田德禄老师学术思想和临床经验总结及诊疗FD经验的临床研究
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摘要
目的：温习田德禄老师的成才之路,总结田老师的学术思想和临床经验,重点总结其诊疗功能性消化不良的经验,并探讨其诊治思路及遣方用药的规律与特点,试图深入领会其学术思想、全面系统地继承其临床经验。
方法：
1.采用不间断的跟师临床侍诊,收集第一手资料等方法,全面记录三年来田老师的全部诊疗过程；通过跟师课余交谈,学习领悟,系统温习老师的著作、论文,精读老师指定的有关古籍等方法,了解其成才之路,找出其学术渊源,进而全面总结其学术思想和临床经验。
2.制订病例收集表,前瞻性地收集田老师特需门诊诊治的功能性消化不良患者105例。将全部病例信息录入用Excel建立的数据库中,采用SPSS 18.0统计软件包,采用卡方检验进行数据分析。得出田老师诊治功能性消化不良的常见证型、各型证候对应的主症、各型证候对应的主方以及常见症状对应的药物,从而总结出田老师诊疗功能性消化不良的证、症、方、药规律,进而挖掘其辨证论治新规律。
结果：
1.田德禄老师的学术渊源可以概括为：北京中医药大学正规教育是其基础,中医古代经典是其来源,北京东直门医院诸多名医指导为其添彩,董建华教授的师传为其指向。
其中,田德禄老师治疗痞满,立足五脏、八法皆宜、重症从饮邪论治的思想来源于张仲景；“宜升胃气”,反对“全用气药”香燥,反对“甚而复下”的思想来源于李东垣；注重于通降之中寓予升清、“淮宜上下分消其气”的思想,来源于朱丹溪；强调虚实分治的思想来源于张景岳；从胃论治的思想来源于其师董建华院士。
田老师诊疗杂病中肾虚证时,重视阴虚火旺、善用大补阴丸的思想来源于朱丹溪；诊治慢性肝病,重视肝肾同治、善用滋水清肝饮的思想来源于高鼓峰。
田德禄老师继承了上述医家的学术思想和临床经验,并有所发挥。
2.田德禄老师的学术思想主要包括：
2.1诊疗脾胃病的学术思想为：五脏论治,独重肝胃；通降胃气,尤重清降,并以祛除胃中实邪作为胃气通降的前提条件；治疗虚证,强调通补；重视气血,力倡“内疡”；衷中参西,重视采纳现代医学研究成果指导中医辨证用药。
2.2诊疗多种脾胃病的临床经验：以诊疗脾胃病的学术思想为基础,针对功能性消化不良,田老师尤其强调“饮邪在胃”在顽固性痞满中的作用；针对胃食管反流病,重视胆热挟胃气上逆的病机,强调“制酸三合汤”、“胃动四主药”的应用。针对慢性胃炎,主张分为实痞、虚痞,强调以甘平养胃法论治慢性萎缩性胃炎。针对消化性溃疡,提出“内疡”概念,从外科理念论治。针对溃疡性结肠炎,也从“内疡”论治,以益气活血解毒法与乌梅丸法为基本思路。针对酒精性肝病,认为,病位在肝脾肾,病机要点为气滞、痰凝、湿热、瘀热、水停、正虚(脾气虚、脾肾阳虚、肝肾阴虚),分早、中、晚三期辨治。
2.3诊疗杂病的学术思想和临床经验：
在对内科杂病的诊疗中,推崇朱丹溪“阳常有余,阴常不足”及“相火论”学术思想,认为目前之肾虚为肾阴暗耗,但往往兼夹湿热痰瘀。治疗首重饮食情绪生活起居等养生,治法当于滋阴降火同时,注意清热化湿、化痰行瘀,仍以通补为宗旨。其对肾虚的认识和补肾经验尤其独特。以此为基本思路,对田老师诊治代谢综合症、更年期综合症及虚症等杂病的临床经验进行了总结。
3.功能性消化不良的中西医研究进展
3.1功能性消化不良的西医研究现状：综述近10年来的西医文献,结论为：①目前国际上有公认的FD标准和定义。②FD的病因及病理生理机制尚未明确,大多认为与胃排空障碍、内脏高敏感性、胃酸分泌异常、幽门螺杆菌感染、精神因素和应激因素以及胃肠激素与脑-肠轴有关。③治疗以改变生活习惯、促动力剂、抑酸剂与抗酸剂、根除幽门螺杆菌以及抗焦虑和抑郁药物的使用为主要方法。但疗效不满意。
3.2功能性消化不良的中医研究现状：综述近10年来的中医文献,结论为,FD的病位在胃,与肝、脾等多脏有密切关系；基本病机为肝胃不和、脾胃虚弱；而以疏肝理气、健脾益气为治疗的基本大法。但各家均未提出针对胃的详细的治法、方药。
田德禄老师更强调“胃气壅滞”在FD的病机、治法中的核心地位。在通调胃之气机的同时,尤其重视清降胃中食滞、痰瘀、湿热等有形邪气,并创立“实痞通”专方治疗此型患者。其诊疗FD有独特的理论认识和治疗经验。
结论：通过对临床研究结果进行进一步分析,得出以下结论：(1)田德禄老师在证型确定时,认为FD的主要症状即是胃气壅滞证,若有口苦、两胁胀痛则定为肝胃不和证。(2)田老师治疗胃气壅滞证,虽然强调“清降”,但首先注重的仍是通降胃气、开通气之郁结；而其重下气开结,并不单纯从胃论治,而是从调整胃、肺、肝三脏的气机入手,体现了其治胃病从五脏入手的学术思想。(3)田老师治疗肝胃不和证,首先注重气机之郁滞,其次,才考虑肝经郁热；此外,往往加用苏子、陈皮或乌药等温行脾胃气机之品,在加强疏肝理气作用的同时,反制柴胡、芍药、枳实、黄芩等寒凉之性,寓有运脾和胃“顾中”之意。(4)对FD最常见的症状体征进行分析,得出：中医诊断以“痞满”为宜；其病位主要在胃,其次为肝,而少见为脾；辨证应以气机壅滞为主,并多兼夹有湿、食、瘀、热；而脾虚证相对少见。(5)对最常用的药物进行分析,得出：在湿、食、瘀、热诸病理因素中,田老师首重食滞,其次为湿郁成毒,瘀热蕴毒位居最后。
意义：通过本次研究,证实了田德禄教授诊疗FD的基本思想—FD的主病在胃,以实证、热证为主,以胃气壅滞为核心病机,治疗强调从肝胃论治。通过研究也发现以下二点：(1)田老师强调通降胃气,并不是单纯从胃论治,而是从调整胃、肺、肝三脏的气机入手。(2)田老师强调“清降”,但在田老师强调的有形邪气中,食滞和湿郁最常见,而瘀热蕴毒反而较少；在用药时,首先注重的仍然是下气开郁,以调整气机升降为主,且在清郁热的同时,往往配以温行脾胃之品以“顾中”。以上二点是对田老师“清降”思想的新诠释,对于准确理解田老师主张的“清降”内涵有重要意义。
