中医处方治疗胃食管反流病的临床疗效探讨

The combined therapy of <i>huazhuo jiedu jiangni</i> decoction and acupuncture achieve the definite therapeutic effects on reflux esophagitis, relieve the symptoms, protect gastric mucosa and reduce the.

Gastroesophageal reflux disease (GERD) and bile reflux gastritis (BRG) are common gastrointestinal (GI) disorders with unmet medical needs. Traditional Chinese medicine has long been used for the treatment of GERD and BRG whereas the ginger-containing formula Wendan decoction (WDD) targets homeostatic disturbances characterized by "reflux" and "gut-juice exposure" problems. Here we used WDD as a therapeutic tool to unravel the common pathogenesis of GI reflux disorders. Control clinical trials reporting the WDD-treated patients with GERD and BRG were included in this systematic review and meta-analysis. Outcome measurements were clinical efficacy defined by symptom relief with normal GI endoscopy, radiology, and pathology. Eventually, 33 studies involved 3253 participants (1351 vs. 1035 of the BRG in 20 publications, 449 vs. 418 of the GERD in 13 studies, and 194 vs. 159 of relapse rate in 6 trials). Pooled data showed a consistent therapeutic efficacy of WDD on BRG (OR = 6.00, 95%C = 4.68-7.69) and GERD (OR = 4.39, 95%CI = 2.72-7.07). The relapse rate was 12.4% for WDD, significantly lower than 44.0% for conventional therapies (OR = 0.14, 95%CI = 0.08-0.26). The consistent therapeutic efficacy of the single TCM formula on GERD and BRD indirectly indicates reflux as a common pathogenesis in reflux-associated GI disorders.

Gastroesophageal reflux disease (GERD) has a high prevalence worldwide. Li <i>et al</i> performed a well-designed study on the efficacy of modified Xiaochaihu decoction (MXD) for GERD, which showed that MXD is an optional therapy for GERD beyond proton pump inhibitors (PPIs). The herbal granule administration mode minimized the bias from traditional herbal formula in clinical trials. One limitation of that study was that it lacked records of side effects and rescue medication. As a chronic disease with recurrent symptoms, GERD rehabilitation requires prolonged observation of the clinical course with MXD therapy.

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Objective To investigate the effect of combined use of acupuncture and medicine on plasma gastrin and motilin in reflux esophagitis patients. An acupuncture-medicine group of 30 patients was treated with acupuncture and Chinese herbal medicine for lowering the adverse flow of qi. A Chinese herbal medicine group of 30 patients was treated with Chinese herbal medicine for lowering the adverse flow of qi. An acupuncture group of 30 patients received acupuncture. A Western medicine group of 30 patients took omeprazole enteric-coated capsules. All the four groups were treated for 60 days as one course. The indices were examined after one course of treatment. All the patients were not given other medicines for gastropathy during treatment. Results There were no statistically significant pre-treatment differences in plasma gastrin and motilin levels among different groups of patients (P0.05). Plasma gastrin and motilin levels increased significantly in each group after treatment compared with before (P0.01). After treatment, plasma gastrin and motilin levels were significantly higher in the acupuncture-medicine group than in the Western medicine and Chinese herbal medicine groups (P0.05).Conclusion Combined use of acupuncture and medicine can significantly raise plasma gastrin and motilin levels, regulate gastroesophageal motility, increase lower esophageal sphincter pressure and prevent food regurgitation in reflux esophagitis patients.

Background: Reflux esophagitis (RE) is one of the gastroesophageal reflux diseases that seriously affect the daily life of patients. Magnolia sieboldii K. Koch has been used as a traditional Chinese herbal medicine for stomach pain relief and deworming and has various physiological activities. Objective: The objective is to investigate the anti-inflammatory and protective effects of the ethanol extract of M. sieboldii buds (MsE) on RE. Materials and Methods: The different concentrations of MsE were used to determine the anti-inflammatory effects on lipopolysaccharide (LPS)-induced cells. In addition, the treatment of MsE on experimental RE rats were used for determining the protective effects of MsE on RE. Results: M. sieboldii treatment effectively inhibited LPS-induced nitric oxide (NO) production, protein expression of inducible NO synthase (iNOS), cyclooxygenase-2 (COX-2), and tumor necrosis factor-alpha (TNF-α) by regulating the activation of nuclear factor-κB (NF-κB) and C-Jun N-terminal kinase/mitogen-activated protein kinase in cells. Furthermore, M. sieboldii treatment significantly ameliorated esophageal tissue damage caused by gastric acid reflux, as well as inhibited the expression of COX-2, TNF-α, and interleukin-1 beta in esophageal tissues through inhibition the activation of NF-κB. Conclusion: We suggested that the ethanol extract of M. sieboldii could consider being an alternative medicine material for treating RE.

Objective:To ingestivate the effect on the contents of NO,VIP,SP,CGRP and NPY in the plasma and esophageal tissue on the rabbit model of reflux esophagitis by the treatment with Jiangni decoction combined with low intensity helium-neon laser.Methods:Twenty rabbits were randomly divided into the blank control group and Chinese herbal medicine combined with laser group.Then a rabbit model of reflux esophagitis was made with infusing acid.Finally,the contents of NO,VIP,SP,CGRP and NPY in the plasma and esophageal tissue of rabbits were detected.Result:The content of NO in rabbit esophageal tissues in the treatment group was significantly lower than that in the blank control group(P0.05).The contents of VIP and CGRP in rabbit esophageal tissues and plasma in the treatment group were significantly lower than that in the blank control group,while the contents of SP and NPY were significantly higher than that in the blank control group.Conclusion:The mechanism of Chinese herbal medicine combined with low-intensity helium-neon laser treating reflux esophagitis may be related to reducing the content of NO in tissues and contents of VIP and CGRP in tissues and plasma,and increasing the contents of SP and NPY in tissues and plasma.

