| ObjectiveTo inherit Professor Li Qiangou’s academic thoughts and precious clinical experience of treating the stomach diseases during nearly the past half century, to guide the clinical practices and improve the clinical efficacy, to learn Prof. Li’s experience, especially in treating the stomach pain.Methods:To discover the sources of Prof. Li’s academic thoughts through the documentation research and theoretical research, and have objective and deep research on them, then develop them into academic theory with the characteristics of guiding the clinic practices. To summarize the experience of diagnosis and treatment by following the teacher and giving lectures. We randomly selected 120 outpatients with functional dyspepsia of abdominal pain syndromes and divided them into the treatment group, guided by "spleen qi deficiency" theory, and the control group treated by omeprazole. The therapeutic effects and results were compared between the two groups.Research ResultsThe paper consists of three parts: Part I:Prof. Li’s academic originProf. Li Qiangou takes that the Spleen and Stomach theory comes from the Yellow Emperor’s Inner Classic, and was applied in clinic by Zhang Zhongjing and amplified by Li Dongyuan. It is a conclusion of long-term argument of every schools and practitioners. The Inner Classic has described the principle of spleen and stomach physiological function in detail, which paved the way of Prof.Li’s academic thoughts. Prof. Li Qiangou tends to use sweet flavor and spleen-nourishing treatment as the fundamental methods to treat the spleen and stomach diseases which come from Treatise on Febrile Diseases. Xiao Jian Zhong decotion, Xiao Chai Hu decotion, Ban Xia Xie Xin decotion and Zhi Zhu pill are the commonly used formulae of Prof. Li in spleen and stomach diseases treatment. Sun Simiao thought highly of treating the spleen and stomach diseases by food nourishment, which is the theoretical foundation of "food as medicine theory" by Prof. Li Qiangou. Qian Yi suggested the five Viscera theory should be applied to treat the gastrointestinal diseases, which inspired Prof. Li Qiangou to invent the main-symptoms-priority-treatment thought. Prof. Li Qiangou regards the spleen deficiency as the main pathological mechanism and uses spleen nourishment as the universal treatment for gastrointestinal diseases, which is greatly influenced by Li Dongyuan’s earth-nourishment thought. Prof. Li Qiangou follows Ye Tianshi to cure constipation by nourishing Yin of stomach.Mr. Guan Youbo’s thought is another academic source of Prof.Li. Mr.Guan emphasize on Qi and Blood of gastrointestinal disease and he regarded the phlegm and blood stasis as the disease cause, all of that and the liver disease treatment experience are absorbed by Prof. Li Qiangou in his academic structure. At the same time, Prof. Li keep a close study on modern scholars and ready to follow the modern medicine development, as a useful supplement of his own academic thoughts.PartⅡ:Prof. Li’s academic thought and clinical experience1 Prof. Li’s academic thought1.1 All diseases resulting from the deficiency of the spleen and stomachVigorous function of the spleen is an important factor which ensures the health of the body.①The spleen and stomach is the center of qi ascending and descending. The qi movement in middle jiao is smooth, so lung qi is dispersing, liver qi flows normally, heart qi is descending, and kidney qi is ascending. Smooth qi movement of spleen and stomach is the key to life activities;②Functions of stomach digestion and absorption are related to patient’s constitution and the diseases prognosis;③We can judge the development and prognosis of diseases through pulse examination of the stomach. Protecting stomach qi is the essence of using the herbs.④Regulate the spleen, the material basis of the acquired constitution, so that oral herbs get better efficacy.1.2 Treating digestive system diseases based on qi deficiency of spleen and stomachProf. Li thinks the manifestations of digestive system diseases are the results of transportation dysfunction of spleen and stomach caused by the qi deficiency.①Treating the stomach diseases based on spleen qi deficiency. Prof. Li thinks the symptoms of stomach diseases in the clinic are inclusion of asthenia and sthenia, but mainly qi deficiency.②Treating constipation based on spleen qi deficiency. Prof. Li thinks the symptoms of constipation in the clinic are inclusion of asthenia and sthenia, so we should tonify the spleen and promote purgation.③Treating diarrhea based on spleen qi deficiency.Diarrhea is mostly caused by the deficiency of spleen and stomach and the spleen’s dysfunction of not transporting the dampness. The spleen deficiency plays an important role both in acute and stable conditions of Ulcerative colitis.