| Chronic atrophic gastritis(CAG) as a commonest gastrointestinal disease, has higher prevalence and threatens healthy seriously. To date, general-accepted effective therapy remains absent. TCM may exert a promising option. But problems exist in therapeutic effect evaluation impair the progress of clinical research.Aim To conclude and analyze the differentiation-prescription rules of CAG; to evaluate the therapeutic effect of TCM for the treatment of CAG, to explore the evaluating methods and raise current problems.Method To analyze the rules of pathogenesis, differentiation and prescription of CAG, by literature analysis and dinning the experience of professor Tang ; to evaluate the therapeutic effect of CAG treated with TCM, and to address the characteristics, advantage and current problem by conducting systematic review and observing efficacy of 65 cases with CAG treated by TCM based on syndrome differentiation.Result1. Differentiation-prescription rules of CAG:(1) Results from literatures analysis: Spleen-stomach deficiency (34.2%) , disharmony between liver and stomach (21.3 %) , stomach-yin deficiency (18.6%) , spleen-stomach damp-heat (15.6%) and blood stasis in stomach collaterals (18.1 %) are the commonest syndromes. Qi and yin deficiency (23.3 % VS 23.5 %) dominate at deficient aspect, qi stagnation and blood stasis (26.7 % VS 18.6%) dominate at excess aspect. Common-used drugs include invigorating spleen, regulating qi, eliminating damp, nourishing yin, promoting blood circulation and promoting digestion, including Bai-shao, Bai-zhu, Ban-xia, Chen-pi, Fu-ling, and etc. Spleen-stomach deficiency syndrome treated with Xiang-sha-liu-jun-zi-tang, combined with drugs of regulating qi, warming interior, promoting blood circulation and nourishing yin; disharmony between liver and stomach syndrome treated with Si-ni-san or Chai-hu-shu-gan-san and Jin-ling-zi-san, spleen-stomach damp-heat syndrome treated with Huang-qin-hua-shi-tang or Huang-lian-wen-dan-tang combined with drugs of regulating qi and invigorating spleen; stomach-yin deficiency treated with Yi-guan-jian or Yi-wei-tang, matched drugs of regulating qi, promoting blood circulation and promoting digestion; blood stasis in stomach collaterals syndrome treated with Shi-xiao-san or Dan-shen-yin, combinded with drugs of regulating qi, invigorating spleen and nourishing yin.(2) Differentiation-prescription experience of professor Tang: Major treating method is regulating qi to promote stomach empting and descending, added drugs of promoting blood circulation, invigorating spleen, eliminating damp; common-used prescriptions includes Xiang-su-yin, Si-ni-san, Xiao-xian-xiong-tang, Jin-ling-zi-san, Dan-shen-yin,Shi-xiao-san and Zuo-jin-wan; drugs include Huang-lian, Chen-pi, Ban-xia, Su-geng, Wu-zei-gu, Yuan-hu, Chuang-lian-zi, and etc;common used drug pairs like Chuang-lian-zi=>Yuan-hu,Xiang-fu=>Chen-pi, Ban-xia=>Huang-lian, and etc.2. Evaluation of therapeutic effect of TCM for the treatment of CAG based on syndrome differentiation(1) Systematic review on TCM for the treatment of CAG: The efficacy was evaluated from both number and score changes. The atrophy improvement of TCM group is more significant than controls (P=0.004 VS 0.008 ), compared with vitacoenzyme, hericium and blank control (P=0.0001, 0.0002 VS 0.01), while symptomatic treatment superior to TCM (P=0.03); For improving IM, TCM is superior to controls (P=0.02 VS P<0.00001), compared with hericium, blank and symptomatic medication (P=0.02, 0.007 VS 0.02), with vitacoenzyme (P=0.69) .For improvement DYS of TCM group is more significant than controls (P=0.006 VS 0.004), compared with symptomatic medication and blank control (P=0.11 VS 0.09), with vitacoenzyme (P=0.0004) .For improving granula-like mucosa and bile reflux, TCM is superior to controls (P=0.05 VS 0.005) ,compared with vitacoenzyme and hericium for visible vessel change (P=0.25 VS 0.83). For Hp eradicative rate, there are significance between TCM and control (P=0.009), with hericium, blank control and bismuth potassium citrate (P=0.02, 0.009 VS 0.009), with hericium and symptomatic medication (P=0.70 VS 0.74) ;for overall symptomatic improvement, TCM is more significant than control (P=0.008) ,for stomach pain (P<0.00001) , epigastric distension and fullness (P < 0.00001) ,belching (P=0.18 VS 0.22) , poor appetite (P=0.0007), for disordered stool (P=0.002 VS 0.03) , heart burn (P<0.00001) , acid reflux (P<0.00001).