| [Objectives] As a clinician of spleen-tonifying school and a fourth batch tutor of the program of Inheriting National Distinguished TCM Doctors’ Experience, Professor Li Qiangou has engaged in the medical work for over 40 years with abundant knowledge being accumulated and is good at treating spleen-stomach diseases. He has academic ideas and clinical experiences being very valuable in spleen-stomach diseases. The objectives of the study are to excavate and inherit these academic ideas and clinical experiences; And focus on learning the experience from Professor Li Qiangou for the treatment of gastroesophageal reflux disease (GERD).[Approaches And Contents] The collating and summarizing work is completed through the following approaches:following Professor Li Qiangou in his clinic work; collating his medical cases; collecting his treatment prescriptions and analyzing his prescription ideas; collecting his lecturing materials, personal notes, special interviews, papers and books; carrying out independent clinical practices so as to further study and adopt his experience in drugs, prescriptions and dialectical methods; indexing of ancient Chinese medicine literature; and analyzing academic ideas which have a large impact on him.60 patients were randomly selected from outpatient and ward, which were respectively subject to spleen-strengthening and counter-flowing stomach Qi-lowering prescription (which is added or subtracted) as well as rabeprazole and compare the clinical effect. And complete clinical study.[Results]The study results is divided into three parts:an overview of Professor Li Qiangou’s academic origins; collation & summary of his academic ideas and clinical experiences; and a study of his syndrome differentiation based treatment of GERD due to counterflowing stomach Qi and spleen deficiencies, whereas he invigorates the spleen and lowers the conterflowing stomach Qi.Part 1:Professor Li Qiangou’s academic originsProfessor Li Qiangou’s academic origins mainly come from two aspects. One aspect comes from some classic works such as "The Yel low Emperor’s Inner Canon", "Treatise on Febrile Diseases", "Synopsis of Prescriptions of the Gold Chamber", etc. The other aspect comes from spleen-tonifying doctrine of "Piwei Lun" and Guan youbo’s "Qi and Blood". Finally he forms the unique academic ideas attaching importance to the spleen, stomach, Qi, and Blood. to take actions that suit local circumstances It specifically includes the following aspects:①Advocating the integrity concept of "The Yellow Emperor’s Inner Canon", which points out that treatment should differentiate from different person, time and local circumstances, and he insists on the theory "Harmony between man and nature".②Pathogenesis of Chinese medicine theory:"Qi deficiency will be provoked by approach of any pathogenic factors. "③Internal injury of spleen and stomach theory:"Internal injury of spleen and stomach will cause diseases. "④The thought of Protection for stomach Qi:"One will be free from diseases throughout an entire year as long as his spleen functions well."⑤Attach importance on Yin, Wei, Qi, Blood and carry through the treatment concept " Activating blood circulation and resolving phlegm" in the whole process for spleen & stomach treatment.Part 2:Collation/Summary of Professor Li Qiangou’s Academic Ideas & Clinical ExperiencesSection 1:Academic Idea and Clinical ExperiencesProfessor Li Qiangou’s academic Ideas and clinical experiences can be summarized into two aspects "fortifying spleen and stomach & adjusting Qi and blood". Spleen and stomach are acquired foundation and the source of Qi and blood. All body organs such as zang-fu viscera, limbs, hundred skeleton, nine orifices, etc. can get foster if healthy state of the spleen, stomach, Qi, Blood, Ying, and Wei is kept. One will be free from diseases throughout an entire year as long as his spleen functions well. The function disorders of spleen and stomach is one of key reasons for disease occurrence. Deficient cold of spleen & stomach and weak primordial qi are main causes for endogenous and exogenous diseases. He attaches importance on spleen and stomach function in his clinical practices. And focus on the important stage for strengthening spleen and stomach to regulate Qi smooth. Strengthening spleen and stomach is commonly used for treatment of internal organs.So Professor Li Qiangou’s clinical experiences can be summarized into follows. In syndrome differentiation, the cause shall be found in Qi and Blood. During the diagnosis first is syndrome differentiation and then dialectical treatment in which attention is paid to main symptoms. Constitution-specific syndrome differentiation and tongue diagnosis are also important. Good at treatment of chronic and incurable diseases based on the spleen and stomach. Regulate Qi movement of the Middle-Jiao based on spleen and stomach during the treatment. The principle to strengthen spleen and regulate Qi shall be in the entire course of treating stomach-spleen diseases. Middle-Jiao Qi should be cared and protected, and it is necessary to be cautious in the use of drugs of cool or cold nature so as to avoid stomach injuries.Section 2:Diagnostic and therapeutic experiences1. GERD (gastroesophageal reflux disease):It is called Xiong Pi in TCM. In it, Professor Li Qiangou has unique insights that the pathogenesis is in abnormal movements of the spleen, stomach, liver and lung. Its cause lies on flooding gastric juice due to counterflowing stomach Qi. The treatment is to regulate liver Qi and harmonize stomach Qi so as to downbear the counterf low and restrain gas tric juice. On the other hand, deficiency and excess, and cold and heat shall be differentiated for specific case to improve clinical effectiveness and reduce recurrence. The principles of regulating liver, harmonizing stomach, subduing the counterflow and restraining gastric juice shall be implemented through the entire course of the treatment. The basic formula is spleen-invigorating & counterflow-downbearing Decoction.2. Helicobacter pylori infection:According to TCM theories such as the concept that one will be free from diseases throughout an entire year as long as his spleen functions well and that Qi deficiency will be provoked by approach of any pathogenic factors, he thinks Hp, as a pathogenic factor, can adhere to the gastric mucosa to cause gastritis or other diseases only when the spleen and stomach are weak and vital Qi is deficient. From such perspectives, the rule to fortify spleen and promote digestion shall be abided by so as to establish the spleen-fortifying digestion-promoting formula. 