The comprehensive analysis of l14 cases concluded that the pathogenesis of H. pylori positive chronic gastritis is the invasion of evil Qi, stagnation of Qi in the middle Wan, internalization of dampness and heat, and weakness of the spleen and stomach. The ideal way to select the medicine is to identify the evidence and combine the results of in vitro and out vivo experiments.
Keywords: chronic gastritis; Helicobacter pylori
Helicobacter pylori (HP) is a bacterium closely related to chronic gastritis and has been named as Campylobacter-like microorganism and Campylobacter pylori. Electron microscopic observation has confirmed the ability of HP to cause cytopathic lesions and participate in the pathogenic process of chronic gastritis. The application of Chinese medicine to clear HP infection and reduce the recurrence rate has gradually become a hot spot in the research of Chinese medicine treatment of chronic gastritis. In this paper, we have discussed the pathogenesis and treatment of HP-positive chronic gastritis by dividing the data of 114 chronic gastritis cases and combining them with relevant clinical reports.
l. Clinical data
1.1 General data
Among 114 cases, 6l men and 53 women; age 18-71 years, average 41,1 years, including 16 cases below 30 years, 42 cases between 30 and 40 years, 33 cases between 41 and 50 years, l5 cases between 5l and 60 years, 8 cases above 6O years; duration of disease 0,5-40 years, average 8,3 years, including 52 cases below 5 years, 23 cases between 5 and 10 years, 29 cases between 11 and 20 years There were 52 cases under 5 years, 23 cases from 5 to 10 years, 29 cases from 11 to 20 years, and 1O cases over 2O years.
1, 2, Methods
Before gastroscopy, Chinese medicine classification was performed according to the criteria established by the Chinese Association of Integrative Medicine Research Committee of Digestive Diseases in 1989, and then gastroscopy was performed and biopsies were taken from obvious lesions for pathological diagnosis and HP detection.
1, 3. Pathological diagnosis and HP detection
Among the 114 cases, there were 102 cases of chronic superficial gastritis and 12 cases of chronic atrophic gastritis. 76 cases were HP-positive and 38 cases were HP-negative. 58 cases of active gastritis were found in the HP-positive group, accounting for 87.88% of the cases, while the number of active gastritis in the HP-negative group was 18 cases, accounting for 37.5% of the cases.
1, 4, Chinese medicine evidence analysis
There were five types of symptoms: liver and stomach disharmony, spleen and stomach dampness and heat, gastric complex blood stasis, gastric yin deficiency and spleen and stomach weakness (cold), and the number of HP positive cases in each type was 30/38, 10/11, 12/18, 4/12 and 20/35, respectively. Among them, the HP positive rate was the lowest in the type of deficiency of stomach yin, and there was a significant difference when compared with the first two types (all P<0, 01); the HP positive rate was also lower in the type of weakness of spleen and stomach (cold), and it was P<0, 05 when compared with the first two types, respectively.
The evidence analysis of the HP positive and negative groups showed that the five most frequent symptoms in the HP positive group were, in order of appearance, Ke 52 cases (68, 42%), fatigue 50 cases (65, 79%), distention and fullness of the abdomen 49 cases (64, 47%), noisy 44 cases (57, 90%), and stomach pain 42 cases (55, 26%); the five most frequent symptoms in the HP negative group were, in order of appearance, fatigue 31 cases (65, 79%), distention and fullness of the abdomen 49 cases (64, 47%), noisy 44 cases (57, 90%), and stomach pain 42 cases (55, 26%). The five most frequent symptoms in the HP-negative group were fatigue in 31 cases (81, 58%), distention and fullness in 29 cases (76, 32%), 24 cases (63, 16%), dullness in 23 cases (60, 53%), and dry mouth in 22 cases (57, 90%). Among them, the occurrence rate of nasal dullness I was much higher in the HP-negative group than in the HP-positive group (19 cases, 25%), P<0, O1.
