Professor Yao Naili’s Academic Thoughts Of Treatment Of Spleen And Stomach Diseases And Clinical Study Of His Experience In Differential Treatment Of Chronic Gastritis

Traditional Chinese medicine (TCM) is the science of studying health, life and diseases in ancient China and has accumulated a wealth of experience in medical practice over millennia, forming a unique theoretical system. TCM is not only a gem of Chinese traditional culture, but also an important part of the world medical system. As a contemporary TCM practitioner, you have to inherit it well if you want to really learn and grasp it. As one of the 5th groups of successors of the Program of Inheritance of Chinese Academic Experience of Veteran Experts of TCM of 2012, in order to be a really excellent TCM practitioner, the author was fortunate to study with Prof. Yao Naili from CACMS and to further improve the knowledge of TCM by "reading the classics, following great masters, and practicing clinically"1.Literature Review1.1 Current Diagnosis and Treatment of Chronic Atrophic Gastritis in TCMRecent research progress in treatment and diagnosis of chronic atrophic gastritis (CAG) by TCM was summarized from three aspects:knowledge of the etiology and pathogenesis of CAG by TCM, clinic treatment of CAG by TCM, and research on the relationship between the pathogenesis and syndromes of CAG and its gastroscopic signs. Of them, self-prescription treatment, syndrome differentiation treatment, acupuncture and acupuncture-medication therapy were reviewed in the section of clinical treatment of TCM. We finally summarized shortcomings of previous studies and put forward our own suggestions.1.2 Research Progress in Correlation between Gastroscopic Signs and TCM syndromes of Chronic GastritisRecent progress in studies of the correlation between gastroscopic signs and TCM syndromes of chronic gastritis (CG) by TCM practitioners was summarized from three aspects:correlations between TCM syndrome differentiation types of CG and signs of gastric mucosa under gastroscopy, between the TCM syndrome differentiation types of CG and the Helicobacter pylori infection, and between tongue pictures of patients with CG and gastroscopic signs. We finally summarized shortcomings of previous studies and put forward our own suggestions.2. Prof. Yao Naili’s Academic Thoughts and Speculative Characteristics of Treatment of Spleen and Stomach DiseasesProf. Yao Naili’s academic thoughts and speculative characteristics of treatment of spleen and stomach diseases can be generalized as follows:"orientation towards replenishing spleen and stomach, frequent use of both harmonizing and balancing methods, importance in dredging collaterals and removing toxicity, and microcosmic syndrome differentiation as an aid". These thoughts could be discussed based on the following eight aspects.1) Replenishing spleen and stomach consolidates body resistance. Prof. Yao argues that deficiency of spleen and stomach is the etiology of spleen and stomach diseases, including deficiency of spleen qi or stomach yin. In particular, deficiency of spleen qi is the primary pathogenic factor. Hence, orientation towards replenishing spleen and stomach is emphasized when treating spleen and stomach diseases.2) Disease and syndrome differentiation places special emphasis on tongue inspection and pulse-taking. He argues a combination of disease and syndrome differentiation with special prescription for special disease, in which tongue inspection and pulse-taking are particularly stressed to improve accuracy of differentiation and treatment.3) Emphasis is laid on harmonizing liver and spleen and "harmonizing method" is used wisely. Because spleen and stomach diseases are mostly related to the emotion, Prof. Yao attaches much importance to the effect of liver on function of the spleen and stomach and makes the best of "harmonizing method" to harmonize liver and spleen to treat spleen and stomach diseases.4) Treating middle jiao resembles a balance and "balancing method" is essential. According to physiological and pathological characteristics of the spleen and stomach, with "treating middle jiao resembling a balance" as the important principle of treatment guiding the differentiation and treatment of spleen and stomach diseases, he uses the "balancing method" to remedy such pathological states as excess of yin-yang, cold-heat or dryness-dampness of the spleen and stomach to restore their normal physiological functions.5) Difficult miscellaneous diseases pay attention to differentiation and treatment based on collateral diseases. During clinical treatment of some of difficult miscellaneous spleen and stomach diseases, they could be differentiated and treated based on collateral diseases if they accord with the onset characteristics of collateral diseases, e.g., atrophic gastritis, precancerous lesions of gastric cancer, viral hepatitis and posthepatitic cirrhosis.6) Pay attention to microcosmic syndrome differentiation. When Prof. Yao diagnoses and treats spleen and stomach diseases, he holds that microcosmic gastroscopic manifestations should be stressed based on macroscopic syndrome differentiation, so as to accurately differentiate and treat diseases in the macroscopic and microscopic views.7) Work