Abstract Background Excessive and continuous inflammation may be the main cause of various immune system diseases. Reflux esophagitis (RE) is a common gastroesophageal reflux disease (GERD). It is an inflammation of the esophagus caused by the reflux of gastric contents to the esophagus due to the dysfunction of the lower esophageal sphincter. Camellia japonica has high medicinal value and has long been used as a traditional herbal hemostatic medicine in China and Korea. Materials and methods Dried C. japonica buds were extracted with 75% ethanol. DPPH and ABTS radical scavenging assay were evaluated according to previous method. The ROS production and anti-inflammatory effects of C. japonica buds ethanol extract (CJE) were evaluated on LPS-induced RAW 264.7 macrophage cells. The protective effects of CJE on RE were conducted in a RE induced Sprague Dawley rat model. Results CJE eliminated over 50% of DPPH and ABTS radical at concentration of 100 and 200 µg/mL, respectively. CJE alleviated changes in cell morphology, reduced production of ROS, NO and IL-1β. Also, down-regulated expression levels of iNOS, TNF-α, phosphorylated NF-κB, IκBα, and JNK/p38/MAPK. CJE reduced esophageal tissue damage ratio (40.3%) and attenuation of histological changes. In addition, CJE down-regulated the expression levels of TNF-α, IL-1β, COX-2 and phosphorylation levels of NF-κB and IκBα in esophageal tissue . Conclusions CJE possesses good anti-oxidation and anti-inflammatory activity, and can improve RE in rats caused by acid reflux. Therefore, CJE may be a natural medicine source with good anti-oxidation and anti-inflammatory effects, and a candidate phytomedicine source for treating RE

GERD has no corresponding name in ancient literature of TCM.TCM named this disease according to its clinical symptoms.Related descriptions could be found in the scope of acid regurgitation,nausea,obstruction of Qi in the chest,medicine hiccups,globus hystericus,dysphagia,stomachache,distention and fullness,etc.But it couldn't be regarded as the same meaning.After we compared the description of TCM pathogenesis of GERD in ancient literature,we concluded that the location of GERD was spleen and stomach,and the cause of it was failure of stomach-qi to descend and upward of turbid-Qi.GERD had close relation with liver depression and converse of gallbladder.It could cause and be caused by the clotted blood and turbid phlegm.Some ancient classical prescriptions based on syndrome differentiation in treating GERD were proved to be satisfactory.

Pharmacognosy Magazine ,2019,15,61,290-297.DOI:10.4103/pm.pm_367_18Published:January 2019Type:Original Article Authors:Hyeon Hwa Nam, Li Nan, and Byung Kil Choo Author(s) affiliations:Hyeon Hwa Nam, Li Nan, Byung Kil Choo Department of Crop Science and Biotechnology, Chonbuk National University, Jeonju, Republic of Korea Abstract:Background: Geranium koreanum, an herbaceous perennial plant, is widely used as a Chinese herbal medicine to treat several diseases. Objective: In the present study, we wanted to demonstrate the anti-inflammatory effects of G. koreanum extracts on esophagus damage in acute reflux esophagitis (RE)-induced rats. Materials and Methods: The anti-inflammatory effects of G. koreanum measured in nitric oxide (NO) production and inducible NO synthase (iNOS) protein expression on lipopolysaccharide (LPS)-induced Raw 264.7 macrophages. To evaluate the improvement in RE, rats were per orally treated with G. koreanum 100 and 200 mg/kg 90 min before RE induction surgery. After 5 h, the rats were sacrificed to confirm the degree of esophageal injury. The esophageal mucosal ulcer ratio and histological changes were examined using Image J program and hematoxylin and eosin (H and E) staining of the rat esophagus, respectively. In addition, expression levels of pro-inflammatory proteins on esophagus in RE rat were measured by western blotting. Results: G. koreanum exhibited anti-inflammatory effects against LPS-stimulated cells by significantly inhibiting NO production and iNOS protein expression. In addition, the LPS-induced morphological transformation of cells was recovered following pretreatment with G. koreanum. In vivo, the result show that G. koreanum 200 mg/kg extract-treated group was ameliorated esophageal damage on histological analysis. The inflammatory mechanism (nuclear factor-κB and mitogen-activated protein kinases signaling pathways) involved in the esophageal damage was investigated by using western blotting with esophageal tissue, and G. koreanum clearly inhibited the inflammatory response in esophagitis-induced rats. Conclusions: This study showed that G. koreanum has anti-inflammatory and ameliorating effects in acute RE. Keywords:Acute reflux esophagitis, anti-inflammatory, gastroesophageal reflux disease, Geranium koreanum, In vivo, Nuclear factor-κBView:PDF (2.3 MB)

Treatment with kampo, the Japanese traditional medicine, is a form of pharmacological therapy that combines modern Western and traditional Asian medical practices. In Japan, various traditional medicines are often combined with Western medicines and prescribed for patients with diseases such as gastroesophageal reflux disease, functional dyspepsia, chronic gastritis, irritable bowel syndrome, and post-operative ileus. Based on numerous past observations, Japanese traditional medicines are thought to be particularly useful in the treatment of medically unexplained physical symptoms such as nausea, abdominal discomfort, and anorexia. However, the detailed mechanism by which they mediate their pharmacological action is yet unknown. In addition, the clinical evidence to support their use is insufficient. This review focuses on the basic evidence of the pharmacological action and the clinical efficacies of kampo medicines accumulated over several past decades. In addition, we introduce both the current novel insights into kampo medicines and the therapeutic approach employed when they are used to treat various disorders of the gastrointestinal tract.

Background. Kampo medicines are traditional herbal medicines which have been approved for medicinal use by the Japanese Ministry of Health and Welfare and are currently being used more and more, often in combination with Western drugs. Thus, the need for investigation of interactions between Kampo medicines and Western drugs is now widely recognized. Aim. To summarize the effects and drug interactions of rikkunshito, a Kampo medicine often prescribed for upper gastrointestinal disorders and anorexia. Methods. Animal and human studies were systematically reviewed to identify published data on rikkunshito. Results describing its effects were abstracted, with an emphasis on drug interactions. Results and Discussion. Rikkunshito ameliorates anorexia induced by anticancer drugs, improves quality of life scores, and can even prolong survival compared with monotherapy. Rikkunshito combined with proton pump inhibitor therapy is shown to be useful in the treatment of PPI‐refractory gastroesophageal reflux disease patients and patients with gastrointestinal symptoms after endoscopic submucosal dissection. Rikkunshito reduces antidepressant‐induced adverse events and improves quality of life without influencing antidepressant effects. Conclusions. Rikkunshito shows ameliorative effects on adverse reactions induced by various Western drugs and can achieve better results (e.g., anticancer drugs and proton pump inhibitor) without influencing the efficacy and bioavailability of Western drugs.

