Gastroesophageal reflux disease (GERD) has a high incidence and seriously affects the quality of life of patients. Some patients have the disease for several years, repeatedly and painfully, and if there is long-term inflammation of the esophagus, ulcers or Barrett’s esophagus, there is a possibility of cancer [1]. Professor Xu Jingfan, the first national medical master, has devoted himself to the research of evidence and treatment of spleen and stomach diseases for decades, and has accumulated rich experience in the treatment of this disease.
1. Multiple causes and different symptoms
The esophagus runs from the pharynx to the stomach, which is called “the system of the stomach” in “The Collection of Difficult Scriptures”. The word “soft and hollow” precisely expresses the anatomical and physiological characteristics of the esophagus. The causes of GERD are many, and they are summarized as follows: the stomach is filled with wine and food, and the stomach does not descend enough; the stomach is weak due to lack of endowment; the stomach is injured by many medicines, and the elevation is not normal; the stomach is injured by worries and cravings, and the stomach is not normal; the liver is depressed due to poor emotions; the stomach is thin, and the lower canal is unfavorable; the stomach is not descending with the bile; the abdomen is large and thick, and the stomach is not moving for a long time; the lungs are not purified, and the stomach is rebellious; the fetal gas is rebellious in the late pregnancy. The above causes are often combined with each other.
Reflux, when the stomach Qi is rebellious. Discomfort in the pharynx is mainly due to phlegm and gas obstruction. Heartburn, with a burning sensation, is mostly due to heat from Qi. The noises that are slowed by food are due to middle deficiency, and those that occur easily after food are often caused by qi stagnation in the middle, loss of harmony and descent of the stomach or qi stagnation turning into fire. Qi depression can cause pain and unfavorable swallowing. In short, this disease is mainly caused by qi disease at the beginning, qi stagnation, fluid distribution is not normal, gathered into phlegm, liver depression and qi stagnation for a long time can turn into heat, and even qi stagnation and blood flow is not smooth, stasis of blood within. If phlegm, qi and blood stasis are obstructed, then choking can lead to diaphragm.
Individual patients may have extra-esophageal manifestations, especially coughing, which is due to the loss of harmony and descent of the stomach and the loss of lung publicity and purification, and the lung and stomach are the same disease.
2, the evidence is divided into four categories, according to the evidence of treatment
The disease varies in severity and symptomatology, but there are mainly four types of symptoms, which should be treated according to the evidence.
2.1 Qi-depression: The symptoms include frequent belching, which is painful, chest tightness, reflux, thin white tongue coating, thin string-like pulse or normal, and symptoms are especially pronounced after emotional discomfort or stressful exertion. The treatment is to regulate qi and relieve depression, harmonize the stomach and subdue rebellion. The formula includes Mu Xiang Qi Tuning San, Wu’s New Orange Peel and Bamboo Roo Soup, and Xie Yu Hep Huan Tang with addition and subtraction.
The Su Wen says: “The liver wants to disperse, eat pungent food urgently to disperse it.” The peppermint and ginger in the formula are precisely pungent products to disperse and ventilate qi and depression. If the heart and liver are depressed and the mind is not nourished, it can be supplemented with licorice, wheat and jujube to sweeten and slow down the heart. If belching is frequent, use products that harmonize the stomach and lower the rebellion, such as orange peel, heliotrope shell, knife bean shell, incense, persimmon, and ochre. In addition to soup, can be used with the “grinding method”, with incense or knife bean seeds ground in water to take the powder, the powder is fine, the effect is better. Instead of incense, it can be replaced by ocimum sanctum, white sandalwood, etc.
2.2 phlegm and gas cross-blocking evidence: symptoms see discomfort in the pharynx, such as object obstruction, coughing, swallowing, sometimes reflux, feel choked eating. The tongue coating is thin and white, and the pulse is small and slippery. The onset and aggravation of symptoms are often related to emotions. The treatment is to regulate Qi and relieve depression, resolve phlegm and disperse knots. The formula is based on the addition and subtraction of Hanxia Houpu Tang. Hou Pao can also be used with flowers (Hou Pao Hua) and can be added with Radix Platycodon, Citrus Aurantium, Green Peel or Chen Pi to regulate the lift of Qi. If there is dry and painful pharynx and congestion in the pharyngeal arch, remove Hou Pu and Ziziphi, and add Shao Gan, Hanging Golden Lamp and Jin Guo Lan to clear heat and promote pharynx.
2.3 Liver and Stomach Heat: The symptoms include belching, reflux, dry mouth or bitter mouth, and dry stools. The tongue is red, and the pulse is small and stringent or fine. The treatment is to clear the liver and stomach, harmonize the stomach and subdue rebellion. The formula is Zuo Jin Wan, Da Huang Gan Cao Tang, Ji Sheng Orange Peel and Bamboo Roo Tang with addition and subtraction. If the mouth is bitter, reflux tastes bitter, and bile heat is rebellious to the stomach, use Artemisia absinthium, Scutellaria baicalensis, and HAI Jin Sha as appropriate. For those with heat in the stomach and dry stools, combining with Da Huang.
