| ObjectiveChief Physician Zhang Fengwu,,one of the advisors of the fifth group of the national experienced physicians in TCM(traditional Chinese medicine)who are involved into the academic experience inheriting,has devoted himself to medicine for more than 40 years and is characterized by experiencing for treating spleen and stomach diseases.As his academic experience successor,I am lucky to worship him for the teacher.By means of clinical learning,collecting and summarizing medical records,teacher-interviewing,retrieving and referring to correlative theses and books,etc.,I have unscrambled the origin of academic experience of Mr.Zhang and summarized academic treatment characteristics on spleen and stomach diseases in order to inherit and develop his clinical experiences.Mr.Zhang is especially good at making a diagnosis and giving treatment of chronic atrophic gastritis.He diagnoses and treats chronic atrophic gastritis from the aspects of spleen deficiency,blood stasis and pathogenic toxin,which have become the basis to build the Jianpi Huatan Jiedu Decoction.This paper,by clinical and trial research,explores the clinical efficacy of Mr.Zhang's Jianpi Huayu Jiedu Decoction in treating chronic atrophic gastritis with spleen deficiency and qi stagnation-type and inner stasis-toxin obstruction-type.MethodsSystematically summarize the academic experience of Mr.Zhang in treating spleen and stomach diseases from the following two aspects of theoretical research and clinical trial research.1.Theoretical researchI have collected the literatures,systemized the clinical medical records and notes,intensively read the four classical medical treatises and books related to Mr.Zhang's academia when taught and learning.Therefore,experience summary and academic thoughts,which don't only accord with clinical condition but also reflect the academic viewpoint of my teacher,Mr.Zhang,on spleen and stomach diseases,could be formed.2.Clinical trial researchThis paper aims at studying the clinic treatment efficacy of the empirical Jianpi Huayu Jiedu Decoction by Mr.Zhang Fengwu,in treating chronic atrophic gastritis.Perspective research method was used to select 92 cases with chronic atrophic gastritis in Mr.Zhang ' s Outpatient Department of National Physician Hall of the Ningxia Hui Autonomous Region Hospital of TCM from Jun.,2014 to Oct.,2015.Meanwhile.All of the above cases conformed to the condition of chronic atrophic gastritis confirmed by results of gastroscope and pathological examination,TCM synMromes of which belonged to spleen deficiency and qi stagnation type and inner stasis-toxin obstruction type.Chinese crude Mrug group was treated with Mr.Zhang' s formula,Jianpi Huayu Jiedu Pills.The control group was treated with stomach restoring pills.After three month' treatment in both groups,the index changes were observed and compared,such as clinical comprehensive therapeutic efficiency,TCM synMrome integral,mucosa integral under gastroscope,pathological effect,eradication rate of Hp(helicobacter pylori)etc.The clinical efficacy of the formula,mentioned above in treating chronic atrophic gastritis belonging to the spleen deficiency and qi stagnation-type and inner stasis-toxin obstruction-type,was explored.Results1.Theoretical research1.1 The origin of Chief Physician Zhang' s academic experience on spleen and stomach diseasesMr.Zhang' s academic experience was derived from the classical theory of ancient TCM books,ancient doctors of all dynasties and clinical experience of contemporary famous doctors.Mr.Zhang considered that theory related to spleen and stomach recorded in The Yellow Emperor's Inner Classic was rather comprehensive and systematic,which had been the source of latter theory of spleen and stomach being acquired foundation.When treating various diseases in clinic,Mr.Zhang,in addition to the synMrome differentiation to treat diseases,insisted on that regulating spleen and stomach was the fundamental and paid much attention to protecting stomach qi,which indicated the thought of spleen and stomach being acquired foundation.Influenced by the thought of spleen and stomach being qi movement foundation of viscera(zang and fu in TCM),Mr.Zhang paid much attention on the relationship between the viscera and put emphasis on spleen and stomach when facing some diseases.He chose to regulate spleen and stomach if affected by problems of other viscera,so that the acquired foundation was enriched to treat the problem viscera,which had been one of the important characteristics of Mr.Zhang in his therapeutics.Based on his cognition on stomach disease pathology,Mr.Zhang considered that un-obstruction was the most important factor in the treatment of stomach troubles.The un-obstruction of qi depression,food accumulation and stomach fire was the key to restore the normal function of spleen and stomach.Essentials from the Golden Cabinet stated that strong spleen at all seasons being pathogen resistant,which indicated that spleen and stomach kept strong so that origin of acquired qi and blood was rich.Consequently,the healthy qi was fully charged and the constitution was strong and healthy to resist the invasion of pathogenic factors.The theory of treating