with the thought of "preventive treatment of disease" all the way through. Prof. Yao holds that "preventive treatment of disease" is closely related to spleen and stomach diseases. In the event of grasping the chance to treat spleen and stomach diseases as early as possible at the onset, principles of prevention before disease onset, prevention of disease from exacerbating, and prevention of the recrudescence of the disease can be achieved.8) Experience in diagnosis and treatment of some spleen and stomach diseases is given. Experience is summarized regarding how Prof. Yao diagnoses and treats intractable constipation and how to treat refractory gastroesophageal reflux disease (RGERD) with modification of "Qixian decoction"3. Study of Prof. Yao’s Clinical Experience in Treating Chronic Atrophic Gastritis3.1 Basic Pathogenic Characteristics of Chronic Atrophic GastritisThis article summarizes how Prof. Yao investigates pathogenic characteristics of chronic atrophic gastritis and its precancerous lesions based on the "collateral disease theory". The pathogenesis of CAG presents a rule for the tendency of disease invading collaterals from qi to blood, while "spleen deficiency, collateral stagnation and toxin damaging" are the fundamental pathogenesis of CAG. Particularly, deficiency of spleen and stomach is the pathogenesis and initial factor of CAG; static blood in stomach collaterals is the key condition of the pathogenesis; stomach collateral injury by toxic factors is the key factor of CAG progressing to precancerous lesions of gastric cancer (PLGC). Pathogenesis manifests as deficiency of spleen and stomach, followed by static blood in stomach collaterals and thus stomach collateral injury by toxic factors. That is, deficiency leads to stasis and accumulated stases develop toxins.3.2 Experience in Treating Chronic Atrophic Gastritis Based on the "Collateral Disease Theory"According to the basic pathogenesis of CAG-"spleen deficiency, collateral stagnation and toxin damaging", Prof. Yao established the principle of treatment of "strengthening spleen, dredging collaterals and removing toxicity", mainly treating this disease by replenishing spleen and stomach, promoting blood circulation for removing obstruction in collaterals, and removing toxins for resolving masses; he also established the "Jianpi Tongluo Jiedu Decoction" as the basic prescription for CAG.3.3 Observation of Efficacy of "Jianpi Tongluo Jiedu Decoction" in Atrophic GastritisThirty-three patients with CAG were observed and treated by macro/microscopic syndrome differentiation and medication in a manner of modifying the basic prescription of "Jianpi Tongluo Jiedu Decoction". Findings are as follows.1) Symptom score:After treating through macro/microscopic syndrome differentiation and medication in a manner of modifying the basic prescription of "Jianpi Tongluo Jiedu Decoction", primary and secondary symptom scores were lower than before treatment. Also, by further comparison between pre- and post-treatment primary, secondary symptom scores and total primary and secondary symptom scores, all post-treatment scores were markedly lower than pre-treatment ones, with statistically significant differences (P<0.05). Out of 33 treated patients, one (3.0%) was cured,19 (57.6%) markedly improved,11 (33.3%) were effective, and two (6.1%) were ineffective. The total clinical response rate was 93.9%, suggestive of a distinct and definite outcome of this regimen in CAG.2) Post-treatment atrophy and intestinal metaplasia scores were markedly lower than pre-treatment ones, especially for intestinal metaplasia scores (P<0.05); 26.3% and 10.5% of patients with atrophy and intestinal metaplasia were aggravated, respectively, and 57.9% of patients with intestinal metaplasia were relieved. This suggested a certain importance of this treatment in relieving atrophy and intestinal metaplasia, especially the latter; and it was of certain significance in delaying and even reversing the developing trend from CG, CAG, and PLGC to gastric cancer (GC).4. Study of the TCM Syndrome Properties of Gastroscopic Signs of Chronic Gastritis4.1 Professor Yao’s Experience in Microscopic Differential Treatment of Chronic Gastritis in Combination with Gastroscopic SignsThis article is to discuss and analyze TCM syndrome properties of gastroscopic signs of chronic gastritis from four aspects:signs of gastric mucosa, mucus, motility and hyperplasia, thereby summarizing Professor Yao’s experience in microscopic differential treatment of chronic gastritis. Conclusions are as follows.Gastroscopic signs prone to "heat syndrome":1) The gastric mucosa is magenta or cerise, with distinct congestion and edema; 2) the gastric juice is yellowish green, viscous and turbid in texture; and 3) peristole becomes faster and even disorderly. Gastroscopic signs prone to "syndrome of blood stasis":1) The gastric mucosa is dark red, with indistinct submucosal vascular network; and 2) the gastric mucosa is rough, with nodular or granular hyperplasia. Gastroscopic signs prone to "qi deficiency":The gastric mucosa is pale; 2) peristole slows down with a large quantity of dilute gastric juice; and 3) the pyloric orifice is open and loose. Gastroscopic signs prone to "qi stagnation":The pylorus is