Clinical Observation Of Curative Effect And Mechanical Study Of Huazhuojiedu Formula In The Treatment Of Chronic Atrophic Gastritis And Precancerous Lesions Based On Zhuodu Doctrine

The zhuodu doctrine is an important doctrine proposed in recent years, tomake a contribution to the enrichment and development of traditional Chinesemedicine. The zhuodu doctrine derived from clinical practice, applied toclinical, should be tested and improved for real application. Precancerouslesion of chronic atrophic gastritis is the clinical common diseasefrequently-occurring disease. But the reverse atrophic and intestinalmetaplasia is yet to be further study, so it prompt us to expand way of thinking,research and development a new theory and method. And apply the drugs ofhuazhuojiedu to the therapy consciously, so the theory of zhuodu wereestablished, and clinical medication by syndrome differentiation. The theoryfor the treatment of chronic atrophic gastritis pre-cancerous lesions opens up anew train of thought. However, in all kinds of literature about the zhuoduscattered on the description of the zhuodu is all a lack of detailedunderstanding. In order to increase awareness of the doctrine, in the first part，the definition of zhuodu, development process of zhuodu, pathogene sis ofzhuodu, virulence characteristics of zhuodu, syndrome clinical manifestationsof zhuodu, treatment principles of zhuodu, common formula of zhuodu,Chinese medicine commonly used of zhuodu are Systematically discussed. Inthe second part, it is a retrospective analysis of medical records about the mainhuazhuo jiedu formula that treatment238cases of chronic atrophic gastritis inpatients with precancerous lesions, summarize the clinical efficacy and themain symptoms and tongue and pulse, establish the primary way of huazhuojiedu treatment, and according to individual differences determine the clinicalsyndrome treatment methods. In the third part, we observe the clinical efficacyof huazhuo jiedu formula on the precancerosis of chronic atrophic gastritis with the syndrome of accumulation of turbidity and toxicity, and observationof patients pepsinogen change, changes in hemorheology to chronic atrophicgastritis of precancerous lesions, to provide the material basis foraccumulation of turbidity and toxicity and its mechanism. In the fourth part,we observe the clinical efficacy of huazhuo jiedu formula on the precancerosisof chronic atrophic gastritis with the syndrome of accumulation of turbidityand toxicity, and observation the impact on the stomach secrete hormone whenpatients gastric juice change, and further explore its mechanism.PartⅠ The formation of the doctrine and the theory of ZhuoduObject: Based on historical records and clinical experience to explore theorigin of the doctrine of the Zhuodu and principle-method-recipe-medicines,then put forward a new academic point of view and theoretical system.Method: Comb in the record of ancient physicians in order to explore itsorigins, truthfully collection and preservation of the original name of the oldclinic experience of experts in medicine, Chinese medicine experts to establishthe unique name of the old clinic information database, forming TCM science,law, formula, drugs.Result: Tease out the origins of the Zhuodu, investigate the toxic cloudhistory, pathogenic characteristics of the etiology and pathogenesis, voicedclinical symptoms, syndrome therapeutic principle, commonly usedprescription and drugs commonly used. Demonstrate the practicality of thedoctrine of the toxic cloud from the clinical.Conclusion: The Zhuodu doctrine has perfect system, can be used toguide clinical practice.PartII2-year retrospective analysis for238patients with chronicatrophic gastritis with pre-cancerous lesions in treatment ofhuazhuo jiedu formula.Object: Observe the mainly clinical manifestation, tongue and pulse ofthe precancerosis of chronic atrophic gastritis with the syndrome ofaccumulation of turbidity and toxicity，mainly by huazhuo jiedu，combinedwith individual differences identified (disease) permits the treatment of dialectical method.Method:238cases diagnosed by endoscopy and pathology CAG withprecancerous lesions were retrospectively analyzed, and precancerous lesionsin36patients before and after their treatment reversed endoscopy andpathology were compared.Result:1It was found that patients with chronic atrophic gastritis femaleones, multi-aged to elderly, with a low proportion of family history of cancer.Chronic atrophic gastritis cancer precursor lesions, dark tongue, greasy moss,pulse string smooth to permit the most common accumulation of turbidity andtoxicity tongue and pulse, which is consistent with clinical experience, thesymptoms of the presence of the top ten on the basis of their individualdifferences on the intrinsic syndrome, according to ten syndrome differentialtreatment.2In238cases