In my first article, I omitted the fact that in addition to eating proper foods, the spirit in which food is eaten is also quite important, according to Chinese medicine. While eating, concentration should be focused on that activity. Worrying or thinking while eating may cause the body harm. Also, returning to work immediately after a meal, or working while eating, could compromise the digestive process. In this article, we continue the discussion on herbal treatment of digestive disorders by presenting some of the other frequently occurring problems of the gastrointestinal system.
HEARTBURN
The most common malady is indigestion, including stomach pain, nausea, vomiting, gas, belching, as well as heartburn. Ten percent of Americans suffer heartburn daily. Common symptoms are burning pain behind the breast bone and acid regurgitation. Cigarette smoking, tomato products, chocolate, coffee, citrus fruits and juices, and of course fried or fatty foods, can cause heartburn, as can individual sensitivities. Relief for most persons is by standing upright or by taking antacids. However, the latter if used over a long period may lead to diarrhea, altered calcium metabolism (calcium containing products such as Tums, actually increases stomach acid secretion), and magnesium retention. It should be mentioned that heartburn is not caused by hiatal hernia whereby the stomach protrudes through an opening in the diaphragm at the junction of the esophagus and stomach.
For acid regurgitation with heat signs, the classic Chinese formula is Left Metal Pill (Zuo Jin Wan). The chief herb, coptis (huang lian), drains liver fire and clears heat from the stomach. The assistant, evodia (wu zhu yu), disperses liver constraint and brings stomach Qi downward. A modification of this formula, known as Coptis and Evodia Formula is available from Seven Forests. According to Bensky and Barolet in Chinese Herbal Medicine: Formulas & Strategies, Left Metal Pill may also be used in treating hernial disorders with a similar presentation (p. 99). The modification includes peony (bai shao) which disperses constrained liver Qi. A formula that I have used successfully to treat chronic heartburn is Ease Plus, which is based on Bupleurum Plus Dragon Bone and Oyster Shell Decoction (Chai Hu Jia Long Gu Mu Li Tang).
A patient with heartburn who was diagnosed as having chronic esophagitis and who had symptoms of liver overacting on the spleen, along with spleen Qi deficiency symptoms such as fatigue, responded quite favorably to Ease Plus. The calcium containing herbs of calcium carbonate (long gu) and oyster shell (mu li) absorb acidity and calm the spirit, while ginseng (ren shen) tonifies the spleen. For simple occasional heartburn another formula, Quiet Digestion, is effective.
Acid regurgitation may also be brought on by a cold spleen, usually the result of injury from cold foods. Six Gentlemen with cardamon and cladimiria souliei may be used in this case to harmonize the function of the stomach and spleen, and to promote the flow of Qi.
CONSTIPATION TREATING
Constipation is big business in the U.S. Patients as well as practitioners should understand that the normal frequency of bowel movement in healthy individuals ranges greatly. Constipation is a symptom that can signal a more serious disease, though it is frequently related to travel, low fiber diet, medications, or repeatedly ignoring the urge to defecate. Chronic constipation may be a symptom of irritable bowel syndrome (IBS), parasitic infection, hormonal imbalance, hemorrhoids, disease affecting the body tissues, nerve damage, and laxative abuse. The latter includes natural laxatives and colon cleansers, found over the counter.
In Chinese medicine, constipation commonly suggests heat, though in the elderly or postpartum women, it may be due to deficiency of blood. The condition may also be associated with extreme internal cold and yang deficiency. A simple and effective formula is Gentle Senna, which addresses heat, as well as blood deficiency, and yin deficiency. The formula is based on Moisten the Intestines Pill (Run Chang Wan), a 700 year-old Chinese remedy.
The formula is ordinarily used for a short time to get the intestines moving, while treating the underlying imbalance that is causing the constipation. Calm Spirit, a fomula based on Ding Shen Wan, is designed to treat stress-related emotions. It contains biota (bai zi ren), tang-kuei (dang gui), and ophiopogon (mai men dong), to moisten the intestines. The remaining herbs, in addition to calming the Spirit, nourish the blood and yin.
For Type A personalities who suffer insomnia, restlessness, and constipation, I suggest using Ease Plus in addition to Calm Spirit. For constipation due to blood and yang deficiency, Deficiency Constipation Formula may be used. Individuals on laxatives or colon cleansers should be weaned slowly from these remedies even while taking Chinese herbs that help moisten the intestines.
DIARRHEA
Another large intestine problem is diarrhea which can be caused by either cold or by damp heat. For spleen qi deficiency exhibiting cold symptoms, the tongue coating is white and the pulse is slow; for damp-heat, the tongue coating is yellow and the pulse rapid. Other manifestations include tiredness of the four limbs in spleen qi deficiency as contrasted by heaviness of the limbs in damp-heat conditions; fever may be present in damp-heat, but not in cases of spleen qi deficiency.
Two excellent spleen qi tonics are Six Gentlemen with cardamon and vladimiria souliei, and Ginseng, Poria, and Atractylodes Macrocephala Powder (Shen Ling Bai Zhu San). Early morning diarrhea is due to kidney yang, thus tonics such as Rehmannia 8 are helpful in such cases. Another formula, Source Qi , specifically treats protracted diarrhea, accompanied by weight loss and wasting of the limbs, food not being digested, fluids not being absorbed and passing through the system, and fever and chills. Source Qi has been used successfully with Artestatin to treat patients with cryptosporidium infestations.
As the above formulas are warming in nature, they are contraindicated when signs of Heat are present such as thirst, red tongue, rapid pulse, dark, scanty, or painful urination, insomnia, red eyes, or bleeding due to heat in the blood.