In terms of tongue and pulse, the rate of yellow moss (thin yellow to yellowish greasy moss) in the HP positive group (40 cases, accounting for 52, 63%) was higher than that in the HP negative group (15 cases, accounting for 39, 47%), but it was not statistically significant, while the rate of tooth mark tongue (15 cases, accounting for 39, 47%) and little (no) moss and flower peeling moss (7 cases, accounting for 18, 42%) in the HP negative group were significantly higher than that in the HP positive group (14, 3 cases, accounting for 18, 42%), respectively. The rate of occurrence of chord (slippery) pulse in the HP positive group (38 cases, accounting for 50, 9%) was higher than that in the HP negative group (10 cases, accounting for 26, 32%), P<0, O5; while the rate of occurrence of fine (number) pulse (23 cases, accounting for 30, 26%) was lower than that in the HP negative group (20 cases, accounting for 52, 63%), P<0, 05.) P
2.1. Pathogenesis
It is generally believed that HP infection belongs to the category of evil invasion in Chinese medicine. The results of our data show that HP-positive chronic gastritis is more common in the real type (liver-stomach disharmony type, spleen-stomach damp-heat type) and less in the deficiency type (spleen-stomach weakness (cold) type, stomach-yin deficiency type).
In all cases, the HP infection rate was higher in the liver-stomach disharmony and spleen-stomach damp-heat types, which had a relatively short duration of illness, and their lesions were in the stage of actual evil; the stomach-yin deficiency and spleen-stomach weakness (cold) types had a longer duration of illness, and they belonged to the state of positive deficiency with no flourishing of evil, and their HP infection rate was lower. As for the type of stagnant blood in the stomach, because it is mostly developed from the changes of other types of evidence, it is often a mixture of deficiency and reality, so the HP infection rate is between the deficiency and actual evidence types.
The common symptoms of both HP-positive and negative groups include the manifestations of qi stagnation and damp-heat internal obstruction such as yellow tongue coating and stringent (slippery) pulse, as well as the manifestations of qi and yin deficiency of the spleen and stomach such as fatigue, dullness, dry mouth and tooth mark tongue and fine (number) pulse, indicating that the deficiency of the spleen and stomach in the middle jiao, qi stagnation, dampness and heat is the general pathological mechanism of chronic gastritis, while HP-positive chronic gastritis is characterized by qi stagnation, dampness and heat. HP positive chronic gastritis is dominated by qi stagnation, dampness obstruction and heat accumulation, while HP negative chronic gastritis is dominated by deficiency of the spleen and stomach.
The results in the relevant clinical reports are also broadly similar. For example, Chen Feisong et al. found that the order of HP positivity among the TCM evidence types was (damp-heat in the spleen and stomach > stagnant blood in the stomach complex > disharmony in the liver and stomach) > (weakness in the spleen and stomach > deficiency in stomach yin), and there was a significant difference between the non-spleen and stomach deficiency group and the spleen and stomach deficiency group. Xu et al. found that in the HP-positive group, the qi-stagnation type was more common, and the symptoms of red tongue, yellow moss (especially yellow greasy moss), stringy and slippery pulse, stomach pain, abdominal distension, dry stools, black stools, acidity, and poor appetite were higher in the HP-positive group than in the negative group; on the contrary, the HP-negative group had a light tongue, thin white moss and small pulse, loose stools, and unpleasant complexion than the HP-positive group.
The clinical manifestations of HP-positive chronic gastritis, we believe that the pathogenesis is the invasion of evil, stagnation of qi in the middle and stomach, dampness and heat, and weakness of the spleen and stomach. This can lead to a series of clinical manifestations of qi stagnation, dampness obstruction, and heat inclusion, and further damage to the spleen and stomach over time, which can lead to spleen and stomach deficiency and lack of biochemical sources.
2. 2. Treatment
Most people treat HP infection as a “disease evil”, and treatment focuses on eliminating the evil and taking into account the body’s positive energy. For example, Wu Dian et al. used the method of clearing heat and dampness as the main treatment, highlighting the clearing of heat, drying dampness and strengthening the stomach, in order to achieve the purpose of supporting the righteousness and eliminating evil; Fang Jingyuan et al. took the treatment of supporting the righteousness and eliminating evil, using medicine to nourish the spleen and clear heat and detoxify; Xu Jianguo et al. also believed that the elimination of evil must take into account the righteousness at the same time, and in addition to clearing heat and regulating qi, the treatment should add products that strengthen the spleen and benefit qi, and warm the middle and dispel cold.
