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Chinese Medicine to Treat Chronic Gastritis

27
Jun
2019

中医药治疗慢性胃炎的临床体会
谢天佐 陈永祥

Clinical Experiences Using Chinese Medicine to Treat Chronic Gastritis Xie Tian-zuo Chen Yong-xiang

Translated by: J. Heaverlo & Xu Zhijun

摘要 通过对慢性胃炎病因病机的认识及中医药治疗慢性胃炎的诊疗思路，联系临床所见病例，体会到临床运用健脾和胃，攻补兼施等综合调理方法可获良好的疗效。

Abstract: This thesis studies the disease causes and pathomechanisms of chronic gastritis. It explores the methods of diagnosing and treating chronic gastritis with Chinese medicine, and cites clinical cases for its support. It is intended to prove that beneficial results can be achieved by using a combination of clinical methods such as fortifying the spleen and harmonizing the stomach, and simultaneous supplementing and attacking.

关键词 胃炎，慢性；中医药；治疗

Key words: Gastritis, Chronic: Chinese medicine; Treatment

慢性胃炎是临床常见的消化系统疾病，唐晓群认为其实质是胃黏膜遭受反复损害导致固有腺体的萎缩，是由各种病因引起的慢性胃黏膜炎症。多数患者前期无症状，或仅表现为上腹痛或不适，上腹胀，嗳气，泛酸，食欲不振等消化不良症状，发病中期才会有明显的临床表现，该病的确诊有赖于胃镜检查，必要时还需进行病理活组织检查。中医学无“慢性胃炎”之病名，根据临床表现归属于中医“胃脘病”、“痞满”、“吞酸”、“呕吐”等病症范畴。

Chronic gastritis is a common disease of the digestive system. According to Tang Xiao-qun, essentially, repeated lesions of the gastric mucosa will lead to the atrophy of the glands. It can be classified as an inflammatory condition of the gastric mucosa and may be due to various causes. Many patients don’t experience early symptoms, or may present with varying symptoms of indigestion such as: epigastric pain or discomfort, abdominal distention, belching, acid regurgitation, or poor appetite. It is not until the middle stages of the disease will more obvious clinical manifestations appear. This disease has to be diagnosed by gastroscopy; and if necessary, a biopsy will be performed. In Chinese medicine there is not a disease name for “chronic gastritis. According to its clinical manifestations, it is classified within the patterns of: “stomach duct disease”，“glomus and fullness”, “acid swallowing”, and “vomiting”.

• 病因病机的认识

慢性胃炎的临床症状表现多样，如胃痛，胀满，吞酸，痞满，嗳气等，引起这些不适的病因病
机非常复杂，发病或因情志不畅，郁怒伤肝，木不疏土；或因饮食不节，酒食过度，直伤脾胃；或因素体禀赋不足，加上外邪相干所致等，有关其病因病机的描述亦可见于历代文献，如：《灵枢·小针解》篇云：“寒温不适，饮食不洁，而病于肠胃。”《素问·六元正纪大论篇》说：“木郁之发……故民病胃脘当心而痛，上支两肋，鬲咽不通，饮食不下。”《景岳全书·心腹痛》则认识到“胃脘痛证，乃有因食、因寒、因气不顺者。”李东垣在《脾胃论》中则进一步指出“饮食不洁则胃病，形体劳役则脾病。”《杂病广要·胸痹心痛》中说：“饮食过多，不能克化，伤于胃脘，病根常在，略伤饮食则闷闷作痛。”

  1. Understanding the disease causes and pathomechanisms

The clinical manifestations of chronic gastritis may vary and they include: stomachache, distention and fullness, acid swallowing, glomus and fullness, and belching. The causes and pathomechanisms are very complicated. It may arise from: affect-mind inhibition and depressed anger damaging the liver; thereby, the liver-wood cannot freely course spleen-earth; dietary irregularities and excessive drinking of liquor; so that the spleen and stomach are damaged directly; or from constitutional insufficiency and invasion of external evil. Relevant descriptions can be found within the documents of past dynasties. For example, in “Magic Pivot ·Explanation of the Use of Small Needles”, it says, “Excessive cold or warmth, or unclean food may lead to the diseases of the intestines and stomach.” In “Plain Questions ·Great Treatise on the Regular Principles of the Six Origins”, it says, “Depressed wood…will lead to the disease of the stomach duct with heart pains. The throat is blocked and unable to pass food.” In “Jing Yue’s Complete Compendium ·Heart and Abdomen Pain”, it says, “The symptoms of stomach duct pain may be due to diet irregularities, cold, or Qi stagntion.” Li dong-yuan points out in his treatise “On the Spleen and Stomach”, “unclean foods lead to stomach disease, physical taxation leads to spleen disease.” In “Miscellaneous Diseases·Chest Impediment and Heart Pain”, it says, “Excessive food intake, and the inability to digest, will harm the stomach duct. If this condition lasts for a long time, pain will arise even with a slightly irregular diet.”

尽管慢性胃炎的病因多种多样，病机复杂，但根据《内径》“正气内存，邪不可干”，“邪之所凑，
其气必虚”的发病学原理和《金匮要略》中“若五脏元真通畅，人即安和”，“四季脾旺不受邪”等理论，联系日常临床所见病例，多数学者认为慢性胃炎的病机主要以虚实夹杂，脾胃虚弱为本，邪气干胃为标。

There are various causes and complicated pathomechanisms with chronic gastritis; however, there are some basic principles of pathogenesis and treatment. For example, in “The Yellow Emperor’s Inner Classic”, it relates, “If the upright Qi is internally maintained, then evil cannot invade.” And, “if evil enters the body, the Qi must be vacuous”. In “ Essential Prescriptions of the Golden Coffer”, it says, “If the true origin of the viscera is unobstructed, the body will be healthy and harmonious”, “evil cannot invade if the spleen is vigorous during the four seasons of the year. Based on these theories and clinical cases, most scholars believe the root cause of chronic gastritis is a vacuity-repletion complex and spleen-stomach vacuity; whereas, the branch is the evil Qi invading the stomach.

• 治疗

目前中医对慢性胃炎的治疗缺乏统一的标准，中医治疗强调审证求因，辨证论治，辨别病症之
虚实寒热。邪盛以驱邪为主，正虚以养胃为主，虚实夹杂者标本兼顾，攻补兼施。笔者结合对慢性胃炎病因病机的认识，联系临床病例认为健脾和胃，补消兼施，调畅肝气，针药结合，综合调理可取得较好的临床疗效。

• Treatment

Up until now Chinese medicine does not have a standardized treatment for chronic gastritis. What Chinese medicine emphasizes is to assess the patterns and seek the cause to determine the treatment. If it is due to exuberant evil Qi, the treatment should focus on dispelling evil Qi; if it is due to upright Qi vacuity, the focus will be on nourishing the stomach; if it is vacuity-repletion complex, both the root and branch should be treated by using supplementing and dispersion methods. The writer believes that in order to achieve good clinical effects, the following combined treatment methods should be utilized: fortify the spleen and harmonize the stomach with simultaneous supplementing and dispersion methods, regulate and open the liver Qi. Treatment should be a combination of acupuncture and herbal medicine.

• 健脾和胃，补消兼施

脾胃为后天之本，脾胃的功能旺盛，则正气易于恢复，疾病易于痊愈，正如李东垣所说“善治
病者，惟在调和脾胃”。李培教授在治疗慢性胃炎方面尤重视健脾，认为健脾则胃安。《素问·阴阳应象大论篇》说：“治病必求于本”，指出治疗疾病时必须究其根本后进行治疗，而本病病久多以脾胃虚弱为主，但纯虚者极少，或多或少都有一些实邪，或气滞，或血瘀，或湿热等证型。故临床治疗本病，即应重视健脾和胃治其本，又应针对不同病邪治其标，或理气，或活血，或清热等治法，使邪去而不伤正。

2.1 Fortify the spleen and harmonize the stomach using both supplementing and dispersion methods

The spleen and stomach are the root of latter heaven. If their function is exuberant, the upright Qi is easy to recover and disease will easily be cured. As Li Dong-yuan says, “good doctors emphasize the regulation of the spleen and stomach”. Professor Li Pei attaches great importance to fortifying the spleen while treating chronic gastritis. According to him, if the spleen is fortified, the stomach will be calm. In “Plain Questions·Great Treatise on the Correspondences and Manifestations of Yin and Yang”, it says, “To treat disease, it is necessary to seek the root”. Chronic gastritis, in most cases, is due to spleen-stomach vacuity, but very few are due to vacuity alone. More often, the symptoms are combined with some form of repletion evil. It may be Qi stagnation, blood stasis, damp-heat, etc. Therefore, in clinical treatment, the focus should be to treat the root by fortifying the spleen and stomach. At the same time, the branches should also be treated in accordance with the presenting disease evil, such as regulating the Qi, quickening the blood, clearing the heat, etc.

