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CN114569690A - Traditional Chinese medicine composition for treating helicobacter pylori infectious gastritis - Google Patents

Traditional Chinese medicine composition for treating helicobacter pylori infectious gastritis Download PDF

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Publication number
CN114569690A
CN114569690A CN202210290669.3A CN202210290669A CN114569690A CN 114569690 A CN114569690 A CN 114569690A CN 202210290669 A CN202210290669 A CN 202210290669A CN 114569690 A CN114569690 A CN 114569690A
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chinese medicine
traditional chinese
helicobacter pylori
root
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CN114569690B (en
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范艺缤
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Nanchong Traditional Chinese Medicine Hospital
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Nanchong Traditional Chinese Medicine Hospital
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Abstract

The invention discloses a traditional Chinese medicine composition for treating helicobacter pylori infectious gastritis, which is prepared from the following raw materials in parts by weight: 10-30 parts of sargentgloryvine stem, 15-30 parts of snakegourd seed, 30-60 parts of hairyvein agrimony, 15-20 parts of radix curcumae, 10-20 parts of inula flower, 5-10 parts of aspongopus, 15-30 parts of Chinese sage herb, 15-30 parts of paederia scandens, 10-20 parts of curcuma zedoary, 10-30 parts of red paeony root, 15-30 parts of fried bighead atractylodes rhizome, 10-20 parts of bletilla striata, 10-30 parts of hibiscus leaf, 10-20 parts of cynanchum paniculatum, 15-30 parts of radix clematidis, 10-20 parts of immature bitter orange, 10-30 parts of oyster, 3-6 parts of nardostachys chinensis and 5-10 parts of liquorice. The composition has precise and appropriate compatibility, can effectively improve the symptoms of stomachache, gastrectasia, acid regurgitation, anorexia and the like of the helicobacter pylori infectious gastritis, and improves the eradication rate of the helicobacter pylori infection.

Description

Traditional Chinese medicine composition for treating helicobacter pylori infectious gastritis
Technical Field
The invention particularly relates to a traditional Chinese medicine composition for treating helicobacter pylori infectious gastritis.
Background
In 1983, Australian scholars Marshall and Warren isolated HP from the mucus layer and epithelial cells of the gastric antrum of patients with chronic gastritis for the first time. Since then, a large number of experimental studies are carried out on chronic gastritis patients by various scholars, HP is cultured in gastric mucosa of 60-90% of chronic gastritis patients, and then the infection degree of HP and the degree of gastric mucositis are found to be in a positive correlation relationship. In 1986, the eighth meeting of the world gastroenterology society suggested that HP infection is one of the important causes of chronic gastritis. Long-term medical practice shows that although the traditional antibiotic therapy and bismuth treatment have obvious curative effect, the problems of side effect, drug resistance, much relapse and the like of the medicines are gradually increased along with the removal of Hp in the treatment process, so that the radical cure rate is obviously reduced, the symptoms are stubborn and difficult to cure, many patients pay attention to the fact that the patients can get the gastric cancer by themselves, and the physical and mental health and the life quality of the patients are seriously affected.
The traditional Chinese medicine considers that the symptoms of chronic diseases, stasis, strange diseases, excessive phlegm, difficult diseases, multiple viruses and difficult diseases are extreme in the patients with helicobacter pylori related gastritis. Gastritis belongs to the categories of stomachache, distention and fullness and the like in the traditional Chinese medicine, the principle of regulating qi, harmonizing stomach and relieving pain is mainly taken as a basic principle in clinic, and a formula based on the principle has certain curative effect on relieving clinical symptoms, but has no specificity on helicobacter pylori infectious gastritis and poor curative effect, so that the condition of the patient is prolonged, the patient attacks repeatedly and is stubborn and not cured.
Disclosure of Invention
In order to solve the problems, the invention provides a traditional Chinese medicine composition for treating helicobacter pylori infectious gastritis, which is prepared from the following raw materials in parts by weight:
10-30 parts of sargentgloryvine stem, 15-30 parts of snakegourd seed, 30-60 parts of hairyvein agrimony, 15-20 parts of radix curcumae, 10-20 parts of inula flower, 5-10 parts of aspongopus, 15-30 parts of Chinese sage herb, 15-30 parts of paederia scandens, 10-20 parts of curcuma zedoary, 10-30 parts of red paeony root, 15-30 parts of bighead atractylodes rhizome, 10-20 parts of bletilla striata, 10-30 parts of hibiscus leaf, 10-20 parts of cynanchum paniculatum, 15-30 parts of radix clematidis, 10-20 parts of immature bitter orange, 10-30 parts of oyster, 3-6 parts of nardostachys chinensis and 5-10 parts of liquorice.
