Summary of Professor Cao Yingxia's Clinical Experience in Treating Chronic Gastritis

: Professor Cao Yingxia believes that the incidence of chronic gastritis is most closely related to the stomach, liver and spleen. The etiology is mainly due to congenital deficiency, irregular diet, emotional disorders, excessive fatigue and so on. She believes that chronic gastritis is mainly based on spleen deficiency, and advocates that the syndrome of chronic gastritis is roughly divided into three types: spleen deficiency and dampness obstruction syndrome, liver depression and spleen deficiency syndrome, spleen and stomach dampness and heat syndrome. The treatment is based on the methods of invigorating qi and invigorating spleen to moisten, invigorating spleen to soothing liver qi, clearing heat and invigorating spleen to benefit dampness, invigorating spleen throughout the whole process, not forgetting to soothing liver, paying attention to the smooth of the middle-jiao qi-movement hub, and at the same time, symptomatic treatment, integrated treatment of traditional Chinese and Western medicine, both specimen and root causes, and has achieved a remarkable effect.

Chronic gastritis is a chronic inflammatory reaction of gastric mucosa caused by various causes, the most important of which is Helicobacter pylori infection [1].Gastroscopy and pathological biopsy are the main diagnostic basis for this disease.Most patients with chronic gastritis have no obvious clinical symptoms, and those with symptoms mainly manifest as non-specific dyspepsia, such as irregular upper abdominal discomfort, fullness, pain, loss of appetite, belching, acid reflux, etc.Some patients may also have mental and psychological symptoms such as amnesia, anxiety, and depression.The symptoms of this disease are prone to recurrent episodes, which seriously affect the quality of life of patients.Among them, chronic atrophic gastritis with intestinal epithelial metaplasia and intraepithelial neoplasia have an increased risk of gastric cancer, which has attracted more and more attention in clinical practice.At present, the important means of modern medicine for treating chronic gastritis is drug therapy.However, there are many substantive problems in the clinical application of drug therapy: long medication cycle, recurrent disease; drug resistance, poor treatment effect; many side effects and adverse reactions, etc. Traditional Chinese medicine has many years of accumulation in the diagnosis and treatment of this disease.In recent years, traditional Chinese medicine has made many progresses and good curative effects in the diagnosis and treatment of chronic gastritis, providing more effective ideas and solutions for the combination of traditional Chinese and Western medicine in the treatment of chronic gastritis.
There is no relevant ancient book record of the disease "chronic gastritis" in traditional Chinese medicine.But according to various clinical symptoms of chronic gastritis, the disease is classified into the category of diseases of the spleen and stomach system in traditional Chinese medicine, such as "gastric pain", "stomach fever", "vomiting" and "noisy".
Professor Cao Yingxia is the chief physician of Shaanxi Provincial Academy of Traditional Chinese Medicine (Shaanxi Provincial Hospital of Traditional Chinese Medicine), an expert of the expert database of central and western China, a standing member of the spleen and stomach professional committee of Shaanxi Provincial Association of Traditional Chinese Medicine Science and Technology Development, and a member of the emergency medical committee of Shaanxi Province.Professor Cao has been engaged in medical work for more than 40 years, paying attention to the combination of traditional Chinese and Western medicine in academic research, and has long been committed to the treatment and research of traditional Chinese and Western medicine for internal difficult diseases.Through syndrome differentiation and treatment, Professor Cao has achieved good results in the clinical treatment of chronic gastritis.Now, the experience of Professor Cao in the treatment of chronic gastritis is summarized as follows for reference by colleagues.

The key to the pathogenesis is spleen deficiency
The etiology of chronic gastritis, according to Professor Cao, is nothing more than congenital deficiency, internal injury diet, emotional disorders, and excessive fatigue.The pathogenesis, according to Professor Cao, is mainly spleen deficiency.Because of the improper diet, the spleen and stomach are damaged, leading to weak spleen and stomach, weak spleen and stomach, and weak stomach.Secondly, liver depression.Because of emotional disorders, the liver qi stagnation is caused, the liver loses its discharge, and against the spleen and stomach, so the disease occurs.Finally, internal dampness.Factors such as body deficiency, overwork and overwork, weak spleen and stomach, endogenous dampness, Qi blockage, or persistent heat, damp heat blockage, so the disease occurs.

