孙氏益气运脾汤治疗脾胃虚弱型慢性胃炎临床疗效观察

发布时间：2018-08-26 20:38

【摘要】：祖国医学典籍中无慢性胃炎这一病名。但是慢性胃炎临床上有胃脘部疼痛或胀满、烧心、嗳气反酸、恶心呕吐等一系列症状。根据这些症状将其归属于中医学中“胃痛”、“胃痞”等范畴。祖国医学认为慢性胃炎的病因有六淫之气的侵袭、饮食及药物的损害、忧思恼怒等情志失调、五脏的虚损、先天赢弱、正气亏虚等原因。认为本病病变部位虽在胃,但尤与肝脾相关。肝与胃是木土乘克的关系,协调机体的气机升降,协助胃消化与吸收。脾与胃二脏同居中焦,五行中皆归于土脏,在阴阳划分中脾属阴,胃属阳,一表一里,相互为用,共调中焦气机,脾主提升,胃主通降,为调节气机的枢纽。脾胃相互影响,一方患病多数涉及于另一方,或者二者同时出现病变。孙浩老师认为慢性胃炎发病与正气亏虚有关。祖国医学所讲的人体正气,就是人的抗病机能,是由先天肾精与后天的脾胃之气结合而成,因此正气与脾胃密切相关,脾气亏虚、脾不散精,正气不充,而发本病。正如《内经》所言：“邪之所凑,其气必虚”。因此孙浩老师认为脾气亏虚是慢性胃炎诸多证候的病理基础,故脾气亏虚是慢性胃炎发病的根本。脾虚气亏虚日久,升降失常,运化失职,制水无权,脾虚不能为胃行其水谷津液,水谷津液不行,停聚于胃而为痰湿。孙浩老师认痰湿瘀滞是慢性胃炎发病之标。孙浩老师认为慢性胃炎病机本质是脾气亏虚。《内经》云：“虚则补之”。故临床治疗慢性胃炎以补虚为第一大法。但脾胃又有痰、湿、瘀、滞等病理产物,若治疗上不顾其实,使脾胃更加壅滞胀满,致使脾胃之气停滞不运,变生他证；慢性胃炎中焦虽有实邪,但正气早虚,已不耐攻伐,孙浩老师认为“运脾法”能够清除脾胃中实邪,而不伤脾胃,为慢性胃炎的治疗大法之二,孙浩老师在慢性胃炎这一特点,提出了“补运结合”为为治疗慢性胃炎法则,二法结合,标本同治。迅速使脾胃恢复健运的功能。孙浩老师在治疗本病时常用炙黄芪、太子参和炒白术等甘温平和药物补益脾气。孙浩老师认为只要祛除脾胃病理产物的且不损伤脾胃的药物皆是运脾药,如用苏梗、陈皮、枳壳等药理脾胃气滞；用炒山楂、神曲、炒麦芽、鸡内金等药物消脾胃食积；用砂仁、陈皮等清中焦痰湿药物。有瘀血者,用丹参、三七等药化中焦瘀血。孙浩老师根据慢性胃炎的病因病机,及用药特点,制定出益气运脾汤(炙黄芪15g、太子参12g、茯苓10g、枳壳8g、陈皮10g、白术10g、砂仁5g、神曲10g、麦芽10g、炙甘草8g)治疗慢性胃炎,也是治疗脾胃虚弱证的基本方剂。此方疗效较好、价格低廉,服用无不良反应,能取得满意的结果。目的：本课题通过运用孙浩老师益气运脾汤加减治疗脾胃虚弱型慢性胃炎,观察临床各方面疗效、主要症状改善情况以及幽门螺杆菌转阴率,探讨本方在治疗脾胃虚弱型慢性胃炎中的作用,为本病提供新的治疗方法。方法：入选2014年06月-2015年05月在江苏省仪征市中医院就诊的门诊及住院病例,参加试验患者有60人,随机分治疗组和对照组,每组30人。对照组用西药：胃炎冲剂,一次一包,3次/天,共28天。若上腹部饱胀、恶心欲吐,加莫沙比利5mg,3次/天。治疗组用孙氏益气运脾汤(炙黄芪15g、太子参12g、茯苓10g、枳壳8g、陈皮10g、白术10g、砂仁5g、神曲10g、麦芽10g、炙甘草8g),每日1剂,水煎,400m1,分两次,早、中饭后服用,连续服用28天,气滞者加香附、柴胡,恶心欲吐者加竹茹、半夏,反酸者加乌贼骨、大贝母,疼痛明显加元胡、檀香。两组均加用丽珠胃三联口服7天。治疗前及结束后分别通过四诊合参收集症状、体征及快速14C呼气试验结果,并进行中医证候积分,使用SPSS19.0软件进行中医疗效统计分析。根据观察指标及数据的不同,分别采用X2检验、t检验和秩和检验。结果：(1)在中医证候积分变化方面,两组治疗后中医证候积分降低均值比较有显著差异(P0.05)。(2)两组幽门螺杆菌转阴情况,治疗组28例,对照组20例,幽门螺杆菌转阴率治疗组93.33%明显高于对照组66.67%,差异有统计学意义(P0.05)。(3)本研究中治疗组有5例治愈,14例有显著疗效,9例有效,无效2例,对照组有2例治愈,14例有显著疗效,15例有效,7例无效。治疗组临床总有效93.33%,对照组总有效率为76.67%,差异有统计学意义(P0.05)。结论：(1)孙氏益气运脾汤治疗脾胃虚弱型慢性胃炎的临床总疗效优于西药胃炎冲剂对照组。(2)孙氏益气运脾汤对幽门螺杆菌有一定的杀灭或者抑制作用。(3)治疗组在胃脘疼痛、痞胀等主要症状改善方面优于对照组。(4)降低中医证候积分方面,治疗组更有优势。(5)孙氏益气运脾汤具有益气运脾、理气和胃之效,切中慢性胃炎脾胃虚弱的病机,故治疗脾胃虚弱型慢性胃炎的临床疗效良好,确能有效改善慢性胃炎的临床症状体征。(6)本方用药平和,治疗未见不良反应。说明孙氏益气运脾汤能整体提高机体自身的免疫能力,提高抗病防病的能力,还有增加胃动力促进排空,抑制胃酸分泌,保护胃粘膜,保护胃黏膜屏障,改善局部微循环而促进细胞修复的作用。故孙氏益气运脾汤方治疗脾胃虚弱型慢性胃炎疗效较好、且治疗费用不高、长期使用无毒副作用。值得进一步研究和推广应用。
[Abstract]:There is no name for chronic gastritis in Chinese medical books. But chronic gastritis has a series of symptoms such as pain or fullness in the stomach, heartburn, belching, nausea and vomiting. Damage of diet and medicine, worry and anger, deficiency of five zang-organs, innate weakness of winning, deficiency of vital energy and so on. It is believed that the lesion of the disease is located in the stomach, but especially