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A filial son, whose mother suffered from liver cancer (Hepatocellular Carcinoma), heard that the longer the decoction time of Chinese herbal medicine, the better the effect. Thus, he decocted a prescription for 6 hours. Taking such herbal liquid was not beneficial to the disease but rather added harm. Another young couple, married recently, where the husband had Hepatitis B (Yi Gan Bing). The wife believed that drinking more herbal liquid yielded better results. She decocted a full thermos flask of herbal liquid daily and drank it in large gulps divided into three times. After ingestion, she experienced uncomfortable epigastric distension and stagnation; how could the Spleen and Stomach transform and transport it?

Physicians through the ages have been very particular about the decoction and administration methods of Chinese herbal decoctions. For example, in *Shanghan Lun* (Treatise on Cold Pathogenic Diseases), under the section for boiling "Mahuang Tang" (Ephedra Decoction), it states: Take the four herbs above, use nine sheng of water, first boil Mahuang (Ephedrae Herba) until two sheng are reduced, then add the other herbs, boil to obtain two and a half sheng of liquid, remove the dregs, take eight ge warm, cover to induce a slight sweat, etc. If the method of decoction and administration is incorrect, even a good prescription with precise syndrome differentiation and appropriate medication cannot exert its due therapeutic effect. So, how should Chinese herbal medicine be correctly decocted and administered?

Decoction Vessels: Clay pots or earthenware jars are best, as they are inexpensive and do not undergo chemical changes. Iron and copper vessels should be avoided because iron and copper contain tannins; organic acids and other components therein easily react chemically with the drugs, destroying drug quality and affecting efficacy.

Drug Inspection: Open the medicine package, remove herbs that need to be decocted first, added later, separately stewed, or taken as powder, and set them aside. Check if the herbs match the prescription and look for foreign objects like mud clumps, hair, or iron nails. After confirming accuracy, pour them into a container for soaking.

Soaking: To fully release the properties of the drugs, before decoction, add pure cold water to cover the herbs and soak for 1 hour. This facilitates the extraction of effective components. If boiled immediately after adding water, certain plant proteins in the drugs coagulate upon heat, making it difficult for effective components to seep out, thus affecting efficacy.

Decoction Method: Generally, put the herbs to be decocted first (such as shell and mineral types: Qinglongchi (Fossilized Mammal Bone), Shijueming (Haliotidis Concha), Zhijia (Testudinis Carapacis et Plastratis Preparata), Lingcishi (Magnetitum), Zhenzhumu (Margarita), Niujiaopian (Bovis Cornu Preparatum), Daizheshi (Haematitum), Muli (Ostreae Concha), etc., which are hard in texture and difficult to extract, should be crushed and decocted first) into a clay pot. Add an appropriate amount of cold water, cover, first use high heat (Wu Huo), then low heat (Wen Huo) after boiling, decoct for half an hour. Then add the soaked and swollen herbs, decoct for 25 minutes. Add the herbs to be added later (such as Bohe (Menthae Haplocalycis Herba), Sharen (Amomi Fructus)), decoct for 5 minutes. Pour out one bowl of herbal liquid into an empty thermos flask. Immediately add boiling water and decoct again for 25 minutes, then pour the liquid into the flask. Do not frequently uncover the pot during decoction to prevent the loss of aroma. Exterior-releasing drugs, heat-clearing drugs, and aromatic drugs need only rapid decoction for 15-20 minutes; rich and nourishing drugs should be slowly decocted with low heat for 30-45 minutes to allow effective components to fully seep out; toxic drugs like Wutou (Aconiti Radix) and Fuzi (Aconiti Lateralis Radix Preparata) should be slow-decocted for a long time to reduce toxicity. Some precious drugs (such as Renshen (Ginseng Radix), Lingyangjiao (Saigae Tataricae Cornu)) are best separately stewed and drunk to preserve and absorb effective components.

Administration Method: Whether the method of taking medicine is appropriate not only affects the efficacy but also reduces adverse reactions of certain drugs; therefore, mastering the administration method is crucial.