案 赵某，女，56岁，退休干部，2007年7月9日初诊。患者胃脘部痞满不适，隐隐作痛3
年余，2006年11月曾作纤维胃镜检查，提示为慢性萎缩性胃炎，间断服枸橼酸铋胶囊、胃必治等药，无明显疗效。1周前因操劳过度，胃脘部痞满不适加重，时有烧灼样痛，以解痉药治疗，疼痛虽明显减轻但胃脘部痞满仍在，其他症状也无明显改善。就诊时患者胃脘部痞满不适，时轻时重，隐隐作痛，不思饮食，倦怠乏力，气短懒言，大便溏泄，舌质淡，苔薄白，脉沉弱，轻度贫血貌，心肺无异常，腹软无抵抗及压痛，肝脾未触及，肾区无叩击痛，心电图，大便常规及B型超声波检查无异常，血常规显示血红蛋白 92 g/L，白细胞 4.8×109/L，中性粒细胞 0.65，淋巴细胞 0.35，纤维胃镜检查提示慢性萎缩性胃炎。西医诊断为慢性萎缩性胃炎，中医诊断为痞证，证属脾胃气虚型。治以健脾益气，和胃消胀。方选香砂六君子汤加减。

Case study:

Female, 56 years old. Her first visit to the hospital was July 9, 2007. The patient complained of glomus, fullness, discomfort and dull pain in the stomach duct. This symptom had continued for more than 3 years. It was diagnosed as chronic atrophic gastritis after a stomach fiber endoscopy in November, 2006. She had been continuously taking potassium citrate capsules and gentamycin sulfate injections but without clear results. One week before the first visit, her condition worsened due to overwork: she experienced increased sensations of glomus, fullness and discomfort in the stomach duct. At times, she experienced scorching pain. After taking spasmolytics, the pain was greatly alleviated but the glomus remained. Other symptoms showed no improvement. At the time of examination, she continued to experience intermittent feelings of glomus, fullness and discomfort, and dull pain in the stomach duct. She had no desire for food or drink. She felt tired and a lack of strength. She was short of breath and no interest in speaking. She had sloppy diarrhea. The tongue was pale and the tongue coating was thin and white. The pulses were sunken and weak. She had slight anemia. The heart and lungs were normal. The abdomen was soft and did not feel pain under pressure. The liver and spleen were not palpated. The kidney area showed no tenderness with applied tapping. Electrocardiogram, stool, and B-type ultrasonic examinations were all normal. Hemoglobin was 92 g/L, leucocyte count was 4.8×109/L，neutrophil count 0.65, and lymphocytes were 0.35. According to western medicine, following an endoscopy, her symptoms were diagnosed as chronic gastritis. According to Chinese medicine, this was diagnosed as spleen-stomach Qi vacuity. The treatment should be to fortify the spleen, boost the Qi, harmonize the stomach and disperse distension. The formula was Costusroot and Amomum Six Gentlemen Decoction (with additions and subtractions).

处方： 党参15g, 白术15g，茯苓15g，砂仁10g，甘草6g，大枣6枚，神曲10g，麦芽10g，
山药15g，陈皮10g，蒲公英15g，佛手10g，丹参10g。水煎分早晚温服，1剂/d。嘱患者调饮食、畅情志、勿劳累。守方加减4周，患者自觉症状消失，精神饮食均佳。将上方制成胶囊，2粒/d, 3次/d，连服3个月以巩固疗效。停药后随访半年，胃病未复发。

Formula: codonopsis (dang shen) 15g, white atractylodes (bai zhu)15g, poria (fu ling) 15g, amomum (sha ren) 10g, licorice (gan cao) 6g, jujube (da zao) 6 pieces, medicated leaven (shen qu) 10g, barley sprout (mai ya) 10g, dioscorea (shan yao) 15g, tangerine peel (chen pi) 10g, dandelion (pu gong ying) 15g, Buddha’s hand (fo shou) 10g, salvia (dan shen) 10g. To be taken warm in the morning and evening. One formulation a day.

The patient was instructed to regulate food and drink, smooth the affect-mind, and not to overwork. After using a modified version of this formula for 4 weeks, the patient felt the symptoms disappeared and reported improvement in both spirit and diet. The patient was advised to continue taking the prescription in capsule form at a dosage of 2 capsules three times per day. This was repeated for 3 months to secure the effect of the treatment. After 3 months the gastritis had not returned.

按 本方取四君子汤之义加减，注意补益脾胃，并配理气活血之品，诸药合用，共奏健脾益胃，
攻补兼施之效，使补而不滞，正气恢复，邪去而疾病痊愈。较好地体现了健脾和胃攻补兼施在治疗慢性胃炎中的应用。

Note: The formula utilizes a modified Four Gentlemen Decoction. The emphasis is on supplementing and boosting the spleen and stomach. With the additional herbs, it can also regulate the Qi and quicken the blood. This formula can fortify the spleen, boost the stomach, and simultaneously supplement and attack. It supplements without causing stagnation. It recovers the upright Qi while dispelling evil in order to effectively treat the disease.

• 脏腑相关，注意调肝

慢性胃炎病位虽在中焦，但多累及肝气而成肝、脾、胃3脏之病，故临床不必见肝郁方调肝气，
治疗时可酌情加入疏肝之品，使肝气疏，中气畅，从而脾胃功能正常。刘景龙，赵瑞华等认为采用疏肝和胃法治疗慢性胃炎效果比较明显，肝属木而主疏泄条达，脾胃属土而主运化受纳，肝与脾胃为木土相克之脏，正常情况下，肝之疏泄条达，有利于脾胃消化吸收，即木能疏土。肝之疏泄条达正常，即可助脾运化，使轻阳升发，水谷精微转输上归于肺，又可助胃受纳腐熟，使浊阴之气下降，使食糜不断下达于肠。

• Chronic gastritis and its relationship with the liver

Although chronic gastritis is located in the central burner, it’s predominant relationship is with the liver Qi. This combination forms an imbalance of the liver, spleen and stomach. Clinically, the liver Qi should be regulated, even without the symptom of liver depression. In treatment, liver-coursing medicinals can be added to course the liver Qi, and unimpede the central Qi, in order to recover the function of the spleen-stomach . According to Liu Jing-long and Zhao Rui-hua, beneficial effects can be achieved when treating chronic gastritis with the method of coursing the spleen and harmonizing the stomach. The liver belongs to wood, which governs free coursing and orderly reaching. The spleen and stomach belong to earth, which governs movement, transformation and intake. The relationship between the liver and spleen-stomach is that of wood and earth. The normal free coursing and orderly reaching is beneficial to the absorption and digestion of the spleen-stomach. This is what is referred to as “wood courses earth”. This not only can assist the movement and transformation of the spleen, upbear clear Yang, and deliver the essence of grain and water up to the lungs; but, it also may assist the stomach decomposition intake, downbear the turbid Yin, and deliver the chyme down to the intestines.

案 袁某，女57岁，退休教师，2007年7月23日初诊。患者胃脘胀满，反复发作2年，生气及饭后尤著，伴嗳气吞酸，口苦，食欲不振，经多方治疗症状未见好转，面色萎黄，舌淡红，苔薄白，脉弦。此次就诊主因与家人生气后上述症状加重。胃镜提示：慢性浅表性胃炎，幽门螺旋杆菌阳性。中医诊断：胃脘痛，证属肝胃气滞型。治宜疏肝和胃，理气止痛。拟以柴胡舒肝散加减。

Case study:

Female, 57 years old. Her first visit to the hospital was on July 23, 2007. The patient had suffered from gastric distention and fullness repeatedly for two years. It was worsened with anger and especially after dinner. This symptom was also accompanied with belching, acid swallowing, bitter taste, and poor appetite. After multiple treatments there was no improvement in the symptoms. The patient had a withered-yellow facial complexion; her tongue was pale red; the tongue fur was thin and white; and the pulse was stringlike. Gastroscopy indicates that her condition is chronic superficial gastritis. Helicobacter pylori was positive. According to Chinese medicine, this was diagnosed as stomach duct pain due to liver and stomach Qi stagnation. The treatment should focus on coursing the liver, harmonizing the stomach, regulating the Qi and relieving the pain. Chai Hu Liver-Soothing Powder was adopted with abductions and subtractions.

