Exploring the mechanism of gastroesophageal reflux disease based on "the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized"

YANG Zhuqing; GUO Min; WANG Xiaoge; LIU Zhenya; YANG Tianchuang; YAO Cuicui; WANG Lu; LI Heguo

doi:10.3969/j.issn.1006-2157.2023.05.018

您当前的位置：

首页 >

文章列表页 >

Exploring the mechanism of gastroesophageal reflux disease based on "the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized"

Clinical Studies | 更新时间：2023-06-05

- Exploring the mechanism of gastroesophageal reflux disease based on "the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized"
- Journal of Beijing University of Traditional Chinese Medicine Vol. 46, Issue 5, Pages: 711-716(2023)
- 作者机构：
  
  1.河南中医药大学第一临床医学院　郑州　450046
  2.河南中医药大学第一附属医院脾胃肝胆科
- 作者简介：
  
  Prof. LI Heguo, Ph. D., Master’s Supervisor. Department of Hepatology and Spleen-Stomach, The First Affiliated Hospital of Henan University of Chinese Medicine, No. 19, Renmin Road, Jinshui District, Zhengzhou 450003. E-mail: lhg1964@163.com
- 基金信息：
  
  National Natural Science Foundation of China(82104776);Inheritance and Innovation Team Project of National Chinese Medicine Treatment of Refractory Gastrointestinal Diseases(ZYYCXTD-C-202010)
- DOI：10.3969/j.issn.1006-2157.2023.05.018
  CLC： R256.33
- Received：04 October 2022，
  
  Published Online：28 March 2023，
  
  Published：30 May 2023
- 稿件说明：
移动端阅览
YANG Zhuqing, GUO Min, WANG Xiaoge, et al. Exploring the mechanism of gastroesophageal reflux disease based on "the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized"[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(5): 711-716.
DOI：

YANG Zhuqing, GUO Min, WANG Xiaoge, et al. Exploring the mechanism of gastroesophageal reflux disease based on "the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized"[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(5): 711-716. DOI： 10.3969/j.issn.1006-2157.2023.05.018.

摘要

胃食管反流病是临床常见的上消化道疾病，中医学认为，其发病除了与肝、胆、脾、胃等脏腑密切相关以外，还与心、肺亦有联系。在《伤寒论》“上焦得通，津液得下，胃气因和”论述的基础上，提出通过调节上焦心、肺的功能，从而辅助中焦脾胃气机的恢复，最终促进中焦胃气和降，即所谓“通上焦，即为和中焦”，若上焦心、肺功能失常则易影响中焦，不利于中焦胃气和降，从而易造成胃食管反流病的发生。进一步结合临床实践和西医学相关研究，若心统血脉，主神明或延及小肠受盛化物功能失常，则易导致食管内脏高敏感和小肠内细菌过度生长；若肺主宣降，司呼吸或累及大肠通降传导功能失常，则易引起食管胃连接处屏障受损与一过性食管下括约肌松弛，亦会造成胃食管反流病的发生。故通过阐明上焦心、肺对胃食管反流病发病的影响，为胃食管反流病的防治提供了新的思路和理论依据，同时，进一步丰富“上焦得通，津液得下，胃气因和”的理论内涵。

Abstract

Gastroesophageal reflux disease (GERD) is a common clinical disease of the upper gastrointestinal tract. According to traditional Chinese medicine (TCM) theory

its pathogenesis is not only closely related to the liver

gallbladder

spleen and stomach

but also to the heart and lung. Based on the theory of "the upper jiao is cleared

the fluid is brought down

and the stomach qi is harmonized" in

Shanghan Lun

our team propose that by adjusting the functions of the heart and lung in the upper jiao

the qi flow of the spleen and stomach in the middle jiao can be restored

which is ultimately conducive to promoting harmonization and descending of the stomach qi in the middle jiao

that is

"clearing the upper jiao with the aim of harmonizing the middle jiao". If the heart and lung of the upper jiao are malfunctioning

it will easily affect the middle jiao

which is not conducive to the harmonization and descending of the stomach qi

thus easily causing GERD to occur. Further combining clinical practice with relevant researches in western medicine

if the functions of the heart governing the blood vessels and spirit are abnormal or the function of the small intestine is abnormal

the person is prone to esophageal visceral hypersensitivity and small intestinal bacterial overgrowth. Furthermore

if the functions of the lung governing dispersion

descending and respiration are abnormal or the function of the large intestine is abnormal

this may cause esophagogastric junction barrier damage and transient lower esophageal sphincter relaxation. All of these eventually lead to GERD. Therefore

the present paper provides a new direction and theoretical basis for the prevention and treatment of GERD by clarifying the influence of heart and lung on GERD. At the same time

it further enriches the theoretical connotation of "the upper jiao is cleared

the fluid is brought down

and the stomach qi is harmonized" .