Generally, one dose is decocted twice and taken in 2-3 portions; in urgent conditions, take once in a single dose. Decoctions are best taken warm. For exterior-releasing and sweating drugs, besides taking warm, one must keep warm and avoid wind, stopping when sweat appears. Medicine is generally taken 1-2 hours before or after meals; cloying and tonifying medicines are taken on an empty stomach; calming spirit medicines are taken before sleep; for fever patients who develop and subside at specific times, take 1-2 hours before the fever starts; esophageal cancer patients, whose disease location is upper and swallowing is obstructed, should take small amounts frequently; ascites patients with abdominal distension, worse after eating, with damaged Liver and Spleen and slow digestion, will suffer increased distension if they drink too much medicine as it cannot be transformed and absorbed, so they should take small amounts frequently; etc. Specifics depend on the condition and syndrome. Sanqisanqi (Notoginseng Radix et Rhizoma) type powders are taken by mixing with water, twice daily.

Medication Taboos: When taking certain medicines, one must not eat certain foods because of interactions between some foods and drugs. For example: "Honey opposes Raw Scallion"; if the prescription contains Zhigancao (Prepared Glycyrrhizae Radix) or Zhijia (Testudinis Carapacis et Plastratis Preparata), avoid eating scallions; Poria (Poria) opposes vinegar; Jia (Testudinis Carapacis et Plastratis Preparata) opposes Amaranth; Bohe (Menthae Haplocalycis Herba) opposes fatty meat; Changshan (Dichroae Radix) opposes scallions; Dihuang (Rehmanniae Radix) and Heshouwu (Polygoni Multiflori Radix) oppose scallions, garlic, and radishes. Additionally, during medication, raw, cold, greasy, and stimulating foods should be avoided.

Part Five

Tumor Overview

1. Traditional Chinese Medicine Prevention and Treatment of Precancerous Lesions of Gastric Cancer

Precancerous lesions refer to pathological changes in body tissues that may evolve into cancer. Many tumors often have a relatively long "benign" process before developing into malignancy. Understanding the pathological changes in this process is of great significance for early diagnosis and early treatment. Taking gastric cancer as an example, 150,000 to 200,000 people die of gastric cancer annually in China. Once diagnosed, the five-year survival rate is only 15%. Chronic Atrophic Gastritis is a common disease in China, mostly occurring after age 40, peaking around age 60, with a very high cancer transformation rate of over 15%. Actively treating atrophic gastritis, preventing cancer before it occurs, and treating early cancer are manifestations of the TCM concept of "treating disease before it arises." In TCM, atrophic gastritis is called Weiwantong (Epigastric Pain), characterized mainly by frequent pain in the epigastric region near the heart pit. Ancient Chinese medicine has recorded this early on.

Understanding of Epigastric Pain in Chinese Medicine

*Neijing* (The Inner Canon) places great emphasis on the Spleen and Stomach theory. *Suwen · Liuyuan Zhengji Dalun* states: "When Wood stagnation erupts, the people suffer from epigastric pain centered below the heart." *Suwen · Zhiyao Dalun* says: "When Jueyin governs the year, excessive Wind wins... the people suffer from epigastric pain centered below the heart, extending to both hypochondria, blocking the throat, inability to eat, stiff tongue base, vomiting after eating, cold diarrhea, abdominal distension, loose stools, masses, and water retention." *Lingshu · Xieqi Zangfu Bingxing Pian* says: "Stomach disease involves abdominal bloating and epigastric pain centered below the heart."

Zhang Zhongjing's *Jingui Yaolue · Abdominal Fullness, Cold Spasms, and Retained Food Disease Pulse, Syndrome, and Treatment Chapter 10*: "Severe cold pain in the chest and heart, vomiting and inability to eat, cold in the abdomen, rising against the skin appearing with heads and feet, pain up and down untouchable, Dajianzhong Tang (Major Construct the Middle Decoction) governs it." *Shanghan Lun* says: "Yangming disease, tidal fever, loose stool, normal urination, persistent chest and hypochondriac fullness, Xiaochaihu Tang (Minor Bupleurum Decoction) governs it."