The pathophysiology of functional gastrointestinal disorders (FGIDs) is still unclear and various complex mechanisms have been suggested to be involved. In many cases, improvement of symptoms and quality of life (QoL) in patients with FGIDs is difficult to achieve with the single-targeted treatments alone and clinical application of these treatments can be challenging owing to the side effects. Herbal preparations as complementary and alternative medicine can control multiple treatment targets of FGIDs simultaneously and relatively safely. To date, many herbal ingredients and combination preparations have been proposed across different countries and together with a variety of traditional medicine. Among the herbal therapies that are comparatively considered to have an evidence base are iberogast (STW-5) and peppermint oil, which have been mainly studied and used in Europe, and rikkunshito and motilitone (DA-9701), which are extracted from natural substances in traditional medicine, are the focus of this review. These herbal medications have multi-target pharmacology similar to the etiology of FGIDs, such as altered intestinal sensory and motor function, inflammation, neurohormonal abnormality, and have displayed comparable efficacy and safety in controlled trials. To achieve the treatment goal of refractory FGIDs, extensive and high quality studies on the pharmacological mechanisms and clinical effects of these herbal medications as well as efforts to develop new promising herbal compounds are required.

The purpose of this study was to investigate the antioxidant and anti-inflammatory effects of the combined extract of Rhei rhizoma and Coptidis rhizoma (RC-mix) in experimental model of acute reflux esophagitis. The antioxidant activity was assessed by in vitro 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays. RC-mix was given at 100, 200, and 400 mg/kg body weight 2 h prior to induction of reflux esophagitis (RE). After 5 h, the effects of RC-mix treated rats were compared with those of normal and control rats. The representative flavonoid contents of RC-mix, such as sennoside A, epiberberine, coptisine, palmatine, and berberine, were detected using HPLC. The elevated esophageal mucosa damage was markedly ameliorated by RC-mix treatment in a dose-dependent manner. Furthermore, the administration of RC-mix reduced the increase of serum reactive oxygen species (ROS) and peroxynitrite (ONOO(-)). The improvement of superoxide dismutase (SOD) and heme oxygenase-1 (HO-1) levels were marked in the group given RC-mix. Moreover, the elevation of inflammatory mediators and cytokines by nuclear factor-kappa B (NF-κB) activation in control rats decreased by RC-mix pretreatment. These results indicate that RC-mix treatment reduces the pathological states of esophagitis via regulating NF-κB mediated inflammation related to oxidative stress.

Modified Banxia Xiexin decoction (MBXD) is a classical Chinese herbal formula in treating gastroesophageal reflux disease (GERD) for long time, but the efficacy of it is still controversial. This study is to evaluate the efficacy and safety of MBXD for the treatment of GERD in adults. The search strategy was carried out for publications in seven electronic databases. RevMan software version 5.3 and the Cochrane Collaboration's risk of bias tool were performed for this review. Twelve RCTs were included for the analysis. The results of overall clinical efficacy and efficacy under gastroscope demonstrated that MBXD was superior to conventional western medicine. Meanwhile, the results of subgroup analysis showed clinical heterogeneity between the two groups. However, there was no statistically significant difference in acid regurgitation between the two groups. But in the improvement of heartburn and sternalgia, the results showed statistically significant differences for the comparison between two groups. In addition, the adverse reactions of the experiment groups were not different from those of the control groups. This systematic review indicates that MBXD may have potential effects on the treatment of patients with GERD. But because the evidence of methodological quality and sample sizes is weak, further standardized researches are required.

SNZJD might be useful in the treatment of GERD, but its long-term effects and specific clinical mechanisms are unclear. Due to the poor quality of the evidence, more samples and high-quality clinical studies should be tested and verified in the future.

This article reviews the effectiveness of Kampo (traditional Japanese herbal medicine) in the treatment of functional gastrointestinal disorders, especially functional dyspepsia (FD) and irritable bowel syndrome (IBS). The results of four randomized, controlled trials (RCTs) suggested the usefulness of rikkunshito in relieving the subjective symptoms of patients with FD. Rikkunshito significantly improved not only gastric symptoms, such as epigastiric discomfort, but also extra-gastric symptoms, such as general fatigue, when compared with control drugs. The therapeutic effects of rikkunshito were more evident when it was prescribed to patients with "kyosho", i.e., low energy. Two RCTs suggested the efficacy of keishikashakuyakuto for IBS.Basic research studies have demonstrated that these Kampo medicines have multiple sites of action to improve subjective symptoms. For example, rikkunshito improves gastric motility dysfunction, including impaired adaptive relaxation and delayed gastric emptying, gastric hypersensitivity, and anorexia via facilitation of ghrelin secretion. It also exhibits anti-stress effects, i.e., it attenuates stress-induced exacerbation of gastric sensation and anorexia, as well as the hypothalamic-pituitary-adrenocortical axis and sympathetic activation. Keishikashakuyakuto exhibited not only an antispasmodic effect on intestinal smooth muscle, but also antidepressant-like effects. Case series suggest that other Kampo prescriptions are also effective for FD and IBS. However, further studies are necessary to evaluate their efficacy.

Compared with PPIs or Prokinetics therapy alone, TCM single therapy can better improve the clinical total effective rate and symptom relief and decrease the recurrence rate and adverse events in the treatment of NERD. Our results suggest that TCM will be a promising alternative therapy for NERD patients in the future.

Current Controlled Trials (ISRCTN 51910678); Clinical Trials.gov Identifier: NCT00987805.

Rikkunshito improved globus sensation in patients with PPI-refractory LPR, in part, because of stimulation of gastric emptying. Thus, rikkunshito is an effective treatment for PPI-refractory LPR.

Gastroesophageal reflux disease (GERD) is a widely prevalent gastrointestinal disorder, affecting ∼13.3% of the global population. There are shortages and limitations of current GERD treatment modalities, and complementary and alternative therapy (CAT) is a promising option to fill in the gap. Dietary and lifestyle modifications might play an important and complementary role in alleviating GERD symptoms. Traditional Chinese medicine and brain-gut behavior therapy, particularly transcutaneous electrical acustimulation and diaphragmatic breathing therapy were shown to be useful adjuncts or alternatives in treating GERD. CAT may help to relieve GERD symptoms, minimize medication dosage, and slow the demand for surgery. The aim of this review was to summarize the existing evidence of some common CATs in treating symptomatic GERD, including dietary modification, lifestyle change, traditional Chinese medicine, and brain-gut behavior therapy.

