中医药治疗慢性胃炎的临床体会 – Clinical Experiences Using Chinese Medicine to Treat Chronic Gastritis

中医药治疗慢性胃炎的临床体会
谢天佐 陈永祥

Clinical Experiences  Using Chinese Medicine to Treat Chronic Gastritis
Xie Tian-zuo  Chen Yong-xiang

Translated by:  XU Zhi-jun & J. Heaverlo

摘要 通过对慢性胃炎病因病机的认识及中医药治疗慢性胃炎的诊疗思路,联系临床所见病例,体会到临床运用健脾和胃,攻补兼施等综合调理方法可获良好的疗效。

Abstract: This thesis studies the disease causes and pathomechanisms of chronic gastritis.  It explores the methods of diagnosing and treating chronic gastritis with Chinese medicine, and cites clinical cases for its support. It is intended to prove that beneficial results can be achieved by using a combination of  clinical methods such as fortifying the spleen and harmonizing the stomach, and simultaneous supplementing and attacking.

关键词 胃炎,慢性;中医药;治疗

Key words: Gastritis, Chronic: Chinese medicine; Treatment

慢性胃炎是临床常见的消化系统疾病,唐晓群认为其实质是胃黏膜遭受反复损害导致固有腺体的萎缩,是由各种病因引起的慢性胃黏膜炎症。多数患者前期无症状,或仅表现为上腹痛或不适,上腹胀,嗳气,泛酸,食欲不振等消化不良症状,发病中期才会有明显的临床表现,该病的确诊有赖于胃镜检查,必要时还需进行病理活组织检查。中医学无“慢性胃炎”之病名,根据临床表现归属于中医“胃脘病”、“痞满”、“吞酸”、“呕吐”等病症范畴。

Chronic gastritis is a common disease of the digestive system. According to Tang Xiao-qun, essentially, repeated lesions of the gastric mucosa will lead to the atrophy of the glands. It can be classified as an inflammatory condition of the gastric mucosa and may be due to various causes. Many patients don’t experience early symptoms, or may present with varying symptoms of indigestion such as: epigastric pain or discomfort, abdominal distention, belching, acid regurgitation, or poor appetite. It is not until the middle stages of the disease will more obvious clinical manifestations appear. This disease has to be diagnosed by gastroscopy; and if necessary,  a biopsy will be performed. In Chinese medicine there is not a disease name for “chronic gastritis. According to its clinical manifestations, it is classified within the patterns of: “stomach duct disease”,“glomus and fullness”, “acid swallowing”, and “vomiting”.

•    病因病机的认识

慢性胃炎的临床症状表现多样,如胃痛,胀满,吞酸,痞满,嗳气等,引起这些不适的病因病
机非常复杂,发病或因情志不畅,郁怒伤肝,木不疏土;或因饮食不节,酒食过度,直伤脾胃;或因素体禀赋不足,加上外邪相干所致等,有关其病因病机的描述亦可见于历代文献,如:《灵枢·小针解》篇云:“寒温不适,饮食不洁,而病于肠胃。”《素问·六元正纪大论篇》说:“木郁之发……故民病胃脘当心而痛,上支两肋,鬲咽不通,饮食不下。”《景岳全书·心腹痛》则认识到“胃脘痛证,乃有因食、因寒、因气不顺者。”李东垣在《脾胃论》中则进一步指出“饮食不洁则胃病,形体劳役则脾病。”《杂病广要·胸痹心痛》中说:“饮食过多,不能克化,伤于胃脘,病根常在,略伤饮食则闷闷作痛。”

1.  Understanding the disease causes and pathomechanisms

The clinical manifestations of chronic gastritis may vary and they include: stomachache, distention and fullness, acid swallowing, glomus and fullness, and belching. The causes and pathomechanisms are very complicated. It may arise from: affect-mind inhibition and depressed anger damaging the liver; thereby, the liver-wood cannot freely course spleen-earth;  dietary irregularities and excessive drinking of liquor; so that the spleen and stomach are damaged directly; or from constitutional insufficiency and invasion of external evil.  Relevant descriptions can be found within the documents of past dynasties. For example, in “Magic Pivot ·Explanation of the Use of Small Needles”, it says, “Excessive cold or warmth, or unclean food may lead to the diseases of the intestines and stomach.” In “Plain Questions ·Great Treatise on the Regular Principles of the Six Origins”, it says, “Depressed wood…will lead to the disease of the stomach duct with heart pains. The throat is blocked and  unable to pass food.” In “Jing Yue’s Complete Compendium ·Heart and Abdomen Pain”, it says, “The symptoms of stomach duct pain may be due to diet irregularities, cold, or Qi stagntion.” Li dong-yuan points out in his treatise “On the Spleen and Stomach”, “unclean foods lead to stomach disease, physical taxation leads to spleen disease.” In “Miscellaneous Diseases·Chest Impediment and Heart Pain”, it says, “Excessive food intake, and the inability to digest, will harm the stomach duct. If this condition lasts for a long time, pain will arise even with a slightly irregular diet.”

