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Chronic
gastritis is a chronic gastric lesion, pathologically characterized by
non-specific chronic inflammation of the gastric mucosa. Its etiology is not
well understood, possibly related to administration of irritating drugs and
food, bile regurgitation, muccal inflammation or autoimmunity. Chronic gastritis
can be divided into two categories, primary and secondary. The former is further
categorized into superficial, atrophic and hypertrophic types; the latter often
complicates gastroduodenal ulcer and gastric cancer. Chronic gastritis occurs
most frequently in the middle-aged people. This disease in TCM pertains to the
categories of "pi" (feeling of fullness in the upper abdomen), "wei
wan tong" (stomachache), etc.
Main Points of
Diagnosis
1.
The chief symptoms are chronic upper abdominal pain, fullness and discomfort,
belching and acid regurgitation which often occur after meals. Mild hemorrhage
of upper digestive tract may be induced by some precipitating factors in a few
cases. Severe atrophic gastritis may be accompanied with anemia and pathologic
leanness.
2.
Physical examination reveals mild but diffuse tenderness in the upper abdominal
region.
3.
Laboratory examination
(1)
Gastric juice analysis: Gastric acid is normal in superficial gastritis, but
mostly reduced or gone in atrophic gastritis.
(2)
X-ray barium examination: Positive rate is not high. Atrophic gastritis presents
gastric hypotension, triviality or disappearance of gastric mucosal folds. The
main purpose of radiological examination is to exclude peptic ulcer and cancer.
(3)
Gastrofiberscope: This method is most contributive in confirming diagnosis.
Through it superficial mucosal erosion with hyperemia, swelling or red spots and
increased ropy liquid could be discovered in chronic superficial gastritis; in
chronic atrophic gastritis, such findings can be caught as thinned and
grayish-pale mucosa, slenderized mucosal folds with exposure of submucosal
vessels, and granular or nodular proliferation. The combined application of
gastrofiberscope and biopsy proves to be an accurate method for the diagnosis of
chronic gastritis.
Differentiation and
Treatment of Common Syndromes
1.
Stagnation of the Stomach-Qi
Main
Symptoms and Signs: Epigastric distension and fullness or pain, loss of
appetite, indigestion, or diarrhea, white coating of the tongue, and slippery
pulse.
Therapeutic
Principle: Regulating the stomach-qi to relieve distension and fullness.
Recipe:
Pinellia Decoction for Purging Stomach-Fire.
pinellia
tuber
dried
ginger
scutellaria
root
coptis
root
codonopsis
root
licorice
root
Chinese
date
All
the above herbs are to be decocted in water for oral administration.
For
the case of a more severe stomachache, 15 grams of white peony root and 9 grams
of corydalis tuber may be employed.
2.
Hyperactive Liver-Qi Attacking the Stomach
Main
Symptoms and Signs: Epigastric distension, pain, fullness, oppression and
discomfort which is aggravated after meals, frequent belching which may be
aggravated by emotional upset, thin and white coating of the tongue, and deep
taut pulse.
Therapeutic
Principle: Relieving hyperactive liver-qi and regulating the stomach.
Recipe:
Modified Bupleurum Powder for Relieving Liver-Qi.
bupleurum
root
cyperus
tuber
white
peony root
bitter
orange
Sichuan
chinaberry
corydalis
tuber
tangerine
peel
perilla
stem
licorice
root
All
the above herbs are to be decocted in water for oral administration.
If
there are acid regurgitation, burning sensation and distress in the stomach, 15
grams of dandelion herb, 9 grams of coptis root and 6 grams of evodia fruit are
to be added to the recipe.
3.
Insufficiency-Cold of the Spleen and Stomach
Main
Symptoms and Signs: Vague pain in the stomach, vomiting of watery fluid,
preference for warmth and press, aggravation from cold, mental fatigue and
weakness, loose stools, pale tongue, deep thready and weak pulse.
Therapeutic
principle: Warming middle-warmer and dispelling pathogenic cold.
Recipe:
Modified Decoction of Astragalus for Tonifying Middle-Warmer.
astragalus
root
cinnamon
twig
white
peony root
aucklandia
root
dried
ginger
amomum
fruit
Chinese
date
prepared
licorice root
All
the above herbs are to be decocted in water for oral administration.
If
the case is complicated with anorexia and belching with fetid odor, 10 grams of
medicated leaven and 10 grams of germinated barley may be administered; if the
case with acid regurgitation, 30 grams of calcined ark shell added; if the case
with dominant cold of insufficiency type, 10 grams of codonopsis root, 10 grams
of white atractylodes rhizome and 10 grams of poria included.
4.
Deficiency of the Stomach-Yin due to Stomach-Heat
Main
Symptoms and Signs: Irregular stomachache with burning sensation which is
aggravated in the afternoon or on empty stomach and is relieved after meals, dry
mouth and throat, or thirst, loss of appetite, dry stool, red tongue with
yellowish and dry fur, and taut and thready or rapid pulse.
Therapeutic
Principle: Clearing away heat from the stomach and nourishing the stomach-yin.
Recipe:
Modified Decoction for Nourishing the Stomach
glehnia
root
ophiopogon
root
fragrant
solomonseal rhizome
white
peony root
scutellaria
root
coptis
root
anemarrhena
rhizome
tangerine
peel
dandelion
licorice
root
All
the above herbs are to be decocted in water for oral administration.
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