第三部分田德禄老师诊疗功能性消化不良经验的临床研究
目的：总结田德禄老师诊疗功能性消化不良的学术思想和临床经验,探讨其诊治思路及遣方用药的规律与特点,挖掘其新的规律。
方法：
1.综述近10年来FD的中西医相关研究文献,掌握目前FD的研究现状。
2.制订病例收集表,前瞻性的收集田德禄老师特需门诊诊治的功能性消化不良患者105例。将所有病例信息录入用Excel建立的数据库中,采用SPSS 18.0统计软件包,采用卡方检验进行数据统计分析。得出田老师诊治功能性消化不良的常见证型、各型证候对应的主症、各型证候对应的主方以及常见症状对应的药物,从而总结出田老师诊疗功能性消化不良的证、症、方、药规律。
3.通过对所得结果进行深入的分析讨论,挖掘田老师辨证论治的新规律。
结果：
1.功能性消化不良的中西医研究现状综述
1.1 FD的西医研究现状
1.1.1诊断标准
目前FD国际上公认的标准为罗马Ⅲ标准,公认的定义为：指起源于胃、十二指肠区域的消化不良症状,同时除外可引起上述症状的器质性、系统性或代谢性疾病的一组临床综合[1]。其中,消化不良特异的症状包括有上腹痛、餐后饱胀、早饱感、上腹胀气、上腹烧灼感、恶心、呕吐、嗳气等八类,并且对每一类都有严格的定义。
1.1.2病因及病理生理机制
尚未明确。目前大多认为与胃排空障碍、内脏高敏感性、胃酸分泌异常、幽门螺杆菌感染、精神因素和应激因素以及胃肠激素与脑-肠轴有关。
1.1.3治疗
以改变生活习惯、促动力剂、抑酸剂与抗酸剂、根除幽门螺杆菌以及抗焦虑与抑郁药物的使用为主要原则。但疗效不满意。
1.2 FD的中医研究现状
FD的病位在胃,与肝、脾等多脏有密切关系；基本病机为肝胃不和、脾胃虚弱；而以疏肝理气、健脾益气为治疗的基本大法。但各家均未提出针对胃的详细的治法、方药。
田德禄老师更强调“胃气壅滞”在FD的病机、治法中的核心地位。在通调胃之气机的同时,尤其重视清降胃中食滞、痰瘀、湿热等有形邪气,并创立“实痞通”专方治疗此型患者。田德禄老师对诊疗FD有独特的理论认识和治疗经验。
2.临床研究：通过前瞻性对田德禄老师诊疗105例FD病人的证型与用药统计分析,得出以下结果：(1)证型频次：最常见者为肝胃不和证与胃气壅滞证。(2)主要证型与对应主症：胃气壅滞证以上腹胀气、餐后饱胀、早饱感、嗳气、纳差为主症,肝胃不和证以口苦、两胁胀痛为特征。(3)主要证型与对应方药：肝胃不和证常用药物为柴胡、赤芍、白芍、黄芩、炒枳实、陈皮、紫苏子、乌药；胃气壅滞证常用药物为苏梗、苏子、制香附。(4)药物化裁：上腹胀气,常用焦三仙；餐后饱胀,常用焦槟榔与苏子；早饱感,常用柴胡、苏梗；纳差,常用砂仁；苔黄腻,常用黄芩、半夏；失眠常用青蒿、知母；便秘,常用虎杖与牵牛子；上腹痛,常用炒枳壳；口苦,常用黄芩、半夏；大便粘腻,常用青皮、砂仁；反酸常用川贝、海螵蛸；两胁胀痛,常用赤芍、白芍、威灵仙、川贝；大便次数多,常用白术。统计结果中,证型分布、常用药物分布基本符合老师的学术思想和用药特点。
结论：通过对临床研究结果进行进一步分析,得出以下结论：(1)田德禄老师在证型确定时,认为FD的主要症状即是胃气壅滞证,若有口苦、两胁胀痛则定为肝胃不和证。(2)田老师治疗胃气壅滞证,虽然强调“清降”,但首先注重的仍是通降胃气、开通气之郁结；而其重下气开结,并不单纯从胃论治,而是从调整胃、肺、肝三脏的气机入手,体现了其治胃病从五脏入手的学术思想。(3)田老师治疗肝胃不和证,首先注重气机之郁滞,其次,才考虑肝经郁热；此外,往往加用苏子、陈皮或乌药等温行脾胃气机之品,在加强疏肝理气作用的同时,反制柴胡、芍药、枳实、黄芩等寒凉之性,寓有健脾和胃“扶中”之意。(4)对FD最常见的症状体征进行分析,得出：中医诊断以“痞满”为宜；其病位主要在胃,其次为肝,而少见为脾；辨证应以气机壅滞为主,并多兼夹有湿、食、瘀、热；而脾虚证相对少见。(5)对最常用的药物进行分析,得出：在湿、食、瘀、热诸病理因素中,田老师首重食滞,其次为湿郁成毒,瘀热蕴毒位居最后。
意义：通过本次研究,证实了田德禄教授诊疗FD的基本思想—FD的主病在胃,以实证、热证为主,以胃气壅滞为核心病机,治疗强调从肝胃论治。通过研究也发现以下二点：(1)田老师强调通降胃气,并不是单纯从胃论治,而是从调整胃、肺、肝三脏的气机入手。(2)田老师强调“清降”,但在田老师强调的有形邪气中,以食滞和湿郁最常见,而郁热蕴毒反而较少；在用药时,首先注重的仍然是下气开郁,以调整气机升降为主,且在清郁热的同时,往往配以温行脾胃之品以“扶中”。以上二点是对田老师“清降”思想的新诠释,对于准确理解田老师主张的“清降”内涵有重要意义。
Purpose:To review Professor Tian Delu's academic thoughts and clinic practices, on FD in particular; to explore the laws and distinguishing features of his treating principles and prescription; and to comprehensively undertake his clinical experience.
Methods:
1. Following up with my tutor to collect first-hand information on his treating for three years; learning and reviewing the teacher's books, papers, and the medicine classics signed by him to comprehensively understand his academic thoughts and clinical practices.
