| Research background:The geographical environment in plateau area is complicated,which have the characteristics of low pressure,hypoxia,dryness,cold and so on.The environment directly affect the body function,and sequentially cause a series of physiological and pathological changes to the digestive system.Some studies have shown that the incidence of chronic atrophic gastritis(C AG)in plateau area is significantly higher than that in plain area and the reasons are complex and varied.The pathogenesis and pathophysiological changes of CAG have the particularity in plateau area.According to the theory of traditional Chinese medicine(TCM),it is believed that the lack of rarefied air in plateau area and the lack of pectoral qi generation in human body can easily lead to qi deficiency and a series of physiological and pathological changes.These environmental and organic differences directly affect the syndrome type distribution,syndrome characteristics,treatment methods and prescription of CAG in plateau area.In view of this,the purpose of this project is to study the pathological characteristics,the law of TCM syndrome and treatment and the prevention and treatment strategies in patients with CAG in plateau area,so as to reveal the essence of the theory "different treatments in different places".Research objectives:By using clinical epidemiological investigation and retrospective research methods,the pathological characteristics,syndrome type distribution,the application rule of treatment methods and TCM formulas and the influence factors of CAG patients were studied.This project put forward the syndrome differentiation,treatment drugs and regimens,and prevention strategy in CAG patients in plateau area.Research methods:(1)In the theoretical research section,the research mainly adopts the literature review method to discuss the influence of plateau environment on body,the understanding of plateau diseases in terms of TCM,the treatment of CAG by TCM and western medicine,and the most recent general summary of CAG in plateau area.(2)In the clinical study section,the research mainly adopts the epidemiological investigation method to collect 1013 cases of CAG in plateau area and record the patient information of gender,age,nationality,plateau habitat living time,altitude,course,occupation,living habits,food preferences,dietary laws,basic disease,family history of disease,pathogenesis inducement,clinical symptoms and the degree,tongue coating,pulse,gastroscopy report(mucosa atrophy grade observed by gastroscopy),pathological diagnosis report(atrophy,inflammation,intestinal metaplasia,dysplasia pathological grade),Helicobacter pylori(Hp)infection situation and so on.By the syndrome differentiation of CAG patients according to the preset of the scheme,the distribution laws of TCM syndrome,syndrome characteristics and related factors were studies.This research summarize the etiology,pathogenesis and syndrome treatment strategy of CAG in plateau area.(3)In the retrospective research section,this study mainly collected 3003 confirmed cases of CAG reported in literature in plateau area by using the literature retrieval method.The treatment methods,prescription and prescription rules were summarized and analyzed.By using the data mining technology,the four qi,five flavor,meridian and core prescriptions of TCM were analyzed.This study summarize the common prescriptions for CAG in the plateau region.Results:(1)Among 1013 CAG patients in clinical investigation,521 patients were male and 492 patients were female.The youngest is 19 years old and the oldest is 84 years old.The mean age was(52.39±11.99)years old.The mean course of disease was(1277.43±1169.38)days.In terms of the influence of patients’ age on the incidence of CAG in plateau area,the result showed that the overall incidence increased with age.In terms of the distribution of CAG patients in different altitudes and age of patients,the result showed that the proportion of young patients showed an overall upward trend with the increase of altitude.In terms of family history of gastric diseases,16.98%of the 1013 patients had a definite family history of gastric diseases,such as CAG and gastric cancer.In terms of the influence of altitude on intestinal metaplasia and dysplasia,the proportion of patients with intestinal metaplasia and low grade intraepithelial neoplasia gradually increased with the increase of altitude.Among 1013 cases,468 cases were independent syndrome type,and 545 cases were merged syndrome type(merged syndrome type consist of 2-4 syndrome types).Among single syndrome types,spleen and stomach qi deficiency syndrome,stomach collateral stasis syndrome and stomach yin deficiency syndrome(including merged syndrome type)accounted for the highest proportion.The syndrome of spleen and stomach qi deficiency combined with stomach collateral stasis syndrome,spleen and stomach qi deficiency combined with stomach yin deficiency syndrome,spleen and stomach qi deficiency combined with liver and stomach qi stagnation syndrome accounted for the highest proportion.In terms of the distribution of syndrome types in different age,the distribution of syndrome types in young patients was as follows:spleen and stomach qi deficiency syndrome>liver and stomach stagnation heat syndrome>spleen and stomach qi stagnation syndrome>stomach yin deficiency syndrome>spleen and stomach deficiency cold syndrome>stomach collateral stasis syndrome.The distribution pattern of syndrome type in middle-aged patients was as follows:spleen and stomach qi deficiency syndrome>stomach collateral stasis syndrome>liver and stomach qi stagnation syndrome>stomach yin deficiency syndrome>liver and stomach stagnation heat syndrome>spleen and stomach dampness-heat syndrome>spleen and stomach deficiency cold syndrome.The distribution of syndrome types in elderly patients was as follows:spleen and stomach qi deficiency syndrome>stomach collateral stasis syndrome>stomach yin deficiency syndrome>liver and stomach stagnation syndrome>spleen and stomach deficiency cold syndrome>spleen and stomach dampness-heat syndrome.With the increase of age(the course of