Further, the medicine is prepared from the following raw materials in parts by weight:
15 parts of sargentgloryvine stem, 15 parts of snakegourd seed, 20 parts of hairyvein agrimony, 15 parts of turmeric root-tuber, 15 parts of inula flower, 10 parts of aspongopus, 30 parts of Chinese sage herb, 30 parts of Chinese fevervine herb, 10 parts of zedoary, 10 parts of red paeony root, 15 parts of largehead atractylodes rhizome, 15 parts of bletilla striata, 15 parts of hibiscus leaf, 15 parts of paniculate swallowwort root, 15 parts of clematis root, 10 parts of immature bitter orange, 20 parts of oyster, 6 parts of nardostachys root and 10 parts of liquorice.
Further, the rhizoma atractylodis macrocephalae is fried rhizoma atractylodis macrocephalae.
Furthermore, the traditional Chinese medicine preparation is a preparation prepared by taking medicinal powder of raw material medicines or water or organic solvent extracts of the raw material medicines as active ingredients and adding pharmaceutically acceptable auxiliary materials.
Still further, the formulation is an oral formulation; the oral preparation is solution, granule, pill, paste or capsule.
The invention also provides a preparation method of the traditional Chinese medicine composition, which comprises the following steps:
(1) weighing the raw materials according to the proportion;
(2) grinding the raw materials into powder, or extracting with water or organic solvent, and adding pharmaceutically acceptable adjuvants or auxiliary components.
The invention finally provides application of the traditional Chinese medicine composition in preparing a medicine for treating helicobacter pylori infectious gastritis.
Further, the drug is a drug for eradicating helicobacter pylori.
The invention starts from the theory of traditional Chinese medicine, aims at four pathological factors of stasis, phlegm, toxin and depression, provides the four methods of strengthening body resistance and removing stasis, descending qi and reducing phlegm, killing parasites and detoxifying, clearing heart and resolving depression for simultaneous use under the guidance of the holistic concept theory of traditional Chinese medicine, and provides a traditional Chinese medicine composition capable of rapidly relieving a plurality of clinical symptoms of stomachache and gastrectasia, acid regurgitation and anorexia and the like of helicobacter pylori related gastritis and radically treating helicobacter pylori and a preparation method thereof. The clinical application obtains more satisfactory clinical curative effect.
The composition takes sargentgloryvine stem, snakegourd seed, hairyvein agrimony and turmeric root-tuber as monarch drugs, wherein the sargentgloryvine stem is used for removing toxin and carbuncle, activating blood and dredging collaterals, and dispelling wind and killing parasites; the agrimony is also called deli grass, treats various kinds of deli and overstrain injuries, and has good effects of strengthening body resistance, eliminating evil, detoxifying and killing insects; semen trichosanthis has effects of clearing heat and eliminating phlegm, relieving chest stuffiness and resolving masses, moistening dryness and lubricating intestines; yu jin moves qi and disperses blood stasis, clears heart and relieves stagnation.
Inulae flos, Aspongopus, herba Salviae chinensis, herba Paederiae, Curcumae rhizoma, radix Paeoniae Rubra, and parched Atractylodis rhizoma as ministerial drugs, and Inulae flos has effects of lowering qi, eliminating phlegm, promoting diuresis, and relieving vomit; aspongopus regulates qi to alleviate pain, and herba Salviae chinensis clears away heat and toxic materials, and promotes blood circulation to relieve pain; herba Paederiae has effects of dispelling pathogenic wind, promoting diuresis, relieving pain, removing toxic substance, resolving food stagnation, promoting blood circulation and relieving swelling; the zedoary has the effects of promoting qi and blood circulation, removing food retention and relieving pain; the red peony root has the functions of clearing heat and cooling blood, and eliminating stasis and relieving pain; stir-baked Bai Zhu strengthens spleen and tonifies qi, eliminates dampness and induces diuresis. Wherein the parched Atractylodis rhizoma helps the herba et Gemma Agrimoniae strengthen body resistance and eliminate pathogenic factors; inula flower helps fructus Trichosanthis kernel to resolve phlegm and dissipate nodulation; aspongopus helps radix Curcumae to promote qi circulation and relieve depression; the Chinese sage herb helps the sargentgloryvine stem clear away heat and toxic materials; paederia scandens, rhizoma zedoariae and red peony root have the functions of promoting digestion and relieving stasis, and simultaneously assisting sargentgloryvine stem and curcuma aromatica to remove blood stasis and relieve pain.
