Traditional Chinese Medicine And Functional Gastrointestinal Disorders Part 1 Functional Dyspepsia

Introduction

The common functional gastrointestinal disorders (i.e. functional dyspepsia and gastroesophageal reflux disease) occur with very high prevalence (40 – 60%) throughout the Western world, and although the nomenclature suggests that they be treated with the aim or restoring normal function, Western medicine (WM) has not yet arrived at this relatively enlightened perspective. Instead they are regarded as ‘functional’ disorders in contradistinction to those disorders caused by structural abnormalities (e.g. tumor or trauma), biochemical abnormalities or the unwanted effects of pharmaceutical drugs. More than 50% of people suffering from these conditions self-medicate and do not seek medical help. However, most of them use over the counter medications that are inappropriate – even from a WM perspective (Niknam, et al., 2016). More importantly, these disorders are poorly diagnosed and treated by WM, the only saving grace being the potential for early detection of cancer, provided that the patient does in fact go to visit a GP. This leaves a large gap in the effective care for common digestive disorders. This paper explores the unique perspective of traditional Chinese medicine (TCM) in this regard, and provides protocols for treatment using prepared Chinese herbal medicines.

Key differences between the WM and TCM approach to digestive disorders

The overall concept of the digestive system in traditional Chinese medicine (TCM) goes far beyond the mouth to anus anatomical and physiological expositions of its Western counterpart. While Western medicine (WM) has only recently become aware of the influence of the mind and emotions on digestive functions, TCM has long been aware of these factors, together with many others, that have a critical influence on digestive health. While a detailed comparison is not the intention of this article, the main point is that in spite of the enormous amount of analytical detail encompassed by the Western paradigm, its understanding of the nature and scope of the digestive system in health and disease is quite limited. Whereas, TCM, on the other hand has a universal scope that places the digestive system at the center of human physiology and highlights the important relationships between the various bodily systems, mental-emotional factors as well as environmental influences.

Although some of the following topics are beginning to receive an increasing amount of attention in WM, the key points of difference that characterise TCM are listed below. Each of these factors have a profound influence on the functioning of the digestive system, as well as the body as a whole:

1. Ingested foods and beverages, both in quantity and quality.
2. Mental and emotional factors.
3. Environmental factors.
4. Behavioural factors, including work and leisure activities.
5. Diseases outside of the digestive system.
6. Internally generated pathogens within the digestive system.

Limitations of the WM paradigm

As noted by W. A. Price, traditional (i.e. pre-industrial) societies understood the concepts listed above in the previous paragraph as a matter of basic survival. (Price, 1939) Although the some aspects of the industrial revolution have enabled a large portion of humanity to extricate itself from dependence on the natural environment,  thus reducing or eliminating the perceived need to live in harmony with nature, ultimately this has destructive consequences both on human health as well as the environment. Viewed in this light, the dominance of the analytic and reductionist approach in Western science only serves to reinforce and perpetuate the status quo.

This phenomenon is strikingly illustrated by the emergence of two new ‘diseases’ in recent years: functional dyspepsia (FD) and gastro-oesophageal reflux disease (GERD). Both of these ‘symptoms-turned-into-disease-entities’ have their origins outside of the medical profession. They are prime examples of pharmaceutical industry marketing activities, centred around the promotion of their products: synthetic chemical drugs that are aimed at alleviating specific symptoms, but are unable to correct the underlying dysfunction. In addition, these drugs have harmful effects, all of which have been carefully hidden. These recent developments within WM represent the dark side of evidence based medicine (EBM) and may rightly be regarded as ‘collateral damage’ resulting from the so called partnership between the medical profession and the pharmaceutical industry in matters of medical research. (Goldacre, 2012; Healey, 2012; Gøtzsche, 2013; Ionnadis, 2005; Ionnadis, 2016, Kendrick, 2014).

