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Integrated

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Integrated

    Integrated

    Jun.2009,Volume6,No.6(SerialNo.55)JournalofUS.ChinaMedicalScience,ISSN1548-6648,USA

    IntegratedTraditionalChineseandWesternMedicineTherapy

    inTreatingGastr0es0phagealRefluxCough

    CHENPeng-dian,XUYun-xiang2,CHENGui-zhen

    flTheLaboratoryofPhotonicChineseMedicine.CollegeofBiophotonicsSchoolofinformationandOptoelectronicScienceand

    Engineering,SouthChinaNormalUniversity,Guangzhou510631,2.CollegeofAcupuncture&Massage-

    GuangzhouUniversityofChineseMedicine,Guangzhou51040~

    Abstract:Inthepresentpaper,theauthorsintroducechiefphysicianHUANGZi-ping'sexperiencein

    treatinggastroesophagealrefluxcoughfrom(1)understandingsoftheetiologyandpathogenesis,(2)Clinical

    integratedapplicationofChineseMateriaMediea,westernagentsaswellasacumoxatherapy,(3)casereport.

    Withthesatisfactorytherapeuticeffect,lowside.toxiceffectsandhighpracticability,it'sworthyofbeingfurther

    developedandpopularizedinclinic.

    Keywords:gastroesophagealrefluxcough;integratedtraditionalChineseandWesternmedicinetherapy;

    clinicalexperience;syndromedifferentiationandtreatment

    Gastroesophageairefluxcough,abbreviatedtoGERC,referstoanobstinatecoughduetostimulationedby

    therefluxoftheacidgastriccontentstotheesophagusandoccu~enceofvagusreflectionmechanism.According

tothestatistics.amongthepatientsfromtheout

    patientdepartmentwhosufferfromchroniccough,about10%to

    40%arediagnosedasGERCl.

    Clinically,itsmanifestationsareasfollows:long-termdrycough,noorIittle sputum,mainlyoccurringatnight,evenaggravatingwhilechangingthebodypostureortakingthespicyoracid

    f0od.accompaniedwiththestu

    Bessofthelowerportionoftheretrosternum,acidregurgitation,belchand hiccup.Evensomepatientscouldfee

    burningsensationatthexyphoidprocess.InTCM,itmaybelongstothe

    categoriesof"retching","acidregurgitation",etc.Havingbeenengagedinclinicalpracticeandresearchforover

    20years,ChiefphysicianHUANGZi

    pingfromJieyangMunicipalHospitalofChineseMedicine,Guangdong

    province,isgoodattreatingintractablediseasesandexcelsinthetreatmentofGERCwithsatisfactorytherapeutic

    effect.NowDr.Huang'sexperienceisintroducedasfoilows.

    ETIoLoGYANDPATHoGENESIS

    InDr.HUANG'sview,GERCalwaysshowsdeficiencyinoriginandexcessinsuperficiality,withamixture

    Ofthedeficiencyandexcess.whichismainlycausedbyimproperfoodintakeorinternalemotionalimpairment,

    leadingtodysfunctionofthezang

    fuorgans.Theuncontroleddiet,overindulgenceofcigarettesandalcohol, excessivepungentandgreasyfoodmayimpairtheanti-refluxfunctionofesophagusandstomach,which

    Acknowledgements:Thisworkwassuppoaedby(No.200704102421thepost

    doctorofChinaFoundmion,(No.2007166)ofthe

    AdministrationofTraditionalChineseMedicineofGuangdongProvince,and(No.8451063101001809)ofGuangdongNatural

ScienceFoundation.

    CHENGui.zhen,Ph.D.,TheLaboratoryofPhotonicChineseMedicine,CollegeofBiophoto

    nics,SchoolofInformationand

    OptoelectronicScienceandEngineering,SouthChinaNormalUniversity,researchfield:me

    chanismresearchofacupointeffects specifitywithoptoelectronictechniques. IntegratedTraditionalChineseandWesternMedicineTherapyinTre

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    consequentlywouldtransformheatintofireanddrynessandimpairtheyinfluid,resultinginheartburnandretch. Thegreasyflavourwouldgeneratedampnessandheat.Withtheaccumulationofdampnessheat,thephlegmis

    formedandtheqiisobstructed,leadingtothefailureofthestomachqiindescendinghencetheo

    ccurrenceofthis

disease.AswasstatedinChapter38ofPlainQuestions,thedisordersoffive

    zangandsix-fuorganscouldcause

    cough,notonlythelung'sweshouldn'tjustfocuscoughonthepulmonarysystem.Italsopointsoutthatthe

    coughisstagnantinthestomachandobstructedinthelungwhichemphasizesthatthecoughsymptomis

    closelyrelatedwiththelungandstomach.InDr.HUANG'sview,asachronicdiseaseduetointernalimpairment,

