中医辨治慢性萎缩性胃炎的思路与对策姜莉云课件

中医辨治慢性萎缩性胃炎的 思路与对策 昆明市中医医院昆明市中医医院 姜莉云姜莉云 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 内 容 1、概论 2、西医对本病的认识 3、中医辨治 4、专家经验 5、现状与展望 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 慢性萎缩性胃炎（慢性萎缩性胃炎（CAGCAG） 定义：定义： 以胃粘膜上皮和腺体萎缩，粘膜变薄，粘膜肌以胃粘膜上皮和腺体萎缩，粘膜变薄，粘膜肌 层增厚及伴有肠上皮化生，不典型增生为特征的慢层增厚及伴有肠上皮化生，不典型增生为特征的慢 性胃病。是消化系统疾病中常见病和难治病之一。性胃病。是消化系统疾病中常见病和难治病之一。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. CAGCAG的发病模式的发病模式 浅表性胃炎（非萎缩性胃炎）胃黏膜萎缩肠 上皮化生 异型增生 胃癌 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 焦点、热门 防治CAG，促使胃黏膜萎缩逆转，阻断癌变过 程，降低胃癌发病率成为消化科医生研究的热门 课题。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 分 型 根据发病部位的不同： 1、胃体部A型 2、胃窦部B型 3、胃体、胃窦皆有AB型 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 流行病学 发病率随年龄增长而增加 芬兰：1665岁健康人 1650岁 占9% 5165岁 占53%， 年龄每增加10岁，平均递增率14%。 法国：65岁以上的一般人群，每100人中45人患 轻度萎缩性胃炎，29人显示重度萎缩性胃炎。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 流行病学 日本：老年人群中发病率高而认为该病在老年人 中是一种“半生理现象”。 中国：50岁以后有中、重度病变者超过半数，中 重度萎缩性胃炎的发病率在各年龄组中均以男性 为高，高龄组男性发病率可达80%左右。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 流行病学 CAG占胃镜检查数13.8% ，胃癌高发区28.1% 。 CAG是胃癌最重要的癌前疾病 ，尤其与胃息肉 同时存在，CAG肠化合并中度至高度不典型增生 时可发生癌变。19781978年年WHOWHO定为胃癌的癌前状定为胃癌的癌前状 态，我国癌变率态，我国癌变率3-5%3-5%。胃癌病例。胃癌病例50%50%以上有萎缩以上有萎缩 性胃炎病史性胃炎病史 西医治疗-不理想，中医药治疗-有优势 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病因 药物与饮食不当、酗酒、吸烟 年龄 HP感染 消化道动力异常， 十二指肠液及胆汁反流 免疫因素 遗传 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 西医治疗原则 主要是疾病的早期治疗和 防癌变治疗。 针对病因的治疗既可以改 善症状，同时也可预防其 癌变的发生率。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 西医治疗原则 CAG的治疗除一般治疗外，即去除病因的治疗， 如避免过热过酸过硬，过分粗糙或刺激性的食物 和饮料，控制钠盐的摄入，多进食新鲜蔬菜和水 果，谨慎服用非甾体类抗炎药等对胃粘膜有损伤 的药物，保持乐观的情绪，积极治疗慢性感染病 灶及治疗引起该病的全身疾病。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 西药治疗： 清除HP，用维酶素、猴头菌以及三联疗法。 张氏等抗菌三联(30例，阿莫西林、德诺、甲硝唑 )和抗菌三联+活血化瘀（30例）： 前组总有效率64.6%，后组总有效率88%，两 组比较P0.05。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 萎缩性胃炎的胃镜随访时间 不伴有肠化和异型增生者-1-2年 中-重度萎缩或伴有肠化者-1年 轻度异型增生并剔除取于癌旁或明显局部病灶者 -6个月 重度异常增生者-立即复查， 必要时手术或内镜治疗 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 临临 床床 症症 状状 以上腹胀痛、纳少嗳气、消瘦乏力为主要表现以上腹胀痛、纳少嗳气、消瘦乏力为主要表现 。