Chronic gastritis is a chronic gastric lesion, pathologically
characterized by non-specific chronic inflammation of the
gastric mucosa. Its etiology is not well understood, possibly
related to administration of irritating drugs and food, bile
regurgitation, muccal inflammation or autoimmunity. Chronic
gastritis can be divided into two categories, primary and
secondary. The former is further categorized into superficial,
atrophic and hypertrophic types; the latter often complicates
gastroduodenal ulcer and gastric cancer. Chronic gastritis
occurs most frequently in the middle-aged people. This disease
in TCM pertains to the categories of "pi" (feeling of fullness
in the upper abdomen), "wei wan tong" (stomachache), etc.
Main
Points of Diagnosis
1. The chief symptoms are chronic upper abdominal
pain, fullness and discomfort, belching and acid regurgitation
which often occur after meals. Mild hemorrhage of upper
digestive tract may be induced by some precipitating factors in
a few cases. Severe atrophic gastritis may be accompanied with
anemia and pathologic leanness.
2. Physical examination reveals mild but diffuse tenderness in
the upper abdominal region.
3. Laboratory examination
(1) Gastric juice analysis: Gastric acid is normal in
superficial gastritis, but mostly reduced or gone in atrophic
gastritis.
(2) X-ray barium examination: Positive rate is not high.
Atrophic gastritis presents gastric hypotension, triviality or
disappearance of gastric mucosal folds. The main purpose of
radiological examination is to exclude peptic ulcer and cancer.
(3) Gastrofiberscope: This method is most contributive in
confirming diagnosis. Through it superficial mucosal erosion
with hyperemia, swelling or red spots and increased ropy liquid
could be discovered in chronic superficial gastritis; in chronic
atrophic gastritis, such findings can be caught as thinned and
grayish-pale mucosa, slenderized mucosal folds with exposure of
submucosal vessels, and granular or nodular proliferation. The
combined application of gastrofiberscope and biopsy proves to be
an accurate method for the diagnosis of chronic gastritis.
Differentiation and Treatment of Common Syndromes
1. Stagnation of the Stomach-Qi
Main Symptoms and Signs: Epigastric distension and fullness or
pain, loss of appetite, indigestion, or diarrhea, white coating
of the tongue, and slippery pulse.
Therapeutic Principle: Regulating the stomach-qi to relieve
distension and fullness.
Recipe: Pinellia Decoction for Purging Stomach-Fire.
pinellia tuber
dried ginger
scutellaria root
coptis root
codonopsis root
licorice root
Chinese date
All the above herbs are to be decocted in water for oral
administration.
For the case of a more severe stomachache, 15 grams of white
peony root and 9 grams of corydalis tuber may be employed.
2. Hyperactive Liver-Qi Attacking the Stomach
Main Symptoms and Signs: Epigastric distension, pain, fullness,
oppression and discomfort which is aggravated after meals,
frequent belching which may be aggravated by emotional upset,
thin and white coating of the tongue, and deep taut pulse.
Therapeutic Principle: Relieving hyperactive liver-qi and
regulating the stomach.
Recipe: Modified Bupleurum Powder for Relieving Liver-Qi.
bupleurum root
cyperus tuber
white peony root
bitter orange
Sichuan chinaberry
corydalis tuber
tangerine peel
perilla stem
licorice root
All the above herbs are to be decocted in water for oral
administration.
If there are acid regurgitation, burning sensation and distress
in the stomach, 15 grams of dandelion herb, 9 grams of coptis
root and 6 grams of evodia fruit are to be added to the recipe.
3. Insufficiency-Cold of the Spleen and Stomach
Main Symptoms and Signs: Vague pain in the stomach, vomiting of
watery fluid, preference for warmth and press, aggravation from
cold, mental fatigue and weakness, loose stools, pale tongue,
deep thready and weak pulse.
Therapeutic principle: Warming middle-warmer and dispelling
pathogenic cold.
Recipe: Modified Decoction of Astragalus for Tonifying
Middle-Warmer.
astragalus root
cinnamon twig
white peony root
aucklandia root
dried ginger
amomum fruit
Chinese date
prepared licorice root
All the above herbs are to be decocted in water for oral
administration.
If the case is complicated with anorexia and belching with fetid
odor, 10 grams of medicated leaven and 10 grams of germinated
barley may be administered; if the case with acid regurgitation,
30 grams of calcined ark shell added; if the case with dominant
cold of insufficiency type, 10 grams of codonopsis root, 10
grams of white atractylodes rhizome and 10 grams of poria
included.
4. Deficiency of the Stomach-Yin due to Stomach-Heat
Main Symptoms and Signs: Irregular stomachache with burning
sensation which is aggravated in the afternoon or on empty
stomach and is relieved after meals, dry mouth and throat, or
thirst, loss of appetite, dry stool, red tongue with yellowish
and dry fur, and taut and thready or rapid pulse.
Therapeutic Principle: Clearing away heat from the stomach and
nourishing the stomach-yin.
Recipe: Modified Decoction for Nourishing the Stomach
glehnia root
ophiopogon root
fragrant solomonseal rhizome
white peony root
scutellaria root
coptis root
anemarrhena rhizome
tangerine peel
dandelion
licorice root
All the above herbs are to be decocted in water for oral
administration.
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