有位孝子，母亲身患肝癌，他听人说；煎中药时间越长，效果越好。一帖药煎了6个小时。服用这样的药汁，于病无益，反添其害。一对新婚不久的青年，丈夫患乙肝，爱妻以为药汁喝的越多，效果越好。每天煎满满一热水瓶的药汁，分3次大口喝下，饮后胃脘胀痞难受，脾胃如何运化？
历代医家对中药汤剂的煎煮、服法十分讲究，如《伤寒论》煮"麻黄汤"条云：上四味以水九升，先煮麻黄减二升，内诸药，煮取二升半，去滓，温服八合，覆取微似汗，等等。一个辨证精确，用药恰当之良方，如果煎、服方法有误，就无以发挥应有的疗效。那么，中药该如何正确煎、服呢？
煎药用具：以砂锅、瓦罐为最好，价廉且不会发生化学变化。铁器、铜器则忌用，因铁、铜之物含有鞣质，其中有机酸等成份易于与药物发生化学反应，破坏药物质量，影响疗效。
药物检查；打开药包，将先煎、后下、另炖、冲服的取出放在一边，查看药材是否相符，有无泥块、头发、铁钉等异物，准确无误后倾入容器浸泡。
浸泡：为了充分透发药物的性能，在煎药前先以水质纯净之冷水，加至漫过药面，浸1小时，这样有利于药物有效成份的煎出。若加水即煎，药物中某些植物蛋白遇热凝固，有效成份不易渗出，影响疗效。
煎法：一般将先煎药物{如介壳、矿石类：青龙齿、石决明、炙必甲、灵磁石、珍珠母、牛角片、代赭石、牡蛎等，因质地坚硬，有效成份难以煎出，应打碎先煎。}倒入砂锅，加适量冷水，加盖，先以武火，沸后用文火，煎半小时，然后倒入已浸胀之药材，煎25分钟，加入后下药{如薄荷、砂仁等}，煎5分钟，倒出一碗药汁，倾入空热水瓶内，立即加开水再煎25分钟，倒出药汁入水瓶内。煎药时不宜频频揭盖，以防气味走失。解表药、清热药、芳香类，急煎15~20分钟即可；厚味滋补药，文火慢煎30~45分钟，使有效成份充分渗出；乌头附子等毒性药，慢火久煎，可减低毒性。某些贵重药{如人参、羚羊角等}，为保存吸收有效成份，以另炖饮服为佳。
服法：服药方法的恰当与否，不仅关系药效的发挥，还可减少某些药物的不良反应，故而，掌握服法至关重要。
一般而言，一剂药煎2次，分2~3次服；病情紧急的一次顿服。汤剂宜于温服，发汗解表药除温服外，须温覆避风，得汗止服。药宜饭前或饭后1~2小时服用；滋腻补益药空腹服；安神药睡前服；按时而发，按时而止的发热病人，宜于发热前1~2小时服用；食道癌患者，病位在上，纳食欠畅，宜少量多次频频呷服；腹水患者脘腹撑满，食后尤甚，肝脾两伤，食入运迟，饮药稍多，无以运化吸收，反增胀痞，宜少量多次饮服；等等。具体分视病情，适证随服。参三七之类，每天分2次冲服。
服药禁忌：服某些药时不可同吃某些食物，因某些食物与药物存在相互作用的问题，如："蜜反生葱"，药中有炙甘草、炙必甲等，应避免食葱；茯苓忌醋；必甲忌苋菜；薄荷忌必肉；常山忌葱；地黄、何首乌忌葱、蒜、萝卜等。此外，服药期间应忌食生冷、油腻、腥发之物。
第五篇
肿瘤综述
1．胃癌前期病变的中医防治
癌前期病变是指机体组织中某些有可能演变成癌的病理变化。有不少癌瘤，在它发展为恶性之前，常有一个相当长的"良性"过程，了解这一过程的病理改变，对早期诊断，早期治疗具有重要意义。以胃癌为例，我国每年死于胃癌的人数达１５－２０万，一经确诊，五年生存率仅１５％．慢性萎缩性胃炎在我国是一种常见病，好发年龄在４０岁以后，６０岁左右为最高峰，其癌变率极高，在１５％以上，积极治疗萎缩性胃炎，无癌早防，有癌早治，是中医治未病医术的体现．萎缩性胃炎，中医称胃脘痛，是以上腹胃脘部近心窝处经常发生疼痛为主症．祖国医学对此早有记载。
