牛兴东主任医师脾胃病学术思想和临床经验总结及反流性食管炎中医临床研究

【作者】 郭增元；

【导师】 牛兴东；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 本论文主要分三个部分：一、牛兴东老师治疗脾胃病的学术思想和临证经验总结；二、反流性食管炎的中医和现代医学研究现状；三、疏肝和胃降逆汤治疗反流性食管炎(肝胃不和)的中医临床研究。第一部分：牛兴东老师的学术思想和临证经验1.牛兴东老师学术思想渊源1.1师承渊源：吾师毕业于包头医学院,后因工作需要拜李氏祖传名中医(自称脾胃派)和西学中专家为师,向他们学习中医,1975年考入内蒙古医学院中蒙医系,系统学习中医基础理论、四部经典和临床各科,接受名师指点。在临床实习时,拜晁恩祥老师为师,毕业后又参加了2年制西学中研究班。工作中博览群书,广泛阅读名家名著,不拘泥于一家之言而无门户之见,勤于实践,形成自己的独特学术思想。1.2牛兴东老师治疗脾胃病的学术思想：牛老师曾先后接受了全面系统的现代医学和中医学教育,曾先后拜多位名医为师,在学术思想上,牛老师博采众家和中西之长。①看中医,病证结合。牛老师主张临证时要辨病与辨证相结合,既要为病寻药又要重视辨证论治,也要辨证论治与辨病论治相统一。此“病”既包含中医之病名,也包含西医之病名。牛老师主张中医要吸收现代科学对疾病的认识,辨证与辨病相结合要把现代科学物理的、生化的、实验室的各方面检查结果作为辨病的依据,同时中医可以将这些检查结果视为望、闻、问、切的延伸和放大,作为辨证论治的佐证。但反对片面强调辨病而丢掉了中医的灵魂-辨证论治。②治未病,脾胃先行。牛老师继承古训,提出治未病,无论是未病先防,还是既病防变,瘥后防复,均应脾胃先行,强调应顾护脾胃之本。脾胃不仅因其生长滋养作用为“后天之本”而攸关人体,也由其所具有的中央枢机功能而成为气机升降,水火运行,脏腑活动的肯綮。脾胃是心肺肝肾生理活动的枢纽,即脾胃一虚,五脏受累。调脾胃可以养五脏,固元气,御外邪,促康健。③脾胃病,重调气血。脾主运化,胃主受纳,为气血生化之源,脾胃又是人体气机升降之枢纽。所以无论内伤或外邪等诸多因素均易导致气虚或气滞血瘀,且脾胃病病程绵长,失治误治,久病入络,血行不畅,瘀血内生。故牛老师论治脾胃病,重视调治气血。调气包含健脾气,降胃气,疏肝气；调血包含养血、活血、化瘀。2.牛兴东老师治疗脾胃病临证经验：阐述了牛兴东老师治疗胃脘痛、反流性食管炎、肠易激综合征、胃术后并发症的临证经验。牛兴东老师在治疗胃脘痛时,认为“调气机,除痛之法“,调畅气机既包括健脾气、疏肝气、和胃气、宣肺气,也包括散实邪、化痰湿、活瘀血、消食滞、解热毒等；“化瘀血,久痛安和”,吾师在治疗胃脘痛时强调应用养血、活血、化瘀之品,特别是久痛患者；“健脾胃,治痛之本”,脾胃虚弱是胃脘痛起病之基础,又贯穿于疾病的整个过程。因此健脾养胃是治疗胃脘痛的固本之法,应贯穿于胃脘痛治疗的全过程。并总结出治疗胃脘痛十二法：健脾益气法、健脾行气法、温胃散寒法、温中健脾法、消食导滞法、疏肝和胃法、泻肝清胃法、燥湿运脾法、清化湿热法、养阴益胃法、化瘀通络法、辛开苦降法。牛兴东老师认为反流性食管炎病因多为情志不畅,或饮食不节,或过食辣,导致气、火、湿、痰、瘀互结。病位在食管、重点在胃,与肝、胆、脾、肺等脏腑密切相关。胃失和降是基本病机,肝胃不和,脾胃升降失调,胃气上逆,气、火、湿、痰、瘀互结于食管为主要病机。故治疗的基本原则为和胃降逆。临证时牛老师多将其分为五型进行辩证施治：肝胃不和型、肝郁胃热型、脾虚气滞型、气滞血瘀型、气郁痰热型。肠易激综合征病位在肠,脾胃虚弱是发病之本,肝气郁结为发病之关键,在治疗上健脾补肾固其本,疏肝安神治其标。临证时吾师多将其分为七型进行辩证施治：肝郁脾虚型；脾胃虚弱型；脾胃湿热型；脾肾阳虚型；肝脾不调,传导失司型；脾虚不运,传导失司型；肾阳不足,传导失司型。吾师认为胃术后并发症病位在胃,脾胃虚弱是病机之本,而气滞、血瘀、湿蕴、痰阻、热郁、食滞为疾病之标。治法当用调气、活血、解毒。调气即健脾气、降胃气、疏肝气；活血即养血、活血、化瘀；解毒即化痰、除湿、清热、消食。临证时吾师多将其分为七型进行辩证施治：脾胃气虚型、脾胃阳虚型、脾胃阴虚型、肝气郁结型、肝胃郁热型、胃肠积热型、胃络瘀阻型。老师处方处方精炼,配伍严谨,作用明确,既传承了经方的理法,又结合了一些现代的药理研究,疗效显著。第二部分：反流性食管炎的中医和现代医学研究现状1.反流性食管炎的中医药研究现状主要从中医对反流性食管炎的中医病名、病因病机探讨、辨证分型论治、专病专方治疗、中西医结合治疗、其他中医方法治疗、实验研究以及今后的研究方向等方面进行了阐述。2.反流性食管炎的现代医学研究现状主要从反流性食管炎的病因和发病机制、诊断方法、治疗等方面进行了阐述。第三部分：疏肝和胃降逆汤治疗反流性食管炎(肝胃不和)的临床研究目的：观察疏肝和胃降逆汤治疗反流性食管炎的临床疗效及对食管黏膜炎症改善情况的影响。方法：选择60例反流性食管炎(肝胃不和)患者,均为2009年1月-2010年12月间我院专家门诊的病人,随机分为治疗组和对照组各30例。治疗组选用疏肝和胃降逆汤：醋柴胡12g、炒枳实15g、炒白芍15g、姜半夏12g、旋覆花10g(包煎)、乌贼骨10g、炒白术15g、党参12g、吴萸10g、黄连5g、枇杷叶10g、生甘草6g。日1剂,水煎分2次服。对照组口服奥美拉唑肠溶片和吗丁啉片。8周为1疗程,疗程结束后1周内复查胃镜。结果：1.两组临床疗效比较,治疗组治愈率33.33%,总有效率86.67%；对照组治愈率为23.33.%,总有效率80.00%,有效率及治愈率均无显著性差异(P>0.05)。2.在改善如烧心、反酸、脘胁胀满或胀痛等症状方面,治疗组与对照组无明显差异(P>0.05),但在改善呃逆、嗳气、善太息、情志抑郁、胃脘嘈杂、纳差等方面治疗组明显优于对照组,有比较显著的差异(P<0.05)。3.胃镜下食管炎疗效比较,治疗后两组胃镜下食管炎症变化结果显示治疗组与对照组总有效率分别为86.67%、70.00%,有显著性差异(P<0.05)。结论：(1)疏肝和胃降逆汤治疗反流性食管炎(肝胃不和)疗效确切,与奥美拉唑合吗丁啉治疗的效果相当。(2)疏肝和胃降逆汤能显著改善患者嗳气、呃逆、情志抑郁、善太息、纳差、胃脘嘈杂等症,对胃镜下食管黏膜炎症改善有明显疗效。(3)本方较适用于反流性食管炎早期,病情轻中度,中医辨证为肝胃不和证的患者。(4)推测本方具有促进胃肠动力恢复,增强食管下括约肌张力,增强胃十二指肠排空,有效减少胃液和胆汁等酸、碱性物质的反流,具有抗炎、抗溃疡,促进食管粘膜修复等多方面的药理作用。(5)本方使用安全,无明显副作用,具有一定的临床推广应用价值。更多还原

