刘涛+张霞+魏玮

摘要：慢性萎缩性胃炎（chronic atrophic gastritis，CAG）是胃癌前疾病，积极防治本病可预防胃癌的发生。中医治疗本病有较大优势。CAG病程长，应辨病与辨证相结合，宏观与微观辨证相补充，以“脾虚寒热瘀毒互结”为基本病机，立“平调寒热，补脾益胃，祛瘀解毒”为基本治法，以法制方，随证用药，阻断或逆转CAG进展，防止胃黏膜炎癌转化。

关键词：慢性萎缩性胃炎；脾虚寒热瘀毒互结；平调寒热；病机

DOI：10.3969/j.issn.1005-5304.2018.02.029

中圖分类号：R274.915.31 文献标识码：A 文章编号：1005-5304（2018）02-0124-03

Diagnosis and Treatment Based on Syndrome Differentiation for CAG Based on

Spleen Deficiency， Cold-heat and Stasis Toxin

LIU Tao1， ZHANG Xia2， WEI Wei1

1. Wangjing Hospital， China Academy of Chinese Medicial Sciences， Beijing 100102， China；

2. Medical College of Datong University， Shanxi 037000， China

Abstract： Chronic atrophic gastritis （CAG） is pre-cancerous condition of gastric cancer. The active treatment for CAG can help with prevention of gastric cancer. TCM has superiority in efficacy for this disease. CAG is the chronic disease with long duration and generally slow progression. Treatment according to syndrome differentiation and symptom differentiation should be combined， and macrocosm and microcosm differentiation should be supplemental. The basic pathogenesis of CAG is mutual acting of “spleen deficiency， cold-heat and stasis toxin”. In view of the above， “regulating cold and heat， replenishing spleen and stomach， removing the blood stasis and detoxifying the toxin” should be set as basic treatment method， formulating principle of prescriptions and medicating according to syndromes， which cans top or reverse the progression of CAG and prevent the transformation from CAG to gastric cancer.

Keywords： chronic atrophic gastritis； spleen deficiency， cold-heat and stasis toxin； regulating cold and heat； pathogenesis

慢性萎缩性胃炎（chronic atrophic gastritis，CAG）是以胃黏膜上皮和腺体萎缩、数目减少，黏膜变薄，黏膜肌层增厚，或伴幽门腺和肠腺化生，或有异型增生为特征的慢性消化系统疾病。其癌变以肠型胃癌为主，与肠上皮化生、异型增生有关[1]。Correa P等[2]提出的肠型胃癌癌变模式为目前所公认，即正常胃黏膜→浅表性胃炎→慢性萎缩性胃炎→肠化生→异型增生→肠型胃癌。由于现代医学治疗的5年生存率低，因此，在胃炎癌转化的关键阶段——慢性萎缩性胃炎时期进行干预，可预防胃癌的发生。

CAG属中医“胃脘痛”“痞满”“嘈杂”“吐酸”等范畴。其病机复杂，临床常见本虚标实，寒热夹杂。现代医学治疗尚无有效方法，而中医在改善患者临床症状、延缓甚至逆转胃黏膜萎缩癌变进程方面疗效确切。笔者现基于“脾虚寒热瘀毒互结”的认识，就CAG辨治探讨如下。

1 注重寒热平调，调畅气机

脾与胃相表里，同居中焦，胃主受纳，脾主运化，胃主降，脾主升，脾升则水谷精微得以输布，胃降则水谷及其糟粕才能下行，故《临证指南医案》有“脾宜升则健，胃宜降则和”。……