| Chronic atrophic gastritis(CAG) as a commonest gastrointestinal disease,has higher prevalence and a certain tendency to canceration.To date,general-accepted effective therapy remains absent.Characteristics and advantages of Chinese medicine treatment in this disease have gradually been recognized.But there are still some problems in syndrome principle distinguishing,characteristics of TCM treatment summarization,especially diagnosis and treatment of patients associated with anxiety and depression,as well as evaluation in the therapeutic effect of differentiation;these problems not only affect the play of advantages and characteristics,but also impedes the development of clinical research.Aim Summing up the characteristics of TCM syndrome principle and diagnosis and prescription of CAG;Summing up the epidemiological characteristics of the CAG,to explore the correlation between TCM syndromes characteristics and abnormal psychological state of anxiety and depression,and providing reference for clinical and scientific research;Making objective analysis on clinical efficacy of TCM treatment of CAG,and to explore the feature of promoting blood circulation therapy in CAG treatment.Method Through collection and quantitative analysis on literature about TCM treatment of CAG,explore the TCM syndromes characteristics and diagnosis and prescription regulations of CAG;Through CAG cross-sectional epidemiological study, select 239 cases with CAG in Beijing for investigation,and describe the risk factors, clinical symptoms,TCM Syndrome,endoscope,pathological diagnosis,with clinical manifestations of psychological disease and Hospital Anxiety and Depression Scale(HAD) measurement results and statistics,of the CAG and the laws of TCM Syndrome Scale HAD anxiety and depression evaluation factors and the relevance of traditional Chinese medicine syndromes of scientific summary;Through clinical observation of CAG 120 including clinical symptoms,performance of endoscopic lesions,histopathology,based on the perspective of Patient reported outcome(PRO),conduct objective evaluation on the efficacy of TCM treatment of CAG and explore the advantages and characteristics of promoting blood circulation therapy in CAG treatment.Result1 Chinese medical literature analysis about CAGA total of 149 relevant literatures were brought into.Syndrome type described is 30 in total of which there are five most common:weakness of the spleen and stomach＞damp-heat obstructing in spleen and stomach＞incoordination between the liver and stomach＞blood stasis in gastric venation＞insufficiency of stomach yin.Deficient and excessive syndromes appearing together is the pathogenesis of CAG,and the deficiency mainly refers to Qi-deficiency and Yin- deficiency,more than yang deficiency,while excess to Qi stagnation,blood stasis,more than damp-heat and heat accumulation.Herbs used under differentiation and treatment mainly include:replenishing qi to invigorate the spleen,soothing the liver,eliminating dampness,clearing heat,nourishing yin,promoting blood,and digesting,Commonly used and more than 10%utilization rate herbs followed by white peony root,Atractylodes macrocephala,Banxia,Tangerine peel,Tuckahoe,Salvia, Astragalus,Cyperus,etc.It reflects the common therapeutic methods in CAG are invigorating the spleen,regulating qi,nourishing yin and promoting blood.Commonly used prescription for weakness of the spleen and stomach syndrome is Xiangsha Liujunzi soup(spleen-stomach deficiency-cold withHuangqi Jian Zhong soup),accompanied by regulating qi herbs(Citrus aurtantium Cyperus,Bergamot),promoting blood circulation herbs(zedoary,Salvia,Angelica,Rhizome corydalis,Panax notoginseng),digestive herbs(Ji Nei Jin);warming the internal(Wu Zhu YU,ginger,Alpinia officinarum Hance); Common used prescriptions for damp-heat obstructing in spleen and stomach syndrome are Er Chen soup,Huo Pu Xia Ling soup,and Xiang Shang Ping Wei San,accompanied by Atractylodes,Lanceolata for regulating qi and invigorating spleen,Su Geng,Zhi Qiao, Bergamot and Bupleurum for soothing the liver,Coptis Chinensis,Dandelion, Capejasmine for killing Helicobacter pylori,Salvia for promoting the blood,Malt for digesting;Commonly used prescriptions for incoordination between the liver and stomach syndrome are Si Ni San,Chai Hu Shu Gan San and Jin Ling Zi San,accompanied by promoting blood circulation herbs(Rhizoma Ligustici Chuanxiong,Salvia,Angelica, Curcuma,Zedoary),,invigorating spleen qi herbs(Atractylodes,Poria),and antipyretics herbs(Capejasmine,Scutellaria,Red Peony Root)and digestive herbs(Jiao San Xian); Commonly used prescriptions for Gastric collateral stasis syndrome are Shi Xiao San or Dan Shen Yin,accompanied by other promoting blood herbs(Angelica,White peony root, Zedoary,Peach kernel,Rhizoma Ligustici Chuanxiong,San Leng,Red Peony Root,Panax notoginseng),invigorating spleen qi herbs(Astragalus,Atractylodes,Lanceolata) and regulating qi herbs(Bergamot,Citrus aurtantium,Bergamot,Tangerine Peel,Aristolochia debilis);Common used prescriptions for insufficiency of stomach yin syndrome are Yi Guan Jian or Sha Shen Mai Dong Soup,accompanied by regulating qi herbs(Bergamot, Chuan lian Zi,Bergamot,Tangerine Peel,Citrus aurtantium,Pinellia