Based On The Experience Of Differential Treatment Of Epigastric Pain (chronic Gastritis) With Mixed Syndromes Of Cold And Heat Based On Modern Medical Records

Aims:1.Based on the ancient and modern literature and the medical records of the famous old Chinese medicine,analyze and excavate the differentiation and treatment rules of epigastric pain with cold and heat miscellaneous syndromes,to provide reference for clinical diagnosis and treatment of spleen and stomach diseases.2.By summarizing the experience in the diagnosis and treatment of epigastric pain with cold and heat miscellaneous syndromes,and expert interviews,it is proposed to accurately distinguish and treat epigastric pain with cold and heat miscellaneous syndromes,and to conduct clinical observations to clarify the characteristics of accurate diagnosis and treatment of epigastric pain with cold and heat miscellaneous syndromes.Methods:Collected medical records of epigastric pain with cold and heat miscellaneous syndromes by searching databases(CNKI,Du Xiu)and related works,using the integrated research and clinical system of Guang’anmen Hospital of China Academy of TCM,using On-Line Analytical Processing(OLAP),and analysis of complex network systems of Chinese medicine,combined with mentor interviews,summarized the rule of differentiation and treatment of epigastric pain,and verified by clinical observation.Results:1.Through analysis and analysis of 286 cases(altogether 741 consultations)of the famous old Chinese medicine,the results are as follows:(1)Symptom characteristics:Common symptoms are mainly epigastric pain,stomach fullness,anorexia,acid reflux,loose stools,belching,bitter mouth,heartburn,dry mouth,dry stool,etc.Common tongues are mainly red tongue,light red tongue,light tongue,dark red tongue,light dark tongue,etc.Common tongue coatings are mainly thin white coating,yellow coating,thin yellow coating,white coating,lose water,etc.pulse like pulse string,pulse string thin,pulse thin,pulse string slip,pulse slip,pulse sink,pulse sink string and so on are common.(2)Syndrome characteristics:From the perspective of the disease location,the episodic syndrome is mainly in the spleen and stomach,and is related to the liver,gallbladder,heart,intestine,and kidney.The syndrome differentiation information related to the positioning of cold and heat in the medical case mainly includes stomach heat,spleen cold,spleen and stomach deficiency cold,liver and stomach stagnation heat,intestinal heat,intestine cold,spleen yang deficiency,stomach yin deficiency,liver yin deficiency,liver fever,kidney yin deficiency etc.From the perspective of morbidity,the symptoms of gastric epilepsy,cold and heat miscellaneous syndrome are mostly mixed with deficiency and reality.Syndrome based on cold and heat miscellaneous syndrome often combined with stagnation,blood stasis,phlegm turbidity,damp heat,food stagnation,turbidity and other pathological factors.The disease mainly affects the liver,gallbladder,intestines,kidneys and other organs based on spleen and stomach physiological disorders.(3)Characteristics of treatment methods:Common treatment methods are as follows:to regulate cold and heat,to strengthen the spleen and stomach,to harden and relieve spleen,to relieve liver and eliminate diarrhea,and to promote blood circulation and stasis.The treatments of the syndrome of intermingled heat and cold of epigastric pain are mainly to regulate cold and heat,improve spleen and stomach,it is supplemented by the methods of regulating qi,promoting blood circulation,dehumidifying and eliminating food.(4)Prescription characteristics:Most of them are based on the combined experience of famous old Chinese medicine practitioners and clinical characteristics of patients.The commonly used prescriptions are Banxiaxiexin Decoction,Wumei Pill,Zuojin Pill,Sijunzi Decoction,Huangqijianzhong Decoction,Pingwei san,Jinlingzi san,Xiaoxianxiong Soup,Hewei Soup,Xuanfudaizhe Soup,etc.(5)Drug characteristics:Commonly used Chinese medicines mainly include coptis chinensis,dried ginger,lanceolata,scutellaria,prepared pinellia tuber,glycyrrhiza,poria,fried atractylodes,cortex magnbliae by singer,tangerine peel,etc.the main categories of medicines are remedy deficiency,the herbs effective to clear heat,drugs warming the internal,Phlegm,antitussive and antiasthmatic drugs,diaphoretics,drugs removing dampness and promoting diuresis,drugs for improvement of blood circulation,digestive drugs,etc.drugs are classified by five flavors in order of frequency are pungent,bitter,sweet,sour,light;the drug flavors are different from cold,slightly cold,deeply cold,hot and deeply hot,meridian is mainly based on lung,spleen,stomach,kidney,heart,liver,large intestine,etc.;commonly used cold and heat medicines are:dried ginger-coptis chinensis,dried ginger-scutellaria,processed evodia rutaecarpa-scutellaria,citrus aurantium-dried ginger,dried ginger-dandelion,coptis chinensis-cassia twig,aconite-coptis chinensis,asarum-coptis chinensis etc,among which the most frequently used cold and heat medicine pair is dried ginger-coptis chinensis.