案例：杨某，女，３２岁，工人。１９９２年８月１７日初诊。肝区疼痛反复发作５年，复发加重１月。５年前因肝区疼痛作肝功检查：ＧＰＴ６０ｕ／赖氏，ＨＢＶ－Ｍ：ＨＢＳＡｇ、抗ＨＢｃ均为阳性。在医务室服用灭澳灵、肌苷片等稍有好转，但若情绪不舒或紧张劳累后肝疼又发。曾在武汉几所医院诊治，先后服用中药（药名不详），未见显效。到诊所见：肝区隐痛，口干咽燥，心烦失眠，纳食不馨，小便色黄，月经失调，经来腹痛，舌红苔薄黄干，脉细数。肝功检查：ＧＰＴ５０ｕ／赖氏，ＨＢＶ－Ｍ：ＨＢｓＡｇ、抗－ＨＢＣ均为阳性。辨属肝肾阴亏，肝郁乘脾，兼夹湿热。拟用滋阴柔肝、舒肝健脾、清化湿热之法。处方：生地１５克、沙参１５克、丹参３０克、枸杞１５克、柴胡１０克、枳壳１０克、元胡１０克、川楝子１０克、香橼皮１０克、茯苓神各１５克、赤白芍各１５克、白花蛇舌草３０克、炒三仙各１０克。
服用上方３０余剂，肝区疼痛基本缓解，口干咽燥、心烦失眠好转，月经正常，惟四肢乏力，纳食欠佳，小便带黄，肝功及乙肝三项检查结果同前，舌红苔薄黄，脉细弦数。宜滋养肝肾、健脾益气、清热解毒。处方：生地１５克、沙参１５克、枸杞１５克、芦根、太子参、五味子、虎杖、炒二芽、白茅根各１５克，麦冬、香橼皮、川楝子各１０克、丹参、白花蛇舌草各３０克。前后加减服至１００余剂，肝病诸证消失，肝功及乙肝三项复常。继用养血柔肝、健脾和胃、清热解毒之法调治２０余剂，病方痊愈。随访半年未发。
（四）瘀血积聚活血化瘀慢性肝炎久治不愈，正气亏虚，邪毒留着，肝气郁滞，脉络瘀阻，日久成为积块。证见面色晦暗，肝脾肿大，质地较硬，腹胀纳差，倦怠乏力，日渐消瘦，蜘蛛痣及肝掌等；若瘀血症积，水湿内停，可见腹大坚满，腹壁青筋显露，或兼发热、齿衄、鼻衄、黄疸，舌质紫暗或有瘀斑，脉沉涩或细涩。治宜活血行气，化瘀消积。药用：丹参、赤芍、制乳没、桃仁、红花、玫瑰花、炮甲珠、鳖甲、第三卷２１１土鳖虫、香附、枳壳、茯苓等。若气血瘀滞，肝区痛甚，加元胡、川楝、三棱、莪术等行气活血止痛；肝胆湿热，病发黄疸者，加茵陈、金钱草、茅根、蛇舌草等以清热利湿退黄；血瘀症积，水湿内停，腹大坚满，小便不通者，加车前子、莱菔子、牵牛子粉，并合用鳖甲煎丸、大黄虫丸等以消症利水；阴伤发热，口干舌燥者，加黄芩、生地、沙参、麦冬、牡蛎等清热育阴；热伤血络，齿鼻衄血，或呕血者，加小蓟、茜草、茅根、三七粉、阿胶等以凉血止血；大便干燥者，加大黄、厚朴、枳实、甘草等以通下里实。
案例：周某，男，５３岁，教师。１９９１年１０月８日初诊。肝区疼痛，肢软无力１年，复发加重３月。１年前因饮食不洁加上工作劳累，病发肝区疼痛，四肢无力，纳食减退，即到该地县人民医院就诊，肝功检查：ＧＰＴ６４ｕ／赖氏，ＨＢＶ－Ｍ：ＨＢｓＡｇ（＋），诊断为乙肝，用中西药治疗无显效。
今年７月份，身体极度疲惫，肢软无力，小便深黄，又到该院诊治，肝功检查：黄疸指数１３ｕ，ＧＰＴ６０ｕ／赖氏，ＨＢｓＡｇ（＋）。经保肝及对症处理，黄疸消退，但极度无力。１９９１年８月５日到某医科大学附院就诊，检查结果：ＧＰＴ６５ｕ／赖氏，ＨＢｓＡｇ、ＨＢｅＡｇ、抗－ＨＢＣ均为阳性。Ｂ超检查：肝脾肿大。诊断为病毒型乙肝，慢性活动肝炎，肝硬化。住院治疗２月余，用药如肌苷片、ＡＴＰ片及中药清热解毒、活血化瘀剂等，病证未减。现症：面色暗黑，见有肝掌，肝区胀痛，肢软乏力，纳食减退，口干口苦，肝脾肿大，小便色黄，大便时干时稀，舌质暗红，苔薄黄，脉弦细。１０年前患过血吸虫病，曾用锑剂治疗。今酶标试验未见血吸虫感染。有烟酒嗜好。李氏断之曰：饮食不洁，感染疫毒，嗜酒无度，复加劳累，以致正虚邪入，湿热毒遏，肝失疏泄，脾失运化，久延不愈，则脉络瘀阻，终至瘀血积聚，而成积块。拟以活血化瘀，疏肝健脾，清热利湿为法。处方：醋炒鳖甲、麦芽、赤白芍、丹参各１５克，炮甲珠、柴胡、炒枳壳、桃红、香橼皮、炒川楝、橘皮络、元胡各１０克，酒炒土鳖虫６克、白茅根３０克。
二诊：服用上方１５剂，精神渐振，胃纳增进，面色红润，肝痛缓解，肝掌亦消失，二便通利，肝功正常，Ｂ超证实肝脾肿大较前明显缩小，舌红苔薄黄脉弦，睡眠有时欠佳。守上法加入养心安神之品。处方：醋炒鳖甲、赤白芍、丹参、茯神各１５克，当归、郁金、炮甲珠、制香附、橘皮络、炒枳壳、元胡、金铃子、柏子仁、柴胡、炒三仙各１０克，蛇舌草、白茅根各３０克，酒炒土鳖虫６克。
三诊：服用上方２０剂，临床症状缓解，未再坚持服药，并参加工作。经常熬夜受累，时过４日，肝痛复发。肝区作胀，纳食减退，脘腹胀气，肢体乏力，腹大坚满，出现腹水，身目发黄，小便深黄，大便时干时稀，舌质暗红苔黄略腻，脉弦细。肝功：总胆红素３０μｍｏｌ／Ｌ、ＧＰＴ１００ｕ／赖氏，ＨＢＶ－Ｍ：ＨＢｓＡｇ、抗－ＨＢＣ均阳性。Ｂ超提示肝硬化伴腹水。遂到县中医院住院，治疗月余，服用中药利胆退黄剂及西药等，病情无明显改善。李氏诊之曰：此肝病痼疾，治未彻底，又妄劳作，正虚邪盛，瘀血症积，湿热蕴结，水气内停，酿为膨胀也。当清热解毒，利水去湿，化瘀消症。
处方：茵陈、赤芍各５０克，丹参、茯苓、茅根、蛇舌草各３０克，醋炒鳖甲、车前草、炒二芽各１５克，炒栀子、泽泻、陈皮、制香附、炮甲珠各１０克，酒炒鳖甲６克，三七粉６克（吞服）。
四诊：服上方１２剂，腹水消退，腹胀缓解，黄疸亦退，精神渐振，小便较前通利，大便成形，惟纳差乏力明显，舌暗红苔黄，脉弦细。再以清热解毒，行气活血，疏肝健脾之治。处方：茵陈、赤芍各５０克，丹参、茯苓、蛇舌草、茅根各３０克，炒鳖甲、炒二芽各１５克，猪苓１２克，炒栀子、炒黄柏、炒白术、泽泻、陈皮、炮甲珠各１０克，制香附子１０克，三七粉６克（兑服）。加减服用５０余剂，诸证皆愈，肝功正常，肝脾缩小变软。随访１年半未发。