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ZHG was effective in treating RE in rats due using mechanisms including improving the pH value of gastric contents, decreasing the gastrointestinal hormones (including GAS, MTL, and VIP), and improving the inflammatory damage.

Our study reveals that the combined treatment of SHF with rabeprazole is more efficacious in managing patients with rGERD when contrasted with sole rabeprazole treatment.

In the rat model of CARE, BHSST can suppress development of esophageal mucosal ulceration <i>via</i> regulation of reactive oxygen species-dependent apoptosis.

Gastroesophageal reflux disease (GERD) is a high-incidence digestive system disease. Western medicine mainly uses drugs such as proton pump inhibitors to inhibit gastric acid secretion, but some patients are accompanied by symptoms such as non-acid reflux and gas reflux, which cannot effectively treat the disease. It is necessary to actively explore other treatment schemes. Traditional Chinese medicine (TCM) has a long history of research on gastroesophageal reflux disease, which emphasizes the treatment based on syndrome differentiation as a whole. Through the treatment of various and multi-component TCM prescriptions, the patient’s body condition can be adjusted, and the treatment effect on gastroesophageal reflux disease is reliable, which has obvious therapeutic advantages. To further clarify the treatment of gastroesophageal reflux disease, this study reviewed and analyzed the research progress of the treatment of liver disease with modified prescriptions, and the report is as follows.

The methodological and reporting quality of SRs/MAs about Chinese medical treatment for GERD is generally poor. The main problems included incomplete search strategies, risk of bias in individual studies, the lack of protocol registration and excluded study list, and incorrect study selection methods.

Heweijiangni decoction (HWJND) is an effective traditional Chinese medicine prescription in clinical treatment of nonerosive reflux disease (NERD). Esophageal hypersensitivity and acid contribute to the disease. However, the exact underlying mechanism of action remains unclear. In this study, we observed the effect of HWJND on esophageal morphology in a rat model of ovalbumin (OVA)-induced visceral hypersensitivity followed by acid exposure. Esophageal morphology was assessed by measuring the extent of dilated intercellular spaces (DIS), desmosome disruption, and mitochondrial fragmentation. HWJND in low, moderate, and high doses relieved DIS and desmosome disruption in esophageal epithelium compared with model group (P&lt;0.05 for all doses). In addition, HWJND in high dose protected mitochondria from fragmentation (P&lt;0.05). Other findings suggest that DIS and mitochondrial fragmentation are independent events, and that omeprazole protects mitochondria. Overall, HWJND significantly resists esophageal morphology changes in OVA-induced and acid exposure rat model.

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Abstract The prevalence of gastroesophageal reflux disease (GERD) is rapidly increasing due to the adoption of a Westernized lifestyle; at the same time, safe and efficient treatment is required due to the side effects and refractoriness of proton pump inhibitors (PPIs). The frequently used multi-compound treatment for GERD in the current traditional Korean medicine (TKM) clinical field comprises Crassostrea gigas Thunberg shell (CGTS), Bambusae Caulis in Taeniam (BCT), Ponciri Fructus Immaturus (PFI), Scutellaria baicalensis Georgi (SBG), medicated leaven (ML) and Glycyrrhizae Radix et Rhizoma (GRR). The current review was based on “Kun-Shin-Choa-Sa” theory and network analysis was conducted to explore the potential pharmacological activities, including efficacy and mechanisms of action of multi-compound treatment against GERD. Hypergeometric test results showed that the targets of multi-compound treatment are significantly associated with GERD gene sets, consistent with the literature review findings. In particular, the enrichment analysis indicated that the SBG targets are related to the IL-17 signaling pathway, bile secretion, small-cell lung cancer, and non-small cell lung cancer, corroborating the literature review, particularly concerning anti-inflammatory effect. In the literature review, CGTS and BCT, classified as “Kun,” play a role in anti-acid, anti-inflammatory, and anti-oxidative effects. The complementary “Shin” herbs, PFI and SBG, showed functions related to improving the prolonged gastric emptying rate, peristalsis, and a gastric cytoprotective effect. With the role of “Choa,” ML was suggested to inhibit H. pylori growth and diminish gastric acid secretion, consistent with the gastric acid secretion pathway in the enrichment analysis. However, the enrichment analysis did not show any significantly related pathways for CGTS and PFI, which may reflect the lack of information in the KEGG database in terms of the link between GERD, its mechanisms, and the abundance of minerals in CGTS. Despite the pharmacological potential of multi-compound treatment, this study should be corroborated by well-designed future experimental studies.

The Shugan Hewei recipe (SHR) is a well-recognized traditional Chinese medicine (TCM) prescription that has been shown to significantly improve chest pain, acid regurgitation, and the mood of GERD. Nonetheless, the underlying mechanisms remain unclear. In this study, the active compounds and targets of SHR were predicted using network pharmacology. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were utilized to explore the therapeutic mechanism of SHR. Combined with the drug target obtained from network pharmacology, the therapeutic effect and mechanism of SHR were observed. SHR's main active compounds included quercetin, kaempferol, and luteolin. The core targets of SHR and GERD were TGF-<i>β</i>1, IL-1<i>β</i>, IL-4, CXCL10, MAPK1, MAPK3, CXCL8, IL-10, IL-2, and FOS, involving virus infection, inflammatory response, and body immunity. The core targets of SHR during the treatment of mental disorders were GABR_A1, GABR_A2, GABR_A3, GABR_A5, and GABR_A6, involving synaptic transmission and transmembrane movement. Animal experiments revealed that SHR could repair the lower esophageal mucosa, mediate inflammatory factors, and GABA receptors and improve the behavior of rats. Overall, our results substantiate that SHR has huge prospects for widespread application in treating GERD subjects with anxiety and depression.

