Professor Kui Jiwu is a national famous veteran Chinese medicine practitioner who has been engaged in the clinical and research work of digestive system diseases for more than 50 years. He has studied the classics of Chinese medicine, diligently sought the ancient teachings and learned from various schools of thought, emphasizing respecting the ancient without muddying the ancient, and referring to the West without deviating from the Chinese. Especially in the treatment of chronic gastritis, he has his unique insights. The author has the honor to study under Master Kui and listen to his teachings. The experience of Master Kui in the treatment of chronic gastritis is summarized below for the benefit of fellow practitioners.
1.Fa Huang’s ancient meaning, the wonderful use of scripture prescription
Chronic gastritis is a chronic inflammation of the gastric mucosa caused by a variety of etiologies, mainly caused by Helicobacter pylori (Hp) infection. In addition, autoimmune mechanisms, genetic factors, duodenal reflux, gastric mucosal damage factors and many other causes can also cause or participate in the process of chronic inflammation formation of the gastric mucosa. According to Kui Shi, chronic gastritis belongs to the category of “gastric pain” and “gangrene” in Chinese medicine, and the pathogenesis is mostly a combination of cold and heat, mixed with deficiency and reality, with irregularities in elevation and elevation and inability to cross the upper and lower tai. As the Jin dynasty typhoid scientist Cheng Wuji said “no and not Thai for the gang”.
The “Treatise on Typhoid Fever” all diarrhea heart soup that is designed for this pathology. There are five diarrhea of the heart soup contained in the Treatise on Typhoid Fever, namely Han Xia Diarrhea of the Heart Soup, Ginger Diarrhea of the Heart Soup, Licorice Diarrhea of the Heart Soup, Rhizoma Huang Lian Diarrhea of the Heart Soup, and Radix Eucommiae Diarrhea of the Heart Soup.
Kui Shi, keeping in mind the pathogenesis of chronic gastritis, often uses Han Xia, Ginger and Licorice as the basic formula, and according to the different clinical symptoms of the patients, he cleverly tailors it to be as effective as a floating drum. If clinical symptoms such as burning pain in the stomach and epigastrium, fullness, nausea and vomiting, and loss of appetite are seen, it is usually treated with the addition and subtraction of Han Xia Di Xuan Xin Tang. In this formula, Hanxia is pungent, warm and dry, it can lower the Qi and open the knots, and harmonize the stomach to relieve the lumpiness. Whenever Kui Shi encounters mild symptoms or Yang deficiency in clinical practice, he often uses Radix et Rhizoma Ginseng instead of Ginseng, and often uses Radix et Rhizoma Astragali together to strengthen the effect of Qi tonicity.
The spleen and stomach live together in the middle jiao, the spleen is responsible for transportation, the stomach is responsible for receiving, the spleen is responsible for ascending the clear, the stomach is responsible for descending the turbid, one for transportation, one for receiving, one for ascending and one for descending, together they complete the digestion of water and grain, absorption, distribution and biochemical functions of qi and blood. Liver stagnation, phlegm-dampness stagnation, food stagnation, and damp-heat congestion can all block the gastric energy and affect the ascending and descending functions of the spleen and stomach. The loss of ascending and descending, the loss of spleen health, dampness from within, and further obstruction of qi, gradually forming the evidence of stomach pain, fullness. It can not only smooth the rise and fall of spleen and stomach qi, but also regulate the deficiency of spleen and stomach yin and yang, so that the rise and fall is restored, clear and turbid are divided, and deficiency and reality are adjusted.
