Old Li is 58 years old, usually good health, brisk personality, like to drink a little wine, smoke a little, drink tea. One night, he had a dinner with friends and went home to sleep after drinking some wine. In the middle of the night, he suddenly felt chest pain, and was rushed to the hospital emergency room by calling 120. Doctors emergency electrocardiogram no abnormalities, check cardiac enzymes are in the normal range, and do upper abdominal CT, blood, urine amylase, lipase are normal. Old Li believed in the test results and said: I am a real chest pain ah, behind the chest like burning pain, how can not find the disease? The doctor suggested that Old Li should have a gastroscopy the next day. Old Li thought what does chest pain have to do with the stomach? Despite the doubts, the gastroscopy was done the next morning and the results were reflux esophagitis grade C (severe) and chronic erosive gastritis. The doctor said that Lao Li was suffering from gastroesophageal reflux disease, and his chest pain was called “non-cardiogenic chest pain”, which means that the chest pain was not caused by heart disease, but by reflux esophagitis, and he got better soon after treatment. Zhang Zhaolan, Department of Splenic, Gastrointestinal and Hepatobiliary Diseases, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine What is gastroesophageal reflux disease? Gastroesophageal reflux disease refers to symptoms and/or tissue damage caused by the reflux of stomach and/or duodenal contents (gastric acid, pepsin, bile, pancreatic juice) into the esophagus, with the main clinical manifestations being heartburn (burning sensation behind the sternum), reflux (conscious reflux of stomach contents into the throat or mouth), chest pain, etc. Reflux esophagitis is a common form of gastroesophageal reflux disease. Some patients may have manifestations outside the esophagus, such as angina-like chest pain, asthma, bronchitis, foreign body sensation in the throat, and pharyngitis. Clinically, some patients may have no abnormalities on X-ray and endoscopy even though they have typical GERD symptoms, and are referred to as endoscopically negative esophagitis. This disease is a common clinical digestive disease. Recent studies have found that reflux esophagitis is a risk factor for esophageal adenocarcinoma. In Chinese medicine, there is no name for GERD, but it is classified as “stomach pain”, “heartburn”, “acid vomiting” and “fullness” according to clinical manifestations. “The pathogenesis of GERD is mostly attributed to alcohol and food. The pathogenesis is mostly attributed to the injury caused by alcohol and food, emotional and mental disorders, and weakness of the spleen and stomach, which eventually leads to the rebellion of stomach qi. The location of the disease is in the stomach and is related to the liver and spleen. The treatment from the following aspects, the effect is very good. 1. clear heat and stomach, lowering rebellion and relieving pain gastroesophageal reflux disease is mostly due to overeating, or hunger and satiety unevenly, damage to the spleen and stomach, resulting in loss of harmony and descent of the stomach; or diet bias, or drinking alcohol, smoking, eating spicy, fried, rough, hot food, heat from the stomach; or eating too fast, like to eat fat and sweet, damage to the spleen and stomach, damp heat within. The main symptoms are pain in the stomach or behind the sternum and burning, thirst for cold drinks, acid reflux and belching, hunger and lack of appetite, dry stools, red tongue, thin yellow fur, and stringy pulse. Treatment is based on clearing heat and stomach, lowering rebelliousness, controlling acidity and relieving pain. Case example: Li, male, 29 years old, a company employee. Complaint: acid reflux and heartburn for 2 weeks. After eating hot pot 2 weeks ago, the patient developed burning pain behind the sternum and in the stomach and epigastric region, noisy, with acidic water coming up to the throat. The mouth is dry and bitter, the stool is dry, the tongue is red at the edge, the coating is thin and yellow, and the pulse is stringent. Gastroscopy report: erosive esophagitis, reflux gastritis. Chinese medicine identifies damp-heat and loss of harmony in the stomach. Treatment is to clear heat, harmonize the stomach, subdue acid and relieve pain. After taking 7 doses, the pain and noisy symptoms in the stomach and sternum were relieved, and the stool was clear. After taking 5 more doses, the symptoms basically disappeared, but considering that the repair of the stomach and esophageal mucosa needed to be consolidated, the medicine was given to Wu Bei San (Squid Bone 20g, Zhe Bei Mu 12g) and continued for 2 weeks. Gastroscopy was repeated and the esophageal mucosa returned to normal, the gastric mucosa improved significantly, and no bile was seen in the stomach. The treatment of the symptoms in the “Treatise on Typhoid Fever” by Zhang Zhongjing was based on the “Xiao Chai Hu Tang” evidence. In clinical practice, the author has modified it and usually used it to treat reflux gastritis and esophagitis with internal heat in the stomach with good results. In this formula, Scutellaria