liver problem by excess spleen was from The Transformation and Development of Disease in zang-fu Organs and Meridians One,Essentials from the Golden Cabinet.It said that preventive treatment was used on disease like liver.We know that problems on liver would transform to spleen,so treatment liver problem needed treat spleen first.The above theory was essential to clinical applications and significant to guide the clinic.Mr.Zhang followed the exposition on etiology and pathogenesis of spleen and stomach disease and the critical treatment thought of Treatise on Cold Damage on six-meridian diseases.His academic idea of tonifying stomach qi and preserving body fluid ran through the whole treatment of six-meridian diseases.The main therapeutic rules on regulating spleen and stomach when treating six-meridian diseases in Treatise on Cold Damage were flexibly applied to clinic and then ten methods treating spleen and stomach diseases were summarized.Treatise on Cold Damage treated spleen and stomach diseases caused by cold and heat in complexity and yin-yang disharmony with Banxia Xiexin Decoction,Shengjiang Xiexin Decoction,Gancao Xiexin Decoction,Dahuang Huanglian Xiexin Decoction,etc.,which had shown the academic thoughts of Zhang Zhongjing in regulating the ascending and descending functional activities of spleen and stomach.They are now used in clinic and receive efficacy whenever used.Stomach yin theory was first appeared in Case Records as a Guide to Clinical Practice proposed that treatment focused on using sweet and cold to emolliate and moisten and nourishing stomach yin.In clinic,Mr.Zhang chose Maimendong Decoction,Zengye Decoction,Shashen Maidong Decoction,Yunv Decoction,etc.in common use when treating patient s with stomach yin deficiency and achieved good effects.Wu Jutong,doctor in Qing dynasty,proposed a famous argument about the treatment of triple energizer diseases in his work Systematic Differentiation of Warm Diseases that treatment of middle energizer diseases needed balance,which had to be treated with Mrug with mild nature.Mr.Zhang thought that the therapeutic principles,which aimed at recovering spleen and stomach function,were all belonging to the rule of treatment of middle energizer diseases needed balance,which had to be treated with Mrug with mild nature.Treatment of middle energizer diseases needing balance adopted the method of ascending and descending homology,combination of cold and warm,interdependence between Mrying and moistening,tonification and purgation in combination to gain a goal of balance in middle energizer and recovery of spleen and stomach function.The differential treatment and experience of Mr.Zhang were derived from Treatise on the Spleen and Stomach.1.2 Experience summary of Chief Physician Zhang in treating spleen and stomach diseasesMr.Zhang' s original views on the etiology and pathogenesis of spleen and stomach diseases was derived from The Yellow Emperor' s Inner Classic,Essentials from the Golden Cabinet,Treatise on Cold Damage,Case Records as a Guide to Clinical Practice,Systematic Differentiation of Warm Diseases,Treatise on the Spleen and Stomach and other classics of TCM and experiences of contemporary doctors.The etiology and pathogenesis of spleen and stomach diseases,considered by Mr.Zhang,can mainly classified as four aspects.The disturbance in ascending and descending of spleen and stomach qi movement could lead to stagnation and problems.The spleen and the stomach weakness were easily caused by multi-factor damage.Chronic diseases transformed to collaterals and static-blood led to retardation.Internal and external were coupling and pathogenic dampness led to trouble.It is significant,considered by Mr.Zhang,to accurately grasp the principle of treatment when treating spleen and stomach diseases,which has been summarized as the following features in clinic:Focusing on dispersing and purging theory,dispelling diseases with the un-obstruction;Combined treatment of spleen and stomach;Divided treatment of spleen and stomach;Paying attention on synMrome differentiation and treatment of qi and blood;Insisting on treatment of manifestation and root cause of disease;Paying attention to treating stomach diseases combined with invigorating spleen and removing dampness-heat;focusing on harmonizing the liver and spleen;diagnosing spleen from the heart.According to the above therapeutic principle and method,Mr.Zhang summarized ten methods in the differential treatment of spleen and stomach diseases:dissipating cold and warming stomach method,tonifying qi and invigorating spleen method,resolving accumulation and removing food stagnation method,clearing stomach and quieting the middle method,harmonizing the middle and enlivening stomach method,soothing liver and harmonizing stomach method,ascending lucidity and benefiting stomach method,descending adverse qi and regulating stomach method,resolving stasis and Mredging collaterals method,nourishing yin and moistening stomach method.Based on having extensively inherited works and classical academic thoughts of doctors of the past,Mr.Zhang had been a doctor for more than 40 years and accumulated rich experience in treatment of spleen and