祖国医学对胃脘痛的认识
《内经》对脾胃学说极为重视．《素问·六元正纪大论》曰："木郁之发，民病胃脘当心而痛。"《素问.至真要大论》云："厥阴司天，风淫所胜，┉民病胃脘当心而痛，上支两胁隔咽不通，饮食不下，舌本强，食则呕，冷泄，腹胀，溏泄，瘕，水闭。"《灵枢·邪气脏腑病形篇》曰："胃病者，腹瞋胀，胃脘当心而痛。"
张仲景《金匮要略·腹满寒疝宿食病脉证治第十》："心胸中大寒痛，呕不能食，腹中寒，上冲皮起，出见有头足，上下痛而不可触近，大建中汤主之。"《伤寒论》曰："阳明病，发潮热，大便溏，小便自可，胸胁满不去者，小柴胡汤主之。"
李东垣著有《脾胃论》等书，重点阐明了脾胃的生理功能，内伤病的致病原因、发病机理、鉴别诊断、治疗方药等学术问题，提出了"内伤脾胃，百病由生"的论点。其曰："夫饮食不节则胃病，┉胃即病则脾无所禀受。┉故亦从而病焉。"李氏十分重视升发脾胃阳气，创制了补中益气汤、升阳益胃汤等方。对胃的滋降提出："胃之不足，唯湿物能滋养。"而用芍药甘草汤、生脉散等酸甘之品。
张子和对脾胃病的治疗主张攻下，"凡宿食在胃，皆可下之"若下后"心下按之而满者，尤宜再下之。"他认为"下之治病，人亦所恶闻也，然积聚陈莝于中，留积寒热于内，留之则是耶，逐之则是耶，《内经》一书唯以气血流通为贵，世俗庸之，唯以闭塞为贵，又只知下之为泻，又岂知《内经》之所谓下者，乃所谓补也。陈莝去而肠胃清，症瘕尽而营卫昌，不补之中真补者存焉。"
《张氏医通》注意到体质因素与胃病的关系。"肥人心下痞闷，内有痰湿也。"瘦人心下痞闷，乃有郁热在中焦。""老人、虚人，则多为脾胃虚弱，运化不及。"
宋·陈无择《三因极一病证方论》对胃脘痛的病因证治亦有论述。"胃中风者，人迎与两关上脉并浮而大。胃为脏海，纳五味以滋养五脏，虚而中邪风。故其状额多汗，食饮不下，隔塞不通，腹善满，失衣则瞋胀，张口，肩息，心下淡淡，食寒则泄．""平胃散：治胃实热，口唇干，呕哕，烦闷，大小便秘涩，及热病后，余热不除，著于胃中，四肢发热，口渴，胸满无汗。厚朴、射干、升麻、茯苓、芍药、枳壳、大黄、甘草"。"养胃汤：治胃虚寒，胫寒不得卧，淅淅恶风，洒洒恶寒，腹中痛，虚鸣寒热如疟，唇口干，面目虚浮，呕哕吐泻，四肢疼痛，不思饮食，或伤寒湿，骨节皆痛。厚朴、藿香、半夏、茯苓、人参、甘草、附子、桔皮、草果、白术。"
萎缩性胃炎是由于各种致病因素损害胃粘膜，久之侵及粘膜较深层，胃腺受到损害，发生萎缩，数量减少，胃腺分泌功能减弱，造成消化不良，影响吸收，逐渐出现消瘦，乏力，贫血等症状。萎缩性胃炎其胃液中游离酸减少或缺乏，空腹胃液常有上皮细胞、白细胞、粘液及幽门螺杆菌；胃脱落细胞检查见异常细胞、核异质细胞及肠上皮化生等改变；胃镜检查见胃粘膜呈灰白、灰黄或灰绿色，萎缩初期可见到粘膜内小血管，严重者可见到粘膜上大血管如树枝状，甚至血管象长在粘膜表面上；病理检查粘膜萎缩，腺体大部消失，尚可发生息肉，甚至转变为胃癌．