胃食管反流病是临床上常见的消化系统疾病，近年来研究发现，越来越多的患者经常规治疗后久治不愈，中医药治疗渐而显示出独有的优势。郑亮教授根据患者的病因病位病机的不同，将患者辩证为：肝胃郁热型、寒热错杂型、肝郁气滞型，灵活遣方用药，并附验案一则以佐证。

目的：探讨胃食管反流病的发病机制与治疗原则，以期为胃食管反流病的诊治提供新的思路和方法。方法：通过对“脾为之卫”理论内涵的梳理，探讨脾脏功能失常对于胃食管反流病发病机制的关系，论述相应的治疗原则与处方用药。结果：“脾失之卫”为胃食管反流病发病关键，其中中虚气逆为发病之本、气郁痰阻为发病之机、湿热胶结为发病之要，根据病机分别以燮理中气、调脾复卫，理气化痰、助脾行卫，清热利湿、醒脾和卫为治疗原则。结论：应用“脾为之卫”理论有助于深化理解脾脏与胃食管反流病发病机制之间的联系，完善从脾脏论治胃食管反流病的诊治思路。

李天望教授认为胃食管反流病的病机关键在于肝郁脾虚，肝郁导致脾胃不和，胃气上逆；腹泻性肠易激综合征的病机关键在于肝郁脾虚、脾虚湿盛。其共同的病机都有肝郁脾虚，治疗以“培土抑木”为大法，具体为疏肝解郁，理气健脾。李教授强调1) 病证结合。辨病是基础，明确胃食管反流病重叠腹泻性肠易激综合征的疾病诊断后再辨证，才能抓住其本虚标实的特点，对其肝郁脾虚特点的认识更加准确，使治疗更加具体。2) 肝郁为标，脾虚为本。3) “培土抑木”是胃食管反流病重叠腹泻性肠易激综合征的关键治法。胃食管反流病重叠腹泻性肠易激综合征发病以肝气郁结、脾虚湿盛为主，故临证时应以疏肝解郁，理气健脾。4) 中西结合，灵活处方是胃食管反流病重叠腹泻性肠易激综合征重要治疗手段。通过中医辨证论治，将“培土抑木”法联合西医治法来调理脾胃，以达到治疗的目的。

脏腑气机升降理论是中医脏腑学说的重要组成部分，气机升降是脏腑生理活动的基本形式，气机升降相宜则脏腑功能协调，生理活动有序，而脏腑之气升降失序则可能导致疾病的发生。口苦为临床常见症状之一，与人体内部脏腑功能失调密切相关，肝肺、脾胃、心肾等脏腑气机升降失调，阴阳失和，都可能导致口苦，治疗上谨遵脏腑气机升降运行规律：疏肝降肺、健脾和胃、降心火温肾水，恢复脏腑气机升降有度。

介绍广西名中医陈国忠运用“疏调气机法”治类梅核气经验，认为类梅核气病机与肺胃失调、气郁津凝、气滞血瘀有关。临床基于“疏调气机法”，针对类梅核气病机创立“提壶揭盖，上通下达、调气行津，痰自消、气血同调”以对应治疗，疗效显著。

黄连汤出自《伤寒论》，作为国家中医药管理局颁布的百首经典名方之一，自产生起被历代广泛使用，同名方剂较多，但药物组成与功效在历代传承中出现了多个版本，故对该方的考证成了重中之重。本研究从古代文献考究和现代临床研究两方面进行整理分析，运用文献分析法寻其历史源流，认为黄连、炙甘草、干姜、桂枝、人参、清半夏、大枣为黄连汤基本组成药物，阴阳失调、寒热夹杂为其治疗的基本病机，现代研究认为本方可用于治疗消化系统炎性疾病，为本方复方制剂的研发提供理论基础。

反流性食管炎是一种临床上较为常见的难治性慢性消化系统疾病，且复发率较高。近年来，反流性食管炎的发病率逐年上升，严重影响人们的生活质量。该病西医治疗一般多以抑制胃酸分泌、促进胃肠动力为主，有一定疗效，但其停药后容易复发，且治疗周期长，治疗方法较单一，不良反应多。对比传统西医治疗，中医治疗本病疗效更为显著，且复发率低，治疗方法多样，副作用少，备受人们欢迎。本文就近年来中医药治疗反流性食管炎的经验研究进行综述，旨在为反流性食管炎的临床有效防治，提供诊疗思路和方法。

胃食管反流病(GERD)，作为一种高发的消化系统疾病，其核心症状表现为反酸与烧心感，严重影响患者的生活质量。西医治疗虽以药物为主，但中医通过整体调节的理念，结合药物、饮食、情志及行为等多方面的干预，展现出独特的治疗优势。中医学认为，GERD的病机核心在于“胃失和降，胃气上逆”。这一理论深刻揭示了GERD症状产生的内在原因，即胃的通降功能失常，导致胃内容物反流至食管，引发一系列不适症状。半夏泻心汤能够针对病机，有效缓解反酸、烧心等症状，同时调整患者的整体状态，减少疾病的复发。进一步探究半夏泻心汤治疗GERD的作用机制和药理作用，有助于我们更深入地理解其疗效背后的科学原理。同时，现代药理研究也揭示了该方在调节胃肠动力、抑制胃酸分泌、保护胃黏膜等方面的作用机制，为中医药治疗GERD提供了科学依据。本文的探讨旨在为临床医生提供更深层次的研究思路和参考，推动半夏泻心汤在GERD治疗中的广泛应用和深入研究。

反流性食管炎(Reflux Esophagitis, RE)是一类临床多见多发的难治性消化系统疾病，近年来，随着众多中医药学者对本病的深入研究，报道了大量关于中医药干预治疗反流性食管炎的文献，本文从中医病名、病因病机的研究、辨证论治、名家经验的总结等角度立论，对RE的研究进展予以综述。

胃食管反流病(GERD)是常见消化系统疾病之一，临床表现为反酸、烧心、胸骨后疼痛等主要症状。现代医学治疗GERD以质子泵抑制剂(PPIs)等药物为主，虽短期效果明显，但长期使用易出现药物依赖、骨质疏松及肠道菌群失调等副作用。中医治疗GERD效果明确，历史悠久，目前主要包括中医内治法和中医外治法，中医内治法以汤药为主，中医外治法以针灸、推拿、艾灸等为主，文章将分别对其予以介绍，以为临床医者提供参考。