ternate,Villous amomum),invigorating spleen qi herbs(Atractylodes,Lanceolata,Radix pseudostell, Chinese yam) and digestive herbs(Hawthorn,Malt,Ji Nei Jin).2 Chronic atrophic gastritis of epidemiological research of TCM syndrome principle2.1 Onset CharacteristicsA total of 239 patients with CAG was surveyed.51 cases with the history of digestive tract diseases(21.3%),mainly including gastroesophageal reflux disease,peptic ulcer, irritable bowel syndrome,gastroptosis,cholecystitis;and have a certain family history; CAG has a long course,incidence of morbidity in the spring＞winter＞autumn＞summer. The disease is closely related with predisposing factors,especially with dietary factors, mental and emotional factors and Climate Change;CAG.onset has close relation with special dietary habits of patients,especially with more salt food,spicy food,sweet;126 patients with abnormal psychological state(52.7%):tensive＞anxiety＞depression＞irritable＞suppression.2.2 Syndrome characterMain symptoms:stomachaches accounts for 74.9%(179cases),stomachache distension 79.0%(189cases),stomached stuffy 66.9%(160cases),heartburn 44.8%(107cases),acid regurgitation 50.2%(120cases),belching 70.3%(168cases),anorexia 40.6%(97 cases),decreased appetite 27.2%(65cases);Main symptom score showed no significant difference(p＞0.05)among all syndromes types;The upper and lower symptoms showed a certain overlap regularity in various types of syndromes.In overlap symptoms,the highest frequency symptom in turn is as followings:gastric distention and abdominal distention＞stomachache and abdominal distention＞blocked stomach and abdominal distention＞belching and abdominal distention and so on;The most overlap syndromes in turn is;syndrome of hepatic qi attacking stomach＞syndrome of spleen-deficiency and Qi-stagnation＞syndrome of damp-heat obstructing in zhong jiqo＞syndrome of damp turbidity obstructing in zhong jiqo＞syndrome of stagnated heat of liver and stomach＞syndrome of spleen-stomach deficiency-cold etc;The diagnosis contain:stomach-ache accounts for 48.1%(115 case),stuffiness and fullness43.9%(105 cases),others7.9%(19 cases) including casting up of gastric acid,swallow acid,hypochondriac pain,regurgitation. The common syndromes in turn are as follows:syndrome of hepatic qi attacking stomach＞syndrome of spleen-deficiency and Qi-stagnation＞syndrome of damp-heat obstructing in zhong jiqo＞syndrome of stagnated heat of liver and stomach＞syndrome of spleen-stomach deficiency-cold＞syndrome of damp turbidity obstructing in zhong jiqo etc. The syndrome of stagnated blood of stomach meridian often combined the other syndromes.2.3 Results of CAG accompanied with anxiety and depression state with HAD ScaleThe HAD scores of normal population selected randomly were negative,which were different from the positive and the suspicious people.The negative scores were 104 cases (43.5%) in 239 cases,while the positive and suspicious were 135 cases(56.5%).The score was related to gender and the female are prone to anxiety or depression(P＜0.05).It was related to the educational background and the higher are prone to anxiety or depression (P＜0.05).It was also concerned with the psychological and mental state.Abnormal psychological state were prone to be anxious and depressive(P＜0.05).The anxiety scores of HAD were positive related with pathohistology examination,dysplasia was prone to be anxious especially(P=0.001＜0.05).Among all related factors,the disease state is the most related to the anxiety scores;the level of pathological points is the most close factor.3 Clinical observations of Syndrome Differentiation and Treatment for120 cases of CAG3.1 Clinical symptomsAfter the treatment,the cardinal symptoms score,the clinical symptoms total score and other each host sickness score improvement has statistics difference(P＜0.05).Cardinal symptoms score and total score of each dialectical group between pre and post treatment all has statistics difference(P＜0.05).Cardinal symptoms in each group all have improvements.3.2 PRO ScoreTotal score of PRO Scale between pre and post treatment has statistics difference (P＜0.05).The dyspepsia,the regurgitation,the general symptom,the abnormal defecation, the social function,the psychological function six dimension score difference between pre and post treatment has statistics difference(P＜0.05).In PRO Scale total score,the general symptom dimensions have the greatest effect on CAG patients,the order are:the general symptom＞the regurgitation＞the psychological function＞the dyspepsia＞abnormal defecation and the social function dimensions.3.3 Gastroscopy and pathological findingsAfter the treatment,the main gastroscope pathological change and gastroscope total score all have statistics difference(P=0.003＜0.05).The main gastroscope pathological change and gastroscope total score all improved.After the treatment,each dialectical group pathology score difference has statistics difference(P=0.000＜0.05),the pathology score all improved.3.4 Blood stasis group and the Non-blood stasis groupThe blood stasis group and the non-blood stasis group partial pathological change score(Pathology main pathological change score,pathology total score) difference has statistics difference(P=0.009,0.021＜0.05),the