沧源县佤族医治胃病验方录

我们参加“云南及周边地区农业生物资源调查”项目，2007年至现在多次深入云南省沧源县进行调查，胃病在沧源县是常见病、多发病、疑难杂症、当地西医难治，佤族草医就用当地植物来防治，疗效较好。现介绍如下。

魏喜保教授辨治胃病经验撷菁

魏喜保教授治疗胃病主要通过调和气机、升清降浊的途径 ,促使脏腑升降气化功能恢复平衡。治法有进食胃痛 ,直辨虚实 ;胃出血者 ,虚实挟杂 ;胃出血后 ,法宗容川。

根据“心胃相关”理论从心论治脾胃病

通过心胃在位置、经脉、功能等生理、病理方面的影响与联系,阐述心胃相关理论。结合名师从心论治脾胃病的临床经验,即从泻心、养心、宁心、化瘀等方面论治脾胃病,进而探讨心与脾胃病的内在关系,探索从心论治脾胃病的理、法、方、药,为临床从心论治脾胃病提供理论基础及思路。

脾胃病证治浅谈

脾胃病变临床多见，究其原因，不外“升与降”，“纳与化”，“燥与湿”之转化与否的结果而已。其临床表现的“证”，所概括为虚、实、寒、热。因此，治疗法则以补治其虚，攻治其实，、清治其热，温之其寒。笔者在学习和临床实践的基础上，对脾胃病的常用治疗方法进行了归纳分析，兹介绍于下：

舌苔在胃病辨治中的临床意义

祖国医学认为,舌苔禀脾胃之气而生,脾主运化,胃为水谷之海,胃在五行属土,舌苔之与胃,辟若草之与土地;舌苔之与胃气,辟若草之与阳光;舌苔之与胃阴,辟若草之与水分;而舌苔之与浊气,则辟若草之与肥料.胃主受纳,腐熟水谷,人体赖以生存的后天营养物质皆由此而化生,故中医学历来非常重视胃的生理功能,称其为"水谷气血之海"、"后天之本"[1].

杨进教授从肝为五脏之贼谈胃病证治

该文旨在整理归纳名老中医杨进教授临证医案,继承杨师治学思想,总结杨进教授从肝为五脏之贼谈胃病证治的理论依据、论治思路及谴方用药物特色,以启迪后学。杨师深知肝为五脏之贼对胃病证治的重要影响,治疗除采用疏肝、养肝、平肝之外,时常注重情志疏理,让患者移情易性,加之辅助心理疏导,消除病人思想负担,治疗每每多获良效。

土家医赶火败毒调理法治胃痛探讨

土家医传统医认为胃痛与饮食、伤食、食积、胃气虚弱、肝郁气带、火郁毒气、瘀血阻络有关;故治疗以“赶火、败毒、调理”六字方针,中医为清热解毒,西医认为螺旋杆菌侵袭干忧,治疗以抗菌消炎、止痛;或疏肝理气,健脾和中,活血化瘀,合理膳食,气味合参,调理脾胃功能。

《临证指南医案》呕吐辨治特色

为探讨《临证指南医案》中叶天士对呕吐病的认识、治疗、用药等方面的特色,并为临床辨治呕吐提供新的思路和方法,本文采用文献研究法,通过研读《临证指南医案》呕吐篇,并结合《临证指南医案》其它篇章中叶天士的相关论述和当代医家的论述,总结了叶天士辨治呕吐的特色。叶氏认为肝木在呕吐的发病中有重要作用,并提出冲脉致吐的观点,临床治疗上,善辨虚实,重视阳气,治疗方法包括暖肝通厥法、苦降辛通法、清上焦以解中焦法、平冲止吐法、通理胃阳法、开泄浊闭法、养阴熄风止吐法,遣方经时兼蓄,用药灵活擅加减,同时亦重视日常调护。