第三卷２１２七、慢性萎缩性胃炎治验慢性萎缩性胃炎是以胃腺萎缩、粘膜变薄、粘膜肌层增厚、胃液分泌减少为病理特征的一种常见病。其病程长，病情复杂，或以胃脘疼痛为主，或以心下痞满为重，或以纳少嗳气、消瘦乏力、嘈杂烧灼为甚，或数者兼并出现，属中医胃脘痛、痞证等范畴。李氏常用的辨治方法如下：（一）胃痛日久益气活血慢性萎缩性胃炎多由慢性浅表性胃炎演变而来。饮食不节，饥饱失常，或劳倦内伤等，均可损伤脾胃，日久而成脾胃气虚。胃失和降，不能受纳腐熟水谷，脾失健运，不能化生气血，食滞不化则气机阻滞，以致胃络血瘀，形成气虚血瘀、本虚标实的病机。《仁斋直指方》谓：“盖气者，血之帅也，气行则血行，气止则血止。”《医林改错》云：“无气则虚，必不能达于血管，血管无气，必停滞而瘀。”气虚和血瘀互为因果，是以影响慢性萎缩性胃炎的发生和发展。临床表现为胃脘胀痛或刺痛，脘腹痞满，或纳呆食少，噫气矢气，胸闷气逆，面黄消瘦，体乏无力，大便不调，舌质暗红或有瘀斑瘀点，脉沉细弦。治以益气健脾，活血化瘀为主。方用黄芪建中汤合活络效灵丹化裁，以达到气充则血行，血行而瘀去的目的。若脾胃虚寒者，加党参、干姜；脾胃阴虚者，去生姜、桂枝，加百合、知母、麦冬；营血不足者，加当归、熟地；气滞痛甚者，加元胡、川楝、陈皮、香附等。曾治蒋某，女，３８岁，工人。胃脘胀痛反复发作１０年，加重半年。形体消瘦，面色萎黄，体倦乏力，嗳气泛酸，大便时干时稀，舌质暗红苔薄白脉弦细。胃镜和病理检查报告：慢性萎缩性胃炎伴肠上皮化生。辨属脾胃气虚，血行瘀滞。药用：炙黄芪、党参、赤白芍、丹参、制乳没、元胡、炒川楝、乌贼骨、法夏、茯苓、炒山楂等，随证加减治疗８个月，症状逐渐缓解。胃镜和病理检查：慢性浅表性胃炎、原萎缩性病灶肠上皮化生均告消失。
（二）病势缠绵治重湿热脾胃素虚，过食生冷，日久易寒积化热，致寒热夹杂，中气困顿，湿浊内生；又因脾为湿土，胃为燥土，若慢性萎缩性胃炎合并有幽门螺旋菌感染，胆汁返流或偏嗜酒辛之人，亦易湿热内蕴，夹杂寒热。表现为胃脘胀满，心下痞闷，口苦气秽，胃中嘈杂，食欲减退，周身乏力，大便干燥或溏而不爽，舌尖红，苔黄厚腻，脉细弦滑。治宜辛开苦降，清热化湿，选用半夏泻心汤化裁。
药用：法夏、太子参、炒黄芩、炒川连、干姜、藿香、陈皮、炒二芽等。若恶心欲呕，加竹茹、苏梗；脘腹胀满加厚朴、枳实；胃胀满痛甚者加元胡、川楝；血行瘀滞加桃仁、丹参、赤芍；大便色黑加茅根、乌贼骨、三七粉等。曾治李某，男，４９岁，干部。胃脘疼痛反复发作９年，加重伴柏油样大便１５天。胃脘胀痛，痛无规律，纳谷不馨，口苦气秽，大便稀溏，色黑如油，小便色黄，体倦乏力，舌淡红，苔黄略腻，脉细弦滑。胃镜和病检：慢性萎缩性胃炎幽门螺旋菌感染（＋＋），大便潜血（＋＋）。辨属湿热中阻，脾胃失运，热伤血络。治拟健脾理气、清化湿热为主。药用：法夏、太子参、炒黄连、炒黄芩、炒川楝、元胡、乌贼骨、丹参、茅根、茜草炭、白芨、炒二芽等。服上方５剂，胃痛缓解，大便成形色黄，纳食增进。继以上方加减药后服用６０余剂，胃痛消除，纳食及二便正常。胃镜和病检：慢性浅表性胃炎、幽门螺旋菌感染（－）。随访２年未发。
第三卷２１３（三）木邪克土调理肝胃许多慢性萎缩性胃炎患者因脾胃失运，肝气郁滞，郁而化火，横逆犯胃，常有肝胃不和的病理表现。症见胃脘胀痛，或烧灼痛，痛窜胁肋，心烦易怒，嘈杂泛酸，口苦咽干，大便干结，小便色黄，舌红苔黄，脉细弦等。选用柴胡疏肝散或逍遥散化裁。药用：醋柴胡、赤白芍、炒枳壳、厚朴、郁金、香橼皮、川楝子、丹参、炒栀子、当归身、茯苓、炒三仙等。若恶心呕吐加竹茹、法夏；反胃吞酸加左金丸；胁肋胀痛加金铃子散；胃脘灼痛加川连、生石膏；腹痛则泻，泻后痛减，是肝气乘脾，可用痛泻要方加减为治。曾治王某，男，４１岁，干部。胃脘疼痛反复发作７年，又发加重３月。胃脘疼痛，有烧灼感连及两胁痛胀，纳食欠佳，心情烦躁，易怒，嗳气反酸，口干口苦，大便干结，小便色黄，舌红苔黄，脉弦略数。胃镜及病检：慢性萎缩性胃炎中度肠上皮化生。此乃肝气郁滞，脾胃失和，内有郁热之证。当疏肝理气、清热和胃。药用：柴胡、炒枳壳、赤白芍、炒栀子、丹参、炒川连、竹茹、金铃子、川楝子、郁金、制香附、茯苓、白术、炒三仙等。随证加减服用半个月后，胃痛缓解，纳食增加，嗳气吞酸等证亦有好转。原方去竹茹、栀子，加陈皮、佛手等，续用３月，症状基本消失。随访１年未发。
（四）善后调治顾护胃阴慢性萎缩性胃炎病程较长，由于其消化吸收功能减退，化源不足，可见脾胃阴伤。另外，若脾胃虚寒，寒极生热；气机郁结，郁而化热；过食辛辣，胃中生热等，均易损伤胃阴，致胃阴亏耗。
症见胃灼隐痛，纳呆痞满，嘈杂吞酸，口干咽燥，五心烦热，倦怠消瘦，大便秘结，舌红少苔，脉细数等。治当酸甘养阴，理气止痛。方用益胃汤合芍药甘草汤化裁。药用：沙参、麦冬、玉竹、生地、石斛、白芍、佛手、陈香圆、绿萼梅、炙甘草等。若气滞胃痛加川楝子、元胡索；血中有热或血行不畅者，加丹参、赤芍、丹皮；纳呆食滞加炒山楂、炒二芽、鸡内金；大便秘结可配合麻仁丸与服。曾治杨某，男，４２岁，工人。胃脘疼痛反复发作１３年，又发加重２月。胃痛隐隐，病无定时，伴灼热感，食后腹胀，又觉嘈杂，伴灼热感，时有嗳气，口干咽燥，心烦难寐，大便干结，小便微黄，舌红少苔，脉象细数。曾至武汉各大医院治疗，服用温中健脾、清热燥湿之剂等甚杂。辨为胃中有热，阴津亏损。治用滋养胃阴，调理气机之法。选用益胃汤或一贯煎化裁。药用：沙参、麦冬、石斛、赤白芍、丹参、茯神、柏子仁、炒川楝、元胡、香橼皮、乌梅、炒山楂等，随证加减连服６个月，胃痛消失，纳食正常，心烦不寐等证缓解，苔薄白而润。胃镜检查：原慢性萎缩性胃炎与前比较明显好转。随访１年基本正常。
脾胃居于中焦，乃人身气机之枢纽，交通上下，布达四末，为后天之根本。脾胃虚弱，气血运行受阻，则致气滞血瘀；脾胃失运，气机不畅，升降失调，则致肝胃不和；脾主运化，胃主受纳，脾胃虚弱，则水湿内停，蕴郁生热，而为湿热内结；脾胃失运，化源匮乏，或热邪伤津，或辛燥太过，又可见有胃阴亏损之证等，临证可循此而辨证论治。然因慢性萎缩性胃炎病机复杂，证情变化多端，故其治法又不可拘于一隅，当随证候之变化而加减用药。
案例：杨某，女，32岁，工人。1992年8月17日初诊。肝区疼痛反复发作5年，复发加重1个月。5年前因肝区疼痛做肝功能检查：谷丙转氨酶（GPT）60单位/赖氏法，乙肝病毒标志物（HBV-M）：乙肝表面抗原（HBsAg）、乙肝核心抗体均为阳性。在医务室服用灭澳灵、肌苷片等药后稍有好转，但若情绪不舒畅或紧张劳累后肝疼又发作。曾在武汉几家医院诊治，先后服用中药（药名不详），未见明显疗效。到诊所就诊时见：肝区隐痛，口干咽燥，心烦失眠，食欲不佳，小便色黄，月经失调，经期腹痛，舌红苔薄黄干，脉细数。肝功能检查：谷丙转氨酶（GPT）50单位/赖氏法，乙肝病毒标志物（HBV-M）：乙肝表面抗原（HBsAg）、乙肝核心抗体（抗-HBc）均为阳性。辨证属于肝肾阴亏，肝郁乘脾，兼夹湿热。拟定用滋阴柔肝、舒肝健脾、清化湿热之法。处方：生地15克、沙参15克、丹参30克、枸杞15克、柴胡10克、枳壳10克、元胡10克、川楝子10克、香橼皮10克、茯苓神各15克、赤白芍各15克、白花蛇舌草30克、炒三仙各10克。
