Heartburn, acid reflux and GERD (gastroesophogeal reflux disorder), are very common complaints among Americans, with nearly 1 in 10 adults suffering at least once a week. Ouch! That’s a lot of “rebellious Qi” but before we delve into Chinese medicine’s views on these disharmonies, let’s look at what their symptoms from a western perspective briefly.
What causes heartburn, acid reflux and GERD from a western medicine perspective?
We can look at these patterns on a spectrum. Heartburn, although severe sometimes, is less a less severe pattern than acid reflux or GER and GERD (Gastroesophageal reflux disorder) which is at the opposite end of the spectrum.
When you swallow food it passes down the throat or the esophagus into the stomach. The lower esophageal sphincter (LES) between the esophagus and stomach is supposed to open when you swallow and close up afterward, keeping the stomach’s acid and your newly ingested food in the stomach.
Heartburn occurs when there is pressure or pain in the sphincter or valve–but not backup fluid. Acid reflux and GERD occurs when this valve fails to function properly causing the acid in the stomach to bubble back up into the esophagus. Over time, repeated up flow of stomach acid will burn or erode the esophageal walls.
Many people experience acid reflux or heartburn from time to time, and it can effect people of any age. Indeed, I’ve seen too many children lately suffering from acid reflux. Whatever the age, it considered a clinical pattern if the you suffer from it 2 times a week or more. Let’s look at the symptoms:
- A burning sensation in the middle of the chest that may radiate to the back. This can last a few minutes to several hours
- Chest pain when moving, bending over or lifting
- Problems swallowing
- A burning sensation in the back of throat
- Acidic, sour taste in the mouth and bad breath
- A sensation that food is stuck in the throat or upper chest
- Heartburn can also cause chronic hoarse or dry throat and coughing
- Can include all or some of the symptoms of heartburn along and.…
- ‘Verps’-what my students used to call vomit erps–burping up a little fluid and undigested food
- Possible vomiting after eating
- Painful distention or upset stomach (dyspepnia)
- Pain after eating, similar to heartburn, but that is sharper and pressure like rather than burning. It can mimic or mirror heart pains or angina.
- Hoarse, burning or sore throat
- Dry cough
- Asthma–yep, GERD can make it worse or appear simply because the nasal and throat tissues are irritated
- Lump or knot in the throat
- Bad breath
- Bleeding gums
- Vomiting and nausea
- Failure to thrive or malnourishment
Like any other disease or disharmony Asian medicine is highly individualized. We look not just symptoms, but lifestyle behaviors, constitution and habits of each person. Using tongue and pulse assessment, detailed questioning and palpation the Asian or Chinese medicine practitioner seeks not just to abate the symptoms but to find and treat the underlying cause of the pattern.
Asian medicine patterns differentiation, signs and symptoms of heartburn, acid reflux and GERD.
Truthfully, there are many patterns of disharmony that can lead to heartburn, acid reflux or GERD, and all patterns have domino effects in the body–one thing will lead to another. We are just going to cover the major patterns that are seen in these disharmonies–likely, your practitioner will find another organ may be compromised too.
Asian medicine focuses on the functional roles of organs. Having stomach qi deficiency doesn’t mean that anything will show up on western tests as physically ‘wrong’ with the organ….
Stomach Qi deficiency
The Stomach holds the major function of “rotting and ripening” the food. When Stomach Qi is deficient it means the Stomach lacks the ‘umph’ to properly function. Digestion would be slow and sluggish. The food may stagnate or putrify in the stomach causing minor heartburn or dyspepsia. Left unchecked, this pattern would evolve into something bigger, possibly Stomach Yin deficiency. Pulses are deficient and weak in the middle right position or possibly across the whole Middle Burner position. The tongue may show a little white coating, maybe a little puffy too. Treatment focuses on aiding digestion and tonifying Qi.
