Wen | Dr. Chi
Editor|Taihu Carp
Chronic atrophic gastritis (chronicatrophicgastritis, CAG) is a common digestive disorder that refers to repeated destruction of gastric mucosal epithelial cells, resulting in a decrease in the number of propria glands, with or without intestinal metaplasia and pseudopyloric metaplasia.
At present, the WHO has defined CAG as a precancerous lesion of gastric cancer, especially CAG with precancerous lesions of gastric or intestinal metaplasia is significantly correlated with the incidence of gastric cancer.
Therefore, how to effectively alleviate and reverse gastric mucosal atrophy has become a top priority in clinical treatment.
At present, the preventive measures used by Western medicine mainly include eliminating HP, preserving the gastric mucosa, and improving the level of gastrointestinal motility, but its therapy is not specific and is easy to recur.
With the development of modern science and technology, TCM has a deeper understanding of CAG, and many domestic scholars use modern science and technology to conduct in-depth research on CAG, and use modern micro-differentiation to provide more favorable scientific evidence for TCM macro differentiation.
Microscopic differentiation was first proposed by Shen Ziyin in 1986, which refers to the further extension and expansion of the "certificate" of Chinese medicine with the help of modern science and technology, and the certificate also has microscopic performance and material basis.
As the cornerstone of micro dialectics, micro indicators are the link between macro and micro, internal and external, that is, "there are all inside, and all the outside must be formed".
The rational use of microscopic differentiation to guide clinical practice is an inevitable trend in the modernization of traditional Chinese medicine, and it is also a significant symbol of the epoch-making combination of traditional Chinese and Western medicine.
Correlation between TCM symptom type and gastroscopic manifestations and pathological changes
Liu Hua and other studies showed that there were differences in the performance of different types under gastroscopy, and the hepatogastric discord was manifested as red and white gastric mucosa in gastroscopy, mainly red, accompanied by hyperemia and edema and bile reflux.
Evidence of spleen and stomach moist heat is often manifested as erosion, hyperemia, or edema of the gastric mucosa. The prominent manifestations of spleen and stomach deficiency in gastroscopy are mostly red-white gastric mucosa, mainly white, and pale and rough.
Evidence of gastric stasis and gastric yin insufficiency often show hidden vascular network and gastric mucosa roughness. At the same time, gastric obstruction shows scattered bleeding points.
The results of Zhang Jinli and other research results showed that gastroscopy was erosion, raised nodules, rough gastric mucosa, mostly turbidity and toxicity, and its pathology often showed intestinal metaplasia or atypical hyperplasia.
The above studies show that there is a correlation between CAG gastroscopy and TCM symptoms, but due to the complexity and changeability of TCM syndromes, gastroscopy manifestations are diverse.
At present, no relevant standardized standards have been formulated, and the correlation between CAG gastroscopy and TCM symptom type needs to be further studied.
Cheng Ruodong and other studies showed that gastric stasis obstruction had the greatest effect on dysplasia among the types, and the most significant effect on gland atrophy and intestinal metaplasia was spleen and stomach weakness.
Wang Shaoli et al. collected 402 CAG patients and found that gastric stasis obstruction was positively correlated with gland atrophy and intestinal metaplasia, while there was a positive correlation between spleen and stomach weakness, gastric stasis obstruction and the incidence of mucosal dysplasia.
Yang Zhenhua and other research results showed that endoscopic bile reflux mainly occurred in the liver and stomach depression and spleen and stomach humid fever, while the spleen and stomach humid heat is because the stomach heat is strong, resulting in gastric burns. In the case of gastric yin insufficiency, endoscopic hemorrhage may be seen.
Evidence of gastric obstruction often shows raised erosions, flat erosions, and dull erosions.
Yang Yang et al. found that gastric obstruction was significantly correlated with the risk of gastric mucosal inflammation and atrophy, indicating that gastric obstruction plays a crucial role in the progression of CAG.