Bletilla striata, hibiscus leaves, paniculate swallowwort root, clematis root, immature bitter orange, oyster and nardostachys root are taken as assistants, and the bletilla striata can astringe to stop bleeding, relieve swelling and promote tissue regeneration; the hibiscus leaves cool blood, detoxify and detumescence; the paniculate swallowwort root has the effects of eliminating dampness and relieving pain; the clematis root is used for removing dampness, dredging collaterals and relieving pain, eliminating phlegm and water and dispersing nodules; immature bitter orange can break qi and remove food retention, resolve phlegm and disperse abdominal mass; concha Ostreae has effects in tranquilizing mind, suppressing yang hyperactivity, nourishing yin, softening and resolving hard mass; the nard is pungent and sweet, warm, regulates qi to alleviate pain, relieves stagnation and activates spleen, and prevents excessive heat-clearing, but the fact is used as a counteradjuvant.
Licorice root, radix Glycyrrhizae is used as a guiding drug to regulate the effects of the drugs in the recipe. The whole formula has the effects of strengthening body resistance and removing blood stasis, reducing phlegm and lowering adverse qi, killing parasites and detoxifying, and removing food retention and relieving pain.
The composition has precise and appropriate compatibility, can effectively improve symptoms of stomachache, gastrectasia, acid regurgitation, anorexia, nausea, anorexia and the like of the helicobacter pylori infectious gastritis, improves the eradication rate of the helicobacter pylori infection, has high curative effect, no toxic or side effect and low cost, is a safe and effective traditional Chinese medicine composition for treating the helicobacter pylori infectious gastritis, and has good application prospect.
Obviously, many modifications, substitutions, and variations are possible in light of the above teachings of the invention, without departing from the basic technical spirit of the invention, as defined by the following claims.
The present invention will be described in further detail with reference to the following examples. This should not be understood as limiting the scope of the above-described subject matter of the present invention to the following examples. All the technologies realized based on the above contents of the present invention belong to the scope of the present invention.
Detailed Description
Example 1 preparation of a composition according to the invention
The formula is as follows: 10g of sargentgloryvine stem, 15g of snakegourd seed, 30g of hairyvein agrimony, 15g of turmeric root-tuber, 10g of inula flower, 5g of aspongopus, 15g of Chinese sage herb, 15g of Chinese fevervine herb, 10g of zedoary, 10g of red paeony root, 15g of fried largehead atractylodes rhizome, 10g of bletilla striata, 10g of hibiscus leaf, 10g of paniculate swallowwort root, 15g of clematis root, 10g of immature bitter orange, 10g of oyster, 3g of nardostachys root and 5g of liquorice
The preparation method comprises the following steps:
weighing the traditional Chinese medicine decoction pieces in parts by weight;
powder grinding: crushing the decoction pieces in the step I into mixed coarse powder, wherein the particle size of the mixed coarse powder is 10-15 meshes;
thirdly, heating and extracting: adding 6-8 times of water into the mixed coarse powder collected in the second step, soaking for 30 minutes, carrying out first decoction, filtering after 30 minutes of decoction, collecting first filtrate, adding 6-8 times of water into filter residue obtained after the first filtration, carrying out second decoction, carrying out second filtration after 30 minutes of decoction, and collecting second filtrate;
Fourthly, the first filtrate and the second filtrate prepared in the third step are combined to obtain mixed liquid, and the mixed liquid is concentrated to 600 ml.
