Biliary reflux gastritis is caused by pylorus dysfunction, or after gastrectomy, causing alkaline intestinal fluid containing bile to flow back into the stomach, destroying the mucosal barrier function of the gastric mucosa, causing gastric mucosal congestion, edema, and even erosion and bleeding, resulting in stomach pain, fullness, noisy, belching, and even bitterness in the mouth and vomiting of mucus and bitter water, which belongs to the category of “bile disease” and “gastric pain” in Chinese medicine. “The disease is often prolonged and untreated. The author treats more than 50 cases with satisfactory results by clearing the liver and gallbladder and lowering the stomach, and the experience is reported as follows. 1, liver and gallbladder heat disturbing the stomach should be cleared liver and gallbladder and stomach to lower the rebellious bile by the drainage function of the liver and excretion, to assist digestion, rely on the power of the stomach gas downward, so that the lower reaches into the intestine and not upward. If the liver and gallbladder are mutually cognate, and the bile is sent to the internal fire, if the emotions are out of order, the liver becomes heat, and the liver heat moves to the gallbladder, then the heat is easy to congestion and rebel against the stomach, and the stomach ligament is burned by the bile and there is pain and burning sensation, and the stomach qi is rebellious, and the bile then goes up to the mouth, then there is bitterness in the mouth, and even vomiting bitter water, that is, the so-called “liver qi is hot, then the bile leaks and the mouth is bitter “The treatment is to clear the liver and gallbladder, harmonize the stomach and subdue the rebellion, with Jing Yue Hepatitis Decoction as the main formula. If the tongue is thin and white and watery, and the middle energy is weak, combine with Liu Jun Zi Tang; if the tongue is red and the coating is yellow and greasy, combine with Xiao Shen Che Tang. Case 1 Liu, a 57-year-old female, had pain and burning sensation in the upper abdomen, accompanied by bitterness in the mouth and even vomiting of yellow-green bitter water, with recurrent episodes, aggravated in the past 3 months, with fullness in the stomach and epigastric region, poor appetite and significant weight loss, which could not be cured for a long time. Gastroscopic examination: extensive congestion, edema and erosion of gastric mucosa, yellow gastric retention fluid, and yellow-green reflux fluid with foam emitted from the pylorus, diagnosed as bile reflux gastritis. The vomiting was frequent, the vomit was yellowish bitter water, irritable, the tongue was red, the tongue coating was thin and white, and the pulse was stringent. The TCM diagnosis was “bile disease”. It is the evidence of liver and gallbladder heat offending the stomach and rebellion of stomach qi. The treatment is to clear the liver and gallbladder, harmonize the stomach and lower the rebellion. Hepatic Decoction combined with Six Gentlemen’s Tonic plus and minus. The medicine used: Gardenia, White Peony, Dampi, Green Chen Pi, Poria, Fried Atractylodes 10g each, Ochre (first decoction) 30g Huang Lian 3g Licorice 6g, Ginger 12g, vomiting stopped after 5 doses, stomach pain and burning sensation was obviously reduced, 66 doses were taken with the addition and subtraction of the formula, and he still felt good after stopping the medicine for a week. Gastroscopy review, gastric mucosal lesions disappeared, no bile reflux was seen. 2, liver heat and stomach cold mismatch when the use of cold and heat to drain the liver and stabilize the stomach, the body of the plain spleen deficiency and stomach cold, in case of liver heat shifting bile, bile gas offending the stomach, the abdomen often have gas attack for pain, cold limbs and loose stools, burning sensation under the heart, stomach pain and vomiting bitter, tongue edge or red, tongue body fat with teeth marks, pulse more string thin, for liver heat and stomach cold, cold and heat mismatch, biliary diseases such as cholecystectomy the latter is more common, the treatment should be bitter, pungent and acidic to drain the liver, pungent, sweet and hot to stabilize the stomach, cold and heat, and the use of both cold and heat. The treatment should be bitter, pungent, sour to drain the liver, pungent, sweet and hot to calm the stomach, combining both cold and heat, and tonic and drainage, using Wu Mei Wan plus reduction. The dosage of Huanglian should be small, which is intended to suppress the liver, with 3g, and the discretionary addition of Chuanxiong and Curcuma to activate blood circulation and remove blood stasis, which can promote the repair and regeneration of gastric mucosal lesions. Case 2 Ji, male, 48 years old. For 2 years after cholecystectomy, he had frequent pain in the stomach and epigastrium, bitterness in the mouth, vomiting of clear bitter water, distension and pain in the epigastrium after eating, often feeling Qi rushing upward from the left side of the abdomen, emaciation, cold limbs and loose stools, red tongue, thin yellow moss, and thin pulse. Gastroscopic examination: the mucosa of the gastric sinus has papule-like elevation with umbilical depression at the top, mucosal exfoliation, partly with white moss, and congestion and edema of the mucosa around the erosion. Pathological examination: papillary hyperplasia of the epithelium of the gastric mucosa. The gastric retention fluid was yellow, suggesting bile reflux gastritis. The