related to the liver and spleen. In the division of Yin and Yang, the spleen belongs to Yin, the stomach belongs to Yang, and the stomach belongs to one table and one interior. They are used for each other. They regulate the Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi-Qi The healthy qi of human body is the anti-disease function of human body, which is formed by the combination of congenital kidney essence and acquired Qi of spleen and stomach. Therefore, the healthy qi is closely related to spleen and stomach, deficiency of spleen-qi, non-dispersing essence of spleen, insufficiency of healthy qi, and pathogenesis. The pathogenesis of chronic gastritis is deficiency of spleen-qi for a long time, abnormal ascending and descending, irregularity of movement and dissolving, no right of water-making, spleen-deficiency can not be used for the stomach to run its valley fluid, water valley fluid can not be used, stop in the stomach and become phlegm-dampness. The essence of chronic gastritis is deficiency of spleen and stomach. Teacher Sun Hao believes that the method of "transporting the spleen" can clear away the pathogenic substances in the spleen and stomach without injuring the spleen and stomach. It is the second major method for the treatment of chronic gastritis. Teachers often use fried Astragalus root, prince ginseng and stir-fried Atractylodes macrocephala to replenish temper. Sun Hao believes that as long as the spleen and stomach pathological products and do not damage the spleen and stomach of the drugs are Spleen-activating drugs, such as stem, orange peel, orange peel and other pharmacological spleen and stomach Qi stagnation; stir-fried hawthorn, Shenqu, stir-fried malt, chicken Jin and other drugs Xiaopi stomach food. According to the etiology and pathogenesis of chronic gastritis, and the characteristics of medication, Professor Sun Hao formulated Yiqi Yunpi Decoction (roasted Astragalus 15g, Radix Pseudostellariae 12g, Poria 10g, Fructus aurantii 8g, tangerine peel 10g, Atractylodes Macrocephalae 10g, Radix Amomi 5g, Shenqu 10g, malt 10g, roasted licorice 8g). Chronic gastritis is also the basic prescription for the treatment of spleen and stomach weakness syndrome.This prescription has good curative effect,low price,no adverse reactions,and can achieve satisfactory results.Objective:To observe the clinical curative effect,main symptoms improvement and Helicobacter pylori(Hp) by using the modified decoction of replenishing qi and transporting spleen of Professor Sun Hao in the treatment of spleen and stomach weakness chronic