Rebellious Stomach Qi
Almost self-explanitory. Each of the 12 organs (Lung, Colon, Stomach, Spleen, etc) have a direction that they are to move the Qi in. Stomach’s functions are: To receive the food, rot and ripen it, and to descend the food to the Small Intestines for further processing. Acid reflux and GERD are a clear failure of the Stomach to move the Qi downward. Treatment of any of these patterns would include points and recommendations that focus on helping the Stomach especially to descend the food rather than allowing it to rebel back up. However, rarely is this the only pattern going on, usually several other systems are out of balance and influencing the Stomach.
Stomach Yin Deficiency
The Stomach likes to be Yin–have lots of fluids, be moist and not too hot. Stomach Yin deficiency arises when there is a lack of the fluids in the Stomach or throughout the body. In the Stomach these fluids create the mucus that protects the stomach wall and the acids that are used in the digestive “rotting and ripening” process. When these fluids are deficient the Stomach lining will be damaged and you will feel the burn. Stomach Yin deficiency presents as a burning or gnawing in the Stomach that is relieved by eating. It may also include bleeding gums, bad breath, hot flashes or night sweets. The tongue is dry and red, the pulse becomes rapid and thin because of lack of fluids and false fire. This pulse may be felt only in Stomach position. This pattern can come from a constitutional weakness or, more commonly, from dietary habits such as eating too large of meals, eating late at night, eating rushed or hurried, eating while emotionally upset or gulping your food all lead to Stomach Yin Deficiency.
Stomach Fire Blazing
Sounds graphic, right? Hotter than Stomach Yin Deficiency this is a pattern of true excess (too much). This pattern is caused by pathogenic heat invading the Stomach (you went to Cambodia or the desert), eating too many hot, spicy and rich foods, or having excessive emotional patterns like hatred that generate heat. Alcohol poisoning is an excellent example– or image someone with anger eating lots of garlic, meat and having shots of bourbon. Hot, hot, hot. The symptoms are hot–burning pain, desire to drink cold drinks, foul breath, scanty urine and constipation, ulcers and bleeding gums. The pulse is rapid and forceful, the tongue will be red, dry, thick and have a yellow coating. Here the practitioner will focus on cooling excess heat and nourishing the fluids that are being cooked away.
Stomach and Spleen have a mutual relationship as the Earth organs. They both reside in the Middle Burner and what hinders one can hinder the other. Spleen dampness is what happens when Spleen qi deficiency is unchecked and foods that encourage damp (greasy, fried, processed, and sugar foods) are eaten excessively. If Spleen dampness is pervasive it can burden the Stomach–creating a quagmire in the digestive organs. Here the pulse becomes slippery and the tongue will be swollen and have a glossy coat. This pattern often arises from eating too many sweets and rich foods and excess worry. Treatment focuses on draining damp and tonifying Qi. Darn those milkshakes and donuts. Other patterns that reflect dampness include allergies, ashma, MS, chronic pain and arthritic conditions. If you feel worse when a weather front moves in, you have dampnes.
Lump in the throat? It might be “plum pit syndrome”–a pattern created when Liver is burdened by habituated emotions (meaning they are running amok), especially if you are holding back saying something you should–sound familiar? Any emotion, in excess or habituated like anger, frustration, resentment, will create stagnation. Liver Qi stagnation symptoms include acid reflux, GERD, IBS, cramping that is relieved once the bowels move, irritability, depression and mood swings. This pattern is very easily disturbed by stress, emotions and being to ‘tightly wound’–it shows up in women with menstrual difficulties. The pulses would display a tense nature and the tongue may be slightly red or constricted around the edges. Treatment would focus on relieving stagnation and harmonizing the liver. Time to exercise and practice those breathing skills.
Another pattern created mostly by emotions. Here the heartburn and acid reflux are strongly affected by emotions. Other symptoms include anxiety, dream disturbed sleep, palpations, arrhythmia or congenital heart problems. The pulse is rapid and thin, especially in the heart position. The tongue is red and has ‘strawberry bumps’ on the tip. Focus is on calming the shen and settling heart fire.