其病因至今尚未完全清楚，一般认为幽门螺杆菌感染是患本病的重要原因，这种细菌吸附在胃粘膜表面分泌多种毒素损伤胃粘膜细胞，而引起慢性胃炎。此外，吸烟，过热饮食，粗糙食物，慢性扁桃体炎等亦可引起．西药对该病的治疗多以缓解症状为主，尚缺乏行之有效的阻断和逆转该病的药物．萎缩性胃炎伴重度不典型增生者考虑行胃切除术。
英国学者研究发现，被幽门螺杆菌感染群体比没有感染的群体胃癌发生危险增加６倍．日本学者也发现长期幽门螺杆菌感染，可引起慢性萎缩性胃炎，肠上皮化生，进而有导致发生早期分化型胃癌可能；倘若在其它致癌因素（如高盐饮食，缺乏新鲜蔬菜，遗传或毒性物质）存在下，是较容易诱发胃癌的，因此，早期清除幽门螺杆菌感染对预防胃癌的发生有积极意义。
病因病机
胃居于膈下，上接食管，下通小肠，其经脉络脾。胃分三部分，其上口贲门部又名上脘，下口幽门部又名下脘，上下脘之间名中脘，三部合之，统称胃脘。胃的主要生理功能是受纳与腐熟水谷，胃以降为和。《素问．玉机真藏论》曰："五脏者，皆禀气于胃；胃者，五脏之本也。"胃为"太仓"，"水谷气血之海。""有胃气则生，无胃气则死"。脾和胃相为表里，居于中焦，同属于消化系统的主要脏器，"脾胃者，仓禀之官，五味出焉。"胃病以受纳腐熟功能障碍，胃气上逆为主要病变。脾病以阳气虚衰，运化失调，水湿痰饮内生为常见。
胃病发生的常见原因有下列几种：
1、寒邪客胃：外感寒邪，内客于胃，寒主收引，致气滞血瘀，经脉凝闭不通，胃气不和，出现肠鸣腹泻脘腹疼痛诸证。《素问-举痛论》曰：寒邪客于肠胃之间，膜原之下，血不得散，小络引急，故痛。
2、饮食伤胃：饮食不节，过饥过饱，或喜好辛酸，恣饮热酒煎熬，或长期食用污染霉变食物，致胃腑受蚀，胃失和降。
3、肝气犯胃：肝胆与脾胃关系密切，木克土也，"土得木而达之。"肝气太过横犯脾胃，脾胃受戕则运化失司，升降失常，腹痛，呕恶，肠鸣，泄泻等证由是而作。反之，肝气不及，郁结不达，不能疏泄脾土，脾失健运，胃失和降，则见脘胁不舒，郁郁不乐，善太息，纳食呕恶等证。《沈氏尊生书-胃痛》云："胃痛，邪干胃脘病也。┉唯肝气相乘为尤甚，以木性暴，且正克也。"
4、脾胃虚弱：脾胃为仓禀之官，主受纳和运化水谷，若饥饱失常，或劳倦过度，或久病脾胃受伤等，均可引起脾阳不足，中焦虚寒，或胃阴受损，失其濡养而发生疼痛。亦有过服寒凉致脾胃虚寒而痛者。
5、瘀血留着：患病日久，气血运行不畅，经络阻滞不通瘀血内结胃脘而痛。
胃为五脏六腑之大源，上述各种原因皆能引起胃受纳腐熟之功能失常，胃失和降而发生疼痛。胃病之因，单一出现者，病理变化与临床证候比较单纯，治之较易；合并出现者，病理变化与临床证候比较复杂，治之为难。胃病初起多在气分，迁延日久，则深入血分，所以久痛胃络受伤，多见呕血或便黑等证。本病病机寒热交错，虚实夹杂。寒由饮食生冷，积冷成寒，或脾胃阳虚，寒从内生；热因嗜食辛辣酒澧，湿热内蕴或脾胃阴分不足，阴虚内热。虚重在脾胃（阳）气虚；实为气滞，血瘀，湿阻等。
辨证论治
胃痛之主要部位系在上腹胃脘部近心窝处，痛时可以牵连胁背，或兼见胸脘痞闷，恶心呕吐，纳差，嘈杂，噯气，或大便溏薄或秘结，甚至呕血，便血等证。首当辨清寒热虚实，治疗以理气和胃止痛为主，再须审证求因，辨证施治，邪盛以祛邪为急，正虚以养正为先，虚实夹杂当兼顾。
1、脾胃虚弱型
主证：胃脘隐痛，喜暖恶寒，纳差，进寒凉食品疼痛加剧，面色萎黄，神疲乏力，四肢不温，口泛清水，大便溏薄，小便清长，舌淡苔白，脉沉弱。
