通过对叶天士通阳泄浊法的理解，探讨阳虚水湿代谢失司与老年胃食管反流病（GERD）的关联，胃气上逆是GERD基本病机，肺脾肾三脏阳气不足是老年GERD发病关键，在此基础上出现津液输布失常，水湿停聚，进而随气上逆发为此病。叶天士治疗此类病证时，认为应当通阳泄浊，给予湿邪出路，即重视阳气发挥的温煦调节作用，以达到“水精四布，五经并行”的目的。根据通阳泄浊法联系临床实际，临证运用时应谨守病机，以通运阳气为主，着眼于恢复肺脾肾三脏阳气，此为本；同时祛湿制酸，泄利湿浊，此为标，标本相和而得其效。

This paper explores the correlation between yang deficiency and disordered water-dampness metabolism with senile gastroesophageal reflux disease(GERD),based on the understanding of YE Tianshi's method of activating yang and draining turbidity. Counterflow of stomach qi is the basic pathogenesis of GERD,while insufficiency of yang qi in the lung,spleen and kidney is the key to the onset of senile GERD. On this basis,the abnormal distribution of body fluids occurs,water-dampness accumulates,and then it flows upward with qi,leading to this disease. In treating such syndromes,YE Tianshi held that yang should be activated and turbidity drained to provide an outlet for dampness pathogen,emphasizing the warming and regulating function of yang qi so as to achieve the goal of “essence of water distributed all through the body and into the five meridians”. Combined with clinical practice,the application of the method of activating yang and draining turbidity should strictly follow the pathogenesis,focusing on activating yang qi and restoring yang qi of the lung,spleen and kidney for the root cause. Meanwhile,eliminating dampness and inhibiting acid,draining and expelling damp-turbidity should be used for the superficial manifestation. Only by coordinating the root and superficial manifestation can satisfactory therapeutic effects be achieved in clinical diagnosis and treatment.