of patients with chronic atrophic gastritis, the totaleffective rate was79.0%, the total effective rate change endoscopy77.7%totaleffective rate of pathological changes of74.4%.3The change of endoscopic type:Premalignant lesion in36patientsfollowed up front mucosa red and white, with white-based12cases, or evendisappear flattened folds, mucosal vascular revealed three cases, granular ornodular mucosa were17cases,17cases of erosion.Premalignant lesion in36patients, follow-up mucosa red and white, withwhite-based10cases, or even disappear flattened folds, mucosal vascularrevealed five cases, granular or nodular mucosa were10cases,12cases oferosion.4Premalignant lesion in36patients, moderate differences before thefollow-up6cases, mild abnormal increase in eight cases, seven cases ofsevere intestinal metaplasia, moderate intestinal metaplasia five cases,11cases of mild intestinal metaplasia, focal intestinal metaplasia5cases.Premalignant lesion in36patients were followed up moderatelyabnormal increase0cases, mild abnormal increase in one case, severeintestinal metaplasia0cases, moderate intestinal metaplasia0cases,10cases of mild intestinal metaplasia, focal intestinal metaplasia1cases.5Outcome of the situation of cancer: there is no cases of pre-cancerouslesions adenocarcinoma after Huazhuo jiedu therapy.Conclusion: Chronic atrophic gastritis precancerous lesions, pathologicalall have metaplasia and (or) changes in intestinal epithelial dysplasia.Syndrome and microscopic pathology tongue dark greasy moss, pulse stringsmooth as chronic atrophic gastritis precancerous lesions accumulation ofturbidity and toxicity permit diagnosis is based, and according to individualdifferences in chronic atrophic gastritis in patients with pre-cancerous lesionscan appear ten major symptoms, huazhuo judu therapy in chronic atrophicgastritis cancer precursor lesions for treatment, according to the mainsymptom resolution (disease) permits the treatment, not only prominenthuazhuo jiedu characteristics, but also the principles of diagnosis andtreatment.Part Ⅲ Effects of Huazhuojiedu Formula on115cases withprecancerosis of chronic atrophic gastritis and influenceon PG and hemorheologyObjective: To observe the therapeutic effects of Huazhuo jiedu Formulaon the precancerosis of chronic atrophic gastritis with the syndrome ofaccumulation of turbidity and toxicity,and the influence on the PG,hemorheology, and to explore its mechanism further.Method: Treatment group: Given a daily Huazhuo Jiedu prescription,taken morning and evening empty stomach and daily.Control group:Given a daily Weifuchun Tablet(WFCT),taken4pieceseach time,3times a day,before meals for30min.Both groups were disabled other drugs for treating chronic gastric in thetreatment period and were treated for2courses,which included3months forone.Result:1Comparison of clinical efficacy of the two groupsThe total efficiency of treatment group was86.7%,the total efficiency ofcontrol group was67.2%.In the total efficiency,the difference was statistically significant(p<0.01)。2Comparison of endoscopic and pathological efficacy of the two groupsCompared endoscopic efficacy of the two groups,there were significantdifference after statistical processing.The total efficiency of treatment groupwas85.0%,the total efficiency of control group was56.4%.Thus treatmentgroup was superior to control group(p<0.05).Compared pathological efficacyof the two groups,there were significant difference after statisticalprocessing.The total efficiency of treatment group was83.3%,the totalefficiency of control group was65.5%.Thus treatment group was superior tocontrol group(p<0.05).Comparison of pepsinogen expression: In both groups, pepsinogenⅠincreased, pepsinogen II reduced after treating. In the treatment group,pepsinogenⅠwas108.32±17.27mPa·s before treating, was143.17±17.81mPa·s after treating; pepsinogen II was10.74±1.88mPa·s before treating,was7.48±1.69mPa·s after treating, therefore the difference was statisticallysignificant(p<0.05). In the control group, pepsinogen Ⅰ was104.92±15.17mPa·s before treating, was8.42±1.62mPa·s after treating, thus thedifference was statistically significant(p<0.05).After treatment,pepsinogen Ⅰin the treatment group increased more than it in the control group, thereforethe difference was statistically significant(p<0.05); pepsinogen II decreasedmore than it in the control group,thus the difference was statisticallysignificant(p<0.05).4Comparison of hemorheology indexes before and after treatment inboth groupsCompared whole blood viscosity in the two groups before and aftertreatment, the difference was statistically significant(p<0.05). In the treatmentgroup, whole blood high shear viscosity values was5.95±0.89mPa s beforetreating, was3.74±0.37mPa s after treating; whole blood low shear viscosityvalues was5.95±0.89mPa s before treating, was15.35±1.11mPa