Clinical Study of Photodynamic Therapy for Upper Gastrointestinal Tract Cancers

Objective： To evaluate the clinical effectiveness and adverse effects of photodynamic therapy （PDT） for the upper gastrointestinal tract cancers. Methods： 56 patients with upper gastrointestinal cancers in different clinical stages were treated with PDT. Diode laser （630 nm） was used as the light source and the parameters were as follows： power density 200 to 400 mW/cm, energy density 100 to 300 J/cm. PHOTOFRIN was used as photosensitizer, which was given in a dose of 2 mg/kg intravenously 12-24 h before irradiation. Results： Evaluation of the 56 patients＇ therapeutic effectiveness showed that 6 patients （10.7%） had a complete response （CR）, 33 patients （58.9%） partial response （PR）, 12 patients （21.4%） mild response （MR）, and 5 patients （8.9%） no response （NR）. The total response rate （CR＋PR） was 69.6%. No patients had severe adverse effects in this group. Conclusion： PDT is an effective and safe palliative modality for upper gastrointestinal tract cancers.

Role of radiation therapy in gastric adenocarcinoma

Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.

New methods for the management of gastric varices

Bleeding from gastric varices has been successfully treated by endoscopic modalities. Once the bleeding from the gastric varices is stabilized, endoscopic treatment and/or interventional radiology should be performed to eradicate varices completely. Partial splenic artery embolization is a supplemental treatment to prolong the obliteration of the veins feeding and/or draining the varices. The overall incidence of bleeding from gastric varices is lower than that from esophageal varices. No studies to date have defi nitively characterized the causal factors behind bleeding from gastric varices. The initial episodes of bleeding from esophageal varices or gastric varices without prior treatment may be at least partly triggered by a violation of the mucosal barrier overlying varices. This is especially likely in the case of varices of the fundus. In view of the high rate of hemostasis achieved among bleeding gastric varices, treatment should be administered in selective cases. Among untreated cases, steps to prevent gastric mucosal injury confer very important protection against gastric variceal bleeding.

Chemotherapy as a component of multimodal therapy for gastric carcinoma

Prognosis of locally advanced gastric cancer remains poor, and several multimodality strategies involving surgery, chemotherapy, and radiation have been tested in clinical trials. Phase Ⅲ trial testing the benefit of postoperative adjuvant chemotherapy over treatment with surgery alone have revealed little impact on survival, with the exception of some small trials in Western nations. A large trial from the United States exploring postoperative chemoradiation was the first major success in this category. Results from Japanese trials suggest that moderate chemotherapy with oral fluoropyrimidines may be effective against less-advanced （T2-stage） cancer, although another confirmative trial is needed to prove this point. Investigators have recently turned to neoadjuvant chemotherapy, and some promising results have been reported from phase Ⅱ trials using active drug combinations. In 2005, a large phase Ⅲ trial testing preand postoperative chemotherapy has proven its survival benefit for resectable gastric cancer. Since the rate of pathologic complete response is considered to affect treatment results of this strategy, neoadjuvant chemoradiation that further increases the incidence of pathologic complete response could be a breakthrough, and phase Ⅲ studies testing this strategy may be warranted in the near future.

Gastric leptomeningeal carcinomatosis: Multi-center retrospective analysis of 54 cases