Li Dongyuan wrote books such as *Piwei Lun* (Treatise on the Spleen and Stomach), focusing on clarifying the physiological functions of the Spleen and Stomach, causes, mechanisms, differential diagnosis, and treatment prescriptions for internal injury diseases, proposing the argument that "internal injury to the Spleen and Stomach gives rise to a hundred diseases." He said: "Irregular diet causes Stomach disease... if the Stomach is diseased, the Spleen has nothing to receive... thus it also becomes diseased." Li greatly valued raising the Yang Qi of the Spleen and Stomach, creating formulas such as Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Shengyang Yiewei Tang (Raise the Yang and Benefit the Stomach Decoction). Regarding the moistening and descending of the Stomach, he proposed: "For deficiency of the Stomach, only damp substances can nourish." And used sour-sweet items like Shaoyao Gancao Tang (Peony and Licorice Decoction) and Shengmai San (Generate the Pulse Powder).

Zihehe advocated purgation for Spleen and Stomach diseases: "Any retained food in the Stomach can be purged." If after purging "fullness remains when pressing below the heart, it is especially suitable to purge again." He believed: "People dislike hearing about purging to treat disease, but if accumulation and old waste remain in the middle, and cold and heat remain inside, is it better to leave them or drive them out? *Neijing* values the free flow of Qi and Blood above all. Vulgar people value obstruction. They only know purging as draining; how could they know what *Neijing* means by purging is actually tonification? When old waste is removed, the intestines and stomach are clear; when masses are exhausted, Ying and Wei flourish. True tonification exists within non-tonification."

Ye Tianshi promoted the theory of "long-standing pain entering the collaterals": "Chronic recurrent stomach pain must involve congealed phlegm and accumulated blood stasis."

*Zhangshi Yitong* noted the relationship between constitution and Stomach disease. "Fat people experience fullness below the heart due to internal Phlegm-Damp." Thin people experiencing fullness below the heart have stagnant Heat in the Middle Jiao. "Elderly and deficient people mostly have Spleen and Stomach weakness and insufficient transformation."

Song Dynasty Chen Wuze's *Sanyin Jiyi Bingzheng Fanglun* also discussed the etiology and treatment of epigastric pain. "Wind striking the Stomach: Renying and pulses at both Guan positions float and are large. The Stomach is the sea of Zang organs, receiving the five flavors to nourish the five Zang. Deficient and struck by evil wind. Thus symptoms include profuse forehead sweating, inability to eat/drink, blockage, abdominal fullness, distension when exposed to cold, open mouth, shoulder breathing, emptiness below the heart, diarrhea after eating cold food." "Pingwei San: Treats Stomach Excess Heat, dry lips, vomiting, irritability, constipation, and after febrile disease, residual heat lingering in the Stomach, heat in limbs, thirst, chest fullness without sweat. Houpo (Magnoliae Officinalis Cortex), Shegan (Belamcandae Rhizoma), Shengma (Cimicifugae Rhizoma), Fuling (Poria), Shaoyao (Paeoniae Radix), Zhike (Aurantii Fructus), Dahuang (Rhei Radix et Rhizoma), Gancao (Glycyrrhizae Radix)." "Yangwei Tang: Treats Stomach Deficiency-Cold, cold calves unable to lie down, aversion to wind/cold, abdominal pain, deficiency mingling with cold/heat like malaria, dry lips/mouth, puffy face/eyes, vomiting/diarrhea, limb pain, lack of appetite, or cold-damp causing joint pain. Houpo (Magnoliae Officinalis Cortex), Huoxiang (Agastaches Pallidae Herba), Banxia (Pinelliae Rhizoma), Fuling (Poria), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix), Fuzi (Aconiti Lateralis Radix Preparata), Jupi (Citri Reticulatae Pericarpium), Caoguo (Tsao-ko Fructus), Baizhu (Atractylodis Macrocephalae Rhizoma)."

