Professor Zhang Yinan's Clinical Experience In Treating Gastroesophageal Reflux Cough

Objective:Nowadays,by the development of medicine,gastro-esophageal reflux cough as an newly-discovered disease,has gained increasingly attention.Gastro-esophageal ref lux cough(GERC)is one of the most common reasons of the chronic cough,also kn own as a unique sort of gastro-esophageal reflux disease's(GERD)clinical manifestati on.It is just because acid and other gastric contents(such as weak acid or weak base material like bile)go up into the esophagus that lead to cough and acid-refluxing sy mptoms.The diagnosis standard of this disease is relatively clear,while the 24-hour e sophageal pH/impedance monitoring as an essential but difficult diagnosis method,has not widely popularized.And even after being clearly diagnosed,the treatments of GE RC also have to be long-lasting.With the effort of the professors in the TCM area,r esearches about GERC and its treatments have made plenty of progress,which almost just concentrated on the stomach.My mentor Prof.Zhang Shunan has committed hims elf to the clinical practice for 30 years,gained abundant clinical experiences about ap plying TCM methods and combining TCM and western medicine principles in treating many respiratory diseases.This paper mainly demonstrates his opinions about GERC with the guidance of the TCM theory,and summarizes the applications of the correlati on theory of pulmonary and stomach in treating GERC,which can provide some inge nious ideas in the field of TCM.Methods:The thesis of this paper could mainly be seperated into two parts.Thefirst p art was the review,which was accomplished by gathering the literatures in order to re search and analyze the ideas about the GERC in both the TCM and modern medicine areas.And the second part is the literature review and experience summary.First of all,review the TCM classic literatures about the evolution of the correlation theory of pulmonary and stomach and its application as a foundation,then,read through Prof.Zhang Shunan's articles on GERC,and collect typical cases from the outpatient and t he hospitalized patients in order to summarize Prof.Zhang Shunan's recognition about GERC,including the following several aspects:etiology,pathogenesis,key syndromes in syndrome differentiation,principles and methods in treatment,prescriptions and me dications of GERC,recuperative care and nursing.Finally,typical-case analysis and co mments were retrospectively summarized to give a better review.Results:Prof.Zhang Shunan has compared the study of ancient literature of TCM and the results of western medicine studies about GERC from fore-mentioned aspects,fin ally got the conclusion that GERC belongs to the endogenous-injury cough,and is sim ilar to the TCM conception:"Wei Ke".This disease is not only lies in the stomach,b ut also lies in the pulmonary.It can be asthenia or sthenia,even the mixture of them,also there are many etiological factors,like exogenous or internal injuries,emotional disorders and phlegm retention,blood stasis,dyspepsia and so on.But the reversing fl ow of Qi,phlegm retention and dyspepsia are the priorities.The main pathogenesis of the Wei Ke is the etiological factors above cause the adverse rising of gastric Qi,th e impairment of dispersing and descending function in the pulmonary and the disorderi ng of the Qi transformation,so cough happens.There are common TCM syndrome ty pes such as pulmonary and stomach Qi inverse syndrome,food accumulation syndrome,phlegm blocking pulmonary and stomach syndrome,pulmonary and stomach Yin defi ciency syndrome,pulmonary and spleen(stomach)Qi deficiency syndrome,etc.For the treatment of Wei Ke,Prof.Zhang Shunan submits that pulmonary and stomach is bot h important,not only to inverse the stomach Qi but also to descend the pulmonary Qi,regulating the Qi transformation is also needed.These three methods can be comb ined.Also,the therapy of relieving hyperacidity,tonifying spleen,aiding digestion can be used as co-operation.In a word,it is suitable to applying treatments which are ba sed on syndrome differentiations and the main formula of Wei Ke is "modified Zhisou Powder".It concludes descending the pulmonary Qi and relieving cough drug as:rad ix asteris,flos farfarae,fructus chebulae,folia eriobotryae,inversing the stomach Qi a nd reducing phlegm drugs as purple perilla,Pinellia ternate,Inula britannica chinensis,tonifying spleen drugs as fructus aurantii immaturus and white atractylodes rhizome;gesso and herba patriniae using acrid opening and bitter down-bearing method to relie ving hyperacidity.At the same time,daily life and diet are also needed to pay attenti on.When Prof.Zhang Shunan treats GERC,he never sticks to any changelesssort of herbs,but uses different herb pairs and flexible drugs,manages to harmonize the pul monary and stomach,to descend Qi and reduce phlegm.Conclusions:GERC is a common disease in clinic,which has a tight relationship with GERD.It often appearances to cough,white phlegm with nausea,vomit,belch or he artbum,etc.Prof.Zhang Shunan recognizes that GERC is similar to "Wei Ke" in TC M.Its theory of pathogenesis is mainly due to the pulmonary and stomach,the advers e rising of gastric Qi,the impairment of dispersing and descending function of the pul monary and the Qi transformation disordering,When it begins,it seems to express mo re excess symptoms,and after the GERC lasts,it tends to express more deficiency sy mptoms or symptoms intermingled deficiency and excess.The treatments make regulati ng lung and stomach and reversing the flow of Qi as the center,and concentrate on i nvolving the pulmonary and stomach,search for the primary cause of disease in treat ment.When treating the Wei Ke,he mainly focuses on the comprehensively usage of differentiating syndrome and disease,also constitution,and regard "modified Zhisou P owder" as a main formula.With the flexibility to add and subtract drug treatment to achieve good curative effect.