The Screening And Evaluation Of Effective Herbs And Formulae For Stomachache

Stomachache is a very commonly seen disease in internal medicine. TCM remedy for the stomach pain has a long history, rich experience, unique methodology, positive curative effect and forms a distinctive system. But at the same time, there exists some problems, e.g. the chaos of different names being used for this disorder; the uncertainty of the name's denotations and connotations. Large as the amount of the classic and modern literature is, their contents are dispersive and recorded formulae of different levels for stomach pain therapy are intermingled; syndrome differentiation and choices of prescriptions are poorly normalized. As a result the clinical effect is unstable and opportunistic, which affects the doctors' and the patients' confidence in the using of TCM therapy for the stomach pain. Hence a systemic research is necessary. Through screening and evaluation, we can discover effective herbs and formulae for stomachache and preliminarily set up a screening and evaluation system. In this way the research and development of new medicine for stomachache can be promoted, meanwhile the understanding of etiology and pathogenesis of stomachache can be improved.Research contents: It can be divided into three parts: systemic collection of literature relating to stomachache, screening of formulae and herbs used in the treatment of stomachache, evaluation of the effectiveness of formulae and herbs being selected.Research method: Based on literature review and group statistic results, screening is carried out by using frequency analysis. Combining principles of evidence-based medicine and on the basis of clinical therapeutic result, the efficacy of herbs and formulae is evaluated.Research result: 75 herbs have been collected through searching of related formulae and these herbs are from 25 medical books separately. 263 prescriptions are found in 115 medical literatures, together with 354 medical notes from 55 medical books separately. Among 75 herbs collected in the preliminary search, 45 herbs are explicitly recorded for the treatment of stomachache. Based on the statistics of literature review, 19 herbs had been listed over six times and they are analyzed separately. The 19 drags are Caodoukou, Lizhihe, Guoluo, Dingxiang Oil(Dew), Baizhu, Baishaoyao, Gaoliangjiang, Wuzhuyu, Shigao, Jiu, Yanhusuo, Danggui, Chuangxiong, Baidoukou, Guiding(Rouguizi), Jianghuang, Huoxiang, Mahuang, Puhuang. Some herbs have been used to treat stomachache for a long time and were cited by many medical workers in different dynasties, like Caodoukou. Some herbs have been used for a long time and were cited considerably by previous literatures, but it was mainly used alone only with a few compatible application, like Lizhihe. Some drags were cited in many previous literatures, but they are out of use nowadays since western medicine which contains useful components of these drags have been widely used because of the administration convenience and low price, like Guoluo. Some drags only appeared once in the literature of Materia Medica, but they were used in many formulae in the literature related to formulae. So basically we can tell they are also effective in the treatment of stomachache, like Danggui and Chuanxiong.Through statistical analysis of herbs and formulae for stomachache, I find 261 dragshave been used in 263 formulae, with the total number of 2251 times. Each drag appeared 8.6245 times, so the closest interger 9 is being used as the criterion for the selection of key drags and 61 drags have been selected (which accounts for 23.37% of the total number of drags). These 61 drags appeared 1705 times, which amounts for 75.74% of the total number (2251). Chenpi appears with the highest frequency (108 times) and the next is Gancao (appeared 87 times), Muxiang (81 times), Xiangfu (71 times), Banxia(55 times), Houpu (53 times), Saren (52 times), Fulin(51 times), Yanhusuo(46 times) etc. Except for Gancao, most of these drags belong to one type of medicine with the function of regulating qi, resolving phlegm and dampness. The complete formula of Ercheng Tang (Decoction) is included, which explains why Ercheng Tang(Decoction)is frequently used for the treatment of stomachache from ancient to present.Effective formulae for stomachache are selected in three ways. First, search in Prescription Dictionary of Traditional Chinese Medicine for famous compound formulae from ancient to present. Second, search in medical record literature from ancient to present for cases of stomachache. Third, search through the up-to-date clinical reports appeared in periodicals.Based on the set criteria, 263 formulae were found, together with 73 formulae from the literature of medical record and 81 formulae (traditional formulae) from up-to-date clinical reports.After comparing formulae selected in the three ways, 25 prescriptions are chosen as key formulae as they appeared in more than one literature source mentioned above. These 25 key formulae have the following characteristics:â‘ Minor prescriptions constitute the majority of these key formulae. Among the 25 formulae, 5 are made of only two kinds of Chinese Medicine and most of the rest are made of 4 to 5 minor formulae.