周毅,湖北中医药大学教授,湖北省中医院脾胃病科主任医师,临床工作二十余年,擅长从脾胃论治各种疾病。对于复发性口腔溃疡,周毅教授基于中医理论将此病辨证为脾虚阴火证,以缓解疼痛、促进愈合、减少复发率为目标,治疗以中药汤剂、中成药、西药联合使用,内外兼治,临床上取得了显著的疗效。笔者有幸跟随周毅教授抄方学习两年,现对周毅教授的治疗经验做以简述。 Zhou Yi, professor of Hubei University of Chinese Medicine and chief physician of spleen and stomach disease department of Hubei Hospital of Traditional Chinese Medicine, has worked in the clinic for more than 20 years, and is good at treating various diseases from spleen and stomach. For recurrent oral ulcer, Professor Zhou Yi, based on the theory of traditional Chinese medicine, differentiated the disease into spleen deficiency yin fire syndrome, aiming at alleviating pain, promoting healing and reducing recurrence rate. In the treatment, traditional Chinese medicine decoction, Chinese patent medicine and Western medicine are used in combination, and both internal and external treatments are used, which has achieved remarkable clinical effect. I had the honor to study with Professor Zhou Yi for two years. Now I will give a brief introduction to Professor Zhou Yi’s treatment experience.
周毅,湖北中医药大学教授,湖北省中医院脾胃病科主任医师,临床工作二十余年,擅长从脾胃论治各种疾病。对于复发性口腔溃疡,周毅教授基于中医理论将此病辨证为脾虚阴火证,以缓解疼痛、促进愈合、减少复发率为目标,治疗以中药汤剂、中成药、西药联合使用,内外兼治,临床上取得了显著的疗效。笔者有幸跟随周毅教授抄方学习两年,现对周毅教授的治疗经验做以简述。
周毅,复发性口腔溃疡,脾虚阴火证,中西医结合治疗
Yanhui Deng, Yi Zhou*
Hubei University of Chinese Medicine, Wuhan Hubei
Received: Oct. 21st, 2022; accepted: Nov. 14th, 2022; published: Nov. 22nd, 2022
Zhou Yi, professor of Hubei University of Chinese Medicine and chief physician of spleen and stomach disease department of Hubei Hospital of Traditional Chinese Medicine, has worked in the clinic for more than 20 years, and is good at treating various diseases from spleen and stomach. For recurrent oral ulcer, Professor Zhou Yi, based on the theory of traditional Chinese medicine, differentiated the disease into spleen deficiency yin fire syndrome, aiming at alleviating pain, promoting healing and reducing recurrence rate. In the treatment, traditional Chinese medicine decoction, Chinese patent medicine and Western medicine are used in combination, and both internal and external treatments are used, which has achieved remarkable clinical effect. I had the honor to study with Professor Zhou Yi for two years. Now I will give a brief introduction to Professor Zhou Yi’s treatment experience.
Keywords:Zhou Yi, Recurrent Oral Ulcer, Spleen Deficiency Yin Fire Syndrome, Integrated Traditional Chinese and Western Medicine
