| Part I Theoretical StudyObjectiveThe origin, connotation, application and influence of the idea of Stomach Qi in Treatise on Cold-Induced Disease were discussed, as well as its theoretical basis and prescriptions that was used to the treatment of gastric ulcer.MethodsThe theoretical origin of Treatise on Cold-Induced Disease was differentiated and analyzed. We selected two books. One of them is Huangdi Neijing, the photocopy of the sculpture edition of Song Dynasty in Qing Dynasty1884that was published by Publishing House of Ancient Chinese medical books (for short, Neijing), Jan.2003. Another is the new anthology of the replica of Treatise on Cold-Induced Disease by Zhao Kaimei in Ming Dynasty according to the revision of Gao Baoheng in Song Dynasty, which was issued by Chongqing Publishing House, Apr.1995. The record scripts of zang-fu organs, twelve meridians, qi of zang-fu organs were normalized, and SPSS Clementine11.1was used to summarize the frequencies of each zang-fu organ, twelve meridians and qi of the five zang and six fu organs respectively. The connotations and applications of Stomach Qi in Neijing and Stomach or Stomach Qi in Treatise on Cold-Induced Disease were deduced according to the original texts. The method of induction was used to analyze the connotation, and developed by learning of the idea of Stomach Qi in the later generations. Combining with the etiology and pathogenesis of gastric ulcer, the theoretical basis of the application of the idea of Stomach Qi and the prescription evidences of Bao Wei Qi Wan were deduced.ResultsIt was generally accepted in academia that Treatise on Cold-Induced Disease absorbed a lot of medical gains in Han Dynasty and before, and mixed the clinical experience of Zhang Zhongjing together. However, there were two views about its theory sources, works and theories of previous doctors, and Yi Yin Tang Ye. Among them, medical classics and works are predominant, the key evidence is the preface of Treatise on Cold-Induced Disease and Miscellaneous Disease by Zhang Zhongjing, which is worthy of believing. Yi Yin Tang Ye theory was emerged in Jing Dynasty, and its core evidences includes the preface of Zhen Jiu Jia Yi Jing, records, grammar and words of Fu Xing Jue Zang Fu Yong Yao Fa Yao of Dun Huang edition, which are still not enough for believing. Moreover, most of the medical classics and works do not involve prescriptions. The prescriptions of Treatise on Cold-Induced Disease recorded in detail, and about79.07%of the medicines occurred in Shen Nong Ben Cao Jing, the record words has little similarities with current medical classics and prescription works.The word, stomach, had been occurred for328times in Neijing, which ranked second among the five zang and six fu organs. There were335times that referred to Yangming, which is the top one among the three Yin meridians and three Yang meridians. The stomach meridian of Foot Yangming or Yangming of Foot had been referred to for67times, and it was the second ranked among the twelve meridians. About23places appeared the words of Stomach Qi, which ranked the second among the Qi of the five zang and six fu organs. The recorded Stomach Qi had four kinds of meaning, including the reflection of the function of spleen and stomach on the pulse, food essence in the stomach, physiological characteristics of the stomach sending the digested food downward, and the physiological function of food intake and digestion. On the aspect of physiology, Stomach Qi is very important to the activity of human lives, Stomach Qi is work in coordination with spleen qi, and the strength of Stomach Qi could be indicated from the pulse. On the aspect of pathology, the manifestations of diseases caused by Stomach Qi include disability of the limbs, presence of visceral exhaustion pulse, outflow of body fluid, fever due to yin deficiency, vomiting and retching, hunger without appetite, etc. The state of Stomach Qi is used to judge the difficulty levels of treatment, and determine the greater or lesser urgency of therapy. Acupuncture is applied to regulate Stomach Qi, and it is very dangerous if there is no Stomach Qi after disease. Stomach Qi is believed to maintain the congenital vitality in health preservation.About49times of Stomach appeared in Treatise on Cold-Induced Disease (item40),70times for Yangming (item61),1for Foot Yangming (item1), and11times for Stomach Qi (item11). Their ranks among the five zang and six fu organs, as well as the three Yin and three Yang meridians, remains the same with those among Neijing. Their ranks among the twelve meridians, and the qi of the five zang and six fu organs, are ahead of those in Neijing. Moreover, only in Treatise on Cold-Induced Disease, can we see Foot Yangming among the twelve meridians and Stomach Qi among the qi of zang-fu organs. The original texts related to Stomach, Yangming or epigastric region were about121items, which occupies30.40%of the total items in the whole book, which involves the treatment of both pulse and symptoms of all the8kinds of diseases. The Stomach it recorded mainly referred to large intestine; stomach and spleen; stomach, gallbladder and intestines; spleen, stomach and intestines; spleen and stomach; Stomach Meridian of Foot Yangming, Stomach of fu organs, Gallbladder Meridian, large and small intestines. Stomach Qi means the biological