disease),the frequency of gastric collateral stasis syndrome increased significantly.In terms of the influence of patients’ body shape on the distribution of syndrome types,the proportion of body weight in patients with stomach yin deficiency syndrome was the highest,and the proportion of obese patients with spleen and stomach dampness-heat syndrome was significantly higher than that of emaciated patients.In terms of the influence of gender on the distribution of syndrome types,the proportion of males in spleen and stomach dampness-heat syndrome,stomach collateral stasis syndrome and liver and stomach stagnation heat syndrome was higher than that of females,while the proportion of females in liver and stomach qi stagnation syndrome and spleen and stomach deficiency cold syndrome was higher than that of males.The distribution of spleen and stomach qi deficiency syndrome and stomach yin deficiency syndrome had no significant gender difference.In terms of the influence of patients’ living and eating habits on the distribution of syndrome types,the proportion of spleen and stomach dampness-heat syndrome and liver and stomach heat-stasis syndrome was relatively high in patients drinking alcohol and smoking,the proportion of liver and stomach heat-stasis syndrome and stomach yin deficiency syndrome was relatively high in patients who often stay up late,and the proportion of stomach yin deficiency syndrome was the highest in patients who liked drinking strong tea.There is a certain correlation between Hp infection and TCM syndrome type distribution.The syndrome distribution of CAG patients infected with Hp from high to low was as follows:spleen and stomach dampness heat syndrome>stomach collateral stasis syndrome>stomach yin deficiency syndrome>liver and stomach stagnation heat syndrome>spleen and stomach qi deficiency syndrome>liver and stomach qi stagnation syndrome>spleen and stomach deficiency cold syndrome.In terms of the correlation research of gastroscopy observation and histologic examination results and syndrome type distribution,the result showed that the distribution of stomach collateral stasis syndrome is the most serious or the highest in gastric mucosa atrophy observed by gastroscopy,atrophy degree diagnosed by pathology,inflammatory pathology state,incidence of intestinal metaplasia and/or low-grade intraepithelial neoplasia.(2)Among 3003 patients in a retrospective study based on literature search,89.94%patients were treated by combined TCM treatment(more than two main treatment combinations).Among the main therapeutic components,the top seven treatment(frequency≥10%)were as follows:invigorating qi and strengthening spleen(79.62%),activating blood circulation and removing blood stasis(64.34%),nourishing yin and benefiting stomach(41.86%),soothing liver and regulating qi(23.01%),warming and neutralizing stomach(11.42%),invigorating spleen and regulating qi(10.52%)and clearing heat and reducing dampness(10.36%).In terms of combined TCM treatment,the top two combinations of the two main treatment methods ranked in the order of frequency:supplementing qi and invigorating spleen,activating blood circulation and removing stasis(integrating condensing method for supplementing qi and activating blood circulation),supplementing qi and strengthening spleen,nourishing yin and supplementing stomach(integrating condensing method for supplementing qi and nourishing yin).The combination of the three main treatment methods had the highest frequency:supplementing qi and spleen,promoting blood circulation and removing stasis,nourishing yin and stomach(integrating and condensing to supplementing qi and promoting blood circulation and nourishing yin).By analyzing the formula,the top ten prescriptions with the highest frequency were:Huangqi sijunzi decoction,Danshen decoction,Yiwei decoction,Shengmai powder,Banxia xiexin Decoction,Baihe decoction,Huangqi gancao decoction,Xiangsha liujunzi decoction,Erchen decoction and Huangqi jianzhong decoction.Data by mining module of complex network analysis showed that the 21 core drugs of the treatment of CAG in plateau area:Huangqi,Dangshen,Baishao,Gancao,Baizhu,Jiaoshanzha,Danshen,Chenpi,Jineijin,Fuling,Banxia,Sanqifen,Zhigancao,Huanglian,Shashen,Wuyao,Chaomaiya,Maidong,Baihe,Baihuasheshecao and Taizishen.Research conclusions:(1)This study shows that CAG in plateau area has significant pathogenesis characteristics.With the increase of living altitude,the proportion of young patients gradually increases,which suggest that high altitude may lead to earlier onset age of patients and higher incidence of intestinal metaplasia and low grade intraepithelial neoplasia.Some bad living and eating habits(drinking alcohol,high salt,eating less fruits and vegetables,etc.)in plateau area are the risk factors of CAG in plateau area.(2)This study refined the distribution law of CAG syndrome type in plateau area.The characteristics of geographical and climatic environment,such as insufficient natural air in plateau area,can lead to the specificity of TCM syndrome type distribution of CAG in plateau area.In terms of the nature of syndrome type,qi deficiency,blood stasis and yin deficiency are the main syndrome.In terms of the mode of syndrome type,merged syndrome type are the main syndrome.Through combination and condensation,a new scheme for the classification of common TCM syndromes of CAG in plateau area was put forward:①qi deficiency and blood stasis syndrome,②qi and yin deficiency syndrome,③spleen and stomach qi deficiency syndrome,④spleen deficiency and qi stagnation syndrome,⑤liver and stomach stagnation heat syndrome.(3)This study innovatively proposed the main treatment for CAG in plateau area:supplementing qi,activating blood circulation and nourishing yin,and the combined treatment method was often used.This study also proposed representative prescriptions,core prescriptions and prevention and control strategies.(4)The results of this study provide a framework and an important reference for developing practical,normalized and standardized TCM diagnosis and treatment plans for CAG in plateau areas in the future. |
PDF Full Text Request