â‘¡These 25 formulae belong to 10 functional categories, with 2.5 for each category. This indicates that this type of formula functions in many different ways and the clinical pattern of stomachache is widely spread.â‘¢The 10 functional categories can be divided into two kinds, tonifying and reducing. The tonifying method contains four ways: to tonify qi, tonify blood, nourish yin and warm yang. The reducing method contains six ways: to regulate qi, activate blood, resolve phlegm, resolve dampness, purge fire and dispel coldness. These methods possibly summarize the principles of treating epigastric pain and also these formulae could serve as the fundamental ones for the treatment of stomachache. Seven formulae - Erchen Decoction, Shixiao Powder, Jinlingzi Powder, Lizhong Decoction, Yueju Bolus, Pinwei Powder and Wu Zhuyu Decoction- are all referred in three kinds of literatures, which shows the great importance of them.Erchen Decoction, a basic formula for dissipating phlegm, has been modified and used by doctors of different times for treating stomachache which is caused by phlegm and dampness all the while. It works significantly well for patients with symptom of vomiting. Shixiao Powder (Powder for Dissipating Blood Stasis) was used for treating puerperal pain of lower abdomen in ancient times. Nvkeqieyao (Essentials in gynecology department) specifically indicates that Shixiao Powder can be used for the treatment of "Weiwantong"(stomachache). Meanwhile it is used in clinic for stomachache caused by qi stagnation and blood stasis. In Ming Dynasty, Jinlingzi Powder was first recorded in Xiuzhengfang (Formulae in pocket edition) for the treatment of chest pain, which is caused by pyretic syncope. In clinic Jinglingzi Powder is used to treat stomachache caused by stagnation of liver-qi transforming into fire. Lizhong Decoction (Decoction for Regulating Middle Energizer), recorded in Treatise on Febrile Diseases Caused by Cold (Shanghanlun), is a basic formula in regulating qi and eliminating cold, so it is effective in treating stomachache (deficiency cold of the spleen and stomach pattern). Yueju Pills was invented by Zhu Danxi to treat varies types of depression and it could be modified to treat stomachache. Pinwei Powder, which is from Taipinhuiminhejijufang (formulae edited officially in Ming dynasty), is used for stomachache caused by dampness. Wuzhuyu Decoction was first presented in Treatise on Febrile Diseases Caused by Cold (Shanghanlun) and proved its efficiency in treating stomachache of middle deficiency and cold congealing pattern.Conclusion and Discussion:1. 19 herbs are frequently used, and they are Caodoukou, Lizhihe, Guoluo, DingxiangOil(Dew), Baizhu,Baishaoyao, Gaoliangjiang, Wuzhuyu, Shigao, Jiu, Yanhusuo, Danggui, Chuangxiong, Baidoukou, Guiding(Rouguizi), Jianghuang, Huoxiang, Mahuang, Puhuang etc. These herbs serve as the effective medicine for treating stomachache. Combined with the formulae analysis, Gancao, Muxiang, Xiangfu, Banxia, Houpo, Sharen, Fulin, and Yanhusuo have been identified to be effective too. Seven formulae, including Erchen Decoction, Shixiao Powder, Jinlingzi Powder, Lizhong Decoction, Yueju Pills, Pinwei Powder, Wuzhuyu Decoction, are found to be effective compound formulae.2. The difference of herb-used-frequency proves the fact that some herbs can achieve therapeutic effect only through combination; while some other herbs can be used alone. These two kinds of herbs are worth noticing.3. Based on the function of effective herbs and formulae, most effective formulae have functions of regulating qi, quickening blood circulation, resolving phlegm and drying dampness, warming middle jiao while dispelling coldness. This findings go with the most commonly seen clinical patterns of stomachache, which are qi stagnation and blood stasis pattern, liver qi depression pattern, phlegm-dampness obstruction pattern and cold congealing due to yang deficiency pattern.