本病发病缓慢、病情顽固、病势缠绵、施治棘。本病发病缓慢、病情顽固、病势缠绵、施治棘 手。中医将本病归属于手。中医将本病归属于“ “胃脘痛胃脘痛” ”、“ “痞满痞满” ”、“ “嘈嘈 杂杂” ”、“ “腹胀腹胀” ”等范畴。等范畴。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病因病机病因病机 （1）外邪犯胃： 初起： 过食生冷 嗜食辛辣肥甘 酗酒 饮食自倍 寒积胃中 湿热内生 食滞中焦 损伤胃气 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病因病机病因病机 （1）外邪犯胃：久病： 血瘀阻气 湿热内生 热伤胃津 虚实夹杂 现代医学也认为： 刺激性饮食如浓茶、酒精、过热、过酸食物 胃粘膜急性炎症病 变 慢性胃炎 CAG Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病因病机病因病机 （2）肝气郁结： 精神抑郁 恼怒伤肝 肝胃不和 肝胃气滞 气郁化火 现代医学: 肝郁气滞 植物N紊乱 幽门功能失调 胆汁返流、胆汁、 胆盐反复刺激 减弱胃粘膜屏障对离子的通透功能 氢离子反弥 散入胃粘膜 加重炎症的发生和发展。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病因病机病因病机 （3）脾胃虚弱： 病后 劳倦 饥饱失宜 过于忧思 先天禀赋虚弱 中气虚损 阳损及阴 寒凝血滞 血脉瘀滞 中医脾虚与体质有关 发病机理：自身免疫、变态反应 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病因病机病因病机 胃阳虚-浅表性胃炎-气分， 胃阴虚-CAG-血分。 气虚血瘀 脾胃虚弱，气阴不足为本 气滞血瘀，湿热邪毒为标。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病因病机 总不离“虚”、“瘀”二字 胃为多气多血之腑，病则气血必受其伤。 初期在气，日久入血，气滞血瘀，不通则痛； 后期脾胃虚弱，化源不足，胃失所养，不荣亦痛 。 气虚、气滞到血虚、血瘀 治疗：健脾活血法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 治疗原则 扶正祛邪，根据阴阳、气血、寒热、虚实侧重不 同治法 该病本质：正虚邪实，正虚为本，邪实为标。 本虚则治本为主，脾胃虚寒证宜温中止痛， 胃阴 不足证宜养阴益胃， 气滞证宜疏肝理气止痛，郁 热证宜清热和胃，血瘀证宜活血祛瘀。 虚实夹杂、寒热并见，临证时兼而治之。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 2、辨证分型、辨证分型 中华中医药学会脾胃病分会中医消化病诊疗指南 将CAG归为“胃痛、痞满、嘈杂”的范畴，并提出6种 辨证分型。 属“实痞”的有“肝胃不和”、“脾胃湿热”、 “湿浊中阻”、“胃络瘀血”；属“虚痞”的有“脾胃 虚弱”、“胃阴不足”。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 2、辨证分型、辨证分型 由于各地气候、患者体质等的差异，以及临 床收集的病历数、分型依据的不同，中医学对CAG 的分型种类繁多。 根据收集的资料进行统计，发现大多数医家 认为CAG以“脾胃气虚”、“肝胃不和”、“气滞 血瘀”、“胃阴不足”、“脾胃湿热”居多。这 与过去的报道及教材辨证分型相类似。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 2、辨证分型、辨证分型 胃为戊土，属腑，以通降为顺，然其受纳、腐 熟，全靠肝的疏泄条达。从病理上来看，肝木过盛 可乘脾伤胃，即“肝木乘土”，而肝木过弱也不能 疏通脾胃，使受纳、腐熟受阻。因此治则为疏肝运 脾 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 2、辨证分型、辨证分型 慢性胃炎以虚实夹杂为多，其用药根据胃腑“ 实而不满”之特点，常使“补而不滞”。 久病必伤气血，所以方中既用黄芪、党参，也 用乌梅、木瓜、甘草、山楂等酸甘化阴之品，还会 加少许理气如陈皮、砂仁、枳壳和活血药如三七、 延胡索、丹参等。