gastritis. Methods: From June 2014 to May 2015 in Yizheng Hospital of Traditional Chinese Medicine in Jiangsu Province, 60 patients participated in the trial were randomly divided into treatment group and control group, 30 in each group. Medicines: gastritis granule, a package, three times a day, a total of 28 days. If the upper abdomen is full, nausea, plus Mosapride 5mg, three times a day. The treatment group with Sun's Yiqi Yunpi Decoction (fried Astragalus 15g, prince's ginseng 12g, Poria cocos 10g, orange shell 8g, orange peel 10g, Atractylodes macrocephala 10g, Shenqu 10g, malt 10g, fried licorice 8g), one dose a day, water decoction, 400m1, twice a day, morning, after lunch. Two groups were given Lizhu stomach triple orally for 7 days. Symptoms, signs and rapid 14C breath test results were collected by four diagnostic methods before and after treatment, and TCM syndromes were carried out. Results: (1) In the aspect of the change of TCM syndrome integral, there was a significant difference between the two groups (P 0.05). (2) Helicobacter pylori negative conversion between the two groups. The negative rate of Helicobacter pylori was 93.33% in the treatment group and 66.67% in the control group. The difference was statistically significant (P 0.05). (3) In this study, 5 cases were cured, 14 cases were significantly effective, 9 cases were effective, 2 cases were ineffective, 2 cases were cured in the control group, 14 cases were effective, 7 cases were ineffective. The total effective rate was 93.33%. The total effective rate was 76.67%. The difference was statistically significant (P (5) Sun's Yiqi Yunpi Decoction has the effect of Invigorating Qi and transporting spleen, regulating qi and stomach. It can cut the pathogenesis of spleen and stomach weakness in chronic gastritis, so it has good clinical effect in treating spleen and stomach weakness chronic gastritis and can effectively improve chronic gastritis. The results showed that Sun's Yiqi Yunpi Decoction could improve the immunity of the body as a whole, enhance the ability of disease resistance and prevention, increase gastric motility to promote emptying, inhibit gastric acid secretion, protect gastric mucosa, protect gastric mucosal barrier, improve local microcirculation and promote cell repair. Therefore, Sun's Yiqi Yunpi Decoction is effective in treating chronic gastritis of weak spleen and stomach, and the treatment cost is not high, long-term use of non-toxic side effects.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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