谢晶日辨治慢性萎缩性胃炎经验

Xie Jingri’s Experience in Treating Chronic Atrophic Gastritis

摘要: 慢性萎缩性胃炎(Chronic Atrophic Gastritis, CAG)是以胃黏膜固有腺体减少为主要病理特征的慢性胃病，可伴肠上皮化生及上皮内瘤变，属于胃癌防治链条中的重要环节。谢晶日教授长期从事脾胃病临床与研究，认为本病以脾胃虚弱为本，肝失疏泄、中焦升降失司为关键环节，痰、湿、瘀、热、毒互结胃络为病机演变之要。其辨治强调“治中焦如衡”，重视因机立法、药对相伍与病理分层，在调气机、健脾胃、抑酸降逆、通腑化滞、化瘀消积、清热解毒诸法之间动态取舍。对于病程较久、肠上皮化生或低级别上皮内瘤变倾向者，尤重“痰瘀伏络、瘀久成毒”的病势判断，主张在顾护脾胃的前提下适时介入化瘀解毒之法，以延缓病理进展。本文结合谢晶日教授相关经验文献、近年来慢性萎缩性胃炎临床研究与基础研究进展，对其病机认识、辨治思路、用药特点及学术价值进行系统整理，以期为名医经验传承与该病临床防治提供参考。

Abstract: Chronic atrophic gastritis (CAG) is a chronic gastric disorder characterized by the loss of intrinsic glands and may be accompanied by intestinal metaplasia or intraepithelial neoplasia, representing an important stage in gastric cancer prevention. Professor XIE Jingri holds that the disease is rooted in deficiency of the spleen and stomach, with impaired liver regulation and disordered ascending-descending movement of the middle burner as the pivotal mechanism, while phlegm, dampness, blood stasis, heat and toxin lodged in the gastric collaterals constitute the key pathological evolution. His treatment emphasizes “balancing the middle burner”, and stresses therapeutic decisions based on mechanism differentiation, herb-pair application and pathological stratification. In clinical practice, he dynamically combines regulation of qi movement, strengthening of the spleen and stomach, acid suppression and downbearing, bowel unblocking, stasis-resolving, mass-dissipating and detoxifying methods. For patients with prolonged disease, intestinal metaplasia or a tendency toward low-grade intraepithelial neoplasia, he particularly values the judgment of “phlegm and blood stasis lurking in the collaterals with stasis transforming into toxin”, and advocates timely use of stasis-resolving and detoxifying therapy on the premise of protecting spleen-stomach function so as to delay pathological progression. Based on Professor XIE’s published experience as well as recent clinical and experimental studies on CAG, this paper systematically summarizes his understanding of pathogenesis, therapeutic strategy, medication characteristics and academic significance, aiming to provide reference for the inheritance of famous physicians’ experience and for the clinical prevention and treatment of CAG.