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 证候诊断 1、肝胃不和证 主症：胃脘胀痛；嗳气频作；嘈杂反酸；脉弦 次症：胸闷；食少；大便不爽；舌质淡，苔薄白 证候确定：主症第1项加其他主症1项或次症2项 以上 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 证候诊断 2、脾胃湿热证 主症：胃脘胀满或胀痛；口苦口干；恶心呕吐； 舌质红，苔黄腻 次症：胃脘灼热；口臭；尿黄；胸闷；脉滑数 证候确定：主症第1项加其他主症1项或次症2项 以上 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 证候诊断 3、湿浊中阻证 主症：胃脘痞满或隐痛；恶心呕吐清水或酸水； 不思饮食，食后胀甚；舌质淡红，苔白腻 次症：身倦乏力；脉濡 证候确定：主症第1项加其他主症1项或次症2项 以上 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 证候诊断 4、胃络瘀血证 主症：胃脘胀满、刺痛；痛处拒按、痛有定处； 舌质黯红或有瘀点、瘀斑 次症：黑便；面色黯滞，脉弦涩 证候确定：主症第1项加其他主症1项或次症2项 以上 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 证候诊断 5、脾胃虚弱证 主症：胃脘隐痛，胃痛喜按喜暖；食后闷胀，痞 满；纳呆少食；大便稀溏；舌质淡，边有齿痕 次症：肢软乏力；气短懒言；呕吐清水；脉细弱 证候确定：主症第1项加其他主症1项或次症2项 以上 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 证候诊断 6、胃阴不足证 主症：胃脘胀满、灼痛，胃中嘈杂，饥不知食； 舌红少津，苔少 次症：食少干呕；大便干燥；口干；脉细 证候确定：主症第1项加其他主症1项或次症2项 以上 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 分证论治 1、肝胃不和 治法：疏肝理气，和胃降逆 主方：柴胡疏肝散（景岳全书加减） 2、脾胃湿热 治法：清热化湿，和胃健脾 主方：芩连平胃散（医宗金鉴加减） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 分证论治 3、湿浊中阻 治法：芳香化湿，健脾和胃 主方：藿朴夏苓汤（医原加减） 4、胃络瘀血 治法：活血化瘀，和胃止痛 主方：丹参饮（时方歌括）合桃红四物汤（ 医宗金鉴）加减 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 分证论治 5、脾胃虚弱 治法：补气健脾，消痞和胃 主方：香砂六君子汤（医方集解）加味 6、胃阴不足 治法：养阴益胃，缓急止痛 主方：益胃汤（温病条辨）加减 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 以上各证型可互相兼夹，临证用药以辨证论治为 主。若伴有幽门螺杆菌感染、重度萎缩、肠化、 异型增生等，可结合辨病，适当选加一些清热解 毒（如白花蛇舌草、半枝莲、半边莲、石见穿、 藤梨根、龙葵等）及活血化瘀消癥(如丹参、三棱 、莪术)之品，以提高疗效。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 路志正（三期论治） 初期-肝郁气滞和脾胃虚寒多见 自拟苏朴饮-疏肝和胃 小建中汤加味-温脾和胃。 中期-脾虚湿热内蕴和胃阴不足多见 四逆散加味-补脾化湿 自拟石斛梅花汤-补阴和胃 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 末期-气阴两伤和津枯血瘀 参荷二梅汤-益气养阴； 失笑散合芍药甘草汤加味-通络化瘀。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 董建华则认为 : 病机:虚、滞、热、瘀。 强调虚是本质，滞是核心，以通为补，治在 通降。 食积郁久化热，久必入络成瘀。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 董建华 常用 : 香附、佛手、苏梗行气 陈皮、鸡内金、莱服子化食滞 石斛、麦冬、沙参滋阴 黄芪、桂枝、甘草祛虚寒 大黄、黄连泻实热 大腹皮、佩兰燥湿 丹参、川楝子、川芎活血化瘀 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 张镜人（国医大师） 治疗兼顾三脏，健脾和胃，疏肝理气是治 疗本病的大法，采用香苏散、芍药甘草汤、旋覆代 赭汤、柴胡疏肝散诸方之复合，虚寒兼顾，寒温得 宜，升降并调，气血同治。