Complementary Replacement Therapy for Chronic Gastritis

Abstract

Gastritis, an inflammation of the stomach lining, arises from diverse causes and ranks among the most frequent digestive ailments. It typically falls into two categories based on the speed of onset: acute and chronic gastritis. Patients with acute gastritis are generally managed symptomatically. Meanwhile, those with chronic gastritis experience ongoing discomfort like epigastric pain, belching, and acid reflux, negatively impacting their quality of life. They can benefit from presently approved medical treatments. To alleviate the physical and mental burden of chronic gastritis and enhance life quality, many patients explore complementary and alternative therapies (CAM). A wide array of CAM options exists, but their safety and effectiveness remain uncertain. If supported by robust evidence, these therapies could potentially become part of standard medical practice for treating chronic gastritis. Approaches like Traditional Chinese Medicine, Acupuncture, Tuina, Diet, Exercise, and Psychological Interventions have demonstrated the capacity to ameliorate symptoms and enhance the well-being of chronic gastritis patients. Identifying high-quality evidence regarding efficacy and safety through Randomized Controlled Trials (RCTs) can facilitate the broader integration of CAM in chronic gastritis treatment. This section offers an overview of the most recent clinical trial findings concerning complementary and alternative therapies.

1. Introduction

Chronic gastritis is a prevalent digestive disorder worldwide, categorized mainly as chronic non-atrophic gastritis and chronic atrophic gastritis. Its occurrence is closely linked to factors such as Helicobacter pylori infection, unhealthy dietary habits, irregular sleep patterns, and emotional instability. According to the World Health Organization, China has witnessed a staggering 30% incidence rate of chronic gastritis. With improving living standards and an aging population, this condition’s prevalence is projected to rise annually. Recurrent chronic gastritis significantly diminishes patients’ quality of life and adds to their emotional burden. Furthermore, if left untreated over extended periods, chronic gastritis can progress to gastric cancer, heightening the risk of cancer among affected individuals. Therefore, the effective prevention and treatment of chronic gastritis present a significant and challenging issue in clinical medicine.

While drugs like gastric acid inhibitors, Helicobacter pylori eradicators, and gastric mucosal protectors have made substantial contributions to managing common chronic gastritis symptoms, they cannot completely eradicate the condition. Moreover, they may lead to adverse reactions and side effects, including reduced drug tolerance, increased drug dependence, and drug interactions. Consequently, many chronic gastritis patients turn to complementary and alternative therapies alongside conventional medical treatments to alleviate discomfort and enhance their quality of life. Complementary and alternative medicine encompasses a range of diagnostic, therapeutic, and preventive methods outside mainstream medicine. It complements mainstream medical practices and offers approaches that mainstream medicine cannot provide. These categories include alternative medicine systems, spiritual intention therapy, biological-based therapies, body adjustment therapy, and energy therapy. Currently, complementary alternative medicine is widely utilized in the clinical management of chronic gastritis, gaining the trust and favor of both patients and healthcare professionals. Traditional Chinese medicine, with its centuries of development, has amassed a wealth of knowledge and techniques for treating digestive system disorders. It stands as a crucial representative of complementary alternative medicine, incorporating Chinese herbal remedies, acupuncture, tuina massage, dietary therapy, qigong exercises, emotional regulation, and other evidence-based treatments tailored to individual patient conditions. These approaches offer several advantages, such as fewer side effects. Over the past decades, extensive research has explored the potential benefits of complementary alternative therapies in preventing and treating chronic gastritis, laying a scientific foundation for their broader adoption. Many complementary alternative therapies, including qigong, moxibustion, and dietary adjustments, are straightforward and easily integrated into people’s daily lives. A comprehensive understanding of these methods enhances patient self-care awareness and provides a valuable reference for patients seeking appropriate treatment options.

This chapter presents the most recent clinical evidence and offers a systematic overview of the current utilization of various complementary alternative therapies for treating chronic gastritis. These therapies encompass Chinese herbal medicine, acupuncture, massage, dietary interventions, exercise, and psychological approaches. The information presented here is not only enlightening but also holds substantial importance for the recovery and enhancement of the quality of life in individuals with chronic gastritis. Additionally, it carries significant implications for advancing research and development in the integration of traditional Chinese medicine with Western medicine. This book caters to a diverse audience, including chronic gastritis patients and their families, healthcare practitioners, and professionals in related fields.

2. Chinese herbal medicine for chronic gastritis

In accordance with traditional Chinese medicine (TCM) principles, chronic gastritis is attributed to imbalances in the Qi mechanism, along with a loss of stomach function and descending. An increasing number of clinical trials have provided compelling evidence for the efficacy of traditional Chinese medicine in the treatment of chronic gastritis. Specifically, it has demonstrated effectiveness in alleviating discomforting symptoms associated with chronic gastritis, such as abdominal distension, abdominal pain, acid reflux, and fatigue. Consequently, it can be considered a dependable complementary therapeutic option that widens the spectrum of treatments available for chronic gastritis.

Tian Guihua, Wu Chuanhong [1], and their team conducted a study involving 20 patients diagnosed with chronic atrophic gastritis of spleen-qi deficiency type. These patients received Sijunzi Decoction continuously for four weeks, leading to noteworthy improvements in clinical discomfort symptoms like abdominal distension and fatigue. Electronic gastroscopy results illustrated that Sijunzi Decoction effectively mitigated gastric mucosa erosion and atrophy in patients with chronic gastritis of spleen-qi deficiency type. The outcomes of the Sijunzi Decoction TCM target network analysis indicate that Radix Astragali can alleviate appetite loss due to spleen deficiency and nourish the spleen and Qi. Rhizoma Atractylodis Macrocephalae, when stir-fried with bran, helps alleviate abdominal distension and increases food intake. Moreover, Poria and honey-fried Radix Glycyrrhizae can alleviate abdominal distension and dull abdominal pain. This study underscores the efficacy of the mentioned traditional Chinese medicine in ameliorating clinical discomfort symptoms associated with chronic gastritis through Qi tonification.