④Treating gallbladder diseases based on spleen qi deficiency. The wood is depressed if the soil is obstructed. The liver and gallbladder diseases will cause the spleen injury first, so we should tonify the spleen before treating gallbladder diseases.1.3 Fifteen methods of treating the spleen The function of the spleen refers to many systems including the digestion, blood, circulation, movement and immune system, "Spleen" is the core of the spleen and stomach theory. According to the physiological functions and pathological characteristics of the spleen, Prof. Li develops the unique fifteen methods of treating the spleen and the method are important parts of his academic thinking.1.4 Treating the spleen and stomach diseases with the sweet flavorProf. Li prefers to the herbs of ginseng、atractylodes rhizome、astragalus、liquorice with sweet flavor, which can invigorate the spleen and benefit the stomach. He prefers to treat yang deficiency syndrome with sweet and warm flavor herbs, and to treat yin deficiency syndrome with sweet and cool flavor herbs. The sweet flavor herbs can remove the pathogenic factors, support the vital qi and relieve spasm and pain.1.5 Coordinating the herbs with moisture and dryness natureThe food can not be digested and absorbed due to spleen deficiency, which also leads to the production of endogenous heat. Inadequate body fluid results in symptoms of thirst, so Prof. Li prefers the herbs with the function of tonifying the spleen and dissipating phlegm. He prescribes the herbs with the function of nourishing yin and generating body fluid, which can remove the dampness and heat, protect fluid, and also can prevent yin damage caused by the herbs with drying dampness and dispersing phlegm.1.6 Homology of herbs and foodThe source of herbs and food are the same. They not only have some food value and nutrition, but also can be used to treat diseases, keep health, which constitute the physical base of the Traditional Chinese Medicine theory called "the same source of medicine and food". The flavor theory is the inherent law and we should regulate diseases under the guidance of the dialectical theory.2 Clinical experience of Professor Li Qiangou2.1 Prof. Li’s experience of diagnosing and treating the stomach pain①Prof. Li first proposes that "Stomach pain" is different from "Stomachache". The former refers to the occurrence of stomach diseases, limited to the stomach organs.②He proposes that the pain is caused by deficient and excess syndrome, and opposes "no supplement qi if there is pain".③He summarizes the patterns referring to the main symptoms combining with the affiliated symptoms of stomach pain to make it easier to diagnose, treat and grasp.④He thinks that spleen qi stagnation is the basic pathogenesis of stomach pain, we use the Sijunzi decoction and Zhizhu pill to nourish the stomach, add or subtract the herbs based on syndrome differentiation. Meanwhile, Prof. Li also stresses the health preservation and rehabitation. 2.2 Prof. Li’s experience of treating atrophic gastritis. Prof. Li thinks qi deficiency and blood stasis are the basic pathogenesis of atrophic gastritis. We should grasp the character and use the herbs of activating blood circulation as soon as possible to reverse the pathological changes of the diseases. He prefers to the Sijunzi decoction, with addition of salvia、zedoary turmeric and always gets good efficacy.2.3 Prof. Li’s experience of treating gastroesophageal reflux diseases. Prof. Li promotes "Xiongpi" as the disease name. He usually treats the liver and stomach together and use the Liujunzi decoction、Xuanfudaizhe decoction combining with Chaihushugan powder, adding or subtracting the herbs according to the syndromes.2.4 Prof. Li’s experience of treating ulcerative colitis. In the ulcerative colitis treatment, Prof. Li regards the wet and heat of spleen deficiency and the impairment of venae of intestinal tract as the main pathological mechanism. Prof. Li divides it into two types, as the acute and the chronic phase, for different treatment.2.5 Prof. Li’s experience of treating functional constipation. The function of six fu-viscera is well when unobstructed, but purgation is not the only way to get unobstruction. We often take the methods of spleen-tonifying and purgation,such as Sijunzi decoction, in which we use the ginseng、raw atractylodes rhizome. We add or subtract herbs according to syndromes, such as blood deficiency and dry intestine, yin deficiency of kidney, yang deficiency of kidney qi deficiency,and treat obstructive symptoms by tonification. For the constipation of excess pattern, we can use the Chengqi decoction together.2.6 Prof. Li’s experience of treating oral ulcers. He thinks we should seize the "fire" and make the excess fire different from the deficient fire. The sufficient ulcer is caused by excessive fire of spleen and heart and we use the Xiexin decoction and Xiehuang powder. The deficient ulcer caused by yin deficiency of kidney and heart and we use the Zhibaidihuang decoction and Zengye decoction, and combining with the local administration to relieve the pain.2.7 Prof. Li’s experience of syndrome differentiationProf. Li is skilled in diagnosis and treatment, opposes the methods of adding one herb when seeing one symptom. He stresses the truth to prevent the misdiagnosis:such as the factors affecting tongue diagnosis and pulse diagnosis are complicated; the symptoms of patients are often not a single cold or heat syndrome, so we should not regard it as cold syndrome when seeing the cold symptom, and heat syndrome when seeing the heat symptom. Qi stagnation can cause abdominal distension, but qi movement is closely related to spleen, liver, lung. So activating qi and removing the distension is only the temporary method, the radical method is to regulate qi movement, such as ascending, descending and lifting. The stomach is the organ with excessive qi and blood, so we should stress qi and blood differentiation, and advocate the combination of macroscopic syndrome differentiation and microscopic syndrome differentiation in TCM2.8 Prof. Li’s experience of treating stomach diseases