尽管慢性胃炎的病因多种多样,病机复杂,但根据《内径》“正气内存,邪不可干”,“邪之所凑,
其气必虚”的发病学原理和《金匮要略》中“若五脏元真通畅,人即安和”,“四季脾旺不受邪”等理论,联系日常临床所见病例,多数学者认为慢性胃炎的病机主要以虚实夹杂,脾胃虚弱为本,邪气干胃为标。

There are various causes and complicated pathomechanisms with chronic gastritis; however, there are some basic principles of pathogenesis and treatment. For example, in “The Yellow Emperor’s Inner Classic”, it relates, “If the upright Qi is internally maintained, then evil cannot invade.” And, “if evil enters the body, the Qi must be vacuous”.  In “ Essential Prescriptions of the Golden Coffer”, it says, “If the true origin of the viscera is unobstructed, the body will be healthy and harmonious”, “evil cannot invade if the spleen is vigorous during the four seasons of the year. Based on these theories and clinical cases, most scholars believe the root cause of chronic gastritis is a vacuity-repletion complex and spleen-stomach vacuity; whereas, the branch is the evil Qi invading the stomach.

•    治疗

目前中医对慢性胃炎的治疗缺乏统一的标准,中医治疗强调审证求因,辨证论治,辨别病症之
虚实寒热。邪盛以驱邪为主,正虚以养胃为主,虚实夹杂者标本兼顾,攻补兼施。笔者结合对慢性胃炎病因病机的认识,联系临床病例认为健脾和胃,补消兼施,调畅肝气,针药结合,综合调理可取得较好的临床疗效。

•    Treatment

Up until now Chinese medicine does not have a standardized treatment for chronic gastritis. What Chinese medicine emphasizes is to assess the patterns and seek the cause to determine the treatment.  If it is due to exuberant evil Qi, the treatment should focus on dispelling evil Qi; if it is due to upright Qi vacuity, the focus will be on nourishing the stomach; if it is vacuity-repletion complex, both the root and branch should be treated by using supplementing and dispersion methods.  The writer believes that in order to achieve good clinical effects, the following combined treatment methods should be utilized: fortify the spleen and harmonize the stomach with simultaneous supplementing and dispersion methods, regulate and open the liver Qi. Treatment should be a combination of acupuncture and herbal medicine.

•    健脾和胃,补消兼施

脾胃为后天之本,脾胃的功能旺盛,则正气易于恢复,疾病易于痊愈,正如李东垣所说“善治
病者,惟在调和脾胃”。李培教授在治疗慢性胃炎方面尤重视健脾,认为健脾则胃安。《素问·阴阳应象大论篇》说:“治病必求于本”,指出治疗疾病时必须究其根本后进行治疗,而本病病久多以脾胃虚弱为主,但纯虚者极少,或多或少都有一些实邪,或气滞,或血瘀,或湿热等证型。故临床治疗本病,即应重视健脾和胃治其本,又应针对不同病邪治其标,或理气,或活血,或清热等治法,使邪去而不伤正。

2.1 Fortify the spleen and harmonize the stomach using both supplementing and dispersion methods

The spleen and stomach are the root of latter heaven. If their function is exuberant, the upright Qi is easy to recover and disease will easily be cured. As Li Dong-yuan says, “good doctors emphasize the regulation of the spleen and stomach”. Professor Li Pei attaches great importance to fortifying the spleen while treating chronic gastritis. According to him, if the spleen is fortified, the stomach will be calm. In “Plain Questions·Great Treatise on the Correspondences and Manifestations of Yin and Yang”, it says, “To treat disease, it is necessary to seek the root”.  Chronic gastritis, in most cases, is due to spleen-stomach vacuity, but very few are due to vacuity alone. More often, the symptoms are combined with some form of repletion evil. It may be Qi stagnation, blood stasis, damp-heat, etc.  Therefore, in clinical treatment, the focus should be to treat the root by fortifying the spleen and stomach. At the same time, the branches should also be treated in accordance with the presenting disease evil, such as regulating the Qi, quickening the blood, clearing the heat, etc.

案  赵某,女,56岁,退休干部,2007年7月9日初诊。患者胃脘部痞满不适,隐隐作痛3
年余,2006年11月曾作纤维胃镜检查,提示为慢性萎缩性胃炎,间断服枸橼酸铋胶囊、胃必治等药,无明显疗效。1周前因操劳过度,胃脘部痞满不适加重,时有烧灼样痛,以解痉药治疗,疼痛虽明显减轻但胃脘部痞满仍在,其他症状也无明显改善。就诊时患者胃脘部痞满不适,时轻时重,隐隐作痛,不思饮食,倦怠乏力,气短懒言,大便溏泄,舌质淡,苔薄白,脉沉弱,轻度贫血貌,心肺无异常,腹软无抵抗及压痛,肝脾未触及,肾区无叩击痛,心电图,大便常规及B型超声波检查无异常,血常规显示血红蛋白 92 g/L,白细胞 4.8×109/L,中性粒细胞 0.65,淋巴细胞 0.35,纤维胃镜检查提示慢性萎缩性胃炎。西医诊断为慢性萎缩性胃炎,中医诊断为痞证,证属脾胃气虚型。治以健脾益气,和胃消胀。方选香砂六君子汤加减。