2. Collected the clinical cases, all together 105 on FD treated by professor Tian in special outpatient service. All cases are inputted in excel databases. The data collected should be analyzed by Spss 18.0 statistics:enumeration data with Chi-square test; measurement data with T-test, Rank tests, and Logistic. By doing so, the law of Professor Tian's prescription on FD can be summarized and the more can be discussed, including symptoms, syndromes, formulae, and herb medicine etc.
The summary:
1. The teacher's academic origins can be summed up in:Beijing University of Chinese Medicine for his formal education and the foundation of his ancient Chinese medicine classics; in Beijing Dong Zhimeng Hospital he got benefits from many eminent doctors and Professor Dong Jianhua guided him as his supervisor.
Professor Tian's thought comes from:(1) Dr. Zhang Zhongjing.Based on Five-organs, all eight-methods could be adopted; For the severe cases, treatment should start from dietary pathogen. (2)Dr. Li Dongyuan. It's better to elevate stomach-qi; Against the herb medicine with fragrant property alone. (3) (1) Dr. Zhu Danxi's. Ascending clear Qi accompanies descending evil Qi; Eliminating evil Qi from both upper and lower parts. (4) Zhang Jingyue's. Identifying deficiency or excess type and treating them separately; (5) The theory of his supervisor, academician Dong Jianhua. In dealing with Stuffy and Full Sensation, treatment centers on the stomach.
Adopted Dr.Zhu Danxi'theory, Professor Tian emphasized on flaming of fire from yin deficiency in deal with kidney deficiency of miscellaneous diseases, wisely used Da Bu Yi Pill (Tonifying Yin Pill).In treating chronic liver diseases, Professor adopts Dr. Gao Gufeng's theory to attache importance to regulating kidney, accompanying patent medicine Zi Shui Qing Gan Yin (Cold Herbal Decoction to Replenish Water to Clear Liver)
Professor Tian carries forwards the academic thoughts and clinic practice of the distinguished doctors above, and furthers them on.
2. Professor Tian's academic theory includes:
2.1 In deal with Five-organs, he emphasizes on liver and stomache;In regulating Qi activities of stomach, he pays more attention to clearing and descending on the condition of eliminating the tangible evils in stomach; In treating deficient syndrome, promoting blood circulation and replenishing are employed. Besides, Professor Tian tends to apply modern medicine results to Chinese medicine prescription base on syndrome differentiation.
2.2 The clinical experience on treating kinds of FD:Based on FD, professor emphasizes on "regulating stomach to eliminate Dietetic Evil" in treating refractoriness distention and fullness. On gastro esophageal reflux disease (GRD), he centers on treating upward perversion of stomach-qi due to gallbladder-heat, and prescribes Zhi Suan San He Tang (Herbal Decoction to Combat Gastric Acid), as well as Wei Dong Si Zhu Yao.
2.3 The academics thoughts and clinic practices on miscellaneous diseases:In treating miscellaneous diseases, he adopts Dr. Zhu Danxi's theory "Commonly yang is excessive while yin deficient" and "Ministerial Fire" theory. In Zhu Danxi's theory, kidney deficiency meant kidney yin worn out, always mixed with phlegm retention due to damp-heat. In treating, attention should be paid to diet, emotion, activities of daily living and health preserving. The principles are to replenish yin to reduce fire, remove heat and dampness, and reduce phlegm and remove blood stasis. Based on these principles, this paper summarized the Professor Tian's treating on metabolic syndrome,climacteric syndrome etc.
3. Both Chinese medicine's and west medicine's researches on FD
3.1 West medicine researches on FD
In west medicine, studies indicated:1) Related to gastric dyskinesis and hypersensitity, FD has no inevitable relation to them.2) In cause and mechanism of the disease, environment, diet, and digestion play a relatively important role; Helicobacter pylori, chronic gastritis, gastric acid secretion and duodenitis in a certain role; No clear connection with interdigestive myoelectrical complex (IMC), disorder of autonomic nervous system, and Hormone Changes; FD is relevant with psychological and pathogenic factors and co-exists with mental diseases, such as, anxiety, in particular. In clinic, the differential diagnosis has been employed usually.3) The treating principle focuses on altering patients'life style, drugs on promoting gastric dynamics, antacid, Helicobacter pylori eradication etc. and the efficacy can hardly be perfect.
(2) Chinese medicine researches on FD
On reviewing the recent 10 years literatures, we can see FD locates in stomach, has close relationship with liver, spleen etc. Its primary pathogenesis is relevant to disharmony between liver and stomach, deficiency of spleen and stomach. The treating method falls into dispersing the stagnated Liver-qi to regulate the qi circulation, invigorating Spleen and benefit qi, and specific treatment and formulae of the schools have hardly been found.
In regulating Qi activities of stomach, he pays more attention to clearing the tangible evils like indigestion, retention of phlegm, damp-heat etc. and has established Shi Pin Fang (prescription to remove the fullness syndrome) for this type, which represents his theory and practice.
Conclusion:By analyzing the clinical data, we arrive at:(1)In identifying the pattern, Professor Tian holds the FD is caused by stomach-qi stagnation, if there are bitter in the mouth, pain in the hypochondrium, they are disharmony between liver and stomach. (2) In regulating Qi activities of stomach, although Professor Tian pays more attention to "clearing and descending", he centers on regulating functional activities of qi on stomach, lung and liver, which indicates the theory that treating stomach diseases start with Five-organs. (3) In treating disharmony between liver and stomach, attention should be paid first, to depression and stagnation of qi, then depressing-heat in Liver Meridian. Perillaseed, pericarpium citri reticulatae or the root of three-nerved spicebush etc. are prescribed to warm and promote the qi activities of spleen and stomach. Meanwhile, in smoothing the liver to regulate qi, herbs with cold property like radix bupleuri, Chinese herbaceous peony, fructus aurantii immaturus, scutellaria baicalensis etc. are conversely added to achieve balance. (4) By study the usual FD's syndromes and signs, we draw the conclusion that in deal with FD, the diagnosis is directed to "stuff and full sensation"; it locates primary on stomach, then liver, rare on spleen. Its differentiation relates to qi -stagnation, which is frequently combined with damp, stagnation and heat. Deficiency in spleen is less frequently seen. (5) By studying his commonly used herbs medicine, we can see that Professor Tian primary focuses on indigestion, then production of pathogen due to dampness stagnation, and pathogen due to stagnant heat in aspects of dampness, stagnation and heat.
