Research Progress of Treating Chronic Atrophic Gastritis by Non-Drug Therapy

ZHANG Rui-qing (张瑞清), LIU Li (刘 力), ZHOU Cheng (周 铖), YANG Yong-feng (杨永锋),ZHANG Cong-wei (张聪伟), WANG Liang (王 梁)

1. Shaanxi University of Chinese Medicine, Xianyang 712000, China

2. The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712000, China

ABSTRACT Modern medicine believes that the incidence and detection rate of chronic atrophic gastritis(CAG) are positively correlated with age. Early detection, monitoring and intervention are helpful to reduce the incidence and mortality of gastric cancer. Non-drug therapy has many unique methods, wide range of application, simple operation, easy to popularize characteristics. In the process of using non-drug therapy to treat CAG syndrome differentiation, the principle of "treating the same disease with different methods"and "treating different diseases with the same method" must be followed. In recent years, in order to improve the quality of life of CAG patients and optimize treatment methods, some research progress has been made in the treatment of chronic atrophic gastritis with non-drug therapy. This paper summarized mainly from the basic function principle and the characteristic of Chinese medicine non-drug therapy, the mechanism of various kinds of non-drug therapy treatment of chronic atrophic gastritis and its respective application.

KEYWORDS Chronic atrophic gastritis; Non-drug therapy; Reviews

Chronic atrophic gastritis (CAG) refers to the patients with gastric mucosal gland atrophy,or accompanied by intestinal metaplasia and atypical hyperplasia of a chronic gastric mucosa inflammation[1], which is an important precursor lesion of intestinal gastric cancer. It usually begins in the gastric antrum and extends proximally to the cardia. Its characteristics go beyond the rigorous field of gastroenterology[2-4]. Clinical manifestations are upper abdominal pain, abdominal distension, or accompanied by heartburn, belching, emaciation,anemia, etc., often lack of specificity. The causative factors of CAG are diverse, and environment,especially diet, is the sole determinant of CAG[5]. H.Pylori infection is an important cause[6]. Insufficient stomach blood flow, arteriosclerosis can cause disease. Epidemiological data show that CAG is associated with two different types of tumors:intestinal gastric cancer (GC) and type I gastric carcinoid (TIGC)[7]. In recent years, domestic and foreign research on CAG has made a lot of progress.Chinese and western medicine treatment of CAG is only limited to the improvement of symptoms, but the effect on gastric mucosal atrophy reversal is not significant[8,9]. The goal of CAG treatment is to improve patients' clinical symptoms, delay or even reverse disease progression, and reduce the risk of cancer. Non-drug treatment of CAG, to a certain extent, highlights the advantages[10,11]. In this paper,several non-drug treatment methods of CAG in recent years were summarized as follows.

BASIC PRINCIPLE AND CHARACTERISTICS OF NON-DRUG THERAPY

There are many kinds of non-drug therapy,each with its principle of action, but in general, it is to implement various non-drug therapy in the body surface local and acupoints, in order to dredge the channels and collaterals, mediate Qi (气)and blood, activate blood circulation and remove blood stasis and other effects, so as to readjust and improve the imbalance of the Zang-fu (脏腑) and Yin (阴) and Yang (阳), so as to improve the ability of disease resistance of the body. The basic principles of action of non-drug therapy can be roughly divided into two categories.

Basic Action Principle of Non-Drug Therapy

Direct action

The direct effect is medical application,fumigation wash, vapor inhalation, ion conductance,etc., making it through the skin, pores, meridians to the whole body. The direct effect can make the chemical components of Chinese medicine stimulate the skin receptors and exert some chemical effects.It can also make medicine permeate, absorb and spread through channels and collaterals, playing the role of "channel tropism" and "regulating Qi (气)". In fact, it has the same effect as the internal medicine,only the route of administration is different.

Indirect effects

Indirect action means that besides medicinal effects, it still has effects of auxiliary warm and heat stimulation, and mechanical physics stimulation,which not only accelerates the permeation absorption and transmission of medicines, but also still makes Qi (气) and blood run smoothly because of all sorts of stimulation. Some physical effects can also generate different effects, such as electromagnetic field effect,bioptric effect and so on.