stomach disease by lots of and long-term clinical practice.He adopted combination method of disease differentiation and synMrome differentiation to treat seven types of gastritis under gastroscope and achieved good effects.Based on the understanding of treatment of spleen and stomach diseases,Mr.Zhang had his own characteristics in treating diarrhea and dysentery.They were distinguishing manifestation,root,deficiency and excess,harmonizing qi and blood,blending of warming and heat-clearing,moistening and Mrying combination,Mredging and collapsing combination and so on.According to the difference in clinic,chronic enteritis could be divided into three types:spleen-kidney yang deficiency,spleen and the stomach weakness and cold-damp affecting spleen,spleen deficiency and dampness-heat.Therefore,it was necessary to use Mrug according to synMrome differentiation.2.Clinical researchThere is no statistical significance between two groups on aspects of gender,age,disease course and Hp positive infection condition(P>0.05).When comparing the comprehensive clinical efficacy of both groups,the differences by statistical test between the two groups have statistical significance(X2=11.03669,P<0.05).The symptom integral of TCM in both groups showed no statistic difference before treatment(P>0.05).The symptom integral of treatment group and control group after treatment were significantly decreased(P<0.01).The symptom integral of treatment group was significantly lower than that of control group.The difference had statistical significance(P<0.01).When comparing the gastric mucosa integral under gastroscope before and after treatment,mucosa integral in both groups after treatment was more improved than that before.The difference had statistical significance(P<0.01).There was no significant difference when comparing the mucosa integral in treatment group and control group after treatment(P<0.01).There was no significant difference when comparing the gastric mucosa atrophy integral,intestinal metaplasia integral and atypical hyperplasia integral in both groups before treatment(P>0.05).The pathological integral in both groups after treatment was significantly improved(P<0.01).The mucosa atrophy integral in treatment group after treatment was obviously lower than that in control group.The difference had statistical significance(P<0.01).However,when comparing with that in control group,the intestinal metaplasia integral and atypical hyperplasia integral in treatment group showed no significant difference(P>0.05).When comparing the Hp eradication rates of both groups,there were 30 cases(68.18%)of Hp infection in treatment group before treatment and of 27 cases(62.79%)in control group.The difference had no statistical significance(P>0.05).There were 9 cases of Hp positive in treatment group after treatment,with the eradication rate of 70.0%,while 14 cases in control group,with the eradication rate of 48.15%.The difference had statistical significance(X2=6.422723,P<0.05).About the safety evaluation,untoward effects like fever and rash did not appear during the patients taking medicine in both groups.There was nothing abnormal detected before and after treatment,such as blood routine examination,routine urine examination,hepatic and renal functions,electrocardiographic examination,etc.ConclusionChief Physician Zhang Fengwu,by reading kinds of classics of TCM and absorbing academic essence of different doctors,has formed his own academic experience characteristics in treating spleen and stomach.The characteristics are:focusing on the dispersing and purging theory,combination and division treatment of spleen and stomach,synMrome differentiation and treatment of qi and blood,insisting on treatment of manifestation and root cause of disease,paying attention to treating stomach diseases combined with invigorating spleen and removing dampness-heat,and focusing on harmonizing the liver and spleen;diagnosing spleen from the heart..Ten treatment methods of spleen and stomach diseases are summarized.In clinic,Mr.Zhang adopts the combination of disease differentiation and synMrome differentiation in treating different types of gastritis under gastroscope and gains good results.In clinic,synMrome differentiation is used to treat chronic superficial gastritis and chronic enteritis and achieves good effects.The Symptoms and pathology in treatment group with Chinese formula,Jianpi Huayu Jiedu Decoction and control group after treatment are all improved.For one hand,the treatment group after treatment can significantly relieve the discomforts of patients,such as stomachache,gasteremphraxis,belching,anorexia,fatigue,epigastric upset,etc.,and improve the gastric mucosa local circulation under gastroscope.On the other hand,Jianpi Huayu Jiedu Decoction in treatment group can also promote the recovery of atrophic glands,relieve the inflammatory conditions of gastric mucosa,and effectively enhance the Hp clearance rate.However,due to the insufficient sample size and short observing period,this research fails to show the differences between two groups on reversing the intestinal metaplasia and the isomerism atypical hyperplasia. |
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