Significance:This study proves that Professor Tian primary theory on treating FD--- FD is caused mostly by stomach and majorly manifests as excess and heat. As FD's core pathogenesis is stagnation of stomach, treating liver and stomach should be carried out. The theory includes (1) In regulating Qi activities of stomach, he centers on regulating functional activities of qi on stomach, lung and liver, which indicates the theory that treating stomach diseases start with Five-organs. (2) Professor Tian pays more attention to "clearing and descending". In the tangible pathogens the most common are indigestion and stagnant dampness, and pathogen due to stagnant heat is less frequent. The herbs prescribed function to regulate the descending and ascending of the qi-activities. In clearing heat, herbs to warm spleen and stomach are companied in order to achieve balance. The two points above throw a new light on Professor Tian's "clearing and descending", which bears significance in the theory.
Purpose:To review Professor Tian Delu's academic thoughts and clinic practices on FD; to explore the laws and distinguishing features of his treating principles.
Methods:
1. Reviewed the past 10 years Chinese and west medicine literatures on FD, having a good hand of the present study on FD.
2. Collected the clinical cases, all together 105 on FD treated by Professor Tian in special outpatient service. All cases are inputted in excel databases and should be analyzed by Spss 18.0 statistics:enumeration data with Chi-square test; measurement data with T-test, Rank tests, and Logistic. By doing so, the law of Professor's prescription in FD can be summarized and the more can be discussed.
3. Analyzing the results obtained to find the law of Professor Tian's application on syndrome differentiation and treatment.
The summary:
1. In treating with FD, the review on Chinese medicine and west medicine
1.1 West medicine researches on FD
1.1.1 Diagnostic criteria
The internationally accepted standards for FD is RomeⅢstandards and its definition: It means FD derives from the stomach and duodenum of indigestion, and can cause these organs a group of physical, systematic or metabolic syndromes[3]. Of indigestion symptoms includes:epigastric pain, after-dinner blown out, early enough, epigastric flatulence and the epigastrium burning sensation, nausea, vomiting, etc.
1.1.2 Cause, pathological and physiological mechanism
It has not been clearly defined. The most accepted theory is that it relates with DGE, visceral hypersensitivity, abnormal gastric acid secretion, helicobacter pylori infection, mental factors, emergency factors, gastrointestinal hormones etc.
1.1.3 Treatment
The treating principle focuses on altering patients'life style, drugs on promoting gastric dynamics, antacid, helicobacter pylori eradication etc. however, the efficacy is hardly perfect.
1.2 Chinese medicine research on FD
On reviewing the recent 10 years literatures, we can see FD locates in stomach, has close relationship with liver, spleen etc. Its primary pathogenesis is relevant to disharmony between liver and stomach, deficiency of spleen and stomach. The treating method falls into dispersing the stagnated Liver-qi to regulate the qi circulation, invigorating Spleen and benefit qi, and specific treatment and formulae of the schools have hardly been found.
In regulating Qi activities of stomach, he pays more attention to clearing the tangible evils like indigestion, retention of phlegm, damp-heat etc. and has established Shi Pin Fang (prescription to remove the fullness syndrome) for this type, which represents his theory and practice.
2. Clinic research:On Analysizing the 105 cases that treated by Professor Tian Delu, we draw the conclusion:(1) Patterns:Most frequently seen are disharmony of liver and stomach, stomach-qi stagnationg.(2)Main patterns and their corresponding symptoms:After-dinner blown out, early enough etc.(3) The main patterns and their corresponding herb medicine: Radices Paeoniae Alba, Lily, Radix Bupleuri, Fructus Aurantii, Fructus Aurantii Immaturus, Pericarpium Citri Reticulatae, Radix Paeoniae Rubrathe (unpeeled) Root of Common Peony, Scutellaria Baicalensis, Radices Saussureae, Perillae, and the Root of Three-nerved Spicebush etc. The usual medicine for syndrome of stomach-Qi stagnation includes Caulis Perillae Acutae, Cyperus Rotundus, Pericarpium Citri Reticulatae, Perillae, Semen Coicis, Radix Bupleuri, Poria Cocos, Scutellaria Baicalensis, Radices Paeoniae Alba, Radix Paeoniae Rubrathe (unpeeled) Root of Common Peony, Fructus Forsythiae, Fructus Amomi, Pericarpium Citri Reticulatae Viride;(4)For constipation, Polygonum cuspidatum, Semen Pharbitidis,for blown out after that heavy meal, charred semen aremen,and perillaseed are suggested.
Conclusion:By analysizing the clinical data, we arrive at:(1)In identifying the pattern, Professor Tian holds the FD is caused by stomach-qi stagnation, if there are bitter in the mouth, pain in the hypochondrium, they are disharmony between liver and stomach. (2) In regulating Qi activities of stomach, although Professor Tian pays more attention to "clearing and descending", he centers on regulating functional activities of qi on stomach, lung and liver, which indicates the theory that treating stomach diseases start with Five-organs. (3) In treating disharmony between liver and stomach, attention should be paid first, to depression and stagnation of qi, then depressing-heat in Liver Meridian. Perillaseed, pericarpium citri reticulatae or the root of three-nerved spicebush etc. are prescribed to warm and promote the qi activities of spleen and stomach. Meanwhile, in smoothing the liver to regulate qi, herbs with cold property like radix bupleuri, Chinese herbaceous peony, fructus aurantii immaturus, scutellaria baicalensis etc. are conversely added to achieve balance. (4) By study the usual FD's syndromes and signs, we draw the conclusion that in deal with FD, the diagnosis is directed to "stuff and full sensation"; it locates primary on stomach, then liver, rare on spleen. Its differentiation relates to qi -stagnation, which is frequently combined with damp, stagnation and heat. Deficiency in spleen is less frequently seen. (5) By studying his commonly used herbs medicine, we can see that Professor Tian primary focuses on indigestion, then production of pathogen due to dampness stagnation, and pathogen due to stagnant heat in aspects of dampness, stagnation and heat.
Significance:This study proves that Professor Tian primary theory on treating FD--- FD is caused mostly by stomach and majorly manifests as excess and heat. As FD's core pathogenesis is stagnation of stomach, treating liver and stomach should be carried out. The theory includes:(1) In regulating Qi activities of stomach, he centers on regulating functional activities of qi on stomach, lung and liver, which indicates the theory that treating stomach diseases start with Five-organs. (2) Professor Tian pays more attention to "clearing and descending". In the tangible pathogens the most common are indigestion and stagnant dampness, and pathogen due to stagnant heat is less frequent. The herbs prescribed function to regulate the descending and ascending of the qi-activities. In clearing heat, herbs to warm spleen and stomach are companied in order to achieve balance. The two points above throw a new light on Professor Tian's "clearing and descending", which bears significance in the theory.