【Abstract】 This thesis is mainly divided into two parts:Part I Summary of academic thinking and clinical experience of treatment of stomach diseases in Niu Xingdong teacher; Part Ⅱ Reflux esophagitis in traditional Chinese medicine and modern medicine Research;PartⅢ The ShuGanHeWeiJiangNiTang treatment of reflux esophagitis (liver-stomach disharmony) Chinese medicine clinical research.Part I:Niu Xingdong the teacher’s academic thinking and clinical experience First,Niu Xingdong the teacher’s academic Ideological Origins1. Under the tutelage of origin:My teacher graduated from Baotou Medical College, because of their work thanks to Lee’s ancestral Chinese medicine (claiming to be the the spleen and stomach to send) to study Chinese medicine and Western experts as a teacher, admitted to the Mongolian Department of Inner Mongolia Medical College, systematic study of Chinese medicine in1975basic theory of four classical and clinical subjects receive teacher guidance. In clinical practice, worship Chao enxiang teacher as a teacher, and after graduation attended the2-year Western research classes. Work-read books, widely read in the famous masterpiece, not rigidly adhere to one of the words without sectarianism and diligent practice, created their own unique academic thought.2, the treatment of stomach diseases in NiuXingdong teacher academic thought: The Niu teacher has received a comprehensive system of modern medicine and medical education, has thanks to the many doctors as a teacher in the academic ideology, Niu teacher gambling house, and Western long.①traditional Chinese medicine, combined with disease. The teacher Niu advocates to identify diseases and dialectical combination of both to find the drug also attach importance to diagnosis and treatment for the disease to diagnosis and treatment with disease on the Treatment of unity;②treating disease,stomach first. Teacher of Niu inherited the old saying, the treatment of disease, whether it is not disease prevention, or both diseases anti change and recover from illness defense complex, should the stomach first, stressed the importance of care of nursing the stomach of this.③stomach illness, re-adjusting blood. The spleen governs the transportation, stomach and the main receiving source of qi and blood, spleen and stomach is the hub of the human air-lift. Regardless of injuries or evils, and many other factors lead to deficiency of qi or blood stasis, and the lingering stomach course of the disease, the loss of government mistreatment and chronic illness into the network, poor blood. Niu teacher is on the Spleen stomach, attention to modulating blood.Second, Niu Xingdong teacher treatment of stomach disease Clinical experience: Described Niu Xingdong teacher treatment of Stomachache, reflux esophagitis.irritable bowel syndrome, the stomach of postoperative complications clinical experience. Niu Xingdong teachers in the treatment of Stomachache that transfer gas machine, in addition to the pain of the law; of blood