服用上方30余剂，肝区疼痛基本缓解，口干咽燥、心烦失眠好转，月经正常，惟四肢乏力，食欲欠佳，小便带黄，肝功能及乙肝三项检查结果同前，舌红苔薄黄，脉细弦数。宜滋养肝肾、健脾益气、清热解毒。处方：生地15克、沙参15克、枸杞15克、芦根、太子参、五味子、虎杖、炒二芽、白茅根各15克，麦冬、香橼皮、川楝子各10克、丹参、白花蛇舌草各30克。前后加减服至100余剂，肝病诸证消失，肝功能及乙肝三项复常。继用养血柔肝、健脾和胃、清热解毒之法调治20余剂，病方痊愈。随访半年未发。
（四）瘀血积聚活血化瘀慢性肝炎久治不愈，正气亏虚，邪毒留着，肝气郁滞，脉络瘀阻，日久成为积块。证见面色晦暗，肝脾肿大，质地较硬，腹胀纳差，倦怠乏力，日渐消瘦，蜘蛛痣及肝掌等；若瘀血症积，水湿内停，可见腹大坚满，腹壁青筋显露，或兼发热、齿衄、鼻衄、黄疸，舌质紫暗或有瘀斑，脉沉涩或细涩。治宜活血行气，化瘀消积。药用：丹参、赤芍、制乳没、桃仁、红花、玫瑰花、炮甲珠、鳖甲、土鳖虫、香附、枳壳、茯苓等。若气血瘀滞，肝区痛甚，加元胡、川楝、三棱、莪术等行气活血止痛；肝胆湿热，病发黄疸者，加茵陈、金钱草、茅根、蛇舌草等以清热利湿退黄；血瘀症积，水湿内停，腹大坚满，小便不通者，加车前子、莱菔子、牵牛子粉，并合用鳖甲煎丸、大黄虫丸等以消症利水；阴伤发热，口干舌燥者，加黄芩、生地、沙参、麦冬、牡蛎等清热育阴；热伤血络，齿鼻衄血，或呕血者，加小蓟、茜草、茅根、三七粉、阿胶等以凉血止血；大便干燥者，加大黄、厚朴、枳实、甘草等以通下里实。
案例：周某，男，53岁，教师。1991年10月8日初诊。肝区疼痛，肢软无力1年，复发加重3个月。1年前因饮食不洁加上工作劳累，病发肝区疼痛，四肢无力，纳食减退，即到该地县人民医院就诊，肝功能检查：谷丙转氨酶（GPT）64单位/赖氏法，乙肝病毒标志物（HBV-M）：乙肝表面抗原（HBsAg）（+），诊断为乙肝，用中西药治疗无显效。
今年7月份，身体极度疲惫，肢软无力，小便深黄，又到该院诊治，肝功能检查：黄疸指数13单位，谷丙转氨酶（GPT）60单位/赖氏法，乙肝表面抗原（HBsAg）（+）。经保肝及对症处理，黄疸消退，但极度无力。1991年8月5日到某医科大学附院就诊，检查结果：谷丙转氨酶（GPT）65单位/赖氏法，乙肝表面抗原（HBsAg）、乙肝e抗原（HBeAg）、乙肝核心抗体（抗-HBc）均为阳性。B超检查：肝脾肿大。诊断为病毒型乙肝，慢性活动肝炎，肝硬化。住院治疗2个多月，用药如肌苷片、ATP片及中药清热解毒、活血化瘀剂等，病证未减。现症：面色暗黑，见有肝掌，肝区胀痛，肢软乏力，纳食减退，口干口苦，肝脾肿大，小便色黄，大便时干时稀，舌质暗红，苔薄黄，脉弦细。10年前患过血吸虫病，曾用锑剂治疗。今酶标试验未见血吸虫感染。有烟酒嗜好。李氏断之曰：饮食不洁，感染疫毒，嗜酒无度，复加劳累，以致正虚邪入，湿热毒遏，肝失疏泄，脾失运化，久延不愈，则脉络瘀阻，终至瘀血积聚，而成积块。拟以活血化瘀，疏肝健脾，清热利湿为法。处方：醋炒鳖甲、麦芽、赤白芍、丹参各15克，炮甲珠、柴胡、炒枳壳、桃红、香橼皮、炒川楝、橘皮络、元胡各10克，酒炒土鳖虫6克、白茅根30克。
二诊：服用上方15剂，精神渐振，胃纳增进，面色红润，肝痛缓解，肝掌亦消失，二便通利，肝功能正常，B超证实肝脾肿大较前明显缩小，舌红苔薄黄脉弦，睡眠有时欠佳。守上法加入养心安神之品。处方：醋炒鳖甲、赤白芍、丹参、茯神各15克，当归、郁金、炮甲珠、制香附、橘皮络、炒枳壳、元胡、金铃子、柏子仁、柴胡、炒三仙各10克，蛇舌草、白茅根各30克，酒炒土鳖虫6克。
三诊：服用上方20剂，临床症状缓解，未再坚持服药，并参加工作。经常熬夜受累，时过4日，肝痛复发。肝区作胀，纳食减退，脘腹胀气，肢体乏力，腹大坚满，出现腹水，身目发黄，小便深黄，大便时干时稀，舌质暗红苔黄略腻，脉弦细。肝功能：总胆红素30μmol/L、谷丙转氨酶（GPT）100单位/赖氏法，乙肝病毒标志物（HBV-M）：乙肝表面抗原（HBsAg）、乙肝核心抗体（抗-HBc）均阳性。B超提示肝硬化伴腹水。遂到县中医院住院，治疗月余，服用中药利胆退黄剂及西药等，病情无明显改善。李氏诊之曰：此肝病痼疾，治未彻底，又妄劳作，正虚邪盛，瘀血症积，湿热蕴结，水气内停，酿为膨胀也。当清热解毒，利水去湿，化瘀消症。
处方：茵陈、赤芍各50克，丹参、茯苓、茅根、蛇舌草各30克，醋炒鳖甲、车前草、炒二芽各15克，炒栀子、泽泻、陈皮、制香附、炮甲珠各10克，酒炒鳖甲6克，三七粉6克（吞服）。
四诊：服上方12剂，腹水消退，腹胀缓解，黄疸亦退，精神渐振，小便较前通利，大便成形，惟纳差乏力明显，舌暗红苔黄，脉弦细。再以清热解毒，行气活血，疏肝健脾之治。处方：茵陈、赤芍各50克，丹参、茯苓、蛇舌草、茅根各30克，炒鳖甲、炒二芽各15克，猪苓12克，炒栀子、炒黄柏、炒白术、泽泻、陈皮、炮甲珠各10克，制香附子10克，三七粉6克（兑服）。加减服用50余剂，诸证皆愈，肝功能正常，肝脾缩小变软。随访1年半未发。
第三卷212 七、慢性萎缩性胃炎治验 慢性萎缩性胃炎是以胃腺萎缩、粘膜变薄、粘膜肌层增厚、胃液分泌减少为病理特征的一种常见病。其病程长，病情复杂，或以胃脘疼痛为主，或以心下痞满为重，或以纳少嗳气、消瘦乏力、嘈杂烧灼为甚，或数者兼并出现，属中医胃脘痛、痞证等范畴。李氏常用的辨治方法如下：
（一）胃痛日久益气活血 慢性萎缩性胃炎多由慢性浅表性胃炎演变而来。饮食不节，饥饱失常，或劳倦内伤等，均可损伤脾胃，日久而成脾胃气虚。胃失和降，不能受纳腐熟水谷，脾失健运，不能化生气血，食滞不化则气机阻滞，以致胃络血瘀，形成气虚血瘀、本虚标实的病机。《仁斋直指方》谓：“盖气者，血之帅也，气行则血行，气止则血止。”《医林改错》云：“无气则虚，必不能达于血管，血管无气，必停滞而瘀。”气虚和血瘀互为因果，是以影响慢性萎缩性胃炎的发生和发展。临床表现为胃脘胀痛或刺痛，脘腹痞满，或纳呆食少，噫气矢气，胸闷气逆，面黄消瘦，体乏无力，大便不调，舌质暗红或有瘀斑瘀点，脉沉细弦。治以益气健脾，活血化瘀为主。方用黄芪建中汤合活络效灵丹化裁，以达到气充则血行，血行而瘀去的目的。若脾胃虚寒者，加党参、干姜；脾胃阴虚者，去生姜、桂枝，加百合、知母、麦冬；营血不足者，加当归、熟地；气滞痛甚者，加元胡、川楝、陈皮、香附等。曾治蒋某，女，38岁，工人。胃脘胀痛反复发作10年，加重半年。形体消瘦，面色萎黄，体倦乏力，嗳气泛酸，大便时干时稀，舌质暗红苔薄白脉弦细。胃镜和病理检查报告：慢性萎缩性胃炎伴肠上皮化生。辨属脾胃气虚，血行瘀滞。药用：炙黄芪、党参、赤白芍、丹参、制乳没、元胡、炒川楝、乌贼骨、法夏、茯苓、炒山楂等，随证加减治疗8个月，症状逐渐缓解。胃镜和病理检查：慢性浅表性胃炎、原萎缩性病灶肠上皮化生均告消失。
