disease is in the stomach and is related to the liver and spleen. The pathogenesis is characterized by deficiency in origin and excess in superficiality. Deficiency in origin means that the spleen and stomach are weak, and excess in superficiality means that the middle-Jiao is stagnated including Qi stagnation, blood stasis, phlegm dampness, and food stagnation. Also, Qi movement is not smooth. The spleen deficiency and Qi stagnation are the basic pathogenesis which is through the entire course of the disease. Clinically, the syndrome of the spleen deficiency and Qi stagnation is often seen. The appropriate treatment method is to remove deficiency in origin and excess in superficiality at the same time, while the main principle is to regulate Qi and strengthen spleen. Three key points are:First is to pay attention to the spleen and help the middle-Jiao Qi movement; second is to dredge liver Qi and regulate Qi activity; and third is to regulate the middle-Jiao. On the basis of strengthening spleen and regulating Qi, addition and subtraction of the prescription are adopted according to changes of the disease conditions.
5. Functional constipation:Professor Li Qiangou thinks that the location of the disease is in the large intestine, and is closely related to the spleen and stomach. Constipation needs syndrome differentiation, while addition and subtraction of the prescription are adopted according to changes of the disease conditions. Clinically, constipation due to interior cold, heat and disorder of Qi is not frequently seen. In most cases, patients with constipation are characterized by syndrome of intermingled deficiency and excess. The deficiency is mainly the spleen deficiency with insufficient fluid in the large intestine, while the excess mainly includes Qi stagnation, blood stasis, heat accumulation, and intestine dryness. The main treatment method is to strengthen spleen and nourish Yin, which is supplemented by regulating Qi and blood plus moistening dryness for relaxing bowels. So, Four Gentlemen Decoction is used to treat constipation through addition and subtraction.
6. Chronic atrophic gastritis:The location of the disease patients is in the stomach, and is closely related to the liver and spleen. At the beginning, it originates from Qi, and a time later, involves in blood gradually resulting in Qi deficiency and blood stasis in stomach collaterals. Professor Li Qiangou thinks that chronic atrophic gastritis is a complex disease, but it is always related to deficiency and stasis. So, it should be treated from the theory of Qi deficiency and blood stasis.
7. Treatment of oral ulcers from fire:Professor Li Qiangou thinks that the clinical practice should pay attention to fire. Deficient fire or excess fire should be identified. Excess fire is often in the heart and spleen, so the drug should be the Rhubarb Xiexin Decoction with Xie Huang San which is added or subtracted. Deficient fire flaring-up is often in the heart and kidney, so the Zhibai Dihuang Decoction with Zeng Ye Tang which is added or subtracted.
8. Be good at treatment of chronic cough from spleen:Professor Li Qiangou is good at treatment of chronic cough from spleen. Lung and spleen interact on pathology. In case of dysfunction of spleen in transportation and loss of water, then gather phlegm into drink. It'11 mostly affect pulmonary dispersing and descending function of lung. So it is an important formula to fortify spleen Qi for treatment of chronic cough and lung deficiency.
Part 3:Study of his treatment of GERD by invigorating the spleen and lowering the counter-flowing stomach Qi
Objectives:To observe the effect of the treatment for GERD due to spleen deficiency and counter-flowing Qi by invigorating the spleen to remove the phlegm and subduing this counter-flowing Qi.
Methods:60 patients were randomly divided into TCM drug group and rabeprazole group, which were respectively subject to Liver-dredging & spleen-strengthening prescription (which is added or subtracted) as well as rabeprazole in the treatment. The treatment course is 4 weeks with the 1 month follow-up. Changes of the symptom frequency and quality of life with patients were mainly observed.
Results:Seen from the statistic scores result for symptomatic seizures frequency before and after treatment, it shows that TCM group has better treatment effect than western medicine group. And there is a distinct difference between groups, which has statistical significance (P<0.01). Furthermore TCM group has more stable treatment effect than western medicine group after one month's drug withdrawal. After 4 weeks of treatment, two treatments can improve the scores of the symptom frequency and quality of life with patients. On the other hand, in improving vitality and overall health, TCM drug group is better than western medicine group, and the effect can be maintained 1 month after drug withdrawal.
Conclusion:There is a good effect with the treatment for GERD by dredging liver and strengthening spleen, which can maintain a more lasting improvement in quality of life for patients.
