Currently, the incidence of reflux esophagitis is on the rise year by year due to social work pressure, lifestyle and other factors. Reflux esophagitis is an inflammatory esophageal lesion caused by the reflux of stomach and duodenal contents into the esophagus with panacidity, heartburn, retrosternal pain, and burning as the main symptoms, which is manifested endoscopically as a breakdown of the esophageal mucosa, visible as esophageal congestion and edema, erosion, ulceration, and fibrosis.
The prerequisite for reflux esophagitis is the reflux of gastric contents across the lower esophageal sphincter (LES) into the esophagus, and the inability of the esophagus itself to remove the reflux as quickly as possible, resulting in prolonged retention of gastric contents in the esophagus, and damage to the esophageal mucosa from the gastric contents, such as gastric acid, bile acids, and pepsin, leading to reflux esophagitis. Some patients may also develop serious complications such as Barrett’s esophagus and even esophageal glands.
1. Chinese medical name
The main clinical manifestations of this disease are acid reflux, heartburn, vomiting, regurgitation, dysphagia, painful swallowing, chest pain, and some patients may experience pharyngeal discomfort such as foreign body sensation, cotton ball sensation, blockage, pharyngitis, hoarseness, cough, and even asthma. There is no name for esophagitis in Chinese medicine, but it belongs to Chinese medicine according to its clinical symptoms.
2. Etiology and pathogenesis
The liver is the master of drainage, liver qi stagnation, transverse offense stomach, liver and stomach disharmony, stomach loss of harmony and descent, so can be seen swallowing acid, belching, desire to vomit, mouth bitterness, dullness, chest and fullness and other symptoms. There is also “Shou Shi Bao Yuan – swallowing acid” cloud: “diet into the stomach, by the damp heat depression, food can not be transformed, so for swallowing acid.” It is said that the lack of diet can damage the spleen and stomach, and the spleen and stomach can not be transported and transformed properly, which can lead to stagnation of food, internal growth of damp heat, congestion of wood and depression of the liver and stomach, so it can be seen as acid swallowing, warmth, and stomach distension. And then there is the “Medical Method – swallowing acid” in the cloud: “cover the cold is not comfortable Yang Qi, gas is not comfortable is depressed and heat, heat is acid.
3.Treatment methods
(1) General treatment
Teachers believe that lifestyle changes are the basic measures for treating this disease, such as elevating the head of the bed 15~500px during sleep, controlling the intake of fat, chocolate, tea, coffee and other foods that will lower the pressure of LES, and prohibiting smoking and alcohol, avoiding full meals 3 hours before bedtime or lying in bed immediately after meals, etc. Patients who are emotionally disturbed should be advised to relax and exercise in moderation, all of which are beneficial to the improvement of this disease.
(2) Discriminatory treatment
Through long-term clinical practice, based on many years of clinical experience, I have summarized the following four common types of symptoms, which have been treated with good results.
Stagnant heat in the liver and stomach
Symptoms include heartburn, noisy acidity, belching, vomiting, bitter and dry mouth, or preference for cool drinks, or irritability, red tongue, yellow fur, and string pulse. This is a case of liver-heat offending the stomach and loss of harmony and descent of the stomach. The treatment is to clear liver-heat, harmonize the stomach and subdue rebellion.
The bitter cold of Huanglian to relieve fire, less with the pungent hot Wu Zhuyu, a cold and a hot, hot medicine to restrain the cold of Huanglian, and Wu Zhuyu into the liver to subdue the rebellion, in order to make the liver and stomach and regulate. I give the mother of pearl to dispel the knots in seeking to de-stress, white peony to nourish the liver and soften the liver, thick park, Citrus aurantium, Chen Pi to regulate the qi, heat is very much added dandelion, gardenia to clear the liver and remove heat. If the liver heat moves to the intestines and the stools are dry, add cassia seeds and rhubarb to clear liver heat and laxative products.