(2) Clinical observation on 65 cases with CAG treated with TCM based on syndrome differentiation: patient of blood stasis with longer course (P=0.044) , more severe pathological lesions (P=0.026) ,non-blood stasis group with female dominance (P=0.013) ,more severe symptoms and PRO scores (P=0.030 VS 0.003) . After treatment the total symptom score, PRO score, endoscopic findings and pathological lesions were improved significantly (P<0.05); dimensions of PRO attribute to overall improvement as dyspepsia ( 0.423 ) >general symptoms (0.362)> Psychological function(0.353) >reflux (0.238) >social function (0.141)> disordered stool (0.106), the social status remains unchanged (P=0.089) .Total symptom scores improvement of non blood stasis group is superior (P=0.004) , especially belching and poor appetite(P=0.040 VS 0.034 ) ,symptoms attribute to overall improvement as gastric fullness (0.397) ,distention (0.330), heart bum (0.292), gastric pain (0.283) ,poor appetite (0.273) ,belching (0.189) . the pathological improvement of blood stasis group is superior (P=0.036) .Conclusion1. Differentiation-prescription rules:CAG manifests as non-specific dyspeptic symptoms like gastric fullness and distention, pain, belching, poor appetite, disordered defecation, general symptoms like lassitude, anorexia and psychological ones like nervous, anxiety and fear of carcinogenesis. The pathogenesis characterized by qi and yin deficiency dominance in deficient aspect, with qi stagnation and blood stasis dominance in excess aspect. Spleen-stomach deficiency is the basic pathogenesis, qi stagnation and blood stasis play a key role in occurrence and development. Commonest syndromes include disharmony and stagnating heat of liver-stomach, spleen-stomach deficiency, damp-heat in middle-Jiao, stomach yin deficiency. Blood stasis of stomach collateral developed in the long course of the disease, accompanied with other syndrome. Main treating method is regulating qi to promoting stomach soothing and descending, matched promoting blood circulating, invigorating spleen, eliminating damp; Each syndrome treated by major prescription, which modified with drugs of other functions, to prevent intense function or adverse effect of major drugs, by comprehensively considering the pathogenic character of the syndrome, drug interaction and the physiological nature of stomach. 2. Therapeutic effect evaluation of TCM for the treatment of CAGThe TCM was superior to controls in improving symptoms, five dimensions of PRO scale, endoscopic findings and pathological changes. Non blood stasis group is superior t in improving dyspeptic symptoms like belching and poor appetite; blood stasis group has more severe pathological lesions and exhibits more significant improvement after treatment. It is concluded that promoting blood circulation plays an important role in improving atrophy, IM and preventing carcinogenesis, which should be used careful for patient with digestion disorder. The phenomena of no change in social status still need further research.Some problems encountered in effect evaluation, which should be improved from following aspects: (1) Making biopsy from constant location, standardizing pathological operations, strengthening qualify control. (2) Strengthening research design, including randomization and allocation conceal, blind evaluation, choosing blank or conventional treatment as control, avoiding controls without recognized efficacy, sufficient sample size, applying recognized diagnostic criteria. (3) Selection of effect evaluating method: Intermingle of symptom, endoscopic and pathological changes should be avoided, scores of above items of pre and after treatment is recommended, differentiate the major and other lesion. The grade and scoring of pathological lesions should refer to updated Sydney system, and make further evaluation for DYS; rational and practical grading method still need further study. The classification and scoring of symptoms should be unify, the major ones should be evaluated from both frequency and intensity, longer duration and follow-up study to observe mortality and gastric cancer incidence rate, pay more attention to evaluation of the health related quality of life and patient reported outcome. (4) Treatment duration should be longer than 3 months, standardizing the Traditional Chinese Medicine Terms of CAG.
|
PDF Full Text Request