In a study led by Zhao Yushu [2], the clinical effectiveness of Banxia Xiexin Decoction in treating chronic atrophic gastritis with mixed cold and heat syndrome was analyzed. A total of 84 patients with this condition were chosen for the study. After one month of continuous treatment, gastroscopy revealed substantial normalization of the gastric mucosa in patients. The pale areas of the gastric mucosa significantly decreased compared to the pre-treatment condition. The observation group achieved an impressive total effective rate of 95.24%, significantly surpassing the control group. The researcher suggests that including Pinellia in Banxia Xiexin Decoction aids in dampness reduction and minimizes adverse effects, while dried ginger warms the stomach and dispels pathogenic cold. Additionally, Scutellaria baicalensis and Coptis chinensis contribute to heat and dampness elimination, detoxification, and Codonopsis pilosula strengthens the spleen and replenishes Qi. The combined effects substantially enhance the clinical effectiveness of patients with chronic gastritis, rendering it a recommended treatment.

Muo-luo-dan, a traditional Chinese medicine preparation comprising Lily, Ophiopogon japonicus, Panax notoginseng, Poria cocos, and Atractylodes macrocephala, was investigated for its clinical efficacy in treating chronic atrophic gastritis in a study conducted by Ma Chunlei et al. [3]. This randomized controlled trial involved 128 patients diagnosed with gastric chronic atrophic gastritis confirmed through gastroscopic biopsy. After a 3-month treatment period, patients receiving Muo-luo-dan treatment exhibited significant increases in Gastrin-17 (G-17) and Pepsinogen I (PG I) levels. Furthermore, the degree of atrophy in the gastric intrinsic gland was notably improved in the Muo-luo-dan treatment group compared to the control group. G-17 is a vital gastrointestinal hormone that regulates digestive tract function, while PG I is closely linked to gastric acid secretion and digestive function, effectively reflecting the extent of gastric mucosal damage. This clinical trial provides robust evidence that traditional Chinese medicine Muo-luo-dan effectively reduces gastric mucosal injury and enhances gastric function in chronic atrophic gastritis patients. These improvements are instrumental in alleviating clinical discomfort symptoms and slowing the disease’s progression.

Numerous clinical trials have also explored the development of new traditional Chinese medicine preparations for chronic gastritis treatment. Yu Bin et al. [4] conducted an open multicenter clinical trial utilizing Liqi Warming Stomach Granules, developed by Jiangxi Huiren Pharmaceutical, for treating chronic superficial gastritis, involving no fewer than 2000 cases. Liqi Nuanwei Granules, composed of Chinese herbal medicines like Bupleurum Radix, Radix Paeoniae Alba, Galangal, and Rhizoma Cyperi, aimed to observe the improvement in primary symptoms in chronic gastritis patients before and after treatment. After a 4-week treatment period, the results indicated an 89.51% total effective rate in alleviating epigastric pain and other symptoms. Additionally, sub-symptoms such as belching, acid reflux, and appetite loss exhibited significant increases in TCM curative effect scores. This trial provides substantial evidence supporting the definite therapeutic efficacy of traditional Chinese medicine in ameliorating the clinical symptoms of chronic gastritis.

Pingwei Decoction is a commonly used prescription for addressing spleen-stomach disharmony and stomach-related ailments. In a study led by Hu Chunping, Cai Yisheng, and their team, 60 patients with chronic gastritis atrophy and intestinal metaplasia were enrolled to assess the clinical efficacy of Pingwei Decoction [5]. The prescription comprises traditional Chinese medicines such as Malt, Poria cocos, Polygonatum sibiricum, Atractylodes rhizome, Pinellia ternata, among others, and was administered once in the morning and once in the evening. Following three months of continuous treatment, the evaluation of treatment outcomes indicated that the treatment group exhibited a significantly higher effective rate of 96.67% compared to the observation group. Gastroscopy findings revealed improvements in the gastric antrum glands and intestinal metaplasia following Pingwei Decoction treatment. Additionally, TCM symptom scores showcased a reduction in epigastric pain, belching, and acid reflux after the intervention. Moreover, serum gastrin test results demonstrated a significant increase in serum gastrin levels post-treatment. These findings robustly support the effectiveness of Pingwei Decoction in managing chronic gastritis, validating its clinical utility. The researcher suggests that Malt in Pingwei Decoction promotes Qi and aids digestion, while Poria cocos and Polygonatum sibiricum fortify the spleen and replenish Qi. Atractylodes rhizome can eliminate dampness and strengthen the spleen, while Pinellia ternata reduces adverse effects and alleviates vomiting. The combined action of these components yields a favorable therapeutic effect for chronic gastritis.

In addition to Pingwei Decoction, Modified Sanren Decoction is another empirical prescription for treating spleen and stomach ailments. Guo Xinyi, et al. conducted a study involving 35 patients with chronic non-atrophic gastritis to assess the clinical effectiveness of Modified Sanren Decoction [6]. The primary constituents of this medicine include Almonds, Coix seed, Cardamom seed, Magnolia officinalis, Pinellia ternata, and Radix bupleurum, administered once in the morning and once in the evening. The therapeutic effects were evaluated after eight weeks of treatment. The results revealed a clinically effective rate of 94.29% in the treatment group, significantly surpassing that of the control group. Following treatment, the scores for TCM symptoms such as epigastric distension and pain, chest and hypochondriac distension and pain, emotional discomfort, epigastric noise, belching, acid reflux, dry mouth, bitter taste, and sticky stool were notably reduced in both groups. Furthermore, the scores and total scores of various traditional Chinese medicine symptoms in the treatment group were lower than those in the control group after treatment. According to these researchers, Almonds in Modified Sanren Decoction promote Qi movement and dampness elimination; Cardamom seed regulates Qi and harmonizes the stomach; Coix seed fosters water retention and strengthens the spleen. Modern pharmacological studies have also indicated that Sanren Decoction can reduce the degree of gastric mucosal inflammation in chronic gastritis by regulating the differential expression of gastric mucosal proteins and lowering the levels of gastrin and gastric actin, resulting in improved clinical symptoms and signs.