Wood Invades Earth (Liver and/or Gall Bladder invade Stomach)
Any organ disharmony left unchecked will eventually influence an organ with which it interacts. In this pattern, Liver and Gall Bladder become excessive and overbearing and then invade the Stomach. There will be symptoms of Liver Qi stagnation along with pain along the ribs, tightness of breath, nausea, possible vomiting and fluctuation from exhaustion to angst and frustration. Treatment in this pattern would focus on harmonizing the Liver, Gall Bladder and Stomach and nourishing Stomach yin. The tongue may be swollen on one side or both and red along the edges. This pattern is very common in those with IBS, Crohn’s, Celiac or any pattern when the bowels may fluctuate from constipation to diarrhea.
As complicated as these patterns can be effectively treated with Amma therapy, Asian medicine and Holistic Nutrition no matter what what age the client is.
It is essential that the practitioner use appropriate methods of assessment (tongue, pulse, asking, listening, palpation) so that acupressure point usage, palpation, accurate food and herbal, and life style recommendations fit the client’s pattern–and client participation is imperative. Here are some common recommendations that you can start with. Children often respond quickly to Chinese medicine and nutritional changes.
Know the foods triggers–we love them, but they may not love us back. Reset your boundaries with particular foods can make incredible improvements.
- Caffeine–possibly the most common culprit. Coffee, tea, energy drinks, chocolate….the caffeine has a relaxing effect on the esophageal sphincter which can allow the stomach acid and contents to bubble back up.
- Fried and fatty foods–are difficult to digest and slow the digestion and create congestion and pressure on the sphincter that can allow for back flow.
- Chocolate–As much as we love chocolate, it is a powerful food, a relationship to not be entered into lightly. Chocolate (cocoa, tea and coffee, too) contains theobromine that relaxes the sphincter, again. Then we add in the sugar that leads to dampness and the emotional components of what compels us to eat chocolate and we are often on a slippery slope.
- Alcohol–Hot, hot, hot. Alcohol both relaxes the sphincter and increase the stomach acid…ouch!
- Tobacco–weakens the stomach, esophageal muscles and breaks down the healthy mucus that protects the throat and sinuses.
- Tomatoes and citrus fruits–more esophageal relaxants.
- Avoid spicy foods–too much spice will aggravate the heat patterns of heartburn and reflux.
- Eat mindfully, slowly and with gratitude—slow down, taste your food, chew your food, give thanks for being able to have food (whatever it is). A positive attitude goes a long way to improving digestion.
- Avoid late night noshing–during the night, the body is supposed to be resting and cleaning the blood. Late night meals drive the qi away from resting functions and force the already burdened digestive system.
- Avoid overeating–creates physical pressure that pushes up on the esophageal sphincter.
- Chew, chew, chew–digestion begins in the mouth and the stomach’s churning process lack teeth to break down big chunks of food further. Food then sits longer in the stomach creating gas, bloating, nausea and belching.
- Don’t lie down right after eating–help the Stomach qi descend by staying upright. Actually, go for a short, easy stroll to help the Liver qi move and aid digestion.
- Have regular eating times–The digestion love routine. Often times just getting a client to eat 3 meals at regular times a day makes a huge difference.
- Manage stress–Qigong, yoga, T’ai Chi and exercise.
- Eat with people you like–It’s not a joke. Back to that mindfulness and positive attitude. When we eat in conditions where we are stressed, angry or upset the Liver Qi stagnation may invade the Stomach.
Eat foods that specifically support digestion
- Clear broths soups or congee.
- Baby food–This isn’t a joke either. I commonly give this recommendation, especially to clients who travel or have very busy schedules and have very compromised digestion.
- Winter Squash and root vegetables–Pumpkin is perfect for the Stomach and Spleen.
- Add in digestive enzymes and or fermented and probiotic foods–Sauerkraut, miso, pickles, kefir, kombucha and other probiotic foods will improve and support your digestion.
- Applesauce–A standard, easy to absorb and healing to the Earth organs.
- Green clay works wonders for easy excessive acid conditions.
If you suffer from heartburn, acid reflux and GERD try implementing a few of these recommendations and get in to get a clear assessment and specific recommendations for your pattern.
April Crowell, Dipl. ABT (NCCAOM), AOBTA CI & CP, CHN