Gastroparesis is a common clinical condition in which the stomach and epigastrium are stuffy and uncomfortable, and even present with painful stuffiness in the chest and diaphragm, less food and dullness, and irregular bowel movements. The key to the pathogenesis of this disease is the blockage of Qi in the middle Jiao and the failure of lifting and lowering, as in the Su Wen Qi Yi Bao Sheng Collection: “The spleen cannot move Qi in the lung and stomach, and the knot does not disperse is a gangrene”. At present, there are different clinical discussions on the etiology and pathogenesis of the disease, and the author, based on years of clinical experience, takes the regulation of the qi mechanism as the basis and treats it from the qi, and now discusses the four aspects of qi stagnation, qi reversal, qi depression and qi deficiency to facilitate clinical treatment.
1.Qi stagnation
The stagnation of qi is caused by the poor flow of qi, mostly due to phlegm, dampness, food accumulation, blood stasis and other tangible evil or external evil invasion into the interior to obstruct the qi flow. The spleen and stomach are located in the middle jiao, the function of transport and transformation, and is the pivot of qi lift, the spleen is the main ascending clear, the stomach is the main descending turbid, the spleen to ascend for use, the stomach to descend for and, clear ascending turbid descending is qi smooth, the normal function of the digestive system.
If the spleen and stomach are damaged, external evil into the heart and stomach, or overeating, wanton eating cold, food and grain does not transform, blocking the stomach, or the spleen and stomach is not healthy, water and damp does not transform, brewing phlegm, phlegm and gas, can be blocked in the middle jiao qi, lifting and lowering the division, and become full. For example, the “Treatise on Typhoid” cloud: “the stomach is not harmonized, the heart is hard and plump”, “the grain is not transformed, the abdomen thunders, the heart is hard and full”, “the pulse is floating and tight …… then The pulse is floating and tight is a plankton, pressed from the moist, but the gas plankton ear”.
Another example is the “Secret Collection of the Orchid Room – full abdominal distension” said: “spleen dampness has surplus, abdominal fullness food does not dissolve”, indicating that regardless of the cause, as long as the stomach gas plastic stagnation, can occur this disease. Ye Tianshi further elaborated on this: “Qi does not stretch, blocking paralysis off the middle’, or “Qi closed for a long time will be Qi knot” (Clinical evidence guide medical case). The “Ming Medical Guide” is in a nutshell, its cloud: “Gang, no also, the meaning of impassable. It is caused by the accumulation of yin and yang, and qi and blood are not far away”. The identification of the evidence is based on the key points of the abdominal auxiliary fullness, stuffiness and congestion, especially when pressed, not thinking about eating and drinking, abnormal stool, yellow and thick greasy moss, and slippery pulse.
The author often uses Chai Ping Tang (drugs: Chai Hu, Bai Shao, Citrus Aurantium, Atractylodes, Hou Pu, Chen Pi, Xiang Shen, Powdered Pueraria Mirifica, Glycyrrhiza Glabra, etc.) with reduction to treat the symptoms with repeated success.
2.Qi rebellion
Qi rebellion is a pathological state in which the qi mechanism rises more and descends less, mostly caused by internal injury of emotion and will. Qi rebellion is one of the main factors leading to this disease, and is closely related to the liver. The liver is a rigid organ, the main rising and active, its qi is easily hyperactive and easily rebellious, violent anger hurts the liver, liver qi rides the spleen, the middle jiao is damaged, the qi is rebellious, the elevation and lowering is not in order and causes fullness. For example, the “Class Certificate of Treatment” cloud: “violent anger injury, Qi rebellion and fullness”, such as “Jing Quanshuyue – fullness”: “violent injury of anger, liver Qi is not calm and fullness”.
Qing “Zhang Iqing medical case” also believes that the cause of gastric plumpness is mostly due to “anger”. In addition, the spleen’s function of transportation and transformation and the stomach’s function of lifting and lowering depend on qi and also on yin. If the spleen and stomach yin is depleted by fever, or if the body is weak, the spleen and stomach yin is deficient, or if the long illness is hot and depressed, depleting the qi and injuring the fluid, or if the yin of other organs is deficient and involved, the spleen and stomach yin is deficient and loses its moistening, so that the spleen is not able to transport and transform, the earth loses its softness, the qi loses its harmony and descent, the congestion does not work, and the rebellion is upward, so that the middle and upper stomach fullness arises, as pointed out in Pu Fu Zhou’s Medical Experience: “Spleen yin deficiency …… annoying and full, not thinking about food”.