Liu Chenping and Li Yiping [7] conducted a study involving 35 patients diagnosed with chronic atrophic gastritis to assess the clinical effectiveness of Anwei Decoction in treating the spleen deficiency and blood stasis type of chronic atrophic gastritis, along with its impact on the hemorheological indicators of patients. The traditional Chinese medicine composition of Anwei Decoction includes Codonopsis pilosula, Atractylodes macrocephala, Poria, Scutellaria baicalensis, tangerine peel, Radix Glycyrrhizae, and others. After three months of treatment, the researchers observed the TCM syndrome scores and hemorheology indexes of both groups. The results revealed that following treatment, the overall clinical effective rate in the treatment group was 91.4%, surpassing that of the control group (80.6%). The TCM syndrome score in the treatment group was lower than that in the control group, and the treatment group exhibited better therapeutic effects in terms of enhancing whole blood reductive viscosity, plasma viscosity, erythrocyte sedimentation rate, and erythropoiesis equality. This suggests that Anwei Decoction could enhance blood flow status in patients, improve local blood supply, and facilitate the repair of gastric mucosa. The researchers posit that Codonopsis pilosula in Anwei Decoction strengthens the spleen and replenishes Qi. When combined with Atractylodes macrocephala, Poria cocos, and Radix Glycyrrhizae, it forms Sijunzi Decoction, amplifying its spleen-tonifying effects. A healthy spleen promotes adequate circulation of Qi and blood, ensuring unobstructed Qi mechanisms.

Years of clinical research and pharmacological investigations have revealed that Xiangsha Liujunzi Decoction, in the treatment of gastrointestinal diseases, can enhance gastrointestinal motility, alleviate spasticity, reduce gastrointestinal mucosal inflammation, and exert a positive influence on gastric mucosa, flora, and small intestinal motility [8]. In a study conducted by Liu Xia [9], 47 patients with chronic atrophic gastritis were enrolled to evaluate the clinical effectiveness of Xiangsha Liujunzi Decoction in treating chronic gastritis. The control group received conventional Western medicine treatment, while the treatment group was administered Xiangsha Liujunzi Decoction. This prescription includes Atractylodes macrocephala, Poria cocos, Codonopsis pilosula, Tangerine peel, Radix Glycyrrhizae Preparata, Amomum villosum, among other ingredients. After two months of treatment, the results revealed that the treatment group receiving Xiangsha Liujunzi Decoction had significantly lower scores for symptoms such as epigastric pain or flatulence, shortness of breath, lazy speech, and loose stool compared to the control group. Moreover, the treatment group exhibited lower scores for gastric mucosal atrophy and intestinal metaplasia compared to the control group. Researchers believe that Amomum villosum in Xiangsha Liujunzi Decoction plays a protective role in gastric mucosa by exerting anti-inflammatory effects and inhibiting platelet aggregation. Pinellia ternata can alleviate cough, phlegm, vomiting, inhibit inflammatory reactions, and impede the development of gastric cancer cells. Tangerine peel offers antioxidant, antibacterial, and immune-regulatory properties, while also reducing blood lipid levels and demonstrating anti-tumor effects. These findings demonstrate the favorable therapeutic effect of Xiangsha Liujunzi Decoction on chronic atrophic gastritis, effectively relieving clinical symptoms and signs while reducing inflammatory damage to the gastric mucosa.

Collectively, the aforementioned clinical trials underscore the substantial advantages of traditional Chinese medicine in the treatment of chronic gastritis. It offers high safety and minimal side effects, effectively improving the clinical symptoms, controlling and reversing gastric mucosal atrophy, reducing recurrence, and decreasing the transformation rate to gastric cancer. As such, it stands as a reliable, safe, and valuable complementary and alternative therapy.

3. Acupuncture and moxibustion, massage for chronic gastritis

3.1 Acupuncture

In clinical practice, chronic gastritis patients are predominantly treated with pharmaceuticals. However, these drugs often come with significant side effects and should not be used over extended periods. Acupuncture, as a treatment for chronic gastritis, offers notable improvements in patients’ clinical symptoms and is gaining increasing attention in research.

Acupoints represent specialized locations along the meridians that carry the flow of qi and blood within the body’s internal organs. They also serve as reaction points for diseases and focal points for acupuncture and other therapeutic interventions. Clinical experiments examining pain-sensitive points in patients with chronic non-atrophic gastritis (CNAG) have revealed [10] that these patients commonly exhibit sensitivity at various acupoints. The most frequently affected meridians are the ren pulse, gastric meridian, spleen meridian, kidney meridian, bladder meridian, with some instances occurring outside meridians and non-acupoint areas. Acupuncture at these sensitivity points significantly alleviates the level of pain sensitivity experienced by patients. This improvement in pain sensitivity helps alleviate clinical symptoms such as stomach pain, abdominal fullness, heartburn, acid reflux, belching, and more. Research has indicated that acupoint pain sensitivity is linked to the sensitization of spinal cord dorsal horn neurons by internal organs. This sensitization leads to a heightened response of neurons to signals originating from the body’s surface. Each organ corresponds to a specific nerve segment, making pain-sensitive points commonly located within the nerve segment innervating the organ or adjacent nerve segment areas.

Acupuncture, a method involving the use of a red-hot needle, quickly punctures the selected point or area with the aid of the dual stimulation of acupuncture and heat. A clinical study conducted at the First Affiliated Hospital of Tianjin University of Chinese Medicine [11] employed fire acupuncture (0.4 × 35 mm) for rapid puncture in the treatment group. The results demonstrated that fire acupuncture significantly improved symptoms like stomach fullness, stomach pain, chest and hypochondrium pain, poor feeding, nausea, and vomiting in patients with chronic gastritis (CG). Moreover, patients’ physiological and psychological well-being saw significant improvement following fire acupuncture treatment. It effectively alleviated anxiety and depression in CG patients and enhanced their overall quality of life.