Two very important, but largely unrecognised, recent studies have pointed to the fact that both of these ‘diseases’ are in reality, functional disorders that are caused by lifestyle factors, i.e. improper management of the diet and manner of eating, particularly in relation to age and activity levels. (Randhawa, Gillessen, 2013; Randhawa, Mahfouz, Selim, Yar, Gillessen, 2015) These issues surrounding FD and GERD speak to the loss of common sense and respect for traditional knowledge within the medical profession: when empirical research is required as evidence for what should be common knowledge. As one author has pointed out, there is no need for a clinical trial when a substance is highly effective (either in a positive or a negative sense), or when certain activities lead to specific consequences. (Healey, 2012) Some simple examples to clearly illustrate this point: If one ingests a certain dose of cyanide, or if one jumps from a plane at altitude without a parachute, the results will be fatal; if a person continues to eat excessive quantities of food before the stomach has finished processing the previous meal, while also leading a sedentary lifestyle, functional disturbances will eventually follow.

Taking advantage of the empty space provided by the mandatory requirement for ‘clinical evidence’ before anything may be regarded as a fact, the pharmaceutical industry has continued to build ‘evidence’ for new ‘diseases’ that can be ‘treated’ by their products. Moreover, by a process that may be regarded as statistical sleight of hand, the risks for developing more serious conditions (e.g. cancer) for those patients suffering from FD and GERD have been grossly exaggerated (principally through discussing ‘relative’ as opposed to ‘absolute’ risk). (Kendrick, 2013; Kendrick 2014, pp.41-75), making ‘preventative’ treatment the major ‘benefit’ of pharmaceutical intervention. However, the drugs involved mostly suppress troublesome symptoms and may have deleterious effects on the overall health of the patient. (Kesser, 2016; Heidelbaugh et al., 2012) Unfortunately, medical guidelines for the assessment and treatment of these disorders play down the risks of treatment and emphasise the ‘benefits’. (Internal Clinical Guidelines Team (UK), 2014; Patti, 2016; Talley & Vakil, 2005).

The TCM approach to digestive disorders: introducing the Spleen

In TCM, the processes that are involved in the digestion and assimilation of nutrients are carried out through the harmonious interaction between the activities of the Spleen, Stomach, Lung, Heart, Small and Large intestines, Liver and Gallbladder. At this point we need to bear in mind that TCM is not concerned with precise anatomical structures, but with groups of related functions that may be understood in the larger context of Qi and Blood production.

Of central importance is the Spleen, the main functions of which, together with the Stomach, are concerned with the ‘transformation’ (i.e. digestion and assimilation) of nutrients. This includes the intake of food and beverages, as well as their break-down and absorption. The Spleen extracts a crude ‘essence’ from foods that have been processed by the Stomach. This extract is referred to as the ‘food-Qi’, and it provides the basis for production of the normal physiological Qi (the ‘nutritive Qi’ or simply the ‘Qi’) that activates or vitalizes the internal organs, and is distributed throughout the body in the Channels and Vessels. The Spleen also contributes towards Blood production, as the food-Qi may be transformed into either Qi or Blood.

The Spleen subsequently sends this crude food-Qi upward to the Lung and Heart, where it is transformed into Qi (in the Lung) and the Blood (in the Heart). These two ‘substances’ are then distributed throughout the body to activate and nourish the internal organs, muscles, bones, tendons, skin, etc. The term ‘substances’ is used loosely here, as Qi may be regarded as both the foundation for as well as the expression of the various functional activities of body and mind. Whereas Blood, on the other hand, is the Yin counterpart of the Qi. The Blood nourishes body structure to support the Qi, and also exerts a tempering action upon it. This harmony between the Qi and the Blood ensures that the Qi flows smoothly and evenly, permitting all of the complex and highly coordinated physical and mental activities to occur in a normal, healthy manner.

When Spleen function is normal, the appetite, digestion, absorption and bowel movements are all regular; vitality is abundant; the flesh and muscles are firm and strong. Dysfunction manifests in poor appetite, indigestion, bloating and loose stools as well as fatigue and wasting of the musculature.

The Spleen also plays a key role in fluid metabolism. It transforms the fluid portion of the ingested nutrients into the physiologically useful body Fluids, separates out the wastes, and moves all Fluids around the body. If this function is impaired, the Fluids that have been incompletely processed may accumulate internally, leading to the production of pathogens (referred to as ‘internally generated’ pathogens), such as Damp and Phlegm. The retention of these pathogens may result in various digestive and respiratory disorders, retention of fluid and excessive body fat.