baicalensis, Huang Lian and Rhubarb are bitter cold to clear stomach heat; Citrus aurantium is used in combination with Rhubarb to eliminate distension and fullness, to move Qi and channel stagnation, to drain heat and pass stools; Ginger is pungent, used in combination with Scutellaria baicalensis and Lian to open bitterness and lower pain; Ochre is used to harmonize the stomach and lower rebellion; Squid bone and Zhe Bei Mo control acidity and relieve pain. The medicine is used together to clear heat and stomach, reduce vomiting, acidity and pain. 2, strengthen the spleen and benefit the qi, and the stomach to reduce rebellion spleen and stomach, live in the middle jiao, each other as the epitome, spleen qi should rise, stomach qi should descend, spleen qi rise is healthy, stomach qi descend is and, both rise and fall due to each other, dry and wet, mutual use, together to complete the digestion and absorption of food in the body. Stomach Qi should be lowered, both the normal physiological function of the stomach, but also the clinical treatment principle. If the gastric Qi does not descend, that is, the gastric emptying disorder, there is no reason for transformation, stagnation into disease, the diet can not be emptied in time, the initial digestion of water and grain essence can not be properly moved to the small intestine, for the spleen to transfer the body, the gas does not descend is full, full is rebellious, the main manifestations of the rebellious gas in the stomach is heartburn, acid, abdominal pain, bloating, fullness of the chest and diaphragm, vomiting and regurgitation, erratic upper gas and other symptoms. Therefore, it can lead to the occurrence of reflux esophagitis. Case example: Xie, female, 62 years old, retired. He complained of heartburn, acid reflux with fullness of stomach and epigastric for 3 months, fullness of stomach and epigastric, aggravated after eating, dullness and belching, loose stools, white tongue coating and sunken pulse. Gastroscopy showed incomplete closure of the cardia and pylorus. There was bile reflux into the stomach, and the diagnosis was bile reflux gastritis. He has a history of hypertension, which is maintained normally with antihypertensive drugs. The evidence is that the spleen is deficient in transportation and the stomach is not harmonizing and descending. Treatment: Radix Codonopsis pilosulae 15g, Poria 15g, Atractylodes macrocephala 12g, Radix Pseudostellariae 10g, Pericarpium chenopodium 12g, Citrus aurantium 10g, Persicariae 20g, Radix dactylodis 20g, Mucuna pruriens 6g, Saxifrage 10g, Ginger 6g, Roasted grass 5g; Add Siberian stalk 15g to broaden the chest and regulate Qi; Aconite 20g, Zhebei 12g to control acidity and relieve pain. Add and subtract according to the symptoms, taking 25 doses in total. The symptoms of stomach fullness, nausea and belching, heartburn and acid reflux were all reduced. The patient is an elderly woman with hypertension and has been taking calcium channel antagonist for years, which damages the spleen and stomach and affects its elevation function, predisposing her to esophageal reflux. This formula uses Si Jun Zi Tang to benefit Qi and strengthen the spleen; Er Chen Tang to dry dampness and resolve phlegm, regulate Qi and harmonize the middle; Citrus aurantium, Persimmon, Cuttlefish and Mullein to regulate Qi and subdue rebellion, eliminate distention and fullness; Sha Ren and Ginger to resolve dampness and move Qi. The whole formula has the function of strengthening the spleen, benefiting the qi, harmonizing the stomach and lowering the rebellion, so it can be effective. 3, dredging the liver and relieving depression, clearing heat and stomach discomfort is one of the main factors that cause for esophageal reflux. In today’s fast-paced life and increasingly fierce competition, many people are depressed and irritated, and what they want is not achieved, excessive worry, depression and anger hurt the liver, resulting in liver failure to regulate, liver gas offending the stomach. The liver is the master of draining, likes to be organized, the master of ascending, active, is an important factor for the draining, smooth, ascending qi, such as Zhou Xuehai said “the world said that the spleen and stomach for the ascension of the root, not also. The spleen, the path from which the rise and development; liver, the root of the beginning of the rise and development.” Zhang Zhaoqing also cloud “wood does not rise, then the heart blood does not rise, the spleen does not for the stomach to move its fluid, the bile can not be lowered into the phase of fire, the stomach can not descend to give Sheng Na.” The drainage function of the liver and the rise and fall of the spleen and stomach are closely related, and the normal drainage function of the liver is a condition for the normal rise and fall of the spleen and stomach. If the liver draining function is abnormal, it not only affects the clearing function of the spleen, but also hinders the lowering function of the stomach: in the upper part, vomiting and belching; in the middle part, distention and pain in the abdomen; in the lower part, constipation. Tang Solchuan<