方药：黄芪建中汤加减：炙芪15克 炒冬术12克 干姜4克 制附片3克 炙甘草3克 甘松3克 茯苓12克 炒鸡金10克砂仁3克 后下
2、胃阴亏损型
主证：胃脘嘈杂疼痛，食后尤甚，口干舌燥，喜食酸物，五心烦热，心悸失眠，尿少便秘，舌红少津苔少或剥苔，脉沉细。
方药：益胃汤加味：川石斛15克 炒山楂12克 乌梅7枚 南北沙参各12克生地10克 西洋参3克 川连3克 杭白芍12克
主证：胃脘胀痛，串及两胁，胸胁痞满，噯气，呃逆，面色苍黄泛青，失眠多梦，头晕目眩，情绪忧郁时症状加重，舌红苔白，脉弦细数。
方药：失笑散合旋复代赭汤加减：五灵脂10克 蒲黄10克 丹参20克 代赭石12克 旋复花包10克 姜竹茹10克 青龙齿30克先煎 枳壳10克 川楝子10克
4、饮食伤胃型
主证：胃痛，脘腹胀满，噯腐吞酸，或吐不消化食物，得食愈甚，吐后反快，大便秘结，苔厚腻，脉滑实。
方药：保和丸加减：姜半夏12克 炒三仙各10克 茯苓12克 陈皮10克 代赭石12克 大黄5克 连翘12克 砂仁3克后下 枳壳12克
5、胃络瘀阻型
主证：上腹疼痛，痛有定处，拒按，病情严重时疼痛加剧可见肢凉，汗出，痛连胸背，或见反复黑便，舌质紫或有瘀斑点，脉细或弦涩。
方药：膈下逐瘀汤加减：桃仁10克 红花5克 赤芍10克 当归10克 川芎6克 丹皮10克五灵脂10克 延胡10克 香附10克 川楝子10克 三七6克
6、寒热错杂
有一位孝子，他的母亲患有肝癌。他听人说：煎煮中药的时间越长，药效就越好。于是他将一帖药煎煮了6个小时。服用这样的药汁，对病情不仅没有益处，反而增加了危害。还有一对刚结婚不久的青年夫妇，丈夫患有乙型肝炎。妻子认为药汁喝得越多，效果就越好。她每天煎满满一热水瓶的药汁，分三次大口喝下。服药后导致胃脘部胀满痞塞，非常难受，脾胃又怎能运化吸收呢？
历代医家对中药汤剂的煎煮和服用方法都非常讲究。例如《伤寒论》中关于煮“麻黄汤”的记载说：取上面四味药，用水九升，先煮麻黄，减少二升水，再加入其他药物，煮取二升半药液，去掉药渣，温服八合，服药后覆盖衣被使身体微微出汗，等等。一个辨证精确、用药恰当的良方，如果煎煮和服用方法有误，就无法发挥应有的疗效。那么，中药应该如何正确煎煮和服用呢？
煎药用具：以砂锅、瓦罐为最好，价格便宜且不会发生化学变化。铁器、铜器则忌用，因为铁、铜制品含有鞣质，其中的有机酸等成分易于与药物发生化学反应，破坏药物质量，影响疗效。
药物检查：打开药包，将需要先煎、后下、另炖、冲服的药材取出放在一边，查看药材是否相符，有无泥块、头发、铁钉等异物，确认准确无误后倒入容器浸泡。
浸泡：为了充分透发药物的性能，在煎药前先以水质纯净的冷水，加至漫过药面，浸泡1小时，这样有利于药物有效成分的煎出。若加水即煎，药物中某些植物蛋白遇热凝固，有效成分不易渗出，影响疗效。
煎法：一般先将需要煎煮的药物（如介壳、矿石类：青龙齿、石决明、炙鳖甲、灵磁石、珍珠母、牛角片、代赭石、牡蛎等，因质地坚硬，有效成分难以煎出，应打碎先煎）倒入砂锅，加适量冷水，加盖，先用武火（大火），煮沸后用文火（小火），煎半小时，然后倒入已浸胀的药材，煎25分钟，加入后下药（如薄荷、砂仁等），煎5分钟，倒出一碗药汁，倾入空热水瓶内，立即加开水再煎25分钟，倒出药汁入水瓶内。煎药时不宜频频揭盖，以防气味走失。解表药、清热药、芳香类药物，急煎15~20分钟即可；厚味滋补药，文火慢煎30~45分钟，使有效成分充分渗出；乌头、附子等毒性药物，慢火久煎，可降低毒性。某些贵重药物（如人参、羚羊角等），为保存吸收有效成分，以另炖饮服为佳。
