Recurrent Gastric Polyps - A Renowned National TCM Physician’s Special Formula to Treat Them from the Root

23. Recurrent Gastric Polyps - A Renowned National TCM Physician’s Special Formula to Treat Them from the Root

Niu Xingdong, a physician of the second batch of National Renowned TCM Physicians, established the treatment principle of “supporting the righteous and dissolving accumulation” for gastrointestinal polyps, and created two specialized formulas: the Stomach Polyp Accumulation-Dissolving Decoction and the Intestinal Polyp Accumulation-Dissolving Decoction.

Pathogenesis

Spleen-Stomach weakness is the fundamental cause; phlegm-stasis turbid toxin mutual binding is the secondary manifestation. When the Spleen is weak, its transportive and transformative functions are deranged, dampness accumulates and condenses into phlegm; when phlegm blocks and Qi stagnates, Blood circulation becomes sluggish and forms stasis; prolonged accumulation of phlegm-stasis generates turbid toxins, which gradually form polyps. After polyp removal, the polyp-prone constitution remains, so recurrence is common. This formula proceeds in parallel by reinforcing the Spleen and boosting Qi to support the righteous, and invigorating Blood to resolve stasis, transforming turbidity, resolving toxins, and expelling pathogenic factors, treating both root and branch.

Formula Composition

Stomach Polyp Accumulation-Dissolving Decoction (Wei Xi Hua Ji Tang)

Composition: Astragalus 20g, Codonopsis 15g, Fried White Atractylodes 15g, Aurantium (Immature) 15g, Chicken Gizzard 30g, Tangerine Peel 15g, Archaeosoma (Nine-Scent Bug) 10g, Vinegar-processed Curcuma Zedoary 10g, Salvia 15g, Paris (Shanzi Gu) 15g, Oldenlandia 20g, Ginger-processed Pinellia 10g, Raw Coix Seed 30g, Bletilla 10g, Honey-processed Licorice 10g

Efficacy: Reinforce the Spleen and boost Qi, invigorate Blood and resolve stasis, resolve toxins, dissolve accumulation, and disperse nodules

Indications: Gastric polyps (Spleen-Stomach weakness, phlegm-stasis turbid toxin mutual binding pattern), characterized by epigastric distending pain, belching with poor appetite, fatigue and lassitude

Astragalus, Codonopsis, and Fried White Atractylodes serve as the sovereign, boosting Qi and reinforcing the Spleen, taking the spirit of the Four Gentlemen Decoction to support the righteous and consolidate the root. Aurantium (Immature), Tangerine Peel, Chicken Gizzard, and Ginger-processed Pinellia serve as the ministers, moving Qi to relieve distension, transforming phlegm, and dissolving accumulation - Aurantium breaks Qi and relieves fullness, Tangerine Peel regulates Qi and harmonizes the middle, Chicken Gizzard digests food and resolves accumulation, and Ginger-processed Pinellia dries dampness and transforms phlegm; the four herbs combined smooth the middle jiao’s Qi mechanism so that tonifying does not stagnate. Archaeosoma (Nine-Scent Bug), Vinegar-processed Curcuma Zedoary, and Salvia serve as assistant 1, invigorating Blood to resolve stasis, and dissolving zheng and dispersing nodules - Zedoary breaks Blood and moves Qi, while Salvia invigorates Blood and removes stasis; the two are used in synergy to treat zheng and masses; the Nine-Scent Bug warms, unblocks, and regulates Qi, supporting the blood-invigorating and stasis-resolving power. Paris (Shanzi Gu), Oldenlandia, and Raw Coix Seed serve as assistant 2, transforming turbidity and resolving toxins, and reducing abscesses and dispersing nodules - Paris clears heat, resolves toxins, and disperses nodules, Oldenlandia clears heat and resolves toxins, reduces swelling, and relieves pain, and Raw Coix Seed reinforces the Spleen, drains dampness, and reduces masses; the three target the secondary manifestation of turbid toxin mutual binding. Bletilla serves as assistant 3, protecting the mucous membrane and generating tissue, safeguarding the damaged gastric mucosa. Honey-processed Licorice serves as the envoy, harmonizing all the herbs; combined with Astragalus and Codonopsis, it boosts Qi and harmonizes the middle.

Zedoary must be vinegar-processed; vinegar processing directs the herb into the Liver channel, enhancing its power to break stasis and dissolve accumulation, while softening its harsh nature. Chicken Gizzard is used at a relatively high dose of 30g, for its efficacy in digesting food and resolving accumulation. Paris is cool in nature; for patients with Spleen-Stomach deficiency-cold, it must be combined with warming herbs.