Clinically, it can be seen that the stomach and abdomen are full, the head is distended and painful, the face is red and the eyes are red, erratic, noisy, dry mouth and throat, hunger and lack of desire to eat, the tongue is red and less fluid, and the pulse is stringent or thin.
The author often uses Yixing Stomach Tang with addition and subtraction (drugs: Bei Sha Shen, Sheng Di Huang, Mai Dong, Bai Shao, Chuan Zi, Dendrobium, Fried Scutellaria, Angelica Sinensis, Dai Ochre, Perilla, Coix Seed, Licorice, etc.).
3.Qi stagnation
Gas stagnation and gas depression were mostly one before the Ming Dynasty, called “yu”, such as the “Jin Kui Xuan – six yu” said: “yu, the accumulation and can not be sent over. When rising can not rise, when descending can not descend, when the change can not change.”. The “yu” is a condition that cannot be changed. After the Ming Dynasty, “yu” refers to depression, such as the “clinical guide to medical cases – yu” said: “yu is stagnant, its stagnation or in the shape of the body, or in the viscera, there must be uncomfortable present symptoms.
…… do not know the depression of emotions, due to the hidden feelings of curvature does not stretch, so the lift of the gas to open and close the pivot is not conducive.” The liver is the main cause of the disease, especially the liver depression is more common. The liver is the master of drainage, likes to be organized and not depressed, once the mood is not smooth, the qi stagnation, transverse offense stomach, the liver and spleen are not in harmony, the turbid gas does not descend, accumulate in the middle, brewing fullness. The symptoms are chest fullness and distension, irritability, belching and vomiting, sighing, white fur and string veins.
The author often uses Chai Hu Dredging Liver San with the addition and subtraction of Prosperity San to treat the symptoms (drugs: Chai Hu, Xiang Fu, Chuan Xiong, Chen Pi, Citrus Aurantium, Bai Shao, Fried Atractylodes, Poria, Fried Scutellaria, Angelica, Peppermint, Powdered Pueraria Mirifica, Licorice 10g), with good results.
4.Qi deficiency
The spleen and stomach are the officials of the granary, excessive exertion and fatigue, or lack of Qi after illness, can deplete the Qi of the spleen and stomach, weakness of the spleen and stomach, loss of transport and transformation, the clear yang of the spleen does not rise, the cloudy yin of the stomach does not descend, the lift is weak, blocked in the stomach and epigastric, suffocating and become full. The source of miscellaneous diseases rhinoceros candle said: “fullness, spleen disease, also, originally from the spleen qi deficiency and gas depression can not run, the heart is stuffed and filled, so there is a lack of Qi, can not be transported and become …….”
This type of evidence is characterized by fullness and distension, sometimes slow and sometimes urgent, warmth and pressure, tiredness and weakness, loose stools, pale tongue with white fur and weak pulse. The treatment is to warm the middle and strengthen the spleen, harmonize the stomach and relieve pain, and the formula is Xiang Sha Liu Jun Zi Tang with reduction (drugs: Lu Dang Ginseng, Fried Atractylodes Macrocephala, Fu Ling, Fa Xian Xia, Chen Pi, Mu Xiang, Sha Ren, Roasted Licorice).
In conclusion, gastric gangrene is a common clinical condition, although it is treated from four aspects: qi stagnation, qi depression, qi reversal, and qi deficiency, but in the process of identification and treatment, it can be seen that the four interact with each other and become a cause and effect, with a mixture of deficiency and reality, which all boils down to the dysregulation of qi in the middle jiao and congestion of qi in the spleen and stomach, while the spleen and stomach are located in the middle jiao, which is the pivot of the human body, once the qi is stagnant in the middle, it will make the opening and loss of profit, loss of up and down communication, dysregulation of the pivot, and fullness of gangrene. The symptoms will arise.
Therefore, in the treatment to promote the flow of qi, lowering the rebellion and relieving depression, tonifying the middle and benefiting the qi, at the same time to distinguish between cold and heat, taking into account the deficiency and the reality, plugging because of plugging with, not treating the plankton and the plankton will be removed. When the qi function of the spleen and stomach is regulated, the clear yang will be raised and transported as usual, the turbid yin will be lowered and the grain will be putrid, the spleen will rise and the stomach will fall, the qi of the middle jiao will be unblocked, and the gastric abnormality will be cured.