基于“因虚致郁”理论探讨胃食管反流病的病机与治法

Exploration of the Pathogenesis and Treatment of Gastroesophageal Reflux Disease Based on the Theory of "Stagnation Due to Deficiency"

摘要:

本文基于“因虚致郁”理论，探讨胃食管反流病的发病机制，认为该病的发生与脾胃虚弱密切相关。脾胃气虚为胃食管反流病的发病之本，气机郁滞为病变之枢，胃气上逆为致病之标。GERD病程迁延，常虚实夹杂，病程演变遵循“由虚致郁、因郁生实、虚实夹杂”的阶段性规律，可分为初期、中期、后期三个阶段。在临床实践中，应结合患者具体病情，分期论治。初期病机以脾虚湿盛为主，治疗当以健脾益气固其本，兼顾芳香化湿；中期呈现土虚木郁、痰气交阻之象，虚实夹杂，治疗宜疏肝健脾、理气化痰，以调畅病变之枢；后期郁久化火、胃气上逆，标实症状突出，治疗需以降逆和胃、清热化痰为主，以治其标。整个治疗过程中，需始终顾护脾胃功能，调畅全身气机，实现标本兼顾、扶正祛邪的治疗目标。

Abstract:

Abstract： Based on the theory of "stagnation due to deficiency， " this paper explores the pathogenesis of gastroesophageal reflux disease （GERD） and proposes that the onset of GERD is closely related to spleen and stomach deficiency. Spleen and stomach qi deficiency is considered the root cause of GERD，qi stagnation serves as the pivotal mechanism of pathological changes，and adverse rising of stomach qi represents the manifestation of the disease. GERD has a prolonged course，often characterized by deficiency interwoven with excess syndrome. The progression of GERD follows a staged pattern of "stagnation due to deficiency， stagnation generating excess， and excess interwoven with deficiency， " which can be divided into three stages： early， middle， and late. In clinical practice， stage-specific treatment should be adopted according to the individual condition. In the early stage， the pathogenesis is mainly characterized by predominant dampness due to spleen deficiency. Treatment should focus on strengthening the spleen and reinforcing qi to support healthy qi，while also incorporating aromatic herbs to transform dampness. In the middle stage，the condition presents as earth deficiency with wood stagnation，complicated by internal block and accumulation of phlegm and qi，reflecting deficiency interwoven with excess syndrome. Treatment should focus on soothing the liver， fortifying the spleen， regulating qi， and resolving phlegm to address the pivotal mechanism. In the late stage， prolonged stagnation transforms into fire， with adverse rising of stomach qi， giving prominence to excess manifestations. Treatment should focus on descending adverse flow of qi，harmonizing the stomach，clearing heat，and resolving phlegm to address the manifestations. Throughout the entire treatment process，attention must be consistently paid to protecting and nurturing the normal functions of the spleen and stomach，regulating systemic qi dynamics，to achieve the therapeutic goals of addressing both root and manifestation， and supporting healthy qi while eliminating pathogenic factors.