| 1ObjectiveGastro esophageal reflux disease (GERD) is a condition in which the stomach or duodenum contents leak backwards into the esophagus, causing damage to esophagus and other complications. GERD is commonly seen in clinic and leading to co-morbidities. The chief complaints of GERD are heartburn and acid regurgitation. The prevalence rate of GERD is increasing gradually in the last years. The treatment for GERD is difficult, and sometimes the disease is misdiagnosed, therefore clinical effectiveness by modern medicine is not satisfactory. GERD causes great influence on the quality of life in patients, and will increase the risk of esophageal adenocarcinoma if treatment is delayed. Therefore, the research for GERD is of urgency and clinical significance. Recently, traditional Chinese medicine (TCM) for treatment of GERD is given great concern and has gained relatively good efficacy. The research on TCM for GERD will be of great importance.The present study focuses on causes, mechanism, pattern identification, pulse diagnosis, herbal prescriptions, and acupoints selection related to GERD and its symptoms recorded in classical traditional Chinese medicine literature. By sorting, analyzing and summing up the materials, the author summarized the theory of pattern identification and prescriptions, and selection of acupoints on traditional Chinese medicine for diagnosis and treatment of acid-regurgitation, in order to offer some suggestions and references of effective therapies for GERD in the long term.2Materials and methodsSearching the electrical database of Chinese Medical Classics, for related literatures with key words of acid swollen, acid vomiting, acid regurgitation, acid heart, and screening and selecting the literature according to pulse diagnosis, herbs, herbal prescription and acupoint. and then standardizing and establishing database. Using frequency in statistical analysis on included data, and combining the knowledge recorded in classical literatures on acid regurgitation, and analyzing the statistical results by employing theories of TCM.3Results3.1Pulse diagnosisThere are19pulses related to acid regurgitation. a total of84frequencies. The top five pulses are collapsing, feeble and slow at Guan section of wrist; slow, stringy and slippery at Cun section of the wrist; and slippery at the wrist. These pulses indicate that natures of acid regurgitation are cold, deficiency, qi depression and phlegm stasis.3.2HerbsSeventeen groups of herbs were identified during the literature search, a total of156 herbs. The most commonly used herbs are interior-warming medicinal, qi-regulating medicinal, heat-clearing medicinal, deficiency-tonifying medicinal and damp-dissolving medicinal. The most frequently used herb was Fructus Evodiae, which is consistent with the top percentage of interior-warming medicinal among all the herbs.3.3Herbal prescription371prescriptions were found from this study, a total of1485frequencies used. The most commonly used types of prescriptions are qi-regulating prescription, interior-warming prescription, and digestion induction prescription. In which, the top five frequently used prescriptions are liu jun zi tang (Liujunzi decoction), er chen tang (Erchen decoction), ping wei san (powder for relieving stomach symptoms), yue ju wan (Yueju pill), and bu zhong yi qi wan (pill for tonifying the inner and strengthening qi). This study indicates that the commonly used prescriptions for GERD are qi regulating, phlem dissolving, spleen-stomach warming and tonifying at ancient times.3.4Acupoint17acupoints were identified in this research, a total of66frequencies, The top five acupoints used were GB24-Ri Yue, HT9-Shao Chong. GB23-Zhe Jin, SP4-Gong Sun and CV-22-Tian Tu. The Gallbladder Meridian of Foot Shaoyang is of the most frequently channel.4ConclusionsBased on the findings from ancient literatures, it can be concluded that ancient doctors regarded the stomach as the main disease location of acid regurgitation, other organs include spleen, liver, and gallbladder. The main causes of GERD are cold-heat imbalance, emotional injuries, obstacle of phlegm and dampness, deficiency in spleen and stomach, and retained food. Mechanisms are mainly consisting of deficiency-cold in spleen and stomach, heat in liver and stomach, dampness-heat depression, phlegm in middle-jiao, liver-qi irritating stomach, and retained food causing spleen-stomach deficiency and qi mechanism in middle-jiao disorder. During clinical treatment, differentiation of root and superficial symptoms should be first, with herbs prescribed according to body features. Patients with excessive syndrome should be treated superficial symptoms, and patients with deficiency syndrome should be treated root disease. Therapies should concentrate on tonifying spleen and stomach, and assisted by heat-clearing for softening the middle.By summing up the pulse diagnosis, herbs and prescription, the related materials of acid regurgitation suggested that deficiency-cold in spleen and stomach, strengthening spleen and warming the middle are the main theory in pulse diagnosis, herbs and prescription, which indicates the consistency of theory, method, prescription and herbs. By summarizing the acupoints, compared with herbal medications, the authre found that literatures about acupuncture for treatment of acid regurgitation are rare, and there are differences between acupuncture and herbal medicine in syndrome differentiation and treatment. Acupuncture for acid regurgitation in syndrome differentiation arises from qi ohstruction of liver-bladder perspective of view, and its treatment always employ the methods of regulating qi by soothing liver and gallbladder.The author combined modern clinical therapies of TCM with ancient literature records of pulse, herbs, prescription and acupoint, and found that during the treatments for GERD, disease differentiation and syndrome differentiation should be combined with each other, and key points should be focused on treatment for spleen-stomach deficiency syndrome and cold syndrome, with main principles focusing on warming the middle-jiao and tonifying spleen-stomach. Meanwhile, further researches should take advantage of acupuncture for treatment of GERD, for the purpose of fully demonstrating the strength of acupuncture for stomach and intestinal diseases. |
PDF Full Text Request