In general, the combination of eliminating the evil and supporting the righteous is the most used method at present. According to the pathological mechanism of HP-positive chronic gastritis, we believe that the basic treatment is to regulate qi, clear heat and dampness, and supplement with products that strengthen the spleen and stomach and invigorate blood. Existing immunopharmacological studies of Chinese medicine have shown that tonic and blood-boosting drugs are two types of Chinese medicine with strong immunomodulatory effects, and it has been reported that there is a certain connection between HP infection and the immune function of the body, and there are specific anti-HP antibodies in the gastric mucosa of HP-positive patients. Therefore, the application of the method of regulating qi and clearing heat and dampness is conducive to the elimination of symptoms and the recovery of inflammatory changes in the gastric mucosa, and the supplementation with products that strengthen the spleen and stomach and invigorate blood is more conducive to the overall regulation of the body’s immune function and the state of blood supply to the gastric mucosa, so as to achieve the purpose of clearing HP infection and restoring the normal state of the gastric mucosa.
2.3.Drug selection
According to the previous clinical reports, there are three types of prescriptions: (1) to formulate the treatment method and use drugs according to the dialectical condition, such as Wu Dian et al.’s “Clear heat and benefit stomach soup” and Xu Jianguo et al.’s “Qing Yu Tang”; (2) to select sensitive drugs by combining the results of drug sensitivity test. (2) Combining the results of drug sensitivity tests to select sensitive drugs, such as Zhang Lin et al.’s “Live Stomach Punch” and Wu Yan et al.’s “Gastritis Clear”, etc.; (3) Combining Chinese and Western drugs, such as Pu Changsheng et al.’s “Gastritis Punch”, etc. The above three types of prescriptions have their own strengths, but from the perspective of highlighting the advantages of TCM treatment and improving the targeting of drugs, it seems to be more appropriate to establish the basic treatment rules based on TCM diagnosis and to select the drugs by combining clinical and experimental research results.
In the previous drug sensitivity tests, we mainly studied some Chinese medicines commonly used in gastric diseases, and found that Huang Lian, Da Huang, Di Yu, Dan Shen, Panax notoginseng, Roselle, Wu Mei, and Pomegranate peel have strong effects on HP and have started to be used in clinical practice. In the future, we should also expand the scope of experiments and focus on the effects of drugs that dredge liver and Qi, clear heat and dampness, strengthen the spleen and stomach, and activate blood circulation and eliminate blood stasis, as well as the effects of herbal compound anti-HP; at the same time, we should conduct more studies on a large number of clinical cases to avoid the inconsistency between the results of in vitro and in vivo tests. On the other hand, we should also pay attention to the study of the indirect anti-HP effect of Chinese medicine, which can be carried out mainly from enhancing the immune function of the body as well as destroying the survival environment of HP and protecting the gastric mucosa from invasion.
References
[1] Yang, H., et al. Chinese Journal of Digestion, 1988;8(6):319
[2] Zhou Jianzhong, et al. Journal of Integrative Medicine, 1990;10(5):318
[3] Ling Q. B. Practical special staining and histochemical techniques for pathology, Guangzhou: Guangdong Higher Education Press. 1987: 42
[4] Chen Feisong, et al. Beijing TCM, 1990; (4): 14
[5] Xu J, et al. Journal of Integrative Medicine, i991;11(3):158
[6] Wu Dian, et al. Zhejiang Journal of Traditional Chinese Medicine, 1990; 25(10): 440
[7] Fang JY, et al. Journal of Integrative Chinese and Western Medicine, 1991;11(3):150
[8] Xu JG, et al. Journal of Traditional Chinese Medicine, 1991;32(7):35
[9]Wyatt JI, et al, Immune response of the gastric mucosa to campylobacter pylori, Scand J Gastroenterology, 1988;142:44
[10] Zhang L, et al, Journal of Integrated Chinese and Western Medicine, 1990:10(5):268
[11] Wu Yan, et al. Jiangsu TCM, 1991;12(6):40
[12] Pu Changsheng, et al. Journal of Integrative Medicine, 1989;9(12):722