The Spleen is susceptible to injury by the following:

• Inappropriate diet and mode of eating, e.g. food preferences; excessive intake of Cold natured foods; excessive consumption of rich foods (i.e. difficult to digest), sweets or alcohol; eating at irregular times; eating while working or moving around.
• Exposure to Cold and Damp environmental conditions
• Intake of contaminated foods or beverages
• Excessive physical activity with inadequate rest
• Excessive worrying and anxiety
• Excessive mental stimulation
• Emotional strain or over-stimulation
• Chronic illness

It is important to note that the TCM concept of the Spleen is much broader and deeper that the Western physiological concept of the ‘digestive system’. The Spleen is the source of one’s acquired constitution. It is crucial that the Spleen functions well, both for the maintenance of good health and also to permit a complete recovery from an illness. Moreover, through the activities of a well-functioning Spleen one can make up for constitutional weaknesses and achieve a state of optimal health. Therefore, care of the Spleen is an important component of health maintenance, disease prevention and disease treatment.

The Spleen and Stomach are often considered together as a single unit and are discussed in terms of ‘the middle Jiao’ or simply ‘the middle’. Indeed, many of their individual functions overlap, or may be seen as extensions of the one function. While the Stomach ‘receives and transmits’ and the Spleen ‘transforms and transports’ it is apparent that the Stomach shares some of the Spleen’s functions and vice versa. The Stomach’s transformation functions are picturesquely described as the ‘rotting and ripening’ of nutrients; while the Spleen’s functions are to ‘transform and transport’ nutrients.

The primary energetic function of the Spleen is to send Qi upwards to the Heart and Lung (in the process of Qi and Blood production) and also to provide the mind and senses with pure Yang Qi in order to activate them and keep them functioning optimally. The primary energetic function of the Stomach is to send the Yin Qi downwards (i.e. moving the chyme down the digestive tract for further processing, extraction and elimination). However, the Stomach also sends clear Yang Qi upwards to nourish the eyes and nose, while the Spleen on the other hand, also sends turbid fluids (i.e. Yin type substances) downwards for discharge as part of its Yin functions.

In light of the above, the main presenting signs and symptoms of Spleen-Stomach disorders are:

• Emaciation, weight loss or inability to gain weight
• Poor appetite
• Fatigue and muscular weakness
• Mental fatigue
• Digestive disturbances such as: epigastric discomfort or pain, epigastric or abdominal distention (i.e. bloating), nausea, reflux, vomiting, loose stools or diarrhea
• Swollen tongue with tooth marks

Functional Dyspepsia

In WM, functional dyspepsia (FD) is defined as chronic (i.e. longer than 6 months) or recurrent (i.e. occurring at least once weekly) pain or discomfort centred in the upper abdomen. (Rome Working Teams, 2006) The Rome III criteria distinguish two separate subgroups: postprandial distress syndrome (PDS), characterized by postprandial fullness and early satiation, and epigastric pain syndrome (EPS), characterized by epigastric pain or burning. It should be noted that those with heartburn as the main symptom are mostly classified as having gastroesophageal reflux disease (GERD). The PDS subgroup have subjective negative feeling that is non-painful, including early satiety, bloating, upper abdominal fullness, or nausea; while the EPS subgroup experience subjective pain in the epigastrium. In recent years the clinical usefulness of this subdivision has been challenged as there may be considerable overlap between these two subgroups. (Tack & Talley, 2013).