Case study:

Female, 56 years old. Her first visit to the hospital was July 9, 2007. The patient complained of glomus, fullness, discomfort and dull pain in the stomach duct. This symptom had continued for more than 3 years. It was diagnosed as chronic atrophic gastritis after a stomach fiber endoscopy in November, 2006. She had been continuously taking potassium citrate capsules and gentamycin sulfate injections but without clear results. One week before the first visit,  her condition worsened due to overwork: she experienced increased sensations of glomus, fullness and discomfort in the stomach duct.  At times, she experienced scorching pain. After taking spasmolytics, the pain was greatly alleviated but the glomus remained. Other symptoms showed no improvement.  At the time of examination, she continued to experience intermittent feelings of glomus, fullness and discomfort, and dull pain in the stomach duct. She had no desire for food or drink. She felt tired and a lack of strength. She was short of breath and no interest in speaking. She had sloppy diarrhea. The tongue was pale and the tongue coating was thin and white. The pulses were sunken and weak. She had slight anemia. The heart and lungs were normal.  The abdomen was soft and did not feel pain under pressure. The liver and spleen were not palpated. The kidney area showed no tenderness with applied tapping.  Electrocardiogram, stool, and B-type ultrasonic examinations were all normal.   Hemoglobin was 92 g/L,  leucocyte count was  4.8×109/L,neutrophil count 0.65, and lymphocytes were 0.35.  According to western medicine, following an endoscopy, her symptoms were diagnosed as chronic gastritis. According to Chinese medicine, this was diagnosed as spleen-stomach Qi vacuity. The treatment should be to fortify the spleen, boost the Qi, harmonize the stomach and disperse distension. The formula was Costusroot and Amomum Six Gentlemen Decoction (with additions and subtractions).

处方: 党参15g, 白术15g,茯苓15g,砂仁10g,甘草6g,大枣6枚,神曲10g,麦芽10g,
山药15g,陈皮10g,蒲公英15g,佛手10g,丹参10g。水煎分早晚温服,1剂/d。嘱患者调饮食、畅情志、勿劳累。守方加减4周,患者自觉症状消失,精神饮食均佳。将上方制成胶囊,2粒/d, 3次/d,连服3个月以巩固疗效。停药后随访半年,胃病未复发。

Formula: codonopsis (dang shen) 15g, white atractylodes (bai zhu)15g, poria (fu ling) 15g, amomum (sha ren) 10g, licorice (gan cao) 6g, jujube (da zao) 6 pieces, medicated leaven (shen qu) 10g, barley sprout (mai ya) 10g, dioscorea (shan yao) 15g, tangerine peel (chen pi) 10g, dandelion (pu gong ying) 15g, Buddha’s hand (fo shou) 10g, salvia (dan shen) 10g. To be taken warm in the morning and evening. One formulation a day.

The patient was instructed to regulate food and drink, smooth the affect-mind, and not to overwork. After using a modified version of this formula for 4 weeks,  the patient felt the symptoms disappeared and reported improvement in both spirit and diet.  The patient was advised to continue taking the prescription in capsule form at a dosage of 2 capsules three times per day.  This was repeated for 3 months to secure the effect of the treatment. After 3 months the gastritis had not returned.

按   本方取四君子汤之义加减,注意补益脾胃,并配理气活血之品,诸药合用,共奏健脾益胃,
攻补兼施之效,使补而不滞,正气恢复,邪去而疾病痊愈。较好地体现了健脾和胃攻补兼施在治疗慢性胃炎中的应用。

Note: The formula utilizes a modified Four Gentlemen Decoction. The emphasis is on supplementing and boosting the spleen and stomach.  With the additional herbs, it can also regulate the Qi and quicken the blood. This formula can fortify the spleen, boost the stomach, and simultaneously supplement and attack. It supplements without causing stagnation. It recovers the upright Qi while dispelling evil in order to effectively treat the disease.

•    脏腑相关,注意调肝

慢性胃炎病位虽在中焦,但多累及肝气而成肝、脾、胃3脏之病,故临床不必见肝郁方调肝气,
治疗时可酌情加入疏肝之品,使肝气疏,中气畅,从而脾胃功能正常。刘景龙,赵瑞华等认为采用疏肝和胃法治疗慢性胃炎效果比较明显,肝属木而主疏泄条达,脾胃属土而主运化受纳,肝与脾胃为木土相克之脏,正常情况下,肝之疏泄条达,有利于脾胃消化吸收,即木能疏土。肝之疏泄条达正常,即可助脾运化,使轻阳升发,水谷精微转输上归于肺,又可助胃受纳腐熟,使浊阴之气下降,使食糜不断下达于肠。

