Clinical experience of Professor Xie Jingri in the deficiency-cold of spleen and stomach type of complex peptic ulcer

Hong-Bo Cai ,Hai-Qiang Wang ,Hong-Yu Cai ,Hao-Lin Li ,Guo-Ying Liang✉

1.The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine,Harbin 150040 2,China

2.Harbin hospital of traditional Chinese medicine,Harbin 150040,China

3.Changchun University of science and technology,Changchun 130600,China

Keywords:Complex peptic ulcer Deficiency cold of spleen and stomach Professor Xie Jingri Clinical experience

ABSTRACT Objective:To summarize Professor Xie's clinical experience in treating the deficiency cold of spleen and stomach type of complex peptic ulcer.Methods:through the observation of the curative effect of the patients with the deficiency cold of spleen and stomach type of complex peptic ulcer in the outpatient department of liver,spleen and stomach department of our hospital,the dialectical application and clinical experience of Professor Xie Jingri's self-made prescription in clinical practice were summarized.Results:Professor Xie Jingri's self-made prescription can effectively improve the clinical symptoms of patients with the deficiency cold of spleen and stomach type of complex peptic ulcer,and through individual syndrome differentiation and treatment,make the self-made prescription vary from person to person,clinical addition and subtraction,so as to further improve the clinical efficacy of patients.Conclusion:Professor Xie Jingri's self-made prescription is effective in treating complex peptic ulcer of spleen stomach deficiency cold type,which is worthy of further clinical application and promotion.

1.Introduction

Epidemiological investigation shows that the incidence of peptic ulcer in China is increasing year by year,and the compound peptic ulcer with gastric ulcer and duodenal ulcer is the most common.In western medicine,proton pump inhibitors are often used to improve gastric acid secretion,which is accompanied by eradication of Helicobacter pylori and protection of gastric mucosa.The therapeutic effect is remarkable.However,there are some side effects,and it is easy to relapse.Traditional Chinese medicine has certain advantages in reducing side effects and recurrence rate,so as to better improve the quality of life of patients [1,2].In clinical practice,complex peptic ulcer is characterized by pain,acid regurgitation,anorexia,belching and other symptoms in upper abdomen and stomach area.Therefore,it also belongs to the categories of "epigastric pain" and "fullness" in traditional Chinese medicine.

Professor Xie Jingri,doctoral supervisor,the academic experience inheritance instructor of the 5th and 6th batch of famous traditional Chinese medicine experts in China,and the leader of key specialties of spleen and stomach diseases in State Administration of traditional Chinese medicine.Professor Xie has used his own prescription to treat complex peptic ulcer of spleen and stomach deficiency-cold type for more than 30 years,and has achieved remarkable curative effect in clinical practice,so we summarize Professor Xie's thoughts and prescriptions here for reference and promotion of the majority of doctors.

2.A brief introduction of the pathogenesis

2.1 Spleen and stomach deficiency,susceptible to cold evil

As recorded in the Rhinoceros Candle in the Origin of Miscellaneous Diseases," The Yang Qi in the gastric cavity is mild,it can remove essence of grain and water and nourish the whole body,which is due to the deficiency of temper ...the heart is full of fullness." Professor Xie pointed out that the spleen and stomach are the office of the granaries,and they are responsible for moving and transforming the essence of grain and water.If the spleen and stomach are deficient,it will easily lead to the dysregulation of moving and transforming,stagnation of stomach qi,and glomus and fullness,when there is stoppage,there is pain.There is also a record in Su Wen:"The algidity is between the stomach and the stomach,under the membrane ...the small collaterals are urgently drawn,so it hurts." Professor Xie pointed out that due to spleen-stomach vacuity,it is easy to be invaded by cold evil,and cold qi mainly plays the role of contracture and tautness,which can lead to contracture of the stomach and epigastric pain.However,if the patient usually eat irregular,hungry disorders,like to eat cold food,which can also cause damage to the spleen and stomach,and cold qi and dampness qi coagulation,accumulating in the stomach,over time can further aggravate the spleen and stomach deficiency,such interaction,leading to repeated and difficult recovery of diseases.