(6)Syndrome-drug relationship:The core drugs of cold and heat miscellaneous syndromes are lanceolata,coptis chinensis,dried ginger,scutellaria,fried atractylodes,white peony root,prepared pinellia tuber,tangerine peel poria,glycyrrhiza,cortex magnbliae by singer,Jujube and so on.From the perspective of the cold and heat properties of the drug,the cold and heat drugs are used together;from the perspective of the efficacy of the drug,remedy deficiency,the herbs effective to clear heat,drugs warming the internal and qi regulating drugs are the main ones.The medicines commonly used for ascending and descending in the combination of syndromes are coptis chinensis,prepared pinellia tuber,,dried ginger,scutellaria,tangerine peel,etc.Qi stagnation is commonly used tangerine peel,cyperus rotundus,radix auckladiae,bupleurum,fried fructus aurantii,perilla stalk,etc.spleen and stomach deficiency commonly used lanceolata,radix pseudostell,baked licorice,poria,fried atractylodes,Jujube,etc.spleen cold commonly used cassia twig,processed evodia Chinese prickly ash,asarum,etc.dampness and heat commonly used coptis chinensis,dandelion,scutellaria etc.kidney yin deficiency commonly used achyranthes root,radix rehmanniae etc.upper heat and lower cold commonly used gardenia jasminoids roasted with ginger etc.stomach heat commonly used coptis chinensis,scutellaria etc.kidney Yang deficiency commonly used prepared aconite root;toxic commonly used phellodendron.stomach loss and lowering methods commonly used prepared pinellia tuber;meridian stasis commonly used angelica sinensis;galli stomachichum corium and jiaosanxian are commonly used for food stagnation;bupleurum and white peony root are commonly used for liver depression.(7)Symptom-drug relationship;Stomach cavity fullness commonly used cortex magnbliae by singer,tangerine peel,fried fructus aurantii,radix auckladiae etc.bitter mouth commonly used scutellaria,dandelion,hedyotis diffusa willd,chinaberry fruit and so on;Evodia,etc.fear cold commonly used dried ginger,processed evodia rutaecarpa etc.Poor stools commonly used poria,scutellaria,coptis chinensis etc.belching commonly used tangerine peel,cortex magnbliae by singer etc;stomach-ache commonly used corydalis yanhusuo;acid reflux commonly used processed evodia rutaecarpa,coptis chinensis etc;heartburn commonly used calcined concha arcae,cuttlebone etc.2.The syndromes observed in the clinical observations of this study are stomach-heat spleen-cold syndrome,upper heat lower-cold syndrome,liver-heat spleen-cold syndrome,stomach-heat intestinal-cold syndrome,stomach-cold intestinal-heat syndrome,lung-heat spleen-cold syndrome.Commonly used drugs mainly include lanceolata,white peony root,tangerine peel,fried fructus aurantii,coptis chinensis,angelica sinensis,prepared pinellia tuber,scutellaria,bupleurum,cassia twig,raw rhizome atractylodes macrocephalae,baked licorice,poria,cortex magnbliae by singer and so on.Commonly used cold medicines are coptis chinensis,scutellaria,fritillary bulb,calcined ochre,dandelion,hedyotis diffusa,radix rehumaniae etc.slightly cold medicines are white peony root,fried fructus aurantii,bupleurum,red peony root,north herba patriniae,salvia,loosestrife etc.Commonly used hot drugs are dried ginger,processed evodia rutaecarpa,Alpinia officinarum.the deeply hot drugs are cinnamon and prepared aconite root.Conclusions:1.Epigastric pain with cold and heat miscellaneous syndromes are mainly in the spleen and stomach,involving the liver,intestines,lungs,heart,and kidneys.According to the different parts of the internal organs where cold and heat are located,epigastric pain with cold and heat miscellaneous syndromes can be divided into stomach heat and spleen cold,liver(biliary)heat spleen cold,lung heat spleen cold,surface cold stomach heat,stomach heat intestine cold,stomach cold intestine hot subclass syndrome.2.By summing up the treatment of epigastric pain with cold and heat miscellaneous syndromes by famous and old Chinese medicine doctors,epigastric pain with cold and hot miscellaneous syndromes are both syndromes,and the disease is mostly mixed with deficiency and solidness(spleen and stomach are mixed with Qi stagnation,blood stasis,phlegm and turbidity).The clinical symptoms are mainly stomach pain,full stomach,bitter mouth,dry mouth,stomach cavity or abdominal chills,cold limbs,loose stools etc.The characteristics of the treatment method are mainly to balance the cold and heat,strengthen the spleen and stomach,and supplement with the methods of regulating qi,promoting blood circulation and reducing phlegm.The core medicines are mainly lanceolata,poria,fried/atractylodes,licorice,Scutellaria,coptis chinensis,white peony root,pinellia ternate,tangerine peel,cassia twig,cortex magnbliae by singer,fried fructus aurantii,radix auckladiae,corydalis yanhusuo and so on.3.For clinical treatment of stomach pain with cold and heat miscellaneous syndromes,the main symptoms and pathogenesis of cold and heat miscellaneous syndromes should be grasped,and the location of the organs of cold and heat,the degree of cold and heat,the transformation of the disease state,the true and false of the cold and heat should be accurately identified,Inside and outside,Yin and Yang,virtual and real of the syndromes should be considered comprehensive tongue and veins,according to the drug’s sexual taste(cold,slightly cold,deeply cold,heat,deeply heat),meridian and ups and downs,and dynamically adjust the cold and heat attributes according to the changes of cold and heat symptoms during the diagnosis and treatment,differential treatment can improve clinical efficacy..