•     Chronic gastritis and its relationship with the liver

Although chronic gastritis is located in the central burner, it’s predominant relationship is with the liver Qi.  This combination forms an imbalance of the liver, spleen and stomach. Clinically, the liver Qi should be regulated, even without the symptom of liver depression. In treatment, liver-coursing medicinals can be added to course the liver Qi, and unimpede the central Qi, in order to recover the function of the spleen-stomach . According to Liu Jing-long and Zhao Rui-hua, beneficial effects can be achieved when treating chronic gastritis with the method of coursing the spleen and harmonizing the stomach. The liver belongs to wood, which governs free coursing and orderly reaching. The spleen and stomach belong to earth, which governs movement, transformation and intake. The relationship between the liver and spleen-stomach is that of wood and earth. The normal free coursing and orderly reaching is beneficial to the absorption and digestion of the spleen-stomach. This is what is referred to as “wood courses earth”. This not only can assist the movement and transformation of the spleen, upbear clear Yang, and deliver the essence of grain and water up to the lungs; but, it also may assist the stomach decomposition intake, downbear the turbid Yin, and deliver the chyme down to the intestines.

案  袁某,女57岁,退休教师,2007年7月23日初诊。患者胃脘胀满,反复发作2年,生气及饭后尤著,伴嗳气吞酸,口苦,食欲不振,经多方治疗症状未见好转,面色萎黄,舌淡红,苔薄白,脉弦。此次就诊主因与家人生气后上述症状加重。胃镜提示:慢性浅表性胃炎,幽门螺旋杆菌阳性。中医诊断:胃脘痛,证属肝胃气滞型。治宜疏肝和胃,理气止痛。拟以柴胡舒肝散加减。

Case study:

Female, 57 years old. Her first visit to the hospital was on July 23, 2007. The patient had suffered from gastric distention and fullness repeatedly for two years. It was worsened with anger and especially after dinner. This symptom was also accompanied with belching, acid swallowing, bitter taste, and poor appetite. After multiple treatments there was no improvement in the symptoms.  The patient had a withered-yellow facial complexion; her tongue was pale red; the tongue fur was thin and white; and the pulse was stringlike.  Gastroscopy indicates that her condition is chronic superficial gastritis. Helicobacter pylori was positive. According to Chinese medicine, this was diagnosed as stomach duct pain due to liver and stomach Qi stagnation. The treatment should focus on coursing the liver, harmonizing the stomach, regulating the Qi and relieving the pain. Chai Hu Liver-Soothing Powder was adopted with abductions and subtractions.

处方: 柴胡10g,川芎10g,香附10g,白芍15g,赤芍10g,陈皮10g,枳壳6g,旋覆花10g,神曲15g,麦芽10g,半夏10g,甘草9g。水煎分服,1剂/d。嘱患者调饮食,畅情志,勿劳累。治疗3个疗程后,诸症消失,胃镜提示:未见异常, HP(-)。随访半年未见复发。

Formula: bupleurum (chai hu) 10g, chuan xiong rhizome (chuang xiong) 10g, cyperus (xiang fu) 10g, white peony (bai shao) 15g,  red peony (chi shao) 10g, tangerine peel (chen pi) 10g, bitter orange (zhi ke) 6 g, inula flower (xuan fu hua) 10g, medicated leaven (shen qu) 15g, barley sprout (mai ya) 10g, pinellia (ban xia) 10g, licorice (gan cao) 9g. Take one formula twice a day. The patient was instructed to regulate food and drink, smooth the affect-mind, and not to overwork. After three courses of treatment all of the symptoms disappeared. Gastroscopy indicated no abnormalities. HP was negative.

按  本方取柴胡舒肝散之义加减,有疏肝解郁,消食和中,理气止痛之效。充分体现了调肝可使全身气机畅达,脾胃功能如常。

Note: Chai Hu Liver-Soothing Powder can soothe the liver, resolve depression, disperse food, harmonize the center, regulate the Qi and relieve pain. This case study illustrates that by regulating the liver, the dynamic of the whole body becomes unblocked and the function of the spleen-stomach return to normal.
•    针药结合 内外同治

针灸疗法为外治法,通过腧穴经络对胃病起调节作用;而内服中药汤剂为内治法,直接对胃腑
起调节作用,两者结合运用可提高疗效,使中药治疗慢性胃炎的特色更加突出。饶燕认为采用针灸治疗慢性胃炎亦能收到良好疗效,通过调节神经通路,提高免疫功能。童春泉等认为可以通过穴位埋线治疗消化溃疡,且远期疗效和安全性较高。临床应用时应综合分析四诊材料,作出正确的诊断和辨证分析,确立正确的疗法,选择正确的方药和穴位,使针药有机结合。

•    Combination of Acupuncture and herbal medicine and the simultaneous treatment of internal and external

Acupuncture is an external method of treatment which works on stomach disease through acupoints and network vessels. Chinese herbal medicine is an internal method of treatment which regulates the stomach directly. Increased results can be achieved by combing these two methods.  However, according to Rao Yan, beneficial results may also be achieved by utilizing acupuncture as a single treatment method.  Immune functions may be improved by regulating the nervous system. According to Tong Chun-quan, in treating peptic ulcer, it is safer to utilize “threaded acupuncture”  which is capable of achieving longer lasting effects. Clinically, it is important to make the correct diagnosis and implement the appropriate method of treatment.

