周正华治疗功能性消化不良经验
Zhou Zheng-hua′s Experience of Treating Functional Dyspepsia
DOI:10.16367/j.issn.1003-5028.2022.02.0047
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1.天津中医药大学第一附属医院,国家中医针灸临床医学研究中心,天津 300381
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赵帅, 周正华. 周正华治疗功能性消化不良经验[DB/OL].(2023-09-15)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.16367/j.issn.1003-5028.2022.02.0047
ZHAO Shuai, ZHOU Zheng-hua. Zhou Zheng-hua′s Experience of Treating Functional Dyspepsia[DB/OL].(2023-09-15)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.16367/j.issn.1003-5028.2022.02.0047
赵帅, 周正华. 周正华治疗功能性消化不良经验[DB/OL].(2023-09-15)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.16367/j.issn.1003-5028.2022.02.0047 DOI:
ZHAO Shuai, ZHOU Zheng-hua. Zhou Zheng-hua′s Experience of Treating Functional Dyspepsia[DB/OL].(2023-09-15)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.16367/j.issn.1003-5028.2022.02.0047 DOI:
肝胃不和为功能性消化不良(functional dyspepsia,FD)主要病机之一,周正华发现,肝胃不和证存在多种亚型,病机遵循“气郁→攻冲→化火→伤阴→成瘀”五步演变过程。初始阶段病机为肝气郁结,木不疏土,秉持“见肝之病,知肝传脾,当先实脾”的既病防变原则,先以四君子汤健脾助运;肝气郁结进一步发展,出现肝气逆乱,疏泄太过,肝气攻冲,治宜散郁调气,方选四逆散合上下左右汤加减;肝气闭郁不疏,日久火象渐现,出现气郁化火,气火同病,方选化肝煎合温胆汤加减;肝热脾寒证,方选柴胡桂枝干姜汤;肝气聚而化火,损伤肝脏气分,阳亢火盛煎灼血分,热熬血浓,运行不畅,以致脉络瘀滞,瘀血内阻,火损营阴,治以柔肝益胃,养阴安神,方选养阴二味合玉女煎加减。对FD日久未愈伴瘀血阻滞明显者,根据不同病机所致的瘀血,治法亦有区分。每个阶段可独立存在,亦可相兼致病,需把握主病机,了解疾病的病性,病势及预后,方可对证施药。
Liver-stomach disharmony is one of themain pathogenesis of functional dyspepsia (FD) . Zhou Zheng-hua has found that there aremany subtypesof liver-stomach disharmony, and the pathogenesis follows the five-step evolution processof"depression→attacking thoroughfare vessel (TV) →transforming into fire→damaging yin→forming blood stasis". In the initial stage, the patho-genesis is stagnation of liver, qi, wood failing to disperse earth. Adhering to the principle of controlling developmentof existing dis-ease, because"liver diseasesmay affect the function of the spleen, strengthening the spleen is themost important". At this stage, Four Gentlemen Decoction can be used to strengthen the spleen and help transport. When the stagnation of liver, qi, develops fur-ther, the disorder of liver, qi, occurs, the dispersing is toomuch, the attack of liver, qi, is too strong, the treatment should focus on reg-ulating, qi, so Frigid Extremities Powder combined with Modified Upper-Lower and Right-Left Decoction can be used. Long-time stagnation of liver, qi, may transform into fire, make, qi, and fire have same disease, so Liver-Resolving Decoction combined with Modified Gallbladder-Warming Decoction can be used. For liver heat and spleen cold syndrome, Bupleurum and Cinnamon Twig and Dried Ginger Decoction can be used towarm cold inmiddle energizer and clear heat in the revertingmeridian. If liver, qi, accu-mulates and transforms into fire, damaging liver, qi, aspect, Yang hyperactivity and excessive fire will burn blood aspect, blood will become thick and fail tomove smoothly, resulting in blocked collaterals, blood stasis, and fire damaging nutrient yin, so the treat-ment is to soften the liver, benefit the stomach, nourish yin and calm themind, and Yin-Nourishing and Two-Ingredient Decoction combined with Modified Jade Lady Decoction can be used. For patientswith FD who have nothealed for a long time but combined with obvious blood stasis, the treatmentmethods are also differentiated according to blood stasis caused by different pathogenesis. Each stage can exist independently or cause disease simultaneously. It is necessary to grasp themain pathogenesis and understand the nature, trend and prognosis of the disease before applying drugs to the syndrome.
功能性消化不良肝胃不和健脾解郁法调逆行气法清火止痛法柔肝益胃法化瘀活络法周正华
functional dyspepsia (FD)liver-stomach disharmonyinvigorating the spleen and relieving depressionregulating counter-flow of qiclearing fire and relieving painsoftening the liver and benefiting the stomachremoving blood stasisand activa-ting collateralsZhou Zheng-hua
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