3. Chronic stomach pain:Advocate the treatment of the chronic stomach pain from deficiency, blood, Qi, liver and spleen.4. Functional dyspepsia:Professor Li Qiangou thinks that the location of the disease is in the stomach and is related to the liver and spleen. The pathogenesis is characterized by deficiency in origin and excess in superficiality. Deficiency in origin means that the spleen and stomach are weak, and excess in superficiality means that the middle-Jiao is stagnated including Qi stagnation, blood stasis, phlegm dampness, and food stagnation. Also, Qi movement is not smooth. The spleen deficiency and Qi stagnation are the basic pathogenesis which is through the entire course of the disease. Clinically, the syndrome of the spleen deficiency and Qi stagnation is often seen. The appropriate treatment method is to remove deficiency in origin and excess in superficiality at the same time, while the main principle is to regulate Qi and strengthen spleen. Three key points are:First is to pay attention to the spleen and help the middle-Jiao Qi movement; second is to dredge liver Qi and regulate Qi activity; and third is to regulate the middle-Jiao. On the basis of strengthening spleen and regulating Qi, addition and subtraction of the prescription are adopted according to changes of the disease conditions.5. Functional constipation:Professor Li Qiangou thinks that the location of the disease is in the large intestine, and is closely related to the spleen and stomach. Constipation needs syndrome differentiation, while addition and subtraction of the prescription are adopted according to changes of the disease conditions. Clinically, constipation due to interior cold, heat and disorder of Qi is not frequently seen. In most cases, patients with constipation are characterized by syndrome of intermingled deficiency and excess. The deficiency is mainly the spleen deficiency with insufficient fluid in the large intestine, while the excess mainly includes Qi stagnation, blood stasis, heat accumulation, and intestine dryness. The main treatment method is to strengthen spleen and nourish Yin, which is supplemented by regulating Qi and blood plus moistening dryness for relaxing bowels. So, Four Gentlemen Decoction is used to treat constipation through addition and subtraction.6. Chronic atrophic gastritis:The location of the disease patients is in the stomach, and is closely related to the liver and spleen. At the beginning, it originates from Qi, and a time later, involves in blood gradually resulting in Qi deficiency and blood stasis in stomach collaterals. Professor Li Qiangou thinks that chronic atrophic gastritis is a complex disease, but it is always related to deficiency and stasis. So, it should be treated from the theory of Qi deficiency and blood stasis.7. Treatment of oral ulcers from fire:Professor Li Qiangou thinks that the clinical practice should pay attention to fire. Deficient fire or excess fire should be identified. Excess fire is often in the heart and spleen, so the drug should be the Rhubarb Xiexin Decoction with Xie Huang San which is added or subtracted. Deficient fire flaring-up is often in the heart and kidney, so the Zhibai Dihuang Decoction with Zeng Ye Tang which is added or subtracted.8. Be good at treatment of chronic cough from spleen:Professor Li Qiangou is good at treatment of chronic cough from spleen. Lung and spleen interact on pathology. In case of dysfunction of spleen in transportation and loss of water, then gather phlegm into drink. It’11 mostly affect pulmonary dispersing and descending function of lung. So it is an important formula to fortify spleen Qi for treatment of chronic cough and lung deficiency.Part 3:Study of his treatment of GERD by invigorating the spleen and lowering the counter-flowing stomach QiObjectives:To observe the effect of the treatment for GERD due to spleen deficiency and counter-flowing Qi by invigorating the spleen to remove the phlegm and subduing this counter-flowing Qi.Methods:60 patients were randomly divided into TCM drug group and rabeprazole group, which were respectively subject to Liver-dredging & spleen-strengthening prescription (which is added or subtracted) as well as rabeprazole in the treatment. The treatment course is 4 weeks with the 1 month follow-up. Changes of the symptom frequency and quality of life with patients were mainly observed.Results:Seen from the statistic scores result for symptomatic seizures frequency before and after treatment, it shows that TCM group has better treatment effect than western medicine group. And there is a distinct difference between groups, which has statistical significance (P<0.01). Furthermore TCM group has more stable treatment effect than western medicine group after one month’s drug withdrawal. After 4 weeks of treatment, two treatments can improve the scores of the symptom frequency and quality of life with patients. On the other hand, in improving vitality and overall health, TCM drug group is better than western medicine group, and the effect can be maintained 1 month after drug withdrawal.Conclusion:There is a good effect with the treatment for GERD by dredging liver and strengthening spleen, which can maintain a more lasting improvement in quality of life for patients. Objectives:To observe the effect of the treatment for GERD due to spleen deficiency and counter-flowing Qi by invigorating the spleen to remove the phlegm and subduing this counter-flowing Qi. Methods:60 patients were randomly divided into TCM drug group and rabeprazole group, which were respectively subject to Liver-dredging & spleen-strengthening prescription (which is added or subtracted) as well as rabeprazole in the treatment. The treatment course is 4 weeks with the 1 month follow-up. Changes of the symptom frequency and quality of life with patients were mainly observed. Results: Seen from the statistic scores result for symptomatic seizures frequency before and after treatment, it shows that TCM group has better treatment effect than western medicine group. And there is a distinct difference between groups, which has statistical significance (P<0.01). Furthermore TCM group has more stable treatment effect than western medicine group after one month’s drug withdrawal. After 4 weeks of treatment, two treatments can improve the scores of the symptom frequency and quality of life with patients. On the other hand, in improving vitality and overall health, TCM drug group is better than western medicine group, and the effect can be maintained 1 month after drug withdrawal. Conclusion:There is a good effect with the treatment for GERD by dredging liver and strengthening spleen, which can maintain a more lasting improvement in quality of life for patients. |
PDF Full Text Request