stasis, long pain Ann; spleen and stomach, treating pain and summarizes the treatment of Stomachache12France. The Niu Xingdong teacher reflux esophagitis causes more rather smooth for love, or improper diet, or too spicy food, resulting in air, fire, wet, phlegm, blood stasis and each node. Disease in the esophagus, closely related to the focus on the stomach, liver, gallbladder, spleen, lungs and other organs. Loss and lower stomach is the basic pathogenesis of disharmony of liver stomach lift disorders, the Stomach Shangni, air. fire, wet. phlegm, blood stasis and each node in the esophagus as the main pathogenesis. Therefore, the basic principle of treatment and Heweijiangni spleen Shengqing. Clinical Niu teacher and more divided into five types of dialectical therapy. The Clinical Niu teacher will be divided into five types of dialectical therapy:incoordination between liver and liver depression and stomach heat type, spleen qi stagnation, qi stagnation, qi and phlegm heat.Irritable bowel syndrome disease in the intestines, spleen and stomach is the onset of the liver qi stagnation for the onset of the key in the treatment of spleen and kidney and its this, the liver qi and soothe the nerves to treat the symptoms. Clinical My teacher more than to be divided into seven types dialectical therapy:Liver and spleen deficiency; weak stomach type; spleen type; spleen and kidney yang; liver and spleen is not adjusted, the conduction loss of the Secretary-type; Spleen does not transport conduction loss of the Secretary-type; kidney is less than the conduction loss of the Secretary type. My teacher think gastric postoperative complications of disease in the stomach, spleen and stomach is the pathogenesis of this, and the stagnation of qi and blood stasis, wet Yun, phlegm, heat Yu, stagnation is the standard of the disease. Governing Law when breathing, blood circulation, detoxification. Transfer gas that health temper down the Stomach, liver qi; that is, nourishing and promoting blood circulation, blood circulation, blood circulation; detoxification phlegm, dampness, heat, digestion. My teacher more than the provisional license is divided into seven types dialectical therapy:the spleen and stomach Deficiency stomach yang type of stomach yin deficiency, qi stagnation, liver and stomach swelter type, gastrointestinal accumulated heat type, the stomach meridian stasis type. Teachers prescription prescription refining, strict compatibility, a clear role, not only to pass by the side of the hair cut, combined with modern pharmacological studies, a significant effect.Part Ⅱ:Reflux esophagitis in traditional Chinese medicine and modern medicine ResearchFirst,Reflux esophagitis of Traditional Chinese Medicine Research TCM diseases from traditional Chinese medicine for reflux esophagitis. the etiology and pathogenesis of the syndrome type of governance, special disease Special Treatment of Integrative