AIM： To identify the clinical features and outcomes of infrequently reported leptomeningeal carcinomatosis （LMC） of gastric cancer.METHODS： We analyzed 54 cases of cytologically confirmed gastric LMC at four institutions from 1994 to 2007.RESULTS： The male-to-female ratio was 32：22, and the patients ranged in age from 28 to 78 years （median,48.5 years）. The majority of patients had advanced disease at initial diagnosis of gastric cancer. The clini-cal or pathologic tumor, node and metastasis stage ofthe primary gastric cancer wasin 38 patients （70%）.The median interval from diagnosis of the primarymalignancy to the diagnosis of LMC was 6.3 mo, rang-ing between 0 and 73.1 mo. Of the initial endoscopic f indings for the 45 available patients, 23 （51%） of the patients were Bormann typeand 15 （33%） patientswere Bormann type. Pathologically, 94% of cases proved to be poorly differentiated adenocarcinomas. Signet ring cell component was also observed in 40% of patients. Headache （85%） and nausea/vomiting （58%） were the most common presenting symptoms of LMC. A gadolinium-enhanced magnetic resonance imaging was conducted in 51 patients. Leptomeningeal enhancement was noted in 45 cases （82%）. Intrathecal （IT） chemotherapy was administered to 36 patients-primarily methotrexate alone （61%）, but also in combi-nation with hydrocortisone/± Ara-C （39%）. The median number of IT treatments was 7 （range, 1-18）. Concomitant radiotherapy was administered to 18 patients, and concomitant chemotherapy to seven patients. Sev-enteen patients （46%） achieved cytological negative conversion. Median overall survival duration from the diagnosis of LMC was 6.7 wk （95% CI： 4.3-9.1 wk）. In the univariate analysis of survival duration, hemoglobin, IT chemotherapy, and cytological negative conversion showed superior survival duration （P = 0.038, P = 0.010, and P = 0.002, respectively）. However, in our multivariate analysis, only cytological negative conversion was predictive of relatively longer survival duration （3.6, 6.7 and 14.6 wk, P = 0.03, RR： 0.415, 95% CI：0.188-0.918）.CONCLUSION： Although these patients had a fatal clinical course, cytologic negative conversion by IT chemotherapy may improve survival.

Updates on esophageal and gastric cancers

Esophageal and gastric cancers are both common and deadly. Patients present most often after disease progression and survival is therefore poor. Due to demographic variability and recent changes in disease incidence, much emphasis has been placed on studying risk factors for both esophageal and gastric cancers. However, with increasing understanding of these diseases, low survival rates persist and continued intensive studies are necessary to optimize treatment plans. This review article discusses updates in the evolving epidemiology, clinical presentation, risk factors, and diagnostic and treatment modalities of esophageal and gastric cancers.

Evaluation of intraoperative radiotherapy for gastric carcinoma with D2 and D3 surgical resection

AIM： TO study the proper sites and doses of intraoperative radiotherapy （IORT） for gastric carcinoma and the effects of this treatment. METHODS： A total of 106 patients with stage Ⅰ -Ⅳ gastric carcinoma who received D2 or D3 radical operation combined with IORT were analyzed. Sixty-seven patients with gastric cancer of the antrum and body underwent distal gastrectomy. The sites of irradiation were at the celiac artery and hepatoduodenal ligment area. Another 39 patients with carcinoma of the cardia and upper part of the gastric body and whole stomach underwent proximal gastrectomy or total gastrectomy. The sites of irradiation for this group were the upper margin of the pancreas and the regional para-aorta. The therapeutic effects （including survival and complications） of these 106 cases received operation combined with IORT （IORT group） were compared with 441 cases treated during the same time period by a radical operation alone （operation group）. RESULTS： The radiation dose below 30 Gy was safe. The therapeutic method of the operation combined with IORT did not prolong the survival of patients with stage Ⅰ and Ⅳ gastric cancer, but the 5-year survival rates of patients with stage Ⅱ and Ⅲ gastric cancers were significantly improved. The 5-year survival rates of the stages Ⅲ cancer patients receiving D2 resection combined with IORT were markedly improved, while for those receiving D3 radical resection, only the postoperative 3- or 4-year survival rates were improved （P 〈 0.005-0.001）. The 5-year survival rate for those patients was raised only by 4.7% （P 〉 0.05）. CONCLUSION： The 5-year survival rates of patients with stages Ⅱ and Ⅲ gastric carcinoma who received D2 lymphadenectomy combined with IORT were improved, and there was no influence on the postoperative complications and mortality.

Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding

AIM:To investigate glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding and to evaluate the long-term efficacy and safety of this therapy.METHODS:A total of 148 cirrhotic patients in our hospital with esophagogastric variceal bleeding(EGVB) were included in this study.N-butyl-2-cyanoacrylate was mixed with lipiodol in a 1:1 ratio and injected as a bolus of 1-3 mL according to variceal size.Patients underwent endoscopic follow-up the next week,fourth week,second month,fourth month,and seventh month after injection and then every 6 mo to determine the cast shape.An abdominal X-ray fi lm and ultrasound or computed tomographic scan were also carried out in order to evaluate the time of variceal disappearance and complete extrusion of the cast.The average follow-up time was 13.1 mo.RESULTS:The instantaneous hemostatic rate was 96.2%.Early re-bleeding after injection in 9 cases(6.2%) was estimated from rejection of adhesive.Late re-bleeding occurred in 12 patients(8.1%) at 2-18 mo.The glue cast was extruded into the lumen within one month in 86.1% of patients and eliminated within one year.Light erosion was seen at the injection position and mucosa edema in the second week.The glue casts were extruded in 18 patients(12.1%) after one week and in 64 patients(42.8%) after two weeks.All kinds of glue clumping shapes and colors on endoscopic examination were observed in 127 patients(86.1%) within one month,including punctiform,globular,pillar and variform.Forty one patients(27.9%) had glue extrusion after 3 mo and 28 patients(28.9%) after six months.The extrusion time was not related to the injection volume of histoacryl.Obliteration was seen in 70.2%(104 cases) endoscopically.The main complication was re-bleeding resulting from extrusion.The prognosis of the patients depended on the severity of the underlying liver disease.CONCLUSION:Endoscopic injection of cyanoacrylate is highly effective for gastric varices bleeding.The glue clump shape is correlated with anatomic structure of vessels.The time of extrusion was not related to dosage of the glue.

Loss of interstitial cells of Cajal network in severe idiopathic gastroparesis

AIM: To report a case of severe idiopathic gastroparesis in complete absence of Kit-positive gastric interstitial cells of Cajal (ICC). METHODS: Gastric tissue from a patient with severe idiopathic gastroparesis unresponsive to medical treatment and requiring surgery was analyzed by conventional histology and immunohistochemistry. RESULTS: Gastric pacemaker cells expressing Kit receptor had completely disappeared while the local level of stem cell factor, the essential ligand for its development and maintenance, was increased. No signs of cell death were observed in the pacemaker region. CONCLUSION: These results are consistent with the hypothesis that a lack of Kit expression may lead to impaired functioning of ICC. Total gastrectomy proves to be curative.

Effect of electroacupuncture at Sibai on the gastric myoelectric acitivities of denervated rats

AIM： To explore the mechanism of the exciting effects of electro-acupuncture （EA） at Sibai on the gastric myoelectric activities. METHODS： A total of 32 rats were randomly divided into four groups. Through intraperitoneal injection with atropine （the anti-cholinergic agent by blockade of muscarinic receptors）, hexarnethonium （automatic nerve ganglion-blocking agent） and reserpine （anti-adrenergic agent by depleting the adrenergic nerve terminal of its norepinephrine store）, effects of EA at Sibai on the gastric myoelectric activities of the denervated rats were observed. RESULTS： After intraperitoneal injection of atropine and hexamethonium, the average amplitude and ratio of period to time in the phase of high activity of gastric myoelectric slow wave, and the average numbers of the peaks of gastric myoelectric fast wave were significantly decreased （P 〈 0.01, P 〈 0.05, P 〈 0.01）, while after intraperitoneal injection of reserpine, the aforementioned three parameters were increased （P 〈 0.01, P 〈 0.05, P 〈 0.01）. EA at Sibai point partially relieved the inhibitory effect of atropine and hexamethonium on the gastric myoelectric activities in the rats （P 〈 0.05 or P 〉 0.05）. CONCLUSION： Cholinergic and adrenergic nervous systems and autonomic nerve ganglion participate in the peripheral passage of the controlling effects of EA at Foot Yangming Channel on gastrointestinal tract.