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

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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，
  
  Online First：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" .

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