案  李某,女,42岁,2007年9月11日初诊。患者诉胃病史3年,3年前因饮食不节,冒雨露宿,随即脘腹胀闷,隐痛时作,大便溏薄,四肢乏力。1年前在某医院胃镜检查诊断为慢性浅表性胃炎,曾服用“雷尼替丁”、“吗丁啉”、“枸橼酸铋胶囊”、“胃必治”等西药,效果不明显。遂于2007年9月11日来我院就诊。诊见胃脘隐痛,喜按,脘胀痞闷,嗳气便溏,时欲呕恶,面色少华,自觉肢冷,舌淡苔白,脉沉细。中医诊断:胃脘痛,证属脾胃虚寒。治宜温阳祛寒,燥湿健脾。以附子理中丸内服配合针灸治疗。附子理中丸,6g/次,每日早晚饭后温开水送服。嘱患者调饮食、畅情志、勿劳累。配合针灸足三里、中脘、章门、关元等穴,以补法为主,一次/d,7次为一个疗程。治疗3个疗程后患者胃脘疼痛消失,大便正常,痞闷减轻,面色转润,精神饱满。续服上药3个疗程以巩固疗效。2008年1月6日胃镜复查显示上消化道未见明显异常。后随访3个月未见复发。

Case study:

Female, 42 years old. The patient’s initial visit was on September 11, 2007. She had suffered from stomach problems for three years. Three years prior, due to dietary irregularities and camping in the rain, she began to feel distention and oppression in the stomach duct and abdomen. She experienced frequent attacks of dull pain. She had thin stools and fatigued limbs. The previous year, her condition was diagnosed as chronic superficial gastritis with a gastroscopy exam. She took ranitidine, domperidone, potassium citrate capsules, gentamycin sulfate injections without obvious effects. The following symptoms were present at the time of examination: dull pain in the stomach duct which is improved with pressure, distention and oppression in the stomach duct, belching, sloppy stool,  frequent sensations of nausea and vomiting, lusterless facial complexion, and cold limbs.  The tongue was pale and the tongue coating was white.  The pulse was fine and sunken.  The Chinese medicine diagnois was stomach duct pain due to spleen-stomach vacuity cold. The treatment focus is to warm the Yang, dispel cold, dry dampness and fortify the spleen. Aconite Center-Rectifying Pill was prescribed, combined with acupuncture. The patient was advised to take 6g of Aconite Center-Rectifying Pill twice a day, mornings and evenings. She was further directed to regulate food and drink, smooth the affect-mind, and not to overwork.  The acupoints used were: Leg Three Miles (ST-36, Zu San Li), Central Stomach Duct (CV-12, Zhong wan), Camphorwood Gate (LV-13, Zhang men), and Pass Head (CV-4, Guan yuan). The primary method of acupuncture was supplementation, and was performed once per day.  One course of treatment consisted of seven treatments.  After three courses of treatment , the stomach duct pain disappeared, the stool was normal, the oppression in the spleen was alleviated, the facial complexion turned moist, and the patient was full of vigor. Three more courses of treatment were added to secure the treatment. On January 6, 2008, a follow up gastroscopy exam showed no abnormalities were found in the upper gastrointestinal tract.

按  附子理中丸取干姜、附子温中散寒以助阳,白术健脾燥湿,人参大补元气以助运化,甘草和中益气。此方可使中焦之寒得辛热而去,虚证得甘温而复,清阳升,浊阴降,运化健而中焦治,加之关元及元气所聚,中脘、章门乃脾胃之募穴,足三里乃足阳明合穴具较强保健之功,针药结合治疗,取其温补而不滞,行气而不散,从而脾胃阳气得复,寒湿得除,由此标本兼顾,正得复,邪得除。另外,李燕认为附子理中丸还可治疗功能性消化不良,附子理中丸对于消化不良导致的慢性胃炎亦能收到良好疗效。

Note:

In the formula of Aconite Center-Rectifying Pill, dried ginger (gan jiang)  and aconite (fu zi) can warm the center and dispel cold to assist the Yang. White atractylodes (Bai zhu) can fortify the spleen and dry dampness. Ginseng (Ren shen) can greatly supplement the original Qi of the body so as to aid movement and transformation. Licorice (Gan cao) can harmonize the center and boost the Qi. In this formula, the cold in the middle burner is dispelled by warm medicinals, the vacuity pattern is treated with warm and sweet medicinals.  When the clear Yang upbears and the turbid Yin downbears, movement and transformation is strengthened, thereby, harmonizing the middle burner. In addition, Pass Head (CV-4, Guan Yuan) is the gathering point of the original Qi, Central Stomach Duct (CV-12, Zhong wan) and Camphorwood Gate (LV-13, zhang men) are the front-mu points of the spleen and stomach,  Leg Three Miles (ST-36, Zu san li) is the uniting point of the foot Yang brightness. Needling these points will have a strong effect on the overall health of the body.  Acupuncture and herbal medicine are used in combination to warm and supplement without stagnating, and to move the Qi without dispersing; thereby, the Yang Qi of the spleen-stomach can be recovered and cold-damp can be dispelled. By treating both the root and branch, the upright Qi can be recovered and evil eliminated. Furthermore, according to Li Yan, Aconite Center-Rectifying can also treat functional indigestion leading to chronic gastritis.