occlusive. Gastroscopic signs prone to "yin deficiency": the gastric juice decreases, and the gastric mucosa is rimous.Further differentiation is required because such manifestations as pale gastric mucosa. mucosal hemorrhage and erosion, and yellowish green gastric juice are complicated TCM syndrome properties.1) Pale gastric mucosa:If it is concurrent with smooth gastric mucosa and unexposed submucosal vascular network, and accompanied by slow peristole, it may be determined as spleen yang deficiency causing yang deficiency and internal cold; if the gastric mucosa is rough, and exposed dendritic vascular network is noted below the mucosa, it may be determined as spleen qi deficiency with blood stasis.2) Gastric mucosal erosion and hemorrhage:If distinct congestion and red swelling are noted in the gastric mucosa, with scarlet hemorrhagic lesions, it may be determined as excessive stomach heat causing frenetic movement of the blood;if the gastric mucosa is dark red or off-white in color and rough in texture, it may mostly be determined as stasis in gastric collaterals leading to failure of blood to circulate in the vessels; if the gastric mucosa is pale, peristole becomes slow and hemorrhagic lesions are dark red old hemorrhages or blood crusts, it may mostly be determined as deficiency of spleen qi and stomach qi causing failure of qi to control blood.3) Yellowish green gastric juice:If the gastric mucosa is dominated by red lesions, with mucosal congestion and erosion, it suggests dampness-heat of liver and gallbladder causing upward reversal of bile; if the gastric mucosa is dominated by white lesions, with distinct slow peristole, it may be determined as deficiency of spleen qi and stomach qi causing upward reversal of bile.4.2 Clinical Study of TCM Syndrome Properties of Gastroscopic Signs of 1167 Patients with Chronic GastritisGastroscopic signs of 1167 patients with chronic gastritis were collected by questionnaire to further investigate TCM syndrome properties of gastroscopic signs of chronic gastritis. Conclusions are as follows.1) There were statistically significant differences between the syndrome of dampness-heat of spleen and stomach and the bile reflux and mucus pool; syndrome of dampness-heat of spleen and stomach was more prone to bile reflux and yellowish green mucus pool compared to other types of syndromes (P<0.05).2) There were statistically significant differences between syndromes of deficiency of spleen and stomach (including syndrome of deficient cold) and lesion sites, suggesting that complete gastritis is mostly common in those with syndromes of deficiency of spleen and stomach (including syndrome of deficient cold) (P<0.05).3) There was statistically significant difference between the syndrome of spleen deficiency and qi stagnation and the cardiac status compared to other types of syndromes (P<0.05), suggesting that syndrome of spleen deficiency and qi stagnation is more prone to cardiochalasia or hernial sac formation.4) There were statistically significant differences between the mucosal color, mucosal granular changes, gastroscopic diagnosis and the syndrome of static blood in stomach collaterals, suggesting that the syndrome of static blood in stomach collaterals is dominated by white lesions in the gastric mucosa and is more prone to granular changes and endoscopic atrophic gastritis compared to other types of syndromes (P<0.05).5) There was a statistically significant difference between the syndrome of static blood in stomach collaterals and the mucosal erosion, suggesting that the syndrome of static blood in stomach collaterals is more common in patients with mucosal erosion than other types of syndromes (P<0.05).6) There was a statistically significant difference between syndrome types and changes of mucosal vascular network, with a higher proportion of changes of mucosal vascular network of types of both static blood in stomach collaterals (34.7%) and stomach yin deficiency (28.0%) (P<0.05).7) Further logistic analysis showed both changes of mucosal vascular network and mucosal erosion were closely related to the syndrome of static blood in stomach collaterals, and the measure of fitness of the regression model was statistically significant (P <0.05), suggesting that the possibility of gastroscopic occurrence of changes of vascular network and erosion was greater in the syndrome of static blood in stomach collaterals than in other types of syndromes.Analysis on the relationship between pathological findings and syndromes comes to the tentative conclusion that CAG is much closely related to the syndrome of static blood in stomach collaterals (P<0.05), followed by syndromes of spleen deficiency, such as stomach yin deficiency and deficiency of spleen and stomach (including deficient cold), suggesting that CAG is common in syndromes of static blood in stomach collaterals and deficiency of spleen and stomach. This partly supports Prof. Yao’s view of "spleen deficiency, collateral stagnation and toxin damaging" as the basic pathogenesis of atrophic gastritis.Above conclusion indicates a closer relationship between signs of gastric mucosa and TCM syndrome, and a flow chart of syndrome differentiation based on signs of gastric mucosa is established accordingly.