关键词

Keywords

references

陈冬雪，钱占红，夏聪媛，等．对Ghrelin/GHSR-1a/GABA通路关键因子在胃食管反流病肝郁证模型中表达水平的研究 [J]. 北京中医药大学学报， 2021 ， 44 ( 6 )： 519 － 526 .

杨勤，李军祥，李晓红．半夏泻心汤加减对非糜烂性反流病症状和生活质量的影响 [J]. 北京中医药大学学报， 2013 ， 36 ( 4 )： 280 － 285 .

中华中医药学会脾胃病分会 . 胃食管反流病中医诊疗专家共识意见(2017) [J]. 中国中西医结合消化杂志， 2017 ， 25 ( 5 )： 321 － 326 .

张仲景．伤寒论 [M]. 北京：中国医药科技出版社， 2016 ： 64 － 65 .

唐容川．伤寒论浅注补正 [M]. 牛波，校注．太原：山西科学技术出版社， 2013 ： 130 .

郑雪霞，卓桂锋，侯雪芹，等 . 论仲景从少阳治大便不通 [J]. 亚太传统医药， 2016 ， 12 ( 24 )： 71 － 72 .

尤怡．金匮要略心典 [M]. 杨旭杰，点校．北京：人民军医出版社， 2009 ： 183 .

杨时泰．本草述钩元释义 [M]. 黄雄，崔晓艳，编著．太原：山西科学技术出版社， 2009 ： 274 .

唐容川．血证论 [M]. 彭荣琛，齐玲玲，点评．北京：中国医药科技出版社， 2020 ： 6 .

张介宾．景岳全书 [M]. 孙玉信，朱平生，校注．上海：第二军医大学出版社， 2006 ： 414 .

王怀隐．太平圣惠方 [M]. 田文敬，孙现鹏，牛国顺，等，校注．郑州：河南科学技术出版社， 2015 ： 195 .

喻昌 . 医门法律 [M]. 2版．丁侃，校注．北京：中国医药科技出版社， 2019 ： 370 .

KIM J , LEE JH , KIM Y , et al . Association between chronic obstructive pulmonary disease and gastroesophageal reflux disease: a national cross-sectional cohort study [J/OL]. BMC Pulm Med , 2013 ， 13 ： 51 [ 2022－09－12 ]. https：//bmcpulmmed.biomedcentral.com/articles/10.1186/1471－2466－13－51 https：//bmcpulmmed.biomedcentral.com/articles/10.1186/1471－2466－13－51 .

唐容川．唐容川医学全书 [M]. 梁宝祥，郭海，张伟，等，校注．太原：山西科学技术出版社， 2016 ： 23 .

秦景明．症因脉治 [M]. 孙玉信，朱平生，主校．上海：第二军医大学出版社， 2008 .

刘凡，张书，郭洁，等．半夏调中颗粒介导MC-PAR－2－TRPV1通路调控非糜烂性反流病大鼠模型内脏高敏感的作用机制 [J]. 时珍国医国药， 2022 ， 33 ( 10 )： 2355 － 2359 .

徐晓蓉，李兆申，杨敏，等．非糜烂性反流病内脏高敏感的外周与中枢机制研究 [J]. 中国实用内科杂志， 2006 ， 26 ( 9 )： 670 － 672 .

JANSSON C , NORDENSTEDT H , WALLANDER MA , et al . Severe gastro-oesophageal reflux symptoms in relation to anxiety, depression and coping in a population-based study [J]. Aliment Pharmacol Ther , 2007 ， 26 ( 5 )： 683 － 691 .

金立鹏，魏良洲．从心身角度认识胃食管反流病 [J]. 中华诊断学电子杂志， 2016 ， 4 ( 3 )： 173 － 176 .

张明倩，崔爽，梁五林，等．养心生脉颗粒对冠心病伴焦虑抑郁大鼠的干预作用及机制研究 [J]. 北京中医药大学学报， 2022 ， 45 ( 8 )： 806 － 814 .

王梦玺，陈晓虎．从认知心理学视角剖析双心疾病 [J]. 北京中医药大学学报， 2022 ， 45 ( 4 )： 342 － 346 .

WANG D , PATEL A , MELLO M , et al . Esophagogastric junction contractile integr-al (EGJ-CI) quantifies changes in EGJ barrier function with surgical intervention [J]. Neurogastroenterol Motil , 2016 ， 28 ( 5 )： 639 － 646 .

