【作者】 梁光宇；

【导师】 赵冠英；

【作者基本信息】 中国人民解放军军医进修学院 ， 中西医结合， 2008， 博士

【摘要】 理论溯源:赵冠英教授长期从事中西医结合治疗慢性胃炎的研究,认为慢性胃炎属于中医学脾胃病中“胃脘痛”、“痞满”、“嘈杂”、“泛酸”的范畴,其病位在胃,病因主要为外邪侵袭、饮食不节、忧思郁怒以及脾胃虚弱等。现代医学认为病因主要有物理化学因素、幽门螺旋杆菌感染、胃动力障碍、胆汁返流、免疫因素、年龄、职业等。学术经验:赵冠英教授在理论上强调人以胃气为本,治胃须遵循胃的生理特性、重视胃与脾、肝、肾三脏的关系,主张治胃先理脾、治胃必疏肝、治胃须补肾。在大量文献研究的基础上,结合长期的临床实践,将慢性胃炎病机特点概括为:虚实互见、寒热错杂、湿热互结、气血同病。病机性质多属本虚标实、虚实错杂。虚为胃气虚弱;实为肝气犯胃、湿热阻滞、气滞血瘀。初病在经属气,久病入络属血。治疗上创立健脾和胃、清胃泻火、辛开苦降、消食导滞、平肝降逆、疏胆和胃、酸甘养阴、化瘀通络等八法。并根据此学术观点,创制了参柴黄连汤治疗慢性胃炎,经长期临床应用,疗效显著。临证时主张中西结合、辨证与辨病相结合;重视察舌诊病;通过中医辨证与胃镜下粘膜相结合,初步将本病分为脾胃虚弱、肝胃不和、脾胃湿热、胃阴不足、胃络瘀滞等五型施治;注意预防调摄,调畅情志,饮食有节和适度运动。临床研究:通过参柴黄连汤治疗慢性胃炎的临床研究,发现该方能显著改善慢性胃炎患者的临床症状、胃镜征象和舌象,抑制或杀灭Hp,对萎缩性胃炎的肠化生和异型增生也有一定的逆转和治疗作用,从而降低或阻断萎缩性胃炎的癌变可能。对于舌苔的改善优于舌质的改善,对于浅袁性胃炎的作用优于萎缩性胃炎。从药理作用分析,疗效可能与增强免疫,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,促进胃动力,解痉止痛,增加胃酸,抑制癌前病变等环节有关。用药规律和经验研究:收集和整理导师治疗慢性胃炎116张资料完整的初诊处方,运用频率分析的方法,整理和总结导师治疗慢性胃炎的用药规律和经验,发现导师治疗慢性胃炎所用中药基本为43种,最常用的药物为党参、白术、茯苓、炙甘草、乌药、白芍、吴茱萸、黄连等8种;较常用的药物是柴胡、枳壳、砂仁、生三仙、陈皮、蒲公英等15种。其它20种为治疗慢性胃炎一般常用药物。常用的方剂主要有四君子汤,左金丸、芍药甘草汤、四逆散、当归补血汤、良附丸、乌贝散。更多还原

【Abstract】 Review: professor Zhao Guan-ying has been studying Chronic Gastritis(CG) with Chinese medicine and west medicine for a long time. CG belongs to the scope of "weiwantong", "piman", "caoza" and "fansuan" in Chinese medicine. It takes place in the stomach and is mainly caused by exogenous pathogens, improper diet, emotion, and weakness of spleen and stomach. While in west medicine it is regarded as causing mainly by the factors of physics and chemistry, Hp, obstacle of stomach movement, immunity, countercurrent of bile, and age,work and so on.Experience of professor Zhao: the function of stomach-qi is very important. Treating stomach should obey to the character of stomach, attach the importance to the relationships among spleen, liver and kidney. Basing on the theory and clinical practise, he sum up the mechanism of CG as follow: coexistence of insufficiency and sufficiency, interveining of cold and heat, stagnation of damp-heat, dual disease of qi and blood. The essence of CG is insufficiency of the normal and excessiveness of the pathogenic. The weakness of stomach is the basis of CG, while liver-qi invading the stomach, stagnation of damp-heat, depression and stagnation of qi and blood are the secondary factors. Firstly it is in channels belonging to qi, finally it is in collaterals belonging to blood. Professor Zhao aslo invents 8 measures to treat CG Basing on the theory, he has founded the docotion Senchaihuangliantang(SCHLT) to treat CG, and its effect is remarkable. When treating patients he always pays attention to comibine Chinese medicine with west medicine, and syndrome differentiation with disease identification, and observe the tongue. By the means of syndromes and gastroscopy, he often divides CG into five syndrome patterns to treat. he also pays attention to preservation, emotion, diet and exercise.Clinical Research: SCHLT can improve the symptoms of patients, tongue coating, and gastroscopy, kill Hp, treat and reverse IM and ATP, so it maybe lower or hinder the occurrence of cancer. It is better to improve tongue coating than tongue proper. It is better to treat in CSG than in CAG. It may take effect in such ways: improving the immunity and blood circulation, defending the stomach, killing Hp, regulating the movement of stomach, killing the pain, increasing the acid, preventing the occurrence of cancer.Experience of durg usage: by frequency analysis with collection of 116 prescriptions, 43 drugs was found by which professor Zhao often gets used to dealing with CG. Such 8 drugs as Tangsheng, Atractylodis Macrocephalae, Poria, Radix Glycyrrhizae Praeparata, White Peony Root Fructus Evodiae, Radix Linderae, Rhizoma Coptidis are most often used in the treatment of CG While other drugs as Thorowax Root,Orange Fruit, Fructus Amomi, Herba Taraxaci, Pericapium Charred Triplet are often used, and other 20 drugs are also used. Such prescriptions as Sijunzi Docotion, Zuojin Pill, Shaoyaogancao Docotion, Power for treating cold limbs, Liangfu Pill and Wubei Power are often used.更多还原