Modern Medical Understanding of Epigastric Pain (Atrophic Gastritis)

Atrophic gastritis is caused by various pathogenic factors damaging the gastric mucosa. Over time, it invades deeper layers, damaging gastric glands, leading to atrophy and reduced quantity, weakening secretory function, causing indigestion, affecting absorption, and gradually presenting symptoms like emaciation, fatigue, and anemia. In atrophic gastritis, free acid in gastric juice decreases or is absent; fasting gastric juice often contains epithelial cells, white blood cells, mucus, and Helicobacter pylori; gastric exfoliative cytology shows abnormal cells, nuclear heterotypic cells, and intestinal metaplasia; gastroscopy shows gray-white, gray-yellow, or gray-green gastric mucosa; in early atrophy, small vessels within the mucosa can be seen; in severe cases, large tree-like vessels are visible on the surface; pathology shows mucosal atrophy, disappearance of most glands, possible polyps, and even transformation into gastric cancer.

Its etiology is not yet fully clear. It is generally believed that Helicobacter pylori infection is an important cause. This bacterium adheres to the gastric mucosa surface, secretes various toxins damaging mucosal cells, causing chronic gastritis. Additionally, smoking, hot diets, rough foods, chronic tonsillitis, etc., can also cause it. Western medicine treatment for this disease mainly focuses on relieving symptoms, lacking effective drugs to block and reverse the disease. Gastrectomy is considered for atrophic gastritis accompanied by severe dysplasia.

British researchers found that the risk of gastric cancer in groups infected with Helicobacter pylori is 6 times higher than in uninfected groups. Japanese researchers also found that long-term Helicobacter pylori infection can cause chronic atrophic gastritis and intestinal metaplasia, potentially leading to early differentiated gastric cancer; especially under other carcinogenic factors (such as high-salt diet, lack of fresh vegetables, genetics, or toxic substances), it is easier to induce gastric cancer. Therefore, early clearance of Helicobacter pylori infection has positive significance for preventing gastric cancer.

Etiology and Pathogenesis

The Stomach resides below the diaphragm, connects to the esophagus above, and communicates with the small intestine below, its meridians linking to the Spleen. The Stomach is divided into three parts: the upper opening Cardia is also called Shangwan (Upper Epigastrium), the lower opening Pylorus is also called Xiawan (Lower Epigastrium), and the area between is called Zhongwan (Middle Epigastrium). Together, these three are collectively called Weiwan (Epigastrium). The main physiological function of the Stomach is receiving and rotting/ripening food and water; the Stomach harmonizes by descending. *Suwen · Yuji Zhenzang Lun* states: "The five Zang organs all derive Qi from the Stomach; the Stomach is the root of the five Zang." The Stomach is the "Great Granary," the "Sea of Food, Water, Qi, and Blood." "With Stomach Qi there is life; without Stomach Qi there is death." The Spleen and Stomach are interior-exterior paired, residing in the Middle Jiao, belonging to the main organs of the digestive system: "The Spleen and Stomach are the officials of the granary, from which the five flavors emerge." Stomach disease primarily involves dysfunction of receiving and rotting/ripening, with rebellious Stomach Qi. Spleen disease commonly involves deficiency of Yang Qi, disordered transformation, and endogenous production of water-dampness and phlegm-fluids.

Common causes of Stomach disease include:

1. Cold Evil Invading the Stomach: External cold evil enters internally into the Stomach. Cold governs contraction and drawing-in, causing Qi stagnation and Blood stasis, meridian condensation and blockage, disharmony of Stomach Qi, presenting with borborygmus, diarrhea, and abdominal pain. *Suwen - Jutong Lun* states: "Cold evil invading between the intestines and stomach, below the membrane source, blood cannot scatter, small collaterals draw tight, thus pain."

2. Diet Injuring the Stomach: Irregular diet, overeating or hunger, preference for pungent/sour, excessive drinking of hot wine, or long-term consumption of polluted/moldy food, eroding the Stomach organ, causing loss of harmony and descending of the Stomach.