Zhou Wei et al. [12] conducted a comparative study to assess the effectiveness of meridian diagnosis and acupuncture against conventional acupuncture in treating CAG. The observation group employed a comprehensive approach, utilizing meridian energy analyzers and hand inspection meridian methods to identify and select meridian points. They also selected the plus Luo-connecting point and Back-Shu point empirically and made adjustments to the points of eight extra meridians following acupuncture principles. In contrast, the control group primarily used acupoints including Zhongwan (RN12), Neiguan (PC6), Zusanli (ST36), and Gongsun (SP4) based on dialectical considerations. The results indicated that meridian diagnosis and acupuncture were superior to conventional acupuncture in treating CAG. This approach produced more significant effects on the pathology of gastric mucosa and maintained stable long-term efficacy.

Acupuncture, when applied in the treatment of CG, has demonstrated positive clinical outcomes by inhibiting inflammatory factors, protecting the gastric mucosa, and enhancing patients’ quality of life. However, certain challenges exist, including the limited scale of research that may affect its credibility. Moreover, different pathological types and traditional Chinese medicine symptom types require distinct treatment approaches, and the criteria for assessing efficacy lack uniformity, diminishing the comparability of various studies. To address these issues, future studies should focus on increasing sample sizes in experimental and clinical research to enhance the credibility of their findings.

3.2 Moxibustion

Moxibustion, a traditional therapeutic technique in Chinese medicine, is renowned for its ability to stimulate acupoints along the body’s meridians, warming them, dispelling cold, alleviating pain, and reducing swelling [13]. It has shown significant effectiveness in improving clinical symptoms of patients suffering from CG and positively impacting abnormal pathological manifestations of the gastric mucosa. Chinese medicine encompasses a variety of traditional moxibustion methods. This section focuses on the current research related to commonly used moxibustion techniques in the clinical treatment of CG.

Mild moxibustion falls within the category of suspended moxibustion, using moxa sticks. In this method, the ignited end of the moxa stick is held approximately an inch away from the skin at the moxibustion site, providing patients with a warm sensation without causing burning pain. Xie Hua et al. observed the clinical effectiveness of mild moxibustion in treating superficial gastritis with spleen and stomach deficiency-cold syndrome. They found that mild moxibustion can improve clinical symptoms in patients and regulate the levels of serum prostaglandin E2 (PGE2), somatostatin (SS), and epidermal growth factor (EGF). Moreover, it has shown long-term efficacy. The team also investigated the varying therapeutic effects of different moxibustion durations for this condition and discovered that mild moxibustion for 20 minutes significantly alleviates gastric pain, while mild moxibustion for 40 minutes has a more pronounced effect on relieving upper abdominal distension symptoms [14, 15].

Grain-sized moxibustion involves applying moxibustion by placing small pieces of moxa floss, approximately the size of a wheat grain, on the skin. The combustion temperature is carefully controlled to ensure optimal efficacy. This method promotes the flow of energy, activates the body’s defense mechanisms, and enhances immune function. Cai Yumei and colleagues [16] observed that grain-sized moxibustion significantly improves symptom scores in patients with chronic superficial gastritis (CSG) and enhances their overall physiological and psychological quality of life scores (PCS and MCS). This technique effectively improves the clinical symptoms and quality of life of CSG patients, with better long-term efficacy compared to warm needle moxibustion. Liu Xiaofeng [17] and others used modified painless grain-sized septic moxibustion combined with traditional Chinese medicine to treat chronic non-atrophic gastritis (CNAG). This approach not only effectively improved the clinical symptoms of CNAG patients but also significantly enhanced their quality of life. The long-term efficacy of this combined treatment surpassed that of traditional Chinese medicine alone. Septic moxibustion, a distinctive therapy in traditional Chinese medicine, stimulates the body’s immune response through the persistent local inflammatory reaction generated during the treatment process [18].

Ginger partition moxibustion is a moxibustion method that involves placing thin slices of ginger as a barrier on the moxibustion site. Ginger’s spicy flavor and mild warming properties are harnessed to enhance the warmth generated during moxibustion. This technique stimulates meridian points in the human body, enhancing stomach motility, regulating gastric protease and gastric acid levels, and inhibiting gastric inflammatory reactions. It can also improve gastric mucosal atrophy and intestinal transformation [19]. Cao Wen [20] further improved the clinical effectiveness of treating CAG by adding ginger partition moxibustion to conventional Western medicine. This approach alleviated symptoms such as stomach distension and pain while protecting the gastric mucosa and reducing atrophy. He Jing [21] compared the clinical effectiveness of traditional moxibustion sticks and smokeless moxibustion sticks with ginger partition moxibustion in CAG treatment. Both methods significantly improved clinical symptoms and regulated serum indicators such as gastric secretin CAS. Traditional moxibustion sticks provided better efficacy due to their longer suitable temperature and stimulation time compared to smokeless moxibustion sticks with ginger partition moxibustion. Additionally, Yi Zhan et al. investigated the effects of different durations of ginger-separated moxibustion on the levels of superoxide dismutase (SOD) and malondialdehyde (MDA) in the serum of patients with chronic superficial gastritis and spleen and stomach deficiency-cold syndrome. The results demonstrated that ginger-separated moxibustion increased the activity of the antioxidant enzyme SOD while decreasing the levels of the free radical MDA in the serum. Furthermore, compared to ginger-separated moxibustion lasting for 20 minutes, ginger-separated moxibustion for 40 minutes had a significantly greater effect on increasing SOD levels. This suggests that the therapeutic effect of ginger-separated moxibustion in treating chronic gastritis may be associated with its positive regulation of the enzyme system involved in the production and clearance of oxygen free radicals [22].