处方: 柴胡10g，川芎10g，香附10g，白芍15g，赤芍10g，陈皮10g，枳壳6g，旋覆花10g，神曲15g，麦芽10g，半夏10g，甘草9g。水煎分服，1剂/d。嘱患者调饮食，畅情志，勿劳累。治疗3个疗程后，诸症消失，胃镜提示：未见异常， HP(-)。随访半年未见复发。

Formula: bupleurum (chai hu) 10g, chuan xiong rhizome (chuang xiong) 10g, cyperus (xiang fu) 10g, white peony (bai shao) 15g, red peony (chi shao) 10g, tangerine peel (chen pi) 10g, bitter orange (zhi ke) 6 g, inula flower (xuan fu hua) 10g, medicated leaven (shen qu) 15g, barley sprout (mai ya) 10g, pinellia (ban xia) 10g, licorice (gan cao) 9g. Take one formula twice a day. The patient was instructed to regulate food and drink, smooth the affect-mind, and not to overwork. After three courses of treatment all of the symptoms disappeared. Gastroscopy indicated no abnormalities. HP was negative.

按 本方取柴胡舒肝散之义加减，有疏肝解郁，消食和中，理气止痛之效。充分体现了调肝可使全身气机畅达，脾胃功能如常。

Note: Chai Hu Liver-Soothing Powder can soothe the liver, resolve depression, disperse food, harmonize the center, regulate the Qi and relieve pain. This case study illustrates that by regulating the liver, the dynamic of the whole body becomes unblocked and the function of the spleen-stomach return to normal.
• 针药结合 内外同治

针灸疗法为外治法，通过腧穴经络对胃病起调节作用；而内服中药汤剂为内治法，直接对胃腑
起调节作用，两者结合运用可提高疗效，使中药治疗慢性胃炎的特色更加突出。饶燕认为采用针灸治疗慢性胃炎亦能收到良好疗效，通过调节神经通路，提高免疫功能。童春泉等认为可以通过穴位埋线治疗消化溃疡，且远期疗效和安全性较高。临床应用时应综合分析四诊材料，作出正确的诊断和辨证分析，确立正确的疗法，选择正确的方药和穴位，使针药有机结合。

• Combination of Acupuncture and herbal medicine and the simultaneous treatment of internal and external

Acupuncture is an external method of treatment which works on stomach disease through acupoints and network vessels. Chinese herbal medicine is an internal method of treatment which regulates the stomach directly. Increased results can be achieved by combing these two methods. However, according to Rao Yan, beneficial results may also be achieved by utilizing acupuncture as a single treatment method. Immune functions may be improved by regulating the nervous system. According to Tong Chun-quan, in treating peptic ulcer, it is safer to utilize “threaded acupuncture” which is capable of achieving longer lasting effects. Clinically, it is important to make the correct diagnosis and implement the appropriate method of treatment.

案 李某，女，42岁，2007年9月11日初诊。患者诉胃病史3年，3年前因饮食不节，冒雨露宿，随即脘腹胀闷，隐痛时作，大便溏薄，四肢乏力。1年前在某医院胃镜检查诊断为慢性浅表性胃炎，曾服用“雷尼替丁”、“吗丁啉”、“枸橼酸铋胶囊”、“胃必治”等西药，效果不明显。遂于2007年9月11日来我院就诊。诊见胃脘隐痛，喜按，脘胀痞闷，嗳气便溏，时欲呕恶，面色少华，自觉肢冷，舌淡苔白，脉沉细。中医诊断：胃脘痛，证属脾胃虚寒。治宜温阳祛寒，燥湿健脾。以附子理中丸内服配合针灸治疗。附子理中丸，6g/次，每日早晚饭后温开水送服。嘱患者调饮食、畅情志、勿劳累。配合针灸足三里、中脘、章门、关元等穴，以补法为主，一次/d，7次为一个疗程。治疗3个疗程后患者胃脘疼痛消失，大便正常，痞闷减轻，面色转润，精神饱满。续服上药3个疗程以巩固疗效。2008年1月6日胃镜复查显示上消化道未见明显异常。后随访3个月未见复发。

Case study:

Female, 42 years old. The patient’s initial visit was on September 11, 2007. She had suffered from stomach problems for three years. Three years prior, due to dietary irregularities and camping in the rain, she began to feel distention and oppression in the stomach duct and abdomen. She experienced frequent attacks of dull pain. She had thin stools and fatigued limbs. The previous year, her condition was diagnosed as chronic superficial gastritis with a gastroscopy exam. She took ranitidine, domperidone, potassium citrate capsules, gentamycin sulfate injections without obvious effects. The following symptoms were present at the time of examination: dull pain in the stomach duct which is improved with pressure, distention and oppression in the stomach duct, belching, sloppy stool, frequent sensations of nausea and vomiting, lusterless facial complexion, and cold limbs. The tongue was pale and the tongue coating was white. The pulse was fine and sunken. The Chinese medicine diagnois was stomach duct pain due to spleen-stomach vacuity cold. The treatment focus is to warm the Yang, dispel cold, dry dampness and fortify the spleen. Aconite Center-Rectifying Pill was prescribed, combined with acupuncture. The patient was advised to take 6g of Aconite Center-Rectifying Pill twice a day, mornings and evenings. She was further directed to regulate food and drink, smooth the affect-mind, and not to overwork. The acupoints used were: Leg Three Miles (ST-36, Zu San Li), Central Stomach Duct (CV-12, Zhong wan), Camphorwood Gate (LV-13, Zhang men), and Pass Head (CV-4, Guan yuan). The primary method of acupuncture was supplementation, and was performed once per day. One course of treatment consisted of seven treatments. After three courses of treatment , the stomach duct pain disappeared, the stool was normal, the oppression in the spleen was alleviated, the facial complexion turned moist, and the patient was full of vigor. Three more courses of treatment were added to secure the treatment. On January 6, 2008, a follow up gastroscopy exam showed no abnormalities were found in the upper gastrointestinal tract.

按 附子理中丸取干姜、附子温中散寒以助阳，白术健脾燥湿，人参大补元气以助运化，甘草和中益气。此方可使中焦之寒得辛热而去，虚证得甘温而复，清阳升，浊阴降，运化健而中焦治，加之关元及元气所聚，中脘、章门乃脾胃之募穴，足三里乃足阳明合穴具较强保健之功，针药结合治疗，取其温补而不滞，行气而不散，从而脾胃阳气得复，寒湿得除，由此标本兼顾，正得复，邪得除。另外，李燕认为附子理中丸还可治疗功能性消化不良，附子理中丸对于消化不良导致的慢性胃炎亦能收到良好疗效。

Note:

In the formula of Aconite Center-Rectifying Pill, dried ginger (gan jiang) and aconite (fu zi) can warm the center and dispel cold to assist the Yang. White atractylodes (Bai zhu) can fortify the spleen and dry dampness. Ginseng (Ren shen) can greatly supplement the original Qi of the body so as to aid movement and transformation. Licorice (Gan cao) can harmonize the center and boost the Qi. In this formula, the cold in the middle burner is dispelled by warm medicinals, the vacuity pattern is treated with warm and sweet medicinals. When the clear Yang upbears and the turbid Yin downbears, movement and transformation is strengthened, thereby, harmonizing the middle burner. In addition, Pass Head (CV-4, Guan Yuan) is the gathering point of the original Qi, Central Stomach Duct (CV-12, Zhong wan) and Camphorwood Gate (LV-13, zhang men) are the front-mu points of the spleen and stomach, Leg Three Miles (ST-36, Zu san li) is the uniting point of the foot Yang brightness. Needling these points will have a strong effect on the overall health of the body. Acupuncture and herbal medicine are used in combination to warm and supplement without stagnating, and to move the Qi without dispersing; thereby, the Yang Qi of the spleen-stomach can be recovered and cold-damp can be dispelled. By treating both the root and branch, the upright Qi can be recovered and evil eliminated. Furthermore, according to Li Yan, Aconite Center-Rectifying can also treat functional indigestion leading to chronic gastritis.

• 结语

慢性胃炎按新悉尼系统的分类方法可分为浅表性、萎缩性和其他特殊类型的胃炎。目前公认的幽门螺旋杆菌感染是慢性胃炎的最主要病因，在治疗方面西医多采取三联疗法根除幽门螺旋杆菌，并配合改善消化系统的药物，如胃肠动力药、抑酸或抗酸药等，虽已取得一定临床疗效，但其服药时间长，且症状可能反复出现，很难达到理想的治疗目标。中医药在治疗慢性胃炎上有其独特优势，在中医基本理论和辨证论治思想的指导下，结合本病的病因病机和病人情况的不同，运用中医经方，以顾护胃气为本，祛除病因为标，注意肝气条达，针药结合，灵活地进行辨证论治，可取得满意的疗效。另外慢性胃炎经过治疗后，病情得以控制，若疾病处于缓解或初愈阶段，此时机体尚处于待恢复状态，胃的功能尚未健全，生活起居如有不慎，亦有复发之虞，所以预防复发也是十分重要的。
贾凤云认为慢性胃炎的发病与情志、饮食等密切相关。殷艳认为慢性胃炎愈后的饮食保健亦是非常重要的，因此预防慢性胃炎复发的措施应当是综合的，除饮食调养、起居调节、精神调摄、加强体育锻炼外，还应慎用对胃黏膜有损害的药物，并可结合药膳以继续改善和加强脾胃的功能，促进体内脏腑机能的恢复，增起御病之“正气”，以使“正气存内，邪不可干”。中医治疗有具有副作用小，疗效显著，经济实惠等优势，容易被患者接受，故具有极为广阔的临床应用前景。

• Conclusion

According to the New Sydney System, chronic gastritis is classified as: superficial gastritis, atrophic gastritis and special type gastritis. Nowadays, it is commonly agreed that the main cause of chronic gastritis is Helicobacter pylori. In treatment, Western medicine generally adopts a triple therapy method to root out helicobacter pylori. Other medicinals are added to improve the digestive system, such as gastrointestinal drugs and antacids. This works to some extent, but it’s hard to achieve ideal effects because the course of treatment is long, and the symptoms may relapse again and again. Chinese medicine has a unique advantage in treating chronic gastritis. Under the guidance of basic Chinese medicine theory and the practice of identifying patterns to determine treatment, satisfactory effects can be achieved. The root treatment is to protect the stomach Qi; and the branch treatment is to eliminate causitive disease factors. In addition, once the condition is under control, it is important to prevent relapse by keeping in mind, the patient is still in a period of recovery and the function of the stomach is still not completely recovered.

