胃食道逆流的中醫辨證與治療

Traditional Chinese medicine syndrome differentiation and treatment of gastroesophageal reflux

胃食道逆流病的發病機制，主要是抗逆流防禦機制減弱和逆流物對食道黏膜的攻擊作用增強所致。多種因素參與胃食道逆流病的發病包括：食道下段括約肌（Low Esophargus spinctor）功能失調、食道廓清功能下降、食道組織抵抗力損傷、胃排空延遲、胃酸及胃蛋白酶等，主要攻擊因數對食道黏膜損害，而幽門螺桿菌感染、社會心理因素、不當的飲食方式等也是致病的重要因素。在辨證論治上可分為以下五證型：1. 肝胃鬱熱證，治法宜疏肝泄熱，和胃降逆，參考方劑為柴胡疏肝散；2. 膽熱犯胃證，治法宜清化膽熱，降氣和胃，參考方劑為龍膽瀉肝湯；3. 中虛氣逆證，治法宜疏肝理氣，健脾和胃，參考方劑為四逆散；4. 氣鬱痰阻證，治法宜開鬱化痰，降氣和胃，參考方劑為旋覆代赭湯；5. 瘀血阻絡證，治法宜活血化瘀，行氣止痛，參考方劑：血府逐瘀湯。

The pathogenesis of gastroesophageal reflux disease is mainly due to weakened defense mechanisms against reflux and increased attack to esophageal mucosa. A variety of factors involved in the pathogenesis of gastroesophageal reflux disease including: lower esophageal sphincter dysfunction, decreased esophageal clearance function, decreased esophageal resistance to damage, delayed gastric emptying, gastric acid and pepsin. Helicobacter pylori infection, psychosocial factors, and improper diet are also important pathogenic factors. The syndrome differentiation and treatment of TCM could be divided into five groups as following: 1. Syndrome of heat depression of the liver and stomach; therapeutic principals are soothing the liver and discharging heat/ harmonizing the stomach and directing qi downward; the reference formula is Chaihushugan powder. 2. Syndrome of gallbladder heat invading the stomach; therapeutic principals are eliminating gallbladder heat/ directing qi downward and harmonizing the stomach; the reference formula is Longdanxiegan decoction. 3. Syndrome of middle qi deficiency and qi counterflow; therapeutic principals are soothing the liver and regulating qi/ fortifying the spleen and harmonizing the stomach; the reference formula is Sini powder. 4. Syndrome of qi movement stagnation and phlegm obstruction; therapeutic principals are opening stagnation and resolving phlegm/ directing qi downward and harmonizing the stomach; the reference formula is Xuanfudaizhe decoction. 5. Syndrome of static blood obstructing the collaterals; therapeutic principals are activating blood and resolving stasis/ moving qi to relieve pain; the reference formula is Xuefuzhuyu decoction.