In clinical cases such as vague pain in the stomach and epigastrium, abdominal distension, intestinal tinnitus, diarrhea, etc., Kui Shi often treats them with ginger diarrhea heart soup plus reduction. Ginger diarrhea of the heart Tang for the treatment of Xiao Chai Hu Tang evidence of misplaced, damage to the Yang, the invasion of external evil, cold and heat, mutual knotting under the heart, thunder and diarrhea of the evidence of the formula, “Typhoid” said: “…… stomach in the discord, the heart under the plankton hard, dry yelp food odor, under the wakefulness of water gas, abdominal thunder, diarrhea of the main, ginger diarrhea of the heart Tang. ” The formula is based on ginger, which warms the middle of the stomach and disperses water, and is supplemented by half-xia diarrhea of the heart soup to eliminate accumulation of Qi, open the knots and remove the hardness, which relieves the muscle in dispersing the plankton.
According to Kui Shi, in this formula, the water disappears when Han Xia gets ginger, and the lump is dispersed when Scutellaria gets dry ginger, which is very appropriate for the condition. For clinical conditions such as distension and pain in the stomach and epigastrium, intestinal tinnitus and vexation, dry vomiting and heartburn, Kui Shi often uses Glycyrrhiza glabra-heart Tang with addition and subtraction to treat them. This formula is used to treat deficiency of the spleen and stomach with concurrent diseases of Shaoyang and Yangming. It is intended to benefit the deficiency of Zhongzhou and ease the urgency of the upper rebellious Qi, so that the upper rebellious Qi can be calmed and the fullness in the chest can be eliminated, then the vomiting and diarrhea can be stopped and the disturbed Qi can be relieved. Although the basic composition of the drugs is the same, the dosage of dry ginger, ginger and licorice in the formula is different, so that the symptoms treated are also different. The three diarrhea of the heart Tang evidence-based treatment of chronic gastritis, as long as the right pathogenesis and the main symptoms, the right evidence to use the formula, all get good results.
2. Regulating Qi at the beginning of the disease and invigorating Blood at the end of the disease
Su Wen – six micro-intelligence great theory” said: “the in and out of the waste is the divine machine extinguished, lift rest is the gas stand alone dangerous. Therefore, non-in and out, it is not to grow strong old has; non-lift, it is not to grow and collect. This is the reason why there are no tools to lift up and down.” Chronic gastritis is usually the first disease in the gas, mainly bloating. Kui Shi believes that imbalance of Qi Qi is the pathogenesis of chronic gastritis at the beginning of the disease, the clinical common liver and stomach Qi disharmony, spleen and stomach Qi disharmony and intestinal Qi disharmony. Therefore, regulating the qi flow up and down, and using it as a tonic, and using it as a chemistry, is an important treatment for the initial stage of chronic gastritis.
The method for regulating qi is commonly used in the treatment of chronic gastritis, such as Qing Chen Pi, Mu Xiang, Sha Ren, Hou Pu, Citrus Aurantium, etc.; the method for promoting tonicity is commonly used in the treatment of Su Stem, Radix et Rhizoma, Shen Xiang, Fried Lycopodium and Xian Ren Tou. Kui Shi believes that the spleen and stomach are the pivot of the body’s qi up and down, although they both belong to the middle earth, but there are differences between yin and yang: the spleen is the main ascending, the stomach is the main descending.
If the method of bitterness and descending is used to regulate the qi, it can cure the stomach, but it is not conducive to the ascension of the spleen. Therefore, Kui Shi is more often to apply the method of raising the spleen while lowering the stomach qi, that is, while lowering the stomach with bitter cold, he also uses pungent and warm products to open the spleen, so that the spleen can be raised and the stomach lowered, so that the human qi can be regulated in an orderly manner and the treatment will be complete.
If the chronic gastritis is prolonged for a long time and does not heal, it will gradually enter the blood component. The “clinical guide to medical cases” has repeatedly mentioned the idea of long-term disease into the luo, such as “the first disease in the meridian, long-term disease into the luo, because the meridian is the main qi, the luo is the main blood”, “the first for the qi knot in the meridian, long-term blood injury into the luo”, “disease for a long time, pain for a long time into the blood luo “Long-term disease and pain will enter the blood ligaments.” etc.