with herbsProf. Li takes the methods of treating stomach diseases according to the syndromes, and prescribes the herbs based on the methods. He uses the effective but not complicated herbs, and stresses the changes. How to reply to the syndromes changes based on supporting and protecting the spleen, which is the materiel basis of the acquired constitution. The paper introduces Prof. Li’s related experience of using the herbs.2.9 Besides the digestive system diseases, Prof. Li Qiangou is also good at treating cervical vertigo and chronic coughing.Part III:the clinical research on treating stomach pain with Jianpiliqi decoctionSelect Prof. Li’s experienced prescription of Jianpiliqi decoction to treat the stomach pain, and the omeprazole for the control group. There are 60 cases in each group. Compared to the TCM efficacy and improvement of the primary syndromes, there was a significant difference between the two groups. The treatment group was superior to control group in improving the stomach pain, epigastric fullness and distention, early satiety and other symptoms. ObjectiveTo evaluate the functions of strengthening spleen and regulating qi on treating dyspepsia epigastric pain syndrome of functional dyspepsia (EPS-FD) by observing the clinical effect of using " spleen-strengthening and qi-regulating formula " to treat epigastric pain syndrome of functional dyspepsia (EPS-FD).Methods1. A total of 120 patients were selected with epigastric pain syndrome, who were in accordance with the inclusion criteria, were randomly divided into the treatment group of 60 cases, the control group of 60 cases. There were no significant differences between two groups on age, gender and total scores of TCM symptoms before treatment and the two groups were comparable(P<0.05);2. Patients in the treatment group were given spleen-strengthening and qi-regulating formula,2 times a day after half an hour of meals for 4 consecutive weeks; the control group were treated with omeprazole 10mg, taken before breakfast, once a day for 4 consecutive weeks.3. The effects were observed respectively, then scores variation of individual symptoms and general symptoms, total scores of syndromes and overall syndrome effects, as well as the life quality scores were compared between the two groups before and after treatment.4. Statistical analysis methods:SPSS 15 software package for statistical analysis, measurement data with (±S), before and after treatment of the groups were compared using paired sample t test, and the two groups were compared using independent samples t test; count data with both groups of overall efficacy were compared using the nonparametric Wilcoxon rank sum test.Result1. The improved aspects in the individual symptom scores:group that given spleen-strengthening and qi-regulating formula can relieve the epigastric burning sensation and early satiety (P<0.05),and can significantly improve the condition of upper abdominal pain and postprandial fullness (P<0.01).The effects of spleen-strengthening and qi-regulating formula group is better than the omeprazole group (P<0.05)in improving this condition; and results were the same after the follow-up for one month.2. Evaluation on overall symptoms:among the 60 cases in treatment group,17 cases were clinical cured,20 cases were excellent effective and 17 cases were effective with the total effective rate of 90%. Among the57 cases in the control group,10 cases were clinical cured, 18 cases were excellent effective and 12 cases were effective with the total effective rate of 70.1%. The overall efficacy of treatment group was better than the control group (P<0.01).3. The total scores of TCM symptoms:the total scores of TCM symptoms were both improved greatly after the treatment(P< 0.01)but the effects of spleen-strengthening and qi-regulating formula group is better than the omeprazole group (P<0.05); and also the same results after the follow-up for 1 month (P<0.01).4. Evaluation on overall syndrome effects:among the 60 cases in treatment group,19 cases were clinical cured,22 cases were excellent effective and 15 cases were effective with 4 cases performing ineffectively; the total effective rate was 93.3%. Among the 57 cases in the control group,12 cases were clinical cured,19 cases were excellent effective,15 cases were effective with11 case performing ineffectively; the total effective rate was 80.7%. The overall efficacy of treatment group was better than the control group (P< 0.01).5. Assessment on quality of life:two groups after the treatment,8 dimensions of quality of life has improved (P< 0.05). Chinese medicine group has improved significantly in physiological function, social function, physical pain and mental health (P< 0.01), and is better than Western medicine group in the social function, body pain, mental health aspects(P <0.05).ConclusionIt suggested that spleen-strengthening and qi-regulating formula for some degree could improve the main functional dyspepsia symptoms with upper abdominal burning sensation, upper abdominal pain, early satiety and postprandial fullness and discomfort, and also can significantly improved clinical symptoms and life quality of patients with functional dyspepsia. Therefore, it was a good method of strengthening spleen and regulating qi to treat functional dyspepsia,especially the epigastric pain syndrome, and it was worthy of further promotion in clinical application. |
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