Absorption Mechanism of Non-Drug Therapy

Skin absorption

The characteristic of skin administration lies in external application of acupuncture points.Medicines are absorbed through the skin, mainly through epidermal cuticle cells, interstitial cells and sweat glands, hair follicles, sebaceous glands, etc..Some medicines are absorbed through one way,while most through a variety of ways. For example,medicine ironing method, medicine rubbing method,fumigation and washing method, on the one hand,can improve the skin temperature, reduce the sebum temperature, accelerate the local blood circulation and promote the absorption of medicines. On the other hand, it can moisturize the skin and enhance the hydration of the cuticle.

Intestinal absorption

Intestinal administration mainly relies on the medicine dissolving in rectal secretions and then being absorbed through the mucous membrane.

EXPERIMENTAL RESEARCH ON NON-DRUG THERAPY

Antibacterial and Antitoxic Effects

It has been confirmed by pharmacological research that many Chinese herbal medicines have chemical components of anti-virus and antibacteria in the treatment of CAG, such as Herba Taraxaci, Radix Scutellariae, Fructus Forsythiae,Radix et Rhizoma Rhei, Folium Isatidis, etc.. Some medicines can have good prevention and curative effect when they are directly applied to local affected areas. Similarly, medicine point injection,smudging and so on have direct or indirect antibacterial effects.

Improving the Immune Function of The Body

Whether medicinal application, acupuncture,acupoint injection, auricular plaster, massage, etc.to a large extent, mainly play the body's defense function, mainly manifested in different degrees to enhance the function of the reticuloendothelium system, enhance the body of various specific antibodies and non-specific antibodies and so on.

Comprehensive Regulation

Regulating effect on blood

Acupuncture has a regulation effect on the changes of various components of blood. Magnetic heat therapy, mild moxibustion, thermal moxibustion and others, not only have physical warm stimulation,but also plays a role in regulating blood composition because of local capillary dilatation and accelerating blood circulation.

Regulation of organs and tissues

Acupuncture, moxibustion and other stomach meridian acupoints can promote gastrin release.It acts not only as a temperature, but also as a mechanical, chemical, and radioactive element,which can regulate the body metabolism,digestion, immune function enhancement and other functions.

Characteristics

The methods are numerous and peculiar,widely used, simple to operate and easy to popularize.

MECHANISM AND APPLICATION OF MULTIPLE NON-DRUG THERAPIES IN THE TREATMENT OF CHRONIC ATROPHIC GASTRITIS

Acupuncture Therapy

Acupuncture and moxibustion can promote the formation of antibodies in the body's humoral immunity. After acupuncture and moxibustion,the amount of serum A, B and C globulin can be increased, and the effect of specific antibodies in the serum such as lectin, indirect hemagglutinin and precipitant can be significantly improved.Acupuncture can also increase the bactericidal ability of the blood, significantly increase the leptin and opsonin, promote the increase of T lymphocytes in the body, and enhance the phagocytic function of the reticuloendothelium system. In the pathological state, acupuncture has different effects on the total number of white blood cells, which is related to the original level and deficiency and excess. The low can increased,and the high can be decreased, which has the adjustment function. Moxibustion can also increase the number of cells and increase the ability of phagocytosis. Numerous studies have shown that acupuncture has a definite effect on CAG[12].Acupuncture treatment of chronic atrophic gastritis proven mechanism mainly include improving the body's immune function, adjusting the central neural pathways, regulating gastrointestinal hormone, increasing blood flow to the stomach,regulating the related cytokines, increasing the function of digestion, adjusting the gastric acid secretion, improving the inflammatory reaction,regulating cell proliferation apoptosis to strengthen gastric mucosa barrier function[13]. Acupuncture and moxibustion therapy and precancerous lesions have obvious curative effects, focusing on removing, improving gastric mucosal blood flow and protecting gastric mucosal barrier, which is related to regulating the body's immune response, plant nerve function and other factors. The total effective rate for the improvement of clinical symptoms was above 80%, and the total effective rate for the improvement of gastroscopy and pathology was around 70%[14]. ZHU and others[15]conducted a research on curative effect of acupuncture on 120 cases of CAG and the effect on the quality of life and on inflammatory markers. The control group took the hospital routine western medicine treatment (omeprazole enteric-coated metformin hydrochloride tablets + amoxicillin metronidazole tablets + folic acid), and the observation group was given acupuncture treatment [main points:Pishu (BL20), Weishu (BL21), Zhongwan (RN12),Qihai (RN6), Guanyuan (RN4), Neiguan (PC6),prescription along with syndromes]. It was found that acupuncture was better than western medicine in treating CAG. XU Xuan etc.[16]conducted a clinical study on "gold fish" stitch HUA Tuo Jiaji (EX-B2) point acupuncture treatment of 64 cases of CAG, and found that acupuncture g r o u p [b i l a t e r a l H U A T u o J i a j i (E X-B 2)point] and western medicine group (colloidal bismuth pectin capsules + citric acid + Mosapride Citrate Dispersible Tablets + omeprazole enteric capsules), found that the curative effect of "gold fish" acupuncture needle after treatment group was superior to western medicines, further illustrating acupuncture method can delay the development of the disease.