Combined with fifty years of clinical experience, Kui Shi believes that Ye’s theory is accurate and is often used clinically to explain the mechanism of chronic gastritis. Long-term disease into the luo, luo injury is blood paralysis, luo channel obstruction and stasis, so the blood activation and elimination of blood stasis should be the positive treatment method. Studies have proved that blood activation and stasis removal can increase blood flow to the gastric mucosa, improve tissue hypoxia, enhance local immunity, and have certain anti-cancer effects.
Kui Shi’s clinically used drugs for activating blood circulation and resolving blood stasis mainly include Angelica sinensis and henbane, which emphasize nourishing blood and activating blood circulation; Panax ginseng powder, Chuanxiong rhizome and Yuanhu, which emphasize activating blood circulation and relieving pain; Sanlun and Curcuma longa, which emphasize breaking blood stasis and dispersing nodules. Master Kui was very cautious about the selection of drugs to activate blood stasis and advocated that calmness was preferable to harshness. He believes that the formation of blood stasis is a gradual accumulation process, not a one-time thing. Chronic gastritis is a long-standing disease with many deficiencies, and the general blood-stasis activating drugs are pungent, warm and dry, which depletes the blood and is not conducive to the recovery of gastric energy.
Therefore, clinically, Dr. Kui prefers to use Salvia miltiorrhiza to treat chronic gastritis with blood stasis. Because of the slightly cold nature of Dan Shen, it is quite compatible with the cool nature of the stomach and the internal organs, as recorded in the “Times and Recipes” when the role of Dan Shen drink: “For the treatment of heart and stomach pains, it is suitable for those who have not been effective in taking hot medicine.” [3] According to Kui Shi, “one flavor of Dan Shen, the same function as four things”, the effect is harmonious but not strong, can both invigorate blood and nourish blood, especially suitable for patients with chronic gastritis for a long time, blood stasis as a problem, new blood is not born, deficiency mixed with reality.
3.Treat the stomach first and regulate the liver and spleen at the same time
After long-term clinical observation and summary, Kui Shi believes that although chronic gastritis is located in the stomach, its pathology is very close to the liver and spleen, so in the treatment of chronic gastritis, the adjustment of liver and spleen function should not be neglected. Kui Shi said, the spleen and the stomach are connected by a membrane, an internal organ, a yin and a yang, a table and a li, a transport and a nano, a rise and a fall, a dryness and a moistening, the opposite of each other, cooperate with each other to complete the digestion and absorption of water and grain and its transmission. Once the spleen is diseased, the failure of transportation and transformation will inevitably affect the circulation and descent of the stomach; and the loss of harmony and descent of the stomach will in turn affect the ascension and transportation of the spleen. Therefore, the treatment of chronic gastritis Kui Shi advocates the treatment of both the spleen and the stomach, that is, to treat the stomach must strengthen the spleen, strengthen the spleen must also harmonize the stomach, the two must be balanced. If either the spleen or the stomach is heavy or there is concurrent evidence, it can be treated by adding and subtracting with the evidence.
In addition, chronic gastritis and the relationship between the liver is also very close. The liver is the main drainage function is normal, can help the spleen and stomach transport and flourish, rise clear and lower turbidity as usual. Once the liver is out of circulation, the spleen and stomach are out of order, that is, the liver and spleen disorders or liver and stomach disharmony and other evidence. According to the relationship between liver, spleen and stomach, Master Kui has defined liver and spleen regulation as another major treatment method. According to Kui, the coordination of the functions of the liver and spleen is the guarantee for the normal physiological functions of the spleen and stomach. Dysregulation of the liver and spleen affects the normal physiological function of the spleen and stomach, leading to the development of chronic gastritis. The main methods commonly used to regulate the liver and spleen are the method of dredging the liver and strengthening the spleen, the method of suppressing the liver and supporting the spleen, the method of transporting the spleen and nourishing the liver, the method of raising the spleen and regulating the liver, and the method of waking the spleen and draining the liver. In clinical practice, the treatment is mostly based on the main prescriptions of Prosperity San, Painful Diarrhea Essentials, Consistent Decoction, Chai Hu Dredging Liver San, and Six Jun Zi Tang, plus and minus.
