Epigastric pain syndrome: What can traditional Chinese medicine do? A randomized controlled trial of Biling Weitong Granules

BACKGROUND Recent research suggests that although prokinetic agents,acid suppressors,and radical treatment for Helicobacter pylori infection may be effective in patients with functional dyspepsia(FD),a large proportion of patients still fail to respond to these treatments or may suffer from severe adverse reactions.Many traditional Chinese medicinal herbs can regulate the status of the entire body and have special advantages in the treatment of functional diseases.The present study was designed to verify the efficacy of Biling Weitong Granules(BLWTG),a traditional Chinese medicinal herbal compound formula,in alleviating epigastric pain syndrome(EPS)in FD patients,in an attempt to provide an effective prescription for the clinical treatment of this disease.AIM To evaluate the clinical efficacy and safety of BLWTG in treating EPS in patients with FD.METHODS In this multicenter,stratified,randomized,double-blind,placebo-controlled,parallel group clinical trial,eligible patients were randomized into the BLWTG and placebo groups who were treated for 6 wk.Efficacy indicators including the severity and frequency of EPS and the time to pain resolution and safety indicators including adverse events were observed and compared.RESULTS The baseline demographic data and clinical characteristics,such as epigastric pain symptoms,pain intensity,and frequency of attacks,were matched between the two groups before randomization.After 6 wk of treatment and after the center effect was eliminated,the epigastric pain was significantly improved in 28.33%and 85.59%of the patients in the placebo and BLWTG groups,respectively(P<0.05).At 6 wk,the resolution rate of epigastric pain was 15%and 69.49%in the placebo and BLWTG groups,respectively(P<0.05).The differences of total FD clinical score between these two groups were significant(P<0.05)at 2,4,and 6 wk(P<0.05).The scores of each item and the total score in the Functional Digestive Disorders Quality of Life Questionnaire showed significant differences between the two groups at 6 wk after both the center and interaction effects were eliminated(P<0.05).There was no significant difference in the incidence of adverse events between the two groups,and no serious adverse event was noted during the observation.CONCLUSION Compared with placebo,BLWTG markedly improved EPS in FD patients without causing serious adverse reactions.

TREATMENT OF EPIGASTRIC PAIN WITH SUBCUTANEOUS NEEDLING

Subcutaneous needling is a new therapeutic method which is based on the features of the meridian-collateral theory of cutaneous regions in traditional Chinese medicine and the neurohumeral theory and skin anatomy of modern medicine and is of the features of “fixed meridian but not fixed acupoints”, “micro stimulation”, and “subcutaneous needling with filiform needles” to achieve the goal of treating diseases. This method is indicated clinically to the analgesia and relaxation of spasm especially the pain caused by the disorders of the internal organs and marked therapeutic effect has been obtained. With method, 150 cases of epigastric pain were treated by our department and the total effective rate was over 90%. It is presented herein below.

Pregnant-Postpartum Women with Severe Epigastric Pain and HELLP Syndrome: A Highly Dangerous Combination

OBJECTIVE: HELLP syndrome is a severe preeclampsia spectrum disorder diagnosed when laboratory evidence of hemolysis, liver dysfunction and thrombocytopenia are present. The presence of epigastric pain with laboratory criteria for HELLP syndrome may indicate higher maternal-fetal risk. Thus we explored maternal outcomes in 42 pregnant/postpartum women that had HELLP syndrome by laboratory criteria in addition to sudden severe epigastric pain. METHODS: A database was constructed from the medical files of all patients with medical/hypertensive disorders evaluated by the first author from 1986-2015 for medicolegal purposes. All patient files of women who presented to their physicians with a diagnosis of presumptive HELLP syndrome were examined. RESULTS: Fifty-eight pregnant/postpartum women fulfilled study inclusion criteria;they presented to physicians for evaluation usually in non-tertiary care hospital settings. Clinical presentation and care including lab data and details of pregnancy outcome were evaluated. A correct diagnosis of HELLP syndrome was verified for 42 women (72.4%);others were determined to have AFLP-Acute Fatty Liver of Pregnancy (n = 8) or TTP-aHUS-Thrombotic thrombocytopenic purpura-adult/atypical hemolytic uremic syndrome (n = 8). All 42 HELLP women (100%) in our cohort had severe epigastric pain. Treatment modalities for maternal HELLP syndrome included magnesium sulfate (n = 35, 83%), antihypertensives (n = 17, 40%);corticosteroids (CORT) for HELLP were not utilized. Major maternal morbidity (21 strokes, 9 liver ruptures/hematomas) affected 41 HELLP women (98%);22 died, 7 were permanently disabled. CONCLUSION: HELLP syndrome patients presenting with sudden, severe epigastric pain in this highly selected cohort experienced very high maternal morbidity and mortality. Laboratory evidence of HELLP syndrome in association with epigastric pain is a dangerous combination that portends great danger to safe motherhood. We speculate that the absence of CORT use in this cohort contributed to poor maternal outcome (word count = 280 as modified for reviewers).