•    结语

慢性胃炎按新悉尼系统的分类方法可分为浅表性、萎缩性和其他特殊类型的胃炎。目前公认的幽门螺旋杆菌感染是慢性胃炎的最主要病因,在治疗方面西医多采取三联疗法根除幽门螺旋杆菌,并配合改善消化系统的药物,如胃肠动力药、抑酸或抗酸药等,虽已取得一定临床疗效,但其服药时间长,且症状可能反复出现,很难达到理想的治疗目标。中医药在治疗慢性胃炎上有其独特优势,在中医基本理论和辨证论治思想的指导下,结合本病的病因病机和病人情况的不同,运用中医经方,以顾护胃气为本,祛除病因为标,注意肝气条达,针药结合,灵活地进行辨证论治,可取得满意的疗效。另外慢性胃炎经过治疗后,病情得以控制,若疾病处于缓解或初愈阶段,此时机体尚处于待恢复状态,胃的功能尚未健全,生活起居如有不慎,亦有复发之虞,所以预防复发也是十分重要的。
贾凤云认为慢性胃炎的发病与情志、饮食等密切相关。殷艳认为慢性胃炎愈后的饮食保健亦是非常重要的,因此预防慢性胃炎复发的措施应当是综合的,除饮食调养、起居调节、精神调摄、加强体育锻炼外,还应慎用对胃黏膜有损害的药物,并可结合药膳以继续改善和加强脾胃的功能,促进体内脏腑机能的恢复,增起御病之“正气”,以使“正气存内,邪不可干”。中医治疗有具有副作用小,疗效显著,经济实惠等优势,容易被患者接受,故具有极为广阔的临床应用前景。

•    Conclusion

According to the New Sydney System, chronic gastritis is classified as: superficial gastritis, atrophic gastritis and special type gastritis. Nowadays, it is commonly agreed that the main cause of chronic gastritis is Helicobacter pylori.  In treatment, Western medicine generally adopts a triple therapy method to root out helicobacter pylori. Other medicinals are added to improve the digestive system, such as gastrointestinal drugs and antacids. This works to some extent, but it’s hard to achieve ideal effects because the course of treatment is long, and the symptoms may relapse again and again. Chinese medicine has a unique advantage in treating chronic gastritis. Under the guidance of  basic Chinese medicine theory and the practice of identifying patterns to determine treatment, satisfactory effects can be achieved.  The root treatment is to protect the stomach Qi; and the branch treatment is to eliminate causitive disease factors. In addition, once the condition is under control, it is important to prevent relapse by keeping in mind, the patient is still in a period of recovery and the function of the stomach is still not completely recovered.

According to Jia Feng-yun, the onset of chronic gastritis is closely related with the affect-mind and diet. According to Yin Yan, it is very important to pay close attention to the diet and health care after treatment. The measures to prevent the relapse should be comprehensive: regulating diet, daily life, physical activity and the mental spirit; the patient should also be careful not to take substances that are harmful to the gastric mucosa.   Medicinal food may also beneficial to improve the function of the spleen and stomach and help recover the function of the internal organs. Chinese medicine has a significant effect in treating chronic gastritis with fewer side effects, and for some, may be economically more viable. Therefore, it is widely accepted by patients and has a broad perspective in it’s clinical application.

中医中药与针灸治疗脱发150 例 – Fu Mei-hua’s Treatment of 150 Cases of Hair Loss with Herbs and Acupuncture

中医中药与针灸治疗脱发150 例 – Treatment of 150 Cases of Hair Loss with Herbs and Acupuncture

富梅华
Translated by Xu Zhi-jun & J. Heaverlo

关键词: 中医中药;针灸;脱发
Key words: Chinese medicine; herbs; acupuncture; hair loss

现代医学将脱发分为斑秃、脂溢性脱发、症状性脱发等多种。中医学也有很多记载,如隋代《诸病源候论》称为“鬼舔头”;明代《外科正宗》有油风记载。症状性脱发从中医理论来看,也属于油风范畴,其病因不同,但治疗上有相同的地方。笔者用中医药、针灸治疗脱发150例,疗效显著,现报告如下。

Modern medicine classifies hair loss into many various types; such as alopecia areata, seborrheic alopecia, and symptomatic alopecia. There are also numerous accounts of hair loss in the Chinese medicine classics. For examples, hair loss is called “demon-licked head” in “The Origin and Indicators of Diseases” of the Sui Dynasty. It is recorded as “oil wind hair loss” in “Orthodox Manual of External Medicine” of the Ming Dynasty. According to Chinese medicine theory, symptomatic alopecia should be categorized into “oil wind hair loss”. Although the disease pathomechanisms may vary, there are commonalities within the treatments. The author has treated 150 cases of hair loss with herbs and acupuncture, and achieved notable results. The following is a report of his findings.

