赵帅 周正华 王威

〔摘要〕 胃食管反流病的致病因素繁杂，肝、脾、肺功能失调导致湿阻气滞是出现反酸、烧心等症状的核心病机。临床根据不同病位分别选用平胃散苦温燥脾湿、加减小陷胸汤苦寒燥胃湿、上焦宣痹汤沉降利肺气、芳香之品醒脾运中气、以及辛散风药燥湿疏肝气，运用上述5种燥湿行气法治疗胃食管反流病收效显著，可在较短时间内恢复患者健康。

〔关键词〕 胃食管反流病;燥湿;行气;肝;脾;肺

〔中图分类号〕R256.3       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.10.022

Discussion on the Application of the Method of Drying Dampness and Promoting Qi in Gastroesophageal Reflux Disease From the Perspective of “Liver， Spleen and Lung”

ZHAO Shuai， ZHOU Zhenghua*， WANG Wei

（First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research

Center for Chinese Medicine Acupuncture and Moxibustion， Tianjin 300381， China）

〔Abstract〕 The pathogenic factors of gastroesophageal reflux disease are complex. The core pathogenesis of pantothenic acid， heartburn and other symptoms is dampness stagnation and Qi stagnation caused by dysfunction of liver， spleen and lung. From different disease location， choosing Pingwei Powder bitter and warm to dry spleen dampness， modified Xiaoxian Xiong Decoction bitter and cold to dry stomach dampness， Shangjiao Xuanbi Decoction sinking and falling to benefit lung-Qi， aromatic products to awaken spleen and transport middle Qi， wind-expelling drugs pungent and emission to dry dampness and soothe liver. The five methods of drying dampness and promoting Qi had significant effect on gastroesophageal reflux disease and could restore the health of patients in a short time.

〔Keywords〕 gastroesophageal reflux disease; drying dampness; promoting Qi; liver; spleen; lung

胃食管反流病（gastroesophageal reflux disease， GERD）是由多种因素导致胃、十二指肠内容物反流入食管，进而发生反酸、胸骨后灼烧感的一种消化系统常见疾病[1]。西医治疗主要采用质子泵抑制剂（proton pump inhibitor， PPI）、H2受体拮抗剂、促动力剂等，复发率高，效果欠佳[2]。中医学将其归属于“吞酸”“嘈杂”“反胃”“胃痞”等范畴。又因其病位在食管，故可将其归属于“食管瘅”的范畴[3]。笔者认为湿阻气滞是肝、脾、肺气机升降失调引发GERD的共有病机，临床灵活运用燥湿行气法治疗GERD收效迅速，不易反复，值得进一步研究与讨论，本文从“肝脾肺”多角度解析燥湿行气法在GERD中的具体应用。

1 胃、食管与肝、脾、肺三脏的生理联系

1.1  脾与胃、食管的联系

脾足太阴之脉，络胃上膈，解剖上脾与胃同膜相连，二者经络互系，脏腑相依。《经络汇编·脏腑联络分合详说》中述：“咽名咽门，其管柔空，其软若皮，下接胃本……此食管也”，脾脏与食管通过咽门经络互属;功能上脾主运化，散精润养肌肉百骸，故食管的平滑肌亦属脾脏管辖，脾气健旺则食管蠕动规整有力，通降正常，胃纳水谷继而生精输脾，形成脾胃食管的良性循环，完成水谷精微的转化与利用。