4.Reference to the West and identification of the disease as a complement
In the treatment of chronic gastritis in Chinese medicine, the main focus is on evidence-based treatment and holistic concept. However, Kui Shi believes that the traditional macroscopic diagnosis also has its limitations. Therefore, he attaches great importance to the relevant modern medical knowledge and commonly used tests (e.g. fiberoptic gastroscopy, Hp test, etc.), which are often used as necessary references for the treatment of the disease. The organic combination of evidence and disease identification has largely compensated for the deficiencies of TCM evidence identification.
In clinical practice, Kui Shi incorporates these microscopic indicators into the TCM diagnosis and treatment system, which greatly improves the accuracy of diagnosis and significantly enhances the therapeutic effect.
For example, if the gastroscopy shows superficial erosion, congestion and superficial ulcer, in addition to adding dandelion, white flowered snake tongue herb, half branch lotus and other drugs in the identification formula, the patient is also asked to take the powdered Panax ginseng, white and other drugs in capsules to protect the gastric mucosa and promote the healing of the ulcer surface; if the gastroscopy shows pale and thin gastric mucosa, and the submucosal blood vessels are permeable, most of the patients have deficiency of qi and blood or spleen and stomach deficiency cold.
If the pathological examination is accompanied by intestinal epithelial metaplasia and atypical hyperplasia, we should add anti-cancer and nodule dispersing herbs such as Radix et Rhizoma alba, Radix et Rhizoma hemipterocarpus, Radix et Rhizoma cunninghamiae, Curcuma longa, etc. (modern medical research proves that the above four herbs have the effect of resisting or killing cancer cells); if the biopsy or culture is confirmed positive for Helicobacter pylori, Kui Lao often uses herbs such as Dandelion, Rhizoma macrophyllum, Scutellaria baicalensis, Radix et Rhizoma yanhusuo, Radix et Rhizoma lacrymae, etc. In the case of biopsy or culture confirmed positive H. pylori, Kui often selects 1-2 herbs from Dandelion, Rhubarb, Scutellaria, Radix et Rhizoma, Yanhuosuo, Fleabane, and Phyllanthus to add to the formula according to different symptoms, so as to enhance the ability to kill Hp and improve the symptoms and efficacy.
5, keep the formula to slow down, the combination of treatment and health
Chronic gastritis patients have different causes, complex pathogenesis, and changing clinical symptoms, plus the reconstruction of normal gastric mucosal glands takes 3-6 months, so Kui Shi insists that the treatment of chronic gastritis should keep the law and keep the prescription, not to change overnight. In the course of treatment, the condition is also susceptible to a series of changes due to various triggers. Whenever the patient is treated, Dr. Kui always asks about the condition, patiently investigates the triggers that cause the patient’s recurring condition, adds and subtracts flexibly on the basis of keeping the law and the prescription, and administers the prescription skillfully.
In addition, Dr. Kui also advises patients to take medicine while eating a regular diet, avoiding cold, spicy and oily food, preferably eating less and more, and taking care of them carefully. Dr. Kui often tells patients that chronic gastritis is “three parts in treatment, seven parts by nourishment; good cooperation between doctors and patients, the disease will automatically run”. This feature of keeping the prescription and slowing down, and combining treatment and nutrition is the academic crystallization of Kui’s decades of treatment of chronic gastritis.
To sum up, Kui’s treatment of chronic gastritis starts with the overall identification of the cause and mechanism of the disease, then further adjusts the cold and heat deficiency of the relevant internal organs, supplemented by reference to the relevant physical and chemical examination results, combined with the development of the patient’s condition, comprehensive analysis, reasonable prescriptions and medication, and finally instructs the patient to pay attention to self-care, achieving a high degree of unity between identification and disease identification, treatment and recuperation, further improving the efficacy of Chinese medicine in the diagnosis and treatment of chronic gastritis.