•    一般资料

150例患者中男性80例,女性70例,年龄11-46岁。

1. General information
Among the 150 cases, there are 80 males and 70 females. The age ranges from 11 to 46.

•    治疗方法

2.1 中药治疗:健脾祛湿、清利湿热、养血生发为主:白术12g、茯苓12g、泽泻12g、生薏米30g、 升麻12g、丹皮12g、当归12g、川芎12g、鸡血藤15g、干生地12g、熟地12g、柴胡12g、首乌12g、焦三仙45g. 每日一剂,每日二次。湿服;如皮脂溢出过多者加赤石脂12g、侧柏叶12g、猪苓12g;如腰腿酸软、遗精盗汗、夜寐不安,加龙骨12g(先煎) 、牡蛎12g(先煎) 、乌梅12g;气虚加黄芪20g;如突然大把脱落,急躁易怒,加女贞子12g、旱莲草12g、钩藤12g等进行辩证论治。

2. Treatment

2.1 Herbs-  The therapy focuses on the following treatment methods: fortify the spleen, dispel dampness, clear heat, nourish the blood and promote hair growth.
White atractylodes (bai zhu) 12g,  poria (fu ling) 12g,  alisma (ze xie) 12g, coix (yi mi ren) 30g, cimicifuga (sheng ma) 12g, moutan (mu dan pi) 12g, Chinese angelica (dang gui) 12g, chuanxiong rhizoma (chuan xiong) 12g, spatholobus (ji xue teng) 15g, dried rehmannia (sheng di huang) 12g, cooked rehmannia (shu di huang) 12g, bupleurum (chai hu) 12g, flowery knotweed (shou wu) 12g, scorch-fried three immortals (jiao san xian) 45 g.   Cook one dose a day and take twice while it is warm.

If there is too much seborrheic production, add happoysite (chi shi zhi) 12g, arborvitae leaf (ce bai ye) 12g, and polyporus (zhu ling) 12g.

If the patient has lumbar soreness and/or leg achiness, seminal emissions, night sweating, and restless sleep, add dragon bone (long gu) (predecocted) 12g, oyster shell (mu li): 12g (predecocted), and mume fruit (wu mei) 12g.

If the patient has Qi vacuity, add astragalus (huang qi) 20 g.

If there is great hair loss with irritability add ligustrum (nu zhen zi) 12g, eclipta (han lian cao) 12g, and uncaria (gou teng) 12g.

•    针灸法:以养血活血祛风、健脾祛湿生发为主:选穴:百会、风池、足三里、血海、
神门、内关。操作方法:以虚补实泻法针刺,除肝俞、肾俞针刺用补法外,其余配穴按实泄法针刺。

2.2    Acupuncture treatment principles are: quicken the blood, dispel wind, fortify the spleen, dispel dampness, and promote hair growth.

Selection of acupuncture points: GV-20 (one-hundred convergences), GB-20 (wind pool), ST-36 (Leg Three Li), SP-10 (sea of blood), HT-7 (spirit gate), and PC-6 (inner pass).

Manual needling methods should be used to supplement vacuity and drain repletion. Use supplementation method on BL-18 (liver transport) and BL-23 (kidney transport). Use draining method on all other points.

•    疗效标准

痊愈:脱发症状消失,脱发试验阴性;好转:脱发症状减轻,脱发试验阳性;无效:
脱发症状未减,脱发试验阳性。

•    Standard of Curative Effect

Full recovery: the symptom of hair loss disappears, and the test result is negative;
Improvement: the symptom of hair loss is alleviated, and the test result is positive;
No effect: the symptom of hair loss remains the same, and the test result is positive.

•    治疗结果

痊愈140例,好转9例,无效1例。

•    Therapeutic effect:

Full recovery: 140 cases;
Improvement: 9 cases;
No effect: 1 case.

•    病例

王某,男,37岁,脱发2个月,患者自述平素工作紧张,平时皮脂溢出过多。 查:脱
发试验阳性,头皮瘙痒,毛发稀疏,头油多,精神欠佳,神疲乏力,夜寐不安,二便正常,舌淡苔白,脉眩滑。诊断:中医:油风(脾虚蕴湿,湿热互结);西医:脂溢性脱发。治疗以健脾祛湿,清利湿热,养血生发为主。处方:生白术12g、茯苓12g、生薏米30g、川皮解15g、车前子15g、泽泻15g、当归12g、首乌12g、川芎12g、黄芪20g、乌梅20g、羌活12g、升麻12g、黄芩10g、黄连12g、龙骨12g先煎、牡蛎12g、枳壳12g、丹皮12g、焦山楂15g、炒麦芽15g。水煎400ml,每次200ml,早晚两次湿服。配合针灸选穴:百会、风池、三阴交、足三里、血海、神门、内关、肝俞、肾俞、按虚补实泻法针刺,每日一次,治疗3d,症状有所减轻;患者腰酸,头晕,故原方加赤石脂12g、侧柏叶12g、枳壳12g、灸山芋12g,以助除湿行气、补益肝肾。按以上方法治疗22d,症状全部消失,随访三个月,未复发,告痊愈。

5. Case Study

Examination:  Mr. Wang is 37 years old. He has been experiencing hair loss for two months. His work is very stressful. He has a considerable amount of seborrheic production. The test for hair loss is positive. His symptoms include itchy scalp, scant hair, and excessively oily hair. He appears listless, has a lack of strength, and restless sleep. His stool and urine are normal. His tongue is pale with a white tongue fur. His pulse is stringlike and slippery.

