| Objective: Professor Zhou Shiyin engages in medicine for more than 50 years with noble medical ethics and rich learning experience, so a comprehensive study and inheritance of his academic thought and clinical experience in the treatment of spleen and stomach diseases to guide clinical practice is a very significant task.Research method and content: through literature and theoretical studies, this paper makes a systematic organization and excavation of the historical origin of Professor Zhou Shiyin's academic thought in the treatment of spleen and stomach diseases for in-depth analysis and the formation of clinical theory. By learning with him, I have summarized his dialectical experience and randomly selected 88 patients with functional dyspepsia in inpatient and outpatient clinics, made a non-randomized concurrent control study with trimebutine using a modified treatment of liver-soothing and stomach-regulating to compare the clinical efficacy.Results: In this paper, the results are elaborated from three parts:Part I: Professor Zhou Shiyin's academic origin overview. It discusses the formation of Professor Zhou Shiyin's academic thought and clinical experience. Through a systematic study, Professor Zhou Shiyin lays equal stress on Chinese and Western medicine in clinical practice. His academic ideology has an inheritance relationship with Neijing, Treatise on Febrile Diseases, Treatise on the Spleen and Stomach and so on, and the source of his thought are from the academic thoughts of Yue Meizhong, Wang Wending,Fang Yaozhong and other famous doctors. Through long-term clinical practice, Professor Zhou Shiyin has realized the importance of the spleen and stomach.Part II: Professor Zhou Shiyin's academic thought and clinical experience summary.(I) Professor Zhou Shiyin's academic thought overview.Professor Zhou Shiyin's academic thought are mainly in the following six areas:strengthening the spleen and stomach to treat disease from the root; regulating functional activities of qi to guide qi downward; regulating moisture and dryness to be appropriate;value liver and spleen with easy and smooth as the degree; regulating viscera to attach equal importance to spleen and stomach; putting prevention first to achieve preventive treatment of disease.The spleen and stomach provide the material basis of the acquired constitution as the source of qi and blood. Therefore, protection of the stomach qi is the first principle in thetreatment of stomach, which should always run through the clinical treatment. As the hub of ascending and descending functional activities of visceral qi, the spleen and stomach should be treated on the basis of regulation. Spleen prefers dryness to moisture, while stomach is just the opposite, so the treatment of stomach disease should not use strong damp-heat and dryness-heat medicine, but adapt to the nature of the spleen and stomach.Regulating hepatogastric relations should take easy and smooth as the degree, so that hepatogastric functional activities of qi are in harmony and good coordination. This is one of the important principles in the treatment of stomach disease. In the clinical diagnosis,Professor Zhou Shiyin pays a special emphasis on the role of abnormal function of the spleen and stomach in disease development. The spleen and stomach should be treated simultaneously by treating deficiency syndrome with tonifying methods and excess syndrome with purgative methods. Regulation of simultaneous deficiency and excess should depend on their bias. Spleen and stomach diseases are characterized by multiple and easy recurrence. Therefore, on the basis of preventive treatment of disease, positive prevention is necessary to reduce the incidence, the progress of disease and recurrence and alleviate the symptoms.(II) Professor Zhou Shiyin clinical experience overview1. It should be treating disease from the root based on the spleen and stomach. Various clinical manifestations of digestive diseases are the result of dysfunctional spleen and stomach, and the fundamental reason is spleen-stomach qi deficiency. With the spleen and stomach theory as guidance in the treatment, Professor Zhou stresses the method of strengthening the spleen and stomach, reinforcing the vital essence and strengthening the primordial qi, whose effect is outstanding.2. Adjusting qi is crucial. Professor Zhou pays attention to treat the liver and spleen,and spleen and stomach simultaneously. He proposes that liver-qi attacking stomach and soothing the liver and regulating qi and stomach are the main pathogenesis and principle of the treatment of stomach disease. According to the different characteristics of different patients' stomach, physiological characteristics of spleen ascending and stomach descending can get well through the "the simultaneous treatment of the spleen and stomach". Promoting the circulation of qi and blood simultaneously to regulate qi and blood can activate and smooth the gastrointestinal functional activities of qi.3. The treatment should focus on syndrome differentiation based on the whole. It should focus on the overall syndrome with syndrome differentiation as the key link.Meanwhile, it should combine disease and syndrome with the latter as the proof.4. The treatment should take care of qi of middle-jiao energy, and medications should be mild. Professor Zhou stresses the important role of the spleen and stomach, with particular emphasis on regulating the spleen and stomach to consolidate the source of acquired constitution. He also advocates mild medications, which must not be too pungent and hot or bitter-cold to avoid bias potency.5. The prescription selection should be differential and the prescription formulating should be strict. In clinical differential prescription selection, it should respect Zhongjing's herbal formulae, be reasonable in pathology, select prescription dialectically and balance the whole. In addition, all of the three should be closely linked to achieve reasonable pathology, accurate therapy, appropriate prescription and medicine. Meanwhile, it should also study ancient approaches but not stick to them, and be flexible in using medicine.6. The treatment should make good use of wind-dispelling drugs. In the treatment of stomach disease, the main functions of wind-dispelling drugs are ascending up spleen-qi and yang, warming yang and removing dampness, strengthening spleen and eliminating dampness, increasing yang-qi by the wind herbs, soothing the liver, promoting qi circulation and relieving pain, trying-in and eliminating evil, etc.7. The treatment should focus on tongue diagnosis based on synthesis of the four diagnostic methods. It pays an emphasis on the collection of four diagnostic evidences and the pursuit of differentiation and truth of the main syndrome with reasonable choices,especially on tongue diagnosis.