Gastric Reflux & GERD
Heartburn, Reflux EsophagitisGastroesophageal reflux disease (GERD) is a common disorder where the gastric contents flow into the esophagus causing symptoms such as heartburn, acid reflux and pain behind the sternum. It affects about 20–30% of the population worldwide.
In modern medicine it is sub-classified into 3 types:
- Non-erosive Reflux Disease (NERD)
- Reflux Esophagitis (RE)
- Barrett esophagus (BE)
Standard treatment in modern medicine is Proton Pump Inhibitors (PPI’s) which give relief in symptoms for around 75% of patients. However about 50% of NERD patients fail to respond to PPI’s, and two-thirds will have relapse after cessation of medication. Further, long-term use of PPI’s has been associated with serious side effects including Chronic Kidney Disease and Dementia. Therefore, Traditional Medicine and can play an important role in this increasingly common disorder.
Traditional Medicine Treatment
In Essence, it is a disharmony between Liver and Stomach/Spleen. In general, we can divide into Hot types and Cold/Phlegm/Damp types. In the former, Liver excess is dominant, while in the latter, Spleen weakness is more pronounced. But successful treatment needs to address both. So even with Spleen weakness and Damp, a little Bitter medicine to drain or “purge” the Liver is often added, and this is manifest in traditional formulas used to treat the disease, and in trials involving modern combinations.
The other important aspect is “Rising Qi”, that is, the irregular movement of Qi upwards. This is also as a result of Liver / Spleen disharmony. While there are special medicines to lower Qi, in general this effect can be achieved with warming, aromatic medicines that regulate Qi while stimulating digestion, evident by formulas like Peptic Powder.
In Chinese Medicine, 2 main pathologies exist:
- Stomach attacked by Liver
- Spleen Deficiency
Reviewing a number of Chinese trials, the most commonly used Chinese herbs include:
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Coptis Huang Lian Pinellia Ban Xia Citrus Chen Pi |
Atractylodes Bai Zhu Poria Fu Ling Licorice (Gan Cao) |
Magnolia Hou Po Bupleurum Chai Hu Jujube (Da Zao) |
It will be noted that these herbs are distributed between those that clear Heat, those that strengthen and harmonize Stomach and Spleen, and those that move or regulate Qi.
Diet
Diet is strongly associated with onset and relapse of Reflux and GERD. Foods that can aggravate or trigger include
fatty, fried, and spicy foods, citrus, tomato, alliums (e.g., onion, garlic), coffee, carbonated beverages, and alcohol. Which foods are associated with specific cases can be ascertained by keeping a food diary.
Regular meals, chewing more and eating less, and avoiding large meals at the end of the day are all good advice.
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Western Tradition Simples
Formulas Ructus acidos curant – Acid Belching, Heartburn Rob of Currants Rob of Barberry Rob of Sumach Rob of Mulberry Rob of Pomegranate Syrup of the Juice of Sorrel (Mesue) Electuary of Aromatics Aromatic Rose Powder (Aromaticum Rosatum) Peptic Powder Powder of Galangal Compound (Diagalanga) (Mesue) Powder of Cumin (Diacyminum) Powder of Three Peppers (Diatrionpiperon) (Mesue) Powder for Digestion (Riverius) Powder Against Heartburn Hiera Pachii Oxymel of Squill Ginger confected Avipattikara Churna (Ayurveda) Calcite 6 Powder (Tibetan) Calcite 9 (Cong zhi dgu pa) (Tibetan) Calcite 21 (Cong zhi nyer gcig) Conqueror of Brown Phlegm (Smug po gyul rgyal). Lotus Stem White Pills (Ril dkar pad sdong) Mauktika Yukta (Pearl Compound) (Ayurveda) Precious Pill of 9 Ingredients (Rin chen dgu sbyor) Varahi’s Combination (Phag mo grub sbyor) (Tibetan) Stomach Heat Rob of Barberry Rob of Sumach Rob of Mulberry Rob of Pomegranate Syrup of the Juice of Sorrel (Mesue) Conqueror of Brown Phlegm (Smug po gyul rgyal). Lotus Stem White Pills (Ril dkar pad sdong) Mauktika Yukta (Pearl Compound) (Ayurveda) Stomach Cold Ginger confected Powder of Galangal Compound (Diagalanga) (Mesue) Powder of Cumin (Diacyminum) Powder of Three Peppers (Diatrionpiperon) (Mesue) Calcite 6 Powder (Tibetan Medicine) Varahi’s Combination (Phag mo grub sbyor) (Tibetan) Damp-Heat Pomegranate 8 Petalled Lotus (Se ‘bru pad ma ‘dab brgyad) Phlegm with Rising Qi Avipattikara Churna (Ayurveda) Liver Qi Stagnation Aromatic Rose Powder (Aromaticum Rosatum) |
Chinese Classification Simples
Formulas Stomach Heat burning acid reflux, abdominal pain, restlessness, dry throat, bitter mouth, fever, prefers cold food Chai Hu Gui Zhi Tang Stomach Cold acid reflux, chest and abdomen feel swelling and, oppression, foul belching, loss of appetite. Xiang Sha Liu Jun Zi Tang Ping Wei San Wu Zhu Yu Tang Liver Qi Stagnation / Liver Qi invading the Stomach recurrent acid reflux, heartburn, epigastric distension, belching, sighing, poor appetite, irritable, dizziness, tension headaches, irregular menstruation Si Ni San Dan Zhi Xiao Yao San Mu Xiang Shun Qi Wan Zuo Jin Wan Stomach and Liver Heat chronic acid reflux, heartburn, sour belching, irritability, foul-smelling stool, dry mouth, thirst, red tongue with a yellow coating Xiao Chai Hu Tang Dan Zhi Xiao Yao San Zuo Jin Wan Liver Heat with Spleen Damp acid reflux, poor appetite, nausea, tongue has damp coating with red edges Xiao Chai Hu Tang Ban Xia Xie Xin Tang Phlegm-Damp acid reflux, heart burn, epigastric and abdominal distension, loose stool, nausea, vomiting, tired, variable fatigue, poor concentration, dizziness, greasy skin, musty body odor. Ping Wei San Ban Xia Hou Po Tang Wen Dan Tang (with Heat) Calcite 6 Powder (Tibetan Medicine) Food Stagnation acid reflux, heart burn, epigastric distension, sour belching, foul breath, nausea, vomiting, constipation, foul coating on tongue. Bao He Wan Mu Xiang Shun Qi Wan Spleen & Stomach Qi Deficiency chronic acid reflux, heartburn, epigastric distension, sour belching, poor appetite, indigestion, fatigue, loose stools, cold intolerance,pale face and tongue Gui Pi Tang Xiang Sha Liu Jun Zi Tang Yin Deficiency of Stomach & Liver chronic acid reflux and heartburn, epigastric distension, lost of appetite, dry mouth and throat, dry stool, constipation Yi Guan Jian Mai Men Dong Tang |
Special Formula
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1. Wormwood, Peppermint, Aniseed 2. Tinospora, Emblic Myrobalan, Licorice Troches for Stomach Heat Burnt Deer Horn Chalk Red Coral Mace Nutmeg Clove Troches of Cucumber Seed Cucumber seed Purslane seed Licorice Tragacanth equal parts Powder, mix with Egg white to form troches or tablets. Used for Heartburn, Stomach Heat, Thirst. Take 1 dram with Barley water. (Syrian ‘Book of Medicine‘, Budge, 1913) Troches of Rose and Spikenard Rose 20 drams Spikenard Licorice root 4 drams each. Powder and form Trcohes with Wine. Dose: 1 dram. Used as the preceding. (Syrian ‘Book of Medicine‘, Budge, 1913) Triphala Electuary for Belching Myrobalan, Chebulia Emblic Belleric Turbith Ginger Red Earth equal parts Powder the Myrobalans with a little Almond oil, then with Honey, form an Electuary. “Intended for belching that is to say, if anyone does not fail to use it for ten days, he will be freed from that infirmity” (Pharmacopoeia Persica, 1681) Iberogast Iberis amara Camomile (Matricaria) Caraway Peppermint Licorice Balm Celandine Silybum Angelica This is a patent medicine that has been used in Germany for over 40 years. In a number of trials it has proven to relieve GERD symptoms, especially epigastric pain, retrosternal pain, and acid regurgitation. |
