Chronic gastritis is a chronic gastric lesion, pathologically characterized by non-specific chronic inflammation of the gastric mucosa. Its etiology is not well understood, possibly related to administration of irritating drugs and food, bile regurgitation, muccal inflammation or autoimmunity. Chronic gastritis can be divided into two categories, primary and secondary. The former is further categorized into superficial, atrophic and hypertrophic types; the latter often complicates gastroduodenal ulcer and gastric cancer. Chronic gastritis occurs most frequently in the middle-aged people. This disease in TCM pertains to the categories of "pi" (feeling of fullness in the upper abdomen), "wei wan tong" (stomachache), etc.  

Main Points of Diagnosis

1. The chief symptoms are chronic upper abdominal pain, fullness and discomfort, belching and acid regurgitation which often occur after meals. Mild hemorrhage of upper digestive tract may be induced by some precipitating factors in a few cases. Severe atrophic gastritis may be accompanied with anemia and pathologic leanness.

2. Physical examination reveals mild but diffuse tenderness in the upper abdominal region.

3. Laboratory examination

(1) Gastric juice analysis: Gastric acid is normal in superficial gastritis, but mostly reduced or gone in atrophic gastritis.

(2) X-ray barium examination: Positive rate is not high. Atrophic gastritis presents gastric hypotension, triviality or disappearance of gastric mucosal folds. The main purpose of radiological examination is to exclude peptic ulcer and cancer.

(3) Gastrofiberscope: This method is most contributive in confirming diagnosis. Through it superficial mucosal erosion with hyperemia, swelling or red spots and increased ropy liquid could be discovered in chronic superficial gastritis; in chronic atrophic gastritis, such findings can be caught as thinned and grayish-pale mucosa, slenderized mucosal folds with exposure of submucosal vessels, and granular or nodular proliferation. The combined application of gastrofiberscope and biopsy proves to be an accurate method for the diagnosis of chronic gastritis.

Differentiation and Treatment of Common Syndromes     

1. Stagnation of the Stomach-Qi

Main Symptoms and Signs: Epigastric distension and fullness or pain, loss of appetite, indigestion, or diarrhea, white coating of the tongue, and slippery pulse.

Therapeutic Principle: Regulating the stomach-qi to relieve distension and fullness.

Recipe: Pinellia Decoction for Purging Stomach-Fire.

pinellia tuber

dried ginger

scutellaria root

coptis root

codonopsis root

licorice root

Chinese date

All the above herbs are to be decocted in water for oral administration.

For the case of a more severe stomachache, 15 grams of white peony root and 9 grams of corydalis tuber may be employed.

2. Hyperactive Liver-Qi Attacking the Stomach

Main Symptoms and Signs: Epigastric distension, pain, fullness, oppression and discomfort which is aggravated after meals, frequent belching which may be aggravated by emotional upset, thin and white coating of the tongue, and deep taut pulse.

Therapeutic Principle: Relieving hyperactive liver-qi and regulating the stomach.

Recipe: Modified Bupleurum Powder for Relieving Liver-Qi.

bupleurum root

cyperus tuber

white peony root

bitter orange

Sichuan chinaberry

corydalis tuber

tangerine peel

perilla stem

licorice root

All the above herbs are to be decocted in water for oral administration.

If there are acid regurgitation, burning sensation and distress in the stomach, 15 grams of dandelion herb, 9 grams of coptis root and 6 grams of evodia fruit are to be added to the recipe.

3. Insufficiency-Cold of the Spleen and Stomach

Main Symptoms and Signs: Vague pain in the stomach, vomiting of watery fluid, preference for warmth and press, aggravation from cold, mental fatigue and weakness, loose stools, pale tongue, deep thready and weak pulse.

Therapeutic principle: Warming middle-warmer and dispelling pathogenic cold.

Recipe: Modified Decoction of Astragalus for Tonifying Middle-Warmer.

astragalus root

cinnamon twig

white peony root

aucklandia root

dried ginger

amomum fruit

Chinese date

prepared licorice root

All the above herbs are to be decocted in water for oral administration.

If the case is complicated with anorexia and belching with fetid odor, 10 grams of medicated leaven and 10 grams of germinated barley may be administered; if the case with acid regurgitation, 30 grams of calcined ark shell added; if the case with dominant cold of insufficiency type, 10 grams of codonopsis root, 10 grams of white atractylodes rhizome and 10 grams of poria included.

4. Deficiency of the Stomach-Yin due to Stomach-Heat

Main Symptoms and Signs: Irregular stomachache with burning sensation which is aggravated in the afternoon or on empty stomach and is relieved after meals, dry mouth and throat, or thirst, loss of appetite, dry stool, red tongue with yellowish and dry fur, and taut and thready or rapid pulse.

Therapeutic Principle: Clearing away heat from the stomach and nourishing the stomach-yin.

Recipe: Modified Decoction for Nourishing the Stomach

glehnia root 

ophiopogon root

fragrant solomonseal rhizome

white peony root

scutellaria root

coptis root

anemarrhena rhizome

tangerine peel

dandelion 

licorice root

All the above herbs are to be decocted in water for oral administration.  

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