Stagnation of Qi in the liver and stomach
Symptoms include acid reflux, belching, chest tightness, distension and pain in the epigastrium, or aggravated by emotional disorders, or like to rest, dullness, restless sleep at night, pale tongue with thin white fur, and string or thin pulse. This is a case of liver qi stagnation, transverse and offensive to the stomach, and upward rebellion of stomach qi. The treatment is to relieve liver stagnation, move qi and harmonize the stomach. To enhance the effect of draining liver qi, promoting blood circulation and relieving pain, so that liver qi can be regulated, qi and blood can be unblocked and qi can be unblocked. Or add Yu Jin to strengthen the detoxification of the liver, and add Gardenia jasminoides, Dampi, Dandelion, etc. to detoxify liver qi and release heat in cases of qi stagnation and heat. Because the liver is a yin body and yang organ, so the Qi regulating products should not be too fragrant and dry.
Qi deficiency and phlegm obstruction
The symptoms include hardness of the heart, yelp that does not go away, or discomfort in the pharynx such as a feeling of foreign body blockage, or regurgitation and vomiting, vomiting saliva, pale tongue with white coating and slippery or weak pulse. The stomach is weak and phlegm is blocking. The treatment is to benefit Qi, harmonize the stomach, subdue rebellion and resolve phlegm.
The main medicine is to subdue phlegm and dissolve phlegm, Chen Pi, Fuxia, ginseng, licorice and jujube to support and benefit the stomach. If phlegm and dampness are obvious, add Poria, Zhe Bei, etc., and add Scutellaria, Bamboo Ru, etc. to drain stomach heat. According to the teacher, this type is the most common in clinical practice and is treated with the above method, which is effective repeatedly.
Stomach Yin Deficiency
Symptoms include vague pain behind the sternum or vague burning pain, dryness of the mouth and throat, dislike of drinking, short and red urine, dry stools, red tongue with little or no fluid, little or no moss, and thin and counted pulse. The treatment should be to nourish yin and benefit the stomach, generate fluid and harmonize the stomach.
The herbs Sheng Di and Mai Dong nourish yin and clear heat, generate fluid and moisten dryness, and are the best products to benefit the stomach. Bei Sha Shen nourishes Yin and generates body fluid to strengthen the power of Sheng Di and Mai Dong to benefit the stomach and nourish Yin. Paeonia lactiflora and Glycyrrhiza glabra sour sweeten yin, slow down the pain. For obvious deficiency of fluid and yin, add rehmannia root, wu mei and smallpox powder to nourish fluid; for dry stools, add fire hemp seed, yu li ren, bitter almond and gua gua ren to laxative; for obvious stagnation of qi, add Buddha’s hand to move qi without hurting yin; for severe pain, add yanhu suo and neem to relieve pain without drying.
The pathogenesis of this disease is liver-stomach disharmony, the spleen and stomach are out of balance, and the qi is unfavorable, so the treatment should be based on the main principle of draining the liver and strengthening the spleen, and harmonizing the stomach and lowering the rebellion. The liver is the “root of the beginning of elevation”, and the stomach is smooth by descending, so treatment should be based on its elevation state to regulate the qi of the whole body. The spleen likes to be dry, and the stomach likes to be soft and moist, so the clinical use of medicine should be moistened and dried, not too warm and dry, more use of pungent and dispersing dampness to resolve the spleen dampness, and add sweet and cool moisten to nourish the stomach yin, together to achieve the effect of resolving dampness but not warm and dry, warm and dry but not help dampness.
The disease has recurrent attacks and is characterized by a mixture of deficiency and deficiency of the spleen and stomach and the symptoms of qi stagnation, phlegm obstruction, blood stasis, etc. Therefore, while tonifying the spleen and stomach, we should also promote the flow of qi and blood, so that the symptoms can be balanced and tonified without stagnation. There are many clinical variations, so the treatment should not be confined to the above-mentioned types, but should be applied flexibly by examining the causes and adding and subtracting according to the symptoms.
(3) Western medicine treatment
Gastric juice and bile reflux are the main pathogenic factors of this disease, while the decrease in LES pressure and esophageal contouring ability is the main cause of this disease, so teachers often use a combination of Chinese and Western methods to treat this disease, Western medicine mostly use acid suppressants (such as proton pump inhibitors) and gastric mucosa protective agents to suppress acid and protect the stomach.
Small doses of acid suppressants can quickly suppress the heartburn and burning sensation in the posterior sternum and epigastrium. If necessary, they can be combined with drugs that promote gastric motility to increase LES pressure, improve esophageal peristaltic function and promote gastric emptying, thus reducing the reflux of gastric contents, which can improve the therapeutic effect.