characteristics of spleen in sending clarity upward, the biological functions of small intestine in separating the refined from residue and large intestine in transmission, the features of stomach preferring moistening to dryness, the characteristic of Gallbladder Meridian of Foot Shaoyang moving half-exterior and half-interior, the property of spleen sending clarity upward, intake and digestion of food in stomach, small intestine separating the refined from residue, large intestine transferring residue, the digestion function of spleen and stomach, food essence in the stomach. Stomach Qi, in the disease conversion, mainly expressed in transition due to stomach deficiency, preventing diseases by strengthening stomach, and preventing transition by protecting stomach. Trying to treat, diet, stool and pulse were shown in the differentiation of disease and pulse. It could be seen all the eight methods attending to the stomach qi, and many methods were used to protect stomach. In the prescription, the herbs and formulas that could protect stomach qi were frequently used, and the dose of the herb is little, preventing from hurting stomach qi. The taboo of taking medicine include stopping taking once the disease begins to recover, drinking rice soup to nourish stomach, supporting the earth to protect stomach, and avoiding hurting stomach qi. In the nursing on prognosis, it emphasizes on the protection of stomach by herbs and rice soup, and reducing diet, and the attention to taboos.The connotation of Stomach Qi in later generations was focused on three aspects:function, substance and superficial characteristics. The meanings of the reflection of spleen and stomach function on the tongue, original qi, qi of the whole body and healthy qi were newly added. Li Dongyuan, Zhang Jingyue, Ye Tianshi inherited and developed the idea of Stomach Qi of predecessors, and established many theories. The idea of Stomach Qi had been widely used to the entire procedure of disease from the prevention to prognosis.The discussion of doctors of all the past dynasties indicated that.the deficiency of spleen and stomach is the fundamental of gastric ulcer, while the combination of cold accumulation, qi stagnation and blood stasis is the symptom of the attack of gastric ulcer. The high incidence of gastric ulcer in the south of the five ridges area is related with the six climatic evils, seven emotions, diet and the way of life. The recent attack of gastric ulcer is rarely seen in the clinic, while chronic gastric ulcer is very common. Its pathogenesis is the coexistence of deficiency and excess, the mixed state of cold, heat, dampness and blood stasis. Bao Wei Qi Wan has multiple functions of invigorating spleen and replenishing qi, warming middle energizer to disperse cold, activating qi to alleviate pain, removing stasis and promoting regeneration.Cone I us i ons①Treatise on Cold-Induced Disease discussed the classics works and theories of many previous medical scientists and physicians that good at using classic formulas, and its academic theory is mainly originated from the medical classics, such as Neijing.②Neijing paid a lot of attention to stomach, stomach meridian and stomach qi, the Stomach Qi it recorded is chiefly referred to the qi of stomach meridian, qi of the stomach organ, the qi movement and qi transformation of stomach organ. It is widely used in the aspects of biology, pathology, treatment, and prognosis and health preservation.③Treatise on Cold-Induced Disease placed more importance to stomach meridian and stomach qi than Neijing, and the idea of Stomach Qi could be seen throughout the whole book. The Stomach and Stomach Qi that it recorded had9and8meanings respectively, which appeared in disease transmission, differentiation of disease and pulse, interpretation of medical science and establishment of principles, application of prescriptions, medication taboo and nursing on prognosis.④The connotation of Stomach Qi in later ages was more plentiful, and it was developed by many physicians, all of which made its application was much wider.⑤Invigorating spleen and replenishing qi, regulating middle energizer qi to disperse cold, and removing stasis and stopping bleeding are commonly used methods in dealing with gastric ulcer. The prescription of Bao Wei Qi Wan fits in with the pathogenesis features of gastric ulcer, i.e. difficult to be healed.Part II Experimental StudyObjectiveThe therapeutic effect and mechanism of Bao Wei Qi Wan on gastric ulcer was discussed.MethodsAbout60SD rats were selected, and divided into three groups of Bao Wei Qi Wan with low, moderate and high dose respectively, as well as model control group, Ranitidine group and Wei Kang Ling group. Bao Wei Qi Wan, normal saline, Ranitidine and Wei Kang Ling were poured into the stomachs of rats in sequence, according to the equivalent dose conversion of body weight. The affect of the size of the ulcer caused by the ligation of pylorus was observed, and the influences on ulcer index and inhibitory rate of gastric ulcer due to water soaking, aspirin, ammonia water and hydrochloric acid-alcohol were also investigated. About60SD rats were randomizedly divided into Bao Wei Qi Wan groups with low, moderate and high dose respectively, along with model control group, Si Da Shu group and Wei Kang Ling group, and Bao Wei Qi Wan, normal saline, Si