Pathogenesis evolution and stage-based treatment of chronic atrophic gastritis based on "Liu Shi Run Zao"

Chronic atrophic gastritis (CAG) has a complex pathogenesis and diverse clinical manifestations. Its protracted and refractory course significantly impairs patients′ quality of life. The "Liu Shi Run Zao" theory aims to unblock stagnation and regulate qi movement, thereby enabling retained fluids to redistribute and circulate, thus moistening sites damaged by dryness. At each CAG phases, the core imbalance centers on the disharmony between dryness and dampness, with "moistening dryness by promoting fluid flow" serving as the guiding principle in both pathological analysis and the formulation of therapeutic strategies throughout the entire disease course. In the dampness stagnation phase, often arising from spleen-stomach deficiency, internal damp-turbidity retention, and qi stagnation, treatment focuses on resolving dampness, eliminating turbidity, fortifying the spleen, and harmonizing the stomach. Mild and neutral formulas, such as Xiangsha Liujunzi Decoction and Sanren Decoction, are used to fortify the spleen, disperse dampness, and promote circulation. In the dryness accumulation phase, where dampness transforms into dryness, consuming stomach yin and leading to malnourishment of the stomach collaterals, treatment emphasizes moistening dryness, clearing heat, and nourishing yin. Formulas like Shashen Maidong Decoction and Yiwei Decoction are prescribed to replenish yin with sweet-cool and moistening herbs. In the deficiency-consumption phase, characterized by yin depletion and blood stagnation, stasis damaging the collaterals, and tissue erosion caused by dryness and toxicity, treatment focuses on enriching yin, unblocking collaterals, resolving toxicity, and dispersing concretions. Formulas such as Tongluo Yiwei Decoction and Jianpi Huayu Jiedu Decoction are used to vigorously supplement stomach yin, activate blood circulation, break up concretions, and prevent cancer. Throughout all phases, the treatment integrates the principles of unblocking and tonifying, moistening and drying, and attacking and defending in an orderly manner, advancing stepwise to effectively reverse gastric mucosal atrophy and prevent carcinogenesis in CAG.