基于“脏腑风湿”论治消化性溃疡——仝小林教授治疗消化性溃疡的新视角
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摘要
消化性溃疡这一常见的消化系统疾病,其人群患病率高达5%～10%~([1])。西医在治疗方面主要是运用抑酸药和黏膜保护剂,合并幽门螺旋杆菌感染时可联合使用抗生素。这一经典的治疗方案,虽然大大提高了消化性溃疡的愈合率,但是复发率仍居高不下。脏腑风湿是仝小林教授提出的一个新学说,即风寒湿邪既可从体表传入脏腑,亦可直中脏腑,久而风寒湿邪伏于脏腑,盘踞痼结,发为脏腑风湿病。仝小林教授基于"胃肠黏膜是风寒湿邪易伏之地"的认识,同时结合伏邪与消化性溃疡均具有反复发作的临床特点,认为消化性溃疡的发生与脏腑风湿密切相关。治疗时则在脾胃病常规辨治心法的基础上,流转中气,适时透邪,同时结合益气健脾、活血化痰、发散火郁等法。通过临床验证,此法可有效提高消化性溃疡的愈合率,降低了复发率。
Peptic ulcer is a very common disease with high morbidity of 5%～10% among population. Antacids and gastric mucosal protector are most widely used for treatment in western medicine, and antibiotics will be used together if infected with H. pylori. Although these treatments obviously increase the healing rate of peptic ulcer, its recurrence rate is too high that most patients complain. Rheumatic Zang-Fu was a new TCM theory that Prof. Tong came up with, which indicated that evil pathogen like wind, coldness or dampness would affect Zang-Fu, the internal organs, by penetrating body skin or even attacking directly, consequently induced stubborn and long-lasting affection inside the organs, and thus resulting in Zang-Fu rheumatism. Prof. Tong regards gastrointestinal mucosa as an area harboring evil pathogen much easily, and also peptic ulcer recurrs frequently as well as latent pathogen, thereby Tong considered that peptic ulcer was closely related to Zang-Fu rheumatism. According to this theory, treatments aim to expel the evil from Zang-Fu has been proved more efficient to treat peptic ulcer compared with using conventional therapy only, and meanwhile decreases the recurrence rate distinctly. Here we exert to clarify peptic ulcer's etiology and pathogenesis and review Prof. Tong's clinic comprehension and treatment experience, and thus making the treatment of peptic ulcer more broadly.
Peptic ulcer is a very common disease with high morbidity of 5%～10% among population. Antacids and gastric mucosal protector are most widely used for treatment in western medicine, and antibiotics will be used together if infected with H. pylori. Although these treatments obviously increase the healing rate of peptic ulcer, its recurrence rate is too high that most patients complain. Rheumatic Zang-Fu was a new TCM theory that Prof. Tong came up with, which indicated that evil pathogen like wind, coldness or dampness would affect Zang-Fu, the internal organs, by penetrating body skin or even attacking directly, consequently induced stubborn and long-lasting affection inside the organs, and thus resulting in Zang-Fu rheumatism. Prof. Tong regards gastrointestinal mucosa as an area harboring evil pathogen much easily, and also peptic ulcer recurrs frequently as well as latent pathogen, thereby Tong considered that peptic ulcer was closely related to Zang-Fu rheumatism. According to this theory, treatments aim to expel the evil from Zang-Fu has been proved more efficient to treat peptic ulcer compared with using conventional therapy only, and meanwhile decreases the recurrence rate distinctly. Here we exert to clarify peptic ulcer's etiology and pathogenesis and review Prof. Tong's clinic comprehension and treatment experience, and thus making the treatment of peptic ulcer more broadly.
引文
[1] 杨子敬.消化性溃疡的研究进展[J].内科,2009(6):925-927.
[2] 姚宏昌.消化性溃疡研究的若干进展[J].医学与哲学,2010,31(5):5-10.
[3] 中华消化杂志编委会.消化性溃疡病诊断与治疗规范[S].全科医学临床与教育,2014,12(3):243-246.
[4] 胡伏莲.消化性溃疡发病机制的现代理念[J].中华消化杂志,2005(3):189-190.
[5] Graham DV,Agrawal NM,Campbell DR,et al.Ulcer prevention in long-time users of nonsteroidal anti-inflammatory drugs:results of a double-blind,randomized,multicenter,ctive-andplacebo-controlled study of misoprostol vs lansoprazole[J]. Archlntem Med,2002,162:169-175.
[6] 张声生,王垂杰,李玉锋,等.消化性溃疡中医诊疗专家共识意见[J].中华中医药杂志,2017,32(9):4089-4093.
[7] 刘果,王新月.伏邪理论在中医药抗溃疡性结肠炎复发中的运用[J].中国中西医结合消化杂志,2009,17(6):391.
[8] 王静,李佃贵,米会平.消化性溃疡的病因病机及中医药治疗进展[J].河北职工医学院学报,2002,19(3):58-60.
[9] 戈焰,邱健行.邱健行治疗消化性溃疡经验[J].中医杂志,2007,48(12):1069.
[10] 胡荣.中医辨治消化性溃疡[J].湖北中医杂志,2009,31(5):43-44.
[11] 王幼立.自拟疏肝消溃散治疗消化性溃疡 58 例[J].中国中医急症,2010,19(6):1026.
[12] 王洪京,赵明.消化性溃疡脾胃湿热证的理论探讨[J].中医研究,2008,21(4):6-9.
