| 黄瑶,王恒苍,马凤岐,等.陈永灿从“本虚毒结”论治慢性萎缩性胃炎伴肠上皮化生经验浅析[J].浙江中医药大学学报,2024,48(2):164-169. |
| 陈永灿从“本虚毒结”论治慢性萎缩性胃炎伴肠上皮化生经验浅析 |
| Analysis of CHEN Yongcan’s Experience in Treating Chronic Atrophic Gastritis with Intestinal Metaplasia Based on the Pathogenesis of “Deficiency in Origin and Toxin Accumulation” |
| DOI：10.16466/j.issn1005-5509.2024.02.005 |
| 中文关键词: 本虚毒结 慢性萎缩性胃炎 肠上皮化生 临证经验 十味泻心汤 三花百草饮 四君贞元饮 陈永灿 |
| 英文关键词: deficiency in origin and toxin accumulation chronic atrophic gastritis intestinal metaplasia clinical experience Shiwei Xiexin Decoction Sanhua Baicao Drink Sijun Zhenyuan Decoction CHEN Yongcan |
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| 中文摘要: |
| [目的] 总结陈永灿主任基于“本虚毒结”治疗慢性萎缩性胃炎伴肠上皮化生的经验。[方法] 通过随师临诊，收集、整理典型医案，结合陈主任临证的阐释，从核心病机、辨证论治、遣方用药三个方面，总结陈主任临床治疗慢性萎缩性胃炎伴肠上皮化生的经验，并附一则验案予以佐证。[结果] 慢性萎缩性胃炎伴肠上皮化生是胃癌发生发展的关键环节，陈主任认为“本虚毒结”是慢性萎缩性胃炎伴肠上皮化生的核心病机，“本虚”即脾胃虚弱，元气不足；“毒结”即浊毒留滞，蕴结隐伏。辨治以寒热错杂为基本面，主张平调寒热，根据虚实偏胜，随证治之。处方以自拟十味泻心汤为主，扶元解毒，如脾虚及肾，加用滋肾之品；兼有气血怫郁，喜用花类疏和；针对痰毒、瘀毒、热毒的不同，分别选用山慈菇、石见穿、猫人参，蜂房、刘寄奴、莪术，蒲公英、半枝莲、白花蛇舌草三对角药治之。验案辨证为脾虚毒结、寒热错杂，治法为健脾解毒、平调寒热，以十味泻心汤为主方，考虑兼有瘀毒阻滞、浊滞血瘀，选用蜂房-刘寄奴-莪术角药；复诊因气血不通，气机升降失调，以三花百草饮轻宣开郁；三诊考虑患者年龄增长，肝肾渐衰，且久病伤元，合四君贞元饮健脾益肾、固本培元。[结论] 陈主任从“本虚毒结”辨治慢性萎缩性胃炎伴肠上皮化生经验独到，疗效显著，值得推广学习。 |
| 英文摘要: |
| [Objective] To summarize Director CHEN Yongcan’s experience in treating chronic atrophic gastritis with intestinal metaplasia the pathogenesis of “deficiency in origin and toxin accumulation”. [Methods] Through following Director CHEN Yongcan’s outpatient service， sorting out and analyzing typical medical cases， combined with the view of Director CHEN in clinical practice，it summed up his experience in treating chronic atrophic gastritis with intestinal metaplasia from three aspects: core pathogenesis， syndrome differentiation and treatment， prescription and medication， and a proved case was attached to support the treatment. [Results] Chronic atrophic gastritis with intestinal metaplasia is one of the key links in the occurrence and development of gastric cancer. Director CHEN Yongcan believes that the “deficiency in origin and toxin accumulation” is the core pathogenesis of chronic atrophic gastritis with intestinal metaplasia. “Deficiency in origin” means deficiency in the spleen and stomach， insufficiency of vital Qi; “toxin accumulation” namely turbidity-toxicity stays stagnation， accumulated and hidden. Taking the cold-heat complex syndrome as the basic point for syndrome differentiation and treatment， it’s called for keeping the balance of cold and heat. According to the proportion of deficiency and excess， he treats the disease with the syndrome. The prescription is mainly self-made prescription Shiwei Xiexin Decoction， which can detoxify and benefit vital Qi. If spleen deficiency causes kidney deficiency， kidney-nourishing herbs should be added to solve this condition. If there’re Qi and blood stasis， flower herbs are preferred for use. Aiming at the difference between phlegm toxin， stasis toxin and heat toxin， three pairs of triplet herbs which include Cremastrae Pseudobulbus-Salvia chinensis-Actinidia Valvata Dunn， Nidus Vespae-Herba Artemisiae Anomalae-Rhizoma Curcumae and Taraxacum mongolicum-Scutellariae Barbatae Herba-Hedyotis Diffusa are selected for treatment. The syndrome differentiation of the case was spleen deficiency and toxin accumulation， and complex cold-heat. The treatment was invigorating the spleen and detoxifying， and adjusting cold-heat in balance， and Shiwei Xiexin Decoction was used， considering the combination of blood stasis and toxin accumulation， Nidus Vespae-Herba Artemisiae Anomalae-Rhizoma Curcumae were selected. At the follow-up visit， because of obstruction of Qi and blood and imbalance of Qi movement， and Sanhua Baicao Drink to gently promote depression. In the third visit， considering age growth， the liver and kidney were gradually declining， the long-term illness damaged primordial Qi， and the Sijun Zhenyuan Decoction was used to invigorate the spleen and tonify the kidney， consolidate the basis and cultivate primordial Qi. [Conclusion] Director CHEN’s experience in differentiating and treating chronic atrophic gastritis with intestinal metaplasia from “deficiency in origin and toxin accumulation” is unique and effective， which is worthy of promotion and learning. |
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