Example 2 preparation of the inventive medicament
The formula is as follows: 10g of sargentgloryvine stem, 15g of snakegourd seed, 30g of hairyvein agrimony, 15g of turmeric root-tuber, 10g of inula flower, 5g of aspongopus, 15g of Chinese sage herb, 15g of Chinese fevervine herb, 10g of zedoary, 10g of red paeony root, 15g of fried largehead atractylodes rhizome, 10g of bletilla striata, 10g of hibiscus leaf, 10g of paniculate swallowwort root, 15g of clematis root, 10g of immature bitter orange, 10g of oyster, 3g of nardostachys root and 5g of liquorice
The preparation method comprises the following steps:
weighing the traditional Chinese medicine decoction pieces in parts by weight;
powder grinding: crushing the decoction pieces in the step I into mixed coarse powder, wherein the particle size of the mixed coarse powder is 10-15 meshes;
thirdly, heating and extracting: adding 6-8 times of water into the mixed coarse powder collected in the second step, soaking for 30 minutes, carrying out first decoction, filtering after 30 minutes of decoction, collecting first filtrate, adding 6-8 times of water into filter residue obtained after the first filtration, carrying out second decoction, carrying out second filtration after 30 minutes of decoction, and collecting second filtrate;
and fourthly, mixing the first filtrate and the second filtrate obtained in the third step to obtain mixed liquor, and concentrating the mixed liquor to 600 ml.
Example 3 preparation of the inventive Agents
The formula is as follows: 15g of sargentgloryvine stem, 15g of snakegourd seed, 20g of hairyvein agrimony, 15g of turmeric root-tuber, 15g of inula flower, 10g of aspongopus, 30g of Chinese sage herb, 30g of Chinese fevervine herb, 10g of zedoary, 10g of red paeony root, 15g of stir-fried largehead atractylodes rhizome, 15g of bletilla striata, 15g of hibiscus leaf, 15g of paniculate swallowwort root, 15g of clematis root, 10g of immature bitter orange, 20g of oyster, 6g of nardostachys root and 10g of liquorice root
The preparation method comprises the following steps:
weighing the traditional Chinese medicine decoction pieces in parts by weight;
powder grinding: crushing the decoction pieces in the step I into mixed coarse powder, wherein the particle size of the mixed coarse powder is 10-15 meshes;
thirdly, heating and extracting: adding 6-8 times of water into the mixed coarse powder collected in the second step, soaking for 30 minutes, carrying out first decoction, filtering after 30 minutes of decoction, collecting first filtrate, adding 6-8 times of water into filter residue obtained after the first filtration, carrying out second decoction, carrying out second filtration after 30 minutes of decoction, and collecting second filtrate;
and fourthly, mixing the first filtrate and the second filtrate obtained in the third step to obtain mixed liquor, and concentrating the mixed liquor to 600 ml.
EXAMPLE 4 preparation of the inventive Agents
The formula is as follows: 20g of sargentgloryvine stem, 20g of snakegourd seed, 30g of hairyvein agrimony, 15g of turmeric root-tuber, 15g of inula flower, 10g of aspongopus, 30g of Chinese sage herb, 30g of Chinese fevervine herb, 15g of zedoary, 15g of red paeony root, 15g of fried largehead atractylodes rhizome, 15g of bletilla striata, 25g of hibiscus leaf, 15g of paniculate swallowwort root, 20g of clematis root, 15g of immature bitter orange, 30g of oyster, 6g of nardostachys root and 10g of liquorice
The preparation method comprises the following steps:
weighing the traditional Chinese medicine decoction pieces in parts by weight;
powder grinding: crushing the decoction pieces in the step I into mixed coarse powder, wherein the particle size of the mixed coarse powder is 10-15 meshes;
thirdly, heating and extracting: adding 6-8 times of water into the mixed coarse powder collected in the second step, soaking for 30 minutes, carrying out first decoction, filtering after 30 minutes of decoction, collecting first filtrate, adding 6-8 times of water into filter residue obtained after the first filtration, carrying out second decoction, carrying out second filtration after 30 minutes of decoction, and collecting second filtrate;
fourthly, the first filtrate and the second filtrate which are prepared in the third step are combined to obtain mixed liquid, and the mixed liquid is concentrated to 600ml
The advantageous effects of the present invention are explained below by way of test examples
Test example 1 clinical study
Clinical data of 60 cases of helicobacter pylori related gastritis collected in traditional Chinese medicine hospitals in Nanqi city from 1 month 2020 to 12 months 2020 are selected for analysis, the patients are divided into two groups according to different clinical treatment schemes, 30 cases of patients treated by single bismuth potassium citrate tablets/tinidazole tablets/Clarithromycin tablets (Lizhuwei triple) + lansoprazole sodium enteric-coated tablets are used as a control group, 30 cases of patients treated by single traditional Chinese medicine in example 3 are used as a treatment group, and the two groups of patients are compared in clinical curative effect, Hp eradication rate and adverse reaction occurrence rate.