    GERCisnotlocatedinthelung,butinthestomach.Thestomach,asafu-organ,istakingdescendingand

    unobstructionasitsnormalfunction.Meanwhile,thelung'sfunctionslieindispersinganddescending.Fromthe

    theoriesofFiveElements.thelungandthestomacharerelatedaschild

    organandmother-organ.Ifthestomach

    qidoesn'tdescend,consequentlythelungqiwouldfailtodescendandcausecough.Thestomach,asthereservoir

    ofthefive

    zangandthesix-fuorgans,istoreceive,digestandtransformwaterandfood.Withtheascendingof

    thespleenqi,thewaterandfoodistransportedtothelunganddistributedtothewholebodywiththelungqi.If

    therearesomeproblemsintheproductionofthesubstancesortherouteofthetransportation,therelated

    symptomsoflungandstomachwouldmanifest.

    Asforthedepressiveemotions,itwouldusuallycauseliverqidepression.Consequently,theliverfailsto

    conveyanddisperse.Asisknownthatthefunctionsofupwardandoutwardmovement,conveyanceand

    dispersionoftheliverqicontributealottothepurificationanddescendingofthelungqi,ascendingofthespleen

    qianddescendingofthestomachqi.Thedysfunctionofconveyanceanddispersionoftheliverwouldleadtothe

    disharmonyoftheliverandstomach.Asaresult,theliverqitransverselyinvadesthestomachandthestomachqi

    failstodescend.Withthegastriccontents,thestomachqireverselyflowsupwardsandcausesthevomitand

    cough.Dr.Huangthinksthattheoriginofthepathogenesisisthedisharmonyoftheliverandstomachleadingto

    thedisorderofascendinganddescendingqimovement;whilethesuperficialityofitistheupwardreverseflowof

    lungqiandthecough.Ifitmissestimelypropertreatment,afteracertainperiod,theliverdisorderwouldtransmit

    tothespleen,resultinginthedysfunctionofthespleenhencetheoccurrenceofthespleendeficiency,withthe

    mixtureofdeficiency

    excesssyndrome.Inclinic,basedontheabovetheories,Dr.Huangalwayslaysstressonthe specialtherapeuticprinciple,thatistoapplythemethodsoftoniflcationandpurgationandherbswithcoldandhot

    propertiestothetreatmenttorecoverthenormalascendinganddescendingfunction.Clinically,thetherapeutic

    methodsaredescendingcounterflowofqitorelievecoughandsoothinglivertoharmonizestomach.

    THEBASICTCMPRESCRIPTIoNANDIT'SMoDIFICA1'IoNS

    Inviewoftheabove

    mentionedpathogenesisandtherapeuticprincipleofGERC,Dr.HUANGdesignsa basicprescriptioncalledJiangniZhikeTang(Decoctionfordescendingcounterflowofqitorelievecough),which

    consistsofShanYao(RhizomaDioscoreae)20g,BaiShao(RadixPaeoniaeAlba)15g,ZhiKuanDongHua

    (FlosFarfaraePreparata)15g,FaBanXia(RhizomaPinelliaePreparata)15g,ChenPi(Perica

rpiumCitri

    Reticulatae)10g,FuLing(Poria)10g,GanJiang(RhizomaZingiberis)10g,ZiWan(RadixAs

    teris)10g,Bai

    Qian(RhizomaCynanchiStauntonii)10g,GanCao(RadixGlycyrrhizae)10g,ChaiHu(Radi

    xBupleuri)5gand

    HuangLianfRhizomaCoptidis)3gt

    .Intherecipe,FaBanXia(RhizomaPinelliaePreparata)combinedwith

    GanJiang(RhizomaZingiberis)andHuangLian(RhizomaCoptidis)areappliedfordescendi

    ngthestomachqi

    andclearingtheheataccumulatedinthestomach,whichcorrespondswiththephysiologicalc

    haracteristicsofthe

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    IntegratedTraditionalChineseandWester

    

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    oesophagealRefluxCough

six.fuorgans,i.e.unobstructionanddescending.

    Beingpungentinflavourandhotinnature,GanJiang(Rhizoma

    Zingiberis)isusedtoinhibitthecoldnatureofHuangLian(RhizomaCoptidis).Inaddition,FaBanXiafRhizoma

    PinelliaePreparata)iseffectiveinresolvingphlegmandcheckingvomit.Modempharmacologicalresearth

    indicatesthatitcannotonlygivetheeffectsofcheckingcoughandexpellingphlegm ,butalsoactivatethe

    etlerentactivityofthevagusthusarrestingvomit,decreasingtheacidityofstomachandprotectingthegastric

    mucosap

    .