s aftertreating.In the control group, whole blood high shear viscosity values was5.66±0.72mPa s before treating, was34.08±0.36mPa s after treating; whole blood low shear viscosity values was20.29±1.87mPa s before treating, was16.02±1.38mPa s after treating. After treatment, the improvement of wholeblood high shear viscosity values in the treatment group was superior tocontrol group(p<0.05), and the difference was statistically significant (p<0.05);changs of whole blood low shear viscosity values was not obvious,so therewas no statistically significant difference(p<0.05).Conclusion:1Huazhuojiedu Formula can reduce the degree ofhyperemia and edema, erosion of gastric mucosal, alleviate gastroscope signs(such as mucosal play, hyperplasia of particles), and improve the cure rate ofpathology in patients with pre-cancerous lesions.2When the body is in a state of chronic atrophic gastritis with intestinalmetaplasia and atypical hyperplasia, it can secret PG Ⅱ,which can result inrising of serum PG Ⅱ. That can damage the gastric mucosa, increase bloodviscosity and slow blood stream which is not conducive to the restoration ofgastric mucosa.3Huazhuojiedu Formula may chang the environment condition of gastricmucosa by lowering the expression of pepsin Ⅱ and reducing bloodviscosity,thereby preventing the further development of pre-cancerous lesions,and even reversing them.Part Ⅳ Influence of Huazhuojiedu Formula on gastric juicecomponents and GAS on the patients with precancerosisof chronic atrophic gastritisObjective: To observe the influence of Huazhuojiedu Formula on gastricjuice components and GAS on the precancerosis of chronic atrophic gastritiswith the syndrome of accumulation of turbidity and toxicity.Method: Treatment group:Given a daily Huazhuojiedu Formula, taken2times on an empty stomach in the morning and evening daily.Control group:Given a daily Weifuchun Tablet(WFCT),taken4pieceseach time,3times a day,before meals for30min.Both groups were disabled other drugs for treating chronic gastric in thetreatment period and were treated for2courses, which included3months for one.Result:1Comparison of clinical efficacy of the two groupsThe total efficiency of treatment group was80.0%,the total efficiency ofcontrol group was62.1%.In the total efficiency,the difference was statisticallysignificant(p<0.01)。2Comparison of endoscopic and pathological efficacy of the two groups:Compared efficacy of the two groups,there were significant differenceafter statistical processing.Compared endoscopic efficacy of the twogroups,the total efficiency of treatment group was81.7%,the total efficiencyof control group was75.9%.Thus treatment group was superior to controlgroup(p<0.05).Compared pathological efficacy of the two groups,the totalefficiency of treatment group was75.0%,the total efficiency of control groupwas62.1%.Thus treatment group was superior to control group(p<0.05).3Comparison of gastric juice components of the two groupsGastric juice components(such as free acid、total acid、lactic acid andnitrite）of the two groups were compared before and after treatment.Before thetreatment, compared the free acid、total acid, lactic acid and nitrite of the twogroups,there was no statistically significant difference(p>0.05). After thetreatment,the free acid and total acid in the gastric juice were improved thanbefore, and the treatment group increased more obviously than the controlgroup(p<0.05); lactic acid and nitrite decreased obviously than before, and thetreatment group decreased more obviously than the control group(p<0.05).4Comparison of gastrin levels before and after treatment of the twogroupsBefore treatment,compared the gastrin levels of the two groups,there wasno statistically significant difference(p>0.05).After treatment,the gastrin levelsof the two groups decreased than before,and the treatment group decreasedmore obviously than the control group(p<0.05).Conclusion：1Huazhuojiedu Formula can reduce the degree ofhyperemia and edema, erosion of gastric mucosal, alleviate gastroscope signs,such as mucosal play, hyperplasia of particles, and improve the cure rate of pathology in patients with pre-cancerous lesions.2The total acid and free acid of patients with precancerosis of chronicatrophic gastritis will decrease, and their nitrite and lactic acid will increase.The nitrite, as a common carcinogens,may promote the further development ofpre-cancerous lesions.The gastrin of the patients will increase reactivity, whichmay promote cellular differentiation and proliferation of patients withintestinal metaplasia or atypical hyperplasia.3Huazhuojiedu Formula can promote the recovery of gastric mucosa,probably through decreasing the expression of gastrin, improving gastric juicecomponents and reducing lactic and nitrite, thereby, prevent the furtherdevelopment of precancerous lesions of gastric cancer.