| Professor Zhu Shi-kai is the instructor of the fifth national old TCM academic inheriting of experts experience, Jiangsu Provincial famous TCM and western medicine expert, doctoral tutor of Nanjing University of Chinese Medicine, engaged in more than fifty years in clinical medicine, especially good at treating spleen and stomach disease. He has accumulated rich experience. Inheriting and carrying forward the tutor's academic thoughts and clinical experience in spleen and stomach disease is the purpose of this study, the author follows the Professor Zhu in clinical practice, collects and collates Professor's medical records, clinical experience, systematically reviews Professor Zhu's writings, papers, and widely reads ancient and modern literature, to identify their academic origin, draw a comprehensive summary of Professor's academic thoughts and clinical experience in spleen and stomach disease, which will be discussed in the following three parts.The first part:Through to the spleen and stomach theory origin, the formation of a review of the development through the ages, explore and analyze the zhu's academic thoughts in the treatment of spleen and stomach disease origin.Professor Zhu believes that the theory was derived from Neijing, developed by Zhongjing, and expressed by Lidongyuan, and developed and enriched by other doctors. Their working make a complete system of academic genre and theories. That is Professor's academic thoughts' foundation and source. Professor Zhu also learned from the other expert's experience, gathered all of their advantages, insist to combine traditional Chinese and western medicine means actively used in clinical.In decades, constantly summed up experience and sublimation theory treating spleen and stomach disease, to improve and complete his theory.The second part:To sum up Professor ZHU's academic thoughts and experience of stomach and spleen diseases in differentiating syndromes, establishing therapies, prescribing medicine and clew of diagnosis and treatment, which were got from Professor ZHU's teaching and my own understanding.The spleen and stomach disease of diagnosis and treatment of Professor ZHU academic ideas basically has the following several aspects:(First) Spleen's and stomach's function has different feature. Spleen is wet earth, like dry and evil embellish; stomach is dry soil, but evil dry or embellish.We should distinguish clearly, also should follow their features on treatment,.He medicine for the treatment of spleen disease often use warm and dry drugs,for stomach often use feminine drugs. Professor ZHU pay attention to ascending and descending movement of spleen and stomach. Spleen transporting nutrients upwards, the stomach being liable to sending digested food downward.They maintain dynamic balance, maintain the normal physiological function of the body. Spleen and stomach disorders, there will be a variety of diseases. (Second) "Yangming disease is mainly with excessive, while Taiyin disease mainly with deficiency." The imbalance of the spleen's physiological function cause indigestion of water and cereals,which lead to the decline of Qi ascending function. Spleen Qi can be easily damaged, while accumulated dampness can also damage the Spleen Yang. Therefore, spleen disease is always related to deficiency, cold syndrome. The damage of stomach function can cause the obstruct of Fu-Qi, which lead to constipation. At the same time, the stomach belongs to Yang,and apt to heat and obstruction, therefore, stomach disease is always related to the excessive, heat syndrome. Professor Zhu think that the stomach-spleen disease is a long course disease, and usually with excessive at the early stage, but as the disease progresses, the damage of spleen function could lead to the mix of excessive and deficiency. The spleen and stomach provide the material basis of the acquired constitution, the deficiency of their function can cause the lack of the source of Qi and blood, Yin and Yang loss, which ultimately lead to deficiency. Therefore, the spleen-stomach disease is mainly with deficiency, clinical treatment should firstly strengthen the spleen and stomach, then disperse XieQi, and should tonify spleen function throughout the whole treatment. (Third) According to pathogenesis of spleen-stomach disease as discussed above, Zhu use the method of emanating with acrid drugs and descending with bitter drugs, cold and heat drugs, tonification and purgation in combination, thus recover the spleen-stomach's normal ascending and descending function. In addition, when Zhu prescribe the benefit drugs for spleen-stomach, he often adds other drugs to adjust the formula, so that it could be complement rather than stagnation, but also to prevent the injury of Yin and Qi. (Forth) Liver and spleen-stomach in physiological interdependence:Liver-Qi promote the function of spleen and stomach to transport of food and