胃食管反流病是临床上常见的一种以烧心、反酸为主要特点的消化系统疾病。本文从中医对胃食管反流病的认识、病因病机、辩证分析、临床诊治方面对该病的研究现状进行了综述。

近年来随着人们生活水平的提高，和生活的不规律，导致反流性食管炎的发病率逐年升高，虽然西医在治疗本病取得了一定进步，但仍然没有突破性进展，长期用药或停药后有其局限性。经过文献查询，发现在中医学中，反流性食管炎主要以肝胃郁热型为主，同时发现柴胡疏肝散合左金丸对于肝胃郁热型有良好的治疗效果，但缺乏对文献的整理，导致合方的价值没能被进一步地挖掘。因此本文从肝胃郁热型反流性食管炎的病因病机、治疗方法，和柴胡疏肝散合左金丸的临床研究、药理分析出发，总结合方治疗上述疾病的文献支持。

目的：观察清胃顺气汤与西药联合治疗反流性食管炎后半年内复发比率，并与单用西药进行对比研究。方法：按纳入标准选定反流性食管炎病例60例，中医证型符合肝胃郁热型，随机分为治疗组与对照组，治疗组采用清胃顺气汤联合西药治疗，对照组则单用西药治疗，两组疗程均为4周，随访半年。结果：随访半年后两组病例的复发率明显不同，治疗组半年内复发率为33.33%，对照组半年内复发率为70%，经统计学处理两组有显著性差异(P < 0.05)。结论：治疗组半年内复发率明显低于对照组，有显著性差异。

目的：探讨中西医结合治疗难治性胃食管反流(rGERD)的作用机制及临床效果，为rGERD临床治疗提供依据。方法：选取2023年1月至2024年1月我院86例rGERD患者，随机分为对照组与观察组各43例。对照组予常规西医治疗(雷贝拉唑 + 多潘立酮)，观察组加用中医辨证治疗(肝胃不和证用柴胡疏肝散加减，脾胃湿热证用清中汤加减)，均治疗8周。比较两组疗效、症状评分、食管黏膜愈合率及不良反应。结果：观察组总有效率93.02%，高于对照组74.42% (P 0.05)。结论：中西医结合治疗rGERD疗效确切，可改善症状、促进黏膜愈合且安全，其机制与调节胃肠动力、抑酸护膜、改善炎症相关。

左金丸是中医的经典名方，出自朱丹溪《丹溪心法》，是由黄连和吴茱萸按照6:1的比例配制而成的，具有清肝泻火、降逆止呕、和胃止痛等功效，主要用于治疗肝火犯胃所致的胁痛、胃脘、胁肋胀满疼痛，嗳气，呕吐，呃逆，吞酸嘈杂等症状。近年来，关于左金丸的现代药理及作用机制的研究有很多，特别是在治疗胃食管反流病方面取得了一定的研究进展。该文从古今应用及药理机制等方面对其治疗胃食管反流病进行论述。

胃食管反流病(GERD)是消化道的常见病和多发病，欧美等发达国家发病率高，但随着经济发展，我国发病率逐渐上升。经大量临床研究证明中医药治疗该病有着提高疗效、减轻副作用等作用。肝胃不和作为本病常见的中医证候类型之一，本文将对近年来中医药治疗肝胃不和型GERD的临床研究成果进行综述。

经方为仲景所创之方剂，随着对经方的挖掘使用，其在治疗胃食管反流病(gastroesophageal reflux disease, GERD)的临床实践中取得了不错的疗效。为展示经方治疗GERD的优势，现从柴胡类、泻心汤类及其它类方剂三个方面，对部分经方治疗GERD的临床疗效进行综述。

胃食管反流病为常见消化系统疾病，其脾胃虚弱，虚而生痰，痰随气逆之病机，与仲景经方旋覆代赭汤之主治病机相类，临床使用疗效显著。本文从“虚、痰、逆”的角度，探析旋覆代赭汤治疗胃食管反流病机理，为能更好地使用经方治疗胃食管反流病提供参考。

该文主要介绍李天望教授辨治肝郁脾虚型胃食管反流病的临床经验。李天望教授认为胃食管反流病的主要病机为肝失疏泄、脾虚失运、胃气上逆，故以疏肝健脾、和胃降逆为大法，自拟疏肝健脾和胃方治疗肝郁脾虚型GERD，并重视情志因素对此病的影响作用，治疗时不忘帮助患者调畅情绪。

谢晶日教授治疗胃食管反流病经验丰富，认为胃食管反流病是由于情志不遂，饮食不节，平素脾胃虚弱等各种因素导致脾气当升不升，胃气当降不降，肝不随脾升，胆不随胃降，以致胃气上逆，上犯食管而形成本病。临证时，谢晶日教授强调从气机升降理论治疗胃食管反流病的重要性，强调调畅气机，重视情志因素在治疗胃食管反流病的作用，临床多获良效。

胃食管反流性咳嗽是临床慢性咳嗽的常见类型之一，但西医易漏诊、误诊且治疗效果不佳。受清代医家黄元御“一气周流、土枢四象”理论的启发，联系临床探讨胃食管反流性咳嗽的论治方法，认为此病的病机为“阳虚土湿，气滞痰凝；内外受邪，胃逆肺寒”，据此提出“温中燥土，利气行郁；外散风寒，降逆温肺”的治法，为临床治疗胃食管反流性咳嗽提供了另一种诊疗思路。

难治性胃食管反流病(rGERD)是消化系统的常见病、多发病。其发病机制复杂，病程迁延，严重影响患者的生活质量。中医药治疗rGERD具有多成分、多靶点、多通道、个体化等优点，能够有效缓解患者的不适症状并降低该病的复发率。通过查阅相关文献，本文对中医药治疗rGERD的研究进展进行了总结，旨在为中医药治疗rGERD提供坚实的理论依据。

胃食管反流病是消化系统中的常见疾病，患病率正在逐年上升。胃食管反流病具有反复发作的特点，故极大影响了患者的生存质量。中医药对治疗胃食管反流病有多种方法且具有稳定的临床效果证明，对治疗胃食管反流病具有较大优势，前景也更为可观。现对近5年关于中医药治疗与研究胃食管反流病的相关文献进行总结，通过归纳中医内治、中成药、中医外治等常用中医治疗方法在胃食管反流病临床中的应用现状与研究进展，找出治疗胃食管反流病的新观点和新方案，为胃食管反流病中医临床治疗提供依据。