2.2 Center burner vacuity cold,loss in warm and nourish

General Medical Collection of Royal Benevolencerecords:"The yang of the stomach is mild,which can remove the essence of grain and water,and nourish the whole body.If center burner vacuity cold,the stomach will be cold,and if the stomach is cold,it will cause indigestion,abdominal pain and diarrhea".Professor Xie pointed out that the insufficiency of center yang in patients can lead to imbalance of spleen and stomach,and inhibite qi dynamic in center burner,vacuity cold is produced from the inside and stagnated;However,center burner vacuity cold cannot warm body fluid,and insufficiency of stomach yin will lead to the warm and nourish of stomach bowel and then develop into the disease. If the disease patients eating disorders,eating too cold food,inadequate protection or the patient is weak but eat too much cold nature medicine,all these can lead to debilitation of yang qi in spleen and stomach,which makes the center burner lose its warm and nourish,unable to move and transform the essence of grain and water,Stagnation in the spleen and stomach,so distension and cold pain.

3.Clinical prescription medication

3.1 Dialectical treatment with private prescription treatment

In the clinical treatment of this syndrome,Professor Xie advocated that warming the center and dissipating cold should be given priority to,and supplemented by moving qi and relieving pain should be supplemented,and tonifying the spleen and stomach throughout the disease treatment.Professor Xie often uses Bupleurum,Rhizoma Atractylodis Macrocephalae to harmonize the center and boost qi;Radix Astragali seu Hedysari,Blast-fried ginger and Cardamom to warm the center and dissipate cold and change the dosage as the syndrome change.Therefore,Professor Xie summed up the following empirical prescriptions through years of clinical practice:15g of Blast-fried Ginger,15g of Bupleurum,15g of Cardamom,15g of Scorch-fried White Atractylodes,20g of Bergamot,15g of Tangerine Peel,15g of Citron,15g of Beautiful Galangal Fruit,20g of Bitter Orange,15g of Magnolia Obavata,15g of Milkvetch Root,15g of Pseudostellaria,15g of Perilla Fruit,15g of Fennel and 10 g of Liquorice.The above drugs are 1 dose,1 dose per day,decocted in 300ml water,and taken warm in the morning and evening.If the patient's stomach distended,poor appetite,add Scorch-fried Crataegus,Medicated Leaven and Stir-fried Barley Sprout to digest food and armonize the stomach;If the patients dry mouth and thirst,eat less and dry retching,add Dendrobium,Adenophora and Ophiopogon to engender liquid and boost the stomach.

3.2 Compatibility characteristics of private prescription

Professor Xie pointed out that patients with spleen-stomach vacuity cold type should should be mainly treated with warming the center and dissipating cold so Blast-fried Ginger is the main ingredient in this prescription.Blast-fried Ginger is pungent,hot,bitter and astringent,and has the effects of warming the center and dissipating cold,warming the channels and staunching bleeding.It is often used for patients with spleen-stomach vacuity cold and abdominal pain and vomiting and diarrhea in clinic.In addition,it is also recorded in Introduction to Medicine:"Warming the spleen and stomach,treating cold and water leakage in the stomach…cold pain,distention and fullness and abdomen in the heart." It has a good effect of warming yang and dissipating cold and keeping and solidifying center burner.Moreover,Cardamom can also warm the center and warm the grain,while Bupleurum can help the Qi of lesser yang and generating hair.Therefore,they are used as auxiliary medicine to help the main medicine to warm the center and dissipate cold.At the same time,patients with spleen-stomach vacuity cold type should also be supplemented by moving qi and relieving pain,so fennel with the function of dispersing cold and relieving pain,rectifying qi and harmonizing the stomach is added in the prescription,which increases the effect of the main medicine to dissipate cold while moving qi and relieving pain.The prescription is also added Beautiful Galangal Fruit with the function of warming the center and moving qi and Bergamot and Citron with the function of rectify qi and relieve pain.In the complex treatment,supplement spleen and stomach should be throughout the treatment of diseases.Therefore,Scorch-fried White Atractylodes,Tangerine Peel,Cortex Magnoliae Officinalis,Bitter Orange,Perilla Fruit,were added in prescription to rectify qi and fortify the spleen.In addition,compatibility of Cortex Magnoliae Officinalis and Bitter Orange can move stagnant qi in center burner,and Pseudostellaria and Radix Astragali seu Hedysari are added to supplement spleen qi.The above are all adjuvant drugs,and finally,licorice is used to harmonize all kinds of drugs to achieve the effect of warming the center and fortifying the spleen and harmonizing the stomach and relieving pain.