Clinical effects of a traditional Chinese medicine nursing programme to intervene in gastric pain of the spleen and stomach with Qi deficiency

BACKGROUND Gastroparesis is a common digestive disorder characterized by delayed gastric emptying,which can lead to symptoms such as nausea,vomiting,abdominal pain,and poor appetite.Traditional Chinese medicine(TCM)has been used for centuries to treat gastrointestinal disorders,including gastroparesis.TCM theory suggests that spleen and stomach qi deficiency syndrome is one of the main pathogenic factors in gastroparesis.Nursing care plays an important role in the treatment of gastroparesis,and TCM nursing interventions have shown promising results in improving patient outcomes.However,there is limited research on the clinical effectiveness of TCM nursing interventions for gastroparesis with spleen stomach deficiency syndrome.This study aimed to evaluate the clinical effect of TCM nursing intervention in the treatment of gastroparesis with spleen stomach deficiency syndrome and to compare it with routine nursing interventions.AIM To analyze the clinical effect of traditional Chinese medicine nursing intervention in the treatment of gastric paraplegia with spleen stomach deficiency syndrome.METHODS From January 2020 to July 2021,80 patients with gastroparesis of spleen stomach qi deficiency type diagnosed in our hospital were selected for the study.The 80 patients were randomly divided into a control group and an experimental group,with 40 cases in each group.During the treatment period,the control group received routine nursing interventions,while the experimental group received traditional Chinese medicine nursing procedures.Compare the nursing effects of the two groups and observe the changes in traditional Chinese medicine symptom scores,pain levels,and sleep quality before and after treatment.RESULTS After treatment,comparing the treatment effects of the two groups,the total effective rate of the experimental group was significantly higher than that of the control group,with statistical significance(P<0.05).There was no statistically significant difference in the TCM symptom score,visual analogue scale(VAS)score,and Pittsburgh sleep quality index(PSQI)score between the two groups before treatment(P>0.05).However,after treatment,the TCM syndrome scores,VAS scores,and PSQI scores of the experimental group were significantly lower than those of the control group,with a statistically significant difference(P<0.05).CONCLUSION In the clinical nursing intervention of patients with mild gastroparesis due to spleen and stomach qi deficiency,the traditional Chinese medicine nursing plan has good clinical application value and nursing effect,and has a good effect on improving patients’pain and sleep quality.

基于网络药理学的柴胡-枳壳配伍治疗功能性消化不良的机制研究

目的基于网络药理学筛选柴胡-枳壳配伍治疗功能性消化不良(FD)的机制。方法通过TCMSP平台收集柴胡、枳壳的成分及靶点。通过GeneCards数据库收集FD的基因,使用STRING 11.0数据库进行分析。结果共获得柴胡成分349个、枳壳17个。FD疾病相关基因1561个,药物与疾病共有的靶点为59个。蛋白互作(PPI)网络发现VEGFA、MAPK8、EGFR等可能是柴胡-枳壳配伍治疗FD的关键靶点。涉及PI3K-AKT、AGE-RAGE、HIF-1等经典信号通路。结论柴胡-枳壳配伍治疗FD具有多途径、多靶点作用的特点,为接下来的实验验证提供了参考和依据。

中药热奄包联合隔姜灸在脾胃虚寒型胃脘痛患者中的临床应用

目的:探究中药热奄包联合隔姜灸在脾胃虚寒型胃脘痛患者中的临床护理效果。方法:选择2023年1—12月广东省第二中医院脾胃病科收治的80例明确诊断为脾胃虚寒型胃脘痛患者作为研究对象,采用随机数表法将患者分为观察组与对照组,各40例。观察组给予中药热奄包联合隔姜灸中医护理,对照组给予该病内科基础性护理服务。比较两组护理效果、中医症候积分、生活质量及护理服务满意度。结果:观察组护理总有效率、护理服务满意度高于对照组,差异有统计学意义(P<0.05);护理7 d后,两组中医症候积分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);护理7 d后,两组躯体职能、躯体疼痛、躯体功能、总体健康评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:中药热奄包联合隔姜灸干预脾胃虚寒型胃脘痛患者护理效果显著,可缓解临床症状,提高生活质量,提升护理满意度。