方法：
1.采用不间断的跟师临床侍诊,收集第一手资料等方法,全面记录三年来田老师的全部诊疗过程；通过跟师课余交谈,学习领悟,系统温习老师的著作、论文,精读老师指定的有关古籍等方法,了解其成才之路,找出其学术渊源,进而全面总结其学术思想和临床经验。
2.制订病例收集表,前瞻性地收集田老师特需门诊诊治的功能性消化不良患者105例。将全部病例信息录入用Excel建立的数据库中,采用SPSS 18.0统计软件包,采用卡方检验进行数据分析。得出田老师诊治功能性消化不良的常见证型、各型证候对应的主症、各型证候对应的主方以及常见症状对应的药物,从而总结出田老师诊疗功能性消化不良的证、症、方、药规律,进而挖掘其辨证论治新规律。
结果：
1.田德禄老师的学术渊源可以概括为：北京中医药大学正规教育是其基础,中医古代经典是其来源,北京东直门医院诸多名医指导为其添彩,董建华教授的师传为其指向。
其中,田德禄老师治疗痞满,立足五脏、八法皆宜、重症从饮邪论治的思想来源于张仲景；“宜升胃气”,反对“全用气药”香燥,反对“甚而复下”的思想来源于李东垣；注重于通降之中寓予升清、“淮宜上下分消其气”的思想,来源于朱丹溪；强调虚实分治的思想来源于张景岳；从胃论治的思想来源于其师董建华院士。
田老师诊疗杂病中肾虚证时,重视阴虚火旺、善用大补阴丸的思想来源于朱丹溪；诊治慢性肝病,重视肝肾同治、善用滋水清肝饮的思想来源于高鼓峰。
田德禄老师继承了上述医家的学术思想和临床经验,并有所发挥。
2.田德禄老师的学术思想主要包括：
2.1诊疗脾胃病的学术思想为：五脏论治,独重肝胃；通降胃气,尤重清降,并以祛除胃中实邪作为胃气通降的前提条件；治疗虚证,强调通补；重视气血,力倡“内疡”；衷中参西,重视采纳现代医学研究成果指导中医辨证用药。
2.2诊疗多种脾胃病的临床经验：以诊疗脾胃病的学术思想为基础,针对功能性消化不良,田老师尤其强调“饮邪在胃”在顽固性痞满中的作用；针对胃食管反流病,重视胆热挟胃气上逆的病机,强调“制酸三合汤”、“胃动四主药”的应用。针对慢性胃炎,主张分为实痞、虚痞,强调以甘平养胃法论治慢性萎缩性胃炎。针对消化性溃疡,提出“内疡”概念,从外科理念论治。针对溃疡性结肠炎,也从“内疡”论治,以益气活血解毒法与乌梅丸法为基本思路。针对酒精性肝病,认为,病位在肝脾肾,病机要点为气滞、痰凝、湿热、瘀热、水停、正虚(脾气虚、脾肾阳虚、肝肾阴虚),分早、中、晚三期辨治。
2.3诊疗杂病的学术思想和临床经验：
在对内科杂病的诊疗中,推崇朱丹溪“阳常有余,阴常不足”及“相火论”学术思想,认为目前之肾虚为肾阴暗耗,但往往兼夹湿热痰瘀。治疗首重饮食情绪生活起居等养生,治法当于滋阴降火同时,注意清热化湿、化痰行瘀,仍以通补为宗旨。其对肾虚的认识和补肾经验尤其独特。以此为基本思路,对田老师诊治代谢综合症、更年期综合症及虚症等杂病的临床经验进行了总结。
3.功能性消化不良的中西医研究进展
3.1功能性消化不良的西医研究现状：综述近10年来的西医文献,结论为：①目前国际上有公认的FD标准和定义。②FD的病因及病理生理机制尚未明确,大多认为与胃排空障碍、内脏高敏感性、胃酸分泌异常、幽门螺杆菌感染、精神因素和应激因素以及胃肠激素与脑-肠轴有关。③治疗以改变生活习惯、促动力剂、抑酸剂与抗酸剂、根除幽门螺杆菌以及抗焦虑和抑郁药物的使用为主要方法。但疗效不满意。
3.2功能性消化不良的中医研究现状：综述近10年来的中医文献,结论为,FD的病位在胃,与肝、脾等多脏有密切关系；基本病机为肝胃不和、脾胃虚弱；而以疏肝理气、健脾益气为治疗的基本大法。但各家均未提出针对胃的详细的治法、方药。
田德禄老师更强调“胃气壅滞”在FD的病机、治法中的核心地位。在通调胃之气机的同时,尤其重视清降胃中食滞、痰瘀、湿热等有形邪气,并创立“实痞通”专方治疗此型患者。其诊疗FD有独特的理论认识和治疗经验。
结论：通过对临床研究结果进行进一步分析,得出以下结论：(1)田德禄老师在证型确定时,认为FD的主要症状即是胃气壅滞证,若有口苦、两胁胀痛则定为肝胃不和证。(2)田老师治疗胃气壅滞证,虽然强调“清降”,但首先注重的仍是通降胃气、开通气之郁结；而其重下气开结,并不单纯从胃论治,而是从调整胃、肺、肝三脏的气机入手,体现了其治胃病从五脏入手的学术思想。(3)田老师治疗肝胃不和证,首先注重气机之郁滞,其次,才考虑肝经郁热；此外,往往加用苏子、陈皮或乌药等温行脾胃气机之品,在加强疏肝理气作用的同时,反制柴胡、芍药、枳实、黄芩等寒凉之性,寓有运脾和胃“顾中”之意。(4)对FD最常见的症状体征进行分析,得出：中医诊断以“痞满”为宜；其病位主要在胃,其次为肝,而少见为脾；辨证应以气机壅滞为主,并多兼夹有湿、食、瘀、热；而脾虚证相对少见。(5)对最常用的药物进行分析,得出：在湿、食、瘀、热诸病理因素中,田老师首重食滞,其次为湿郁成毒,瘀热蕴毒位居最后。
意义：通过本次研究,证实了田德禄教授诊疗FD的基本思想—FD的主病在胃,以实证、热证为主,以胃气壅滞为核心病机,治疗强调从肝胃论治。通过研究也发现以下二点：(1)田老师强调通降胃气,并不是单纯从胃论治,而是从调整胃、肺、肝三脏的气机入手。(2)田老师强调“清降”,但在田老师强调的有形邪气中,食滞和湿郁最常见,而瘀热蕴毒反而较少；在用药时,首先注重的仍然是下气开郁,以调整气机升降为主,且在清郁热的同时,往往配以温行脾胃之品以“顾中”。以上二点是对田老师“清降”思想的新诠释,对于准确理解田老师主张的“清降”内涵有重要意义。
第三部分田德禄老师诊疗功能性消化不良经验的临床研究
目的：总结田德禄老师诊疗功能性消化不良的学术思想和临床经验,探讨其诊治思路及遣方用药的规律与特点,挖掘其新的规律。