3.3 Modern pharmacological characteristics of private prescription

Professor Xie Jingri's private prescription has the effects of resisting ulcer,promoting gastrointestinal peristalsis and promoting gastric mucosa repair.The decoction of Blast-fried Ginger can significantly inhibit gastric ulcer in experimental rats and effectively inhibit the growth of gastric cancer SGC-7901 cells in vitro [3].Studies on Bupleurum have shown that the effect of mix-fry with vinegar on chronic gastritis is more remarkable.It is helpful to repair the gastric mucosa and reduce the pain degree of patients [4].On the other hand,Katsumada's galangal seed can protect gastric mucosa,resist ulcer and promote gastrointestinal motility,and it has also been proved to have a good inhibitory effect on Helicobacter pylori[5,6].Scorch-fried White Atractylodes has biphasic regulation on gastrointestinal function.Atractylenolide I,an effective chemical component of Scorch-fried White Atractylodes,has a certain repair effect on gastrointestinal mucosa injury [7].Tangerine Peel and Magnolia have the effects of resisting gastric ulcer and inhibiting gastrointestinal smooth muscle contraction [8,9,10].Bergamot,citron and bitter orange have good anti-inflammatory and bacteriostatic effects,and Bergapten,an effective component of bergamot,can also resist the proliferation of gastric cancer cells in vitro.Bitter Orange can enhance gastrointestinal peristalsis [11,12].Radix Astragali seu Hedysari can increase the tension of gastric fundus and gastric smooth muscle strips and increase the movement index of pyloric circular muscle strips [13].Pseudostellaria can improve the immune function and effectively reduce the positive rate of spleen deficiency in mice [14].Perilla Fruit has anti-inflammatory,gastrointestinal motility promoting and gastrointestinal reaction against cancer[15].Fennel has the functions of relieving pain,inhibiting bacteria and resisting inflammation,promoting gastrointestinal peristalsis,expelling gas and relieving gastrointestinal distention [16,17].Radix Glycyrrhizae has the functions of regulating immune function and resisting inflammation.Studies have shown that after 30 days of administration of Glycyrrhiza flavonoids,an effective component of Radix Glycyrrhizae,the atrophy of gastric mucosa glands can be significantly improved,and it can effectively reduce the pathological score of gastric tissues [18,19].The combination of the above medicines can promote the peristalsis of gastrointestinal tract,effectively resist the formation of ulcer and repair the injury of gastrointestinal mucosa.Anti-stomach inflammation can prevent and cure the occurrence and development of chronic non-atrophic gastritis.In addition,Professor Xie also followed the principles of" invigorating the spleen and nourishing stomach,dispel evil and support right" and combined Chinese and Western medicine to improve the curative effect [20].

4.Examples of medical records

Jia,female,aged 51.The first diagnosis was made on September 7th,2016.The main complaint was stomach pain,hot drink for one year,and aggravation for one week.The patient underwent gastroscopy in a local hospital one year ago,and the results showed gastric ulcer and duodenal ulcer.Now,the patient has stomachache,and every cold drink aggravates the symptoms,and the stool is not shaped,chest tightness and poor appetite.The tongue is light,with white fur and slippery pulse.Prescription:given to the above private prescription.Add 20 doses of lindera (20 g),Bitter Orange(20 g),Curcuma (15 g) and Coix (30 g),one dose a day,warm in the morning and evening.At the second visit on September 27th,2016,the patient reported that after taking the medicine,the swelling and pain in the epigastrium improved and the stool was still shapeless.The tongue is light,with white fur and slippery pulse.On the basis of the original prescription,removing Pseudostellaria,Perilla Fruit and adding Finger Citron(15 g),Perilla Stem(20 g),Rhizoma Ligustici(15 g),Costusroot (10 g),sparganium(15 g),Rhizoma Curcumae(15 g),a total of 20 doses,one dose per day,taken warm in the morning and evening;After the third visit on October 17th,2016,the patient reported that after taking the medicine,the symptoms improved and the stool formed.The tongue is light,with white fur and slippery pulse.On the basis of the second diagnosis prescription,Katsumada's Galangal Seed,Costusroot were replaced by Bupleurum(10 g),pseudostellaria(15 g),Amomum(5 g),After follow-up,the patient reported that condition had improved.