Estimates of prevalence range from 20 – 40% of adult population. However, in spite of having symptoms, less than half of these consult a physician. (Harmon & Peura, 2010; Talley & Ford, 2015) Although precise figures are lacking due to nature of the treatment protocols (i.e. restricted used of endoscopy and first line treatment of H. Pylori, as outlined below), it has been estimated that up to 25% of these have peptic ulcer disease (Grainger, et al, 1994, Anand & Katz, 2015) and less than 2% have localised cancer (Talley et al., 1998). Moreover, there is considerable overlap with other conditions (e.g. GERD, IBS) in 30-50% of patients. (Talley et al., 1993; Klauser et al., 1990)

Patients diagnosed with FD are first tested for the presence of H. Pylori and if they test positive, are given antibiotics. If H. Pylori is not detected they are treated with one or more of the following: over the counter antacids, H2 blockers, a proton pump inhibitor drug (PPI), or other anti-secretory drugs. Most commonly used are the PPI’s, such as Prilosec, Prevacid and Nexium. Antidepressants and anxiolytics may be prescribed in refractory conditions. In patients over age 55, and/or with ‘alarm features’ (i.e. unexplained weight loss, progressive dysphagia, odynophagia [painful swallowing], persistent vomiting, family history cancer, previous cancer, ulcer of the stomach, lymphadenopathy, abdominal mass) where the risk of malignancy has become significant, endoscopic investigation is carried out in order to rule out or confirm this possibility. (Internal Clinical Guidelines Team (UK), 2014: Tack, Masaoka, Janssen, 2011; Harmon & Peura, 2010; Talley & Vakil, 2005)

Outcomes of WM treatments

The outcomes of the WM treatment approach are as follows:

• H. pylori eradication: Although eradication therapy was found to be superior to placebo, the number needed to treat (NNT) was 17 – meaning that out of seventeen people treated, 16 will not have any symptom relief, which equates to a 5.9% effectiveness rate. (Moayyedi et al., 2004)
• Acid reduction: PPIs are effective in treating patients with investigated functional dyspepsia, 6.8% effectiveness (NNT = 14.6) (Delaney et al., 2000; Wang et al., 2007)
• Unwanted deleterious effects of PPI’s include an increased risk of:

1. Nutritional deficiencies (e.g. B12)
2. Food poisoning
3. Dysbiosis
4. Pneumonia
5. Bone loss
6. Hip fractures
7. Infection with Clostridium difficile
8. Dementia
9. Renal disease
10. Heart disease

(Yepuri et al., 2016; Sukhovershin & Cooke, 2016; Zavros, et al., 2002 (a); Zavros, et al., 2002 (b); Heidelbaugh et al., 2012; FDA, 2016; Wedro & Anand, 2016; Harvard Health Publications, 2016; Gomm et al., 2016; Haenisch et al., 2015; Tennant et al., 2008; Marcuard et al, 1994; Bavishi, & Dupont, 2011; Laheij et al., 2004; Dial, 2009; Hvid-Jensen et al., 2014; Rosch, 2010; Lazarus et al., 2016; ie et al., 2016; de Wit & Numans, 2016; Haenisch et al., 2015, Shah et al., 2015)

As discussed elsewhere, medical studies that use statistical methodology are ideally suited for assessing risks (as was their original purpose, within epidemiology) and are rather poorly suited for assessing efficacy of treatments. (Reid, 2015) Viewed in this light, the citations at the end of the previous paragraph above point to risks, the seriousness of which (e.g. dementia, cancer, heart disease) require only a very small degree of increase to preclude the use of these drugs, particularly in a disorder that is not life threatening nor significantly disabling. It is doubtful that patients would consent to undergo prolonged treatment with PPI’s if they were presented with this list of risks at the time of consultation. It is also doubtful whether or not patients receive a detailed explanation of how these drugs work and how they do not cure the condition, but require an indefinite course so as to suppress the symptoms of the underlying problem (thus maximizing exposure as well as the subsequent risks).

In summary, the WM diagnosis is not very specific and the treatments are very poor. The only redeeming feature of the WSM approach is the potential for early detection of cancer.

TCM APPROACH

According to the symptomatology, functional dyspepsia correlates with the traditional disease categories of ‘epigastric pain’ (wei wan tong) and ‘epigastric distention’ (wei zhang). These disorders may arise from various causes: invasion by exogenous pathogens, inappropriate or excessive food intake, stress and emotional strain, deficiency conditions of the Spleen and Stomach, or internally generated pathogens.