方法：
1.综述近10年来FD的中西医相关研究文献,掌握目前FD的研究现状。
2.制订病例收集表,前瞻性的收集田德禄老师特需门诊诊治的功能性消化不良患者105例。将所有病例信息录入用Excel建立的数据库中,采用SPSS 18.0统计软件包,采用卡方检验进行数据统计分析。得出田老师诊治功能性消化不良的常见证型、各型证候对应的主症、各型证候对应的主方以及常见症状对应的药物,从而总结出田老师诊疗功能性消化不良的证、症、方、药规律。
3.通过对所得结果进行深入的分析讨论,挖掘田老师辨证论治的新规律。
结果：
1.功能性消化不良的中西医研究现状综述
1.1 FD的西医研究现状
1.1.1诊断标准
目前FD国际上公认的标准为罗马Ⅲ标准,公认的定义为：指起源于胃、十二指肠区域的消化不良症状,同时除外可引起上述症状的器质性、系统性或代谢性疾病的一组临床综合[1]。其中,消化不良特异的症状包括有上腹痛、餐后饱胀、早饱感、上腹胀气、上腹烧灼感、恶心、呕吐、嗳气等八类,并且对每一类都有严格的定义。
1.1.2病因及病理生理机制
尚未明确。目前大多认为与胃排空障碍、内脏高敏感性、胃酸分泌异常、幽门螺杆菌感染、精神因素和应激因素以及胃肠激素与脑-肠轴有关。
1.1.3治疗
以改变生活习惯、促动力剂、抑酸剂与抗酸剂、根除幽门螺杆菌以及抗焦虑与抑郁药物的使用为主要原则。但疗效不满意。
1.2 FD的中医研究现状
FD的病位在胃,与肝、脾等多脏有密切关系；基本病机为肝胃不和、脾胃虚弱；而以疏肝理气、健脾益气为治疗的基本大法。但各家均未提出针对胃的详细的治法、方药。
田德禄老师更强调“胃气壅滞”在FD的病机、治法中的核心地位。在通调胃之气机的同时,尤其重视清降胃中食滞、痰瘀、湿热等有形邪气,并创立“实痞通”专方治疗此型患者。田德禄老师对诊疗FD有独特的理论认识和治疗经验。
2.临床研究：通过前瞻性对田德禄老师诊疗105例FD病人的证型与用药统计分析,得出以下结果：(1)证型频次：最常见者为肝胃不和证与胃气壅滞证。(2)主要证型与对应主症：胃气壅滞证以上腹胀气、餐后饱胀、早饱感、嗳气、纳差为主症,肝胃不和证以口苦、两胁胀痛为特征。(3)主要证型与对应方药：肝胃不和证常用药物为柴胡、赤芍、白芍、黄芩、炒枳实、陈皮、紫苏子、乌药；胃气壅滞证常用药物为苏梗、苏子、制香附。(4)药物化裁：上腹胀气,常用焦三仙；餐后饱胀,常用焦槟榔与苏子；早饱感,常用柴胡、苏梗；纳差,常用砂仁；苔黄腻,常用黄芩、半夏；失眠常用青蒿、知母；便秘,常用虎杖与牵牛子；上腹痛,常用炒枳壳；口苦,常用黄芩、半夏；大便粘腻,常用青皮、砂仁；反酸常用川贝、海螵蛸；两胁胀痛,常用赤芍、白芍、威灵仙、川贝；大便次数多,常用白术。统计结果中,证型分布、常用药物分布基本符合老师的学术思想和用药特点。
结论：通过对临床研究结果进行进一步分析,得出以下结论：(1)田德禄老师在证型确定时,认为FD的主要症状即是胃气壅滞证,若有口苦、两胁胀痛则定为肝胃不和证。(2)田老师治疗胃气壅滞证,虽然强调“清降”,但首先注重的仍是通降胃气、开通气之郁结；而其重下气开结,并不单纯从胃论治,而是从调整胃、肺、肝三脏的气机入手,体现了其治胃病从五脏入手的学术思想。(3)田老师治疗肝胃不和证,首先注重气机之郁滞,其次,才考虑肝经郁热；此外,往往加用苏子、陈皮或乌药等温行脾胃气机之品,在加强疏肝理气作用的同时,反制柴胡、芍药、枳实、黄芩等寒凉之性,寓有健脾和胃“扶中”之意。(4)对FD最常见的症状体征进行分析,得出：中医诊断以“痞满”为宜；其病位主要在胃,其次为肝,而少见为脾；辨证应以气机壅滞为主,并多兼夹有湿、食、瘀、热；而脾虚证相对少见。(5)对最常用的药物进行分析,得出：在湿、食、瘀、热诸病理因素中,田老师首重食滞,其次为湿郁成毒,瘀热蕴毒位居最后。
意义：通过本次研究,证实了田德禄教授诊疗FD的基本思想—FD的主病在胃,以实证、热证为主,以胃气壅滞为核心病机,治疗强调从肝胃论治。通过研究也发现以下二点：(1)田老师强调通降胃气,并不是单纯从胃论治,而是从调整胃、肺、肝三脏的气机入手。(2)田老师强调“清降”,但在田老师强调的有形邪气中,以食滞和湿郁最常见,而郁热蕴毒反而较少；在用药时,首先注重的仍然是下气开郁,以调整气机升降为主,且在清郁热的同时,往往配以温行脾胃之品以“扶中”。以上二点是对田老师“清降”思想的新诠释,对于准确理解田老师主张的“清降”内涵有重要意义。
Purpose:To review Professor Tian Delu's academic thoughts and clinic practices, on FD in particular; to explore the laws and distinguishing features of his treating principles and prescription; and to comprehensively undertake his clinical experience.
Methods:
1. Following up with my tutor to collect first-hand information on his treating for three years; learning and reviewing the teacher's books, papers, and the medicine classics signed by him to comprehensively understand his academic thoughts and clinical practices.