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 张镜人（国医大师） 偏重于脾胃不和，而呈气虚血瘀证候，气虚 与血瘀互为因果，逐渐演变为虚实错杂的病理变 化及临床证候，辨为气虚血瘀者占70%左右，立 调气活血法，制成“萎缩安”冲剂，由太子参、柴 胡、炒黄芩、丹参、制香附、徐长卿等。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 徐景藩（国医大师） （1）CAG的主要证型有三： A、中虚（脾胃气虚）气滞证：调中理气汤 B、肝胃不和证：疏肝和胃汤 C、胃阴不足证：养胃理气汤 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 （2）治疗CAG善用调肝之法：“医者善于调肝， 乃善治百病”。无论生理、病理，肝、胃密切相 关。 （3）运用泡脚疗法，收效显著。 川芎10克，红花10克，仙鹤草15克，鬼针草15克 。 用上药水煎，冷至40度，双脚放入盆中20分钟， 午饭后、睡前各1次。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 李乾构认为：脾胃虚弱气滞血瘀证是 CAG的主要证候，治：补益脾胃理气 化瘀，方用四君子汤加味。 基础方：党参10克，莪术10克，茯苓10克， 陈皮10克，枳实10克，薏仁米30克，白花蛇舌草 15克。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 活血化瘀是治疗CAG的重要法则，贯穿 治疗始终。 抑杀CAG的元凶（HP）是治愈CAG的关键。 莪术、白花蛇舌草、薏仁米是治疗CAG的要药。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 山药薏米粥： 山药60克，薏米30克，大米30克， 小米15克 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 吴荣祖：温水燥土达木法 李某某、女性、53岁，2008年10月就诊。患者因“胃脘 部烧灼样疼痛4年余，加重1月”就诊。患者为省电视台 记者，因2008年汶川地震赴灾区工作。在灾区工作期间 极为劳累，且心理上承受巨大压力。回昆工作后即开始 出现胃脘部烧灼样疼痛。至省级医院就诊，行电子胃镜 检查，诊断为慢性萎缩性胃炎伴胆汁反流。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 主症：胃脘部烧灼样疼痛，疼痛以午后明显，夜 间入睡时发作频繁， 次症：面色萎黄夹青，感极度神疲乏力、倦怠思 睡、口干喜热饮、口苦、嗳气频作、喜太息、纳 差、毫无食欲、眠差多梦易惊，舌暗红，舌下脉 络迂曲，苔微白腻，脉弦，重取沉细无力 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 脾肾阳虚、肝寒犯胃。肝者，罴极之本。疲劳及 情感波动肝先受之，且长期疲劳，劳则气耗，肝 气受损，疏泄不畅。再考患者胃痛午后出现，夜 间最重，次日清晨可缓解，此谓旦慧昼安，夕加 夜甚，是阳虚阴寒之象。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 且神疲乏力、倦怠思睡、脉虽弦但重取沉细无力 。故少阴病脉微细但欲眛之象可凭。这即为隐潜 性阳虚之象，如此即可明确患者脾肾阳虚之证。 而不必定要见恶寒怕冷、四末欠温、四肢厥逆、 下利清谷、脉微欲绝方可运用姜附。 法当补火生土、温肝顺气、降逆和胃 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 专家经验专家经验 方以吴芋四逆汤加味治疗。 川附片100克、干姜20克、吴芋10克、 炒花椒9克、川芎10克、佛手15克、 炒香附10克、茵陈15克、砂仁10克、 公丁香10克、桂子10克、鸡内金15克、 海螵蛸15克、炙甘草10克。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 治疗原则治疗原则 中医内科学六版教材： 实者：泻热、消食、化痰、理气 ；虚者：温补脾胃。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 4 4、临床治疗、临床治疗 4.1.1 健脾益气法 张氏自拟参芪胃生汤66例： 治愈21例，有效37例，无效8例，总有效率87.9%。 巫氏归芍六君子汤加味