Press:The patient was diagnosed as epigastric pain due to deficiency cold of spleen and stomach in TCM and compound peptic ulcer in Western medicine.The main treatment principles are warming the center and fortifying the spleen,harmonizing the stomach and relieving pain.Stomach pain is caused by spleen and stomach dystrophy,and viscera and meridians lose their warmth,which belongs to "no honor is pain".In syndrome differentiation,attention should be paid to deficiency of essence and excess of reality,and treatment should focus on warming the center and dissipating cold,supplemented by promoting qi and relieving pain.Stomach collaterals lose nourishment,stomach yang is deficient,or stomach yin is injured after a long illness,stomach loses nourishment,stomach qi is not harmonious,and stomachache occurs.Therefore,in the treatment,Professor Xie’s private prescription was given to strengthen the spleen,warm the middle,harmonize the stomach and relieve pain,and the patient's symptoms improved.However,the patient's stool is still unformed,so removes Perilla Fruit with the effect of moistening the intestines and freeing the stool,and adds Perilla Stem with the effect of rectifying qi,loosening the center and relieving pain,Costusroot and Rhizoma Ligustici with the effect of promoting qi and relieving pain,Rhizoma Sparganii and Rhizoma Curcumae with warm nature to further play the role of rectifying qi,warming the center,promoting qi and relieving pain,thus it can achieve better clinical effect.

Qian,male,55 years old.The first diagnosis was made on April 10th,2019,and the chief complaint was that the stomach was distended with pain for more than 2 years and aggravated for 1 week.The patient was treated by gastroscope in the First Hospital of Harbin Medical University.The results showed that gastric ulcer,multiple polyps of stomach and frostbite ulcer of duodenal bulb.At present,the patient's stomach is full and painful,with occasional acid reflux,nausea,dry mouth,cold pain around the umbilicus,and conscious cold in the lower abdomen and stomach.The stool is thin.The tongue is dark,the coating is white,greasy and slightly yellow,and the pulse string is slightly slippery.Prescription:Radix Bupleuri (15 g)、Scorch-fried White Atractylodes (15 g)、Fructus Citri Sarcodactylis (20 g)、Tangerine Peel (15 g)、Citron (15 g)、Cardamom (15 g)、Ssemen Alpiniae Katsumadai (15 g)、Fructus Aurantii Immaturus (10 g)、officinal magnolia bark (15 g)、Betel Nut (10 g)、She Cao (30 g)、Radix Astragali seu Hedysari (15 g)、pseudostellaria (15 g)、Dendrobium (15 g)、Perilla Fruit (15 g)、Fennel (15 g)、blast-fried ginger (15 g)、scorch-fried medicated leaven (15 g),a total of 14 doses,one dose per day,taken warm in the morning and evening.Second visit on May 8th,2019,the patient's fullness and pain improved,and the cold pain around the umbilicus and stomach was relieved.The stool had been formed,and occasionally it was thin,with poor sleep and occasional head pain.The tongue is dark,with yellow fur,and the pulse string is thin and slightly slippery.On the basis of the original prescription,added Flowery Knotweed Stem (30 g),Silk Tree Flower (15 g),Dahurian Angelica (15 g),Rhizoma Ligustici(15 g),Amomum (15 g),Lindera(15 g),Mix-fried Licorice (15 g),total of 14 doses,one dose per day,taken warm in the morning and evening.After follow-up,the patient reported that his condition had improved.

Press:The patient was diagnosed as epigastric pain due to deficiency cold of spleen and stomach by TCM,and gastric ulcer,duodenal bulb ulcer and gastric polyp by Western medicine.Deficiency of spleen and stomach in this case will easily lead to imbalance of transportation and transformation,stagnation of stomach qi,and fullness,which belongs to "impassability leads to pain".However,due to weakness of spleen and stomach,the patient is easily attacked by cold evil.If the patient eats too much and is cold or has inadequate protection,It is easy to cause cold pain in the stomach and lower abdomen,complicated with diarrhea,and the middle energizer loses its warm-keeping,which is not caused by the subtle movement of Shui Gu,and then stops to gather in the stomach.Therefore,in the treatment,the basic treatment principle is to strengthen the spleen and warm the middle,and harmonize the stomach to relieve pain,and the above self-made prescription is adopted and added and subtracted with the syndrome.Because of the fullness of the patient's stomach.Medicated Leaven,rectifying qi,fortifying the spleen and dispersing accumulations was added on the basis of self-made prescription,accompanied by Unripe Bitter Orange and Areca with breaking qi and dispersing accumulation.In addition,due to the patient's conscious dry mouth,Dendrobium,which benefits the stomach and promotes fluid production,is added again,so the patient's fullness and pain are improved during the second visit,and the cold pain around the navel and stomach is also reduced.Moreover,the patient has poor sleep and occasional head pain.It is added with Flowery Knotweed Stem and Silk Tree Flower to nourish the heart and quiet the spirit and added with Rhizoma Ligustici、Radix Linderae、Fructus Amomi Villosi、Dahurian Angelica to regulate qi,relieve pain and harmonize the stomach.So as to increase the drug effect,so that better curative effect can be achieved in clinic.