Differentiating three syndromes and treating them mainly by strengthening the spleen
With more than 40 years of medical practice, countless patients have been received.Combined with clinical case data and comprehensive analysis of the etiology and pathogenesis of the disease, Professor Cao has roughly divided chronic gastritis into three major clinical syndromes, namely: spleen deficiency and dampness obstruction syndrome, liver depression and spleen deficiency syndrome, spleen and stomach damp-heat syndrome.The treatment is Shenling Baizhu powder, Chaishao Liujunzi Decoction, and Detoxification Pill.Starting from strengthening the spleen and strengthening the spleen, we should protect the stomach qi, and at the same time, we should not forget to loose the liver qi, treat the liver, spleen and stomach together, so as to achieve good results.

Syndrome of spleen deficiency and dampness obstruction
Clinical manifestations: abdominal distension and stiffness, especially after eating, limbs tired and weak, little breath and lazy words, poor urination, thin and clear stools, light and fat tongue, white and smooth moss, slow pulse.
Professor Cao analyzed that, on the one hand, in the high temperature and dry climate of autumn and summer, people like to eat raw and cold food, which belongs to yin, and is most likely to injure yang, and the spleen yang is damaged.The spleen's ability to transport and transform water and dampness decreases, and the body fluids are transported and distributed disorderly, which accumulates and produces dampness, which is blocked in the middle Jiao, so this syndrome is seen;on the other hand, people with weak congenital endowment, weak spleen and stomach, dereliction of duty in transport and transformation, and water and dampness are born, which also shows this syndrome.In the treatment, Professor Cao took the method of invigorating qi and strengthening spleen and dampness, and selected the classic prescription Shenlingbaizhu powder for adjustment and reduction.The ginseng in the prescription is often changed to the pseudostellariae radix.Modern research has shown that Shenlingbaizhu powder [2] can improve the immune function of the body, regulate the intestinal flora, reduce inflammatory reactions, and promote the repair of intestinal mucosa.Professor Cao pointed out that in the process of disease, dampness evil has the change from yin to yang, which mainly depends on the patient's own factors.The dampness evil in this syndrome belongs to the change from yin, which is mostly caused by the patient's usual yang deficiency and weak spleen and stomach, dampness from cold, and the victory of dampness is the weakness of yang, further damaging the yang qi of spleen.Therefore, Professor Cao often adds cinnamon, cloves, psoralea, Sharpleaf Glangal Fruit and other medicines to warm and tonify the spleen Yang in clinical practice, and advises that the dosage should be small, because such medicines are warm and dry products, easy to help wet heat, excessive fear of dampness from the Yang, which is why Professor Cao is too warm and dry to use Huangqi Jianzhong Decoction for this syndrome.In addition, when mentioning the medicine Sharpleaf Glangal Fruit, Professor Cao pointed out that the spleen is saliva in liquid, if the disease also sees spleen deficiency and salivation, it can be reused as appropriate to warm the spleen and absorb saliva.For dampness, it must have a way out, so it is necessary to increase pericarpium arecae and cortex periplocae to diuresis and eliminate dampness.Inheriting the idea of treating the liver and spleen together, Professor Cao often adds Exocarpium Citri Grandis, Semen Aesculi, Fructus Citri Sarcodactylis, Rhizoma Cyperi to play the effect of soothing the liver and regulating qi, drying and reducing phlegm.
In terms of clinical addition and subtraction, if there is halitosis and long-term thick and greasy tongue coating but no obvious heat, Professor Cao is happy to add a little Fructus Tsaoko to dry and wet the middle.If abdominal distension is very serious, it is often accompanied by Jiao Sanxian, Jineijin, and Semen Raphani to eliminate distention.If there is stomachache caused by dampness blocking the middle Jiao, Qi is not favorable, it is often added with Yanhusuo and Szechwan Chinaberry Fruit to soothe the liver and regulate qi and relieve pain, and "Biling Weitong Granules" to regulate Qi and relieve pain.If dampness hinders vomiting, it is often used with eupatorium and Herba Pogostemonis to aromatize dampness and stop vomiting.
The essence of this syndrome lies in spleen deficiency, which causes dampness.Professor Cao believes that the treatment should be to replenish the deficiency and purify the substance, and to strengthen the spleen throughout the disease, while not forgetting to scatter the liver, paying attention to to the smooth of the middle-jiao qi-movement hub, so as to achieve "treating the disease for the root cause".In addition, do not forget to pay attention to the outlet of dampness, benefiting urination to eliminate dampness to enrich the stool, while avoiding "closing the door and leaving the coward" in medication.