Moxibustion Therapy

Mild moxibustion

In western medicine, the treatment of CAG is generally based on acid-suppressing medicines and bismuth agents, combined with two kinds of antibiotics. However, with the enhancement of medicine resistance in western medicine and the wide application of various moxibustion methods in clinical practice, moxibustion for CAG is gradually accepted by people[17]. WANG Ya-dong[18]divided 24 clean grade SD rats into four groups, namely normal group, model group, moxibustion stomach meridian group and moxibustion non-acupoint group, with 6 rats in each group. In addition to the normal group, the other three groups prepared the rat model of CAG by alternately drinking ammonia solution (0.1%) and sodium deoxycholic acid solution(20 mmol/L) on a daily basis in combination with the starvation barrier method, and then stimulated the relevant parts of the rats in the moxibustion stomach meridian group and the rats in the non-acupoint group with moxibustion respectively. It revealed the pathogenesis of CAG and proved that moxibustion of stomach meridian points has an exact therapeutic effect on CAG.

Thermal moxibustion

LI and others[19]observed the effects of thermal moxibustion on CAG model rats' stomach gastrinreleasing (GAS) and somatostatin (SS), gastric dynamic element (MTL) and interleukin (IL-6) by animal experiments, and explored its mechanism of action is probably by regulating gastrointestinal hormone secretion, improving the gastric mucosal blood flow, inhibiting inflammatory factor, reducing the gastric mucosa damage. The results showed that thermal moxibustion could up-regulate the levels of GAS and SS in CAG rats and down-regulate the levels of MTL and inflammatory factor IL-6, with obvious curative effects.

Moxibustion with medicinal cakes

HUANG Yan and others[20]randomly divided 20 successfully modelled rats into three groups: a medicinal cake moxibustion group (ground powder prepared with Radix Aconiti Lateralis Preparata,Cortex Cinnamomi and Radix Scutellariae in a certain proportion), electroacupuncture group[Zhongwan (RN12) point and Qihai (RN6) point],Western medicine group (folic acid suspension 1.0 mL/100 g), model group, and normal group(4 rats in each group). The normal and model groups did not intervene. The results showed that the different genes involved in the intervention of medicinal cake moxibustion were extensive.

Acupoint injection

Acupoint injection is a therapeutic method of injecting potions into acupoints to prevent and treat diseases. It can combine acupuncture stimulation with medical actions and penetration of acupoints to give full play to its comprehensive effect.ZHANG etc.[21]randomly divided into 59 patients with CAG into control group [Xiangsha Liujunzi Decoction (香砂六君子汤), Huanglian Wendan Decoction (黄连温胆汤), Danshen Decoction (丹参饮) combined with Shixiao Powder (失笑散),treatment based on syndrome differentiation] and treatment group [added Zusanli (ST36) acupoint injection and acupoint massage on Neiguan(PC6), Zusanli (ST36) and Zhongwan (RN12)].The total curative effective rate of mucosa under gastroscope in treatment group was 86.7%, and the control group was 65.5%. The difference was statistically significant (P＜0.05). It indicated that acupoint injection with acupoint massage can improve the curative effect of CAG. WU Xu etc.[22]divided into 93 CAG patients into the control group[taking Weifuchun Tablet (胃复春片)] and the acupoint injection group [Ganshu (BL18), Weishu(BL21) and Zusanli (ST36) for Huangqi Injection(黄芪注射液) and Danggui Injection (当归注射液)].The results showed that the therapeutic effect of acupoint injection on CAG prevention and treatment was significantly better than that of the Weifuchun group, indicating that the therapeutic effect of acupoint injection on CAG prevention and treatment was accurate. CHEN Fei etc.[23]used Huangqi Injection (黄芪注射液) at Zusanli (ST36) for the treatment of 30 cases of the disease, and a control group (Domperidone + Amoxicillin Capsules (阿莫西林胶囊)+ Colloidal Bismuth Pectin Capsules +Ranitidine Hydrochloride Capsules) and treatment group [on the basis of control group plus Huangqi Injection (黄芪注射液) at Zusanli (ST36)]. The clinical symptoms improved significantly in treatment group, which was better than the control group. It showed that acupoint injection can alleviate the clinical symptoms and improve the signs of the disease.