服法：服药方法的恰当与否，不仅关系药效的发挥，还可减少某些药物的不良反应，故而，掌握服法至关重要。
一般而言，一剂药煎2次，分2~3次服用；病情紧急的一次顿服。汤剂宜于温服，发汗解表药除温服外，须温覆避风，得汗止服。药宜饭前或饭后1~2小时服用；滋腻补益药空腹服；安神药睡前服；按时而发、按时而止的发热病人，宜于发热前1~2小时服用；食道癌患者，病位在上，纳食欠畅，宜少量多次频频呷服；腹水患者脘腹撑满，食后尤甚，肝脾两伤，食入运迟，饮药稍多，无以运化吸收，反增胀痞，宜少量多次饮服；等等。具体分视病情，适证随服。参三七之类，每天分2次冲服。
服药禁忌：服某些药时不可同吃某些食物，因某些食物与药物存在相互作用的问题，如：“蜜反生葱”，药中有炙甘草、炙鳖甲等，应避免食葱；茯苓忌醋；鳖甲忌苋菜；薄荷忌肥肉；常山忌葱；地黄、何首乌忌葱、蒜、萝卜等。此外，服药期间应忌食生冷、油腻、腥发之物。
第五篇
肿瘤综述
1．胃癌前期病变的中医防治
癌前期病变是指机体组织中某些有可能演变成癌的病理变化。有不少癌瘤，在它发展为恶性之前，常有一个相当长的“良性”过程，了解这一过程的病理改变，对早期诊断、早期治疗具有重要意义。以胃癌为例，我国每年死于胃癌的人数达15－20万，一经确诊，五年生存率仅15％。慢性萎缩性胃炎在我国是一种常见病，好发年龄在40岁以后，60岁左右为最高峰，其癌变率极高，在15％以上，积极治疗萎缩性胃炎，无癌早防，有癌早治，是中医治未病医术的体现。萎缩性胃炎，中医称胃脘痛，是以上腹胃脘部近心窝处经常发生疼痛为主症。祖国医学对此早有记载。
祖国医学对胃脘痛的认识
《内经》对脾胃学说极为重视。《素问·六元正纪大论》曰：“木郁之发，民病胃脘当心而痛。”《素问·至真要大论》云：“厥阴司天，风淫所胜，……民病胃脘当心而痛，上支两胁隔咽不通，饮食不下，舌本强，食则呕，冷泄，腹胀，溏泄，瘕，水闭。”《灵枢·邪气脏腑病形篇》曰：“胃病者，腹瞋胀，胃脘当心而痛。”
张仲景《金匮要略·腹满寒疝宿食病脉证治第十》：“心胸中大寒痛，呕不能食，腹中寒，上冲皮起，出见有头足，上下痛而不可触近，大建中汤主之。”《伤寒论》曰：“阳明病，发潮热，大便溏，小便自可，胸胁满不去者，小柴胡汤主之。”
李东垣著有《脾胃论》等书，重点阐明了脾胃的生理功能，内伤病的致病原因、发病机理、鉴别诊断、治疗方药等学术问题，提出了“内伤脾胃，百病由生”的论点。其曰：“夫饮食不节则胃病，……胃即病则脾无所禀受。……故亦从而病焉。”李氏十分重视升发脾胃阳气，创制了补中益气汤、升阳益胃汤等方。对胃的滋降提出：“胃之不足，唯湿物能滋养。”而用芍药甘草汤、生脉散等酸甘之品。
张子和对脾胃病的治疗主张攻下，“凡宿食在胃，皆可下之”若下后“心下按之而满者，尤宜再下之。”他认为“下之治病，人亦所恶闻也，然积聚陈莝于中，留积寒热于内，留之则是耶，逐之则是耶，《内经》一书唯以气血流通为贵，世俗庸之，唯以闭塞为贵，又只知下之为泻，又岂知《内经》之所谓下者，乃所谓补也。陈莝去而肠胃清，症瘕尽而营卫昌，不补之中真补者存焉。”