肝胃不和胃脘痛辨治经验

胃脘痛包括现代医学的各种急慢性胃炎和消化性溃疡,是消化系统常见病、多发病。在中医学藏象学说和病因病机理论中,肝胃不和是导致胃脘痛发作的主要病机之一,若肝的疏泄功能失职,导致气滞、气郁、化火、克脾等皆可直接或间接影响胃之通降,形成肝病及胃或肝胃同病,均可导致胃脘痛。笔者根据肝胃不和的临床表现将肝胃不和病机归纳总结为肝气郁结、胃失和降,肝郁化火、肝胃郁热,肝郁气滞、肝胃阴虚,肝胃气滞、气滞血瘀,肝郁脾虚、胃失和降,胆胃不和、气逆不降,胆胃郁热、痰湿中阻7个证型。现就肝胃不和辨证和治法方药进行梳理分析,以期对临床辨治胃脘痛有一定的借鉴。

名中医治疗胃脘痛经验概述

中医药治疗胃脘痛具有较好的疗效,能有效缓解患者症状,显著降低该病的复发率,有着独特的优势。当代名中医拥有数十年的临床经验,对于治疗胃脘痛更有其独到见解,这些宝贵的经验对于指导临床颇为有益。通过检索近5年名中医治疗胃脘痛的相关文献的方法并进行概述,旨在为临床治疗胃脘痛提供更多参考。

中医治疗胃脘痛的研究进展

胃脘痛是临床最常见的病证之一,病因繁多,病机复杂且治疗方法不一,病情易反复,对人们的生活质量产生了巨大的影响。本病的西医疗法主要包括抑制胃酸分泌、保护胃黏膜以及抗幽门螺杆菌治疗等。长期服用可产生药物依赖及不良反应。本文通过从经典方、自拟方、药对等方面进行深入分析,发现中医治疗胃脘痛注重中焦升降平衡,主要从疏肝、导滞、温中等方向入手;临床多数医家使用经典方或自拟方进行治疗,首选的基础方为柴胡疏肝散、黄芪建中汤。通过对方剂中的药对分析,发现延胡索、川楝子和白芍的使用频次最高,现代药理学发现其均具有镇痛作用。中医针灸、推拿等外治法,针药结合及中西医结合治疗也广泛应用于临床。本文主要对近年来治疗胃脘痛的文献进行系统梳理总结和分析,以期为胃脘痛的临床治疗提供思路与参考。

虎符铜砭刮痧干预肝胃不和型胃脘痛的效果

目的观察虎符铜砭刮痧干预肝胃不和型胃脘痛的临床疗效。方法选取2021年6月至2022年6月河南中医药大学第一附属医院收治的61例肝胃不和型胃脘部疼痛患者,采用随机数字法分为对照组(31例)和治疗组(30例)。两组均接受常规治疗,即口服奥美拉唑及中药,治疗组加用虎符铜砭刮痧治疗。对比干预前后两组患者中医症状积分、汉密尔顿焦虑量表(HAMA)评分、胃肠道生活质量指数评分表(GIQLI)评分。结果治疗后,治疗组和对照组患者中医症状积分,HAMA,GIQLI得分均降低,但治疗组患者得分降低更明显(P<0.05)。结论虎符铜砭刮痧干预肝胃不和型胃脘痛效果较好。

慢性萎缩性胃炎的中西医诊疗研究进展

慢性萎缩性胃炎(CAG)是临床常见的消化系统疾病,其治愈率低、复发率高,若得不到及时、有效的治疗,不但影响患者的生活质量,且若长期反复发作,甚至会导致癌前病变,更甚者发为胃癌。此文对近些年CAG的中西医诊疗研究进展予以综述。