Medicinal cakes used in partition moxibustion are typically composed of warm and pungent herbs such as Aconiti Radix and Cinnamomi Ramulus. When subjected to the heat produced during moxibustion, the active ingredients in these medicinal cakes are absorbed through the skin. This method avoids potential liver damage that can occur with oral medication metabolism. Gu Mu’en [23] conducted a comparison between the treatment of CAG patients using partition moxibustion with medicinal cakes and ginger partition moxibustion. The results indicated that both methods improved clinical symptoms in CAG patients and alleviated gastric mucosal atrophy and intestinal transformation. The use of medicinal cakes in partition moxibustion had advantages in improving symptoms like stomach pain and decreased appetite.

Moxa box moxibustion involves inserting moxa into a special moxa box placed in corresponding parts for moxibustion. The use of moxa boxes concentrates the heat generated by burning moxa sticks, maintaining a consistent moxibustion temperature and fully leveraging the warming and tonifying effects on the body’s deficiencies and qi and blood. Wang Xiaowen [24] employed box moxibustion combined with herbal warm compress to treat chronic gastritis patients, resulting in significant alleviation of epigastric pain and improved clinical efficacy.

In conclusion, moxibustion therapy has demonstrated significant effectiveness and safety in treating chronic gastritis. In the future, further exploration of various moxibustion techniques for gastritis treatment, including acupuncture point selection, clinical procedures, and therapeutic effects, can be conducted to establish standards. This will hold greater significance for guiding scientific research and clinical practice.

3.3 Massage therapy for chronic gastritis

The vibration method is a commonly employed massage technique in clinical practice, known for its positive therapeutic effects on spleen and stomach diseases along with their accompanying symptoms and complications. In the vibration method, the entire palm, base of the palm, or fingertip of the finger serves as the focal point. It generates tremors through small and rapid alternating contractions and relaxations of the forearm flexor and extensor muscles, transmitting force to the deeper parts of the body [25].

Abdominal vibration massage is a commonly used massage technique in the clinical treatment of chronic gastritis [26]. This method focuses on the abdominal Shenque acupoint and involves stimulating various meridians, including the Ren meridian, kidney meridian, spleen, and stomach meridian. It induces stable and continuous tremors, triggering biochemical reactions and neurohumoral changes in the body. This approach helps regulate immune function, improve physiological functioning, and contribute to disease treatment. When combined with abdominal massage, it effectively regulates the middle energizer and the three energizer passageways, which is essential for balancing spleen and stomach qi function in the treatment of chronic gastritis. Effective treatment of chronic gastritis revolves around maintaining the balance of spleen and stomach qi. This balance is achieved through mechanical and warm stimulation that promotes the absorption of gastric mucosal inflammation, ulcer repair, and disease control. The abdominal vibration massage method focuses on the abdomen, using the Shenque acupoint at the palm’s root as the center. It gently and continuously vibrates, stimulating the spleen and stomach meridians of the middle energizer and both sides. During the procedure, practitioners can also apply pressure to the Qihai (RN6), Tianshu (ST25), and Zhongwan (RN12). Chronic gastritis often has a connection to liver depression, and patients’ clinical symptoms are frequently linked to emotional fluctuations. The abdominal vibration massage method targets the Shenque acupoint as the center and stimulates the Belt Vessel and Tianshu acupoints on both sides through gentle rhythmic vibrations. This helps unblock liver and gallbladder qi, regulate the central nervous system, promote qi circulation, alleviate depression, clear the intestines, and enhance gastrointestinal peristalsis. Additionally, abdominal rubbing and kneading techniques generate heat and drive subcutaneous tissue, benefiting individuals with severe Qi stagnation. Yi Liujuan [27] conducted research on the effect of the palm vibration method as the primary massage technique combined with stellate ganglion catgut embedding for improving clinical symptoms in patients with chronic gastritis. The results indicated that single catgut embedding treatment was slower in its effect. However, when combined with the palm vibration method, it significantly improved traditional Chinese medicine symptoms, clinical symptoms, and reduced oxidative stress reactions in patients with chronic gastritis. This combination therapy demonstrated enhanced efficacy in alleviating chronic gastritis symptoms.

The back massage method is often employed to treat chronic gastritis, especially in cases where patients exhibit spleen and stomach deficiency, an inability to transform their diet, or damage to the middle yang. Chronic gastritis of this nature may manifest as endogenous deficiency and cold, bloating, pain, a gradual loss of spleen and stomach transformation, a decline in spleen yang, and even involvement of kidney yang. In such cases, all organs lack nourishment. Abdominal vibration massage, when used in this context, targets the Shenque acupoint and stimulates the meridians, navel circumference, and vital gate. It strengthens the central area while nourishing the fire and soil, promoting warmth and nourishment in the body. Jiang Manjun [28] also suggested that massage therapy can be beneficial for individuals with chronic superficial gastritis of the spleen-stomach deficiency cold type. The treatment involves using the thumb or middle finger’s abdominal force to massage specific parts or acupoints on the abdomen and back, focusing on the Governor Vessel and back shu acupoints. This approach follows the theory of acupoint matching between back-shu points and front-mu points and interacts with abdominal and Conception Vessel acupoints, which are related to corresponding organs. By infusing Yang Qi into each organ, it stimulates Yang Qi distribution throughout the body via the meridians. This ensures the normal operation and gasification function of organs like the spleen and stomach. Li Nanxi [29] and others have also demonstrated that massaging along the meridians on the abdomen and back can clear the meridians, regulate yin and yang, strengthen the spleen and stomach, and promote qi regulation. This approach has shown promise in treating chronic gastritis.