2.4 Qi stagnation and blood stasis: with a long history and clinical manifestations other than the evidence of qi stagnation, often accompanied by stabbing pain behind the sternum, weakness in eating, and a purple tongue. Treatment should be to move Qi and remove blood stasis. The treatment should be to move the qi and remove the stasis. The treatment can be applied to Blood Mansion and Stasis Removal Soup and Xie Yu Huan Tang.
The above four types of symptoms are often preceded by qi-depression, which leads to depression-heat, phlegm aggregation and blood stasis. There are still a few patients who see phlegm and blood stasis each other, so it is more important to distinguish the main and secondary points and properly regulate the treatment.
3.Running, promoting and lifting, the main points of treatment
In view of the symptoms of GERD and the physiological characteristics of “soft and empty” esophagus, clinical attention should be paid to the following principles of treatment and the combination of prescriptions and medicines to improve the effectiveness of treatment.
3.1 Moisten the dryness
The treatment principle of “moisten and nourish the deficient and cleanse the actual” was proposed in the Jin Kui Wing by You Zai Jing. For those who are deficient in yin and fluid, the esophagus should be nourished with yin and fluid; for those who are deficient in blood, it is also advisable to nourish the blood and the camp. If there is qi stagnation, heat depression, phlegm obstruction or blood stasis, the treatment is to regulate qi, clear heat, resolve phlegm and remove blood stasis, which are all in the category of sparing and boiling. Esophageal disease after a long period of time, each more deficiency and reality mixed, with Run with dry must be properly balanced.
If you feel that the esophageal area is burning and noisy, and even swallowing with a dry and unfavorable feeling, dry mouth, red tongue, you need to use a moistening agent, according to the evidence of the choice of Maimendong, yu zhu, raw earth, almonds, white honey and other products, and blood deficiency with angelica, white peony, wolfberry, shou wu, mulberry seeds and so on. Among the moistening agents, we should also add Hovenia husk, Chuanpo flower, orange peel and other slightly pungent drugs to regulate qi, so that the stomach can be harmonized and lowered, which will help the moistening agents to better play their medicinal effects.
If the evidence is mainly qi stagnation, it is advisable to dredge the qi mechanism, move the qi and resolve phlegm. The acidity and softness of white peony and the sweetness and moistening of rhizome can be added to the above formula, so that there is softness in the rigidity, and the rigidity and softness can be combined with the moistening and dryness. If there is inflammation or ulcer in the esophagus, add white peony, yam and lotus root to clear and moisten and protect the membrane at the same time.
3.2 Ascending and descending
For patients with food reflux, it is advisable to take pungent and bitter to descend on the basis of evidence. Ginger, incense, cardamom seed, clove, half-xia and Chen Pi all have different degrees of pungency, while Huang Lian and Hou Pu have bitterness. According to the evidence and with the entry, can improve the effectiveness of treatment.
For general cases, the use of qi-regulating and qi-lowering agents can bring gradual improvement. However, in the case of persistent illness or recurrent attack, the treatment effect is not yet satisfactory, so it is necessary to extrapolate the medicine from the word “lift”, such as Citrus Aurantium with Radix et Rhizoma, Incense with Radix et Rhizoma, Almond with Psidium Guajava, Bamboo Roo with Radix et Rhizoma, Radix et Rhizoma with Radix et Rhizoma (usually with Radix et Rhizoma, with interpharyngeal and retrosternal pain with Radix et Rhizoma), Radix et Rhizoma with Radix Persicariae, etc., all of them are agents of lifting and matching. It is very important for the treatment of this disease to have the right ascending and descending and ascending and ascending and descending. If we can pay attention to the ascending and descending law and make the right combination, we can often improve the treatment effect.
3.3 Xuan Tong
The aforementioned drugs for Qi management and phlegm removal have the function of Xuan Tong. In addition, Xu often chose to add goose pipe stone, Sha Luo Zi, orange luo, Tong Cao, Acute seed, Wei Ling Xian, Wang Bu Liu Xing and other Xuan Tong medicines in clinical practice. Goose pipe stone for treating chest and diaphragm fullness, “Xuanming theory formula” burning incense through the partition in the early years of Xu Lao study with Zhu Chunlu, treatment of choking and diaphragmatic disease commonly used goose pipe stone with mother clove, every see good results, said to have “expansion of the esophagus” effect.
