When I was a child, my dream was to be a doctor. I remember the vow I made at that time to conquer cancer, and now I think about it, when I was young, I always spoke wildly, innocently and childishly.
During my college and postgraduate studies, I remembered deeply what my teacher said: “If you study medicine for three years, there will be no incurable disease in the world; if you practice medicine for three years, there will be no usable prescription in the world. Sincerely teach us these fledgling, blood and vitality of the boys.
The meaning is to learn medicine when full of confidence, think have learned the doctor, can treat everyone’s disease, and really when the doctor, there is soon a sense of frustration, because the book writes how to how to treat the prescription, why it always does not work, and then later, in the face of the life of old age, sickness and death, there will be a little indifference, come and go, from the birth of obstetrics, to geriatrics, ICU resuscitation of helplessness, gradually have the thickness of medical life.
Throughout the human disease now, how many diseases can really be cured? Many diseases require patients to live and fight with them for a long time, and finally live in harmony. Therefore, to face diseases more objectively and calmly, we must first understand the uncertainty of medicine and point out the probability of curing the disease according to the existing level of diagnosis and treatment of the disease, in order to attract the high attention of patients; on the other hand, we must know that most diseases do not affect normal as long as they receive good treatment and health care and live in the right way. For example, the treatment of peptic ulcer can never be solved by just going to the hospital and taking medicine. The main purpose of going to the hospital is to receive comprehensive health education in the specialty of gastroenterology, so that patients can realize the causes and possible consequences of peptic ulcer and its controllability, and let them know that patients themselves play a leading role in the treatment of peptic ulcer. At the same time, physicians need to adjust the most appropriate medication based on the latest credible evidence, using the best current evidence.
Medicine is the science of uncertainty and the art of possibility, and the doctor and patient share the uncertainty of treatment and the joy of overcoming the disease.
For medical treatment, one thing that can be 100% sure is that: any advertisement that says 100% can cure the disease is a fraud.
The people always say that the cure should be the root of the disease, how can it be considered the root of the disease? How is the disease even better.
For atrophic gastritis and precancerous lesions of the stomach, everyone has different opinions and expectations. Zhang San said that no pain is on the line, Li Si said that the future will not attack, whether the root can be removed, Wang Wu pursued is whether to eat normally; and Zhao Liu worried about whether it will be cancerous, can live a few years.
All these questions are actually considered by doctors and medical research. For a drug, it is good to meet one wish, and often this one wish that is met may only be probable.
Worldwide, the incidence and mortality rate of gastric cancer ranks second among malignant tumors, seriously threatening the health of human beings. The definition of precancerous lesions of gastric cancer (PLGC) was proposed by WHO to draw attention to the fact that it comes from a pathological concept, including intestinal epithelial metaplasia (Intestinal metaplasia), which is the most common malignant tumor in China. Intestinal Metaplasia (IM) and Dysplasia (Dys), recently renamed intraepithelial neoplasia, mainly associated with chronic atrophic gastritis (ChroniC ?AtroPhiC? Gastritis, CAG), is an important stage in the process of transformation from normal gastric mucosa to gastric cancer. important stage in the transformation process from normal gastric mucosa to gastric cancer. In other words, precancerous gastric lesions are an intermediate process in the transformation of gastritis to gastric cancer.
There are two main reasons for WHO to define this gastric precancerous lesion.1 The etiology of gastric cancer is not completely clear, and it is difficult to implement primary prevention against the etiology, so the study of gastric precancerous lesion becomes one of the important elements of secondary prevention of gastric cancer. Early identification and prevention of pre-cancerous diseases and pre-cancerous lesions have become more effective methods to reduce the incidence and mortality of gastric cancer.2. It is to scare people, in order to draw their attention and to cause high attention.
The diagnosis and treatment of gastric precancerous lesions are often encountered in outpatient clinics, and the word intestinal epithelial metaplasia is often seen in pathological reports. Especially, it is scary to hear that it is a precancerous lesion. In fact, for atrophy and intestinal chemosis, it is a localized lesion, the surface area of the stomach is so large, and the atrophy of the point taken does not mean that the whole stomach is atrophied, most of it is working normally.
Diagnosing the disease is a complex process. What we do is guilty inference, any examination by eye and hand, as well as the machine to get the results, is the evidence that we have to make inference. When all kinds of traces match, you can convict the disease, and you cannot say you are innocent without conviction. That is, the gastroscopic pathology report has intestinal atrophy, that can be diagnosed and convicted, like not being sentenced, are suspects, thieves stole something, but we did not catch the evidence, can not be convicted. Just like in the stomach atrophy intestinalization has actually occurred, but we obtained pathology did not take. Not seen, then sorry, you still need to be observed.
Gastroscopy as well as pathology shows that it is atrophic intestinalization, then we can diagnose it, without showing it, we cannot exclude the disease. When you hear this, won’t everyone be at risk, knowing that the world is still full of good people, and if normal people wish they had cancer, it’s a very difficult road, and we have all kinds of other signs that indicate the possibility that you are good.