According to Jia Feng-yun, the onset of chronic gastritis is closely related with the affect-mind and diet. According to Yin Yan, it is very important to pay close attention to the diet and health care after treatment. The measures to prevent the relapse should be comprehensive: regulating diet, daily life, physical activity and the mental spirit; the patient should also be careful not to take substances that are harmful to the gastric mucosa. Medicinal food may also beneficial to improve the function of the spleen and stomach and help recover the function of the internal organs. Chinese medicine has a significant effect in treating chronic gastritis with fewer side effects, and for some, may be economically more viable. Therefore, it is widely accepted by patients and has a broad perspective in it’s clinical application.

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Treatment Of Dizziness During The Menstrual Cycle

27
Jun
2019

徐志华 － 经行头晕

Xu Zhihua’s Treatment Of Dizziness During The Menstrual Cycle
Translated by J. Heaverlo & Xu Zhijun

经行前后或经期，出现头目眩晕，并伴随月经周期发作者，称 “经行头晕”。徐老着重于”无痰不作眩”，施用半夏天麻自术汤而获效.

Dizziness may develop before, during or after the menstrual period. When this occurs it is called “dizziness during menstrual cycle”. Xu Zhi-hua emphasizes the concept “Without phlegm, there can be no dizziness”. He achieves excellent results with the formulation ban xia tian ma bai zhu tang.

经行头晕责痰障 施用半夏天麻汤
Menstrual cycle dizziness due to phlegm – use ban xia tian ma tang

半夏天麻白术汤
组成:天麻 10g 姜夏 10g 白术10g 神曲lOg 麦芽 lOg 泽泻lOg 党参 10g 夜苓 10g 黄柏 10g 陈皮lOg 于姜 10g 生姜 3 片

Ban Xia Bai Zhu Tian Ma Tang
Ingredients: tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces

功用:健脾燥湿，桂痪降浊。

主治:经行头晕。

Functions: Strengthens the Spleen and dries damp. Expels phlegm and descends turbidity

Primary Treatment: dizziness during the menstrual cycle

方解:天麻性味辛微温，善能祛风化痰，为治疗肝风而夹痰湿之眩晕要药;二陈汤加浑泻、黄柏化湿除痰、降逆止呕;党参、白术健脾益气;神曲、麦芽健胃和中;生姜宣散水湿。

Explanation: Tian ma is acrid and slightly warming. It can expel wind and transform phlegm. It serves as the chief herb when there is liver wind and phlegm damp causing dizziness. This formula also contains er chen tang with ze xie and huang bai. Together these herbs can transform damp and expel phlegm, descend counterflow and stop vomiting. Dang shen and bai zhu strengthen the spleen and benefit the qi. Shen qu and mai ya strengthen the stomach and harmonize the center. Sheng jiang disperses water dampness.

案例:
例一:女，42岁。初诊日期: 1987 年 5 月5 日。患者近年来每至经行之时即觉头晕，后脑作胀微痛，不能见行驶车辆。发作严重时恶心呕吐，不能起坐。头重如蒙，胸闷纳少，整日昏昏欲睡。月经初潮 15 岁，3 － 5 ／ 2 6 － 3 0天，量中色红无块，末次月经: 1987 年 4 月 11 日，舌质淡，苔白腻，脉濡。

Case Study 1:
A 42 year old female patient reports, in the past few years, at the time of her menstrual period, she has dizziness and occipital distention with slight pain. She cannot even bear to see moving vehicles. When the dizziness worsens she also experiences nausea and vomiting, and cannot sit up. The head feels heavy and foggy. She has chest oppression and is unable to eat much. She feels tired all day and only desires sleep. Her menstrual cycle began when she was 15 years old. The cycle lasts 26-30 days and the period is 3-5 days. It is medium in amount, red in color and without clotting. Her last menstrual period was 3 weeks prior to the time of diagnosis. The tongue body is pale-red and the coating is white and greasy. The pulse is soggy.

此由痰浊蒙蔽清阳，故头晕头重如蒙;痰浊中阻，浊阴不降，气机不利，故胸闷恶心，脾阳不振则少食多寐，加之经行气血下注，其气益虚，清阳不升，痰湿上扰所致。投半夏天麻白术汤。

This condition is due to phlegm turbidity obstructing the clear yang, causing dizziness and a sensation of fogginess and heaviness in the head. When phlegm turbidity obstructs the center, the turbid yin cannot descend causing the Qi mechanism to become obstructed. Therefore, there will be chest oppression and nausea. The spleen yang is unable to ascend, causing diminished appetite and excessive sleepiness. In addition, during the menstrual cycle, the Qi and blood pour downward, causing the Qi to be even more vacuous. The clear yang is unable to ascend causing phlegm-damp to harass the upper body. Administer ban xia tian ma bai zhu tang.

天麻 10g，姜夏 10g，臼术 1 g，泽泻 10g，党参 10g夜苓lOg ，干姜 10g，陈皮 10g，黄柏 10g，麦芽10g，神曲10g，生姜 3 片。4 剂。水煎服。

Ingredients: tian ma 10g, jiang ban xia 10g, bai zhu 10g, ze xie 10g, dang shen 10g, fu ling 10g, gan jiang 10g, chen pi 10g, huang bai 10g, mai ya 10g, shen qu 10g, sheng jiang 3 pieces. 4 formulas were administered for decoction.

二诊: 1987 年 5 月 10 日。此次经行已 3 天，精神明显好转，仅觉轻度头晕，尚能坚持正常教学。舌质淡，苔白微腻，脉濡滑。嘱下次经前 5天按上方再服 4 剂。3 月后随访，头晕己愈。

Follow up: At the time of the second visit (5 days later) the patient was on day 3 of her period. Her vitality had clearly improved. Not only was the dizziness less intense but she was able to return to work. The tongue body was pale-red. The tongue coating was white and slightly greasy. The pulse was moist and slippery. The patient was urged, next time to start taking the herbal formulation 5 days before her menstrual cycle begins. She was instructed to take 4 formulations at that time. After 3 months, follow up showed that her dizziness had already recovered.

例二:付某，女，37 岁，干部，已婚。1990 年 11 月 7日初诊。患者经前头晕反复发作 2 年，头晕多在月经前 1 周发作。头晕头重如裹，胸院痞塞，恶心欲呕，纳呆，肢重乏力。末次月经，1990 年 10 月 12 日。舌质淡红，苔白腻而厚，脉滑。证属痰湿中阻，风痰上扰。方用半夏臼术天麻汤:

Case Study 2:
A 37 year old female patient reports dizziness occurring one week before her menstrual cycle begins. This has been repeatedly occurring for 2 years. The head feels heavy as if wrapped. There is a sensation of chest and stomach glomus and blockage, nausea with a desire to vomit, torpid intake, and heavy limbs without strength. Her last menstrual cycle was 3 1/2 weeks prior. The tongue is pale-red. The tongue coating is white, greasy and thick. The pulse is slippery. The diagnosis is phlegm-damp obstructing the center with wind-phlegm harassing the upper body. Administer ban xia bai zhu tian ma tang.

天麻lOg ，姜夏 10g，自术 10g，神曲 10g，麦芽 10g，浑海 10g，党参 10g，夜苓 10g，黄柏 10g，陈皮 10g，干姜10g，生姜 3 片。5 剂。

Ingredients: tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces. 5 formulas were administered.