《张氏医通》注意到体质因素与胃病的关系。“肥人心下痞闷，内有痰湿也。”瘦人心下痞闷，乃有郁热在中焦。“老人、虚人，则多为脾胃虚弱，运化不及。”
宋·陈无择《三因极一病证方论》对胃脘痛的病因证治亦有论述。“胃中风者，人迎与两关上脉并浮而大。胃为脏海，纳五味以滋养五脏，虚而中邪风。故其状额多汗，食饮不下，隔塞不通，腹善满，失衣则瞋胀，张口，肩息，心下淡淡，食寒则泄。”“平胃散：治胃实热，口唇干，呕哕，烦闷，大小便秘涩，及热病后，余热不除，著于胃中，四肢发热，口渴，胸满无汗。厚朴、射干、升麻、茯苓、芍药、枳壳、大黄、甘草”。“养胃汤：治胃虚寒，胫寒不得卧，淅淅恶风，洒洒恶寒，腹中痛，虚鸣寒热如疟，唇口干，面目虚浮，呕哕吐泻，四肢疼痛，不思饮食，或伤寒湿，骨节皆痛。厚朴、藿香、半夏、茯苓、人参、甘草、附子、桔皮、草果、白术。”
萎缩性胃炎是由于各种致病因素损害胃粘膜，久之侵及粘膜较深层，胃腺受到损害，发生萎缩，数量减少，胃腺分泌功能减弱，造成消化不良，影响吸收，逐渐出现消瘦，乏力，贫血等症状。萎缩性胃炎其胃液中游离酸减少或缺乏，空腹胃液常有上皮细胞、白细胞、粘液及幽门螺杆菌；胃脱落细胞检查见异常细胞、核异质细胞及肠上皮化生等改变；胃镜检查见胃粘膜呈灰白、灰黄或灰绿色，萎缩初期可见到粘膜内小血管，严重者可见到粘膜上大血管如树枝状，甚至血管象长在粘膜表面上；病理检查粘膜萎缩，腺体大部消失，尚可发生息肉，甚至转变为胃癌。
其病因至今尚未完全清楚，一般认为幽门螺杆菌感染是患本病的重要原因，这种细菌吸附在胃粘膜表面分泌多种毒素损伤胃粘膜细胞，而引起慢性胃炎。此外，吸烟，过热饮食，粗糙食物，慢性扁桃体炎等亦可引起。西药对该病的治疗多以缓解症状为主，尚缺乏行之有效的阻断和逆转该病的药物。萎缩性胃炎伴重度不典型增生者考虑行胃切除术。
英国学者研究发现，被幽门螺杆菌感染群体比没有感染的群体胃癌发生危险增加6倍。日本学者也发现长期幽门螺杆菌感染，可引起慢性萎缩性胃炎，肠上皮化生，进而有导致发生早期分化型胃癌可能；倘若在其它致癌因素（如高盐饮食，缺乏新鲜蔬菜，遗传或毒性物质）存在下，是较容易诱发胃癌的，因此，早期清除幽门螺杆菌感染对预防胃癌的发生有积极意义。
病因病机
胃居于膈下，上接食管，下通小肠，其经脉络脾。胃分三部分，其上口贲门部又名上脘，下口幽门部又名下脘，上下脘之间名中脘，三部合之，统称胃脘。胃的主要生理功能是受纳与腐熟水谷，胃以降为和。《素问·玉机真藏论》曰：“五脏者，皆禀气于胃；胃者，五脏之本也。”胃为“太仓”，“水谷气血之海。”“有胃气则生，无胃气则死”。脾和胃相为表里，居于中焦，同属于消化系统的主要脏器，“脾胃者，仓禀之官，五味出焉。”胃病以受纳腐熟功能障碍，胃气上逆为主要病变。脾病以阳气虚衰，运化失调，水湿痰饮内生为常见。
胃病发生的常见原因有下列几种：
1、寒邪客胃：外感寒邪，内客于胃，寒主收引，致气滞血瘀，经脉凝闭不通，胃气不和，出现肠鸣腹泻脘腹疼痛诸证。《素问-举痛论》曰：寒邪客于肠胃之间，膜原之下，血不得散，小络引急，故痛。
2、饮食伤胃：饮食不节，过饥过饱，或喜好辛酸，恣饮热酒煎熬，或长期食用污染霉变食物，致胃腑受蚀，胃失和降。
