TCM Pattern Differentiation In GERD

Gastroesophageal Reflux Disease (GERD) is an incredibly common complaint in clinical practice. According to The Merck Manual Online, "Incompetence of the lower esophageal sphincter allows reflux of gastric contents into the esophagus, causing burning pain. Prolonged reflux may lead to esophagitis, stricture, and rarely metaplasia or malignancy. Diagnosis is clinical, sometimes with endoscopy, with or without acid testing. Treatment involves lifestyle modification, acid suppression using proton pump inhibitors, and sometimes surgical repair. Gastroesophageal reflux disease (GERD) is common, occurring in 30 to 40% of adults. It also occurs frequently in infants, typically beginning at birth."

The complications of this disorder include esophagitis, peptic esophageal ulcer, esophageal stricture, Barrett's esophagitis or esophageal adenocarcinoma. The primary symptom of GERD is heartburn with or without regurgitation of acid into the mouth which may be accompanied by vomiting, irritability, anorexia and sometimes chronic aspiration (in infants) and cough, hoarseness or wheezing (in adults with chronic aspiration). Treatment strategies in Western medicine include elevation of the head of the bed; avoidance of coffee, alcohol, fats and smoking; and the use of proton-pump inhibition drugs (including omeprazole, lansoprazole, esomeprazole, ranitidine, metoclopramide).1

In the case of GERD (at least the kind with the symptom of acid regurgitation) we have a rare 1:1 correlation of the allopathic disease description and the Chinese disease category. The Tun Suan "acid regurgitation" disease category of Chinese medicine is where GERD is naturally at home. According to Sionneau and Gang in The Treatment of Disease in TCM, there are three pattern differentiations to be considered in the treatment of GERD with Chinese medicine. Those patterns are as follows:

1. Liver fire invading the stomach (treatment principles: clear the liver and harmonize the stomach; formula: modified Zuo Jin Wan; acupoints: CV-13, CV-11, LV-2, GB-34CV-12, ST-36, UB-17, PC-6, ST-44)

2. Cold dampness obstructing internally (treatment principles: rectify the qi, transform dampness, and harmonize the center coupled with clearing heat; formula: modified Xiang Sha Liu Jun Zi Tang; acupoints: CV-13, CV-12, CV-10, SP-9, GB-34, CV-17, PC-6, ST-36, TB-6)

3. Food accumulating & stagnating in the stomach (treatment principles: harmonize the center and disperse stagnation; formula: modified Bao He Wan; acupoints: CV-21, ST-20, CV-12, ST-36, SP-4, ST-25, TB-6, PC-6)2

I generally encourage patients of mine to consider the Chinese medicine approach to the management of this disorder to avoid the side effects of proton pump inhibitors which include headache, diarrhea, constipation, abdominal pain nausea and rash.

Scandalli Accordion