[13] 童学彪.五脏痹实质探讨[J].南京中医药大学学报,1996,12(6):6-7.
[14] 仝小林,刘文科,田佳星.论脏腑风湿[J].中医杂志,2013,54(7):547-549.
[15] 何丽莎,刘文科,仝小林.论脏腑风湿理论在临床中的应用[J].中华中医药杂志,2017,32(5):2087.
[16] 顾成娟,吴学敏,王涵,等.诸型感冒,太卫胃表,皆属于膜:仝小林教授对感冒的认识及病机探讨[J].吉林中医药,2018,38(2):142-145.
[17] 仝小林,刘文科.论过敏性疾病的中医药治疗[J].上海中医药大学学报, 2011,25(5):8-10.
[18] 胡震宇.胃肠疾病幽门螺杆菌感染与中医分型关系的研究[J].浙江中医杂志,2009,44(2):107-108.
[19] 李军.从伏邪论治慢性萎缩性胃炎思路探讨[J].江苏中医药,2012,44(11):9.
[20] 张北平.伏邪、伏毒理论古文献整理及其在溃疡性结肠炎中的应用[D].广州:广州中医药大学,2014:14-24.
[21] 沈华娟,葛惠男.消化性溃疡中医辨证分型的研究[J].吉林中医药,2015,35(4):355-357.
[22] 仝小林.维新医集[M].上海:上海科学技术出版社,2015:29-33.
[23] 李冀,柴剑波,孙琳林.浅谈活血化瘀法防治消化性溃疡[J].中国中医药信息杂志,2006,13(3):92-93.
[24] 张仲景.金匮要略[M].北京:人民卫生出版社,2005:23,42,77.
[25] 张仲景.伤寒论[M].北京:人民卫生出版社,2005:106.
[26] 李东垣.内外伤辨惑沦[M].北京:人民卫生出版社,2007:24,27.
[2] 姚宏昌.消化性溃疡研究的若干进展[J].医学与哲学,2010,31(5):5-10.
[3] 中华消化杂志编委会.消化性溃疡病诊断与治疗规范[S].全科医学临床与教育,2014,12(3):243-246.
[4] 胡伏莲.消化性溃疡发病机制的现代理念[J].中华消化杂志,2005(3):189-190.
[5] Graham DV,Agrawal NM,Campbell DR,et al.Ulcer prevention in long-time users of nonsteroidal anti-inflammatory drugs:results of a double-blind,randomized,multicenter,ctive-andplacebo-controlled study of misoprostol vs lansoprazole[J]. Archlntem Med,2002,162:169-175.
[6] 张声生,王垂杰,李玉锋,等.消化性溃疡中医诊疗专家共识意见[J].中华中医药杂志,2017,32(9):4089-4093.
[7] 刘果,王新月.伏邪理论在中医药抗溃疡性结肠炎复发中的运用[J].中国中西医结合消化杂志,2009,17(6):391.
[8] 王静,李佃贵,米会平.消化性溃疡的病因病机及中医药治疗进展[J].河北职工医学院学报,2002,19(3):58-60.
[9] 戈焰,邱健行.邱健行治疗消化性溃疡经验[J].中医杂志,2007,48(12):1069.
[10] 胡荣.中医辨治消化性溃疡[J].湖北中医杂志,2009,31(5):43-44.
[11] 王幼立.自拟疏肝消溃散治疗消化性溃疡 58 例[J].中国中医急症,2010,19(6):1026.
[12] 王洪京,赵明.消化性溃疡脾胃湿热证的理论探讨[J].中医研究,2008,21(4):6-9.
[13] 童学彪.五脏痹实质探讨[J].南京中医药大学学报,1996,12(6):6-7.
[14] 仝小林,刘文科,田佳星.论脏腑风湿[J].中医杂志,2013,54(7):547-549.
[15] 何丽莎,刘文科,仝小林.论脏腑风湿理论在临床中的应用[J].中华中医药杂志,2017,32(5):2087.
[16] 顾成娟,吴学敏,王涵,等.诸型感冒,太卫胃表,皆属于膜:仝小林教授对感冒的认识及病机探讨[J].吉林中医药,2018,38(2):142-145.
[17] 仝小林,刘文科.论过敏性疾病的中医药治疗[J].上海中医药大学学报, 2011,25(5):8-10.
[18] 胡震宇.胃肠疾病幽门螺杆菌感染与中医分型关系的研究[J].浙江中医杂志,2009,44(2):107-108.
[19] 李军.从伏邪论治慢性萎缩性胃炎思路探讨[J].江苏中医药,2012,44(11):9.
[20] 张北平.伏邪、伏毒理论古文献整理及其在溃疡性结肠炎中的应用[D].广州:广州中医药大学,2014:14-24.
[21] 沈华娟,葛惠男.消化性溃疡中医辨证分型的研究[J].吉林中医药,2015,35(4):355-357.
[22] 仝小林.维新医集[M].上海:上海科学技术出版社,2015:29-33.
[23] 李冀,柴剑波,孙琳林.浅谈活血化瘀法防治消化性溃疡[J].中国中医药信息杂志,2006,13(3):92-93.
[24] 张仲景.金匮要略[M].北京:人民卫生出版社,2005:23,42,77.
[25] 张仲景.伤寒论[M].北京:人民卫生出版社,2005:106.
[26] 李东垣.内外伤辨惑沦[M].北京:人民卫生出版社,2007:24,27.