3. Liver Qi Invading the Stomach: The Liver and Gallbladder have a close relationship with the Spleen and Stomach; Wood controls Earth. "Earth reaches expansion through Wood." Excessive Liver Qi horizontally invades the Spleen and Stomach; if the Spleen and Stomach are injured, transformation fails, ascending/descending is abnormal, leading to abdominal pain, vomiting, borborygmus, diarrhea, etc. Conversely, if Liver Qi is insufficient, stagnates and does not reach, failing to vent the Spleen Earth, the Spleen loses healthy transport, the Stomach loses harmony and descending, presenting with epigastric/hypochondriac discomfort, depression, sighing, poor appetite, vomiting, etc. *Shenshi Zunsheng Shu - Weitong* says: "Stomach pain is disease of evil interfering with the epigastrium... Liver Qi multiplying is especially severe, as Wood nature is violent and directly controls."

4. Spleen and Stomach Weakness: The Spleen and Stomach are officials of the granary, governing receiving and transforming food/water. Irregular eating/drinking, overwork, or long-term illness injuring the Spleen/Stomach can cause Spleen Yang deficiency, Middle Jiao deficiency-cold, or Stomach Yin damage, losing nourishment and causing pain. Also, excessive intake of cold/cool substances causing Spleen-Stomach deficiency-cold pain.

5. Blood Stasis Lingering: Long-standing illness leads to poor Qi and Blood circulation, meridian blockage, and Blood stasis knotting in the epigastrium causing pain.

The Stomach is the great source of the five Zang and six Fu organs. All the above causes can lead to dysfunction of receiving and rotting/ripening, loss of harmony and descending, resulting in pain. Single causes of Stomach disease present simpler pathological changes and clinical syndromes, making treatment easier; combined causes present complex changes and syndromes, making treatment difficult. Stomach disease initially stays in the Qi level; prolonged migration enters the Blood level. Thus, long-standing pain injures Stomach collaterals, often presenting with hematemesis or melena. The pathogenesis of this disease involves intermixed cold and heat, and mixed deficiency and excess. Cold comes from consuming raw/cold food, accumulating cold into cold, or Spleen-Stomach Yang deficiency generating internal cold; Heat comes from craving spicy/alcoholic drinks, internal damp-heat accumulation, or insufficient Stomach Yin generating internal deficiency heat. Deficiency focuses on Spleen-Stomach (Yang) Qi deficiency; Excess involves Qi stagnation, Blood stasis, Dampness obstruction, etc.

Syndrome Differentiation and Treatment

The main site of Stomach pain is the epigastric region near the heart pit. Pain may radiate to the hypochondria and back, or be accompanied by chest/epigastric fullness, nausea/vomiting, poor appetite, burning sensation, belching, loose or constipated stool, even hematemesis or melena. First, distinguish clearly between Cold, Heat, Deficiency, and Excess. Treatment focuses on regulating Qi and harmonizing the Stomach to stop pain. Then, examine the syndrome to seek the cause, treat according to syndrome differentiation. When Evil is strong, dispelling Evil is urgent; when Righteous Qi is deficient, nourishing Righteous Qi is primary; when mixed deficiency and excess exist, both must be considered.

1. Spleen-Stomach Weakness Type

Main Syndromes: Dull epigastric pain, preferring warmth and fearing cold, poor appetite, pain worsens with cold food, sallow complexion, mental fatigue and weakness, cold limbs, clear fluid regurgitation, loose stool, clear/profuse urine, pale tongue with white coating, deep/weak pulse.

Treatment Method: Warm the Middle and strengthen the Spleen, tonify Qi and benefit the Stomach.

Prescription: Huangqi Jianzhong Tang modified: Zhi Huangqi (Prepared Astragali Radix) 15g, Chao Dongzhu (Stir-fried Atractylodis Macrocephalae Rhizoma) 12g, Ganjiang (Dried Zingiberis Rhizoma) 4g, Zhi Fupian (Prepared Aconiti Lateralis Radix) 3g, Zhi Gancao (Prepared Glycyrrhizae Radix) 3g, Gansong (Nardostachyos Radix et Rhizoma) 3g, Fuling (Poria) 12g, Chao Jijin (Stir-fried Cruris Galli Gizzard Membrane) 10g, Sharen (Amomi Fructus) 3g, added later.

2. Stomach Yin Deficiency Type

Main Syndromes: Burning/painful epigastric sensation, worse after eating, dry mouth/tongue, craving sour foods, five-palm heat, palpitations/insomnia, scanty urine/constipation, red tongue with little moisture/scanty or peeled coating, deep/fine pulse.

