In the past five years of my clinical practice, I have seen an astonishing upsurge in the chronic use of proton-pump inhibitor (PPI) medications for the gastrointestinal issue diagnosed by allopathic medicine as GERD. It is not uncommon to encounter patients taking these prescriptions for five-plus years.
While GERD can be a serious concern, these side effects are also not without significant concerns. Traditional Chinese medicine offers many options for patients as potential alternatives to the chronic use of PPI medications. This month, let's discuss my four most commonly utilized patent medicines in cases of chronic GERD.
Bao He Wan
This patent medicine is one of my all-time most utilized formulas, and I'm often shocked at how underutilized it is. Bao He Wan resolves food stagnation, harmonizes the stomach, descends the stomach qi, clears heat, dispels damp, and promotes digestion. The key signs for this patent medicine are an excess, slippery or wiry pulse and a greasy. yellow tongue coating.
I find this patent particularly effective for patients who are suffering from GERD with the aforementioned tongue / pulse signs, and who consume high-protein and/or high-fat diets. I also find this patent medicine particularly effective with patients who find traditional digestive enzymes ineffective and have a tendency toward constipation, which can over time result in what TCM refers to as "food stagnation."
Mu Xiang Shun Qi Wan
This is an extremely important patent medicine which is also underutilized in cases of both GERD and almost any digestive complaint due to spleen qi deficiency. Mu Xiang Shun Qi Wan tonifies spleen qi, dispels damp, harmonizes liver and spleen, descends stomach qi, removes food stagnation, frees the stool, and warms the spleen and stomach. The key pulse signs are weak and soft or wiry and slippery, while the tongue tends to be swollen / pale with a greasy coat.
This patent medicine is excellent for patients with the aforementioned tongue / pulse signs with a tendency toward alternating constipation / loose stools and/or what is termed a "nervous stomach." I have used this patent medicine extensively with patients who consume large amounts of raw foods; as well as those on vegan diets.
Xiang Sha Yang Wei Tang
This patent medicine dispels damp, dissolves phlegm, harmonizes the stomach, descends the stomach qi, tonifies spleen qi, soothes the liver, promotes digestion, and stops nausea. Pulse signs are wiry or slippery, and the tongue can be normal or coated with a thin white coating.
This patent medicine is especially effective if the patient has a history of liver qi stagnation with underlying spleen qi deficiency. Patients with this complex pattern often crave sweets / carbohydrates and have a tendency toward loose stool and nausea.
I frequently use this patent medicine with patients who are taking probiotics for chronic GERD with concomitant lower GI symptoms; as well as with patients suffering from GERD and SIBO issues showing signs of liver qi stagnation with spleen qi deficiency. I find this patent medicine more effective than the predictably overused Xiao Yao San.
Huo Xiang Zheng Qi San
This unique patent medicine was originally crafted for exogenous wind-cold invasion with concurrent stagnation in the middle jiao. I use this patent medicine extensively for the common cold / flu with signs of gastric distress, most often in combination with Gan Mao Ling; particularly cases occurring during the warmer, humid seasons.
Huo Xiang Zheng Qi San dispels pathogenic factors, resolves the exterior, clears summer heat, dispels damp, dispels turbidity, descends stomach qi, harmonizes the middle jiao, and resolves diarrhea. The pulse signs are typically slippery and/or floating; tongue signs are typically white / normal or normal with a yellow, greasy coating.
This patent medicine has a shockingly wide range of application besides acute cold / flu issues and chronic GERD issues with underly spleen qi deficiency, such as food poisoning, alcohol hangovers, acute stomach pains due to overeating, and motion sickness.
Clinical Pearls
My hope with the above discussion is to encourage TCM practitioners to look deeper into the underlying patterns behind the allopathic diagnosis of GERD and view each patient suffering from GERD with a unique lens. While GERD most often has predictable symptoms, each patient's unique underlying pattern is most often not predictable.
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