"Deficiency" and "stagnation" are prominent pathological features throughout peptic ulcer.
Peptic ulcer can be divided into "epigastric pain", "noisy" and "fullness" in traditional Chinese medicine. Mao pointed out that the normal function of digestive system depends on the coordination of physiological functions of spleen and stomach and the normal operation of liver and gallbladder functions. When the spleen and stomach are healthy, qi and blood are active; Liver and gallbladder shine together, and the spleen and stomach rise and fall in an orderly manner.
If you don't eat properly, such as overeating, eating too much and catching cold, or being hungry and combining work and rest, you can damage the middle qi, resulting in the stomach being unable to accept and rotting, and the spleen being unable to transport. For example, Li Dongyuan's spleen and stomach theory said: "If the husband has a bad diet, he will suffer from stomach disease ... If he has a stomach disease, the spleen will suffer nothing ... and the spleen will get sick; Physical labor causes asplenia ... asplenia causes the stomach to be unable to conduct body fluids. Therefore, it is also sick. Deficiency of the spleen and stomach for a long time leads to qi damage to yang, which leads to spleen and stomach deficiency and cold syndrome. Congenital deficiency, loss of body yang, loss of middle energizer and warm nourishment will cause spleen and stomach deficiency and cold for a long time. Deficiency of spleen and stomach leads to poor transport, insufficient source of qi and blood biochemistry, malnutrition of viscera, and loss of honor of stomach collaterals leads to pain; Abnormal rise and fall of spleen and stomach, qi stagnation, obstruction of middle energizer and obstruction of stomach collaterals also hurt. Therefore, a number of syndrome groups with epigastric pain as the main symptom can appear, which is the pathological basis of peptic ulcer. In the formation and development of the pathogenesis of spleen and stomach deficiency and cold, if the body has bad emotions, it can lead to liver failure and qi stagnation; The soil is weak, the liver qi is excessive, and the middle energizer is damaged, resulting in stagnation of liver and stomach qi; Spleen and stomach deficiency and cold, abnormal transport and transformation, water and liquid are blocked, and it stops gathering in the body, which is phlegm and blood stasis; Stomach loss of appetite, spleen loss of transport, eating difficulties, and gradually become food stagnation; Yang Qi deficiency will lead to slow blood circulation, blood stasis and blood stagnation. In the pathogenesis of peptic ulcer, all kinds of blood stasis can be accompanied by spleen and stomach deficiency and cold.
Based on the above understanding, Mao emphasized that the pathogenesis of peptic ulcer has two prominent pathological characteristics: one is "deficiency", that is, deficiency of spleen and stomach leads to internal cold; One is "stagnation", which refers to qi stagnation of spleen and stomach, liver stagnation or liver and stomach, as well as pathological products such as phlegm and blood stasis, dampness stagnation, food stagnation, heat stagnation and blood stasis. The former is the pathological essence of peptic ulcer, and the latter is the pathological appearance of peptic ulcer. In a word, the pathogenesis of peptic ulcer can be summarized as deficiency and cold with stagnation, and its location is in the stomach (intestine), but it is closely related to spleen, liver (gallbladder) and other viscera.
Warming meridians and dredging stagnation is the basic principle of treating peptic ulcer.
Ye's Clinical Guide to Medical Records points out that "ascending is spleen health, descending is stomach harmony". Only when they work together can the digestion, absorption, transmission and subtle distribution of food and drink be completed. Su Wen Bao Bao Ming Xing Lun said: "The soil can find its place", which means that the normal assimilation of spleen and stomach depends on the function of liver and gallbladder. Because the pathogenesis of peptic ulcer is spleen-stomach deficiency and cold stagnation, while spleen-qi will rise and stomach-qi will fall, and the premise of ascending and descending is smooth qi flow, Mao pointed out that the word "tong" should be the main word in clinical treatment of this disease, and the goal should always be to reconcile spleen and stomach, relieve its stagnation and restore its ascending and descending. The methods of communication are flexible and changeable: strengthening the spleen and benefiting qi, warming the middle warmer and dispelling cold, soothing the liver and relieving depression, regulating qi and relieving depression, resolving phlegm and dampness, resolving food stagnation and removing blood stasis. In short, the purpose of clinical treatment is to eliminate stagnation of deficiency-cold of spleen and stomach, restore normal functions of spleen and stomach, such as absorption, decomposition and transport, so that Yang Can of spleen can be restored, deficiency-cold can be eliminated, qi can be unblocked, and stagnation can be dissipated, so that syndromes no longer exist. "Su Wen Zang Qi Lun" said: "The spleen wants to slow down, the urgent food wants to slow down, and the bitter diarrhea wants to make up"; "The liver is bitter and anxious, and it is urgent to eat slowly"; "The liver wants to disperse, eat spicy food to disperse it, fill it with spicy food, and diarrhea with acid. On this basis, Mao pointed out that warming the middle warmer and strengthening the spleen, regulating qi and relieving depression are the fundamental methods to treat peptic ulcer.