In summary, patients treated with the vibration massage as the primary method have experienced significant improvements in clinical symptoms such as loss of appetite, bloating, abdominal pain, belching, and pantothenic acid. In clinical practice, SOD and MDA are commonly used oxidative stress indicators [30]. The massage method, particularly the vibration method, changes the internal environment’s state through stimulation. Techniques like pressing, pressing, and rubbing unblock the meridians, enhance gastrointestinal motility, and significantly reduce oxidative stress reactions. Overall, massage treatment for chronic gastritis has demonstrated favorable therapeutic effects and promising applications.

4. Diet therapy for chronic gastritis

Diet therapy plays a significant role in the management of chronic gastritis. TCM diet therapy utilizes the principles of TCM to strengthen the body’s resistance and eliminate pathogenic factors. In Chinese culture, there has long been an understanding that “medicine and food are homologous,” emphasizing the idea that food can have therapeutic effects similar to medicine.

Chronic gastritis is a type of epigastric pain in traditional Chinese medicine (TCM). As the saying goes, “Treating the stomach requires three parts treatment and seven parts nourishment.” Treating chronic gastritis involves adopting sensible dietary habits. Several studies have indicated that by understanding the causes of chronic gastritis and combining medication with dietary control, patients can alleviate symptoms and manage the disease’s progression [31, 32, 33]. In recent years, a growing body of clinical data has affirmed that nourishing the spleen and stomach through diet benefits gastrointestinal function and is a crucial approach for treating and caring for chronic gastritis.

Wang Shurong et al. [34] adhere to TCM dietotherapy principles in clinical practice, providing tailored treatments based on patients’ unique conditions. They conducted a study involving 60 patients with CAG. The control group received a regular diet, while the treatment group received a regular diet combined with dietotherapy based on syndrome differentiation. In TCM, CAG is categorized into various syndromes, including Deficiency-cold syndrome of spleen and stomach, Stomach Yin Deficiency Syndrome, Syndrome of stagnation of heat in the liver and stomach, Syndrome of blood stasis blocking the stomach, and Syndrome of food stagnation. Food materials are classified according to meridians for balanced compatibility, with corresponding treatments such as dried ginger porridge with yam, Adenophora ginseng and lily porridge, Ophiopogon japonicus porridge, Hawthorn and Tremella Soup, and Divine Comedy and Grain Sprout Porridge. The results revealed that the treatment group achieved an overall response rate of 95.0%, significantly higher than the control group’s 83.3%, demonstrating the effectiveness of dialectical dietary therapy in improving chronic atrophic gastritis.

Wang Zhenzhen et al. [35] assert that, prior to commencing dietary nursing interventions, it is crucial to comprehensively explain the significance of dietary adjustments to patients. The research encompassed 110 patients suffering from chronic gastritis. The control group received standard nursing care, while the observation group had tailored dietary nursing strategies devised based on their specific syndrome types. For individuals with a Deficiency of spleen and stomach, the recommendation included consuming more easily digestible foods such as porridge, which nourishes the spleen and boosts qi, while also warming the stomach and dispelling cold sensations. These foods encompass millet, carrots, yams, etc. Conversely, they were advised to steer clear of cold and refrigerated fruits, as well as raw or chilled beverages like watermelon and bitter gourd. Patients exhibiting disharmony between the liver and stomach were directed to prioritize liquid and pasta-based meals, emphasizing slow chewing and swallowing, in addition to adhering to regular meal schedules. During their nursing period, abstaining from smoking or alcohol was encouraged, along with the consumption of foods conducive to stomach comfort and qi regulation, such as lotus root, lentils, and hawthorn, while avoiding fatty and heavy fare such as greasy meats and seafood, etc. For those with damp-heat type spleen and stomach conditions, an intake rich in heat-clearing, diuretic, yin-nourishing, and fluid-promoting foods, like lotus seeds, red beans, cucumbers, etc., was suggested. On the flip side, spicy and fiery foods, such as pepper and ginger, were to be avoided. Patients exhibiting stomach yin deficiency were advised to include more qi-replenishing, yin-nourishing, and moisture-enhancing foods in their diets, like duck, milk, tremella, and lily, while steering clear of items known to generate heat and harm yin, such as mutton, dog meat, strong tea, coffee, and garlic, etc. Those with blood stasis in stomach collaterals were encouraged to consume foods promoting qi and blood circulation, including eggplant, kelp, and mushrooms, while avoiding astringent and cold items like dark plum, sweet potatoes, and persimmons, etc. Furthermore, it was recommended to prompt patients to diligently record their daily dietary choices, meal times, and meal frequency. Healthcare professionals should maintain continuous monitoring of the patients’ adherence to their dietary plans and offer timely, tailored guidance. The results demonstrated that, in comparison to the control group, patients in the observation group experienced a shorter duration of upper abdominal pain, abdominal distension, and other adverse symptoms. They also reported greater satisfaction and exhibited improved nutritional status. This study underscores that judicious application of dietary therapy as an adjunctive treatment in patients with chronic atrophic gastritis serves not only as nutritional support but also as a therapeutic measure. Additionally, it can enhance patients’ quality of life and satisfaction with nursing care. Dietary therapy effectively merges prevention and treatment, yielding satisfactory therapeutic outcomes and showcasing the distinctive facets of TCM dietary practices.

Liu Jun [36] emphasizes the limitations of single-drug therapy and underscores the importance of incorporating diet therapy into the treatment of chronic gastritis alongside peptic ulcers. This study involved 82 patients with both chronic gastritis and peptic ulcers. In this approach, physicians are advised not only to guide patients in taking omeprazole capsules regularly and in appropriate doses but also to offer dietary recommendations tailored to the patient’s clinical symptoms and condition. A scientifically sound dietary plan should be devised to encourage the consumption of low-fat, high-protein, and easily digestible foods. It is recommended to include items such as cucumber, cabbage, apples, pears, and to consume warm water before meals, which can effectively safeguard the gastric mucosa.