反流性食管炎(RE)是消化系统常见疾病，中医药治疗颇具特色。严光俊教授从医三十余载，治疗脾胃病临证经验丰富，认为RE的病机关键为肝郁，脾虚为病变根本原因，以疏肝健脾，和胃降逆为基本治疗原则，亦重视化瘀通络，身心同治等，临床用药灵活，疗效显著。

基于黄元御“一气周流”的学术思想，认为胃食管反流病的发病以中气失运、胃中浊阴上逆为病机根源，水寒木郁，肝肾左升不达；火金上逆，心肺右降不及为其发生发展的重要病理环节。治疗上以调节脏腑气机为基本原则，抓住中气斡旋之核心，把握肝心肺肾四脏气机的整体变化，通过促进脾阳的运化而复运中气，方选天魂汤加减；促进肝气的升发和肾阳的温煦而调理肝肾左升，方选达郁汤、乌肝汤加减；通过肃肺气、降心火而清降心肺，方选下气汤加减。多脏同调，恢复人体气机周流运转进而促进疾病向愈。

胃食管反流病(GERD)是一种由酸性胃内容物反流进入食管导致食管损伤的消化系统疾病，胃酸和酸性胆盐会加剧食管上皮细胞的氧化应激反应并导致炎症反应的加剧，进而破坏食管黏膜的完整性。中医学认为GERD是多种因素导致胃气上逆而引起。现代中医名家从丰富的物质条件和社会环境变化的角度出发，认为肝胃不和、脾虚湿热和肺胃失和为GERD的病因病机。大柴胡汤具有疏肝解郁、内泻阳明之热，调畅脾胃气机的功效。实验研究发现大柴胡汤具有抗炎和抗氧化应激的作用。本文将GERD的病因病机、大柴胡汤对其治疗机制及临床运用其综述如下，为临床运用大柴胡汤治疗GERD提供治疗依据。

胃食管反流病(GERD)是一种由胃、十二指肠内容物反流引起的常见的消化系统疾病，常见症状有反酸、烧心、胸痛、嗳气和吞咽困难。GERD发病率在世界范围内很高(2.5%~51.2%)。在大多数情况下，质子泵抑制剂(PPI)可有效治愈病变和改善症状，但高达30%的GERD患者对PPI治疗反应不足。中国专家共识将经双倍标准剂量抑酸剂治疗8周后，反流、烧心等症状仍无明显改善的GERD定义为难治性胃食管反流病(RGERD)。RGERD严重影响患者生活质量，也会增加医疗保健资源的消耗。本文就近年来RGERD药物治疗的研究进展作一综述。

目的是探讨沈小珩教授“胆胃同治”理论治疗慢性胃炎思路和方法。出现慢性胃炎常见症状及加重，且迁延反复者，往往胃镜检查并未发现特别异常，仅有浅表性胃炎等，多考虑与胆囊疾病相关，根据“胆胃同治”理论，采用疏利肝胆法治疗慢性胃炎，疗效显著。并举验案3则。

甘爱萍教授是湖北省知名中医师，临证四十余载，尤善治脾胃疾患；以“治中焦如衡”为核心，围绕“未病先防、既病防变、病后防复”基本观点辨证论治，临床屡见奇效，深受广大病友信任。甘爱萍教授勤求古训，并对“治中焦如衡”理念有所发挥，笔者有幸跟诊甘爱萍教授，将结合实际新探甘爱萍教授所运用的“治中焦如衡”理念，以飨同道。

萎缩性胃炎是一种常见的消化系统疾病，孙雪英主任总结多年临床经验，认为该病病机虚、实、寒、热错杂，其中虚以脾虚常见，实以肝郁气滞为主，常兼湿邪、血瘀。临床上，患者往往多种病机错杂，故应辨证论治，处方用药随症加减。现择取二则典型医案，分享孙雪英主任治疗萎缩性胃炎的经验。

自《黄帝内经》时期提出胃主通降理论至金元时期补土派代表李东垣著成《脾胃论》一书，脾胃学说即已成为中医早期理论体系中最具完整性和鲜活性的学说，其核心思想是通降理论，至今，通降理论在各代医家的传承、发展、创新中不断完善，对诊疗脾胃疾病具有重要指导意义。结合现代医学对消化系统疾病的认识，医务工作者将更好的继承前人的思想，将通降理论贯穿脾胃病的诊治过程。

儿童梅核气是临床常见疾病，常表现为咽喉异物感、清嗓等。本文总结田理教授运用健脾疏肝法治疗儿童梅核气的临证经验。田理教授通过多年临床经验及实践认为儿童具有脾常不足的体质特点，同时肝郁气滞为儿童梅核气诱发因素，所以脾虚肝郁常为其核心病机。宜治以健脾化痰、疏肝解郁，肝脾同调方可病除，另外需注重纠正错误喂养方式及患儿情绪疏导。

本文旨在总结和探讨杨玉虎副主任中医师在基层运用中医理论治疗脾胃病的学术思想和临床经验。杨玉虎老师擅长中西医结合诊治肿瘤、消化系统、心血管系统、血液系统等危重疑难病，尤其在脾胃病治疗方面积累了丰富的经验。通过对杨玉虎老师治疗脾胃病的学术思想和临床经验的总结，为基层中医师提供借鉴和参考，促进中医药在脾胃病治疗中的传承与发展。

目的：利用数据挖掘，分析卢云教授治疗亚急性咳嗽的用药特点，探讨其用药规律；方法：收集2023年06月01日至2023年10月30日于成都中医药大学附属医院卢云教授门诊就诊的亚急性咳嗽患者处方，对中药进行频数分析、关联规则分析、聚类分析及复杂网络分析；结果：共纳入120首中药处方，涉及药物67味，关联规则20条，聚类分析得到4类药物；复杂网络分析提示桔梗、浙贝母、甘草、白芷、紫苏叶、细辛、荆芥、薄荷等18味药物之间的关联度最高；结论：卢云教授治疗亚急性咳嗽以祛风化痰，宣肺止咳为主，常用处方以加味止嗽散为主。

本文主要总结了具有燥湿功效的药物，主要有半夏、苍术、黄连、龙胆、黄芩、黄柏、厚朴、陈皮、白术、秦皮等，对其治疗脾胃病的临床研究进行综述，为燥湿药的进一步研究提供理论和实验依据。