Pattern-Based Modifications

Niu Xingdong emphasizes that gastric polyps do not form overnight; the medication cycle should be long - persist in conditioning for 3-6 months after surgery, then re-examine by gastroscopy. When the righteous Qi has already declined, one must not recklessly use drastic attacking methods; Blood-invigorating and stasis-resolving herbs are bitter and cold in nature and easily injure Spleen Yang, so they must be used on the basis of reinforcing the Spleen and tonifying deficiency.

Summary

The Stomach Polyp Accumulation-Dissolving Decoction is grounded in reinforcing the Spleen and boosting Qi, and proceeds in parallel by transforming phlegm to dissolve accumulation, invigorating Blood to resolve stasis, and transforming turbidity to resolve toxins, with Bletilla protecting the mucous membrane and generating tissue. It is suitable for gastric polyps of the Spleen-Stomach weakness, phlegm-stasis turbid toxin mutual binding type, and is especially appropriate for preventing recurrence after endoscopic resection.

References

[1] China TCM Newspaper. National Renowned TCM Physician Niu Xingdong’s Experience in Treating Gastric Polyps. 2023-04-12.

[2] China TCM Newspaper. National Renowned TCM Physician Niu Xingdong’s Experience in Treating Large Intestine Polyps. 2023-09-16.

[3] Inner Mongolia Autonomous Region Hospital of TCM. Niu Xingdong National Senior TCM Physician Inheritance Studio: Collection of Academic Experience.

23. 胃息肉反覆長出，全國名中醫一張中藥方，從根源上治療

牛興東第二屆全國名中醫，針對胃腸息肉創立”扶正化積”治則，自擬胃息化積湯、腸息化積湯兩首專方。

病機

脾胃虛損為本，痰瘀濁毒互結為標。脾虛則運化失職，溼聚成痰，痰阻氣滯則血行不暢而成瘀，痰瘀久蘊化生濁毒，積漸而成息肉。息肉切除後息肉體質仍在，故易復發。本方以健脾益氣扶正、活血化瘀與化濁解毒祛邪並行，標本兼顧。

方藥組成

組成：黃芪 20g、黨參 15g、炒白朮 15g、枳實 15g、雞內金 30g、陳皮 15g、九香蟲 10g、醋莪術 10g、丹參 15g、山慈菇 15g、半枝蓮 20g、姜半夏 10g、生薏苡仁 30g、白及 10g、炙甘草 10g

功效：健脾益氣，化瘀解毒，消積散結

主治：胃息肉（脾胃虛弱、痰瘀濁毒互結證），症見胃脘脹痛、噯氣納差、神疲乏力

黃芪、黨參、炒白朮為君，益氣健脾，取四君子湯之意扶正固本。枳實、陳皮、雞內金、姜半夏為臣，行氣消痞、化痰消積——枳實破氣消痞，陳皮理氣和中，雞內金消食化積，姜半夏燥溼化痰，四藥合用疏通中焦氣機，使補而不滯。九香蟲、醋莪術、丹參為佐₁，活血化瘀、消癥散結——莪術破血行氣，丹參活血祛瘀，兩藥相須為用治癥瘕積聚；九香蟲溫通理氣，助活血化瘀之力。山慈菇、半枝蓮、生薏苡仁為佐₂，化濁解毒、消癰散結——山慈菇清熱解毒散結，半枝蓮清熱解毒、消腫止痛，生薏苡仁健脾滲溼消瘤，三藥針對濁毒互結之標。白及為佐₃，護膜生肌，保護胃黏膜損傷面。炙甘草為使，調和諸藥，合黃芪、黨參益氣和中。

莪術須用醋制，醋制後引藥入肝，增強破瘀消積之力，且減緩峻烈之性。雞內金用量偏大至30g，取其消食化積之功。山慈菇性涼，脾胃虛寒者需配溫藥同用。

隨證加減

牛興東強調，胃息肉形成非一朝一夕，服藥週期宜長，術後堅持調理3—6個月複查胃鏡。正氣已衰不可妄用攻伐，活血化瘀藥性味苦寒易傷脾陽，須在健脾補虛基礎上使用。

小結

胃息化積湯以健脾益氣為本，化痰消積、活血化瘀、化濁解毒並行，白及護膜生肌。適用於胃息肉屬脾胃虛弱、痰瘀濁毒互結者，尤其適合內鏡切除術後防復發。

參考文獻：

[1] 中國中醫藥報. 全國名中醫牛興東治療胃息肉經驗. 2023-04-12

[2] 中國中醫藥報. 全國名中醫牛興東治療大腸息肉經驗. 2023-09-16

[3] 內蒙古自治區中醫醫院. 牛興東全國老中醫傳承工作室學術經驗彙編