（二）病势缠绵治重湿热 脾胃素虚，过食生冷，日久易寒积化热，致寒热夹杂，中气困顿，湿浊内生；又因脾为湿土，胃为燥土，若慢性萎缩性胃炎合并有幽门螺旋菌感染，胆汁返流或偏嗜酒辛之人，亦易湿热内蕴，夹杂寒热。表现为胃脘胀满，心下痞闷，口苦气秽，胃中嘈杂，食欲减退，周身乏力，大便干燥或溏而不爽，舌尖红，苔黄厚腻，脉细弦滑。治宜辛开苦降，清热化湿，选用半夏泻心汤化裁。
药用：法夏、太子参、炒黄芩、炒川连、干姜、藿香、陈皮、炒二芽等。若恶心欲呕，加竹茹、苏梗；脘腹胀满加厚朴、枳实；胃胀满痛甚者加元胡、川楝；血行瘀滞加桃仁、丹参、赤芍；大便色黑加茅根、乌贼骨、三七粉等。曾治李某，男，49岁，干部。胃脘疼痛反复发作9年，加重伴柏油样大便15天。胃脘胀痛，痛无规律，纳谷不馨，口苦气秽，大便稀溏，色黑如油，小便色黄，体倦乏力，舌淡红，苔黄略腻，脉细弦滑。胃镜和病检：慢性萎缩性胃炎幽门螺旋菌感染（++），大便潜血（++）。辨属湿热中阻，脾胃失运，热伤血络。治拟健脾理气、清化湿热为主。药用：法夏、太子参、炒黄连、炒黄芩、炒川楝、元胡、乌贼骨、丹参、茅根、茜草炭、白芨、炒二芽等。服上方5剂，胃痛缓解，大便成形色黄，纳食增进。继以上方加减药后服用60余剂，胃痛消除，纳食及二便正常。胃镜和病检：慢性浅表性胃炎、幽门螺旋菌感染（-）。随访2年未发。
第三卷213 （三）木邪克土调理肝胃 许多慢性萎缩性胃炎患者因脾胃失运，肝气郁滞，郁而化火，横逆犯胃，常有肝胃不和的病理表现。症见胃脘胀痛，或烧灼痛，痛窜胁肋，心烦易怒，嘈杂泛酸，口苦咽干，大便干结，小便色黄，舌红苔黄，脉细弦等。选用柴胡疏肝散或逍遥散化裁。药用：醋柴胡、赤白芍、炒枳壳、厚朴、郁金、香橼皮、川楝子、丹参、炒栀子、当归身、茯苓、炒三仙等。若恶心呕吐加竹茹、法夏；反胃吞酸加左金丸；胁肋胀痛加金铃子散；胃脘灼痛加川连、生石膏；腹痛则泻，泻后痛减，是肝气乘脾，可用痛泻要方加减为治。曾治王某，男，41岁，干部。胃脘疼痛反复发作7年，又发加重3个月。胃脘疼痛，有烧灼感连及两胁痛胀，纳食欠佳，心情烦躁，易怒，嗳气反酸，口干口苦，大便干结，小便色黄，舌红苔黄，脉弦略数。胃镜及病检：慢性萎缩性胃炎中度肠上皮化生。此乃肝气郁滞，脾胃失和，内有郁热之证。当疏肝理气、清热和胃。药用：柴胡、炒枳壳、赤白芍、炒栀子、丹参、炒川连、竹茹、金铃子、川楝子、郁金、制香附、茯苓、白术、炒三仙等。随证加减服用半个月后，胃痛缓解，纳食增加，嗳气吞酸等证亦有好转。原方去竹茹、栀子，加陈皮、佛手等，续用3个月，症状基本消失。随访1年未发。
（四）善后调治顾护胃阴 慢性萎缩性胃炎病程较长，由于其消化吸收功能减退，化源不足，可见脾胃阴伤。另外，若脾胃虚寒，寒极生热；气机郁结，郁而化热；过食辛辣，胃中生热等，均易损伤胃阴，致胃阴亏耗。
症见胃灼隐痛，纳呆痞满，嘈杂吞酸，口干咽燥，五心烦热，倦怠消瘦，大便秘结，舌红少苔，脉细数等。治当酸甘养阴，理气止痛。方用益胃汤合芍药甘草汤化裁。药用：沙参、麦冬、玉竹、生地、石斛、白芍、佛手、陈香圆、绿萼梅、炙甘草等。若气滞胃痛加川楝子、元胡索；血中有热或血行不畅者，加丹参、赤芍、丹皮；纳呆食滞加炒山楂、炒二芽、鸡内金；大便秘结可配合麻仁丸与服。曾治杨某，男，42岁，工人。胃脘疼痛反复发作13年，又发加重2个月。胃痛隐隐，病无定时，伴灼热感，食后腹胀，又觉嘈杂，伴灼热感，时有嗳气，口干咽燥，心烦难寐，大便干结，小便微黄，舌红少苔，脉象细数。曾至武汉各大医院治疗，服用温中健脾、清热燥湿之剂等甚杂。辨为胃中有热，阴津亏损。治用滋养胃阴，调理气机之法。选用益胃汤或一贯煎化裁。药用：沙参、麦冬、石斛、赤白芍、丹参、茯神、柏子仁、炒川楝、元胡、香橼皮、乌梅、炒山楂等，随证加减连服6个月，胃痛消失，纳食正常，心烦不寐等证缓解，苔薄白而润。胃镜检查：原慢性萎缩性胃炎与前比较明显好转。随访1年基本正常。
脾胃居于中焦，乃人身气机之枢纽，交通上下，布达四末，为后天之根本。脾胃虚弱，气血运行受阻，则致气滞血瘀；脾胃失运，气机不畅，升降失调，则致肝胃不和；脾主运化，胃主受纳，脾胃虚弱，则水湿内停，蕴郁生热，而为湿热内结；脾胃失运，化源匮乏，或热邪伤津，或辛燥太过，又可见有胃阴亏损之证等，临证可循此而辨证论治。然因慢性萎缩性胃炎病机复杂，证情变化多端，故其治法又不可拘于一隅，当随证候之变化而加减用药。
Case: Yang, female, 32 years old, worker. First visit on August 17, 1992. Recurrent pain in the liver area for 5 years, aggravated for 1 month upon recurrence. Five years ago, due to pain in the liver area, liver function tests were performed: Alanine Aminotransferase (GPT) 60 U/L (Rees method), Hepatitis B Virus Markers (HBV-M): Hepatitis B Surface Antigen (HBsAg) and Anti-Hepatitis B Core Antibody (Anti-HBc) were both positive. Taking Metabolite (Mie'ao Ling) and Inosine Tablets at the clinic resulted in slight improvement, but if emotions were unsmooth or after tension and fatigue, liver pain would recur. She had been diagnosed and treated in several hospitals in Wuhan, taking traditional Chinese medicine (names unknown) successively without significant effect. Upon visiting the clinic: dull pain in the liver area, dry mouth and throat, irritability and insomnia, poor appetite, yellow urine, menstrual irregularities with abdominal pain during menstruation, red tongue with thin yellow dry coating, fine and rapid pulse. Liver function test: GPT 50 U/L (Rees method), HBV-M: HBsAg and Anti-HBc were both positive. Syndrome differentiation belongs to Deficiency of Liver and Kidney Yin, Liver Qi Stagnation invading Spleen, complicated with Damp-Heat. The method prescribed is Nourishing Yin and Softening the Liver, Soothing Liver and Strengthening Spleen, Clearing and Transforming Damp-Heat. Prescription: Sheng Di Huang (Rehmanniae Radix) 15g, Sha Shen (Glehniae Radix) 15g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 30g, Gou Qi Zi (Lycii Fructus) 15g, Chai Hu (Bupleuri Radix) 10g, Zhi Qiao (Aurantii Fructus) 10g, Yuan Hu (Corydalis Rhizoma) 10g, Chuan Lian Zi (Meliae Fructus) 10g, Xiang Yuan Pi (Citri Reticulatae Pericarpium) 10g, Fu Ling (Poria) and Shen Qu (Medicated Leaven) each 15g, Chi Shao Yao (Paeoniae Radix Rubra) and Bai Shao Yao (Paeoniae Radix Alba) each 15g, Bai Hua She She Cao (Hedyotis Diffusae Herba) 30g, Chao San Xian (Fried Hawthorn, Fried Medicated Leaven, Fried Malt) each 10g.
After taking the above prescription for more than 30 doses, pain in the liver area was basically relieved, dry mouth and throat, irritability and insomnia improved, menstruation normalized, only limbs were weak, appetite was poor, urine was yellow, liver function and three hepatitis B markers remained the same as before, red tongue with thin yellow coating, fine, wiry and rapid pulse. The appropriate method is Nourishing Liver and Kidney, Strengthening Spleen and Boosting Qi, Clearing Heat and Detoxifying. Prescription: Sheng Di Huang 15g, Sha Shen 15g, Gou Qi Zi 15g, Lu Gen (Phragmitis Rhizoma), Tai Zi Shen (Pseudostellariae Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), Hu Zhang (Polygoni Cuspidati Rhizoma et Radix), Chao Er Ya (Fried Rice Sprout and Fried Barley Sprout), Bai Mao Gen (Imperatae Rhizoma) each 15g, Mai Dong (Ophiopogonis Radix), Xiang Yuan Pi, Chuan Lian Zi each 10g, Dan Shen, Bai Hua She She Cao each 30g. After adding and subtracting ingredients over more than 100 doses, all symptoms of liver disease disappeared, liver function and three hepatitis B markers returned to normal. Subsequently, using the method of Nourishing Blood and Softening Liver, Strengthening Spleen and Harmonizing Stomach, Clearing Heat and Detoxifying for regulation for more than 20 doses, the disease was cured. Follow-up for half a year showed no recurrence.