Mao Yanping et al. [37, 38] have established a strong connection between dietary cellulose intake and dietary habits with CAG (chronic atrophic gastritis). A high dietary fiber diet has demonstrated the ability to delay or even reverse the progression of this disease. Zheng Jie, and others [39] contend that many high dietary fiber sources exhibit excellent anti-inflammatory and antioxidant properties, with common sources being legumes, seaweed, mushrooms, fruits, vegetables, and rhizomes. Notably, seaweed boasts the highest dietary fiber content, followed by grains, mushrooms, roots, fruits, and vegetables. Building upon this, Zhu Chunhua and Feng Yuke [40] conducted a group intervention and observation study involving 86 CAG patients to investigate the application of a high-fiber diet. The results demonstrated that after the intervention, both groups experienced improvements in mental health, physiological function, emotional well-being, and social function, with the observation group showing greater improvements. This highlights the significant impact of a high-fiber diet on CAG patients, enhancing their condition, nutritional status, and overall quality of life.

Gao Fan [41] conducted a review of clinical data from 80 children with chronic gastritis to assess the effectiveness of seamless nursing combined with diet intervention. Nutritionists crafted personalized dietary plans based on the child’s age and condition. These plans included foods rich in fiber, protein, vitamins, and zinc, such as eggs, lotus root, carrots, and shrimp. Additionally, easily digestible and light foods like broccoli, noodles, and bananas were recommended, while hard, overheated, excessively cold, highly acidic, spicy, or greasy foods were discouraged. Guidance on developing healthy eating habits, including chewing slowly, consuming smaller, more frequent meals, and avoiding overeating, was provided. The results indicate that, alongside effective chronic gastritis treatment, it is essential to create a scientifically rational dietary plan tailored to the child’s condition. This approach helps alleviate clinical symptoms and enhance compliance. Dietary intervention effectively assists children with chronic gastritis in forming healthy eating habits, ensuring adequate nutrition during treatment, promoting physical recovery, and bolstering overall health [42, 43].

Lu Meirong and Zheng Shufeng [44, 45] both stress the significance of dietary intervention and dietary health education in caring for patients with chronic gastritis. Zheng conducted a study with 56 chronic gastritis patients, dividing them into a control group and an observation group. The control group received standard care, while the observation group underwent specific dietary interventions, including the following steps: Firstly, doctors should guide patients in adapting their diet plans, emphasizing eating smaller, more frequent meals, and increasing the frequency of chewing during meals to enhance digestion. Secondly, it is essential to establish a rational dietary structure, encouraging patients to consume more vegetables and foods rich in vitamins that are easily digestible and highly nutritious. Cooking methods should primarily involve steaming, boiling, stewing, and braising, while methods such as frying and roasting should be avoided. Legumes and peanuts should be cooked before consumption. Lastly, attention should be devoted to dietary hygiene, avoiding overeating and refraining from consuming spicy, irritating, and cold foods to prevent aggravation of the condition due to irritation of the gastric mucosa. For patients experiencing symptoms like nausea, vomiting, and acute massive bleeding, it is advisable to abstain from eating. For patients with peptic ulcers, a diet consisting of mild and liquid foods is recommended after 12–24 hours of bleeding cessation. In the case of cirrhosis patients, they should opt for liquid foods rich in vitamins and high in calories after 2–3 days of bleeding cessation, while strictly limiting sodium, salt, and protein intake. These research findings indicate that dietary care serves a dual purpose: on one hand, it helps mitigate the gastrointestinal burden resulting from poor dietary habits, which can stimulate gastric mucosal function and exacerbate the condition; on the other hand, it provides essential nutrients for recovery, facilitating disease improvement. Effective management of chronic gastritis cannot be divorced from sound dietary practices. The integration of dietary intervention with health education not only prevents and treats chronic gastritis but also enhances patients’ psychological well-being, sleep quality, quality of life, and daily functioning, while also reducing the risk of disease recurrence. It stands as a vital measure in the treatment and care of chronic gastritis.

The clinical trial results mentioned above demonstrate the effectiveness of dietary therapy in enhancing the well-being of chronic gastritis patients. It effectively alleviates adverse symptoms like nausea and vomiting, boosts patients’ psychological health, elevates nutritional levels, mitigates complications arising from nutritional deficiencies during treatment, enhances patients’ quality of life, and improves their overall physical condition. This underscores that dietary therapy is a dependable, efficient, and secure complementary treatment option deserving of widespread clinical adoption and utilization.

5. Chronic gastritis exercise alternative therapy

Chronic gastritis is primarily characterized by symptoms like epigastric pain, abdominal bloating, and indigestion. Engaging in appropriate and moderate exercise can have several positive effects on gastrointestinal health. It can enhance gastrointestinal peristalsis, improve blood circulation to the gastric mucosa, facilitate the healing of gastric mucosal inflammation, and consequently enhance digestive function and stimulate appetite. Additionally, regular physical activity can alleviate symptoms of anxiety, depression, and loneliness often experienced by chronic gastritis patients. Moreover, it contributes to the maintenance of a balanced yin and yang within the body. In traditional Chinese medicine, the practice of gongfu exercises is known to boost yang qi, regulate the flow of qi and blood, strengthen the body, and enhance the body’s ability to prevent diseases [46].

A survey conducted by Deng Tietao, a master of Traditional Chinese medicine, examined 147 individuals. It found that 64 individuals “felt that their spleen and stomach functions were normal,” of whom 60.94% (39/64) engaged in regular physical activity. In contrast, of the remaining 83 individuals who “felt that their spleen and stomach functions were not normal,” 32.53% (27/83) engaged in regular physical activity. This survey explored public attitudes toward Chinese medicine exercise techniques, exercise habits, and gastrointestinal health. The findings suggest that individuals with normal spleen and stomach functions are more likely to be frequent physical exercisers, hinting at the potential benefits of exercise for spleen and stomach health. Research has shown that exercise has a bidirectional stimulating effect on gastrointestinal muscles, promoting gastrointestinal muscle peristalsis, enhancing the secretion of digestive juices, regulating cerebral intestinal peptides, and improving the body’s microenvironment [47].