To treat peptic ulcer with warming therapy, we must master the corresponding clinical indications. Referring to the Guiding Principles of Clinical Research on the Treatment of Peptic Ulcer with New Traditional Chinese Medicine and combining with the clinical practice, the research group formulated the Diagnostic Criteria of Spleen and Stomach Deficiency and Cold Syndrome. Main symptoms: 1 dull pain in stomach pain, preference for warm pressure, eating less loose stool, and easy to attack or aggravate after catching a cold or fatigue; 2 empty abdominal pain is very severe, and the pain is relieved, abdominal distension after meals; The tongue is tender and smooth, fat, with teeth marks on the edge and thin white fur; Pulse is weak or late. Secondary symptoms: 1, stomach pain aggravated by emotional exhaustion, or accompanied by fullness in chest and hypochondrium, hiccups and belching; 2. Stomach fullness, purulent acid, nausea and vomiting, thick and greasy tongue coating; Persistent stomachache, severe pain at night, or hematemesis, dark stool, pale tongue, or ecchymosis. If the above-mentioned main symptom 1 is satisfied, any one of the main symptoms and any one of the secondary symptoms can be diagnosed as peptic ulcer with spleen-stomach deficiency and cold coagulation, which can be treated by warming and dredging stagnation.
Anweiqingyou recipe is an effective prescription for treating peptic ulcer.
Mao found in long-term clinical observation that the basic pathogenesis of peptic ulcer is spleen and stomach weakness and cold coagulation. However, modern medicine believes that the occurrence of peptic ulcer is related to the imbalance of the "attack and defense mechanism" of the body, in which the attack factors mainly refer to gastric acid, pepsin and Helicobacter pylori (Hp), and the defense factors mainly refer to the gastric mucosal barrier. In particular, Helicobacter pylori plays a very important role in the pathogenesis of peptic ulcer.
Mao summarized the basic prescription for treating peptic ulcer-An Wei Qingyou Prescription according to the knowledge of Chinese and Western medicine and after long-term repeated clinical screening and verification. Its medicinal composition is: 30g of raw astragalus, 0g of codonopsis pilosula15g, 0g of raw atractylodes macrocephala15g, 0g of raw white peony root10g, 5g of areca nut, 5g of galangal officinale, 0g of cassia twig/kloc. Astragalus membranaceus in the prescription is warm and sweet, enters the spleen and lung meridians, benefits qi, and has the functions of lifting yang, supporting toxin and promoting granulation, so it is the monarch medicine. Codonopsis pilosula belongs to Ganping, which can "strengthen the spleen and nourish the stomach" ... strengthen the spleen but not dry, and nourish the stomach yin but not wet "(herbal justice); Atractylodes macrocephala is bitter and warm, which can strengthen the spleen and stomach, dispel cold and dampness, and stop vomiting and diarrhea. "The ability to eat and tonify the valley is also the first medicine for strengthening the spleen" ("Seeking Truth from Materia Medica"), which is the same as the minister medicine of Dangshen. Paeonia lactiflora is bitter and slightly cold, which can harmonize the spleen and stomach and prevent Wang Mu from occupying the soil; Guizhi is sweet and warm. "It can be used for recuperating, activating yang, promoting diuresis, lowering qi, removing blood stasis, and tonifying the middle energizer" (Shuzheng in Classic), and can be used together with Paeonia lactiflora to recuperate qi and blood; Alpinia officinarum is pungent and hot, which specializes in treating spleen and stomach cold pathogens, and has the effects of warming the middle warmer to dispel cold, relieving pain and stopping vomiting; Areca nut is hard and warm, "a medicine for treating various qi, eliminating miasma, breaking depressed qi, releasing depressed qi, reducing phlegm, removing accumulated qi, eliminating pathogenic qi, eliminating valley qi, removing water vapor, dispersing beriberi, killing insects, ventilating qi, relaxing middle qi and releasing lower qi", "This medicine is widely used, so that qi can be dispersed and blood can be eaten. Of the above four flavors, * * * is an adjuvant. Licorice is sweet, which is beneficial to middle energizer, ginseng, invigorating qi and surgery. Secondly, compatibility with Radix Paeoniae Alba can relieve pain and treat abdominal colic caused by deficiency and cold of spleen and stomach. Third, the medicine can be adjusted, which is an auxiliary medicine. The whole prescription * * * has the functions of warming the middle warmer, strengthening the spleen, harmonizing and nourishing blood, regulating qi and relieving depression, removing blood stasis and relieving pain.
Clinically, add and subtract according to symptoms: for patients with pantothenic acid, cuttlefish bone 10g and Fritillaria thunbergii10g can be added; For retching patients, add Pinellia ternata 10g or bamboo shavings 10g and ginger10g; For drooling, add 10g kitchen soil (dissolved mixture); For patients with liver depression, add bergamot 10g and raw malt 10g.