(For the sake of brevity, the citations in this section are as follows: Maciocia, 1994, pp.383-417; Xu, 1994, pp.116-20; Bo, 2000, pp.365-70; Shi, 2003, pp.63-72; Maclean & Lyttleton, 2002, pp.338-80, 862-908; Bing & Zhen, 1995, pp.73-85)

The pathways of pathogenesis are as follows:

1. Exogenous pathogens invading the Stomach: Commonly, this is due to the ingestion of Cold natured foods, in excessive amounts (i.e. in quantities that exhaust the Yang Qi of the Stomach). Alternatively, exposure to cold temperatures for prolonged periods (e.g. wearing a wet, full body swimming costume in a cold and windy environment) may exacerbate or cause the Stomach to be overwhelmed by Cold Qi. This leads to the accumulation of pathogenic Cold in the Stomach. Depending on other factors, such as the passage of time, underlying constitution, other foods eaten and environmental conditions, the Cold pathogen may transform into Heat.  Alternatively, exogenous pathogenic Heat may invade the Stomach directly, in ways analogous to those for exogenous Cold, leading to Heat in the Stomach. Thus, the above processes may lead to excess type syndrome-patterns where there are either Cold or Heat pathogens disrupting Stomach function. These syndromes are treated by dispelling the pathogen.
2. Immoderate intake of food, exceeding the body’s digestive capacity: This may come about due to one or more of the following: overeating, eating too many varieties of foods at one meal, eating before the Stomach has emptied, eating excessive amounts of oily or fatty foods (particularly deep-fried foods), generally together with a sedentary lifestyle. The end result is that incompletely digested material accumulates in the Stomach, and acts as a pathogen, which, in turn generates further pathogens, such as Heat and/or Phlegm. This is referred to as food stagnation, and is treated with herbal combinations that promote digestion, regulate the Qi and dispel Phlegm.
3. Liver Qi constraint: Prolonged or intense stress and/or emotional strain affect the Liver, resulting in failure of the Liver’s function to promote the smooth and even flow of Qi throughout the body, particularly in the digestive tract (i.e. the Stomach and Spleen). This mostly leads to Qi stagnation in the Stomach and failure of the Stomach Qi to move downwards and drive normal peristaltic movements. This condition is treated by soothing the Liver and regulating the Qi.
4. Deficiency conditions: Deficiency of the Spleen and Stomach Qi may occur due to physical over-exertion with insufficient rest, malnutrition, chronic illness, or prolonged stress. In addition to the general symptoms of fatigue, poor appetite and lack of muscular strength, patients become more susceptible to environmental pathogens or the effects of inappropriate food intake. Another common deficiency, particularly in the middle aged and elderly, is Stomach Yin deficiency. This condition shares many features with Stomach Qi deficiency; however, it is characterized by Dryness (e.g. dry mouth and throat, constant unquenchable thirst, dry stools) and Heat (red tongue, vague burning epigastric pain). This condition looks similar to pathogenic Heat in the Stomach (see 1., above), the major difference being the concomitant signs of Stomach Qi deficiency. These conditions are treated by tonification of the Stomach and Spleen.
5. Deficiency Cold of the Spleen and Stomach: Also referred to as Yang deficiency of the Spleen and Stomach, this may be regarded as a more severe form of Stomach Qi deficiency, in which the normal warming and activating functions of the Stomach Qi have and become reduced to the point where additional symptoms become manifest – all centered around lack of warmth and impaired movement of the Qi (i.e. cold limbs, cold sensation in the epigastrium, possibly also vomiting of clear fluid). This is treated by warm-tonification (i.e. tonification together with warming)

All of the above pathological processes eventually lead to stagnation of the Qi, which then tends to cause Blood stasis. The former gives rise to mild, poorly localized pain or discomfort with a sense of distention, while the latter gives rise to localized pain.

The above pathways of pathogenesis highlight the deleterious effects of a Western lifestyle where food is abundant, much of the population works in sedentary employment and stress is a normal part of life. Thus, proper treatment protocols should be based upon appropriate lifestyle modifications that remove or ameliorate the causative factors, in addition to a limited course of suitable herbal combinations.

Note: the lifestyle modifications below are taken from: Bo, 2000; Bing & Zhen, 1995; Maclean & Lyttleton, 2002.