Liver depression and spleen deficiency syndrome
Clinical manifestations: flank pain, susceptible sigh, emotional depression or irritable, abdominal distention, stool discomfort, bowel movement, or abdominal pain and diarrhea, diarrhea pain reduction, white or greasy moss, pulse string or slow.
Professor Cao believes that, on the one hand, people in modern society are more impatient, and they are prone to emotional loss, anger injures the liver, the liver loses its discharge, the spleen and stomach are attacked, the spleen loses its health transport, and the stomach loses its peace and health, so this syndrome is seen.Secondly, for a living, people work hard, exhaustion, overwork injury, spleen damage, spleen dysfunction, liver loss of discharge, also see this syndrome.The liver and spleen are closely related, and they are often treated together in clinic.As the medical sage Zhang Zhongjing said: "When you see liver disease, you should know that the liver passes to the spleen, and the spleen should be strengthened first."For the treatment of this syndrome, Professor Cao took the method of strengthening the spleen and soothing the liver qi, and selected Chaishao Liujunzi Decoction for addition and subtraction.In the recipe, Professor Cao added a little Hypericum perforatum and Cordyceps cicadae to enhance the effect of soothing the liver and relieving depression, and used a small amount of agilawood and Acruginous Turmeric Rhizome to enhance the effect of promoting qi and relieving pain.At the same time, she gave the Chinese patent medicine "Jinyin Lidan Capsules" to enhance the effect of clearing heat and promoting dampness, soothing the liver and benefiting the gallbladder.Modern research has shown that Chai Shao Liu Junzi Decoction [3] has the effect of enhancing the human immune system, reducing inflammation and pain, regulating the gastrointestinal function of patients, and restoring the function of the spleen and stomach by inhibiting gastric acid secretion and promoting microcirculation.And Hypericum Perforatum [4] has obvious anti-anxiety and depression effects.
In terms of clinical addition and subtraction, if there is epigastric pain, the red and white two peony are often used together to exert the maximum effect of activating blood circulation and relieving pain.If there is acid reflux caused by liver qi, add Sepiae Endoconcha with thunberbg fritillary bulb namely "Wubei San" to inhibit acid reflux and relieve pain; If the acid reflux is severe, often add Concha Arcae and clamshell to restrain the acid production.If there is an upward reflux of stomach qi, add a little clove and Shidi to stop the reflux.If there is pain and diarrhea caused by liver and spleen disorders, add Fructus Citri Sarcodactylis to play the effect of "Tongxie Yaofang".If there is poor sleep caused by emotional insomnia, add Silktree Albizia Bark and Albiziae Flos to calm the nerves and relieve depression, or add Yejiaoteng and Spine Date Seed into the heart liver meridian to nourish the heart and calm the nerves; and if there is insomnia caused by depression of the liver generates pathogenic fire, add gardenia and Rhizoma anemarrhenae to remove the trouble.In addition, based on many years of clinical experience, Professor Cao taught that the irregular and uncomfortable stools caused by this syndrome are mostly caused by liver loss, liver qi stagnation, and the liver-gallbladder-fire.It can be attributed to the treatment of liver-gallbladder-heat syndrome of constipation.Often given "DangGuiLongZuoPian" to clear the liver and gallbladder, relieve fire and defecate.At the same time, the patient is told to take smooth stools as the degree.Because this medicine is bitter and cold, it will damage the spleen and stomach in case of overuse, and should be stop at this circumstance.
Whenever this syndrome is encountered in clinical practice, Professor Cao always reminds that the syndrome is mainly caused by spleen deficiency, and the pathogenic conditions should be blamed on liver depression.Therefore, the main treatment is still to strengthen the spleen, and to relieve liver depression as a supplement.The treatment of liver and spleen is combined to play its effect, so as to achieve good results.