blood stasis group histo-pathology pathological change is more serious.In the atrophy,intestines,and the activity score,the blood stasis group and the non-blood stasis group has statistics difference(P=0.023,0.013,0.036＜0.05),the blood stasis group intestines,atrophy,and activity score are higher than the non-blood stasis group.After treatment,the blood stasis group and the non-blood stasis group's cardinal symptoms score and the symptom total score have statistics difference (P=0.003＜0.05),symptoms all have been improved.After treatment,improvement of the non-blood stasis group the gastroscopic main pathological change score,the secondary pathological change score and the gastroscopic total score all have non-statistics difference(P=0.446＞0.05),while the blood stasis group gastroscopic main pathological change score and gastroscopic total score have statistics difference(P=0.002＜0.05).After treatment,change of the pathology main pathological score and pathology total score between blood stasis group and non-blood stasis group has statistics difference(P＜0.05), and the blood stasis group is prior to the non-blood stasis group.Conclusion1 Characteristics of TCM Syndrome and Regulations of Differentiation and medicine usage in CAGClinical manifestations of CAG mainly are indigestive symptoms,such as gasteremphraxis,stomachache,nausea,belching,inappetence,stool abnormity, accompanied by other symptoms such as fatigue,weight loss,and psychological symptoms including tension,anxiety,depression,etc.The diagnosis mainly is stomach-ache accounts, stuffiness and fullness.Defcient and excessive syndromes appearing together is the pathogenesis of CAG,and the deficiency mainly refers to Qi-deficiency and Yin-deficiency, while excess to Qi stagnation,blood stasis,more than damp-heat and heat accumulation.The disease is prone in the wrinkly,whose kidney essence were thought to be deficient increasingly and organs' function also decreased according TCM theory. Modern medicine also believes that the antiviral ability of gastric mucosal and gastric motility become reduced,emptying of food delayed,and glands become atrophied in the wrinkly,Based on the above understanding,we can conclude that spleen deficiency is closely related with the CAG,it is the pathological basis of CAG.The deficiency leads to stagnation of QI,damp obstruction,heat obstruction,blood stasis and phlegm stasis,among that pathogenesis,stagnation of QI and blood stasis are most important.According the theory of"Prolonged illness enters into venation" and" Prolonged illness surely has blood stasis",the long course of the disease will lead the blood stasis.Five common patterns of syndrome are:weakness of the spleen and stomach,damp-heat obstructing in spleen and stomach,incoordination between the liver and stomach,blood stasis in gastric venation, and insufficiency of stomach yin.According to the pathogenesis of CAG,spleen deficiency is the pathological basis,Qi stagnation,blood stasis is important parts in the disease development,so determine the important methods of invigorating spleen,regulating qi,promoting blood circulation for the treatment of CAG should be throughout the course of treatment.The evidence-based medicine have a certain regularity,on the basis of main decoction and main drugs,have a comprehensive consideration of the characteristics of pathogenesis,and the interaction between drugs,and the physiological characteristic of stomach,appropriate use of other drugs,in order to increase the effectiveness of treatment while reduce its potential side effects,fully embodies the feature of traditional Chinese medicine.Basic prescription for weakness of the spleen and stomach syndrome is Xiangsha Liujunzi soup(spleen-stomach deficiency-cold with Huangqi Jian Zhong soup),accompanied by regulating qi herbs,promoting blood circulation herbs and digestive herbs;Basic prescriptions for damp-heat obstructing in spleen and stomach syndrome are Er Chen soup,Huo Pu Xia Ling soup,and Xiang Shang Ping Wei San,accompanied by regulating qi herbs, invigorating spleen herbs,and antipyretics herbs;Basic prescriptions for incoordination between the liver and stomach syndrome are Si Ni San,Chai Hu Shu Gan San and Jin Ling Zi San,accompanied by promoting blood circulation herbs,invigorating spleen qi herbs, and antipyretics herbs;Basic prescriptions for incoordination between the liver and stomach syndrome are Shi Xiao San or Dan Shen Yin,accompanied by invigorating spleen qi herbs and regulating qi herbs;Basic prescriptions for insufficiency of stomach yin syndrome are Yi Guan Jian or Sha Shen Mai Dong Soup,accompanied by invigorating spleen qi herbs,regulating qi herbs and digestive herbs.2.Relativity of CAG syndrome characteristics and the psychological state of anxiety and depressionSymptoms of CAG are various and often not typical,and extent of disease and symptoms are not consistent,so the diagnosis and treatment has a certain difficulties.The study found that there is no obvious regularity in CAG main symptoms and secondary symptoms,and upper gastrointestinal symptoms and lower gastrointestinal symptoms show some Overlapping and regularity in all types of the symptoms.These overlapping