The above studies can show that the occurrence of gastric mucosal dysplasia is more common in gastric stasis and has a significant correlation.
Factors such as cold stomach, poor qi machine, poor diet and other factors coagulate the stomach body for a long time, resulting in the formation of blood stasis, which accumulates over time, coagulates in the stomach, and hinders the operation of the gastric qi machine and blood veins.
This produces a tangible product, manifested as dysplasia of the gastric mucosa. It suggests that the intervention and treatment of gastric stasis in CAG should be paid attention to clinically.
Correlation between TCM certificate type and laboratory tests
Helicobacter pylori infection, the cause of CAG is not clear, modern studies have shown that its occurrence is related to HP infection, genetic immune factors, physical and chemical factors, etc.
Studies have shown that the probability of distribution of CAG in the population has a certain correlation with HP infection.
Liu Changming and other studies showed that among the various types, the highest rate of HP infection was the evidence of spleen and stomach humid fever and liver and stomach discord, and the rest were blood stasis obstruction, gastric yin deficiency, and spleen and stomach weakness.
In addition, the results of this study showed that the content of interleukin-10 in CAG patients showed an upward trend.
In particular, the spleen and stomach humid fever and hepatogastric discord were the most prominent, and the expression of IL-10 in the CAG group with hp infection was higher than that in the non-hp group. However, the correlation between IL-10 expression and CAG syndrome in TCM has not been reported so far.
Huang Yahui et al. observed 317 CAG patients and showed that the infection rate of hp in spleen and stomach was the highest among all types, followed by hepatogastric discord.
The remaining infection rates were spleen deficiency and stagnation, spleen and stomach weakness, gastric stasis obstruction, and gastric yin insufficiency.
Among the 338 CAG patients selected by Li Li et al., the positive rate of hp was 55.3%, among which the positive rate of spleen and stomach humid fever was the highest, followed by spleen and stomach weakness, liver and stomach gas stagnation, liver and stomach depression, gastric yin deficiency and gastric stasis.
The above studies show that the early stage of CAG is mainly characterized by evil symptoms, and with the development of the disease, it is manifested as a mixture of false and real symptoms in the later stage.
In addition, for patients with CAG diagnosed clinically with spleen and stomach humid fever, the possibility of hp infection should be ruled out in time so that the cause can be found early.
Serum pepsinogen PG, Su Zeqi et al. observed the correlation between serum PG and G-17 and TCM syndrome, and found that hepatogastric fever, hepatogastric discord were compared with hepatic depression and spleen deficiency and spleen deficiency.
The levels of PGI, G-17 and PGr were obvious, indicating that serological tests for real fever syndrome were more screenable than hypothermic syndromes.
Zong Xiangyu et al. showed that in serological testing, the highest expression level of serum G-17 was evidence of hepatogastric discord and spleen and stomach humid fever, and the highest expression level of PGII was evidence of spleen and stomach weakness and spleen and stomach humid heat.
The highest level of PGI expression is the spleen and stomach moist fever. Dong Qiyan's study found that the expression of spleen and stomach weakness was low in the expression level of PGI. The expression of spleen and stomach humid fever, liver and stomach depression, liver and gastric stagnation and gastric yin insufficiency was higher than that of other types.
The expression levels of serum G-17, PGII. and PGr in spleen and stomach weakness were lower than those of other types.
There are great differences in the above research results, which may be due to the small sample size and different evaluation standards of the type of evidence, which need to be further studied.
Immunohistochemistry, cell markers, Meng Jianyu et al. found through immunohistochemistry that endothelial cell marker antigens CD34 and KI67 had the highest expression levels in spleen and stomach humid fever and liver depression and stagnation, and their intraepithelial tumor mutation rate and intestinal epithelial metaplasia rate were higher than those of other types.