Clinical Protocols

The commonly encountered syndrome-patterns in FD are listed below. It should be noted that in real life scenarios more than one may be present, e.g. food stagnation often accompanies deficiency conditions. Liver constraint is often accompanied by food stagnation and/or deficiency.

• Food stagnation 
• Liver Qi invasion of the Stomach
• Stomach Heat
• Cold pathogen in the Stomach (Stomach excess Cold)
• Stomach Yin deficiency
• Spleen-Stomach Yang deficiency

Food stagnation

Key clinical features: Dull pain with a sensation of fullness and distention, symptoms worsened or brought on by eating, malodorous belching, nausea that may be alleviated by belching or passing flatus, irregular bowel motions, thick and greasy tongue coat, slippery or wiry-slippery pulse.

Principle of treatment: Resolve food stagnation and promote digestion, redirect the Stomach Qi downwards.

Treatment formulas

Bao He Wan (Citrus & Crataegus Formula) a.k.a. DIGEST-AID Formula (Bao He Xiao Shi Fang)  

Variations:

With moderate pain, combine the above formula with Xiang Sha Yang Wei Wan (Cyperus & Cardamon Formula).

Lifestyle modifications:

‘Eating less and light food’. Reduce quantity of food eaten, select a light easily digestible diet (avoid excessive oil, deep fried foods, excessive meat, hard cheeses, combining too many different foods at one meal). Soups and stews based on grains (such as rice, barley or millet) and beans (such as mung, split mung or aduki) and a variety of vegetables and lean meats (if desired) are most suitable.

Liver Qi invasion of the Stomach

Key clinical features: Recurring pain or discomfort brought on or aggravated by emotional strain or stress, pain may radiate towards the hypochondria, poor appetite, belching, sighing, tongue has a thin white coat, wiry pulse.

Principle of treatment: Soothe the Liver and regulate the Qi

Treatment formulas

Shu Gan Wan (Cyperus & Peony Formula)

Variations:

• With Heat or Fire, combine the above formula with Jia Wei Xiao Yao San (Bupleurum & Peony Formula) a.k.a. STRESS RELIEF 1 Formula (Jia Wei Xiao Yao San)
• With pain, combine the above formula with Xiang Sha Yang Wei Wan (Cyperus & Cardamon Formula)

Lifestyle modifications:

‘Regulate emotions and avoid irritation’. Introduce such measures as: stress management, meditation, relaxation, counselling, gentle exercise program, as appropriate. Reduce or avoid sour tasting foods, select a light and easily digested diet (as per above, under ‘Food stagnation’) with moderate use of strong flavors.

Stomach Heat

Key clinical features: Sudden onset of pain, burning pain that is worse with pressure and hot natured foods, halitosis, red tongue with dry yellow coat, wiry-slippery-rapid pulse.

Principle of treatment: Clear Heat from the Stomach to alleviate pain

Treatment formulas

Huang Lian Jie Du Wan (Coptis & Scute Formula) a.k.a. ANTITOX 2 FORMULA (Huang Lian Jie Du Tang)

+ Wen Dan Tang (Bamboo & Hoelen Formula BP050) a.k.a. CLEAR THE PHLEGM Formula (Wen Dan Tang)

Lifestyle modifications:

‘Avoid pungent and greasy food’. Avoid the following: hot spices, deep fried food, cooking with excessive amounts of oil or fat. Avoid: garlic, onion, lamb, alcoholic drinks, coffee, chocolate.

Cold pathogen in the Stomach

Sudden onset of pain, pain is alleviated by the application of warmth, pain is aggravated by the application of cold, absence of thirst or (if thirsty) desire for warm drinks, tongue is normal or pale with a thin white coat, wiry-tight pulse.

Note: this is an acute condition that may become chronic if left unresolved.

Principle of treatment: Expel the Cold (pathogen) to alleviate pain.

