何友成 骆云丰 杨正宁 孙月明 方文怡 黄铭涵

〔摘要〕 慢性萎缩性胃炎（chronic atrophic gastritis， CAG）是一种多致病因素性疾病及癌前病变，国医大师杨春波擅长脾胃相关疾病的诊治。杨老师认为，CAG以脾虚为本，湿热为标，气滞络瘀是其重要病理环节，此外还需详辨寒热变化。临证时，重视参伍舌象，注重把握证候虚实主次关系。治疗上，立理脾固本、清化湿热、平调寒热、调气舒络为常用治法。结合杨老师治疗CAG的验案，阐述杨老师辨治CAG的临证思路，以期对临床诊治有所启发。

〔关键词〕 慢性萎缩性胃炎;脾虚;湿热;络瘀;名医经验;杨春波

〔中图分类号〕R256.3;R573.3+2       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.07.001

〔Abstract〕 Chronic atrophic gastritis （CAG） is a disease with multiple pathogenic factors and precancerous lesions. The master of Chinese medicine Yang Chunbo is good at diagnosis and treatment of spleen and stomach related diseases. Teacher Yang believes that CAG is based on spleen deficiency， dampness and heat as the treetop， Qi stagnation and collateral stasis are important pathological links. In addition， it is necessary to distinguish cold and heat changes in detail. In clinical syndrome， he thinks attention should be paid to the tongue image and the primary and secondary relationship between deficiency and real syndrome. In the treatment， Yang takes regulating the spleen and strengthening the foundation， clearing away dampness and heat， regulating cold and heat， regulating Qi and dredging collaterals as the common treatment methods. Combined with Yang's experience in treating CAG， this paper expounds Yang's clinical thinking of differentiation and treatment of CAG， in order to enlighten the clinical diagnosis and treatment of this disease.

〔Keywords〕 chronic atrophic gastritis; spleen deficiency; damp-heat; collateral stasis; experience of famous doctors; Yang Chunbo

慢性萎縮性胃炎（chronic atrophic gastritis， CAG）是慢性胃炎的一种类型，是指胃黏膜上皮遭受反复损害导致固有腺体的减少，伴或不伴肠腺化生和（或）假幽门腺化生的一种慢性胃部疾病[1-2]。经典的炎-癌转化模型，即“正常胃黏膜—非萎缩性胃炎—萎缩性胃炎—肠上皮化生—异型增生（上皮内瘤变）—胃癌”，是目前学术界普遍认可的胃癌演变模式[3-4]。因此，作为胃癌演变进程的重要阶段，CAG是胃癌二级预防的重点[5-7]。杨春波教授为第三届国医大师，从事消化系统疾病临床、教学、科研研究六十余载，尤擅CAG的中医辨治。兹述管窥如下，以期对临床辨治CAG有所裨益。

1 病机阐幽

杨老师认为，CAG中医病机以脾虚为本、湿热为标，复有寒热因素。同时，气滞络瘀也是CAG重要的中医病理特征。

1.1  脾虚为本

CAG临床表现与内镜下及其病理严重程度并无明显相关性，起病隐缓、病程漫长，这也为诸多内外致病因素长期、隐匿损伤脾胃提供了重要条件。……