仝小林"独藏"辨识治疗难治性功能性消化不良OA

Refractory functional dyspepsia(RFD)is mainly characterized by postprandial fullness,early satiation,and epigastric pain or burning sensation.Due to the atypical nature of its symptoms and the tendency for recurrence after conventional Western medicine treatment,its treatment based on syndrome differentiation is quite challenging.The"Ducang"(the only core symptom hidden in many symptoms)identification is treatment based on syndrome differentiation approach proposed by Professor Tong Xiaolin,which takes grasping the main symptoms as the core,the disease as the guiding principle,syndrome differentiation as the pivot,and follows the steps of determining the disease domain based on the disease,understanding the pathogenesis based on the symptoms,establishing therapeutic methods based on pathogenesis,and selecting formulas according to therapeutic methods.In this case,the patient presented with not only epigastric fullness,early satiation,accompanied by aversion to cold in the epigastrium,loose stools and other symptoms,but also recurrent oral ulcers characterized by depressed ulcer surfaces and surrounding erythema.The oral ulcers were identified as the"Ducang symptom"of this case.In this case,by integrating the heat manifested by the ulcers with the coldness of the spleen and stomach,the underlying pathogenesis was further identified as spleen–stomach deficiency,cold–heat complexity,and stagnation of qi in the middle jiao.In this case,treatment focused on tonifying the spleen and stomach,regulating the middle jiao through the simultaneous use of acrid-warm and bitter-cold herbs,and harmonizing cold and heat,with modified Gancao Xiexin Decoction as the principal formula.For patients with RFD accompanied by recurrent oral ulcers,treatment can start from"Ducang symptom"to enhance the pertinence of treatment based on syndrome differentiation.