Master of traditional Chinese medicine talks about pathological examination.

Professor Dai Jinzhong of Nanjing University of Traditional Chinese Medicine summed up Professor Xu Jingfan's understanding of chronic atrophic gastritis through data mining, and thought that the pathogenesis was divided into the following four points:

① Spleen and stomach acquired, based on qi deficiency. Qi deficiency of spleen and stomach is the root cause of atrophic gastritis. According to the characteristics of the disease, the disease has a long course of disease, repeated failures, chronic illness and many deficiencies, and it is easy to damage the spleen and stomach. The disease is more common in middle-aged and elderly people. Such patients are weak in spleen and stomach, unable to resist exogenous pathogens, and often have spleen and stomach qi deficiency. Looking at the pathogenic factors of atrophic gastritis, "Miscellaneous Books of Ming Medicine" said: "If you only eat improperly and live from time to time, it will damage the spleen and stomach, but the stomach damage is unbearable, while the spleen damage cannot be absorbed, and the spleen and stomach are both damaged, it is difficult to absorb, and the vitality is weak and all evils are easy to invade." "Spleen and stomach theory" contains: "Emotion, anxiety, loss of vitality, spleen and stomach qi deficiency, lack of vitality." "The Standard of Syndrome Differentiation and Treatment" says: "All insects are deficient in viscera and spleen and stomach." It can be seen that improper diet, fatigue, emotional disorders, HP infection and other factors can damage the spleen and stomach, leading to spleen and stomach weakness. Judging from the characteristics and pathogenic factors of atrophic gastritis, it is not unreasonable that qi deficiency of spleen and stomach is the source of its pathogenesis.

② Body yang uses yin, and yin deficiency is the normal state. The stomach is yang soil, and it likes dryness and hates dampness. Its assimilation function depends not only on the evaporation of stomach qi, but also on the moistening of body fluids in the stomach, which is the material basis of water absorption. Su Wen's On the Image of Yin and Yang says: "Yang turns into qi, while Yin turns into shape." The mucous membrane of the stomach is moist and thick, and the glands in the stomach secrete acidified substances, which is closely related to the nourishing effect of the stomach yin. In the treatment of this disease, we should always pay attention to protecting the body fluid in the stomach to prevent dryness, gas consumption and yin injury, or misuse bitter cold to diarrhea and yin injury. As the saying goes, "When a person is forty years old, his Yin Qi is half". Deficiency of stomach yin is a physiological feature of middle-aged and elderly people, and it is a common disease. Spicy diet, addiction to alcohol and tobacco, intense internal heat, burning stomach yin; If you can't get what you want, the liver qi will stagnate, and if you stagnate for a long time, it will turn into heat and damage the stomach yin; Long-term illness, bitter cold by mistake, damage to stomach yin; Infected with HP, damp heat persists for a long time, and heat turns negative. There is a cloud in "Theory of Blood Syndrome": "The stomach is dry and cannot be eaten, and eating less cannot be dissolved. For example, if there is no water in the kettle, you can't cook. " Deficiency of stomach yin, loss of nutrition, weakening of transport and digestion, loss of appetite, damage to stomach fu-organs, and over time, thinning of mucosa and atrophy of glands lead to this disease.

(3) Wood can dredge soil, and liver depression is important. "On Blood Syndrome" said: "Qi entering the stomach depends entirely on the qi of liver and wood to relax, while Shui Gu turns it into phlegm." Between the liver and the stomach, the position is adjacent, closely linked, physiologically assisted and pathologically related. The middle jiao spleen and stomach, one dirty and one fu-organ, is the hub of qi movement. If the rise and fall of qi is appropriate and balanced, the spleen and stomach will be transported normally, and qi, blood and body fluid will be transformed. The liver governs the drainage, is good at regulating the whole body's qi, promoting the spleen and stomach to transport and transform, and helping bile excretion. If the liver qi is smooth, the drainage is reasonable, the spleen and stomach rise and fall properly, and the transportation is normal; If the liver loses its function of dispersing qi, the stomach qi will stagnate and Shui Gu will not rotate. "On the Spleen and Stomach" said: "If you win madness ... madness will carry fire, if you are fearless, you will act rashly, and your spleen and stomach will suffer first." The liver loses the function of activating qi, and qi stagnation leads to stomach diseases. As Ye said, "the liver is the source of disease, and the stomach is the transmission of disease." Clinically, spleen and stomach diseases caused by stagnation of liver qi are very common. Professor Xu Jingfan thinks that disharmony between liver and stomach is an important pathogenesis, with special emphasis on the influence of liver wood on stomach soil. Emotional disorder, first hurt the spleen and stomach. Patients are generally depressed, and their fear of cancer is also reasonable, which is more likely to lead to stagnation of liver qi, dereliction of duty and aggravation of illness.

④ The pathogenesis is complicated, and the syndrome cannot be forgotten. "Suwen Babylon" says: "If you double your diet, your stomach will be hurt." Patients with atrophic gastritis are weak in spleen and stomach, unable to transport and digest food, but damage the spleen and stomach. "Su Wenyin, Yang Ying and Xiang Da Lun" says: "Wet in the coke." Spleen governs the transport and transformation, and the essence of water, while Shui Gu remains unchanged, stops dampness and blocks the spleen and stomach. Ye Tianyan said: "Qi is trapped in the meridians at the beginning of the disease, and blood hurts into the collaterals after a long illness." The course of the disease is long, with qi-stagnation, blood stasis, obstruction of gastric collaterals and atrophy of mucosa. It can be seen that food stagnation, dampness resistance, blood stasis and many other factors can damage the spleen and stomach, leading to the onset. There are many pathological factors, uncertain clinical symptoms, lingering illness and complicated pathogenesis. Professor Xu Jingfan thinks that weakness of spleen and stomach, deficiency of stomach yin and disharmony between liver and stomach are the main symptoms of this disease, but the syndromes of food stagnation, dampness resistance, blood stasis and stomach cold can not be ignored. At the same time, we should be flexible in dealing with the three types. Long-term symptoms can induce complications and aggravate the main symptoms. Therefore, clinical treatment should be considered comprehensively and carefully, and the pathology and pathogenesis of the disease should be reviewed as a whole.