Reflux / heartburn
Reflux means that stomach contents flow back towards the esophagus. This may give a burning sensation behind the sternum, but reflux can also express itself as acidic regurgitations, many belching, an acidic or bitter taste in the mouth, nausea, an irritated throat or a compressive sensation in the upper abdomen.
Occasional reflux is common. When the symptoms return regularly or the esophagus gets irritated, gastroesophageal reflux disease (GERD) may occur. In addition to acid reflux there is also gall reflux, where bile from the small intestine flows back to the stomach and sometimes further towards the esophagus. Among other things, a bitter taste, nausea and pain or burning sensation may occur in the upper abdomen.
Nutrition and eating habits often play a role, but also stress, obesity, pregnancy, certain medicines and diseases of the stomach or oesophagus can contribute. Within Chinese medicine, it is then examined why the stomach contents are rising and what other symptoms are present.
Common symptoms
Reflux may be expressed as:
- burning sensation behind the sternum or in the upper abdomen
- Sour or bitter recesses
- flowing back from stomach contents to throat or mouth
- belching, bloating or a feeling of fullness
- nausea
- sour or bitter taste in the mouth
- symptoms after eating, ducking or lying down, or at night
- throat, hoarseness or cough irritation
Not everyone experiences reflux in the same way. In some people, the burning feeling is at the forefront, while others suffer mainly from runaways, peasants, nausea or a full feeling.
When to contact your doctor?
Sustained reflux, swallowing problems, unexplained weight loss, blood vomiting, black stools or new or severe chest pain are reasons to have the symptoms medically assessed. New or changing symptoms in a person who has been having stable reflux for a long time also deserve renewed medical attention.
Possible causes
In acid reflux, the transition between stomach and oesophagus does not function sufficiently as a barrier, making it easier for stomach contents to rise. For example, a diaphragm fracture can contribute to this.
Complaints can be provoked or aggravated by large or fat-rich meals, alcohol, certain foods, leave food and soon after the meal. Also overweight, pregnancy and certain medications can promote reflux.
Stress doesn't cause reflux by definition, but can affect digestion and sensitivity to stomach and esophageal problems. Some people notice clearly more complaints during periods of stress.
In galreflux, gall flows back from the small intestine to the stomach. This may be associated with, for example, upset effect of the gastric output or develop following certain gastric or gallbladder surgeries. Acid reflux and galreflux can also occur simultaneously.
How can acupuncture help with reflux?
Acupuncture not only looks at the rise in stomach contents, but also at the overall picture of complaints. One can especially feel heartburn and thirst, while another has a bloated feeling, belching, nausea or stress-related symptoms at the forefront.
During and immediately after treatment, acupuncture may include:
- supporting the Stomach's normal downward movement, so that regurgitation, belching and nausea can be reduced
- reducing tension and stagnation when reflux is clearly related to stress or emotions
- to relieve burning sensation and irritation in Heat or Dampness-Hitte-related complaints
- reducing a bloated or full feeling around the meal
What treatment principles are important varies from one person to another and may change during the course of treatment.
How can Chinese herbal medicine help with reflux?
Chinese herbs are also chosen on the basis of the overall grievance image. Two people with the same diagnosis of reflux can get different herbs. Unlike acupuncture, herbs are used daily to gradually build up and support digestion.
Depending on the pattern, herbal treatment may include:
- structural strengthening of the Spleen and Stomach when weaker digestion plays an important role
- reducing food tagging when symptoms occur especially after large or heavy meals
- feeding Yin when long-term symptoms are associated with dryness and signs of inadequate stomach nutrition
- making Qi and Blood move better again in case of prolonged, more stuck complaints
Herbs can be used daily between acupuncture treatments. The composition is adapted to the pattern and to changes during the treatment course.
How does Chinese medicine view reflux?
Within Chinese medicine, Stomach has an important function in the processing of food. The normal direction of Stomach-Qi is down: the stomach contents must move further into the digestive tract from the stomach.
In reflux, this movement is disturbed. In TCM this is often described as rebellious Stomach-Qi: the movement goes up instead of down. This may manifest itself as reflux, emesis, peasantry, nausea or vomiting.