Atrophic gastritis, once atrophied and intestinalized, is very difficult to reverse, like a fading flower, but the complexity and beauty of the human body is that anything is possible, just less probable. For chronic atrophic gastritis, it would be a blessing for the majority of patients if there was a drug that could clearly reverse it.
I have seen several patients recently where the intestinal epithelial chemosis disappeared on follow-up, and both the patient and I were delighted. I have had a number of such cases verified by gastroscopy before and after one year of treatment, as well as by pathological sections of the same site. I hope to find the pattern from the prescription, how the intervention can be reversed, so that the steps towards gastric cancer can be stopped, reversed and rerouted towards health.
Facing this one phenomenon, the objective analysis and hypothesis are as follows.
1. the patient is young in age, with good various functions and vigorous metabolism
2, the duration of the disease is not long, the degree is mild, the disease lesion is not yet too deep.
3, inside the stomach, when doing gastroscopy, after a year and then taken to the original location, it is not too easy also may be sampling location deviation.
4, Chinese medicine identification has the possibility of reversing precancerous lesions of the stomach.
5, comprehensive treatment has the possibility to help improve the quality of life of gastric precancerous lesions and slow down the disease progression.
The disease is so complex that it is very cautious and arduous to make a definite judgment, which requires arduous efforts of medical science researchers.
Currently in outpatient clinics, chronic atrophic gastritis is tilting toward younger people. This is related to the current fast-paced life, the change in dietary patterns, and the impatient social environment. Fundamental change requires a regular life and a balanced mind.
Pre-cancerous lesions of the stomach are not terrible, and it takes a long way for intestinalization and heterogeneous hyperplasia (intraepithelial neoplasia) to develop into gastric cancer. It is not more than 5% of patients that will turn into gastric cancer. 5% is a statistically small probability event and can be considered as almost never occurring, which is based on statistics, so it is reasonable to think that intestinalization and heterogeneous hyperplasia are relatively safe and unnecessary to cause too much anxiety and worry. Nor should we be full of concern.
Also gastroscopic diagnosis under the naked eye and pathological diagnosis are often inconsistent, due to the difference in vision between what is seen by the naked eye and pathology, with pathological diagnosis as the gold standard. In other words, if the pathological diagnosis sees intestinalization and intraepithelial neoplasia, then the diagnosis is confirmed as gastric precancerous lesion. But pathological diagnosis is a very small place, if the pathology shows no intestinalization, it will be possible that there are two states: 1) the disease development really did not go to the step of gastric precancerous lesion; 2) the pathological tissue taken was not at the site of the lesion. For the first case, it is the result we hope for, while for the second case, another review, or even multiple reviews, are needed to confirm the diagnosis. Therefore, the absence of pre-cancerous lesions in the stomach cannot be ruled out, but only by the experience of the gastroscopist and multiple reviews. No one can say that the possibility of precancerous gastric lesions can be ruled out after several gastroscopies, but we can only keep approaching the truth.
Other areas that are not precancerous lesions of the stomach have to be diagnosed by gastroscopy. It is common that all lesions in a stomach are not the same, some are atrophic and some are not. But intestinalization and heterogeneous hyperplasia must have started to atrophy. It needs to be brought to our attention.
If you have enterosis and heterogeneous hyperplasia, depending on the specific situation, you can choose to review the gastroscopy for the first time in 3 months, 6 months, or a year after the doctor’s diagnosis, and then follow up and clinical observation. In younger patients, some of the enterosis and heterogeneous hyperplasia can disappear and be reversed. Of course, this requires active cooperation with treatment.
What is the remedy for gastric precancerous lesions, of course, the first thing is to go back to the correct life pattern and eating habits. There are no drugs and interventions that are definitely effective in reversing gastric precancerous lesions, but there are studies and observations that show that some drugs may reverse, or block or delay the occurrence of gastric cancer.
The prescriptions used in these cases were mainly derived from Si Jun Zi Tang as well as Huang Qi, Dang Ginseng, Coix Seed, Sha Ren, and Chicken Nei Jin for a course of about 3 months. Chronic atrophic gastritis and gastric precancerous lesions are generally due to deficiency of cold in the spleen and stomach, deficiency of Qi and blood or even stagnation of blood in prolonged illness. Only highly targeted prescriptions are more effective.
I am also happy to see the reversal of patients with precancerous gastric lesions. However, it is important to think equally calmly about the medical efficacy evaluation and face the reality objectively: first, whether the original lesion tissue was indeed taken, perhaps it was taken last time and this time it deviated by a few centimeters; second, the complexity of the human body is far from our awareness, perhaps gastric precancerous lesion is a self-healing disease; third, the patients who did not reverse are still the majority and need our further exploration and research.