| Chronic a trophic gastritis (CAG) is a kind of chronic inflammation of the gastric mucosa caused by a variety of reasons. It is characterized by the gastric mucosal epithelium atrophy and glandular, the mucosal thinning, the muscularis mucosa thickening which accompanied by intestinal metaplasia and dysplasia. CAG is the precancerous condition indicated by WHO in 1978. Intestinal metaplasia (IM) and dysplasia (Dys) is named precancerous lesion of grastic cancer (PLGC). There is a long process of precancerous condition before the normal mucosa change into carcinoma. Currently, the accepted model of the evolution is chronic superficial gastritisâ†'chronic atrophic gastritisâ†'intestinal metaplasia of gastric mucosaâ†'dysplasia of gastric mucosaâ†'gastric cancer (intestinal type). Positive reversal of PLGC is particularly important for gastric cancer prevention. Western medicine haven't any effective therapy for PLGC. The symptomatic treatment is usually used to treat the PLGC and it is difficult to reverse the development trend of PLGC. The traditional Chinese medicine(TCM) treatment of PLGC has unique advantages, it is not only can control the disease progresses, but also reverse the atrophy, even intestinal metaplasia and dysplasia.So the research on TCM to prevent PLGC has become the focus in domestic and international.The thesis consists two parts:literature review and clinical observation.1 literature review:In the first article,I summarized the etiological factor, pathogenesis, diagnoses, and therapeutics of western medicine research on PLGC. Second article, the research progress of the the name, the etiology and pathogenesis, the treatment of PLGC were introduced in the view of traditional Chinese medicine.Third article, it discusses the formulation and development,the theoretical foundation,the clinical application and the modern research of pungent drugs for dispersion and bitter drugs for purgation in treating the spleen and stomach diseases.2 Clinical observation:Objective:To make an objective effect evaluation by using pungent drugs for dispersion and bitter drugs for purgation to treat the spleen and stomach diseases, to discuss its possible pathogenesis and characteristics of the prescript ions, thus it can provide the theoretical basis for the clinic application.Method:According to the inclusion criteria of PLGC, the cases were divided into treatment group and control group. The treatment group has 40 patients,us ing pungent drugs for dispersion and bitter drugs for purgation,at the same time they took Weikangning granules,2g/time,3 t imes/day.There are 40 patients in control group to give We ifuchun tablet,4 tablets/time,3 times/day.A course of treatment is 3 months and the both of groups were treated by 2 courses. The two groups were not allowed to take other drugs. Clinical symptoms,endoscopic features, pathology, Hp infection were observed before and after treatment, and statistical analysis were made to compare the treatment effect.Results:After 2 courses, the total effective rate is 87.5% in the treatment group and the control groupis 82.5%, the difference is significant (P<0.05). Clinical symptoms before and after treatment has improved in both groups. The symptom scores'total effective rate is 92.5% in the treatment group and the control group is 87.5%, the difference is significant (P<0.05). The symptom scores of dull ache or swollerpain in stomach, epigastric fullness and poor appetite between the treatment group and control group are s ignificantly different (P<0.05). The improvement rate of endoscopic manifestations in the treatment group is 75.0% and the control groupis 45.0%, the difference is significant (P<0.05). After treatment by the Weikangning granules, the inflammation, atrophy and intestinal metaplasia are significantly improved (P<0.05), there is no significant improvement in dysplasia (P>0.05); both two groups are significant ly different in improving the glandular atrophy (P<0.05). The rate of Hp negative-inverted in the treatment group is 73.7% and the control group is 40.9%. The difference is significant (P<0.05).Conclusions:Weikangning granules can relieve the clinical symptoms of PLGC, reduce inflammation,atrophy and intestinal metaplasia. It has a certain inhibitory effect of Hp infection. According to pungent drugs for dispersion and bitter drugs for purgation, Weikangning granules can concurrent treatment of both cold and heat, which reflects the characteristics and advantages of TCM. |
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