二诊: 1990 年 11 月 13 日。头晕减轻，纳可。现月经将至，舌脉同前，原方加泽兰叶lO g，再进 7 剂，经净晕止，一切正常，以后每临经前，继续宗方调治半年，痊愈。

Follow up: After one month, the dizziness was mitigated and the appetite returned. At the time of the follow up, the menstrual period was about to begin. The pulse and the tongue were unchanged. The same formulation was administered with the addition of ze lan ye 10g. Seven formulations were prescribed. After the period, the dizziness stopped and the symptoms were no longer present. At each follow up visit, prior to the beginning of the menstrual cycle, the same formulation was prescribed. After 6 months the patient recovered completely.

按1 经行头晕是妇科临床常见症候之一。轻者闭目即止，重者如坐舟车，旋转不定。加之经行之时，营血趋向于下，髓海空虚，肝阳偏亢，阳扰于上，则头目为之昏眩。正如《内经》云:”诸风掉眩，皆属于肝”、”上虚则眩”、”髓海不足则脑旋耳鸣”, <金匮要略》云:”心下有痰饮，胸胁支满目眩，”刘河间认为眩晕由风火所致;朱丹溪认为”无痰不作眩”，张景岳认为”无虚不作眩”等。因此，眩晕之由，不外风、火、痰、虚。而以风阳上扰及气血亏虚者最为多见。治疗中必须首先审证求因，分清虚实，然后再确立治法。本类患者脾虚水湿失运，聚而成痰，经行痰浊上扰，蒙闭清窍，清阳被遏，故经行头晕。

Discussion: Clinically, in gynecological medicine, dizziness during the menstrual cycle is a commonly seen condition. In less severe cases, if the patient closes their eyes the dizziness will stop. In more severe cases, however, it may feel as if one is riding on a boat, causing a continuous spinning sensation. In addition, during the menstrual period, the construction blood are moving downward leaving the sea of marrow empty and depleted. The inclination is for the liver yang then to ascend and harass the upper body causing dizziness. The Nei Jing states “All wind with shaking and dizzy vision is ascribed to the liver.”“when the upper body is vacuous there will be dizziness”, “when the sea of marrow is insufficient there will be dizziness and tinnitus.”. The Jin Gui Yao Lue states, ” when there is phlegm-rheum below the heart there will be distention in the chest and rib-side, and dizziness.” Liu He-jian believes dizziness is caused by wind-fire. Zhu Dan-xi states ” without phlegm there cannot be dizziness.” Zhang Jing-yue states “without vacuity there cannot be dizziness”. Therefore, the causes of dizziness are nothing more than external wind, fire, phlegm and vacuity. Among these causes the most commonly seen are due to the liver yang rising to harrass the upper body and qi and blood depletion and vacuity. Treatment first must be determined by seeking the root cause and distinguishing between vacuity and repletion. After this, the correct treatment method can be established. Typically, these are patients with spleen vacuity and water damp causing loss of transportation. This allows for the accumulation of phlegm. At the time of the menstrual cycle, this phlegm turbidity will ascend and harass the upper causing fogginess and obstruction of the clear orifices. The clear yang will be blocked leading to “dizziness during the menstrual cycle”.

徐老几十年的临床实践中，对东垣指出的”足太阴痰厥头晕非半夏不能疗，眼黑头旋，虚风内作，非天麻不除”体会尤深。遵其所论，以半夏天麻臼术汤加减屡用皆效。《本草从新》称:”天麻入肝经，通血脉，疏痰气，治诸风掉眩, 头眩眼黑”、”半夏体滑性燥，能走能散，治咳逆头眩，痰厥头痛”，浑泻利水行饮下走水道，小便一行，水湿有其出路，三焦阳气通达，表里通畅，故头晕病解。
Xu Zhi-hua has numerous years of clinical practice that has brought about a deep understanding of this condition. As Li Dong-yuan points out ” ban xia is capable of treating foot tai-yin phlegm-rheum causing dizziness. When the eyes are black and the head is spinning, and there is vacuity wind internally occurring, tian ma is indispensable”. Following this theory, the usage of modified ban xia tian ma bai zhu tang will bring results. The Ben Cao Cong Xin states, ” tian ma enters the liver channel, opens the blood vessels, dredges the phlegm-qi and thereby treats all wind with shaking and dizzy vision, as well as, dizzy head and dim eyes. Ban xia is slippery in body and dry in nature. It is capable of moving and dispersing and can treat cough, counterflow, dizziness, and phlegm reversal headaches.” Ze xie opens waterways, moves fluids downward and promotes urination. Once urination is unblocked, water-damp finds a passage out and the Yang Qi of the Triple Burner becomes open and free. Thus, both the exterior and interior are open and unblocked and the dizziness can be relieved.

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Acupuncture Found Effective For Lumbar Disc Herniations

26
Jun
2019

source: healthcmi.com

Acupuncture combined with herbal medicine is effective for the treatment of lumbar disc herniations. Beijing Timber Factory Worker’s Hospital researchers investigated the effects of warm needle acupuncture and Chinese herbal medicine on patients with lumbar disc herniations. The combined therapy produced a 69.2% total effective rate. Using warm needle acupuncture as a standalone therapy absent the use of herbal medicine produced a 50.7% total effective rate.

All patients included in the study suffered from lumbar disc herniations due to cold dampness. In Traditional Chinese Medicine (TCM), lumbar disc herniations are categorized into several differential diagnostic patterns including cold dampness, damp heat, qi and blood stasis, and kidney qi deficiency. The pattern investigated in this study, cold dampness, is characterized by lower back pain, tingling, numbness, range of motion impairments, a sense of heaviness in the lower back, and radiculopathy (pain, weakness, or numbness along the path of the impinged nerve). Cold dampness type herniations are chronic and are exacerbated by exposure to cold, dampness, and excess sitting, lying, or inactivity.

One of the most common types of lumbar disc herniation presentations is lumbar disc herniation with cold damp syndrome (Li & Wang). Common treatment methods include surgery, injections, medications, acupuncture, moxibustion, traction, and electroacupuncture (Sun, Wang & Xu). According to TCM principles, the Du (Governing Vessel), Bladder Foot-Taiyang, and Gallbladder Foot-Shaoyang channels are primarily affected by cold damp type disc herniations. The condition is often alleviated by warmth and therefore standalone moxibustion or warm needle acupuncture using moxibustion or a TDP heat lamp may be used to alleviate cold damp type disc herniations. The researchers followed standard TCM protocols and included moxibustion in their procedures. Acupuncture points included in the treatment protocol included the following:

L1–L5 Huatuojiaji (based upon affected vertebral segments)
BL22 (Sanjiaoshu)
BL23 (Shenshu)
BL24 (Qihaishu)
BL26 (Guanyuanshu)
M-BW-24 (Yaoyan)
BL54 (Zhibian)
GB31 (Fengshi)
BL40 (Weizhong)
BL57 (Chengshan
BL60 (Kunlun)
GB39 (Xuanzhong)
GV3 (Yaoyangguan)
GV4 (Mingmen)
Each acupuncture session lasted for 45 minutes. Patients received one acupuncture treatment per day for 15 consecutive days, comprising one course of care. In total, 3 courses of care were applied with a 2 day break between each course. Treatments began with patients in a prone position. Acupoints were disinfected with a 75% alcohol solution. Perpendicular insertion of filiform acupuncture needles at a high needle entry speed was used with 28 gauge acupuncture needles. The 28 gauge needle diameter is 0.35 mm and is labeled a #10 gauge in the Japanese system. This stout gauge is commonly applied in mainland China but is less common in the USA.

Manual acupuncture techniques were applied with lifting, thrusting, and rotating techniques to obtain deqi and for the purposes of applying attenuating and reinforcing methods. Once deqi was obtained at each needle, the needles were retained for the duration of the treatment session. Deqi was determined as a measure of the patient’s experience of soreness, numbness, or an electric sensation produced by the needle. Practitioner observations of needle reactions were also used to indicate the arrival of deqi. Moxibustion was added to the Huatuojiaji, BL23 (Shenshu), and BL40 (Weizhong) acupoints. Medicinal moxa pieces of approximately 2 cm were attached to the needle handles and ignited. Thick paper heat shields were placed over the skin for protection. The following herbal formula was decocted for all patients (Wenshen Juanbi Tang):

Sheng Di Huang, 10 g
Wu Gong, 5 g
Lu Rong 5 g
Jiang Can, 10 g
Dang Gui, 10 g
Fu Ling , 10 g
Fu Zi, 15 g
Bai Zhu, 20 g
Qing Feng Teng, 10 g
Mu Gua, 15 g
Xi Xin, 10 g
Niu Xi, 10 g
Gui Zhi, 10 g
Yin Yang Huo, 10 g
Xian Mao, 10 g
Yi Yi Ren, 15 g
Sang Ji Sheng, 20 g
Lu Xian Cao, 10 g
The herbs Tao Ren and Hong Hua were added for patients diagnosed with blood stasis. Note: this herbal formula is only appropriately administered by licensed acupuncturists and is contraindicated for pregnant women. The combined therapy of acupuncture and herbs achieved a 69.2% total effective rate.