2. Collected the clinical cases, all together 105 on FD treated by professor Tian in special outpatient service. All cases are inputted in excel databases. The data collected should be analyzed by Spss 18.0 statistics:enumeration data with Chi-square test; measurement data with T-test, Rank tests, and Logistic. By doing so, the law of Professor Tian's prescription on FD can be summarized and the more can be discussed, including symptoms, syndromes, formulae, and herb medicine etc.
The summary:
1. The teacher's academic origins can be summed up in:Beijing University of Chinese Medicine for his formal education and the foundation of his ancient Chinese medicine classics; in Beijing Dong Zhimeng Hospital he got benefits from many eminent doctors and Professor Dong Jianhua guided him as his supervisor.
Professor Tian's thought comes from:(1) Dr. Zhang Zhongjing.Based on Five-organs, all eight-methods could be adopted; For the severe cases, treatment should start from dietary pathogen. (2)Dr. Li Dongyuan. It's better to elevate stomach-qi; Against the herb medicine with fragrant property alone. (3) (1) Dr. Zhu Danxi's. Ascending clear Qi accompanies descending evil Qi; Eliminating evil Qi from both upper and lower parts. (4) Zhang Jingyue's. Identifying deficiency or excess type and treating them separately; (5) The theory of his supervisor, academician Dong Jianhua. In dealing with Stuffy and Full Sensation, treatment centers on the stomach.
Adopted Dr.Zhu Danxi'theory, Professor Tian emphasized on flaming of fire from yin deficiency in deal with kidney deficiency of miscellaneous diseases, wisely used Da Bu Yi Pill (Tonifying Yin Pill).In treating chronic liver diseases, Professor adopts Dr. Gao Gufeng's theory to attache importance to regulating kidney, accompanying patent medicine Zi Shui Qing Gan Yin (Cold Herbal Decoction to Replenish Water to Clear Liver)
Professor Tian carries forwards the academic thoughts and clinic practice of the distinguished doctors above, and furthers them on.
2. Professor Tian's academic theory includes:
2.1 In deal with Five-organs, he emphasizes on liver and stomache;In regulating Qi activities of stomach, he pays more attention to clearing and descending on the condition of eliminating the tangible evils in stomach; In treating deficient syndrome, promoting blood circulation and replenishing are employed. Besides, Professor Tian tends to apply modern medicine results to Chinese medicine prescription base on syndrome differentiation.
2.2 The clinical experience on treating kinds of FD:Based on FD, professor emphasizes on "regulating stomach to eliminate Dietetic Evil" in treating refractoriness distention and fullness. On gastro esophageal reflux disease (GRD), he centers on treating upward perversion of stomach-qi due to gallbladder-heat, and prescribes Zhi Suan San He Tang (Herbal Decoction to Combat Gastric Acid), as well as Wei Dong Si Zhu Yao.
2.3 The academics thoughts and clinic practices on miscellaneous diseases:In treating miscellaneous diseases, he adopts Dr. Zhu Danxi's theory "Commonly yang is excessive while yin deficient" and "Ministerial Fire" theory. In Zhu Danxi's theory, kidney deficiency meant kidney yin worn out, always mixed with phlegm retention due to damp-heat. In treating, attention should be paid to diet, emotion, activities of daily living and health preserving. The principles are to replenish yin to reduce fire, remove heat and dampness, and reduce phlegm and remove blood stasis. Based on these principles, this paper summarized the Professor Tian's treating on metabolic syndrome,climacteric syndrome etc.
3. Both Chinese medicine's and west medicine's researches on FD
3.1 West medicine researches on FD
In west medicine, studies indicated:1) Related to gastric dyskinesis and hypersensitity, FD has no inevitable relation to them.2) In cause and mechanism of the disease, environment, diet, and digestion play a relatively important role; Helicobacter pylori, chronic gastritis, gastric acid secretion and duodenitis in a certain role; No clear connection with interdigestive myoelectrical complex (IMC), disorder of autonomic nervous system, and Hormone Changes; FD is relevant with psychological and pathogenic factors and co-exists with mental diseases, such as, anxiety, in particular. In clinic, the differential diagnosis has been employed usually.3) The treating principle focuses on altering patients'life style, drugs on promoting gastric dynamics, antacid, Helicobacter pylori eradication etc. and the efficacy can hardly be perfect.
(2) Chinese medicine researches on FD
On reviewing the recent 10 years literatures, we can see FD locates in stomach, has close relationship with liver, spleen etc. Its primary pathogenesis is relevant to disharmony between liver and stomach, deficiency of spleen and stomach. The treating method falls into dispersing the stagnated Liver-qi to regulate the qi circulation, invigorating Spleen and benefit qi, and specific treatment and formulae of the schools have hardly been found.
In regulating Qi activities of stomach, he pays more attention to clearing the tangible evils like indigestion, retention of phlegm, damp-heat etc. and has established Shi Pin Fang (prescription to remove the fullness syndrome) for this type, which represents his theory and practice.
Conclusion:By analyzing the clinical data, we arrive at:(1)In identifying the pattern, Professor Tian holds the FD is caused by stomach-qi stagnation, if there are bitter in the mouth, pain in the hypochondrium, they are disharmony between liver and stomach. (2) In regulating Qi activities of stomach, although Professor Tian pays more attention to "clearing and descending", he centers on regulating functional activities of qi on stomach, lung and liver, which indicates the theory that treating stomach diseases start with Five-organs. (3) In treating disharmony between liver and stomach, attention should be paid first, to depression and stagnation of qi, then depressing-heat in Liver Meridian. Perillaseed, pericarpium citri reticulatae or the root of three-nerved spicebush etc. are prescribed to warm and promote the qi activities of spleen and stomach. Meanwhile, in smoothing the liver to regulate qi, herbs with cold property like radix bupleuri, Chinese herbaceous peony, fructus aurantii immaturus, scutellaria baicalensis etc. are conversely added to achieve balance. (4) By study the usual FD's syndromes and signs, we draw the conclusion that in deal with FD, the diagnosis is directed to "stuff and full sensation"; it locates primary on stomach, then liver, rare on spleen. Its differentiation relates to qi -stagnation, which is frequently combined with damp, stagnation and heat. Deficiency in spleen is less frequently seen. (5) By studying his commonly used herbs medicine, we can see that Professor Tian primary focuses on indigestion, then production of pathogen due to dampness stagnation, and pathogen due to stagnant heat in aspects of dampness, stagnation and heat.
