Clinical Observation On The Treatment Of Refractory Gastroesophageal Reflux Disease Of Liver-Stomach Disharmony Type By Of The Self-designed TiaoShen HeWei Decoction

Objective: The clinical experience of Professor Liu Xingshan in the treatment of Refractory gastroesophageal reflux disease(r GERD)was summarized,and the clinical efficacy and improvement of mental and psychological status of r GERD in the treatment of Liver-Stomach Disharmony Type with the Self-designed Tiaoshen He Wei Decoction were observed based on the method of modern medical diagnosis and Chinese medicine discernment.To further explore the advantages of treating r GERD based on the Tradition Chinese Medicine(TCM)theories and discriminatory ideas,and to guide the wide application of the Self-designed Tiaoshen He Wei Decoction in clinical practice.Methods: Eighty patients with Liver-Stomach Disharmony Type r GERD who visited the outpatient clinic of Liu Xingshan,director of the Department of Spleen and Gastroenterology,Weifang Hospital of Traditional Chinese Medicine from December 2021 to December 2022 were randomly selected and divided into 40 cases each in the treatment group and the control group.Firstly,health education was given to the patients before treatment;secondly,different treatment methods were given to the two groups:(1)Control group: Double dose of Omeprazole Capsule(40mg bid),take orally 30 min before breakfast and dinner;(2)Treatment group: Regular dose of Omeprazole Capsule(20mg bid),take orally 30 min before breakfast and dinner,combined with the “Self-designed Tiaoshen He Wei Decoction” Chinese herbal granules were taken orally with 100 ml of boiled water,0.5-1h after breakfast and dinner.After 8 weeks of continuous medication treatment,the reflux disease diagnostic questionnaire(RDQ scale),Chinese medicine evidence score scale,anxiety self-assessment scale(SAS)and depression self-assessment scale(SDS)were collected and compiled before and after treatment in both groups,and the data were analyzed using SPSS 26.0 statistical software.Results:1.A total of 77 patients finally completed this study,39 cases in the treatment group and 38 cases in the control group.2.Efficacy Indexes:(1)Comparison of clinical symptom(RDQ)scores: there was a statistically significant difference(P < 0.05)in the comparison of RDQ total scores,retrosternal burning sensation,pain sensation,and gastric contents reflux symptom scores,and there was no statistically significant difference(P >0.05)in the comparison of acidity in the mouth/bitterness in the mouth symptom scores.It indicatied that the treatment group was effective in improving clinical symptoms,especially more advantageous in improving retrosternal burning sensation,retrosternal pain sensation and gastric contents reflux symptoms;the total effective rate of clinical symptoms in the treatment group and the control group were 87.18% and 73.68%,respectively,and the total effective rate of treatment of r GERD in the treatment group was higher in the treatment group.(2)Comparison of TCM syndrome points: The differences were statistically significant(P < 0.05)when comparing the total TCM symptom score,the main symptom score,aggravated by emotional discomfort,irritable,distended,and poor sleep symptom scores,and not statistically significant(P > 0.05)when comparing the noisy and easily hungry,dry mouth and bitter,and dry or loose stools symptom scores,indicating that the treatment group was effective in improving the TCM symptoms,especially more advantageous in terms of improving mood indicators and sleep quality;The total effective rates of TCM symptoms in the treatment and control groups were 89.74% and 60.52%,respectively,indicating that the total effective rates of TCM symptoms in the treatment group were higher.(3)Mental and psychological conditions: The post-treatment SAS scores were 46.85±43.752 and 53.00±4.591,and SDS scores were 47.67±3.173 and53.05±3.834 in the treatment group and the control group,respectively,and the differences in SAS scores and SDS scores between the two groups after treatment were tested to be statistically significant(p<0.05),indicating that the treatment group had an advantage in improving the mental psychological status.3.Safety analysis: during the study observation period,no adverse events occurred in either group.Conclusion:(1)The treatment of rGERD with Liver-Stomach Disharmony Type by combining the Self-designed Tiaoshen He Wei Decoction with western medicine regimen has remarkable efficacy,especially in improving clinical symptoms such as burning sensation behind the sternum,pain behind the sternum,reflux of gastric contents,as well as TCM syndrome such as worsening of symptoms due to emotional discomfort,irritability,distention and fullness in the abdomen and stomach,poor sleep,and has significant intervention effects on the anxiety and depression status of r GERD patients,and the treatment regimen is safe and feasible.(2)The combination of Chinese and Western medicine can make up for the shortcomings of single Western medicine treatment,reduce the incidence of potential adverse effects of long-term or double-dose PPIs,and solve the problem of "intractability" of r GERD by formulating individualized treatment plans through the method of Chinese medicine identification,thus increasing the efficiency and improving the mental and emotional state,which is worth promoting in clinical application.(3)Liver wood is in the opposite direction of the middle earth,and the stomach is not in harmony with the lowering of the stomach,resulting in the disorder of the internal organs and the disturbance of the mind,which may be one of the causes of the "intractability" of r GERD,which provides the clinical basis for the treatment theory of "regulating the mind and stabilizing the will,draining the liver and harmonizing the stomach".