5.Epilogue

Compound peptic ulcer belongs to the categories of "stomach duct pain" and "glomus and fullness" in traditional Chinese medicine.There is a record in "Danxi’s experiential therapy,lomus ":The temper is not harmonious and the central government is guilty,all of which are caused by soil evil." At the same time,it is also recorded in "Orchid room Secret Collection,Center Fullness Abdominal Distention "Spleen Yang does not rise,not to transport,food does not change,stomach fullness,less food,belching." Professor Xie believes that the occurrence of chronic non-atrophic gastritis is mainly caused by deficiency of spleen and stomach,easy invasion of cold evil,deficiency of cold in middle jiao and loss of warm maintenance.If the patient is deficient in spleen and stomach,it will easily lead to imbalance of transportation and transformation,stagnation of stomach qi,and pain if he is full,but the spleen and stomach are weak,and he is more vulnerable to cold evil,and cold can lead to contracture of the stomach and epigastric pain;Deficiency of yang in patients can lead to imbalance of spleen and stomach,poor qi activity in middle jiao,endogenous stagnation of deficiency cold.However,deficiency-cold of middle energizer cannot warm body fluid,and deficiency of stomach yin causes stomach fu-organs to lose warm maintenance,and it also hurts when they are not honored.Patients with unhealthy diet,abnormal hunger and satiety,cold due to overeating,inadequate protection,or too many cold medicines due to deficiency of essence can lead to deficiency of spleen and stomach yang qi.In turn,the middle jiao loses its warm maintenance,which makes it impossible to transport and change the Shui Gu to be subtle and stops in the spleen and stomach.Therefore,it swells and causes cold pain,which can further lead to the injury of the spleen and stomach.Cold-dampness condensation stops in the stomach,which can further aggravate the deficiency of the spleen and stomach over time.Therefore,in terms of treatment,Professor Xie mainly warms the middle warmer and relieves cold,supplemented by promoting qi and relieving pain.Fennel,Blast-fried Ginger,Bupleurum,Fructus Citri Sarcodactylis,Citron with the effect of dissipating cold and relieving pain,rectifying qi and harmonizing the stomach,cardamom with the effect of moving qi and warming the center were used in clinical practice.However,the spleen and stomach deficiency of the patient is declining,so tonifying the spleen and stomach is throughout the treatment of the disease.In clinical treatment,Radix Astragali seu Hedysari,scorch-fried white atractylodes,Tangerine Peel are often used to invigorate spleen-qi,promote qi and stomach,thus achieving remarkable clinical effects.At the same time,Professor Xie Jingri has applied the above private prescription in clinic for more than 30 years,and Professor Xie dialectically added and subtracted according to the patient's own situation,and treated according to the syndrome,so he can achieve more remarkable curative effect.Therefore,the author summarizes Professor Xie's academic thoughts and flexible application of prescriptions here for reference and promotion by doctors.

Author’s contribution

1.Cai Hongbo,deputy chief physician of the First Affiliated Hospital of Heilongjiang Univ TCM,is mainly responsible for collecting clinical data and sorting and writing papers,with a contribution rate of 40%;

2.Liang Guoying,chief physician of the Department of Liver,Spleen and Stomach Diseases,First Affiliated Hospital of Heilongjiang Univ TCM,is mainly responsible for collecting clinical data and participating in paper writing,with a contribution rate of 25%;

3.Haiqiang Wang,chief physician of the Department of Liver,Spleen and Stomach Diseases,First Affiliated Hospital of Heilongjiang Univ TCM,is mainly responsible for clinical data collection,with a contribution rate of 15%.

4.Cai Hongyu,chief physician of Harbin Hospital of TCM,is mainly responsible for consulting data and references,with a contribution of 10%.

5.Li Haolin,mainly responsible for consulting data and sorting out clinical data,with a contribution of 10%.