(III) Summary of Professor Zhou Shiyin's clinical diagnosis and treatment experience1. Diagnosis and treatment of chronic superficial gastritis. The disease is located in the stomach and spleen. The main pathogenesis is spleen and stomach disharmony and stomach qi rising. Phlegm, qi, wet, heat and diet have a mutual resistance in the stomach and interact as both cause and effect. In the early stage, excess syndrome is common, in the middle stage, intermingled deficiency and excess are common, and in the later stage,deficiency syndrome is common. Depending on specific condition of patients, the treatment should be flexible according to different syndromes. Medicines should be used to regulate the flow of qi but not consume qi, to clear heat but not hurt the stomach, warm the middle warmer but not hurt the stomach-yin. Promoting blood circulation and cure indigestion should discontinue medication as soon as get effect. Treatment and aftercare should combine to regulate excessiveness and take care of stomach qi.2. Diagnosis and treatment experience of gastric neurosis. Its onset is slow with a chronic, persistent or recurrent syndrome most of the time. Its clinical manifestations are complex, which are usually caused by affect-mind internal damage, blocked qi function,dysfunctional liver, spleen, stomach and others. The key of treatment lies in the differential treatment alone in addition to diagnosis and treatment, and the promotion of integrated therapies.3. The diagnosis and treatment experience of chronic atrophic gastritis. The pathogenesis is dysfunctional ascending and descending of the spleen and stomach,resulting in pathological states of deficient root and excessive superficial. As the most common clinical syndrome of this disease, spleen-stomach deficiency sometimes exists in the disease process from beginning to end. It should be treated by functioning the dysfunctional spleen and stomach according to the syndrome.4. The diagnosis and treatment experience of bile reflux gastritis. This disease is caused by the disruption in the balance of stomach's ascending and descending and physiological dysfunction. Therefore, it should restore and adjust the qi function of the liver and stomach. Therapeutic methods include soothing liver and harmonizing stomach,removing blood stasis and satisfying stomach, clearing heat and lowering the adverse flow of qi, nourishing yin and moistening stomach, soothing liver and strengthening spleen and so on. The use of these methods should be accompanied by the medicine to regulate qi and promote the stomach operation.5. The diagnosis and treatment experience of chronic ulcerative colitis. In the acute phase, the disease is mainly characterized by abundant accumulation of dampness and heat;while in the chronic phase, it is mainly characterized by spleen deficiency and deficiency of the spleen and kidney. The treatment should take the principle of combining holistic therapy and local therapy. The disease's manifestation lies in its stomach, and its root cause lies in the spleen, so it is required to adjust the spleen, stomach and kidney functions simultaneously. Treatment should take invigorating spleen Qi and supplementing qi as the basic, accompanied by resolving dampness qi and regulating qi and blood, removing stagnancy, warming yang, tonifying kidney, inducing astringency and so on as the rules,identify deficiency and excess and chills and fever, determine the therapeutic method according to the syndrome, and adapt to functions. Local therapy should take the principles of anti-inflammation and detoxification, resolving dampness and removing necrotic tissue,and promoting blood circulation and tissue regeneration, with the use of traditional Chinese medicine enteroclysis.Part III: clinical research on Professor Zhou Shiyin's treatment of functional dyspepsia and incoordination between the liver and stomachObjective: To observe the efficacy of the method of liver-soothing and stomach-regulating for the treatment of functional dyspepsia.Methods: Using non-randomized concurrent control method, 88 patients are divided into TCM group and Western medicine trimebutine group. Their treatments are respectively soothing liver and harmonizing stomach(ascending and descending according to the syndrome) and trimetazidine. The course of treatment is 4 weeks with 1 month follow-up. It mainly observes the changes of frequency and anxiety state in patients' symptoms.Results: In the aspect of symptom improvement before and after treatment,the experimental group was better than the control group with a significant difference between the two groups in the epigastric pain, two threatened fullness, stagnation of discomfort,poor appetite, stoolc.(P <0.01). In the aspect of symptom scores, the experimental group is better than the control group and it is positively correlated with the treatment time(P<0.01). In the aspect of TCM syndrome effect, the experimental group is better than the control group generally in improving TCM syndrome; along with the duration of treatment,the effect is durable and stable. The experimental group is better than the control group in improving Hamilton anxiety score, but the cumulative effect will take time. No cases of abnormal blood routine and liver and kidney function are found before the entire clinical observation, indicating that TCM is safe and reliable for the soothing liver and harmonizing stomach group.Conclusion: The method of soothing liver and harmonizing stomach has a good effect in improving the main symptoms of incoordination between the liver and stomach and functional dyspepsia. With a durable and stable effect, long-term application can significantly improve the clinical syndrome, anxiety state and quality of life for patients with incoordination between the liver and functional dyspepsia stomach. |
PDF Full Text Request