Da Shu and Wei Kang Ling were poured into the rat stomachs in turn, according to the equivalent dose conversion of body weight, so as to observe the effects of ulcer index and healing rate of gastric ulcer caused by acetic acid.About70SD mice were randomizedly divided into normal control group, Bao Wei Qi Wan groups with low, moderate and high dose, model control group, Ranitidine group and Wei Kang Ling group. On the basis of equivalent dose conversion of body weight, the mice of normal control group were poured distilled water into the stomachs, while the mice of the other groups were poured Bao Wei Qi Wan, distilled water, Ranitidine and Wei Kang Ling in order, and gastric ulcer models were made at the same time. The effects on gastric fluid, gastric acid, pepsin and gastric mucous (without normal control group) of rats with gastric ulcers due to the ligation of pylorus were observed separately, as well as the influences on PGE2content of ulcer rats caused by aspirin, the effects on the blood flow of gastric mucous of the ulcer rats due to water soaking stress, the effects on GAS, NO and EGF of ulcer rats caused by acetic acid (without Ranitidine group). Panel method was used to assay the minimal inhibitory concentration of Bao Wei Qi Wan. The Balb/c mice were randomizedly divided into Bao Wei Qi Wan groups with low, moderate and high dose, along with normal control group, model control group and amoxicillin group, and each group contains18,19,18,10,16and17mice respectively. Chemical reaction method was applied to the detection of urease, Enzyme linked immunosorbent assay method was used to determine the serum Hp urease antibody, and Fuchsin staining method was used to the histopathological detection, so as to observe the effect of Bao Wei Qi Wan on Hp.ResultsThe low and moderate dose of Bao Wei Qi Wan could obviously lower the ulcer index of the model group mice with gastric ulcer caused by acetic acid, water soaking stress, aspirin and ammonia water (P<0.01or0.05). The moderate dose of Bao Wei Qi Wan could also lower the ulcer index of the model group mice with gastric ulcer due to hydrochloric acid-alcohol (P<0.01). The high dose of Bao Wei Qi Wan could reduce the ulcer index of the model group mice with gastric ulcer significantly (P<0.01or0.05), and all of the low, moderate and high doses could decrease the ulcer area of the model group mice with gastric ulcer due to the ligation of pylorus (P<0.01).The low and moderate doses of Bao Wei Qi Wan could reduce the quantity of gastric fluid (P<0.05). All of lower, moderate and high dose of Bao Wei Qi Wan could lower the gastric acidity (P<0.01or0.05), while high dose of it could reduce pepsin (P<0.05). However, Wei Kang Ling could not lower the quantity of gastric fluid, acidity and pepsin. There is no significant difference of Ranitidine and Bao Wei Qi Wan on the indexes above (P>0.05). The low and high dose of Bao Wei Qi Wan, as well as Ranitidine, could increase the gastric mucous obviously (P<0.05). The moderate and high dose of Bao Wei Qi Wan, Wei Kang Ling and Ranitidine could enhance the content of PGE2 significantly (P<0.05or0.01). The high dose of Bao Wei Qi Wan and Wei Kang Ling could increase the blood flow of gastric mucous markedly (P<0.05). The low dose of Bao Wei Qi Wan could increase the content of NO (P<0.05). The low, moderate and high dose of Bao Wei Qi Wan, along with Wei Kang Ling, could increase the content of EGF (P<0.05or0.01). All of the low, moderate and high dose of Bao Wei Qi Wan had no influence on the content of GAS (P>0.05). At the same time, Ranitidine had no effect on the blood flow of gastric mucous (P>0.05), and there was no influence of Wei Kang Ling on the content of NO (P>0.05).The minimal MIC of Bao Wei Qi Wan is0.0416g/ml. The rapid detection of urease indicated that the positive rates of Hp had no significant difference among the low, moderate and high dose of Bao Wei Qi Wan, and amoxicillin (P>0.05). The detection of serum Hp urease antibody showed that the low and high dose of Bao Wei Qi Wan and amoxicillin could reduce the positive rate of Hp obviously (P<0.01). From the pathological tissue section, it could be seen that the low, moderate and high dose of Bao Wei Qi Wan and amoxicillin could lower the positive rate of Hp (P<0.01), and the effect of high, moderate and low dose of Bao Wei Qi Wan in inhibiting Hp showed the dose effect relationship in some degree.Conclusion①Bao Wei Qi Wan could reduce the ulcer index and severity of the model group rats with6kinds of gastric ulcer, and had effects on gastric ulcer due to many kinds of factors, but its efficacy had differences on different models.②Bao Wei Qi Wan could reduce the invading factors, such as the quantity of gastric fluid, gastric acidity and the activity of pepsin, etc. However, it could also enhance the gastric mucous, the blood flow of gastric mucosa, PGE2, NO and EGF, all of which are defensive factors.③The minimal inhibitory concentration of Bao Wei Qi Wan in vitro is0.0416g/ml, which could reduce the infectious factors of Hp, for example urease, lower the infection rate of Hp, and there was some dose effect relationship between them.④The mechanism of Bao Wei Qi Wan in treating gastric ulcer is to regain the balance between the invading-defensive factors, and inhibit Hp. |
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