1.1 comparison of clinical efficacy
After the treatment of two groups of patients with the Hp-related gastritis is finished, the symptoms and the gastroscope changes are observed to judge the clinical curative effect. The Chinese medicine composition is prepared according to documents of digestive disease society of the Chinese medical society and Chinese consensus opinion on chronic gastritis: and (3) curing: the symptoms basically disappear, the acute inflammation of the gastroscope disappears after rechecking, the chronic inflammation is improved, and the gastric acid secretion is normal; the effect is shown: the main symptoms disappear, the secondary symptoms disappear basically, the acute inflammation of the gastroscope disappears basically after the examination, the chronic inflammation is improved, and the gastric acid secretion is improved; the method has the following advantages: the main symptoms are obviously reduced, the gastric mucosa lesion of the gastroscope is reduced by over 1/2 after the examination, and the inflammation is reduced to some extent; and (4) invalidation: can not reach the effective standard.
1.2Hp eradication Rate comparison
After the treatment of two groups of Hp-related gastritis patients is finished and the medicines are stopped for 4 weeks, a carbon 13 urea breath test is carried out, the negative is the elimination of Hp, and the difference of the Hp elimination rates of the two groups is compared.
1.3 comparison of adverse reaction incidence
After the treatment of two groups of patients with the Hp-related gastritis is finished, the incidence rate of adverse reactions of the two groups of patients is observed and compared.
2. Statistical method
SPSS 18.0for Windows statistical software is adopted, two groups of syndrome integrals are compared by t test, curative effect and rate are compared by x test2And (6) checking.
3. Results
3.1 comparison of clinical efficacy
In the aspect of relieving clinical symptoms, a control group cures 12 cases, 5 cases with obvious effect, 5 cases with effect and 8 cases with no effect, and the effective rate of treatment is 73.33%; the treatment group has 22 cases of cure, 6 cases of obvious effect, 2 cases of effect and 0 case of no effect, and the effective rate of treatment is 100 percent;
the difference between the two samples has statistical significance (P is less than 0.05).
3.2Hp eradication Rate comparison
30 cases in a treatment group, 29 negative cases in a carbon 13 urea breath test, and 96.6 percent of Hp eradication rate;
the control group had 30 cases, carbon 13 urea breath test negative 21 cases, and the Hp eradication rate was 70%.
The difference between the two types of the Chinese medicinal composition has statistical significance (P is less than 0.05).
3.3 comparison of adverse reaction incidence
30 cases of treatment groups have no obvious adverse reaction in treatment, and the incidence rate is 0%;
30 cases of a control group, 5 cases of nausea and 8 cases of anorexia in treatment, and 43.3 percent of adverse reaction incidence rate;
the difference between the two types of the Chinese medicinal composition has statistical significance (P is less than 0.05).
Conclusion the traditional Chinese medicine composition can improve the symptoms of patients, improve the eradication probability of helicobacter pylori infection and reduce the adverse reaction rate when the patients with helicobacter pylori related gastritis are treated by the traditional Chinese medicine composition.
Test example 2 typical cases
Patient Liu of certain, female, age 48, will be treated 3 months and 18 days in 2020.
The main complaints are: repeated epigastric distending pain, heartburn and belching are caused for 5 years, and aggravation is 1 month. Patients repeat epigastric distending pain, heartburn and belching for 5 years, the symptoms are aggravated by qi generation before 1 month, poor sleep is received, phlegm is in the pharynx, expectoration cannot occur, pharynx cannot descend, stool is dry, discharge is weak, tongue is red, ecchymosis is on the edge, the tongue coating is yellow and greasy, and the pulse is wiry and smooth.
Gastroscopy: chronic non-atrophic gastritis with erosion. Carbon 13 urea breath test positive. And (3) Western diagnosis: chronic non-atrophic gastritis with erosion, helicobacter pylori infection.
Traditional Chinese medicine diagnosis: stomach ache.
