An Experiential Formula for Treating Chronic Atrophic Gastritis
Chronic atrophic gastritis is a precancerous lesion of gastric cancer; it is protracted and difficult to cure, its treatment is thorny, and patients often suffer from gastric distension and pain. Zhongguo Minjian Liaofa (Chinese Folk Therapy, 2004, 12(9): 45) once published an experiential formula for chronic atrophic gastritis called “Huangqi Renshen Tang” (Astragalus and Ginseng Decoction).
The composition of this formula is as follows: Huangqi (Astragalus) 15g, Shengma (Cimicifuga) 6g, Chao Dangshen (fried Codonopsis) 15g, Chenpi (tangerine peel) 6g, Maimendong (Ophiopogon) 10g, Cangzhu (Atractylodes lancea) 10g, Baizhu (Atractylodes macrocephala) 12g, Huangbai (Phellodendron) 12g, Jiao Liushenqu (charred medicated leaven) 10g, Jiu Danggui (wine-processed Angelica) 10g, Zhigancao (honey-fried Glycyrrhiza) 6g, and Wuweizi (Schisandra) 6g. One dose daily, decocted in water and taken in two divided doses. Follow up once every 1–2 weeks, with 3 months as one course of treatment.
Using this formula to treat 61 cases of chronic atrophic gastritis, the clinical results were: markedly effective in 36 cases (59.0%); effective in 21 cases (34.4%); ineffective in 4 cases (6.6%), for a total effective rate of 94.4%. The gastroscopic and pathological findings were: markedly effective in 29 cases (47.5%); effective in 20 cases (32.8%); ineffective in 12 cases (19.7%), for a total effective rate of 80.3%.
This formula is built by taking Buzhong Yiqi Tang (made of Huangqi, Baizhu, Chenpi, Shengma, Chaihu, Renshen, Gancao, and Danggui), removing Chaihu, and combining it with Shengmai San (made of Renshen, Maimendong, and Wuweizi) and Er Miao Wan (made of Cangzhu and Huangbai), then adding charred Liu Shenqu. Buzhong Yiqi Tang fortifies the spleen and boosts qi; Shengmai San boosts qi and engenders fluids, and nourishes yin and moistens dryness; Er Miao Wan is a representative formula for damp-heat; charred Liu Shenqu aids digestion. This line of composition gives comprehensive attention to the spleen deficiency, fluid depletion, and damp-heat patterns caused by atrophic gastritis, and so is well matched to the condition.
Chronic atrophic gastritis is mostly formed when the gastric mucosal epithelium is repeatedly damaged after infection with Helicobacter pylori; the patient's inherent gastric glands atrophy, with or without intestinal metaplasia. Chronic atrophic gastritis is a precancerous lesion of gastric cancer, and about 1% of patients with it may develop carcinoma. If the patient also has unhealthy dietary and living habits such as a fondness for pickled foods, staying up late, drinking, and smoking, the probability of canceration is greater.
China is one of the regions with the highest incidence of gastric cancer, which is related to the high rate of H. pylori infection caused by our culture of shared dining. H. pylori can be transmitted through shared tableware, so we should advocate a divided-meal system. In the early stage of H. pylori infection, quadruple therapy can eradicate it, but as H. pylori keeps evolving, the eradication rate of quadruple therapy is no longer as high as it once was.
Most patients with chronic atrophic gastritis have no obvious clinical symptoms; a minority have adverse symptoms such as gastric distension, stomach pain, acid reflux, and heartburn. In TCM, atrophic gastritis belongs to the diseases of “stomach distension,” “stomachache,” and “stomach reflux,” and treatment should primarily fortify the spleen. But because the stomach ailment lingers and progresses, it can lead to depletion of stomach yin and the engenderment of damp-heat, so one must also attend to nourishing yin and fostering the stomach, and to clearing heat and draining dampness.
Based on the author's experience, when using this formula, modifications may still be made according to the patient's specific condition. For depletion of stomach yin with a dry mouth and tongue, add Shihu (Dendrobium), Tiandong (Asparagus cochinchinensis), and Jiaogulan (Gynostemma) to nourish yin and moisten dryness; for acid reflux and heartburn, combine with Wu Ji San (cuttlefish bone 10g, Bletilla 6g)—cuttlefish bone suppresses acid, and Bletilla repairs the gastric mucosa; for stomach pain due to blood stasis, combine with Danshen Yin (Salvia 15g, Dalbergia 3g, Amomum 3g), and for severe pain add the patent medicine Yuanhu Zhitong Tablets; for abdominal distension and indigestion, judiciously add Chao Maiya (fried barley sprout) and Jiao Shanzha (charred hawthorn); for belching and hiccups, add Shidi (persimmon calyx), Dingxiang (clove), Xuanfuhua (Inula), Daizheshi (Hematite), and Zhuru (bamboo shavings); for marked abdominal distension, add Houpo (Magnolia), Fabanxia (processed Pinellia), and Muxiang (Aucklandia); for H. pylori positivity, judiciously add Pugongying (dandelion), Baihua Shebingshecao (Oldenlandia), and Huanglian (Coptis).