Chronic gastritis is a common clinical disease. According to the criteria established by the Professional Committee of Digestive Diseases of the Chinese Society of Integrative Medicine in 2003, it can be classified into six types of TCM evidence-based treatment: liver and stomach disharmony, spleen and stomach weakness (cold), spleen and stomach dampness and heat, stomach yin deficiency, blood stasis in the stomach complex and spleen deficiency and qi stagnation.
I. Chinese medicine evidence type
1. Liver and stomach disharmony
(1) Main symptoms: (1) Distension and pain in the stomach and epigastrium or pain in both sides. (2) Frequent belching. (3) Noisy and acidic. ④Strict pulse.
(2) Secondary symptoms: ①Acute active inflammation of the gastric mucosa. ②Bile reflux. (3) Secondary symptoms: ①Acute active inflammation of the gastric mucosa.
(3) Evidence type determination: with 2 items of primary evidence plus 1 item of secondary evidence, or the first item of primary evidence plus 2 items of secondary evidence.
2. Weakness of the spleen and stomach (including deficiency cold)
(1) Main symptoms: ① hidden pain in the stomach and epigastrium. ② Preferring to press and warmth. (3) Stuffiness in the stomach after eating. ④Sluggishness with little food. (5) Loose stools and diarrhea. (6) Weakness of limbs. (7) Pale red tongue with tooth marks and thin white or white coating.
(2) Secondary symptoms: ①Red spots or roughness in the gastric mucosa. (2) Mucus is thin and abundant. (3) Stomach acid is low. ④Pulse is sunken and thin.
(3) Determination of the type of evidence: with three main symptoms plus one secondary symptom, or two main symptoms plus two secondary symptoms.
3.Spleen and stomach damp-heat evidence
(1) Main symptoms: ① burning and distension in the stomach and epigastrium. (2) Bitter mouth and bad breath. (3) Stuffy stomach and abdomen, thirsty and unable to drink. ④Red tongue with deep red edges and thick yellow or greasy coating.
(2) Secondary symptoms: ① acute active inflammation of the gastric mucosa, congestion and erosion is obvious. (ii) Yellow urine. (③) Smooth or moistened pulse.
(3) Determination of the type of evidence: with two main symptoms plus one secondary symptom.
4, stomach yin deficiency evidence
(l) Main symptoms: ① burning pain in the stomach and epigastrium. ②Dry mouth and tongue. ③Dry stool. ④Red tongue with little fluid and no moss or peeling or cracked moss.
(2) Secondary symptoms: ①Gastric mucosa is granular or blood vessels are exposed. (2) Stomach mucosa is dry, with little mucus or low gastric acid. (3) Mucosal congestion and edema or small erosion. ④Pulse is fine or stringy.
(3) Determination of evidence type: with 2 main evidence items plus 1 secondary evidence item, or 1 main evidence item plus 2 secondary evidence items.
5.Stagnation of stomach ligaments
(1) Main symptoms: (1) Stomach and epigastric pain with a fixed location, not like pressing or refusing to press. (2) Positive fecal occult blood or black stool. (3) Dark red or purple tongue with stasis.
(2) Secondary symptoms: ①Stomach pain for a long time. (2) Secondary symptoms: ①Gastric pain persisting for a long time. ②Gastric mucosa is congested and swollen with petechiae or bleeding spots. (③) The pulse is stringent and astringent.
(3) Determination of the type of evidence: having 2 items of the main evidence, or the first item of the main evidence plus 2 items of the secondary evidence.
6.Spleen deficiency and Qi stagnation
(1) Main symptoms: (1) fullness or distension of the stomach and epigastrium, with a feeling of heaviness in the stomach. (2) Loss of appetite and abdominal distension after eating. (3) Frequent belching.
(2) Secondary symptoms: ① loose stools at times. (2) Secondary symptoms: (1) Loose stools and sometimes knots. (2) Atrophy. (3) Fatigue and weakness. ④Fat tongue, light red texture, thin white coating. ⑤ pulse is sluggish or sunken.
(3) Determine the type of evidence: with the main evidence of two items plus secondary evidence of one item, or the main evidence of the first item plus secondary evidence of two items.
Identification and treatment
1. Liver and stomach disharmony
Treatment: Diversify the liver and Qi, harmonize the stomach and relieve depression.