symptoms make it confuse with other digestive system diseases easily,such as functional dyspepsia,peptic ulcer,etc.Some patients maybe have no clear symptoms;we can diagnose CAG by endoscopy and histopathology.Therefore,the identification and diagnosis of CAG must be cautious and clear,to prevent misdiagnosis.For a clear diagnosed CAG,conduct clinical follow-up monitoring,periodic endoscopy review,gastric cancer screening is the basis of early diagnosis,early detection and early treatment. Overlapping symptoms often occur in hepatic qi attacking stomach syndrome, spleen-deficiency and Qi-stagnation syndrome,damp-heat obstructing in zhong jiqo syndrome,and syndrome of damp turbidity obstructing in zhong jiqo,syndrome of stagnated heat of liver and stomach etc.Qi-stagnation in zhong jiqo will lead to pain. Symptoms as upper abdominal pain,abdominal distension,and stool abnormity have close relation with spleen and liver.Hepatic qi attacking stomach result into belching, inappetence,stomach distension and stomachache etc.Upper digestive tract and the lower digestive tract together form the main channel of the digestive system which is for the digest transform water food,transporting and transforming nutrients from foodstuff of spleen and stomach in physiology,while interact in the pathology.Stagnation of dampness due to splenic deficiency can result in stomach distension,abdominal distension and stomachache,stomach blocking,nausea,belching and other gastrointestinal symptoms.At the same time doing a good job in the differential diagnosis,treatment should be combined with the physiological and pathological characteristics of the digestive tract.Among surveyed population,43.9%of chronic atrophic gastritis patients had varying degrees of anxiety,depression in performance,CAG accompanied by mental illness should be given enough attention,because the CAG patients with performance and risk factors of mental illness on the basis of premonitory symptoms is an important basis for the adverse prognosis of patients,and such anxiety and depression state can not only induce disease, but also an important factor in the development of the disease.The study found that poor emotional state,TCM syndromes showed relevance with gastroscopy and pathological examination.Hospital Anxiety and Depression(HAD) scale points have some type of relevance with the syndrome,the anxiety card points of hepatic qi attacking stomach, spleen-deficiency and Qi-stagnation syndrome were more obvious than the other types of syndromes.HAD scale points and the seriousness of pathological examination results showed relevance,in particular the anxiety sub-scale and severity of dysplasia was a positive correlation,and patients who responded to HAD points had higher relevance than the suspicious patients。This shows that the influence of disease to psychological state of patients,and traditional Chinese medicine theory explain the incidence of emotional factors is most closely related with the liver and spleen.In this study,the HAD Scale is the self-rating scale for Anxiety and Depression mental illness Screening in Hospital.It is simple,convenient and easy to operate, Compared to other questionnaire rating scale and self-rating scale used by psychiatrists, HAD Scale is more in line with the actual needs of digestive department physicians for rapid differential diagnosis whether CAG patients combined with abnormal mental state., such as anxiety and depression.3.The clinical efficacy research in traditional Chinese medicine treatment of CAGIn evaluation of CAG effect applicated with traditional Chinese medicine differentiation with PRO scale,we found that PRO scale designed 36 entries covering all the details of the clinical symptoms from six functional dimensions,different emphasis for complicated CAG symptoms lack of specificity.For its stong maneuverability,this Scale can provide objective basis for clinical and scientific research.TCM treatment of CAG in the clinical symptom score,the various dimensions of scale and total score of patients clinical report outcome(PRO),endoscopic mucosal lesion, histopathology all improved in varying degrees.;Those above have proved the efficacy of Chinese medicine in the treatment of CAG and precancerous lesions is positive,and Chinese medicine has characteristics and advantages.Histopathological score of blood stasis group improved better than non-blood stasis group,especially in histopathological lesions,such as atrophy,intestinal metaplasia,while the non-blood stasis group is relatively complicated.The result indicates that promoting blood circulation to remove blood stasis played an important role in improving atrophy and preventing the disease progress.My tutor -Professor Tang Xudong emphasizes that regulating qi and promoting blood circulation to remove blood stasis are the fundamental principle in the treatment of CAG. In the use of Chinese medicine treatment,we should pay attention to patients with anxiety and depression,and apply psychological guidance and life recuperation at the same time, give a more comprehensive treatment in order to achieve the purpose of enhance the effectiveness of treatment.
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