Objectives:To observe the effect of the treatment for GERD due to spleen deficiency and counter-flowing Qi by invigorating the spleen to remove the phlegm and subduing this counter-flowing Qi. Methods:60 patients were randomly divided into TCM drug group and rabeprazole group, which were respectively subject to Liver-dredging & spleen-strengthening prescription (which is added or subtracted) as well as rabeprazole in the treatment. The treatment course is 4 weeks with the 1 month follow-up. Changes of the symptom frequency and quality of life with patients were mainly observed. Results: Seen from the statistic scores result for symptomatic seizures frequency before and after treatment, it shows that TCM group has better treatment effect than western medicine group. And there is a distinct difference between groups, which has statistical significance (P<0.01). Furthermore TCM group has more stable treatment effect than western medicine group after one month's drug withdrawal. After 4 weeks of treatment, two treatments can improve the scores of the symptom frequency and quality of life with patients. On the other hand, in improving vitality and overall health, TCM drug group is better than western medicine group, and the effect can be maintained 1 month after drug withdrawal. Conclusion:There is a good effect with the treatment for GERD by dredging liver and strengthening spleen, which can maintain a more lasting improvement in quality of life for patients.
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26邓聪,任敏之.承伯钢辨治胃食管反流病的经验[J]医,2006,24(6)：6-7.
27王建波.路广晁治疗反流性食管炎的经验[J].北京中医,2007,26(9)：568-598.
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2袁耀宗,邹多武,汤玉茗编译.胃食管反流病的蒙特利尔(Montreal)定义和分类-—基于循证医学的全球共识[J].中华消化杂志,2006,26(10)：686-689.
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4中国胃食管反流病研究协作组.反流性疾病问卷在胃食管反流病诊断中的价值[J].中 华消化杂志,2003,23(11)：651-654.
5李乾构,周学文,单兆伟主编.中医消化病诊疗指南[M1.北京：中国中医药出版社,2006.7-8
6李鲁,王红妹,沈毅.SF—36健康调查量表中文版的研制及其性能测试.中华预防医学杂志2002,36(10)：109-113
7中华中医药学会脾胃病分会.胃食管反流病中医诊疗共识意见(2009,深圳)[J].中医杂志,2010,51(9)：844-847
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25薛辉,王少墨,陈正,等.王庆其治疗胃食管反流病经验[J].中华中医药杂志(原中国医药学报),2007,22(2)：108-110。
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27王建波.路广晁治疗反流性食管炎的经验[J].北京中医,2007,26(9)：568-598.
1潘国宗,许国铭,郭慧平,等.北京上海胃食管反流症状的流行病学调查[J].中华消化杂志,1999,19(4)：223.
2袁耀宗,邹多武,汤玉茗编译.胃食管反流病的蒙特利尔(Montreal)定义和分类-—基于循证医学的全球共识[J].中华消化杂志,2006,26(10)：686-689.
3中华医学会消化病分会.反流性食管炎诊断及治疗指南(2003)[J].中华消化内镜杂志,2004,21(4)：221-222.
4中国胃食管反流病研究协作组.反流性疾病问卷在胃食管反流病诊断中的价值[J].中 华消化杂志,2003,23(11)：651-654.
5李乾构,周学文,单兆伟主编.中医消化病诊疗指南[M1.北京：中国中医药出版社,2006.7-8
6李鲁,王红妹,沈毅.SF—36健康调查量表中文版的研制及其性能测试.中华预防医学杂志2002,36(10)：109-113
7中华中医药学会脾胃病分会.胃食管反流病中医诊疗共识意见(2009,深圳)[J].中医杂志,2010,51(9)：844-847
8蔡淦.治疗胃食管反流性疾病经验.上海中医药杂志2005,39(8)：27-28
9杜琳,郭琳.单兆伟治疗胃食管反流病经验.山东中医杂志,2004,23(4)：238
10刘红书,张林,谷越涛治疗胃食管反流病经验.山东中医杂志,2004,23(4)；240
11陈明.李乾构教授诊治胃食管反流病经验.中国民间疗法,2005,13(10)：4
12王锐,何群英,杨晓峰,等.孙喜才教授治疗反流性食管炎的经验.贵阳中医学院学报,2004,26(4)：8
13刘群.张琼英,林娜,涂志红.涂福音教授治疗反流性食管炎经验.中国中西医结合脾胃杂志,2000,8(1)：36-37
14王日希星,李廷荃.肖汉玺从肝论治反流性食管炎经验.中国中西医结合脾胃杂志,2000,8(1)；38
15马淑颖,孙永顺.朱生梁治疗胃食管反流病经验拾莘.辽宁中医杂志,2005,32(11)；111
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