Huang et al. achieved superior positive patient outcome rates in their investigation. People’s Hospital of Han Nan District researchers (Huang et al.) achieved a 90% total effective rate for the treatment of lumbar disc herniations with acupuncture plus moxibustion. Acupuncture as a standalone therapy produced an 85% total effective rate. A significant reduction or elimination of lower back pain and radiculopathy was achieved plus motor functional improvements were confirmed with diagnostics. The primary acupuncture points employed in the investigation were the following:

Huatuojiaji (lower back region)
Shenshu (BL23)
Mingmen (DU4)
Yaoyangguan (DU3)
Huantiao (GB30)
Rotating and thrusting were applied for 2–3 minutes to Shenshu (BL23), Mingmen (DU4), and Yaoyangguan (DU3) to elicit the arrival of deqi. Stimulation of Huatuojiaji acupoints was maintained until the arrival of deqi. For L4–L5 disc herniations, Yanglingquan (GB34) was added. For L5–S1 disc herniations, Weizhong (BL40) was added. Moxa was added to the needles of Shenshu (BL23), Mingmen (DU4), and Yaoyangguan (DU3) with 2 cm moxa pieces. Treatment was administered once per day for 6 days followed by a 1 day break from treatment. Next, an additional six days of acupuncture plus moxibustion was applied. A 90% total effective rate was achieved using acupuncture plus moxibustion. An 85% total effective rate was achieved using acupuncture as a standalone procedure.

References:
Li M & Wang B. (2011). Warm acupuncture combined with TCM in treating 70 patients with Cold-dampness type of chronic pelvic inflammation. Journal of Beijing University of Traditional Chinese Medicine. 30(1): 45-47.

Sun YQ, Wang FG & Xu Q. (2008). Bilateral approach of percutaneous laser disk decompression (PLDD) in treating lumbar disc herniation. 17(3): 173-174.

Wang T, Ma XL, Zheng YF et al. (2007). The application of lumbar vertebral posterior decompression in treating 120 cases of lumbar disc herniation. Chinese Journal of Surgery of Integrated Traditional And Western Medicine. 13(5): 482-483.

Huang JH. (2015). Observations on the Efficacy of Warm Acupuncture in Treating 60 Patients With Lumbar Disc Herniation. China Health Standard Management. 6(3).

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Treatment of Acute Phases of COPD

26
Jun
2019

慢性阻塞肺病急性发作期的辨治要点
作者：周仲瑛
译者：何安杰 (美国谦益翻译公司）

The Treatment of Acute Phases of Chronic Obstructive Pulmonary Disorder

Author: ZHŌU Zhòngyīng
Translated by J. Heaverlo & XU Zhi-jun

慢性阻塞性肺疾病 (COPD, 简称慢阻肺)是具有气流阻塞特征的慢性支气管炎和(或)肺气肿。气流阻塞进行性发展，但部分有可逆性， 可伴有气道高反应性。慢性支气管炎，某些支气管哮喘患者， 在疾病进程中发展为不可逆性气流阻塞， 当支气管哮喘与慢性支气管炎和(或)肺 气肿重叠存在或难以鉴别时，也列入慢性阻塞性肺疾病范围。在慢性阻塞性肺疾病发展过程中，根据病情可分为急性加重期和稳定期。急性加重期，患者在短期内咳 嗽，喘息加重，痰呈脓性或黏液脓性，量明显增加，可伴发热等炎性表现。稳定期，患者咳嗽，咳痰，气短等症状稳定或症状轻微。

Chronic Obstructive Pulmonary Disorder (C.O.P.D) is a condition that is characterized by an obstruction of the pulmonary airflow. It is commonly seen with chronic bronchitis or emphysema. Obstruction of the airflow is typically a progressive development, however some cases may be reversible. It is possible that an obstruction may accompanied by a hyperreactive airway. Chronic bronchitis and some bronchial asthma patients, during the course of their illness, will develop irreversible pulmonary obstruction. With bronchial asthma and chronic bronchitis patients, there may be some overlapping occurrences of emphysema, as well as the development of Chronic Obstructive Pulmonary Disorder. This makes for difficulty in differentiating the separate diseases. During the development process of COPD, it is possible to divide each case into one of three stages: acute stage, mid-term stage, and a stable stage. In the acute and mid-term stage, the patient within a short period of time will develop coughing, panting, and gasping for breath that becomes increasingly severe. There will be phlegm and pus, or sticky mucus with pus. Symptoms will become increasingly obvious and possibly accompanied by fever and other inflammatory conditions. During the stable stage, the patient will experience coughing, coughing with phlegm, and shortness of breath. Symptoms will not increase in severity and will be relatively light in nature.

中医学把慢阻肺归于慢性咳嗽，喘证，肺胀等疾病。外邪侵袭，饮食不当，情志刺激，体虚劳卷等都可以导致慢性阻塞性肺疾病。急性期以实证邪盛为主，如风寒犯 肺，谈热，痰湿等蕴肺，缓解期以肺脾肾虚为主，兼有痰浊与瘀血阻肺。发作期治疗，主要集中在清热化痰，清热活血，化痰祛瘀，通腑泄热等方面，也有并用益气 活血，补肾健脾，温阳扶正者。对于缓解期治疗，基本以补肺，健脾，益肾为主，兼以祛邪。总之，通过临床观察证候规律大致为发作期多伴有热象，治以清热化痰 活血；迁延期多以痰，瘀，虚为主，治从化痰活血，兼加补益，或益气，或益气养阴，或助阳；缓解期以虚为主，兼有痰瘀，治疗在益肺健脾补肾基础上化痰，活 血。

Chinese Medicine categorizes COPD as chronic cough, panting, and lung distention. In addition, external evil attack, improper diet, irritability, weak constitution, and fatigue can all lead to the development of COPD. An acute-stage of COPD is governed by replete exuberant evils. Such as, wind-cold invading the lungs, phlegm-heat, and phlegm-damp collecting in the lungs.

During the non-acute stages, , the organs governed by vacuity are lungs, spleen, and kidney. Simultaneously, there will be phlegm turbidity and blood stasis obstructing the lungs. In an acute stage, the chief concentration of the treatment should be to clear heat and transform phlegm, clear heat and quicken the blood, transform phlegm and expel stasis, open the fǔ organs and drain heat. In addition, boost the qì and quicken the blood, supplement the kidneys, strengthen the spleen, warm the yáng, and support the upright qì.
During a stable-stage, the treatment principles are to supplement the lungs, strengthen the spleen, and boost the kidneys while simultaneously expelling evil.

Furthermore, during an acute-stage, after completing an examination to determine the patterns for treatment, it is possible to find various overlapping signs of heat. The treatment method is to clear heat, transform phlegm, and quicken the blood. Periods of long delays between symptoms are governed by phlegm, stasis, and vacuity. Therefore, the treatment principles are to transform phlegm, quicken the blood, while simultaneously supplementing and boosting, or boosting the qì, or boosting the qì and nourishing the yīn, or assisting the yáng.

The stable-stage is governed by vacuity. Additionally, there will be phlegm and stasis. The treatment principles are to boost the lungs, strengthen the spleen, and supplement kidneys while employing a foundational treatment to transform phlegm and quicken the blood.

周民认为，慢性阻塞性肺病的临床表现主要为咳嗽，咳痰，气喘，属于中医学肺胀，痰饮，咳喘等病症范畴。主病之脏在肺，可累及脾，肾和心，病理性质多属标实本虚，寒热错杂，病机特点为肺虚痰瘀。 由于本病多为发作与缓解交替，发作期偏于标实，多属感受外邪诱发；缓解期偏 于本虚，多属脏气不足。本着急则治标，缓则治本的原则，应矛分别处理。慢性阻塞性肺病急性发作期以邪实为主，治疗重在缓解标急，外解表邪，内祛痰瘀，且应杂合。

ZHŌU Zhòngyīng believes the chief clinical manifestations of chronic obstructive pulmonary disorder are coughing, coughing with phlegm, and asthma. He believes it belongs in the Chinese medicine disease category of lung distention, phlegm-rheum, coughing and panting. The primary organs involved in this disorder are the lungs, exhaustion reaching the spleen, the kidneys, and the heart. The main pathological nature is; repletion in the branch, vacuity at the root, cold and heat combined, lung qì vacuity with phlegm, and stasis.

With COPD there will be an alternating between acute stages and periods of symptom relief. During the acute-stage the branch becomes replete, mostly due to externally contracted evils. During stable periods where there is relief from symptoms, there is a tendency towards the root being vacuous, which is largely categorized as organ insufficiency. In the acute-stage treat the branch. In the stable-stage treat the root. There should be a clear distinction between the two methods of treatment. Acute stages of COPD are governed by replete evils. The chief objective of the treatment is to settle the acute branch by releasing the exterior and resolving external evils, while simultaneously expelling phlegm and stasis internally.