Therapeutic method: strengthening body resistance, dispelling blood stasis, lowering qi, eliminating phlegm, killing parasites, removing toxic substances, clearing away heart-fire, and relieving depression
The prescription is as follows: same as example 4
The using method comprises the following steps: 7 dose, 1 dose per day by decocting with water, and administered separately in the morning, at noon and evening.
And B, diagnosis: year 2020, 3, 25. After the patient takes the medicine, the epigastric distending pain, heartburn and belching are obviously relieved, the appetite and sleep are improved, the pharyngeal symptom is relieved, and the defecation is smooth. The medicine takes effect and is treated by the former method. 7 doses are taken as before.
Three diagnoses: year 2020, 4, 3. The patients have no symptoms, and take 7 doses of the following medicines to consolidate the curative effect. All in one
Example 1
After 1 month, the gastroscope is rechecked to ensure that the acute inflammation and the erosion of the gastroscope disappear, the chronic inflammation is obviously improved, the carbon-13 urea breath test is negative, and the chronic inflammation is clinically cured.
In conclusion, the composition has precise and appropriate compatibility, can effectively improve symptoms of stomachache, gastrectasia, acid regurgitation, anorexia, nausea, anorexia and the like of the helicobacter pylori infectious gastritis, improves the eradication rate of the helicobacter pylori infection, has the advantages of high curative effect, no toxic or side effect and low cost, and has clinical popularization and application values.

Claims (8)

1. A traditional Chinese medicine composition for treating helicobacter pylori infectious gastritis is characterized in that: the traditional Chinese medicine is prepared from the following raw materials in parts by weight:
10-30 parts of sargentgloryvine stem, 15-30 parts of snakegourd seed, 30-60 parts of hairyvein agrimony, 15-20 parts of radix curcumae, 10-20 parts of inula flower, 5-10 parts of aspongopus, 15-30 parts of Chinese sage herb, 15-30 parts of paederia scandens, 10-20 parts of curcuma zedoary, 10-30 parts of red paeony root, 15-30 parts of bighead atractylodes rhizome, 10-20 parts of bletilla striata, 10-30 parts of hibiscus leaf, 10-20 parts of cynanchum paniculatum, 15-30 parts of radix clematidis, 10-20 parts of immature bitter orange, 10-30 parts of oyster, 3-6 parts of nardostachys chinensis and 5-10 parts of liquorice.
2. The traditional Chinese medicine composition according to claim 1, characterized in that: the traditional Chinese medicine is prepared from the following raw materials in parts by weight:
15 parts of sargentgloryvine stem, 15 parts of snakegourd seed, 20 parts of hairyvein agrimony, 15 parts of turmeric root-tuber, 15 parts of inula flower, 10 parts of aspongopus, 30 parts of Chinese sage herb, 30 parts of Chinese fevervine herb, 10 parts of zedoary, 10 parts of red paeony root, 15 parts of largehead atractylodes rhizome, 15 parts of bletilla striata, 15 parts of hibiscus leaf, 15 parts of paniculate swallowwort root, 15 parts of clematis root, 10 parts of immature bitter orange, 20 parts of oyster, 6 parts of nardostachys root and 10 parts of liquorice.
3. The traditional Chinese medicine composition according to claim 2, characterized in that: the Atractylodis rhizoma is parched Atractylodis rhizoma.
4. The Chinese medicinal composition according to any one of claims 1 to 3, wherein: the preparation is prepared by taking medicinal powder of raw material medicines, or water or organic solvent extracts of the raw material medicines as active ingredients and adding pharmaceutically acceptable auxiliary materials.
5. The traditional Chinese medicine composition according to claim 4, wherein: the preparation is an oral preparation; the oral preparation is solution, granule, pill, paste or capsule.
6. A method for preparing the Chinese medicinal composition of any one of claims 1 to 5, which is characterized by comprising the following steps: it comprises the following steps:
(1) weighing the raw materials according to the proportion of claim 1;
(2) grinding the raw materials into powder, or extracting with water or organic solvent, and adding pharmaceutically acceptable adjuvants or auxiliary components.
7. Use of the Chinese medicinal composition of any one of claims 1 to 6 in the preparation of a medicament for treating helicobacter pylori infectious gastritis.
8. Use according to claim 7, characterized in that: the medicine is used for eradicating helicobacter pylori.
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