(IV) Blood Stasis Accumulation: Invigorating Blood and Resolving Stasis. Chronic hepatitis that has not healed after long-term treatment, deficiency of healthy Qi, retention of pathogenic toxins, stagnation of Liver Qi, obstruction of collaterals by blood stasis, eventually forming accumulations over time. Symptoms include dark complexion, hepatosplenomegaly with hard texture, abdominal distension and poor appetite, fatigue, gradual emaciation, spider angiomas and liver palms; if blood stasis and fluid retention occur, visible are large and firm abdomen, prominent veins on the abdominal wall, or accompanied by fever, epistaxis, gingival bleeding, jaundice, purple tongue body with ecchymosis, deep and choppy or fine and choppy pulse. Treatment should focus on Invigorating Blood and Promoting Qi Flow, Resolving Stasis and Dissipating Accumulation. Medicines used: Dan Shen, Chi Shao Yao, Zhi Ru He (Processed Frankincense and Myrrh), Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Mei Gui Hua (Rosae Rugosae Flos), Pao Jia Zhu (Testudinis Carapax et Plastrum processed), Bie Jia (Testudinis Carapax et Plastrum), Tu Bie Chong (Eupolyphaga seu Steleophaga), Xiang Fu (Cyperi Rhizoma), Zhi Qiao, Fu Ling, etc. If Qi and Blood stagnation causes severe liver area pain, add Yuan Hu, Chuan Lian, San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma) to promote Qi flow, invigorate Blood and stop pain; if Gallbladder-Liver Damp-Heat causes jaundice, add Yin Chen (Artemisiae Scopariae Herba), Jin Qian Cao (Lysimachiae Herba), Mao Gen, She She Cao to clear Heat, drain Dampness and relieve jaundice; if Blood Stasis and accumulation with fluid retention cause large firm abdomen and urinary obstruction, add Che Qian Zi (Plantaginis Semen), Lai Fu Zi (Radish Seed), Qian Niu Zi Powder, combined with Bie Jia Jian Wan (Turtle Shell Decoction Pill) and Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) to dissipate accumulation and promote urination; if Yin injury causes fever, dry mouth and tongue, add Huang Qin (Scutellariae Radix), Sheng Di, Sha Shen, Mai Dong, Mu Li (Ostreae Concha) to clear Heat and nourish Yin; if Heat damages blood collaterals causing epistaxis, gingival bleeding, or hematemesis, add Xiao Ji (Cirsii Herba), Qian Cao (Rubiae Radix et Rhizoma), Mao Gen, San Qi Fen (Notoginseng Powder), E Jiao (Colla Corii Asini) to cool Blood and stop bleeding; if stool is dry, add Da Huang (Rhei Radix et Rhizoma), Hou Po (Magnoliae Officinalis Cortex), Zhi Shi (Aurantii Fructus Immaturus), Gan Cao (Glycyrrhizae Radix et Rhizoma) to purge interior excess.
Case: Zhou, male, 53 years old, teacher. First visit on October 8, 1991. Pain in the liver area, softness and weakness of limbs for 1 year, aggravated for 3 months upon recurrence. One year ago, due to unclean diet and work fatigue, pain in the liver area and limb weakness occurred, along with reduced appetite, leading to a visit to the county people's hospital. Liver function test: GPT 64 U/L (Rees method), HBV-M: HBsAg (+). Diagnosed with Hepatitis B, treated with Chinese and Western medicines without significant effect.
In July this year, extreme physical exhaustion, limb weakness, and dark yellow urine led to another visit. Liver function test: Jaundice Index 13 U, GPT 60 U/L (Rees method), HBsAg (+). After hepatoprotective and symptomatic treatment, jaundice subsided, but extreme weakness persisted. On August 5, 1991, visited an affiliated hospital of a medical university. Test results: GPT 65 U/L (Rees method), HBsAg, HBeAg, Anti-HBc were all positive. Ultrasound: Hepatosplenomegaly. Diagnosed with Viral Hepatitis B, Chronic Active Hepatitis, Cirrhosis. Hospitalized for over 2 months, treated with Inosine Tablets, ATP Tablets, and TCM such as Clearing Heat and Detoxifying, Invigorating Blood and Resolving Stasis agents, but symptoms did not decrease. Current symptoms: dark complexion, liver palms present, distending pain in liver area, limb weakness, reduced appetite, dry and bitter mouth, hepatosplenomegaly, yellow urine, alternating dry and loose stools, dark red tongue body, thin yellow coating, wiry and fine pulse. History of Schistosomiasis 10 years ago, treated with antimony agents. Enzyme-linked immunosorbent assay now shows no Schistosomiasis infection. Has habits of smoking and drinking alcohol. Mr. Li concluded: Unclean diet, infection with epidemic toxins, excessive drinking, plus fatigue, leading to deficiency of healthy Qi and invasion of pathogens, Damp-Heat and toxins obstructing, Liver failing to course and discharge, Spleen failing to transport and transform. Prolonged non-healing leads to collateral obstruction by blood stasis, ultimately resulting in blood stasis accumulation and formation of masses. The method proposed is Invigorating Blood and Resolving Stasis, Soothing Liver and Strengthening Spleen, Clearing Heat and Draining Dampness. Prescription: Cu Chao Bie Jia (Vinegar-fried Turtle Shell), Mai Ya (Hordei Fructus Germinatus), Chi Bai Shao (Red and White Peony Root), Dan Shen each 15g, Pao Jia Zhu, Chai Hu, Chao Zhi Qiao (Fried Aurantium Fruit), Tao Hong (Peach Kernel and Safflower), Xiang Yuan Pi, Chao Chuan Lian (Fried Melia Fruit), Ju Pi Luo (Tangerine Peel Vein), Yuan Hu each 10g, Jiu Chao Tu Bie Chong (Wine-fried Polyphaga) 6g, Bai Mao Gen 30g.
Second Visit: After taking the above prescription for 15 doses, spirit gradually revived, stomach appetite increased, complexion became rosy, liver pain relieved, liver palms disappeared, bowel and bladder movements smooth, liver function normal, ultrasound confirmed significant reduction in hepatosplenomegaly compared to before, red tongue with thin yellow coating, wiry pulse, occasional poor sleep. Adhering to the previous method, added herbs to nourish Heart and calm Spirit. Prescription: Cu Chao Bie Jia, Chi Bai Shao, Dan Shen, Fu Shen (Poria with Hostwood) each 15g, Dang Gui (Angelicae Sinensis Radix), Yu Jin (Curcumae Longae Radix), Pao Jia Zhu, Zhi Xiang Fu (Processed Cyperi Rhizoma), Ju Pi Luo, Chao Zhi Qiao, Yuan Hu, Jin Ling Zi (Meliae Fructus), Bai Zi Ren (Biota Seed), Chai Hu, Chao San Xian each 10g, She She Cao, Bai Mao Gen each 30g, Jiu Chao Tu Bie Chong 6g.
Third Visit: After taking the above prescription for 20 doses, clinical symptoms relieved, did not persist in medication, and resumed work. Frequent late nights and fatigue led to recurrence of liver pain after 4 days. Distension in liver area, reduced appetite, abdominal bloating and gas, limb weakness, large and firm abdomen, ascites appeared, yellowing of body and eyes, dark yellow urine, alternating dry and loose stools, dark red tongue with slightly greasy yellow coating, wiry and fine pulse. Liver function: Total Bilirubin 30 μmol/L, GPT 100 U/L (Rees method), HBV-M: HBsAg, Anti-HBc both positive. Ultrasound suggested cirrhosis with ascites. Then hospitalized in County Traditional Chinese Medicine Hospital. After more than a month of treatment with TCM choleretic and jaundice-relieving agents and Western medicines, condition showed no obvious improvement. Mr. Li diagnosed: This is a stubborn liver disease, treatment was not thorough, plus reckless labor, leading to deficiency of healthy Qi and excess of pathogens, blood stasis and accumulation, Damp-Heat accumulation, water qi retention, brewing into distension. Should Clear Heat and Detoxify, Drain Water and Remove Dampness, Invigorate Blood and Resolve Stasis to dissipate masses.
Prescription: Yin Chen, Chi Shao Yao each 50g, Dan Shen, Fu Ling, Mao Gen, She She Cao each 30g, Cu Chao Bie Jia, Che Qian Cao (Plantaginis Herba), Chao Er Ya each 15g, Chao Zhi Zi (Fried Gardenia), Ze Xie (Alismatis Rhizoma), Chen Pi (Tangerine Peel), Zhi Xiang Fu, Pao Jia Zhu each 10g, Jiu Chao Bie Jia (Wine-fried Turtle Shell) 6g, San Qi Fen (Notoginseng Powder) 6g (swallowed).