1。祛邪
久病咳喘，肺虚卫外不固，外邪每易反复侵袭，诱使急性发作。对外邪的班证，既应区别其寒热属性，分风寒，风热治疗，更要重视其内外合邪，同气相召，互为关联影响。如寒痰(饮)蕴 肺者易为风寒所乘，表现外寒内饮证，治当解表散寒，温肺化饮，方如小青龙汤；痰热郁肺者，易为风热所伤，治当解表清理，清肺化痰，方如越脾加半夏汤，麻杏 石甘汤；若外寒束表，肺热内郁，客寒包火，又当加重辛散解表药的药味和用量，如小青龙加石膏汤；若寒邪入里化痰，则当清肺化痰，入桑白皮汤。必须注意外邪 的病理性质，每与内在宿邪及体质有关， 阳虚寒痰蕴肺者，外邪易从寒化而表现为内外皆寒，甚至因机体外邪的反应能力低下，虽为感受邪热，仍可见邪从寒化者；阴虚痰热郁肺者，外邪又易从热化，表现 为表里皆热。基于反复感邪的病理根由是正虚，或耗气，或伤阴，若气虚可配党参，黄芪，太子参，阴虚可配沙参，麦冬，知母。治疗时要做到祛邪不忘扶正，但又 忌恋邪。

  1. Expel Evil
    In chronic diseases of coughing and panting the lungs will become vacuous allowing for the defensive qì and exterior to become insecure. This insecurity will make it possible for wind evil to easily attack, thereby causing an acute episode. When diagnosing the nature of the exterior evil pattern, one should clearly differentiate between either a hot condition or a cold condition. Thereby, separating the treatment into either wind-cold or wind-heat. Equally important, one must carefully inspect to determine whether the internal and external evils have mutually combined or if they are conjointly influencing one another.

For example, cold phlegm collecting in the lungs is easy to be taken advantage by cold evil. It will manifest as a pattern of exterior cold with internal phlegm. The treatment principles are to release the exterior and disperse cold, warm the lungs and transform rheum. The exemplar formula is xiǎo qīng lóng tāng.

In cases of phlegm heat depressing the lungs it is easy for wind and heat to cause damage. The treatment principles are to release the exterior and clear interior, clear the lungs and transform phlegm. The exemplar formula is yuè pí jiā bàn xià tāng, and má xìng shí gān tāng.

With the diagnosis of external cold evil binding the exterior, lung heat internal depression, and guest cold binding heat, use acrid, dispersing, exterior resolving medicinals. The exemplar formula is xiǎo qīng lóng tāng jiā shí gān tāng.

With cold evil entering the interior and transforming heat the treatment methods are to clear the lungs and transform phlegm. The exemplar formula is sāng bái pí tāng.

It is very important to pay close attention to the pathological nature of the exterior evil. Each external evil has a particular relationship with evils currently lodged within the interior of the body. In yáng vacuity with cold phlegm collecting in the lungs, an external cold evil readily transforms in to an interior-exterior cold pattern. Even though the body’s ability to react is lowered and it has contracted an exterior heat evil, it is still possible to see the evil transforming from cold; In yīn vacuity with phlegm heat depressing the lungs, an externally contracted evil easily transforms into heat. It will manifest as both internal and external heat. When there is repeated contraction of external evils it will lead to a vacuity of the upright qì or will eventually damage the yīn. If there is qì vacuity use dǎng shēn, huáng qí, and tài zǐ shēn. If there is yīn vacuity use shā shēn, mài dōng, zhī mǔ. When treating, one should not only expel evil without forgetting to support the upright qì but also separate from evil.

麻黄辛温解表散寒，宣肺止咳平喘，故为久病咳喘，感邪诱发之首先药，历来用治咳喘的麻黄类方甚多，且可根据辩证配药，较广泛地应用多种证候。如麻黄配石膏 辛凉宣泄，外解在表之风寒，内清肺经之郁热，适用于表寒里热证；配黄芩清宣肺热，适用于痰热郁肺，肺失宣降之证；配葶苈子泻肺祛饮，宣泄肺气，适用痰饮壅 肺，肺气上逆之证； 配大黄宣上导下，适用于肺胃热盛，痰饮壅肺，肺气不通之证；配五味子，散敛相合，适用肺虚气逆，寒饮内停，肺失宣降之证；配熟地滋肾平喘，适用于肺实痰 壅，肾阴亏耗，肺气上逆，肾虚不纳之证；配黄芪一散一固，宣肺平喘，益气固表，适用于寒痰阻肺，气虚卫弱之证。

Má huáng is acrid and warm. It releases the exterior and disperses cold, diffuses the lungs, stops coughing, and arrests wheezing. Therefore, it is appropriate to select this herb in chronic diseases of cough and panting or externally contracted evils. According to the individual diagnosis, má huáng may also be paired with other herbs and has a relatively wide range of suggested usage for many types of patterns. For example, má huáng may be paired with shí gāo. Where one herb is acrid, the other is cold. Where one herb diffuses, the other drains. Together, they release the exterior and expel wind-cold, while at the same time internally clear depressed heat in the lung channel. It is suitable to use in cases of exterior cold with internal heat. When combined with huáng qín, the pairs herbs are capable of diffusing lung heat and can be used with patterns of phlegm heat depressing the lungs, or lungs failing to diffuse and down-bear. The combination of má huáng and tíng lì zi can drain lungs and expel phlegm-rheum, as well as diffuse and descend lung qi. This combination of herbs is suitable for use with phlegm-rheum obstructing the lungs or lung qi counter-flowing upwards. When combined with dà huáng, the combination can diffuse the upper and simultaneously guide downward. It is appropriate to use with lung and stomach heat exuberance, phlegm-rheum obstruction and binding, and blocked organ qì. Má huáng with wǔ wèi zi, where one herb disperses, the other astringes. It is suitable to use with lung qì vacuity with qì counter-flow, cold rheum internally collecting, and lungs failing to diffuse and descend. Má huáng with shú dì enriches the kidneys and calms panting. It is suitable in cases of lung repletion with phlegm stagnation, kidney yīn depleted and consumed, lung qì counter-flow, and kidney vacuity not receiving. Má huáng paired with huáng qí, where one herb disperses and the other herb secures. Together they can diffuse the lungs and calm panting, boost the qì and secure the exterior. This combination is appropriate for cold phlegm obstructing the lungs, and qì vacuity with weakened defensive qì

另一方面，特别要注意掌握麻黄治喘的禁忌证，如额头汗出清冷，心悸喘促，气短息弱，有喘脱征象者；痰少而黏，不易咯出，咽干，手足心热，舌红苔少或光剥，脉细数等肺肾阴液亏竭者；平素肝阳上亢，头痛眩晕者，均不宣用。

In addition, it is especially important to have a firm understanding of the contra-indications for má huáng in regards to its application of treating cough patterns. For example, it is contra-indicated when there is sweating of the forehead with chills, heart palpitations, rapid panting, shortness of breath with weak inhalations,panting leading to desertion, small amounts of phlegm or sticky phlegm that is difficult to expectorate, dry throat, five palm heat, a red tongue with little coating or peeled; a rapid, thin pulse, or lung and kidney yīn fluid depletion and exhaustion. Commonly, these patients will also have liver yáng overbearing with headaches and dizziness. The use of má huáng is contra-indicated for use with all the above conditions.

2。涤痰
感受外邪诱致本病急性发作时，每因外邪引触肺中伏痰而致痰浊壅阻气道，肺气不 利，痰涌气闭，导致窒息危候，此时痰黏稠浊腻，难化难消，已属顽痰，老痰一类，故涤痰利肺最为当务之急。如能及时祛除气道的胶痰，通过吐利荡涤排出，则窒 息之势自可逆转，方如六安煎，三子养亲汤，葶苈泻肺汤，药如半夏，白芥子，桔梗，莱菔子，葶苈子，海浮石，礞石，泽漆，皂荚等，并伍沉香，苏子，陈皮，厚 朴顺气导痰。寒痰可加干姜，细辛，热痰加知母，黄芩，竹沥，肺热腑实加大黄，风化硝。

2。 Flush Phlegm
When the contraction of an external evil occurs it is possible for it to cause an acute episode of COPD. No matter which external evil it is, it can lead to the lungs being overcome by phlegm or phlegm turbidity obstructing the air passages, which in turn causes the lung qì to become inhibited. The phlegm bubbles upward to obstruct the air circulation leading to choking sensations and other critical signs. At this time the phlegm will be sticky, thick, turbid, greasy, difficult to transform, and difficult to eliminate. This type of phlegm belongs to the category of “stubborn” phlegm. Phlegm that has been retained for a long period of time is another example. Therefore, the treatment must flush the phlegm and disinhibit the lungs. It is important to promptly expel and eliminate the glue-like phlegm from the airways by means of vomiting or disinhibiting. It is likely, once the phlegm has been expelled and cleaned up, that the sensation of choking will naturally resolve. The exemplar formula is liù ān jiān, sān zi yǎng qīn tāng, tíng lì xiè fèi tāng, with medicinals such as bàn xià, bái jiè zǐ, jié gěng, lái fú zi, tíng lì zi, hǎi fú shí, méng shí, zé qī, zào jiá, together with chén xiāng, sū zi, chén pí, hòu po to assist in smoothing the qì to help guide out the phlegm. In the case of cold phlegm add gān jiāng and xì xīn. In the case of hot phlegm add zhī mǔ, huáng qín, and zhú lì. When there is lung heat organ repletion add dà huáng or fēng huà xiā.