基于数据挖掘探讨杨小军教授治疗功能性消化不良用药规律

目的探讨杨小军教授治疗功能性消化不良的用药规律,为临床用药提供参考和借鉴。方法收集杨小军教授治疗功能性消化不良的门诊病历,通过建立数据库进行数据挖掘。结果高频药物有陈皮、白术、半夏、茯苓、砂仁、太子参、柴胡、木香、枳壳、香附、白芍、鸡内金、川芎等。药味以甘、苦、辛为主,药性以温、寒、平为主,涉及药物主要归于脾、胃、肝、肺经。药物功效分类主要归为理气药和补虚药两大类。核心处方由香砂六君子汤合柴胡疏肝散加减组成。结论杨小军教授治疗功能性消化不良以辛开苦降、寒温并用、多脏同调、燮理气机、健脾和胃、疏肝解郁为特点。

脾胃虚寒型胃脘痛患者腹部穴位按摩及隔姜灸护理临床观察

目的观察脾胃虚寒型胃脘痛患者应用腹部穴位按摩及隔姜灸护理的效果。方法选入2021年1月—2022年1月上海市嘉定区中医医院治疗脾胃虚寒型胃脘痛患者58例,将使用腹部穴位按摩及隔姜灸护理的29例患者作为结合组,将使用腹部穴位按摩护理治疗的29例作为单一组,对比2组临床疗效、中医证候积分、生活质量量表(SF-36)评分、视觉模拟量表(VAS)评分、护理满意度。结果结合组总有效率为93.10%(27/29),高于单一组的68.97%(20/29)(P<0.05)。护理后,结合组的胃脘或脘腹胀满、胃脘疼痛、嗳气反酸的中医证候积分低于单一组;生理职能、社会功能、心理健康得分高于单一组;VAS评分低于单一组,差异均有统计学意义(P<0.05)。结合组护理满意度为96.55%(28/29),高于单一组的72.41%(21/29)(P<0.05)。结论脾胃虚寒型胃脘痛患者应用腹部穴位按摩及隔姜灸护理,较仅使用腹部穴位按摩护理的临床效果好,能够改善患者临床症状、减轻疼痛,提高护理满意度及生活质量。

基于网络药理学研究消化复宁汤治疗浅表性胃炎胃脘痛的作用机制

目的:利用网络药理学方法及分子对接技术探究消化复宁汤治疗浅表性胃炎(CSG)胃脘痛的作用机制。方法:通过中药系统药理学数据库(TCMSP)、中医药百科全书数据库(ETCM)、本草图鉴数据库(HERB)搜索消化复宁汤组成药物的有效成分及靶点,在GeneCards、DisGeNET、OMIM数据库搜索CSG的基因靶点,进而获得药物-疾病交集靶点;将交集靶点导入STRING蛋白质互作分析数据库和Cytoscape 3.9.1绘图软件,构建PPI网络图,并筛选核心靶点;再将核心靶点导入DAVID数据库,对其分别进行GO功能富集分析和KEGG通路富集分析;最后选择消化复宁汤的有效成分与核心靶点用AutoDockTool 1.5.6与PyMOL 2.5.0软件进行分子对接及可视化。结果:检索到消化复宁汤药物活性成分118个,靶点基因305个,浅表性胃炎疾病靶点973个,交集靶点118个;筛选出核心靶点21个,分别为IL-1β、ALB、IL-6、Akt1、TNF等。GO功能富集分析结果表明,消化复宁汤治疗CSG主要涉及炎症、药物反应,细胞生长凋亡等;KEGG通路富集程度相对较高的通路有癌症与糖尿病并发症通路、MAPK信号通路、IL-17信号通路、PI3K-Akt信号通路等。分子对接结果显示,核心作用靶点与有效成分具有较稳定的结合能力。结论:消化复宁汤中各种药物成分通过多靶点、多通路协同治疗CSG,为进一步研究CSG胃脘痛治疗提供了线索。

谢晶日基于“舌脉相因论”辨治上腹痛综合征经验拾萃

上腹痛综合征是由脾虚气滞、胃失和降所致的功能性胃肠病。谢晶日从舌脉辨证,从肝脾论治将上腹痛综合征。分为饮食积滞、肝胃不和、脾胃湿热、瘀血停滞、脾胃虚弱5种证型,取保和丸、柴胡疏肝散、连朴饮、失笑散合丹参饮、黄芪建中汤或芍药甘草汤等方剂单独或联合应用,疗效显著,附1则验案加以佐证。

