Traditional Chinese medicine believes that this disease falls under the category of "epigastralgia." It is often caused by irregular diet (excessive consumption of cold or irritating foods), irregular eating and resting habits, excessive smoking and drinking, as well as emotional distress, all of which can harm the spleen and stomach, or lead to spleen-stomach weakness, resulting in impaired spleen and stomach function, depression and stagnation of qi movement, and thus causing epigastric pain. The main mechanism of the disease is due to spleen and stomach injury, obstruction of middle energizer qi movement, internal retention of dampness, and the generation of heat from stagnation; emotional distress injuring the spleen, liver depression and qi stagnation, which transversely invades the spleen and stomach, leading to disharmony between the liver and spleen (stomach); liver depression transforming into fire, or excessive consumption of spicy and dry foods, excessive drinking and smoking, which injures stomach yin; overexertion leading to qi consumption, excessive rest leading to qi stagnation, and over time, blood stasis in the stomach collaterals.

bubble_chart Modern Research

Chronic gastritis is a persistent non-specific chronic inflammation or atrophy of the gastric mucosa caused by repeated attacks from various disease-causing factors (including autoimmune reactions). Clinically, it is characterized by persistent pain in the upper and middle abdomen, anorexia, vomiting, weight loss, and anemia.

Modern medicine believes that this disease is mainly caused by long-term stimulation of the gastric mucosa due to immune genetic factors, physical and chemical factors, infections (such as Helicobacter pylori infection), dietary habits, and psychological or humoral factors. The mechanism of autoimmune reaction causing the disease is: about 90% of patients with gastric mucosa atrophy accompanied by pernicious anemia can find intrinsic factor antibodies and parietal cell antibodies in their blood, which are specific autoimmune antibodies of G cells, belonging to the IgG system. In addition, the atrophic gastric mucosa has diffuse infiltration of lymphocytes and plasma cells, indicating that cellular immune reactions also participate in the pathological evolution of atrophic gastritis.

Medical history: a history of repeated episodes of acute gastritis, or a history of frequent overeating and irregular eating habits, or a long-term history of alcohol consumption, smoking, and the use of salicylic acid preparations.

Symptoms: mainly manifested as dull pain or burning pain in the upper abdomen, epigastric upset, fullness and discomfort, belching, loss of appetite, acid regurgitation, and nausea. Severe chronic atrophic gastritis patients may experience weight loss and anemia.

Signs: some patients may have grade I tenderness in the upper abdomen, glossitis, atrophy of tongue papillae, anemia, and significant weight loss.

Laboratory tests and other examinations: fiber gastroscopy can reveal various pathological changes in the gastric mucosa; X-ray double-contrast barium meal can show abnormal gastric mucosal folds, with the antral mucosa appearing as blunt serrations; Helicobacter pylori detection is mostly positive; serum parietal cell antibody detection is mostly positive.

