The Study On The Regularments Of Syndrome And Treatment Of Chronic Atrophic Gastritis With Intestinal Metaplasia

Objective:Through researching the articles about chronic atrophic gastritis(CAG) with intestinal metaplasia (IM) in recent ten years and summarizing the treatment experiences of the author’s mentor on CAG with IM, the regular pattern of syndrome and treatment about the CAG with IM was concluded in this paper.Methods:First retrieving all relevant documents in China journal full-text database (CNKI)、 Chongqing Weipu database (VIP). Wan-fang database and other domestic databases between January 2006 and January 2016, then the statistical analysis of these documents were performed on syndrome elements-targeted-rule of the combination of syndrome elements theory, and it was summarized about the rule of syndrome, syndrome elements, corresponding targets and syndrome elements with syndrome elements, targets with targets and syndrome elements with targets appeared in the literatures on CAG with IM treatment; and the included literatures with a modified formula were statistical analyzed in order to obtain the drug regular pattern of all kinds; at last, combined with clinical treatment, the experiences of my mentor on CAG with IM was summed up, the commonly used formulas and clinical medical records with good effect was analyzed, and the therapy regularity of this disease was further explored.Results:1)The literatures about CAG with IM diagnosis and treatment which are consistent with the inclusion criteria in recent 10 years are 63, and syndrome types after specification are 36, the frequency of them are as following:stomach Yin deficiency syndrome>dampness-heat of spleen and stomach syndrome> liver-stomach disharmony syndrome> spleen and stomach qi deficiency syndrome> static blood in stomach collaterals syndrome> deficient cold of spleen and stomach syndrome> qi stagnation and blood stasis syndrome> liver and spleen disharmony syndrome> cold and heat complicated syndrome; 2)Syndromes elements appeared more than 10 times respectively are internal heat,deficiency of qi,Yin deficiency, qi depression, blood stasis,internal wet, Yang deficiency and qi stagnation. Syndrome elements combinations have two card certificates,three card certificates and four card combinations.In them two card combination has the highest frequency.In two card combinations"qi depression + internal heat" and "internal wet + internal heat" frequency is the highest; The corresponding targeted respectively are stomach,spleen,liver,heart,and bravery, mainly involves stomach,spleen and liver.Targeted-targeted combination mainly involves spleen-stomach, stomach-stomach, liver-stomach combination. In syndrome factor-targeted combinations, stomach-internal heat, spleen-qi deficiency, and stomach-Yin deficiency, stomach-blood stasis, liver-qi depression, stomach-qi deficiency, spleen-internal heat, liver-internal heat, spleen-wet are the top nine.3)There are 198 kinds of drugs in total in the 224 articles which used modified formulas, and the frequency of them were 2534 times. The tonifying deficiency drugs, qi-regulating drugs, heat-clearing drugs, blood-invigorating and stasis-eliminating drugs, eliminating dampness drugs, phlegm-resolving drugs and digestant drugs ranked top 7. The top 10 frequently used drugs are licorice, atractylodes, radix paeoniae alba, dangshen, astragalus membranaceus and salvia miltiorrhiza, poria cocos, pinellia, spreading hedyotis herb, coptis chinensis respectively. The qi-tonifying drug and blood-tonifying drugs are the most frequently used to treat deficiency syndrome, and qi-tonifying drugs are liquorice, atractylodes, dangshen, astragalus membranaceus; blood-tonifying drugs are white paeony root and angelica; qi-regulating drugs are dried tangerine or orange peel, bitter orange, radix bupleuri, bergamot, costustoot; heat-clearing and detoxicating drug and clearing heat and dampness drug are the most in clearing heat medicine which are represented by spreading hedyotis herb, rhizoma coptidis, dandelion, radix scutellariae;In activating blood circulation drug salvia miltiorrhiza, rhizoma zedoariae, rhizoma corydalis are the most frequently used. And in phlegm drugs, pinellia ternate is the most.Conclusion:1.Based on the research on literature of recent 10 years about syndrome elements-targeted-rule of the combination of syndrome elements theory about CAG with IM, it is can be concluded that stomach Yin deficiency syndrome, spleen and stomach damp-heat syndrome, liver-stomach disharmony syndrome, spleen and stomach qi deficiency syndrome, blood stasis resistance gastric collaterals syndrome, deficient cold of spleen and stomach syndrome are the top 6 factors in syndrome differentiation about CAG with IM. Disease mainly concern stomach, spleen, liver, heart, bravery and other related viscera.2. In the 224 articals which use fixed formulas add and subtract in CAG with IM, tonifying deficiency drug, spleen drug, clearing heat drug,blood-activating and stasis-eliminating drug, removing dampness drug, digestant drug and phlegm-resolving drug are the top 7. In tonifying deficiency drugs,the frequency of qi-tonifying drug is the highest, followed by hematinic, Yin, Yang tonic medicine, which suggest that modern physicians treat the CAG with IM on the basis of tonifying deficiency, especially tonifying qi, and the possibility of appearing qi depression (including qi stagnation), internal heat, blood stasis, dampness,indegesition, phlegm retention is more. According to the laws of the drug can launch that the pathogenesis of CAG with IM mainly is vital qi weakness, as well as vigorous pathogenic factor. Vital qi weakness mainly cover qi deficiency of spleen and stomach, spleen and stomach Yin deficiency, spleen and stomach cold,and vigorous pathogenic factor mainly include qi depression (including qi stagnation), internal heat, blood stasis, dampness, indigestion, phlegm turbidity and so on.3.According to the clustered formula, in syndrome differentiation and treatment of the diseases, it can be divided into 7 types, which are spleen qi deficiency syndrome, spleen and stomach cold syndrome, stomach Yin deficiency syndrome, cold and heat complicated syndrome, stomach blood stasis syndrome, Liver depression and qi stagnation syndrome, and spleen and spleen-stomach damp-heat syndrome. They were respectively treated by Liu Junzi Tang decotion, Xiao Jianzhong Tang modified decotion, Shashen Maidong Tang modified decotion; Banxia Xiexin Tang modified decotion, Danshen Yin decotion combined with Baihe Wuyao Tang decotion, Shixiaosan modified decotion,Taohong Siwu Tang decotion and modified Sini decoction with jinlingzi powder etc.