Chinese medicine diagnosis: :  “Oil wind hair loss” due to spleen vacuity and damp-heat binding.

Western medicine diagnosis: seborrheic alopecia.  TCM treatment principles should be: fortify the spleen, dispel dampness, clear heat, disinhibit dampness, nourish the blood, and promote hair growth.

Therapy: fresh white atractylodes (sheng bai zhu) 12g, poria (fu ling) 12g, coix (yi mi ren) 30g, rhizoma dioscorea (bi xie) 15g, plantago seed (che qian zi) 15g, alisma (ze xie) 15g, Chinese angelica (dang gui) 12g, flowery knotweed (shou wu) 12g, chuanxiong rhizoma (chuan xiong) 12g, astragalus (huang qi) 20g, mume fruit (wu me) 20g, notopterygium (qiang huo) 12g, cimicifuga (sheng ma) 12g, scutellaria (huang qin) 10g, coptis (huang lian) 12g,  dragon bone (long gu) (predecocted) 12g oyster shell (mu li) 12g, bitter orange (zhi ke) 12g,  moutan (mu dan pi) 12g, scorch-fried hawthorne fruit (jiao shan zha) 15g, stir-fried barley sprout (chao mai ya) 15g.

(Combine herbs and 1200 ml of water).  Decoct in water until 400 ml. remain. Drink 200 ml twice per day.  Drink once in the morning and once in the evening.  Should be consumed warm.

Acupuncture treatment was used in combination. Selections of acupuncture points: GV-20 (hundred convergences), GB-20 (wind pool), ST6 (three Yin intersection), ST-36 (Leg Three Li), SP-10 (sea of blood), HT-7 (spirit gate), and PC-6 (inner pass), BL-18 (liver transport) and BL-23 (kidney transport). Manual needling methods used should be supplement vacuity and drain repletion. Acpuncture is performed once a day.

After 3 days of treatment, the symptoms were alleviated to some extent. The patient also had sore and aching low back and dizziness.  Therefore additional herbs were utilized.  Additions include: halloysite (chi shi zhi) 12g, arborvitae leaf (ce bai ye) 12g,  mix-fried dioscorea (zhi shan yu) 12g.  These additions may help dispel dampness, move the Qi, supplement the liver and kidney.

The symptom completely disappeared after 22 days of treatment.   After 3 months, the symptoms had not returned.

•    讨论

皮肤病虽发于皮肤,但常是和内脏有密切的联系,有诸内必形于外,运用中医理论,
对疾病进行综合分析、归纳、总结,找出皮肤病与肌体内脏的关系,正确的辩证施治,是治疗皮肤病的关键。方中白术、茯苓、生薏米、生侧柏、赤石脂、枳壳、川皮解、车前子、泽泻,健脾行气除湿;升麻、龙骨、牡蛎、乌梅、以收敛固涩、升阳安神、益精开胃;当归、川芎、鸡血藤、首乌、黄芪、丹皮益气养血活血,祛瘀生新;黄芩、黄连清热燥湿,清上焦头目之热;灸山芋补益肝肾;山楂、炒麦芽调理脾胃功能,使枢机功能得以改善;配合针灸针刺,疏通经络,调理脾胃肝肾功能。综观,使气血大和,毛发得以精血充养,则诸症消失。可见中药,针灸联合治疗脱发,疗效快,复发率低。

•    Discussion:

Although skin diseases manifest on the skin, they are often closely related with the viscera. According to Chinese medicine theory, the key to treating skin diseases is to find the relationship between the disease and the viscera, and then to administer treatment according to the pattern. In the therapy, atractylodes (bai zhu), poria (fu ling), coix (yi mi ren), arborvitae leaf (ce bai ye), halloysite (chi shi zhi), bitter orange (zhi ke), rhizoma dioscorea (bi xie), plantago seed (che qian zi), and alisma (ze xie) can fortify the spleen, move the Qi and dispel dampness. Cimicifuga (sheng ma), dragon bone (long gu), oyster shell (mu li), and mume fruit (wu mei) can astringe and secure, upbear the Yang, quiet the spirit, boost the essence and increase the appetite. Chinese angelica (dang gui), rhizome chuanxiong (chuan xiong)  spatholobus (ji xue teng), flowery knotweed (shou wu), astragalus (huang qi), and moutan (mu dan pi) can boost the Qi, nourish and quicken the blood, dispel stasis, and engender the new. Scutellaria (huang qin) and coptis (huang lian) can clear heat, dry dampness, and clear  heat on the head and eyes. Mix-fried dioscorea (zhi shan yu) can supplement the liver and kidney. Hawthorne fruit (shan zha) and stir-fried barley sprout (chao mai ya) can regulate the stomach.   Acupuncture can free the channels, and regulate the spleen, stomach, liver and kidney. The overall effect is to greatly harmonize the Qi and blood so that the hair can be nourished by the essence and blood.