从“脾虚瘀毒”理论治疗慢性萎缩性胃炎经验

Experiences in Treating Chronic Atrophic Gastritis from the Perspective of the “Spleen Deficiency, Blood Stasis, and Toxin” Theory

摘要: 慢性萎缩性胃炎(Chronic Atrophic Gastritis, CAG)作为一种胃癌前病变，其有效干预对降低胃癌风险至关重要。刘华一教授基于“脾虚瘀毒”理论，系统阐述了CAG的病机与治则。该理论认为，CAG的核心病机为本虚标实：“脾虚”为本，即中焦虚弱、运化失权，为疾病之始动与基础；“瘀、毒”为标，乃因虚致瘀，久病入络，湿热痰瘀搏结，化生毒邪，损及胃络，此为病情进展与癌变之关键。三者互为因果，形成恶性循环。在治疗上，主张以“扶正祛邪”为纲，立健脾益气之法以固其本，施活血化瘀、解毒散结之方以治其标。临床通过辨证论治，运用相应方药干预，可显著改善患者症状，促进胃黏膜修复与病理逆转(包括萎缩、肠化生及异型增生)，从而延缓疾病进程。结论：以刘华一教授“脾虚瘀毒”理论为指导的健脾化瘀解毒法，是治疗CAG的有效策略，深刻体现了中医“治病求本”与“既病防变”的思想，临床价值显著，应用前景广阔。

Abstract: Chronic Atrophic Gastritis (CAG), as a precancerous gastric lesion, requires effective intervention to mitigate the risk of gastric cancer. Professor Liu Huayi, based on the “Spleen Deficiency, Blood Stasis, and Toxin” theory, has systematically elucidated the pathogenesis and treatment principles of CAG. This theory posits that the core pathogenesis of CAG is a deficiency-root with excess-manifestations: “Spleen Deficiency” constitutes the root, referring to weakness of the middle energizer and impaired transportation and transformation, which is the initiating factor and foundation of the disease. “Blood Stasis and Toxin” are the manifestations, arising when deficiency leads to stasis, chronic disease penetrates the collaterals, and dampness, heat, phlegm, and stasis intermingle to generate pathogenic toxins that damage the stomach network. This process is critical for disease progression and carcinogenesis. These three elements interact reciprocally, forming a vicious cycle. Regarding treatment, the principle of “Supporting Healthy Qi and Eliminating Pathogenic Factors” is advocated, establishing the method of Fortifying the Spleen and Boosting Qi to secure the root, while applying strategies of Activating Blood Circulation to Resolve Stasis, and Detoxifying to Dissipate Nodules to address the manifestations. Clinical practice guided by syndrome differentiation and treatment, utilizing corresponding herbal formulations, can significantly alleviate patient symptoms, promote gastric mucosal repair and pathological reversal (including atrophy, intestinal metaplasia, and dysplasia), thereby slowing disease progression. In conclusion, the therapeutic method of fortifying the spleen, resolving stasis, and detoxifying, guided by Professor Liu Huayi’s “Spleen Deficiency, Blood Stasis, and Toxin” theory, represents an effective strategy for treating CAG. It profoundly embodies the TCM concepts of “treating disease by seeking the root” and “preventing disease progression”, demonstrating significant clinical value and broad application prospects.