bubble_chart Pattern Analysis

1. Liver-stomach Disharmony︰Epigastric distending pain, or pain radiating to both hypochondria, frequent belching, symptoms occur or worsen with emotional distress. Tongue pale red with thin white coating, pulse wiry or wiry-thin. Soothe the liver and regulate qi, harmonize the stomach to relieve pain. Modified Bupleurum Liver-Soothing Powder combined with Aquilaria Qi-Descending Powder. Bupleurum 10g, Bitter Orange 10g, Peony Root 15g, Prepared Licorice Root 5g, Sichuan Lovage Rhizome 10g, Cyperus 10g, Aquilaria 10g (to be decocted later), Villous Amomum Fruit 10g (to be decocted later), Chinaberry Fruit 12g, Corydalis Tuber 12g. If accompanied by aversion to cold, preference for warmth, bland taste in the mouth, no thirst or thirst with preference for hot drinks, add Evodia Fruit 10g, Water Caltrop Peel 10g, Fresh Ginger Rhizome 3-5 slices. If complicated by food stagnation, add Medicated Leaven 10g, Hawthorn Fruit 15g, Stir-fried Millet Sprout 10g, Stir-fried Germinated Barley 10g. If pain is severe, add Citron Fruit 10g, Finger Citron 10g.
2. Spleen and Stomach Yang Deficiency︰Dull pain in the epigastrium, relieved by warmth and pressure, poor appetite, postprandial epigastric stuffiness and fullness, loose stool, mental fatigue, lack of strength. Pale red tongue with white coating, deep, thin, and weak pulse. Warm the middle and tonify deficiency, tonify qi and strengthen the spleen. Modified Astragalus Center-Fortifying Decoction combined with Xiangsha Liujunzi Decoction. Ingredients: Raw Astragalus Root 20g, Maltose 30g (melted), Cinnamon Twig 10g, Peony Root 15g, Prepared Liquorice Root 6g, Dried Tangerine Peel 10g, Tangshen 15g, White Atractylodes Rhizome 12g, Poria 10g, Aucklandia Root 10g, Villous Amomum Fruit 10g (to be decocted later), Hawthorn Fruit 15g, Stir-fried Millet Sprout 10g, Stir-fried Germinated Barley 10g. Modifications: - For acid regurgitation, remove maltose and add Coptis Rhizome juice and Stir-fried Evodia Fruit, 6g each. - For excessive clear fluid regurgitation, add Pro Formula Pinellia 10g and increase Poria to 20g. - For severe cold and pain, add Dried Ginger 15g and Cassia Bark 10g.
3. Stomach Heat︰Abdominal distension and fullness, distending pain, acid regurgitation, epigastric discomfort, bitter taste in the mouth, dry mouth, yellow urine, constipation. The tongue is red with yellow and rough coating, and the pulse is wiry and rapid or thin and rapid. Clear the stomach and purge heat, harmonize the middle and relieve pain. Modified Stomach-Clearing Powder combined with Left Metal Pill. Raw Gypsum 20-30g (to be decocted first), Coptis Rhizome 10g, Evodia Fruit 3g, Moutan Bark 10g, Chinese Angelica 10g, Unprocessed Rehmannia Root 15g, Anemarrhena 12g, Aucklandia Root 10g, Submature Bitter Orange 10g. For yellow and greasy tongue coating, add Magnolia Bark 12g and Atractylodes Rhizome 10g; for hypochondriac distending pain and irritability, add Green Tangerine Peel 15g, Peony Root 15g, and Gardenia 12g; for severe constipation, add Raw Rhubarb Rhizome 12-15g (soaked in water for oral administration).
4. Stomach Yin Deficiency︰Burning and painful epigastrium, dry mouth with a preference for cold drinks, epigastric upset resembling hunger, vexing heat in the chest, palms, and soles, restless sleep, dry and hard stools. The tongue is dry, red, and with scant coating; the pulse is thin and weak or thin and rapid. Nourish yin and benefit the stomach, produce fluid to moisten dryness. Modified All-Along Decoction combined with Peony Root and Liquorice Root Decoction. Glehnia 30g, Ophiopogon Tuber 30g, Unprocessed Rehmannia Root 15g, Polyghace Seche 20g, Smallpox Powder 15g, Hyacinth Bean 10g, Chinaberry Fruit 12g, Chinese Angelica 10g, Peony Root 15g, Prepared Liquorice Root 10g, Dendrobium 15g, Chinese Yam 20g. If there is burning epigastric upset resembling hunger, add Coptis Rhizome 6g and Evodia Fruit 3g. If accompanied by stabbing pain in the hypochondriac region, add Bupleurum 10g and Submature Bitter Orange 10g. If gastric acid secretion is insufficient, add Green Plum 15g and Smoked Plum 12g. If the tongue is purplish-dark and the pain persists for a long time, add raw Typha 10g and Corydalis Tuber 12g.
5. Blood Stasis Obstructing the Stomach Collaterals︰Epigastric stabbing pain or localized pain that worsens with pressure, or black, tarry stools. Dark purple tongue or with ecchymosis, sublingual vein stasis and tortuosity, choppy or slow pulse. Activate blood and dispel phlegm, move qi to relieve pain. Modified Sudden Smile Powder combined with Salvia Decoction. Trogopterus Dung 15g, stir-fried Typha 15g, Salvia 15g, sandalwood 5g (to be decocted later), Villous Amomum Fruit 6g (to be decocted later), raw Rhubarb Rhizoma powder 10g (to be taken orally), Pseudoginseng powder 5g (to be taken orally), raw Liquorice Root 6g. If bright red hematemesis, red tongue with yellow coating, wiry or rapid pulse, add Coptis Rhizome 10g, Phellodendron Bark 10g, Skullcap Root 10g, Gardenia 12g, common Bletilla pseudobulb powder 10g (to be taken orally). If dark purple hematemesis, sallow complexion, cold limbs, pale tongue, thin rapid and weak pulse, add Cooking Stove Earth 30g (wrap-boiling), Mugwort 10g, blast-fried Ginger 15g; if black, tarry stools, add Sophora Flower 15g, Sanguisorba 15g.