Study on the treatment of peptic ulcer with the method of warming depression.
Mao's clinical treatment of peptic ulcer is based on Qingyou recipe, which is modified with the symptoms and has obvious curative effect. From 1996 to 1997, under the guidance of Mao, the author made a serious and systematic observation on 30 patients with peptic ulcer. The results showed that the total effective rate of An Wei Qingyou Decoction in treating this disease was 93.3%, which was equivalent to bismuth preparation (P >; 0.05), the main symptoms disappeared quickly after taking the medicine, and there was no obvious adverse reaction, which initially confirmed the correctness of the method of warming and removing stagnation in treating peptic ulcer.
From 20 12 to 20 13, the research group conducted a further clinical study on the treatment of peptic ulcer with An Wei Qingyou recipe, and 30 patients with peptic ulcer were treated with An Wei Qingyou recipe and Lansoprazole tablets respectively. The results showed that after 8 weeks of treatment, the total effective rate under gastroscope was 96.7%, which was better than that in lansoprazole control group (83.3%, P < 0.05). 0.05); The total clinical effective rate was 96.7%, which was better than 80% in lansoprazole control group (P
In addition, the research group also conducted a study on the effect of An Wei Qingyou Formula on the healing quality of gastric ulcer in experimental rats. The results showed that An Wei Qingyou recipe significantly increased the levels of serum epidermal growth factor (EGF), prostaglandin E2(PGE2) and nitric oxide (NO) in rats with gastric ulcer, significantly reduced the ulcer area of rats with gastric ulcer, increased the pH value of gastric juice and increased the thickness of regenerated mucosa, which had a good therapeutic effect on gastric ulcer, and its mechanism was related to the improvement of ulcer healing quality and ulcer mucosa repair function.
typical case
Qin, male, 42 years old, driver, saw a doctor in August. 1993.
He has a hobby of drinking and smoking, and has suffered from epigastric pain for more than 3 years. At the beginning of the year, barium meal fluoroscopy was done in the local county people's hospital, suggesting that there was a niche shadow in the duodenum and occult blood in the stool was positive. Diagnosis: dull pain in the upper abdominal cavity, sometimes accompanied by hypochondriac pain, especially on an empty stomach, sometimes accompanied by pantothenic acid, reduced diet, poor spirit, sticky yellow stool and yellow urine. The tongue is red with little yellow fur, and the pulse is thin and weak. Diagnosed as disharmony between liver and stomach, damp heat. The main treatment is regulating qi, soothing liver, invigorating spleen and regulating stomach, and the prescription is An Wei Qingyou Decoction. Prescription: Radix Astragali 30g, Radix Codonopsis15g, fried atractylodes10g, Radix Paeoniae Alba10g, Areca catechu10g, Rhizoma Alpiniae Officinalis10g, Ramulus Cinnamomi10g, cuttlefish bone/kloc. Decoct with water, 14 dose. And told him to give up smoking and drinking.
The second diagnosis: after taking the medicine, the stomachache was slightly relieved, the diet was delicious, the stool was uncomfortable, and the urine was yellow. The rule of law is still the same as before, and the general plan has changed. Prescription: 30g of raw Radix Astragali, 0g of fried atractylodes10g, 0g of fried Radix Paeoniae Alba10g of cassia twig10g of Fritillaria thunbergii10g of raw Lily15g of fried Radix Linderae10g of radix aucklandiae.
Three diagnoses: epigastric pain basically disappeared, diet improved, stool formed, yellow urine, thin and white tongue coating. Continue to use the top, add fried yam15g,14g.
Four diagnoses: I have a slight stomachache every morning, and there is no other pain. Ask to take granules in case you go out to take them. Prescription: Radix Astragali10g, Rhizoma Atractylodis preparata10g, Ramulus Cinnamomi 6g, Radix Paeoniae Alba preparata 6g, Radix Aucklandiae 6g, Fritillaria thunbergii 6g, Rhizoma Dioscoreae10g, Fructus Citri Sarcodactylis 6g and Radix Glycyrrhizae 6g. 30 doses, daily 1 dose or daily 1 dose.
Mao believes that peptic ulcer is mostly a syndrome of deficiency and cold with stagnation, with deficiency and cold of spleen and stomach as the basis and qi stagnation and blood stasis as the standard, but its primary and secondary symptoms should be determined according to clinical symptoms. The patient is addicted to alcohol, tobacco and alcohol, which leads to disharmony between liver and qi, qi stagnation and blood stasis for a long time. Therefore, An Wei Qingyou recipe was used to treat the patient, and finally good curative effect was achieved. Mao also pointed out that two points should be paid attention to in the treatment of ulcers: first, quitting smoking and drinking is the premise of treatment, and drugs are difficult to work without it; Second, the dosage should not be too large. The ancients said that "there is no near success in kingcraft", which means that it is not appropriate to use warming tonics to rush for success. The dosage is light, although the effect is slow, but the effect is consolidated.