Fourth Visit: After taking the above prescription for 12 doses, ascites subsided, abdominal distension relieved, jaundice also receded, spirit gradually revived, urination smoother than before, stool formed, only poor appetite and fatigue were obvious, dark red tongue with yellow coating, wiry and fine pulse. Continue with Clearing Heat and Detoxifying, Promoting Qi Flow and Invigorating Blood, Soothing Liver and Strengthening Spleen treatment. Prescription: Yin Chen, Chi Shao Yao each 50g, Dan Shen, Fu Ling, She She Cao, Mao Gen each 30g, Chao Bie Jia, Chao Er Ya each 15g, Zhu Ling (Polyporus) 12g, Chao Zhi Zi, Chao Huang Bo (Phellodendri Cortex), Chao Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ze Xie, Chen Pi, Pao Jia Zhu each 10g, Zhi Xiang Fu Zi 10g, San Qi Fen 6g (mixed in). After adding and subtracting ingredients for more than 50 doses, all symptoms resolved, liver function normal, liver and spleen shrank and softened. Follow-up for 1.5 years showed no recurrence.
Vol 3 p212 VII. Treatment Experience of Chronic Atrophic Gastritis. Chronic Atrophic Gastritis is a common disease characterized pathologically by gastric gland atrophy, thinning of mucosa, thickening of muscularis mucosae, and reduced gastric juice secretion. Its course is long, condition complex, mainly presenting as epigastric pain, or subcardiac fullness, or poor appetite with belching, emaciation and fatigue, heartburn and burning sensation, or a combination of these, belonging to the categories of Epigastric Pain and Fullness Syndromes in TCM. Mr. Li's commonly used diagnostic and treatment methods are as follows:
(I) Long-standing Stomach Pain: Boosting Qi and Invigorating Blood. Chronic Atrophic Gastritis often evolves from Chronic Superficial Gastritis. Irregular diet, abnormal hunger and fullness, or internal injury from fatigue can damage Spleen and Stomach, leading to Spleen-Stomach Qi Deficiency over time. Stomach fails to harmonize and descend, unable to receive and rot/ripen food and water; Spleen fails to transport and transform, unable to generate Qi and Blood; food stagnation blocks Qi mechanism, leading to blood stasis in stomach collaterals, forming a pathology of Qi Deficiency and Blood Stasis, root deficiency and branch excess. "Ren Zhai Zhi Zhi Fang" states: "Qi is the commander of Blood; when Qi moves, Blood moves; when Qi stops, Blood stops." "Yi Lin Gai Cuo" says: "Without Qi there is deficiency, it cannot reach the blood vessels; without Qi in blood vessels, stagnation and stasis must occur." Qi Deficiency and Blood Stasis are mutually causal, thus affecting the occurrence and development of Chronic Atrophic Gastritis. Clinical manifestations include distending or stabbing pain in epigastrium, abdominal fullness, poor appetite and little food intake, belching and passing flatus, chest tightness and rebellious Qi, sallow complexion and emaciation, body fatigue, irregular bowel movements, dark red tongue body with ecchymosis or petechiae, deep, fine and wiry pulse. Treatment focuses on Boosting Qi and Strengthening Spleen, Invigorating Blood and Resolving Stasis. Formula: Huang Qi Jian Zhong Tang (Astragalus Decoction to Construct the Middle) combined with Huo Luo Xiao Ling Dan (Meridian-Activating Efficacious Spirit Pill) modified, to achieve the goal of sufficient Qi promoting Blood flow, and Blood flow resolving stasis. If Spleen-Stomach Deficiency-Cold, add Dang Shen (Codonopsis Radix), Gan Jiang (Zingiberis Rhizoma); if Spleen-Stomach Yin Deficiency, remove Sheng Jiang (Zingiberis Rhizoma Recens), Gui Zhi (Cinnamomi Ramulus), add Bai He (Lilii Bulbus), Zhi Mu (Anemarrhenae Rhizoma), Mai Dong; if Ying-Blood insufficient, add Dang Gui, Shu Di Huang (Rehmanniae Radix Preparata); if Qi stagnation with severe pain, add Yuan Hu, Chuan Lian, Chen Pi, Xiang Fu, etc. Once treated Jiang, female, 38 years old, worker. Recurrent epigastric distending pain for 10 years, aggravated for half a year. Emaciated, sallow complexion, body fatigue, belching with acid regurgitation, alternating dry and loose stools, dark red tongue with thin white coating, wiry and fine pulse. Gastroscopy and pathology report: Chronic Atrophic Gastritis with Intestinal Metaplasia. Syndrome differentiation belongs to Spleen-Stomach Qi Deficiency, Blood Stasis. Medicines: Zhi Huang Qi (Honey-fried Astragalus), Dang Shen, Chi Bai Shao, Dan Shen, Zhi Ru He, Yuan Hu, Chuan Lian, Ou Hai Gu (Sepiae Endoconcha), Fa Xia (Pinelliae Ternatae Rhizoma Preparata), Fu Ling, Chao Shan Zha (Fried Hawthorn), etc. Modified according to syndrome for 8 months, symptoms gradually relieved. Gastroscopy and pathology: Chronic Superficial Gastritis and intestinal metaplasia of original atrophic lesions both disappeared.
(II) Lingering Disease Course: Emphasizing Damp-Heat. Spleen-Stomach originally deficient, excessive consumption of cold/raw foods easily leads to Cold accumulation transforming into Heat over time, resulting in mixed Cold and Heat, middle Qi exhaustion, endogenous turbid Dampness; furthermore, Spleen is Wet Earth, Stomach is Dry Earth; if Chronic Atrophic Gastritis is complicated with Helicobacter pylori infection, bile reflux, or preference for alcohol and spicy foods, Damp-Heat easily accumulates internally, mixed with Cold and Heat. Manifestations include epigastric distension, subcardiac oppression, bitter taste and foul breath, stomach discomfort, reduced appetite, whole-body fatigue, dry stool or loose but unsatisfactory defecation, red tongue tip, thick greasy yellow coating, fine, wiry and slippery pulse. Treatment should use Acrid Opening and Bitter Descending, Clearing Heat and Transforming Dampness, selecting Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) modified.
Medicines: Fa Xia, Tai Zi Shen, Chao Huang Qin (Fried Scutellaria), Chuan Lian (Fried Coptis), Gan Jiang, Huo Xiang (Agastaches Herba), Chen Pi, Chao Er Ya, etc. If nausea and vomiting desire, add Zhu Ru (Bambusae Caulis in Taenia), Su Geng (Perillae Caulis); if abdominal distension and fullness, add Hou Po, Zhi Shi; if severe stomach distension and pain, add Yuan Hu, Chuan Lian; if Blood Stasis, add Tao Ren, Dan Shen, Chi Shao Yao; if black stool, add Mao Gen, Ou Hai Gu, San Qi Fen, etc. Once treated Li, male, 49 years old, cadre. Recurrent epigastric pain for 9 years, aggravated with tarry stool for 15 days. Epigastric distending pain, irregular pain, poor appetite, bitter taste and foul breath, loose stool, black like oil, yellow urine, body fatigue, pale red tongue, slightly greasy yellow coating, fine, wiry and slippery pulse. Gastroscopy and pathology: Chronic Atrophic Gastritis with Helicobacter pylori infection (++), Fecal Occult Blood (++). Syndrome differentiation belongs to Damp-Heat Obstructing Middle, Spleen-Stomach Failure to Transport, Heat Damaging Blood Collaterals. Treatment plans to Strengthen Spleen, Regulate Qi, primarily Clearing and Transforming Damp-Heat. Medicines: Fa Xia, Tai Zi Shen, Chao Huang Lian (Fried Coptis), Chao Huang Qin, Chuan Lian, Yuan Hu, Ou Hai Gu, Dan Shen, Mao Gen, Qian Cao Tan (Charred Rubiae Radix et Rhizoma), Bai Ji (Bletillae Rhizoma), Chao Er Ya, etc. After taking 5 doses of the above prescription, stomach pain relieved, stool formed and yellow, appetite increased. Continuing with modified prescription for more than 60 doses, stomach pain eliminated, appetite and bowel/bladder movements normal. Gastroscopy and pathology: Chronic Superficial Gastritis, Helicobacter pylori infection (-). Follow-up for 2 years showed no recurrence.