He Wei Jiang Ni Granule This formula was developed by Dongfang Hospital Affiliated to Beijing University of Chinese Medicine and is based on the classical formula Ban Xia Xie Xin Decoction Scutellaria Huang Qin Coptis Huang Lian Pinellia Ban Xia Ginger (Gan Jiang) Gentiana Long Dan Cao Dandelion (Pu Gong Ying) Fritillaria Zhe Bei Mu Citrus aurantium Zhi Shi Trichosanthes fructus Gua Lou Licorice (Gan Cao) This has been proven clinically effective. In addition, it was shown that recurrence after cessation of treatment was longer than with PPI’s. (see research here) Jian Pi Qing Hua Decoction Pueraria Ge Gen 30g Scutellaria Huang Qin 9g Coptis Huang Lian 6g Euonymus Gui Jian Yu 15g Codonopsis Dang Shen 30g Astragalus Huang Qi 30g Dioscorea Shan Yao 30g Polygonatum Yu Zhu 30g Si Ni Zuo Jin Decoction Bupleurum Chai Hu Citrus Zhi Shi Paeonia Bai Shao Licorice Coptis Huang Lian Evodia Wu Zhu Yu Researchers found two primary formulas prescribed for GERD were variations of the classical formulas Si Ni San and Zuo Jin Wan. These herbs were combined into one formula and have been used and found effective, but further trials were recommended.. (See here) Sample Formulas that have been used in trials 1. Codonopsis Dang Shen Allium macrostemon Xie Bai Atractylodes Cang Zhu Trichosanthes Gua Lou Pi Coptis Huang Lian Evodia Wu Zhu Yu Costus Mu Xiang Clove (Ding Xiang) Citrus Qing Pi Aesculus Suo Luo Zi Pinellia Ban Xia Citrus Chen Pi Bambusa Zhu Ru 2. Evodia Wu Zhu Yu Ginseng (Ren Shen) Jujube (Da Zao) Fresh Ginger (Sheng Jiang) 3. Atractylodes Bai Zhu Eriobotrya Pi Pa Ye Platycodon Jie Geng 4. Atractylodes Bai Zhu Ginseng (Ren Shen) Pinellia Ban Xia Poria Fu Ling Citrus Chen Pi Jujube (Da Zao) Licorice (Gan Cao) Fresh Ginger (Sheng Jiang) |
Gastroesophageal Reflux-induced Chronic Cough
A major symptom associated with chronic GERD is chronic Cough.
Wu Ji San
Atractylodes Bai Zhu
Ephedra Ma Huang
Citrus Chen Pi
Pinellia Ban Xia
Ginger (Gan Jiang)
Cinnamon twig (Gui Zhi)
Dang Gui
Jujube (Da Zao)
Licorice (Gan Cao)
Paeonia Bai Shao
Angelica dahurica Bai Zhi
Poria Fu Ling
Citru aurantii Immaturus Zhi Shi
Ligusticum Chuan Xiong
Magnolia Hou Po
Platycodum Jie Geng
Cyperus rotundus Xiang Fu
This is one of the most commonly prescribed formulas in Korea for digestive disorders. In a trial it was taken with Sheng Mai San (Ophiopogon Mai Men Dong, Ginseng and Schisandra Wu Wei Zi). This treatment was found effective. (see here)
Research
–Different Traditional Herbal Medicines for the Treatment of Gastroesophageal Reflux Disease in AdultsHerbs:
–Anti-Inflammation and Protective Effects of Anethum graveolens L. (Dill Seeds) on Esophageal Mucosa Damages in Reflux Esophagitis-Induced Rats.
–Myrtle (Myrtus communis L.) fruit syrup for gastroesophageal reflux disease in children: A double-blind randomized clinical trial.
Formulas
–Efficacy and safety of the Chinese herbal formula Hewei Jiangni recipe for NERD with cold-heat complex syndrome: study protocol for a double-blinded randomized controlled trial.
–Modified Xiaochaihu Decoction for gastroesophageal reflux disease: A randomized double-simulation controlled trial.
–New treatment for gastroesophageal reflux disease: Traditional Chinese medicine Xiaochaihu decoction