Embedding thread at acupoints

YAO Qiu-ling etc.[24]selected Zhongwan(RN12), Weishu (BL21), Zhangmen (LR13),Pishu (BL20) for gut implanted in the acupuncture point. Relying on the biological effect of solutes through the nervous system and neurohumoral system, the effect of the acupuncture points on diffusion, infiltration and local stimulation enhanced and continued the comprehensive efficiency of acupuncture points. Through the feeling of the brain,along the meridians and efferent nerve of viscera and endocrine gland, the viscera function is adjusted to restore endocrine gland secretion, thus achieving the goal of treatment for the disease. In clinical treatment of CAG, special embedding needles and No. 0, 2 and 3 catgut are more commonly used,and the length of catgut is 0.8-1 cm[25]. Studies have shown that acupoint catgut embedding can play a role in the treatment of CAG by inhibiting inflammatory response factors, protecting the gastric mucosa, and regulating gastrointestinal hormones[26]." WANG Jing-min etc.[27]divided 103 CAG patients into two groups: 51 cases in the control group were treated with folic acid tablets,and 52 cases in the observation group were given acupoint embedding thread [Qihai (RN6), Zusanli(ST36), Xiawan (RN10), Zhongwan (RN12),Shangwan (RN13), Tianshu (ST25)] treatment.TCM syndrome, the gastric mucosa lesion scores and IL-11, IL-8, the level of TNF-α in the observation group after treatment was lower than the control group (P＜0.05), and the total effective rate was higher than the control group (P＜0.05).It indicates that acupoint catgut embedding was effective in treating CAG. ZHANG Feng-yi[28]collected a total of 64 patients with CAG from the outpatient department who were randomly divided into the embedding group [Shangwan (RN13),Zhongwan (RN12), Xiawan (RN10), Zusanli (ST36),Qihai (RN6), Tianshu (ST25)] and the Western medicine group (folic acid tablet), and it was found that the therapeutic effect of acupoint embedding for CAG with spleen and stomach weakness was better than that of western medicine taken orally. HU Hong-jun etc.[29]selected a total of 52 patients with CAG as study subjects, and divided into two groups: control group [Weifuchun Tablets(胃复春片)] and experimental group [acupoint embedding therapy: Ganshu (BL18), Weishu (BL21),Pishu (BL20), Geshu (BL17), Sanyinjiao (SP6)].The results showed that the effective rate in the experimental group was significantly higher than the control group (P＜0.05). The treatment of CAG patients with acupoint catgut embedding could effectively eliminate the glandular inflammatory lesions and promote the repair of gastric mucosa.

Auricular point pressing method

Auricular point sticking and pressing method is a new therapy developed on the basis of ear needles. Generally, plant seeds (such as the seed of cowherb, rapeseed, white mustard seed, mung bean, white pepper, prickly ash seed, etc.), or pills or magnetic metal particles are used as medicine seeds to stick and press auricular points, stimulate auricular points, and play a therapeutic role. Its mechanism of action is through stimulation. Through the conduction of auricular channels, it plays a therapeutic role. At the same time, sustained mild benign stimulation of the auricular point can also produce needle-like effects to achieve systemic adjustment. NIU She-hui[30]randomly divided 100 patients with CAG into a control group [Weiwei Granule (萎胃颗粒)] and observation group (Weiwei Granule (萎胃颗粒) combined with ear point pressing bean). The total effective rate of treatment in the observation group was 87.76%, which was significantly higher than the control group (74.47%),and the difference was statistically significant(P＜0.05). This indicates that Weiwei Granule (萎胃颗粒) with ear points pressing therapy has a significant clinical effect on atrophic gastritis, which can effectively relieve the disease and reduce adverse reactions, with high safety. SUN Xi-liang etc.[31]divided 180 Hp infection of CAG patients into control group (Pantoprazole Sodium Enteric-Coated Capsules + Amoxicillin Capsules + Metronidazole Tablets + Colloidal Bismuth Pectin Capsules) and treatment group [on the basis of control group with Hewei Zhitong Granules (和胃止痛颗粒), ear beans(耳豆)]. Ear bean treatment chooses one ear's liver,stomach, Shenmen, endocrine area for. The Hp eradicate rate of the treatment group (93.33%) was higher than the control group (71.11%), and the difference was statistically significant (P＜0.01). The results showed that Hewei Zhitong Granules (和胃止痛颗粒) combined with auricular acupoint pressing bean could improve the function of gastric mucosa and increase the eradication rate of Hp.