黄芪建中汤是经典名方之一，临床广泛应用于治疗消化系统疾病，诸多研究发现其对慢性萎缩性胃炎(chronic atrophic gastritis, CAG)有明显疗效，本文旨在探讨近年来关于CAG的危险因素，同时总结中医对CAG的相关认识及黄芪建中汤在CAG治疗中的相关药理学和临床研究，以期为临床防治慢性萎缩性胃炎提供依据。

高清食管测压是采用密集的压力感受器同步采集整个食管压力数据的检验方法。通过计算机软件转变为三维空间图像，更简单直观帮助我们了解食管运动与症状间的关系。食管测压是诊断食管动力异常的重要手段，可测定LES压力、显示频繁的一过性LES松弛和评价食管体部动力功能。非阻塞性吞咽苦难属于中医“噎膈”、“梅核气”等病的范畴。笔者导师王敏教授通过临床观察，挑选代表性的病案进行分析，进一步证实了相关理论是临床效果通过追踪、分析典型病案中的高清食管测压评估慢性阻塞性吞咽困难的中医临证具体运用，以此总结出的临床价值及疗效，对于一些食管动力异常的疾病在中医临证运用中起到很好疗效，望能进一步对中医药的临床工作起到参考性作用。

慢性萎缩性胃炎(Chronic Atrophic Gastritis, CAG)是一种很常见并且难根治易复发的消化系统疾病，临床治疗相对困难，世界卫生组织于1978年将其列为胃癌前状态，以胃角为中心波及胃窦及胃体的多灶萎缩发展为胃癌的风险增加。在本文中，笔者将主要论述慢性萎缩性胃炎在中医学上的证型分布和辨证论治以及西医治疗和中西医结合治疗慢性萎缩性胃炎的研究进展。

放射性食管炎是胸部恶性肿瘤放疗后常见的并发症之一，治疗难度大、效果不甚理想。目前中医对放射性食管炎的发生发展及变化规律正在逐步深化，但临床上仍以对症治疗为主。本文基于仝小林院士的“态靶辨治”体系和中医对放射性食管炎的认识，重新对疾病进行分类、辨态、识靶。辨治放射性食管炎辨以“热、毒、瘀、虚”四态；识“吞咽困难、恶心、呃逆、胸骨后刺痛”之症靶；“白细胞介素-6、内镜下黏膜损伤分级”之标靶。治疗以“清热、解毒、补虚、化瘀”为主。文章通过初步构建放射性食管炎的态靶辨治体系，为提高放射性食管炎治疗效果提供新的临床思路。

慢性萎缩性胃炎(CAG)作为常见消化系统疾病，临床常并发不同程度情绪障碍。中医认为，CAG伴焦虑状态主要因气血失调所致，而“少阳为枢”理论在此类病症治疗中具有独特优势。少阳涵盖肝、胆及三焦，是人体气机升降出入的重要调节枢纽。CAG伴焦虑患者多存在少阳枢机不利、脾胃升降失调现象，进而影响消化功能与情绪状态。治疗原则为和解少阳、调畅气机，以恢复少阳枢机功能、调和脾胃、缓解焦虑。本文基于“少阳为枢”理论，从少阳对气机升降、气血运行的调节作用出发，剖析少阳枢机不利与CAG病机间的关联，并以调畅少阳枢机为切入点，探讨枢利少阳法在治疗CAG伴焦虑状态中的疗效，为针灸治疗CAG提供新的临床诊疗思路。

胃食管反流病是常见的消化系统疾病且常常同时合并有食管裂孔疝，伴随着复杂多样的令人苦恼的症状，通过治疗能够改善患者生活质量，减轻社会经济压力。目前针对胃食管反流病合并食管裂孔疝的治疗多种多样，没有一成不变的治疗方案，本文针对目前主要的内外科治疗方式进行综述。

胃食管反流病(GERD)是一种常见病，除了反酸和烧心这些典型症状，患者越来越多地表现为慢性咳嗽、咽部异物感、声音嘶哑、哮喘、吞咽困难等咽喉部症状，这些症状发生的病理生理机制尚未明确，且以其为主要表现的GERD患者的诊断及治疗方案尚未标准化。文章主要概述了伴有咽喉部症状的GERD患者的发病机制、当前的诊断方式和治疗方案，为其早发现、早诊断、早治疗提供思路。

胃食管反流病(gastroesophageal reflux disease, GERD)是一种常见的慢性消化系统疾病，严重影响患者的生活质量。对于胃食管反流病的诊断和疗效判断，目前临床上以常规应用胃镜和24小时pH-阻抗的结果进行判断，但二者都为有创检查，患者耐受度较差，且在基层医院无法进行。胃食管反流病的主要治疗目的是缓解症状并提高患者的生活质量。因此，无创监测和有效的症状评估是至关重要的。基于此，本文总结目前胃食管反流病的无创监测指标以及诊断评分的研究进展，为临床医师在临床工作中诊断胃食管反流病和评估疗效提供参考。

胃食管反流病是一系列由胃酸反流至食管、口咽部或甚至气管引发的疾病，其主要病因很可能是食管下括约肌功能出现障碍所致。随着生活水平的提高，胃食管反流病的发病率也逐年升高。目前，针对胃食管反流病的治疗方法主要包括改变日常生活习惯、药物疗法、内窥镜治疗以及外科手术疗法。本文就对于胃食管反流病的各个治疗方式进行叙述。

慢性萎缩性胃炎(chronic atrophic gastritis, CAG)，是指胃黏膜上皮反复受到损伤，致固有腺体减少，伴或不伴有肠上皮化生或不典型增生，是一种常见的慢性胃部炎症性疾病。对CAG的治疗，西医多采用对症支持疗法等，虽短期可以快速改善胃部不适的症状，但因慢性萎缩性胃炎发病机制复杂、治疗难度大、恢复期长等特点，患者长时间的三联或者四联西医治疗，易形成耐药，且病情易反复发作，中西医结合在治疗本病方面有独特优势，且具有安全性高、副作用小、疗效显著等优点。

慢性咽炎是耳鼻喉科常见的慢性疾病之一，病因复杂，多见于成年人，且多与职业、呼吸道感染、饮食及情绪关联密切，缠绵难愈。目前对慢性咽炎的治疗方式不胜枚举，主要包括中医治疗、西医治疗以及将两者结合的中西医结合治疗，本文旨在总结阐述治疗慢性咽炎的中西医治疗方法。