3、肝气犯胃：肝胆与脾胃关系密切，木克土也，“土得木而达之。”肝气太过横犯脾胃，脾胃受戕则运化失司，升降失常，腹痛，呕恶，肠鸣，泄泻等证由是而作。反之，肝气不及，郁结不达，不能疏泄脾土，脾失健运，胃失和降，则见脘胁不舒，郁郁不乐，善太息，纳食呕恶等证。《沈氏尊生书-胃痛》云：“胃痛，邪干胃脘病也。……唯肝气相乘为尤甚，以木性暴，且正克也。”
4、脾胃虚弱：脾胃为仓禀之官，主受纳和运化水谷，若饥饱失常，或劳倦过度，或久病脾胃受伤等，均可引起脾阳不足，中焦虚寒，或胃阴受损，失其濡养而发生疼痛。亦有过服寒凉致脾胃虚寒而痛者。
5、瘀血留着：患病日久，气血运行不畅，经络阻滞不通瘀血内结胃脘而痛。
胃为五脏六腑之大源，上述各种原因皆能引起胃受纳腐熟之功能失常，胃失和降而发生疼痛。胃病之因，单一出现者，病理变化与临床证候比较单纯，治之较易；合并出现者，病理变化与临床证候比较复杂，治之为难。胃病初起多在气分，迁延日久，则深入血分，所以久痛胃络受伤，多见呕血或便黑等证。本病病机寒热交错，虚实夹杂。寒由饮食生冷，积冷成寒，或脾胃阳虚，寒从内生；热因嗜食辛辣酒澧，湿热内蕴或脾胃阴分不足，阴虚内热。虚重在脾胃（阳）气虚；实为气滞，血瘀，湿阻等。
辨证论治
胃痛之主要部位系在上腹胃脘部近心窝处，痛时可以牵连胁背，或兼见胸脘痞闷，恶心呕吐，纳差，嘈杂，噯气，或大便溏薄或秘结，甚至呕血，便血等证。首当辨清寒热虚实，治疗以理气和胃止痛为主，再须审证求因，辨证施治，邪盛以祛邪为急，正虚以养正为先，虚实夹杂当兼顾。
1、脾胃虚弱型
主证：胃脘隐痛，喜暖恶寒，纳差，进寒凉食品疼痛加剧，面色萎黄，神疲乏力，四肢不温，口泛清水，大便溏薄，小便清长，舌淡苔白，脉沉弱。
方药：黄芪建中汤加减：炙芪15克 炒冬术12克 干姜4克 制附片3克 炙甘草3克 甘松3克 茯苓12克 炒鸡金10克砂仁3克 后下
2、胃阴亏损型
主证：胃脘嘈杂疼痛，食后尤甚，口干舌燥，喜食酸物，五心烦热，心悸失眠，尿少便秘，舌红少津苔少或剥苔，脉沉细。
方药：益胃汤加味：川石斛15克 炒山楂12克 乌梅7枚 南北沙参各12克生地10克 西洋参3克 川连3克 杭白芍12克
主证：胃脘胀痛，串及两胁，胸胁痞满，噯气，呃逆，面色苍黄泛青，失眠多梦，头晕目眩，情绪忧郁时症状加重，舌红苔白，脉弦细数。
方药：失笑散合旋复代赭汤加减：五灵脂10克 蒲黄10克 丹参20克 代赭石12克 旋复花包10克 姜竹茹10克 青龙齿30克先煎 枳壳10克 川楝子10克
4、饮食伤胃型
主证：胃痛，脘腹胀满，噯腐吞酸，或吐不消化食物，得食愈甚，吐后反快，大便秘结，苔厚腻，脉滑实。
方药：保和丸加减：姜半夏12克 炒三仙各10克 茯苓12克 陈皮10克 代赭石12克 大黄5克 连翘12克 砂仁3克后下 枳壳12克
5、胃络瘀阻型
主证：上腹疼痛，痛有定处，拒按，病情严重时疼痛加剧可见肢凉，汗出，痛连胸背，或见反复黑便，舌质紫或有瘀斑点，脉细或弦涩。
方药：膈下逐瘀汤加减：桃仁10克 红花5克 赤芍10克 当归10克 川芎6克 丹皮10克五灵脂10克 延胡10克 香附10克 川楝子10克 三七6克
6、寒热错杂
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.