艾灸结合中药汤剂治疗脾胃虚寒型胃脘痛的中医治疗进展

胃脘痛是上腹胃脘部以疼痛为主要症状的病症,临床上最常见的证型为脾胃虚寒型。临床研究发现艾灸结合中药汤剂治疗脾胃虚寒型胃脘痛效果更优,这种内外同治之法的优势在于艾灸增强了汤药的温通功效,汤药补充了艾灸通络行气的作用。本文从艾灸、中药汤剂及二者结合治疗进行综述,为进一步探索脾胃虚寒型胃脘痛的预防和治疗提供依据,以期在临床上发挥更大的价值。

耳穴压豆结合穴位贴敷对胃脘痛患者复发率的意义分析

目的分析耳穴压豆结合穴位贴敷对胃脘痛患者复发率的意义。方法选取60例患有胃脘痛的患者,随机分为对照组与试验组,每组30例。对照组采取临床常规治疗方法,试验组在临床常规治疗方法的基础上采取耳穴压豆结合穴位贴敷治疗。比较两组患者中医症状评分、综合疗效、生活质量评分、焦虑抑郁情绪评分、复发率相关评分。结果治疗第1、2、3周,试验组患者中医症状评分分别为(63.1±5.1)、(44.2±3.1)、(29.3±1.3)分,均低于对照组的(73.9±5.2)、(51.1±3.2)、(39.9±1.4)分,差异有统计学意义(P<0.05)。试验组患者临床总有效率83.33%高于对照组的53.33%,差异有统计学意义(P<0.05)。试验组患者生活质量评分(73.6±7.3)分高于对照组的(57.1±5.9)分,焦虑抑郁情绪评分(3.3±0.1)分、复发率相关评分(22.7±3.3)分低于对照组的(5.2±0.2)、(57.3±4.7)分,差异有统计学意义(P<0.05)。结论耳穴压豆结合穴位贴敷治疗对胃脘痛患者的治疗效果显著,能改善患者的临床症状,值得推广。

慢性萎缩性胃炎中医舌象研究进展

慢性萎缩性胃炎(CAG)是消化系统常见病、多发病,常见舌象为舌质淡伴齿痕、腻苔,与患者内镜下表现、病理、幽门螺杆菌(Hp)感染及理化指标等相关。随着患者内镜下炎症的加重,其舌苔增厚、黄色加深。结合病理发现,随着萎缩及肠化生、异型增生的加重,患者厚腻苔、黄苔及胖大舌、裂纹舌比例增加,其中以黄腻苔患者Hp感染率最高。同时,应用电子显微镜观察不同证型的CAG患者,发现其亦有不同的细胞改变及微循环变化。CAG舌象的基础研究取得了一些成果,但仍需进一步研究证实。

180例慢性胃炎患者中医证型与内镜视野下微环境相关性研究

目的通过观察108例慢性胃炎患者5个中医证型与内镜视野下微环境的相关性,以期为其中医辨证及治疗提供依据。方法选取180例慢性胃炎患者进行中医辨证分型,搜集患者一般资料、镜下黏膜表现、幽门螺杆菌(Hp)感染情况、病理结果、胃液pH值并进一步分析与中医证型的相关性。结果胃镜下黏膜白相在脾胃虚寒证患者中检出率最高,红相在痰热郁结证患者中检出率最高,不同证型间镜下黏膜表现差异有统计学意义(P<0.01)。不同证型间Hp感染率比较,痰热郁结证>气滞痰阻证>胃阴不足证>瘀血内停证>脾胃虚寒证,差异有统计学意义(P<0.01)。在病理诊断方面,萎缩性胃炎中胃阴不足证多见,非萎缩性胃炎中痰热郁结证多见,慢性胃炎病理分型在中医各证型差异有统计学意义(P<0.01)。各证型肠化生阳性率、不典型增生、胃液pH值比较,差异无统计学意义(P>0.05)。结论通过此项研究考虑慢性胃炎中医证型与镜下微环境、病理分型存在一定的相关性。

手指点穴联合中药膏摩治疗胃脘部胀痛1例的护理体会

本文总结手指点穴联合中药膏摩治疗1例胃脘部胀痛患者的护理体会,包括护理评估、生活指导、饮食护理、手指点穴以及中药膏摩操作方法等。根据辩证分析选取穴位,配合常规护理,运用手指点穴联合中药膏摩的护理方法能够有效缓解患者胃脘部胀痛症状。