Treatment formulas

Ban Xia Hou Po Tang – Jia Wei (Pinellia & Magnolia Combination)

Variations:

• With abdominal or epigastric distention:

+ Xiang Sha Yang Wei Wan (Cyperus & Cardamon Formula)

• With nausea:

+ Wen Dan Tang (Bamboo & Hoelen Formula) a.k.a. CLEAR THE PHLEGM FORMULA (Wen Dan Tang)

Lifestyle modifications:

‘Avoid raw and cold food’. Reduce or eliminate the intake of raw foods and refrigerated items; add ginger and crude (unrefined) sugar to cooking. Avoid watermelon, banana, cucumber, radish.

Stomach Yin deficiency

Key clinical features: Chronic dull and vague pain with a burning sensation, hunger but feels full after eating very little or with aversion to eating anything, dry mouth and throat, dry stools, dry red tongue with little or no coat, or coat with bare patches, thready-rapid or thready-wiry pulse.

Principle of treatment: Nourish the Stomach Yin and generate the body fluids, regulate the Stomach Qi.

Treatment formulas

Zhi Yin Gan Lu Yin (Rehmannia & Asparagus Formula)

Variations:

• With Spleen Qi deficiency, combine the above formula with Shen Ling Bai Zhu San (Ginseng & Atractylodes Formula)
• With constipation, combine the above formula with Run Chang Wan (Linum & Rhubarb Formula)

Lifestyle modifications:

‘Eat easily digested food. Avoid pungent, raw, cold, coarse and hard foods’. Avoid the following: hot spices, deep fried food, hard crusts on bread or baked items. Reduce fiber intake. Avoid: garlic, onion, lamb, alcoholic drinks. Eat smaller meals and eat more frequently during the day. Select a light easily digested diet as per above, under ‘Food stagnation’.

Spleen-Stomach Yang deficiency

Key clinical features: Chronic mild, dull pain that is relieved by warmth and pressure (e.g. massage) and after eating, pain worsened by hunger, vomiting of thin watery fluids, poor appetite, fatigue, cold limbs, loose stools, pale tongue with a white coat, weak-slow and possibly also deep pulse.

Principle of treatment: Warm-tonify the Spleen and Stomach

Treatment formulas

Fu Zi Li Zhong Wan – Jia Wei (Dangshen & Ginger Formula)

Lifestyle modifications:

‘Avoid raw and cold food and Cold Damp’. Reduce or eliminate the intake of raw foods and refrigerated items; add ginger and crude (unrefined) sugar to cooking. Avoid foods that generate Cold-Damp: ice cream, banana, watermelon, persimmon. Select a light easily digested diet as per above, under ‘Food stagnation’.

In addition to the above protocols, the following formulas may be used in combination with any of the above syndrome patterns.

Halitosis, nausea, severe reflux:

Wen Dan Tang (Bamboo & Hoelen Formula) a.k.a. CLEAR THE PHLEGM FORMULA (Wen Dan Tang)

Stress or emotional strain due to Liver Qi constraint (select one):

Jia Wei Xiao Yao San (Bupleurum & Peony Formula) a.k.a. STRESS RELIEF 1 FORMULA (Jia Wei Xiao Yao San) – general use

Xiao Yao San (Bupleurum & Danggui Formula) a.k.a. STRESS RELIEF 2 FORMULA (Xiao Yao San) – with mild deficiency

Chai Hu Shu Gan Wan (Bupleurum & Cyperus Combination) a.k.a. QI MOVER FORMULA (Chai Hu Shu Gan Wan) – with moderate to severe pain

Stomach (or Spleen-Stomach) Qi deficiency (fatigue, muscular weakness, poor appetite, pallor):

Xiang Sha Liu Jun Zi Wan (Saussurea & Cardamon Formula) a.k.a. DIGESTIVE TONIC FORMULA (Xiang Sha Liu Jun Zi Tang) 

Stomach (or Spleen-Stomach) Qi deficiency with food stagnation:

Jian Pi Wan (Ginseng & Citrus Formula) – mainly deficiency

DIGEST-AID FORMULA (Bao He Xiao Shi Fang) – mainly food stagnation

Note: The above Chinese herbal formulas are available from Sun Herbal Pty Ltd.

Part 2 of this series will deal with gastroesophageal reflux disease (GERD), providing a critical review of the different approaches taken by WM and TCM, as well as clinical treatment protocols using prepared Chinese herbal medicines.

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