Treatment Method: Nourish Yin and harmonize the Stomach.

Prescription: Yiwei Tang modified: Chuan Shihu (Dendrobii Caulis) 15g, Chao Shanzha (Stir-fried Crataegi Fructus) 12g, Wumei (Mume Fructus) 7 pieces, Nan/Beisha Shen (Glehniae Radix / Ginseng Radix) 12g each, Shengdi (Rehmanniae Radix) 10g, Xiyangshen (American Ginseng Radix) 3g, Chuanlian (Coptidis Rhizoma) 3g, Hang Baishao (Paeoniae Radix Alba) 12g.

3. Liver-Stomach Disharmony Type

Main Syndromes: Distending/painful epigastrium radiating to both hypochondria, chest/hypochondriac fullness, belching, hiccups, sallow/bluish complexion, insomnia/dream-disturbed sleep, dizziness/vertigo, symptoms worsen with depression, red tongue with white coating, string-taut/fine/rapid pulse.

Treatment Method: Soothes the Liver and harmonizes the Stomach, activates collaterals and resolves stasis.

Prescription: Shixiao San combined with Xuanshu Daizhe Tang modified: Wulingzhi (Trogopterori Faeces) 10g, Puhuang (Typhae Pollen) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 20g, Daizheshi (Haematitum) 12g, Xuanshua (Inulae Flos) wrapped 10g, Jiang Zhuru (Bambusae Caulis in Recens) 10g, Qinglongchi (Fossilized Mammal Bone) 30g, decocted first, Zhike (Aurantii Fructus) 10g, Chuanlianzi (Toosendan Fructus) 10g.

4. Diet Injuring the Stomach Type

Main Syndromes: Stomach pain, epigastric/abdominal fullness, belching with rotten smell/acid regurgitation, or vomiting undigested food, worse after eating, relief after vomiting, constipation, thick/greasy coating, slippery/excess pulse.

Treatment Method: Digest food and guide out stagnation, harmonize the Stomach and direct rebellious Qi downward.

Prescription: Baohe Wan modified: Jiang Banxia (Pinelliae Rhizoma Preparatum cum Zingibere et Alumine) 12g, Chao Sanxian (Stir-fried Three Immortals: Shanzha, Shenqu, Maiya) 10g each, Fuling (Poria) 12g, Chenpi (Citri Reticulatae Pericarpium) 10g, Daizheshi (Haematitum) 12g, Dahuang (Rhei Radix et Rhizoma) 5g, Lianqiao (Forsythiae Fructus) 12g, Sharen (Amomi Fructus) 3g, added later, Zhike (Aurantii Fructus) 12g.

5. Stomach Collateral Blood Stasis Obstruction Type

Main Syndromes: Upper abdominal pain, fixed location, rejection to pressure, severe pain with cold limbs/sweating, pain radiating to chest/back, or repeated melena, purple tongue or with petechiae/ecchymoses, fine or string-taut/choppy pulse.

Treatment Method: Invigorate Blood and resolve stasis, regulate Qi and harmonize the Stomach.

Prescription: Gexia Zhuyu Tang modified: Taoren (Persicae Semen) 10g, Honghua (Carthami Flos) 5g, Chishao (Paeoniae Radix Rubra) 10g, Danggui (Angelicae Sinensis Radix) 10g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 6g, Danpi (Moutan Cortex) 10g, Wulingzhi (Trogopterori Faeces) 10g, Yanhu (Corydalis Rhizoma) 10g, Xiangfu (Cyperi Rhizoma) 10g, Chuanlianzi (Toosendan Fructus) 10g, Sanqi (Notoginseng Radix et Rhizoma) 6g.

6. Mixed Cold and Heat

Main Syndromes: Epigastric hardness/fullness, dry belching with food odor, borborygmus and diarrhea in abdomen, yellow-and-white mixed tongue coating, string-taut/rapid pulse.

Treatment Method: Acrid-open and bitter-descend, harmonize the Stomach and dissipate fullness.