Spleen-stomach damp-heat syndrome
Clinical manifestations: abdominal distention, nausea and vomiting, yellow urine, heavy limbs, or body heat, sweating and heat.Tongue red and yellow greasy, soft and rolling pulse.
Professor Cao adheres to the idea of "Dietary excess injures the spleen and stomach".She believes that with the rapid development of modern society, feasts, delicacies, and overeating are the most easy to injures the spleen and stomach.Diet without discipline, fond of fatty and thick flavor, easy to hurt the spleen and hinder the stomach, and retention of water in the body; constitution with excess yang, five flavors extreme, spicy without limit, and greedy drinking wine, is easy to help damp heat, so we see the syndrome of damp heat in the spleen and stomach.Therefore, Professor Cao takes clearing heat and strengthening the spleen, eliminating dampness and eliminating turbidity as the method, clearing heat and removing dampness simultaneously and chose Ganlu Xiaodu Dan, often adding Jiao Sanxian to stimulate appetite and digestion.Modern research has shown that Ganlu Xiaodu Dan [5] has the functions of sterilization, anti-inflammation, anti-endotoxin, antioxidant, liver protection, gastrointestinal mucosa protection, regulation of the body's immunity and lipid reduction.Professor Cao reminded that there are still famous prescriptions such as Sanren decoction, Mysterious Four Powder, Longdan Xiegan decoction for the treatment of damp-heat syndrome in clinic.However, in many years of clinical practice, when patients with this disease were treated with Ganlu Xiaodu Dan, the effect was more significant than the above famous prescriptions.Therefore, for the clinical diagnosis and treatment of this syndrome, Professor Cao learned to use Ganlu Xiaodu Dan as the main prescription and clinical addition and subtraction.The dampness, heat transformed from yang, damp-heat interlocking, so it becomes the damp-heat syndrome.Similarly, in order to find a way out of the damp-heat syndrome, Professor Cao used cold and cool products such as Hedyotis Diffusa , Dandelion, Herba Artemisiae Scopariae, christina loosestrife herb, common portulaca, etc. to clear heat and promote dampness and promote urine to induce damp-heat from urine.In terms of clinical addition and subtraction, if nausea and vomiting are severe, Bamboo Shavings and orange peel are often added to stop vomiting.If jaundice caused by damp-heat blocking the middle focus is also seen, Herba Artemisiae Scopariae, christina loosestrife herb, Japanese Climbing Fern Spore and other products that promote dampness and relieve jaundice are often used.If constipation is also seen, a little rhubarb or tiger stick is often added to relieve heat and defecate, and "DangGuiLongZuoPian" are also applicable.
In clinical practice, patients with this syndrome often have "halitosis" symptoms.Professor Cao has deep feelings about this: halitosis is generally caused by oral cavities, but mostly by the stomach fire.In clinical practice, the most common medication for the stomach fire is powder for clearing away stoma or gypsum decoction, but the actual effect is often not optimal; many patients' tongue diagnosis is pale, white, fat, and greasy, which is syndrome differentiation for spleen asthenia and dampness retention, heat transformed from yang, and even most of the patients have oral ulcers for many years.In treatment, Professor Cao prefers to add and subtract Ganlu Xiaodu Dan, which aims to "eliminate" and "guide".With the help of the role of drugs, spleen-tonifying and dampness-removing, heat-clearing and detoxification, and guiding the turbid gas in the body to drop.This is the central link in the treatment of halitosis and mouth ulcer.With the addition and subtraction of drugs according to syndrome differentiation, the clinical effect is quite good.

Discussion
In summary, Professor Cao Yingxia has always adhered to the idea of "spleen deficiency as the basis, treating liver and spleen together, and combining Chinese and Western medicine".She emphasizes that we should pay attention to the overall concept, and take measures according to people, time and place.At the same time, she emphasizes that we should pay attention to the close relationship between liver and spleen, so as to strengthen the spleen without forgetting to slacken the liver, and slacken the liver without forgetting to strengthen the spleen, and treat both symptoms and root causes.And Professor Cao emphasizes the long course of chronic gastritis, easy to repeat, usually should pay attention to diet regulation, adjust the mood, appropriate exercise, pay attention to "three points medicine, seven points nursing".Only then can we achieve good results.