Vol 3 p213 (III) Wood Evil Overacting on Earth: Regulating Liver and Stomach. Many patients with Chronic Atrophic Gastritis, due to Spleen-Stomach failure to transport, Liver Qi stagnation, stagnation transforming into Fire, invading Stomach horizontally, often have pathological manifestations of Liver-Stomach Disharmony. Symptoms include epigastric distending pain or burning pain, pain radiating to hypochondrium, irritability, heartburn with acid regurgitation, bitter taste and dry throat, dry stool, yellow urine, red tongue with yellow coating, fine and wiry pulse, etc. Select Chai Hu Shu Gan San (Bupleurum Powder to Soothe the Liver) or Xiao Yao San (Free Wanderer Powder) modified. Medicines: Cu Chai Hu (Vinegar-fried Bupleurum), Chi Bai Shao, Chao Zhi Qiao, Hou Po, Yu Jin, Xiang Yuan Pi, Chuan Lian Zi, Dan Shen, Chao Zhi Zi, Dang Gui Shen (Dang Gui Root Tip), Fu Ling, Chao San Xian, etc. If nausea and vomiting, add Zhu Ru, Fa Xia; if regurgitation and acid swallowing, add Zuo Jin Wan (Left Metal Pill); if hypochondriac distending pain, add Jin Ling Zi San (Golden Bell Seed Powder); if epigastric burning pain, add Chuan Lian, Sheng Shi Gao (Gypsum Fibrosum); if abdominal pain then diarrhea, pain relieved after defecation, indicating Liver Qi invading Spleen, use Tong Xie Yao Fang (Essential Formula for Painful Diarrhea) modified. Once treated Wang, male, 41 years old, cadre. Recurrent epigastric pain for 7 years, aggravated for 3 months. Epigastric pain with burning sensation extending to bilateral hypochondriac distension, poor appetite, irritability, anger, belching and acid regurgitation, dry and bitter mouth, dry stool, yellow urine, red tongue with yellow coating, wiry and slightly rapid pulse. Gastroscopy and pathology: Moderate Intestinal Metaplasia in Chronic Atrophic Gastritis. This is a syndrome of Liver Qi Stagnation, Spleen-Stomach Disharmony, internal郁 Heat. Should Soothe Liver, Regulate Qi, Clear Heat and Harmonize Stomach. Medicines: Chai Hu, Chao Zhi Qiao, Chi Bai Shao, Chao Zhi Zi, Dan Shen, Chuan Lian, Zhu Ru, Jin Ling Zi, Chuan Lian Zi, Yu Jin, Zhi Xiang Fu, Fu Ling, Bai Zhu, Chao San Xian, etc. After modifying and taking for half a month, stomach pain relieved, appetite increased, belching and acid swallowing improved. Original formula removed Zhu Ru, Zhi Zi, added Chen Pi, Fo Shou (Citrus Sarcodactylis Fructus), etc., continued for 3 months, symptoms basically disappeared. Follow-up for 1 year showed no recurrence.
(IV) Post-treatment Regulation: Protecting Stomach Yin. Chronic Atrophic Gastritis has a long course; due to reduced digestion and absorption functions, insufficient source of transformation, Spleen-Stomach Yin Injury can be seen. Additionally, if Spleen-Stomach Deficiency-Cold, extreme Cold generates Heat; Qi mechanism stagnation transforms into Heat; excessive consumption of spicy foods generates Heat in Stomach, etc., all easily damage Stomach Yin, leading to Stomach Yin Consumption.
Symptoms include dull burning pain in stomach, poor appetite and fullness, heartburn with acid regurgitation, dry mouth and throat, five-palm heat, fatigue and emaciation, constipation, red tongue with little coating, fine and rapid pulse, etc. Treatment should use Sour and Sweet to Nourish Yin, Regulate Qi and Stop Pain. Formula: Yi Wei Tang (Benefit the Stomach Decoction) combined with Shao Yao Gan Cao Tang (Peony and Licorice Decoction) modified. Medicines: Sha Shen, Mai Dong, Yu Zhu (Polygonati Odorati Rhizoma), Sheng Di, Shi Hu (Dendrobii Caulis), Bai Shao, Fo Shou, Chen Xiang Yuan (Citri Reticulatae Pericarpium aged), Lv E Mei (Green Calyx Plum), Zhi Gan Cao (Honey-fried Licorice), etc. If Qi stagnation stomach pain, add Chuan Lian Zi, Yuan Hu Suo; if Heat in Blood or poor Blood circulation, add Dan Shen, Chi Shao Yao, Dan Pi (Moutan Cortex); if poor appetite and food stagnation, add Chao Shan Zha, Chao Er Ya, Ji Nei Jin (Gallae Membranaceae Gigeriae Endothelium Corneum); if constipation, can take Ma Ren Wan (Hemp Seed Pill) together. Once treated Yang, male, 42 years old, worker. Recurrent epigastric pain for 13 years, aggravated for 2 months. Dull stomach pain, irregular timing, accompanied by burning sensation, postprandial abdominal distension, feeling of discomfort with burning sensation, occasional belching, dry mouth and throat, irritability and difficulty sleeping, dry stool, slightly yellow urine, red tongue with little coating, fine and rapid pulse. Previously treated in major hospitals in Wuhan, taking various warm-middle and strengthen-spleen, clear-heat and dry-dampness agents. Differentiated as Heat in Stomach, Yin-Jin Deficiency. Treatment uses Nourishing Stomach Yin, Regulating Qi Mechanism. Selected Yi Wei Tang or Yi Guan Jian (One-Glance Decoction) modified. Medicines: Sha Shen, Mai Dong, Shi Hu, Chi Bai Shao, Dan Shen, Fu Shen, Bai Zi Ren, Chuan Lian, Yuan Hu, Xiang Yuan Pi, Wu Mei (Mume Fructus), Chao Shan Zha, etc. Modified according to syndrome and taken continuously for 6 months, stomach pain disappeared, appetite normal, irritability and insomnia relieved, thin white moist coating. Gastroscopy: Original Chronic Atrophic Gastritis significantly improved compared to before. Follow-up for 1 year basically normal.
Spleen and Stomach reside in the Middle Jiao, serving as the hub of Qi mechanism in the human body, connecting upper and lower, distributing to four extremities, being the foundation of acquired constitution. Spleen-Stomach weakness, obstruction of Qi and Blood circulation, leads to Qi Stagnation and Blood Stasis; Spleen-Stomach failure to transport, Qi mechanism unsmooth, ascending and descending dysfunction, leads to Liver-Stomach Disharmony; Spleen governs transport and transformation, Stomach governs reception, Spleen-Stomach weakness leads to internal retention of Water-Dampness, accumulation and generation of Heat, resulting in internal Damp-Heat binding; Spleen-Stomach failure to transport, scarcity of source of transformation, or Heat pathogen damaging fluids, or excessive acrid-dryness, can also show Stomach Yin Deficiency syndromes, etc. In clinical practice, one can follow this to differentiate syndromes and treat. However, because the pathogenesis of Chronic Atrophic Gastritis is complex and conditions change frequently, its treatment methods cannot be confined to one corner, but should modify medications according to changes in syndromes.