Medicine, other TCM methods of treatment, laboratory research, and future research directions, etc. are described.Second, Reflux esophagitis Modern Medical Research Mainly from the etiology and pathogenesis of reflux esophagitis, diagnosis, and treatment are described.PartⅢ:The ShuGanHeWeiJiangNiTang treatment of reflux esophagitis (liver-stomach disharmony) Chinese medicine clinical research.Objective:To observe ShuGanHeWeiJiangNi Tang the treatment of reflux esophagitis and its effect on esophageal mucosal inflammation to improve the situation.Methods:60patients with reflux esophagitis patients are January2009to December2010in our hospital to digest the internal medicine specialist out-patient, and Western diagnosis of reflux esophagitis, TCM liver-stomach disharmony.Their treatment of the order were randomly divided into treatment group and control group of30cases. The treatment group selection of self ShuGanHeWeiJiangNiTang. Control group treated with omeprazole enteric-coated tablets.8weeks for1week course of treatment, after treatment endoscopy.Results:(1) treatment group compared with the control group clinical overall efficacy in the treatment group of30cases of clinical cure in10cases,12cases markedly effective in4cases, ineffective4cases, the total efficiency of86.67%in the control group were7cases.11cases,6cases.6cases, the total efficiency of80.00%. Efficiency and recovery rates there was no significant difference (P>0.05).(2) treatment group to improve, such as abdominal threat fullness or pain, heartburn, acid reflux and other individual symptoms, compared with the control group, no significant difference (P>0.05). but the two groups in improving the belching, hiccups, and emotional depression good heave a deep sigh, anorexia, epigastric noise such as a more significant difference (P<0.05), the treatment group than the control group. Endoscopic esophagitis, two sets of endoscopic esophageal inflammatory changes after treatment, results showed that the treatment group was86.67%. control group, the total efficiency of70.00%compared two groups of total efficiency and a significant sexual difference (P<0.05).Conclusion:(1) The ShuGanHeWeiJiangNiTang treatment of reflux esophagitis (liver stomach disharmony) efficacy can significantly improve patients’symptoms, signs, reached with the effect of Western medicine omeprazole domperidone treatment.(2) Mentor experience side ShuGan Heweijiangni of soup prescription rigorous compatibility precise and appropriate, can significantly improve patient belching, hiccups, emotional depression, good heave a deep sigh, anorexia, epigastric noisy embolism, Endoscopic esophageal mucosal inflammation improve efficacy.(3)The party is more suitable for reflux esophagitis early stage, the condition of mild to moderate, evidence-based patients. Side is effective, and safe to use, no significant side effects, should be widely applied.更多还原