Clinical Experience Study Of Professor Yao Naili In Treatment Of Chronic Atrophic Gastritis

BackgroudChronic atrophic gastritis is a kind of common digestive system disease that evolved from chronic superficial gastritis. The pathologic features of the chronic disease are thinner mucosa, the atrophy of gland, a decrease in the number of gland and even intestinal metaplasia or dysplasia.In our country, the number of CAG positive patients accounted for 7.5%-13.8% of the total number of tested people. World Health Organization reports that the risk of CAG increased with age.As a high risk factor, causing gastric, CAG’s canceration rate is 0.5%-1% every year and about 16 million people died of stomach cancer each year in our country. In 1978, CAG was listed as the precancerous condition of gastric cancer by WHO and which is defined as seriously harmfulness on human health.At present, there is no specific among western medicine for CAG, and the disease index and the results attached great importance in the treatment. In the early stages of CAG, the symptom usually is not obvious, so no treatment will be adopted. As the disease got worse, observe closely and surgery can be used lately.Recent years, a large number of clinical studies had demonstrated that traditional Chinese medicine can not only improved the symptoms of the CAG, but also had good curative effect on gland atrophy, intestinal metaplasia, hyperplasia, acute or chronic inflammatory pathological changes. Therefore, more and more CAG patients are willing to accept treatment of traditional Chinese medicine or the treatment combined Chinese traditional with western medicine.Combined the experiences of predecessors with decades of clinical practice,professor Yao Naili had a deep research on the morbidity factor, pathogenic mechanism and the evolution of symptoms of chronic atrophic gastritis, intestinal metaplasia and dysplasia as well as his unique experience and characteristics in treatment of chronic atrophic gastritis with the guidance of traditional Chinese medicine theory.PurposeBy summary of the etiology and pathogenesis of chronic atrophic gastritis, the diagnosis and treatment carried by Professor Yao Naili, and the speculative characteristics and clinical experience of Professor Yao, the aim of this paper is to inherited fully the academic ideas and clinical experience of old Chinese medicine. At the same time, this paper observed the therapeutic effects of Jianpi hewei Jiedu tongluo basic prescription used by Professor Yao Naili in practice and taked a combination of experience and clinical trial. The purpose is to inherit and carry forward the clinical experience and academic thoughts of famous TCM doctor, provide models for later scholars, and improve the clinical effect of TCM by the way to develop the potential ability of Jianpi hewei Jiedu tongluo basic prescriptionMethodBy collecting the clinical cases of chief physician Yao Naili in his treatment on chronic atrophy gastritis, learning from teacher and accepting personal guide of Professor Yao Naili,this paper summarized the clinical experience of Professor Yao Naili which included the etiology and pathogenesis, diagnostic and therapeutic approaches, syndrome differentiation and treatment experience and prescription.The clinical curative effect observation was performed in 60 CAG patients by using the self-control study methods.The study used Jianpi Hewei Jiedu Tongluo basic prescription as the basic prescription and treatment course lasts for six months,.Signs and symptoms of the patients were observed before and treatment, Patients’data were recorded at the start, the third months, sixth months, and ninth months respectively, and pathologic histology and related security index were recorded before treatment and after treatment (6 months after treatment). SPSS 17.0 was used as the statistical analysis software and the clinical curative effect valuation.ResultThe paper summarized the clinical experience of Professor Yao Naili in treating chronic atrophic gastritis. In the part of etiology and pathogenesis, he thinks that the disease results from improper diet, emotional disturbance and heat and cold toxin impaired the spleen and stomach leading to the stomach disagree declare war falls,cold-heat jumble, blood stasis and meridian dystrophy.He proposed that weakness of the spleen and stomach, cold-heat jumble, the stomach disagree declare war falls, lingering pathogenic toxin and meridian dystrophy are the basic pathogenesis of the disease and weakness of the spleen and stomach is the basis cause of disease, cold-heat and damp and toxin are important reason for disease occurrence, meridian stasis is the basic pathological change in occurrence, development of chronic atrophy gastritis and the key factor of pathogenesis of the disease is weakness of the spleen and stomach, poison damaged and meridian stasis.In the clinical practice, we must first grasp the basic pathogenesis of the diseases, combine the diseases differentiation and syndromes differentiation, especially emphasizes the important role of tongue in the process of syndrome differentiation.Then combining the physiological characteristics of spleen and stomach with the relations among the viscera, we should pay attention to liver and spleen, the results of electronic gastroscopy, and syndromes differentiation at the macroscopic scale and microscopic scale.In clinical diagnosis and treatment, This paper established the basic therapeutic from four aspects:to pay attention to spleen and stomach for treating the root, to toxin-relieving in case of a change, to change the rise-and-fall for regulating Qi, to treatment the whole for recovering.In drug usage, the characteristics of medication were use little dosage to tone spleen and stomach, pay attention to rise and fall to regulate Qi, vary the composition with syndrome, adjust treatment according to climate, locality and individual。Adopting Jianpi Hewei Jiedu Tongluo basic prescription in treatment of chronic atrophy gastritis, the total integral of main signs and symptoms after treatment oneand six months and the followed three months had respectively significant difference when contrast with the performance before treatment (P<0.01).And every sign and symptom before and after treatment 6 months were significantly different (P< 0.01).In the part of pathological score, there were significant differences in gastric atrophy, intestinal metaplasia, dysplasia and chronic inflammation of lesser curvature except active pathology from six months treatment and before treatment(P<0.05 or P <0.01).The differences of pathological score and total score at the greater curvature of gastric antrum before and after treatment were striking (P<0.05 or P<0.01).The pathology scores of gastric angle dysplasia had no statistic meaning before and after treatment.While the different scores of gastric atrophy, intestinal metaplasia, chronic inflammation and active pathology of lesser curvature except dysplasia after and before treatment had the significant meaning (P<0.05 or P<0.01).From the perspective of the curative effect evaluation of TCM symptom, eight (13.79%) cases have good effect, forty-four (75.86%)cases have effect, six(10.35%) cases have no effect, and the total treatment rate was 89.65% when patients accepted six months treatment.From the view of pathological effects, there were five cases to reverse atrophic gastric mucosa (8.62%), twenty-seven(46.55%)cases had effect,26(44.83%) cases have no effect, after treatment 6 months,There were three (5.17%) cases had marked effect on changing the intestinal metaplasia, thirty-two (55.17%) cases had effect, twenty-three(39.66%) cases had no effect.And to treat dysplasia, eleven (55.00%) cases had marked effect on, three (15.00%) cases had effect, six(30.00%) cases had no effect.After treatment,the total cure rate of patients’atrophic gastric mucosa, intestinal metaplasia and dysplasia were respectively 55.17%%、60.34%、 70.00%.ConclusionProfessor Yao Naili adopted unique treatment for chronic atrophy gastritis from aspects of etiology, pathogenesis, syndrome, treatment, medication and nursing. In clinical practice, Modified Jianpi Hewei Jiedu Tongluo basic prescription had better efficacy, higher safety in the treatment of chronic atrophy gastritis.