Discussion On TCM Syndromes And Syndrome Factors Of Reflux Esophagitis Based On Literature

Objective:Through literature retrieval and classification,the distribution status and structural characteristics of TCM syndromes in reflux esophagitis(RE)were understood.This paper discusses the correlation between syndrome element and syndrome formation,syndrome type structure and disease pathogenesis,and analyzes the influence degree of common syndrome element on TCM syndrome,treatment and prescription drugs,so as to provide certain reference for the establishment of TCM syndrome differentiation scheme with syndrome element as the core and provide reference for TCM clinical syndrome differentiation and treatment.Method:?More than 50 medical journals related to syndrome differentiation and treatment of RE are searched from 2004 to 2019,including China National Knowledge Infrastructure(CNKI),Vip Database(VIP),China Biology Medicine(CBM)and Wanfang data center.According to inclusion criteria and exclusion criteria,a total of 4340 RE cases were included,with 96 documents meeting the criteria.?The description of clinical symptoms,syndrome types and Chinese drug names was standardized,and the evidence collection factors were extracted from the syndrome types to establish a database.?The frequency analysis of RE syndrome type,syndrome factors,clinical symptoms,treatment method and prescription is carried out to conclude the general structure of RE main syndrome types,syndrome factors,symptoms,treatment methods and formulae.?The correlation between RE syndrome and syndrome element,syndrome element and treatment and prescription is analyzed.Results:?There are many types of RE syndrome differentiation in traditional Chinese medicine,including 27 independent,rare,occasional and compound syndromes.However,the composition ratio of liver-stomach disharmony syndrome(32.40%),liver-stomach stagnation syndrome(29.15%),spleen deficiency and qi stagnation syndrome(6.45%),and cold-heat syndrome(5.35%)is the largest,especially the liver-stomach disharmony syndrome.?The results of literature summary and statistics show that compound syndrome elements constitute the first proportion in 4340 RE cases,in which 5 disease location syndrome elements(stomach,liver,spleen,meridian and bile)and 11 disease syndrome elements(qi stagnation,internal heat,qi inversion,phlegm,dampness,cold,blood stasis,food volume,qi deficiency,Yang deficiency and Yin deficiency)appear in total.The main syndromes were stomach,liver and spleen,and the stomach is the first.The main syndromes were qi stagnation,internal heat,qi adverse reaction and qi deficiency.?Through the summary of the four diagnosis information,it is found that acid vomiting and heartburn are the main symptoms of RE,while chest pain and belching are the common side effects of RE.?There are 14 kinds of treatment methods involved in the literature,the most common treatment method is soothing the liver and regulate qi and stomach.The method of soothing the liver,relieving heat and stomach,the method of invigorating the spleen and regulating qi and stomach,and the method of opening pungent and descending bitter and stomach are all behind it.Their occurrence rate is more than 5%,and they are all common treatments.The cumulative frequency of regulating stomach and lowering the adverse is 96.02%.Soothing the liver and regulating qi is often used to treat re together with clearing heat,tonifying spleen,transforming phlegm and regulating stomach(78.34%).?In the literature,116 prescriptions are used,of which 26 are classic prescriptions(prescriptions of classics and formulae),and 90 are mixed,or added or subdivided,or self-formulated.The composition ratio of the classic prescriptions is zuo jin pills(6.36%),banxia xiexin soup(3.96%),chai hu shugan powder(3.94%),and si inversion Dan tang(3.85%).?The classic prescriptions with the highest frequency of frequent witness are:A syndrome of disharmony between liver and stomach:chaihu shugan powder(12.16%);B.Syndrome of liver and stomach heat:zuojin pills(18.66%);C syndrome of spleen deficiency and qi stagnation:xiangsha liujunzi soup(8.57%);D cold and hot mixed syndrome:pinellia xiexin soup(19.44%).?The top 10 drugs with the frequency of use for the treatment of common witnessing type are:A syndrome of disharmony between liver and stomach:licorice root,radix bupleuri,squid bone,rhizoma coptidis,pinellia,evodia rutaeus,radix rutaeus,white peony root,white and tangerine peel;B.Syndromes of liver and stomach stasis:rhizoma coptidis,evodia rutaeus,licorice,chaihu,.pinellia,tucia cocos,cuttlefish bone,spirulina,ochre,gardenia;C syndrome of spleen deficiency and qi stagnation:licorice root,poria cocos,pinellia,tangerine peel,atractylodes,radix codonopsis codonopsis,arenaceous kernel,wood incense,jujube,yu jin;D mixed syndromes of cold and heat:licorice root,radix scutellariae,pinellia,dried ginger,rhizoma coptidis,radix codonopsis codonopsis,rhizoma atractylodes,radix rutaeus,fulia cocos.Conclusions:?Liver and stomach disharmony syndrome,liver and stomach stasis syndrome,spleen deficiency and qi stagnation syndrome,cold and heat mixed syndrome are the main clinical syndromes of RE.?The main pathogenesis of RE is liver loss and drainage,spleen and stomach transport function loss of division,stomach disharmony,stomach qi on the reverse,turbidity gas endogenous,internal heat,phlegm,blood stasis,cold,wet and so on.?The characteristics of RE syndrome are mainly empirical,with more heat and less cold.The onset of RE syndrome often involves multiple disease syndrome elements represented by the liver,spleen and stomach.Qi stagnation,qi inversion,internal heat and qi deficiency are the most common,and they are combined with dampness,phlegm,cold,Yin deficiency,Yang deficiency and blood stasis.?In clinic,the basic treatment is regulating qi and stomach,which is often supplemented by the treatment methods of clearing heat,strengthening the spleen,and eliminating phlegm,etc.But the common treatment methods are:soothing the liver and regulate qi and stomach;soothing the liver,relieving heat and stomach;invigorating the spleen and regulating qi and stomach;opening pungent and descending bitter and stomach.?The commonly used prescriptions with high frequency of frequent witness mainly include:disharmony between liver and stomach:chaihu shugan powder;liver stomach yu heat syndrome:zuojin pills;syndrome of spleen deficiency and qi stagnation:xiangsha liujunzi soup;cold and hot mixed syndrome:pinellia xiexin soup.This result is not exactly the same as the consensus on the diagnosis and treatment of gastroesophageal reflux disease issued by the digestive diseases committee of the Chinese society of integrated traditional and western medicine in 2017,the classification and treatment of syndrome types of liver-stomach disharmony syndrome,liver-stomach stasis syndrome,cold and hot mixed syndrome are roughly the same.However,there is a lack of introduction and treatment of spleen deficiency and qi stagnation.We believe that the syndrome of spleen deficiency and qi stagnation is also common in the course of RE.The results of this study provide some reference for the establishment of TCM syndrome differentiation scheme with syndrome element as the core in the future,and provide reference for the treatment of TCM clinical syndrome differentiation.