For diarrhea due to chronic damp-heat, the formula Phellostatin is quite effective. This remedy helps rid the body of Candida which may be present in individuals presenting with damp-heat. Chronic damp-heat conditions are common among Americans because of our fast-paced lifestyle and a diet that includes alcohol, caffeinated beverages, fast foods, sweets, dairy products, and the like. Therapeutic and recreational drugs also contribute to the problem. Phellostatin can be taken with Quiet Digestion, and started at a reduced dosage.
One last word about damp-heat: persons with chronic damp-heat often have concomitant spleen qi deficiency because dampness absorbs the body’s energy which is in part devoted to nourishment. Diarrhea that arises from traveling, food, poisoning, or stomach flu, is effectively countered with Quiet Digestion. The usual dosage is one or two capsules every two hours. Although enzyme formulas containing pancreatin are effective short-term, they are not recommended for prolonged use since they interfere with the body’s own production of pancreatin.
GALLSTONES
Over 25 million Americans suffer from gallstones. Women between the ages of 20 and 60 are three times more likely to develop gallstones as are men. Women who are overweight, have been pregnant, or who have used oral menopausal estrogen therapy are at risk of developing gallstones. Gallstones can also develop in women soon after they lose weight. Symptoms of gallstones include intense abdominal pain, bloating, gas, nausea, and discomfort following the consumption of fatty foods. Currently, oral ursodiol is used to dissolve stones, however, there is a 70% recurrence rate. Cholecystectomy, the surgical removal of the gallbladder, is one of the most common surgical procedures. But this should be a last resort since surgery weakens the body, and puts the patient at risk for developing secondary infections associated with hospital visits.
Finally, removal of the gallbladder may have energetic consequences that we do not yet fully understand. An empirical formula, GB-615, is used in China to prevent and eliminate gallstones, and to treat the discomfort associated with gallbladder inflammation. In Chinese clinics, after an acute attack which is treated with decoctions, GB-6 is administered as a follow-up therapy for three months. American practitioners have given this formula as a follow-up to ursodiol and surgery, since surgery may not relieve the symptoms of pain, gas, bloating, nausea, and accumulated damp heat. It should be noted that the health food remedy of lemon and olive oil liver flush is actually counterproductive. The main constituent of olive oil, oleic acid, has been found experimentally to increase the risk of developing gallstones. Furthermore, consuming large quantities of oil constricts the gallbladder, thus increasing the chances of a gallstone blocking the bile duct (Encyclopedia of Natural Medicine, p. 325).
Diverticulosis Diverticula are small, saccular, mucosal herniations through the muscular wall of the colon. They occur anywhere in the colon, but most often in the sigmoid. Inflammation of one or more diverticula is known as diverticulitis. Symptoms of inflammation include fever, abdominal pain, and an elevated white blood cell count. Treatment usually involves bed rest, pain relievers, antibiotics, and intravenous fluids. Surgery may be required if an abscess, fistula, or perforation develops.
Isatis Cooling is a formula that I have used successfully to treat patients with Crohn’s disease, colitis, or painful IBS. It can also be used effectively in conjunction with biomedical therapy for diverticulitis. The presenting syndrome pattern is that of Blood stagnation which is characterized by constant, fixed, stabbing pain, bruises or dark blotches of the skin, and a purple tongue. For cases that also present with Qi stagnation, Aloe 22 can be included in the therapeutic regimen. Common symptoms of Qi stagnation include pain that is non-fixed, distention, feeling of fullness, depression, mood swings, and frequent sighing. Aloe 22 can also help alleviate constipation. If chronic loose stools are associated with diverticulitis, a more conservative formula is Six Gentlemen with cardamon and vladimiria souliei, which relieves Qi stagnation.
To assist digestion, another formula, Quiet Digestion, can be used before and after each meal along with Aloe 22 or Six Gentlemen. Longer term therapy can involve Six Gentlemen and Astra Essence, when kidney deficiency is present. A stronger kidney tonic such as Rehmannia 8 may be used when there is obvious kidney yang deficiency.
GLUTEN INTOLERANCE
This condition is also known as celiac disease which is a malabsorbent syndrome brought on by ingesting gluten-containing foods, primarily wheat and rye, and to a lesser degree barley and oat, products. Potato and rice products must be substituted. Furthermore, gluten is so widely used that patients must be exceedingly wary of what they eat. Even herbal formulas that contain gluten both as active or inert ingredients must be avoided, such as Chinese patent medicines that have malt (mai ya) and the like.
Symptoms of gluten intolerance include abdominal distention, flatulence, weight loss, fatigue, anemia, difficulty in breathing, and stools that are bulky, frothy, fatty, and malodorous. Other symptoms of malabsorption and malnutrition may be present. One formula that addresses many of the acute digestive symptoms is Stomach Caps which is tolerated quite well. Individuals who are not responding to herbal therapy should not only undergo further tests for parasite infection, but also gluten intolerance.
CONCLUDING REMARKS
A final area where Chinese herbs have a major impact is post-surgical recovery. Many individuals suffer food stagnation as well as general Qi and blood deficiency after surgery. An excellent formula for these cases is Quiet Digestion which addresses food stagnation. It can be combined with Six Gentlemen and Eight Treasures which tonify Qi and blood and eliminate dampness. In my estimation, the etiology of many chronic digestive disorders is congenital kidney yang deficiency, which leads to spleen Qi deficiency, and then to dampness. Poor dietary and lifestyle habits induce the accumulation of dampness which transforms into damp-heat.
Successful treatment of digestive disorders warrants the correct analysis and application of the correct formula for the presenting syndrome pattern. Since conventional medical treatment for chronic digestive disorders is not very promising, there is a great opportunity for Chinese medicine to help this large group of patients. As practitioners we should be more outspoken about the power of alternative medicines in healing diseases that are often un-healable in Western medicine.