Copyright © 2022 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
复发性口腔溃疡(recurrentoral ulcer, ROU)又名复发性阿弗他溃疡(recurrent aphthous ulcer, RAU),是一种好发于唇、舌、颊、前庭及软腭等部位的孤立的、圆形或椭圆形溃疡,发病率居口腔粘膜疾病的首位,女性发病率高于男性,发病年龄段多局限于青少年及中年,发作时伴有剧烈灼痛感,以周期性反复发作、具有自限性为特点 [
口腔溃疡在中医内科学中可归属于“口疮”、“口糜”一类,病名最早见于《素问·气交变大论》“岁金不及,炎火乃行,民病口疮”的记载 [
本病西医发病机制尚不明确,现代医学认为遗传因素、胃肠道疾病、月经期、口腔健康状况、焦虑等是ROU患者的相关因素 [
患者,岳某阳,女,27岁,2018年9月4日初诊。
口腔溃疡反复发作3年,加重伴胃痛一周。
患者自诉口腔溃疡反复发作3年,每次发作持续两周左右,曾服用抗炎药、西瓜霜喷剂、维生素B12可缓解疼痛,促进愈合,但不日复发且口苦加重,近一周再次发作,口腔灼痛感,进食或说话时疼痛加重,影响日常工作和生活,伴上腹部隐痛,与进食无关,腹胀,打嗝嗳气,反酸,口干不欲多饮,口腔异味,无烧心、无发热恶寒、无后背疼痛、无关节疼痛等不适,纳差,不欲饮食,精神倦怠,夜寐欠佳,难以入睡,大便干结,2~3日一行,小便色黄,量少。末次月经本月4日,行经3日,量少,色红,质稀。周师询问其生活习惯得知患者平素工作压力大,长期加班熬夜,睡眠质量较差。查体见口腔粘膜有两个直径约3~5 mm的椭圆形溃疡面,底覆灰白苔,边缘微红,舌质红,舌体瘦,舌苔少,脉细数,剑突下有压痛。辅助检查:2018年9月3日湖北省中医院无痛胃镜提示:1) 慢性糜烂性胃炎(II级);2) 反流性食管炎(A级)。脉症合参,周师将其中医诊断为口疮,辨证为脾胃虚弱,阴虚火旺证。西医诊断为复发性口腔溃疡。处理:1) 泮托拉唑钠肠溶胶囊(规格40 mg),口服,一日两次,一次一粒,早餐前及临睡前空腹;2) 康复新液(规格100 mL)含漱后口服,一日三次,一次10 mL,餐前;3) 治拟益气生津,滋阴降火。方用七味白术散加减。处方:黄芪20 g,党参15 g,白术12 g,葛根12 g,茯苓10 g,木香10 g,陈皮10 g,北沙参12 g,麦冬12 g,玉竹12 g,当归10 g,知母10 g,熟地黄12 g,牡丹皮10 g,白芨10 g,海螵蛸30 g,煅瓦楞子30 g。处方14剂,水煎服,每日2剂,早晚温服;4) 嘱患者服药期间清淡饮食,避免劳累,调畅情志。二诊(2018年9月11日):患者诉口腔灼痛感明显缓解,无口干口苦、打嗝嗳气等症,精神可,乏力感好转,食欲较前改善,稍反酸,进食后偶发腹痛、腹胀,夜寐欠安,大便干结,一日一次,小便正常。查体见口腔黏膜溃疡面积呈米粒大小,周边黏膜充血改善,舌质淡红,边有齿痕,苔薄白,脉细数。体格检查剑突下轻微按压痛。处理:继服泮托拉唑钠肠溶胶囊、康复新液;中药原方去茯苓,加茯神10 g,大腹皮10 g,肉苁蓉10 g,砂仁10 g。处方14剂,煎服法同前。三诊(2018年9月18日):患者诉口腔已无疼痛感,无明显腹胀腹痛,反酸较前好转,食欲一般,精神可,未感乏力,夜寐尚安,大便软,一日一次,小便正常。查体见口腔溃疡面已完全消退,周围黏膜红肿消失,舌淡红苔薄白,脉弦细。体格检查无压痛及反跳痛。周师嘱继服泮托拉唑钠肠溶胶囊、康复新液4周,中药14付,继上方加炒二芽各10 g,煎服法同前,服药期间不适随诊,清淡饮食,避免劳累,调畅情志。笔者随访一年,患者诉精神明显改善,纳食正常,睡眠正常,未复发口腔溃疡。2019年8月30日复查胃镜提示胃黏膜未见异常。
按:《脾胃论·阴病治阳阳病治阴》曰:“饮食失节,及劳役形质,阴火乘于坤土之中……”《脾胃论·脾胃虚则九窍不通》曰:“脾胃既为阴火所乘……九窍为之不利。”李东垣认为饮食不节、形体劳累损伤脾胃之元气,继之阴火乃生。周师辨证该患者久病、过度劳倦思虑皆伤及脾胃之元气,导致脾胃气虚,气血津液生化不足,故患者乏力倦怠、纳差、小便量少、大便干结、少苔,所谓津血同源,津亏血少则不能濡养心、肝、肾,导致心火、相火的亢盛,故患者舌红、夜寐欠佳难以入睡、月经量少行经期短;另一方面,脾胃受损导致脾不得升胃不得降,水谷精气滞留胃中,故患者腹胀、腹痛,胃气不降反升故患者打嗝、嗳气、反酸,久之郁而化热,热邪又耗伤阴津,加重了阴虚火旺的程度,《杂病源流犀浊·口唇舌病源流》云:“中焦气不足,虚火上泛亦口糜;服凉药不效,阴亏火泛亦口糜;内热亦口糜。”脾胃虚弱是本,阴火上炎是标,素体脾胃虚弱,易引起虚火上炎,致口疮反复发作。正如《圣济总录》所讲“口疮者,由心脾有热,气冲上焦,熏发口舌,故作疮也。又有胃气弱,谷气少,虚阳上发而为口疮者。”根据李东垣“伤其内为不足,不足者补之”,即虚者补,损者益的治疗原则,周师用七味白术散化裁以益气生津,滋阴降火。其中党参甘温补气,扶脾养胃,养血生津;黄芪味甘微温,补益中焦,助生气血,兼以托毒生肌;白术苦温,健脾燥湿,益气助运,研究表明其调节胃肠道运动、调节肠道微生态、修复胃肠道黏膜损伤、抗炎的作用机制可帮助缓解患者胃肠道症状 [
以对目前复发性口腔溃疡的研究进展来看,西医方面尚无较明确的发病机制,缺乏有效的根治方法。如西医用抗生素等相关含漱液 [
邓炎辉,周 毅. 周毅教授中西医结合治疗复发性口腔溃疡经验浅析Professor Zhou Yi’s Experience in Treating Recurrent Oral Ulcer with Integrated Traditional Chinese and Western Medicine[J]. 中医学, 2022, 11(06): 1206-1210. https://doi.org/10.12677/TCM.2022.116176