Formula: Chai Hu Dredging Liver San plus or minus (Chai Hu, Bai Shao, Citrus Aurantium, Chuanxiong, Xiang Fu, Chen Pi, Fructus, Su Stem, Yan Hu Suo, Licorice)
Add and subtract: if it is cold, add Gao Liang Jiang or Wu Yao; if it is hot, add Chuan Huang Lian or Gardenia; if it is distended, add Guang Mu Xiang and Sha Ren; if it swallows acid, add forged squid bones, corrugated roots and Zhe Bei Mu; if it is painful, add Chuan Neem.
2. Weakness of the spleen and stomach
Treatment: Warming the middle and strengthening the spleen, benefiting the qi and harmonizing the stomach.
Formula: Xiang Sha Liu Jun Zi Tang with Huang Qi Jian Zhong Tang plus reduction (Dang Shen, Fu Ling, Bai Zhu, Chen Pi, Guang Mu Xiang, Sha Ren, Huang Qi, Gui Zhi, Bai Shao, Sheng Jiang, Licorice)
Add and subtract: add fried lentils, coix seeds and lotus seeds if the abdomen is bloated and loose; add aromatic rafters, Buddha’s hand and fried sanxian if the abdomen is bloated and belching after eating; add ginger and half asia and herbaceous cardamom if the abdomen vomits clear water; add Liang Fu Wan or dry ginger and cinnamon if the cold Qi is strong.
3.Spleen and stomach damp-heat evidence
Treatment: clear heat and dampness, harmonize the middle and awaken the spleen.
Formula: San Ren Tang with Lian Pu Drink plus or minus (Huang Lian, Scutellaria baicalensis, Baikou Ren, Dandelion, Coix seeds, Fa Han Xia, Fu Scutellaria, Hou Pu, Licorice)
Add and subtract: add Yanhuosuo, Neem, Yujin if the stomach pain is very severe; add Rhubarb and Citrus aurantium if the stool is unpleasant; add Bamboo Roo, Ginger and Pelargonium if nausea and vomiting; add Chicken Neijin, Grain Bud and Wheat Bud if the stomach is dull.
4.Deficiency of stomach yin
Treatment: Nourish Yin, benefit the stomach, harmonize the luo and relieve pain.
Formula: Consistent decoction with peony and licorice soup plus reduction (northern ginseng, prunus ginseng, maidenhair, raw earth, gardenia, angelica, golden bell, white peony, licorice, green calyx plum, August zha, aromatic rafter skin, chicken neijin)
Add and subtract: add smallpox powder and dendrobium if the mouth is dry and the tongue is red; add XuanShen and HuoHaoRen if the stool is dry; add Grain bud, malt, WuMei, Hawthorn if the stomach is sluggish.
5.Stagnation of stomach ligament
Treatment: Promote blood circulation, resolve blood stasis, promote qi flow and relieve pain.
Formula: Loss of Smile San combined with Danshen Drink plus or minus [Wulingdian, Puhuang, Danshen, Tanxiang (later on), Sharen, Panax notoginseng powder (punch), Yanhuosuo, Yujin, Citrus aurantium shell, Fried Curcuma].
Addition and subtraction: in case of actual heat, add Rhubarb and Neem; in case of cold, add Cinnamon and Ocimum sanctum; in case of Qi deficiency, add Radix Astragali and Radix Codonopsis; in case of Yin deficiency, add Radix Rehmanniae Praeparata, Radix Paeoniae Alba and Rhizoma Polygonati; in case of black stool, add Blood Yu Char and Colla Corii Asini (melted).
6.Spleen deficiency and Qi stagnation
Treatment: Strengthening the spleen and regulating qi, activating blood circulation and resolving blood stasis.
Formula: Si Jun Zi Tang with Si Wei San plus reduction (Chai Hu, Bai Shao, Citrus Aurantium, Radix Codonopsis, Atractylodes Macrocephalae, Poria, Yu Jin, Phellodendron, Wu Ling Ling Li, Jiuxiang Bu, Danshen, Licorice)
Add and subtract: if the pain is severe, add Yanhuosuo and Saponaria; if cold, add Cinnamon and Ocimum sanctum; if empty abdominal pain is accompanied by panacidity, add Sargassum bones and Zhaoyu; if abdominal distension is painful and full, with frequent belching, add Houpao, Su Stem and Xiangxiang; if loose stools are present, add Gui Zhi and Ginger; if constipation is present, replace Citrus aurantium with Citrus aurantium shell, add Lycopodium, Betel nut and Fructus.