ZACHARIAH RA , GOO T , LEE RH . Mechanism and Pathophysiology of Gastroesophageal Reflux Disease [J]. Gastrointest Endosc Clin N Am , 2020 ， 30 ( 2 )： 209 － 226 .

LIANG BM , FENG YL . Association of gastroesophageal reflux disease symptoms with stable chronic obstructive pulmonary disease [J]. Lung , 2012 ， 190 ( 3 )： 277 － 282 .

ATES F , VAEZI MF . Insight Into the Relationship Between Gastroesophageal Reflux Disease and Asthma [J]. Gastroenterol Hepatol (N Y) , 2014 ， 10 ( 11 )： 729 － 736 .

徐杨 . 基于呼吸运动检测的肺藏司呼吸功能异常的客观测评研究 [D]. 北京：中国中医科学院， 2021 .

付旭明，王纪红，潘殿柱．慢性阻塞性肺疾病患者膈肌移动度情况及其与肺功能的相关性研究 [J]. 中国全科医学， 2021 ， 24 ( 5 )： 561 － 565 .

KIM KM , KIM BT , LEE DJ , et al . Erosive esophagitis may be related to small intestinal bacterial overgrowth [J]. Scand J Gastroenterol , 2012 ， 47 ( 5 )： 493 － 498 .

姚佳，原丽莉，朱娜，等．反流性食管炎与小肠细菌过度生长的关系研究 [J]. 中华消化杂志， 2013 ， 33 ( 12 )： 865 － 866 .

PIMENTEL M , LIN HC , ENAYATI P , et al . Methane, a gas produced by enteric bacteria, slows intestinal transit and augments small intestinal contractile activity [J]. Am J Physiol Gastrointest Liver Physiol , 2006 ， 290 ( 6 )： 1089 － 1095 .

陈青海，于海洋，李巧梅，等．基于《黄帝内经》“心合小肠”理论谈肠道微生态与骨质疏松症相关性 [J]. 中国骨质疏松杂志， 2020 ， 26 ( 8 )： 1185 － 1188 .

SKIM HI , HONG SJ , HAN JP , et al . Specific movement of esophagus during transient lower esophageal sphincter relaxation in gastroesophageal reflux disease [J]. J Neurogastroenterol Motil , 2013 ， 19 ( 3 )： 332 － 337 .

SHARMA P , YADLAPATI R . Pathophysiology and treatment options for gastroesophageal reflux disease: looking beyond acid [J]. Ann N Y Acad Sci , 2021 ， 1486 ( 1 )： 3 － 14 .

ZHENG Z , SHANG YX , WANG N , et al . Current Advancement on the Dynamic Mechanism of Gastroesophageal Reflux Disease [J]. Int J Biol Sci , 2021 ， 17 ( 15 )： 4154 － 4164 .

KAHRILAS PJ , SHI G , MANKA M , et al . Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia [J]. Gastroenterology , 2000 ， 118 ( 4 )： 688 － 695 .

MOMMA E , KOEDA M , TANABE T , et al . Relationship between gastroesophageal reflux disease (GERD) and constipation: laxative use is common in GERD patients [J]. Esophagus , 2021 ， 18 ( 1 )： 152 － 155 .

惠毅，杨宇，唐洪屈，等．从肺病模型大鼠胃肠动力学角度探讨“肺病及肠”病理传变机制 [J]. 中国中医基础医学杂志， 2013 ， 19 ( 1 )： 50 － 51 .

Views

212

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Exploring the pathogenesis and treatment of gastroesophageal reflux disease with emotional disorders based on the trinity life view of body, qi, and spirit

Characteristics and pathogenesis of heart meridian diseases in the Lingshu·Meridians chapter

Discussion on the decoction and dosing methods of rhubarb root and rhizome in classical prescriptions

Treating Parkinson′s disease from the perspective of the liver and lung based on the theory of " restraining excessiveness to acquire harmony"

Related Author

SU Kunhan

LIU Wanli

LIU Fujia

LI Wang

LU Hongrong

REN Zilin

LI Changxiang

ZHENG Yuxiao

Related Institution

Nanjing First Hospital, Nanjing Medical University

Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing University of Chinese Medicine

Institute of Basic Theory of Chinese Medicine, China Academy of Chinese Medical Sciences

School of Traditional Chinese Medicine, Beijing University of Chinese Medicine

Affiliated Hospital of Shandong University of Traditional Chinese Medicine

AI问答

Postal code：100029
Tel：(010)53911857 Email：jbutcm@bucm.edu.cn
Technical support is provided by Beijing Founder electronics co., LTD 京ICP备09064830号-19 京公网安备11010802024621
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