Magnetic acupoint therapy

Magnetic acupoint therapy is a new technique developed on the basis of the theory of meridian and magnetic therapy in Chinese medicine. It uses magnetic field to produce a certain biological magnetic effect on certain acupoints, pain area or parts of human body to improve and restore the imbalance of Yin and Yang state of the body, in order to achieve the purpose of treatment. Experiments showed that under the effect of magnetic field, white blood cells were active, phagocytic function was enhanced, and non-specific immunity of the body was enhanced, which had obvious analgesic and anti-inflammatory effects on CAG patients. Magnetic therapy can adjust the change of human body function. The rotation of magnetic field releases a weak high-frequency biological current, which is beneficial to CAG patients to resist the invasion of exogenous pathogens. Common magnetic therapy methods for CAG treatment include magnetic sticking method, rotation method, electromagnetic method, magneto-thermal method, etc.. Commonly used magnetic therapy points are bilateral Tianshu(ST25), Shangwan (RN13), Xiawan (RN10), etc..

Biofeedback therapy

Biofeedback is a new psychological and behavioral therapy. It uses a feedback instrument to feedback some physiological signals (such as skin electricity, myoelectricity, skin temperature,etc.) in the form of visual or auditory signals to CAG patients, and then uses information to actively control the changes of these physiological signals,so as to achieve the purpose of treating CAG.

Massage therapy

Massage is an important part of the treasure house of Chinese medicine. It does not rely on medicinal power, nor does it need complicated equipment and instruments. It is just the hands of the doctor (or himself). According to the theory of traditional Chinese medicine and based on the principle of syndrome differentiation, it adopts different techniques according to the disease and operates at certain parts or points, to dredge the channels and collaterals, harmonize Qi (气) and blood, calm the mind, dispel pathogen, promote the body to enhance disease resistance, etc.

Music therapy

Music therapy is the use of modern technology music, color, breath, air anion and other means of integration of comprehensive therapy. It can enter into the brain through the human vision, hearing,smell and other sensory information, and have feedback effect on the organs, with the overall regulation of tissue and organ function, in order to treat a variety of diseases. In fact, this therapy was further developed based on the ancient pentatonic scale, the five-Zhi (五志) (happiness, anger,sadness, thoughts, fear) and the mechanism of the five viscera function of the human body. CAG has a long course of disease and is prone to relapse.Patients are often accompanied by varying degrees of anxiety, so this method is commonly used in clinical treatment of patients with liver and stomach Qi (气) stagnation syndrome CAG. Many modern studies have shown that music does calm breathing,rhythm of the heart, nerve adjustment, muscle strength and so on.

SUMMARY AND OUTLOOK

There are many ways to treat CAG without drug therapy. The clinical application must follow the guidance of the basic theory of TCM,the premise of treatment based on syndrome differentiation, the flexible use of various rules of TCM (due to person, due to time, due to place), the adoption of comprehensive treatment measures, and the mastering of indications and contraindications. At present, modern science and technology can be used to further improve the efficacy of TCM non-drug therapy, so that the traditional non-drug therapy is constantly updated and developed. In the future, we can increase the scientific research investment of TCM non-drug therapy to treat this disease, encourage clinicians to dig into ancient books, and study or demonstrate from modern scientific theoretical knowledge. The continuous combination of modern science and technology will further improve the efficacy of nondrug therapy, make non-drug therapy constantly updated and developed, and further promote the application of non-drug therapy in the clinical treatment of CAG.