water, liver and spleen collaboratively control blood generation and storage. The spleen and stomach Yin blood moisten liver, which can Inhibit liver-Qi. Liver, spleen and stomach in the pathology influence each other, which one organ's disease can influence the other, can lead to the excessive liver Qi affend spleen, or the weakness spleen Qi insulated by liver. So Zhu emphasis the liver theory when in the treatment of the spleen and stomach disease. At the same time, pay attention to the combination of physiological and psychological factors, despite the use of drug, but also often give patients with psychological treatment. (Fifth) In the treatment of spleen-stomach disease, Zhu use the combination of western medicine and Chinese traditional medicine, based on the combination of disease differentiation, patient's characteristics, syndromes performance and indicators, which can be more hit the pathogenesis, make the treatment in line with clinical practice.Zhu is experienced in clinical treatment of diseases of the digestive system, we select some diseases to summarize his thoughts of diagnosis and treatment, as following:1, chronic atrophic gastritis:pathogenesis based on root deficien cy and branch excess, root deficiency presents with spleen-stomach Qi-Yin insu fficiency and branch excess with obstructed blood in stomach meridian, as the standard treatment of blood circulation and tonification of the spleen and stoma ch for the basic law, he prescribes the "Huo Wei Hua Yu formula".2, function al dyspepsia:pathogenesis is characterized by weak stomach, obstructed Qi, im balance of ascending and descending function, mostly pathologically mixed wit h excessive and deficiency, based on the spleen deficiency, the accumulation of Qi, food, dampness, heat, phlegm and blood as the excessiveness. Syndrom e differentiation should based on the actual situation of cold and heat, and stre ngthen the Spleen and regulate Qi is the basic treatment. In particular, attentio n should be paid to the ascending and descending function, this should always been regarded throughout the treatment.3, irritable bowel syndrome can be di vided in three type:diarrhea, constipation and mixed. The pathogenesis is char acterized by liver depression spleen deficiency, disharmony between liver and spleen, the declination of ascending and descending function, intestinal disorder s. Pathological factors include Qi stagnation, coldness and dampness, heat, and Phlegm, food and so on. Differentiation should distinguish cold and heat, as w ell as and the accompany syndromes. "No obstruction no pain and vice versa" is the basic treatment of IBS with abdominal pain. Differentiation should disti nguish the weakness and excessiveness, correctly chose the tonfication or dispel ling treatment. Diarrhea type should be clear the dampness, heat, sooth at the first stage, and strengthen the spleen lately. When treat constipation, regulate th e liver Qi in Qi stagnation type, and clear heat and moisten the intestine in th e dryness and heat acclamation type.4, chronic constipation:The pathogenesis is characterized by conduction disorders, closely related to the spleen, stomach, lung, liver and kidney organs function. The main pathogenesis include:transp ort of weakness caused by the Qi deficiency of lung and spleen, intestinal fail ure to moisten caused by the deficiency of fluid and blood; liver qi stagnation; the loss of body fluid caused by heat accumulated in the intestine; the accum ulation of cold caused by Yang deficiency and weakness. Treatment should dist inguish the actual situation, use reducing and purgation method in excessive, w hile tonficaiton and nourish fluid in deficiency.The third part:The clinical study of the Jianpi Tiaogan Guchang formula on Diarrhea type irritable bowel syndrome (IBS-D). Method:80 patients met the diagnose criteria of IBS-D was divided into two groups,40 cases each. The treatment group was treated with Professor's Jianpi Tiaogan Guchang formula, the control group was treated with pinaverium bromide. The treatment course was four weeks. Records and two sets of main symptoms and signs scores were compared between before and after treatment. Follow-up 4 weeks after the drug was stopped, carries on the long-term curative effect observation. Result:Treatment group for diarrhea IBS patients stool, abdominal symptoms (abdominal pain or discomfort) and the accompanying symptoms improved better than that in control group (P< 0.05). And long curative effect in 4 weeks after discontinuation of treatment group is better than that of control group, the difference was statistically significant (P<0.05). Conclusion:The Jianpi Tiaogan Guchang formula can more effectively improve the symptoms of diarrhea type irritable bowel syndrome patients which are liver depression and spleen deficiency, improve the curative effect. |
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