Significance:This study proves that Professor Tian primary theory on treating FD--- FD is caused mostly by stomach and majorly manifests as excess and heat. As FD's core pathogenesis is stagnation of stomach, treating liver and stomach should be carried out. The theory includes (1) In regulating Qi activities of stomach, he centers on regulating functional activities of qi on stomach, lung and liver, which indicates the theory that treating stomach diseases start with Five-organs. (2) Professor Tian pays more attention to "clearing and descending". In the tangible pathogens the most common are indigestion and stagnant dampness, and pathogen due to stagnant heat is less frequent. The herbs prescribed function to regulate the descending and ascending of the qi-activities. In clearing heat, herbs to warm spleen and stomach are companied in order to achieve balance. The two points above throw a new light on Professor Tian's "clearing and descending", which bears significance in the theory.
Purpose:To review Professor Tian Delu's academic thoughts and clinic practices on FD; to explore the laws and distinguishing features of his treating principles.
Methods:
1. Reviewed the past 10 years Chinese and west medicine literatures on FD, having a good hand of the present study on FD.
2. Collected the clinical cases, all together 105 on FD treated by Professor Tian in special outpatient service. All cases are inputted in excel databases and should be analyzed by Spss 18.0 statistics:enumeration data with Chi-square test; measurement data with T-test, Rank tests, and Logistic. By doing so, the law of Professor's prescription in FD can be summarized and the more can be discussed.
3. Analyzing the results obtained to find the law of Professor Tian's application on syndrome differentiation and treatment.
The summary:
1. In treating with FD, the review on Chinese medicine and west medicine
1.1 West medicine researches on FD
1.1.1 Diagnostic criteria
The internationally accepted standards for FD is RomeⅢstandards and its definition: It means FD derives from the stomach and duodenum of indigestion, and can cause these organs a group of physical, systematic or metabolic syndromes[3]. Of indigestion symptoms includes:epigastric pain, after-dinner blown out, early enough, epigastric flatulence and the epigastrium burning sensation, nausea, vomiting, etc.
1.1.2 Cause, pathological and physiological mechanism
It has not been clearly defined. The most accepted theory is that it relates with DGE, visceral hypersensitivity, abnormal gastric acid secretion, helicobacter pylori infection, mental factors, emergency factors, gastrointestinal hormones etc.
1.1.3 Treatment
The treating principle focuses on altering patients'life style, drugs on promoting gastric dynamics, antacid, helicobacter pylori eradication etc. however, the efficacy is hardly perfect.
1.2 Chinese medicine research on FD
On reviewing the recent 10 years literatures, we can see FD locates in stomach, has close relationship with liver, spleen etc. Its primary pathogenesis is relevant to disharmony between liver and stomach, deficiency of spleen and stomach. The treating method falls into dispersing the stagnated Liver-qi to regulate the qi circulation, invigorating Spleen and benefit qi, and specific treatment and formulae of the schools have hardly been found.
In regulating Qi activities of stomach, he pays more attention to clearing the tangible evils like indigestion, retention of phlegm, damp-heat etc. and has established Shi Pin Fang (prescription to remove the fullness syndrome) for this type, which represents his theory and practice.
2. Clinic research:On Analysizing the 105 cases that treated by Professor Tian Delu, we draw the conclusion:(1) Patterns:Most frequently seen are disharmony of liver and stomach, stomach-qi stagnationg.(2)Main patterns and their corresponding symptoms:After-dinner blown out, early enough etc.(3) The main patterns and their corresponding herb medicine: Radices Paeoniae Alba, Lily, Radix Bupleuri, Fructus Aurantii, Fructus Aurantii Immaturus, Pericarpium Citri Reticulatae, Radix Paeoniae Rubrathe (unpeeled) Root of Common Peony, Scutellaria Baicalensis, Radices Saussureae, Perillae, and the Root of Three-nerved Spicebush etc. The usual medicine for syndrome of stomach-Qi stagnation includes Caulis Perillae Acutae, Cyperus Rotundus, Pericarpium Citri Reticulatae, Perillae, Semen Coicis, Radix Bupleuri, Poria Cocos, Scutellaria Baicalensis, Radices Paeoniae Alba, Radix Paeoniae Rubrathe (unpeeled) Root of Common Peony, Fructus Forsythiae, Fructus Amomi, Pericarpium Citri Reticulatae Viride;(4)For constipation, Polygonum cuspidatum, Semen Pharbitidis,for blown out after that heavy meal, charred semen aremen,and perillaseed are suggested.
Conclusion:By analysizing the clinical data, we arrive at:(1)In identifying the pattern, Professor Tian holds the FD is caused by stomach-qi stagnation, if there are bitter in the mouth, pain in the hypochondrium, they are disharmony between liver and stomach. (2) In regulating Qi activities of stomach, although Professor Tian pays more attention to "clearing and descending", he centers on regulating functional activities of qi on stomach, lung and liver, which indicates the theory that treating stomach diseases start with Five-organs. (3) In treating disharmony between liver and stomach, attention should be paid first, to depression and stagnation of qi, then depressing-heat in Liver Meridian. Perillaseed, pericarpium citri reticulatae or the root of three-nerved spicebush etc. are prescribed to warm and promote the qi activities of spleen and stomach. Meanwhile, in smoothing the liver to regulate qi, herbs with cold property like radix bupleuri, Chinese herbaceous peony, fructus aurantii immaturus, scutellaria baicalensis etc. are conversely added to achieve balance. (4) By study the usual FD's syndromes and signs, we draw the conclusion that in deal with FD, the diagnosis is directed to "stuff and full sensation"; it locates primary on stomach, then liver, rare on spleen. Its differentiation relates to qi -stagnation, which is frequently combined with damp, stagnation and heat. Deficiency in spleen is less frequently seen. (5) By studying his commonly used herbs medicine, we can see that Professor Tian primary focuses on indigestion, then production of pathogen due to dampness stagnation, and pathogen due to stagnant heat in aspects of dampness, stagnation and heat.
Significance:This study proves that Professor Tian primary theory on treating FD--- FD is caused mostly by stomach and majorly manifests as excess and heat. As FD's core pathogenesis is stagnation of stomach, treating liver and stomach should be carried out. The theory includes:(1) In regulating Qi activities of stomach, he centers on regulating functional activities of qi on stomach, lung and liver, which indicates the theory that treating stomach diseases start with Five-organs. (2) Professor Tian pays more attention to "clearing and descending". In the tangible pathogens the most common are indigestion and stagnant dampness, and pathogen due to stagnant heat is less frequent. The herbs prescribed function to regulate the descending and ascending of the qi-activities. In clearing heat, herbs to warm spleen and stomach are companied in order to achieve balance. The two points above throw a new light on Professor Tian's "clearing and descending", which bears significance in the theory.
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