基于"虚、郁、瘀、毒"探析老年难治性胃食管反流病的中医病机及治疗思路OA

Elderly refractory gastroesophageal reflux disease(RGERD)is a challenging disorder in gastroenterology,and treatment with acid suppression alone often yields unsatisfactory outcomes.This paper systematically elucidates the core pathogenesis of elderly RGERD as"deficiency of the middle Jiao and disorder of the pivotal mechanism".It proposes that the disease evolution follows a dynamic transformation pattern among"deficiency,stagnation,stasis,and toxin".Deficiency of the middle Jiao leads to ascending and descending derangement of Qi movement;liver Qi stagnation with phlegm obstruction generates Qi stagnation;chronic disease invading the collaterals results in simultaneous deficiency and stasis;and accumulation of turbid toxin eventually causes structural damage.Based on this pathogenetic characteristic,a five-dimensional therapeutic system is established,including reinforcing the earth and consolidating the root,dredging and rectifying Qi movement,harmonizing blood and unblocking the collaterals,resolving turbidity and detoxifying,and treating via Sanjiao differentiation.This provides a theoretical basis and clinical pathway for integrated traditional Chinese and Western medicine management of RGERD.Future research may focus on the core biological signatures of"deficiency,stagnation,stasis,and toxin"to further refine the precise application of this diagnostic and therapeutic system.