Zhao Changpu et al. used retrospective analysis to observe the relationship between different TCM types of CAG and pathological changes of gastric mucosal histopathology, and the results showed that CAG had the highest rate of intestinal metaplasia in gastric mucosal tissue with gastric mucosal fever.
Patients with the highest rate of intraepithelial neoplasia and positive expression rate of KI67 are hepatic depressed Qi stagnation, suggesting that in clinical treatment, patients diagnosed with spleen and stomach humid fever and hepatic depressed Qi stagnation should pay attention to the risk of cancerous changes in their gastric mucosal tissues in time.
Combined with microscopic differentiation to guide medication
While treating CAG, modern doctors pay attention to modern micro indicators such as gastroscopic performance and laboratory tests, and use the combination of macroscopic and microscopic differentiation, so that the selection of CAG prescriptions is more scientific, standardized and reasonable.
Yao Naili used drugs to strengthen the spleen and invigorate qi such as codonopsis, astragalus and baishu and drugs to reduce qi and reduce qi such as tangerine peel, magnolia flower, and Fa banxia for those whose gastric mucosa is mainly white and the peristalsis of the stomach body is significantly slowed down.
When the gastric mucosa is rough and uneven, Danshen, angelica, Chuanxiong and other blood circulation drugs are used.
Blood stasis is represented, microscopic appearance is gastric mucosal denourishment, stasis obstruction, mainly manifested as submucosal can see the vascular network, gastric mucosa gray-white changes, gastric antrum and gastric body mucosa are obviously rough and uneven.
At this time, you can choose to use drugs such as triangular and curcum to remove blood stasis and rejuvenate. When the disease reaches the middle and late stages, poison the stomach network, treat the spleen and stomach, break blood stasis, and loosen soft and firm knots, such as Zhejiang fritillary, oyster, summer hay, mountain mushroom, white flower snake tongue grass, etc.
At this time, gastroscopy is mainly manifested as rough and uneven mucosa, the bulge is nodular and granular, and the pathological diagnosis can be accompanied by severe atrophy, moderate to severe intestinal metaplasia or even dysplasia.
Pharmacological studies have shown that Snake Tongue Grass, Grass vulgaris and Mountain Ci Mushroom have the effects of inhibiting gastric mucosal inflammation, regulating the multiplication of tumor cells, and inducing apoptosis of tumor cells.
Using modern scientific and technological methods, the clinical manifestations, pathological changes, cell markers, immunohistochemistry, etc. under CAG gastroscopy were analyzed, aiming to reveal the internal mechanism of TCM differentiation.
Explore the material basis of its pathogenesis and development, and provide objective and quantitative auxiliary diagnostic basis for clinical practice.
Micro differentiation has multiple attributes such as objectivity, openness, universality, correlation, and dynamics, while the characteristics and advantages of TCM dialectic lie in overall dialectic and macroscopic dialectics, and micro-dialectic can be used as an extension and supplement to TCM macro-dialectics.
The combination of the two is an inevitable product of the modernization of Chinese medicine, which is conducive to improving the scientificity, objectivity and standardization of TCM diagnosis and treatment.
At the same time, it is also conducive to the modernization and development of Chinese medicine. However, microscopic differentiation cannot be simply equated with the "evidence" of traditional Chinese medicine, which is the pathological state produced by the development of the disease to a certain stage, which is different from a simple microscopic index.
Micro indicators are some single phenomena at the overall level, which cannot represent the essence of macroscopic diseases, and the use of a single microscopic index to distinguish is contrary to the overall dialectic of Chinese medicine, and any single microscopic index can not fully clarify the essence of the disease.
Therefore, microscopic indicators cannot reverse the TCM certificate type. Microscopic differentiation in clinical application only provides reference for macroscopic differentiation of traditional Chinese medicine, and multi-index combination and dynamic analysis are required to better guide clinical practice.
The study of micro indicators has refined and improved the differentiation system of traditional Chinese medicine, which is conducive to promoting the modernization process of traditional Chinese medicine.