In a study by Wang Jing, 124 cases of bile reflux gastritis were randomly divided into a treatment group and a control group. The results revealed that combining exercise therapy with Western medicine for the treatment of bile reflux gastritis can improve clinical outcomes, offering valuable insights for clinical practice [48]. Traditional Chinese Medicine Guidance, a branch of exercise therapy, incorporates traditional techniques like the Eight-Section Brocade, Tai Chi, Five-Animal Exercise, and more. It emphasizes the integration of physical movement, breathing, and psychological regulation, focusing on regulating the body, breathing, and heart as fundamental elements. This approach has demonstrated clinical efficacy and research significance in preventing and treating diseases of the digestive system, cardiovascular system, and tumors [49]. Utilizing Traditional Chinese Medicine Guidance, such as the Eight-Section Brocade and Five-Animal Exercise, often yields positive therapeutic outcomes in the treatment of chronic gastritis.

Huang Lingshan conducted research on the treatment of chronic gastritis patients using Eight-Section Brocade Exercises. The treatment group exhibited significantly quicker pain reduction compared to the control group. Eight-Section Brocade Exercises, characterized as mild and safe aerobic exercise, play a role in harmonizing internal organs and achieving the goal of “stabilizing the five organs and stabilizing the blood vessels.” This exercise, with its “rigid and flexible” movements, can effectively clear qi and blood meridians, regulate internal organ function, enhance physical fitness, improve the quality of life for patients with chronic gastritis and liver-stomach disharmony, and enhance the effectiveness of treatment [50]. Li Zhou and colleagues investigated the impact of Eight-Section Brocade on the care outcomes of patients with chronic gastritis accompanied by anxiety and depression. In the study, the control group received routine treatment and care, while the observation group incorporated the Eight-Section Brocade into their care regimen alongside routine treatment. The results revealed that the observation group experienced better therapeutic outcomes compared to the control group. The application of Eight-Section Brocade in the care of patients with chronic gastritis and comorbid anxiety and depression positively influenced their clinical symptoms and psychological well-being, thereby facilitating their recovery [51].

Zhang Ping researched the effects of Bear Exercise within the Five-Animal Exercise regimen on patients with chronic atrophic gastritis. The findings demonstrated that the addition of Bear Exercise to conventional treatment was more effective in alleviating gastrointestinal discomfort symptoms, with improvements becoming more pronounced over time [52].

Chronic gastritis, characterized by its enduring and recurrent nature due to multiple factors, benefits from exercise in improving and regulating organ function to establish a relative balance between yin and yang within the body. Experimental studies have revealed that exercise induces the cerebral cortex to enter an inhibitory state, facilitating the restoration of normal regulatory function in the central nervous system. This adjustment influences the activity of the autonomic nervous system, enhancing gastric peristalsis and diaphragmatic movement, which, in turn, promotes gastric juice secretion and an increase in salivary amylase content, thus boosting appetite and facilitating weight gain [53].

Consequently, regular exercise holds considerable benefits for patients with chronic gastritis, aiding in their recovery and overall well-being. Exercise serves as a pivotal component in the prevention and treatment of chronic gastritis and can serve as a valuable reference for clinical practice.

6. Psychological intervention therapy for chronic gastritis

Chronic gastritis, a prevalent gastrointestinal ailment, is chiefly characterized by upper abdominal pain, feelings of fullness and burning sensations, which tend to worsen after meals, significantly impacting the daily lives and work routines of affected individuals. The protracted treatment course and unpredictable nature of the condition can lead to persistent abdominal pain during the therapeutic process, subsequently giving rise to negative emotions such as anxiety, depression, pessimism, or tension among patients. Prolonged negative emotions can gradually precipitate psychological disorders, manifesting not only as gastrointestinal lesions stemming from gastritis but also encompassing symptoms like depression, irritability, and insomnia, further exacerbating the condition and impeding treatment effectiveness. In light of these challenges, it is recommended to complement the standard treatment of chronic gastritis with essential psychological interventions aimed at mitigating adverse psychological states and enhancing patient treatment compliance.

In a recent clinical study involving 77 patients grappling with chronic gastritis [54], a noteworthy distinction became evident between two distinct groups. When compared to the control cohort, which solely received fundamental care measures, the experimental group underwent a comprehensive regimen encompassing individualized dietary guidance and behavioral psychological interventions. The results were remarkable: the experimental group exhibited significantly reduced levels of anxiety, depression, and pain. Simultaneously, they experienced substantial enhancements in social interactions, sleep quality, and emotional well-being. These findings underscore the significant potential of individualized dietary care and behavioral psychological interventions in augmenting the efficacy of chronic gastritis treatment, ultimately elevating the overall quality of life for patients.

In another clinical study conducted at the Zhengzhou Hospital of Traditional Chinese Medicine [55], 61 patients diagnosed with chronic gastritis were randomly divided into two groups. The control group (n = 30) received standard care, while the study group (n = 31) received standard care coupled with comprehensive psychological support. This support encompassed mental health assessments, empathetic listening, health education, mindfulness-based silence therapy, cognitive and emotional therapy, as well as verbal and non-verbal communication. Following the intervention, it became evident that the study group, in comparison to the control group, exhibited superior improvements in SAS and SDS scores. Additionally, the study group demonstrated a notably higher treatment compliance rate (96.77%) when contrasted with the control group (73.33%). This study underscores the potential advantages of integrating comprehensive psychological care with standard treatment to assist patients in managing their emotional well-being, rectifying misconceptions, and enhancing treatment compliance.

The clinical study results mentioned above consistently highlight the significant advantages of incorporating psychological interventions, which are inherently safe. These interventions efficiently alleviate negative emotions in chronic gastritis patients, improve treatment adherence, and notably alleviate the clinical symptoms associated with this condition. As such, they represent a dependable, safe, and complementary therapeutic approach that merits broader promotion and adoption.