猪牙皂与皂荚同功而祛痰开闭尤佳，历来用于痰喘气闭，顽痰壅塞气道，黏稠难咯，胸满，气逆，闷塞绝之急症。虽属劫夺之品，劫有开上导下，利肺通腑之神功，周民用于咳喘壅气闭之实证，屡获奇效。每次用量2－3g，可入煎剂，或配入丸散中。入属痰热闭肺，喘促气粗，胸满胁胀，痰涎壅盛，甚则动风痉厥者，可用猴枣散（药物组成：猴枣，羚羊角，天竺黄，川贝，礞石，沉香，麝香，硼砂），清热豁痰，息风开窍。用法：每次服0。3－0。6g, 每日2次。验之临床，中药祛痰药颇具尤势，其疗效机理多端，轻者可化，可豁，进而可祛，可涤，甚者予以吐利攻逐。若能辩证选药，根据治痰药的性味，功用特点组方配药，合理使用，更能提高疗效。

Other herbs that are particularly effective in expelling phlegm and opening obstruction are zhū yá zào and zào jiá. Historically these herbs are used with cases of; phlegm panting and qì obstruction, stubborn phlegm obstructing the airways, sticky, dense and difficult to expectorate phlegm, chest fullness, qì reversal, plus oppression and congestion that is inconsolable. Even though these herbs belong to the category of “expelling” nevertheless they can miraculously open the upper and guide downward, disinhibit the lungs and open the zàng organs. ZHŌU Zhòngyīng is able to repeatedly receive wonderful results when administering these herbs for repletion patterns such as coughing and panting, phlegm obstruction, and qì blockage. With phlegm heat obstructing the lungs with hasty panting, rough breathing, chest fullness, rib-side distention, phlegm-drool encumberance and congestion leading to stirring wind and tetanic reversal use hóu zǎo sàn (hóu zǎo, líng yáng jiǎo, tiān zhú huáng, chuān bèi, méng shí, chén xiāng, shè xiāng, péng shā) to clear heat, sweep phlegm, extinguish wind and open the orifices. Directions: each dose administer 0.3g-0.6g, twice per day.

Through clinical examinations, Chinese herbal medicines have displayed outstanding potential for expelling phlegm. The mechanisms by which its curative effects are attained are multi-fold. They can gently gently transform phlegm, clear phlegm, even penetrate deeper to expel lodged phlegm. Chinese herbal medicines are commonly used to expel phlegm and re-open air passages. When selecting herbs according to the identified patterns, selections will be based on the herb’s nature, flavor and special characteristics. When used appropriately,they can increase the efficacy of treatment.

3。化痰
久病咳喘，痰浊潴留，肺气不利，治节失司，心血营运不畅，而致肺病及心，瘀血阻碍肺气，瘀滞心脉，表现久病入络，痰瘀互结同病的病理变化。不仅要痰瘀同治，且应重在治瘀。
若痰饮壅阻肺气，喘而气逆痰涌，胸部憋闷，胁肋胀痛，面黯，唇甲青紫，舌苔浊，质紫，脉细滑者，当化痰祛瘀，选用杏苏二陈汤合加味旋覆花汤，药如苏子，白芥子，葶苈子，法半夏，杏仁，桃仁，当归，旋覆花，茜草根，降香等。
如痰瘀壅肺，肺失吸清呼浊之职，浊邪害清，上蒙神机，以致神志淡漠，恍惚，烦 躁，昏昧，面黯，唇紫，喘促气逆，痰黏难咯，舌苔浊腻，质紫，脉细滑数，治当涤痰泄浊，化瘀开窍，选用涤痰汤合通窍活血汤，药如半夏，南星，天竺黄，炙远 志，陈皮，茯苓，菖蒲，郁金，丹参，赤芍，川芎，桃仁，红花，麝香等。

  1. Transform Phlegm
    In chronic illnesses of coughing and panting phlegm turbidity pools and lodges, therefore causing the lung qì to become inhibited and lose its management and regulation. Cardiovascular transportation will become impeded as the lung disease reaches the heart. Static blood will in turn obstruct the lung, as well as stagnate the heart channel. Chronic disease manifests in the luò channels. Phlegm and blood stasis will eventually combine and transform into one disease. In this situation it is not sufficient to merely treat the phlegm stagnation but it is equally necessary to treat blood stasis.
    If phlegm-rheum obstructs the lung qì there will be panting, qì counterflow with phlegm regurgitation, chest oppression and stifling, rib-side distention and pain, and a dark complexion. The lips and nails will be greenish purple. The tongue coating will show turbidity and the tongue body will be purple in color. The pulse will be thin and slippery. The treatment principle is to transform phlegm and expel stasis. The exemplar formula is xìng sū èr chén tāng with xuán fù huā tāng, with such medicinals as sū zi, bái jiè zǐ, tíng lì zi, fǎ bàn xià, xìng rén, táo rén, dāngg uī, xuán fù huā, qiàn cǎo gēn, jiàng xiāng.

如痰瘀壅阻气机，脉络不通，气化失宣，津液失于输化，则可导致血瘀水停，身肿 足浮，腹满，喘急咳逆，心慌动悸，颈脉动甚，面唇，爪甲，舌质暗紫，脉来三五不调，表现肺心同病之候，治疗当重在瘀利水，药用苏木，泽兰，路路通，当归， 丹参，桃仁，茯苓，泽泻，汉防己，泽漆，万年青根，蟾皮，茶树根等。苏木咸能入血，辛能走络，功能活血祛痰消肿。参苏饮，取人参，苏木二味，一补肺气，一 降瘀血。周民常用苏木以治肺心喘满，咳逆胸胀，面浮色紫之症。泽漆辛苦而凉，功能行水消肿，祛痰散结，主药，用治喘咳痰多，身肿。周民曾用治肺心病房颤， 喘咳面浮，手臂肿胀之患者。而苏木与泽漆合用，祛痰散结以行水，相得益彰。

If there is phlegm-stasis obstructing the qì dynamic, the vessels and network channels will become blocked causing the qì transformation to lose its ability to diffuse. Hence, there will be a loss of fluids and fluid transformation, which, in turn can lead to blood stasis with water collecting. The entire body will be swollen and the feet will have floating edema. There will be abdominal fullness, rapid panting, cough with counterflow, flustered emotions, palpitations and stirring of the neck vessels. The face, lips, fingernails, and tongue body will all be dark purple. The pulse will be irregular. In addition, there will be clinical manifestations of a lung and heart combined illness. It is important for the treatment to transform phlegm and disinhibit water. Use medicinals such as sū mù, zé lán, lù lù tōng, dāng guī, dān shēn, táo rén, fú líng, zé xiè, hàn fáng jǐ, zé qī, wàn nián qīng gēn, chán pí, chá shù gēn.

Sū mù is salty and therefore capable of entering the blood. Its acrid nature allows it to reach the luò vessels. Its functions include quickening the blood, expelling stasis, and dispersing swelling. The formula shēn sū yǐn combines rén shēn and sū mù. One herb boosts the lung qì while the other descends bloods stasis. ZHŌU Zhòngyīng often uses sū mù to treat lung and heart patterns characterized with panting and fullness, cough with counterflow, chest distention,and a facial complexion that is transient purple.

Zé qī is acrid, bitter, and cool. Its functions are to move water and disperse swelling, expel phlegm, and disperse binding. It is mainly used to treat water swelling with lower abdominal fullness, phlegm-rheum, panting and coughing, plus scrofula patterns. Zé qī tāng utilizes zé qī as the chief ingredient to treat panting and coughing with copious amounts of phlegm and swelling of the entire body. ZHŌU Zhòngyīng uses this formulation to treat lung and heart illnesses characterized by atrial fibrillation, panting and coughing, facial edema with hand and arm swelling, plus distention. Furthermore, su mu and ze qi can be combined together to expel phlegm, disperse binding and move water. As a pair herb combination they achieve a synergistic effect to maximize efficacy.

［周仲瑛。慢性阻塞肺病急性发作期的辨治要点。江苏中医药2006；27（7）：5］

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