diagnosis of Chinese medicine is “bile disease”. The evidence belongs to liver heat and stomach cold, liver heat shifting to bile, bile Qi offending the stomach, phlegm stagnation blocking the gastric ligament. The gastric ligament is damaged and the gastric qi is carried by the bile upward, so use bitter, pungent and sour to drain the liver and pungent, sweet and hot to calm the stomach. This formula is based on Wu Mei Wan plus or minus. Umei, Angelica sinensis, Paeonia lactiflora, Neem, Radix Codonopsis pilosulae, Cornu Cervi Pantotrichum, 10g each, Huanglian 3g Gunpowder, Sichuan pepper 6g each, Fa Hanxia, Dai Ochre (first decoction) 30g each, Poria, Fried Atractylodes 12g each, Chuanxiong, Curcuma 10g each, Roasted licorice 6g. After 5 doses, the vomiting and bitter water stopped, and the stomach pain and noises were significantly reduced. After taking more than 90 doses, the stomach and epigastric discomfort was relieved, and the patient was consolidated for half a month with Six Jun Zi Tang. Gastroscopy review, mucosal congestion, edema and erosion foci all disappeared, no bile reflux was seen, no recurrence so far. 3, the residual gastric bile reflux should be cleared liver and gallbladder bitter down pungent open after gastric surgery, especially after the Bi II surgery, the loss of the pylorus “directional valve” type role, rich in bile duodenal fluid can freely return to the stomach, almost without exception in causing bile reflux gastritis. The symptoms are pain in the stomach and epigastric, noisy, full, belching, bitter mouth, and even vomiting yellow-green bitter water, the treatment should be to clear the liver and gallbladder, bitter and pungent and used to lower the rebellion and stomach, can relieve the condition wu hui pill, gold bell seeds san combined with small sunken chest soup plus reduction, deficiency cold people should Xiang Sha Liu Jun Zi Tang plus flavor. Case 3, Shi, male, 51 years old, had undergone a major gastrectomy for refractory gastric ulcer for one year. In the past year, he had a burning sensation in the stomach and epigastric region, pain after meals, fullness, bitterness in the mouth, even vomiting yellow-green bitter water, which could not be relieved by taking alkaline drugs, gradually losing weight, having heart trouble, having dry stools, with a light red tongue, greasy and slightly yellow coating, and a smooth pulse. Gastroscopy showed bile reflux gastritis. He was diagnosed as “bile disease” by TCM. The evidence belongs to liver and gallbladder heat disturbing the stomach with bile upward, and phlegm and food stasis heat disturbing the stomach. The treatment is to clear the liver and gallbladder, and to lower the rebellion by bitterness and pungency. Medicine with gardenia, neem, Huanglian 10g each, Guaou 30g WuYu 2g HuJin 20g, FaHanXia, YuanHu, Curcuma japonica 12g ginger 12g each, after taking 7 doses of vomiting bitter water to stop, burning feeling significantly better, after taking 14 doses of feeling good, automatically stop the drug. In the future, every attack, after taking the above 5 doses can be relieved. 4, concluding remarks bile reflux gastritis in the liver, gallbladder and stomach. Liver heat and bile, bile gas offending the stomach, with similar “directional valve” role of the pylorus dysfunction, stomach gas with bile on the reverse, is the cause of bitter mouth and vomiting bitter water, stomach pain and noisy is the reflux of bile burning stomach complex. Chinese medicine diagnosis of bile reflux gastritis: some belong to the category of “bile disease” and some belong to the category of “gastric pain”, the difference lies in the presence or absence of symptoms of bitterness in the mouth and vomiting of bitter water. This is because “bile” refers to a disease characterized by bitterness in the mouth, vomiting, burning sensation in the stomach and epigastric region, and distension and pain in the stomach and epigastric region due to the bile evil offending the stomach and the loss of bile and stomach descent, or in combination with other symptoms of the stomach and epigastric region, while bile reflux gastritis does not always present with bitterness in the mouth and vomiting of bitter water, but can be similar to general chronic gastritis, and bitterness in the mouth is not unique to bile. It is not a symptom unique to biliary disease. The presence or absence of bile reflux under gastroscopy is also related to the gentleness and skill of the physician during the gastroscopy operation and the sensitivity of the patient, as well as the intraoperative tension or not. The difference should be noted. Biliary reflux gastritis in the liver and gallbladder manifests as heat, while in the stomach it can be cold or hot, either deficient or real. The treatment is based on clearing the actual heat in the liver and gallbladder, harmonizing the stomach and lowering the rebellion, supplemented by removing phlegm and eliminating blood stasis, with the addition and subtraction of formulae such as Huali Decoction, Wu Mei Wan and Si Wei San. Yangming is a meridian with a lot of qi and blood, so adding one or two of the blood activating and stasis-removing herbs, such as Sanguine, Curcuma, and Salvia, is beneficial to the repair and regeneration of gastric mucosa and regulation of gastrointestinal motor function. If there is no obvious manifestation of heat and cold, Sihui San can be used with Han Xia, Ochre and Salvia. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things.