    ChaiHu(RadixBupleuri)combinedwithBaiShao(RadixPaeoniaeAlba)areusedtosootheand

    regulatetheliverqi.Thestomachwouldbeharmonizedonconditionthattheliverisinnormalfunction.nle

    combineduseofthefollowingdrugssuchasShanYao(RhizomaDioscoreae),ChenPi(PericarpiumCirri

    Reticulatae)andFuLing(Poria)canproducethejointeffectofinvigoratingthespleenandstomachhencetreating

    theorigin.DrugssuchasZiWan(RadixAsteris),ZhiKuanDongHua(FlosFarfaraePreparata1andBaiQian

    (RhizomaCynanchiStauntonii)cancomplementeachotherinmoisteninganddescendingthelungqiandtreatthe

    uperficiality?Theprescription,takenasawhole,Callgivetheeffectsofsoothingliverqi,descendingstomachqi

    andmoisteninglungqi,withthesimultaneoustreatmentoftheoriginandthesuperficiality. Forthosewithheartburn,ZuojinWan(Coptis-EvodiaPil1)canbeadded;forpatientswithfrequentbelching,

    herbssuchasZhuRu(CaulisBambusaeinTaeniam),ZhiPiPaYe(FoliumEriobotryaePrepar

ata).XuanFuHua

    (FlosInulae),DaiZheShi(Haematitum)couldbeadded;forthosewithseriousacidregurgitation.

    HaiPiaoXiao

    (OsSepiaeSeuSepiellae)isproperlyadded;forpatientswithlittlesputumanddifficultexpectoration.ChuanBei

    Mu(BulbusFritillariaeCirrhosae)andGuaLouPi(PericarpiumTrichosanthis)couldbeappliedtoCOnSolidate

    theeffectsofclearinglung?6reandeliminatingphlegm;forthosewithscorchingpainofthestomach.PuGong

    Ying(HerbaTaraxaci),whichisbitterinflavourwithout

    stomach,isaccordinglyadded;forthoseaccompaniedwith

    impairingyinandcoldinnaturewithoutimpairing

    sorethroatanddrytongue,Dr.Huangpreferstouse

    XuanShen(RadixScrophulariae)combinedwithChanTui(PeriostracumCicadae)tonourishyinandsoothethe

    throat;forpatientswithstabbingpainbehindthesternumwithalongduration ,whichindicatesthattheblood

    stasisexists,ShuiZhi(Hirudo),DanShen(RadixSalviaeMiltiorrhizae),WuLingZhi(FaecesTrogopterori)and

    PuHuang(PollenTyphae)areoftenused;forthosewithweakconstitutionandspleendeficiencymanifestedas

    lassitude,blandtasteinthemouth,sloppystool,paletongueproperwithwhitecoating,etc,DangShen(Radix

    Codonopsis)andBaiZhu(RhizomaAstractylodisMacrocephalae)shouldbeaddedcombinedwiththeChinese

    patentdrugQiweiYiqiJiaonang(Seven?IngredientCapsulesforInvigoratingQi1toconsolidatethetherapeutic

    effectofinvigoratingspleen;forpatientswithstomach

    yindeficiencymanifestedasdrythroat.redtongueproper

withlittleco~ingandthready-rapidpulse,

    thebasicprescriptionshouldbegivenup.Instead,modified

    MaimendongTang(DecoctionofRadixOphiopogonis)isapplied,whichcontainsMaiDong(Radix

    Ophiopogonis)20g,BeiShaShen(RadixGlehniae)15g,FaBanXia(RhizomaPinelliaePreparata115g,YuZhu

    (RhizomaPolygonatiOdorati)15g,ZiWan(RadixAsteris)15g,ShengJiang(RhizomaZingiberisRecens)3

    slicesabout0.2-0.3cmthick,DaZao(FructusJujubae)4grainsandGanCao(RadixGlycyrrhizae)6g.The

    recipe,takenasawhole,canproducethejointeffectsofnourishingstomach

    yin,descendingup.flowofqi,

    moisteninglungandarrestingcough.

    50

    INTEGRATEDTREATMENTBYBoTHTRADITIoNAL

    CHINESEANDWESTERNMEDICINE

    Basedonthelong-termclinicalexperience,duetothesusceptivitytorelapseandthecomplicated

    IntegratedTraditionalChineseandWesternMedicineTherapyinTreatingGastroesophagealRefluxCough

    pathogenesisofGERC,Dr.HUANGthinksthattheintegratedtreatmentofbothChineseandwesternmedicine

    shouldbetakenasthetoppriority.Thewesternagentssuchasprotonpumpinhibitor(PPI)combinedwith

    prokineticdrugcouldincreaseloweresophagealsphincter(LES)pressure,improvethegastricemptyingaswell

    asstopthesecretionofthegastricacidbyspeciallyinhibitingtheprotonpumpsystemofthecellsinthegastric

    wall,whichcouldrapidlyrelievetheclinicalsymptomssuchasacidregurgitation,belchingandheartburn.In

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