Sha Luo Zi moves Qi and broaden the chest and diaphragm, and can promote the heart and esophagus, the sternum behind the hidden pain, stabbing pain, the use of very effective. It is good for treating diaphragmatic disorders, is light and clear, and can be taken for a long time without harm. Tongcao enters the lung and stomach, is sweet and light but cool, cool but not cold, and is also an auxiliary medicine for esophageal diseases with Xuan Tong function. Acute seed, “Compendium of Materia Medica” contains: “treating choking and diaphragm, lowering bone sticking”, breaking stasis and softening hardness, effective for short-term use for those who have difficulty in swallowing. It is effective for short-term use for those who have difficulty in swallowing. Wei Ling Xian walks but does not guard, declares the twelve meridians, and has been used to treat bone i in the throat. Wang Bu Liuxiang moves water and dissolves blood stasis, which can be used for those with esophageal disorders of phlegm and stasis.
4.Tonics frequently taken, life regulation
The original recipe of Hanxia Houpu Tang for the treatment of plum kernel gas contains: “divided into warm serving, three days and nights a serving”, suggesting that GERD taking the soup to drink frequently for many times is appropriate. 1 dose per day, decoction 2 times, each time the liquid is divided into 2 to 3 doses, including one at night before bedtime. If you use incense, it is best to add a small amount of cold boiling water on a rough pottery or stone grinding, so that the grinding into a mixed suspension, a small amount of frequent consumption, the effect is better. Can also use a very small amount of incense powder placed on the tongue (or under the tongue) contain, so that the drug effect longer.
In short, should pay attention to the appropriate method of taking medicine. If it is inconvenient to take the medicine several times during the day, you can use “tea substitute”, such as 3g of orange peel, 2g of orange peel, 3-5g of wood butterfly, boiling water bubble with a lid and smothered for a few minutes, drink and take tea substitute. If the patient is suffering from liver and stomach heat, add 10-15g of maitake and 2g of raw licorice.
Many clinical patients with GERD have lingering and recurrent illnesses, which are difficult to treat. Individual patients are dependent on acid suppressants and cannot stop taking them, so their quality of life is significantly reduced;
Quit smoking, quit drinking, avoid foods that reduce the tension of the lower esophageal sphincter, such as chocolate, fat, coffee, strong tea, etc.; do not eat at night before bedtime; for overweight patients, especially weight control; strengthen exercise, Xu often instructs patients to do abdominal deep breathing, that this method helps restore the lifting function of the spleen and stomach, so that the pathological state of gastric rebellion is improved; when sleeping, the head of the bed can be padded 3 to 5 cm. The textbook contains 10-15cm seems too high, the clinical is not suitable, especially for some patients with cardiovascular and cerebrovascular diseases, easily induced ischemia of the heart and brain and become other changes. In addition, mental relief should be given to encourage patients to maintain an optimistic mood, and strive to “relieve emotions and change sex”, to abstain from anger and depression, to establish confidence in the cure.
5, thick decoction of paste, lying down to take medicine
Where the esophagus has inflammation (including esophageal diverticulitis), ulcers, treatment drugs strive to stay slightly in the esophagus, so that the drug on the esophageal mucosa directly. From his clinical practice, Xu concluded the method of taking medicine in the lying position.
According to the evidence of the disease and the prescription, the soup requires a thick decoction, the first decoction and the second decoction are each thickened to about 150ml. Add 1 to 2 spoonfuls of lotus root powder to the liquid each time. If root powder is not available, yam powder or rice powder can be used instead. After fully blending, heat over moderate heat, stirring while boiling, and make a thin paste of semi-liquid medicine. The patient should undress and lie on the bed, swallowing 1 to 2 spoonfuls of the medicine on the left, flat, right and prone sides, and swallowing the rest of the medicine while lying on the back.
After taking the medicine, gargle with warm water and spit it out, lie down on the bed, turn over slightly, and do not drink water or eat any food for half an hour; if the medicine is taken at night, sleep after taking it according to the above method, the effect is especially good.
If you take the medicine in an upright or sitting position, it will be taken quickly through the esophagus and into the stomach, instead of taking the medicine in a reclining position, coupled with the stickiness of the powder paste, can be conducive to direct action on the disease. The root has the function of clearing heat and cooling the blood, and the root powder is sticky and can protect the membrane. If the patient has hidden pain or stabbing pain behind the sternum, the pain is fixed and the evidence is accompanied by stagnation, the medicine paste can also be mixed with ginseng sanqi powder 1~1.5g each time or Yunnan baiyao 0.5g each time. if the diagnosis is esophageal diverticulitis, the medicine can be taken in the prone position as shown on the X-ray film and sleep to the side of the diverticulum protrusion, with the waist and hip slightly padded.
After 10-20min turn to the opposite side of the bed for 20min. at this time, pull out the pillow, so that the head position low, 20min after adding pillows. In this way, the drug can be made to act on the diverticulum site first, and then make it flow out. Take the medicine according to the above method, for esophageal inflammation, ulcers and other diseases, can improve the efficacy.