Why Stomach-Qi goes up, however, may differ. In one person there is mainly Heat in the Stomach, in another the digestion becomes overloaded by food and in others tension from the Liver system disturbs the Stomach. In the case of long-term complaints, a shortage of Qi or Yin can occur.
The Spleen also plays a role. Within TCM, Spleen and Stomach together form an important part of the digestive system. When this system is weakened, a full or bloated feeling, decreased appetite, fatigue and a tendency to loose stools may occur.
Galreflux also involves the Gallbladder system. The free discharge of bile is connected within TCM, among other things, to the Liver and Gallbladder. Therefore, patterns with Liver-Qi stagnation, Gallbladder-Heat or Dampness-Heat can play a greater role when a bitter taste and galreflux are at the forefront.
In the case of long-term complaints, the Stomach can also not be sufficiently nourished and moistened. This is called Stomach-Yin deficiency. Blood stasis can also occur in case of very chronic or more stuck complaints.
A recognizable combination of symptoms, tongue and wrist characteristics and other symptoms is called a TCM pattern within Chinese medicine.
The most common patterns in reflux are discussed below. Other patterns are possible and multiple patterns may occur at the same time. Moreover, you do not need to have all the symptoms mentioned of a pattern. The pattern is determined on the basis of the overall grievance picture.
Most common TCM patterns at reflux
Liver-Qi attacks the Stomach
With this pattern, tension in the Liver system disturbs the normal downward movement of the Stomach. As a result, complaints can vary greatly and increase significantly during stress, frustration or emotional stress.
Common symptoms: reflux and regurgitation that increase with stress, many belching, a compressive or tense sensation in the upper abdomen or under the ribs, bloating, nausea, irritability or tension.
Examples of Western disorders: gastrooesophageal reflux disease (GERD), functional dyspepsia and reflux symptoms without apparent structural abnormalities.
Stomach-Heat / Liver-Stomach-Heat
Here Heat in the Stomach is at the forefront, sometimes combined with prolonged stagnation from the Liver system. The complaints are usually clearly burning in character.
Common symptoms: strong heartburn, acid regurgitation, burning or painful upper abdomen, thirst, dry mouth, bad breath, irritability and sometimes constipation.
Examples of Western disorders: GERD, reflux oesophagitis, gastritis and functional dyspepsia.
Phlegm-Dampness in the Stomach
In this pattern, Phlegm (also known as Fleem) accumulates in the Stomach, often in combination with Dampness. This inhibits the normal downward movement of Stomach-Qi and gives a heavy, full feeling that can become worse due to lying and through dairy, cheese or fat and creamy food. This pattern is relatively common and often associated with chronically blocked nasal sinuses or mucus on the chest.
Common symptoms: reflux with a clearly bloated, full feeling in the upper abdomen, a heavy and tired feeling in the arms and legs, a misty head and reduced concentration, nausea, a lot of salivation or feeling to swallow something, a tendency to fat or sticky stools, and sometimes overweight.
Examples of Western disorders: GERD with high mucus formation, chronic sinus symptoms in combination with reflux, and functional dyspepsia.
Dampness-Heat in Stomach and Gallbladder
Dampness-Heat combines signs of heat with a feeling of heaviness, fullness or stagnation. When the Gallbladder is involved, a bitter taste can be particularly striking. This pattern can therefore also occur in galreflux.
Common symptoms: burning reflux, bitter taste, nausea, feeling full or heavy in the upper abdomen, loss of appetite, sticky or abnormal stools and sometimes a heavy feeling in the body.
Examples of Western disorders: GERD, galreflux, gastritis and bile or gallbladder-related digestive symptoms.
Food stagnation
If the Stomach has temporary or long-term difficulty in processing food properly, according to TCM, food may remain stagnant in the Stomach. This can occur for example with oversized meals, irregular eating or a lot of heavy and fat food.
Common symptoms: reflux especially after eating, acidic regurgitation, many belching, a strong full or bloated feeling, pressure in the upper abdomen, nausea, bad breath and stool that can smell strongly.
Examples of Western disorders: reflux after meals, functional dyspepsia and delayed gastric emptying.
Cold and Heat vermengd in the Stomach
This pattern features weakness or Cold and Heat at the same time. The digestive system does not function sufficiently powerful, while local irritation or Heat is present.
Common symptoms: reflux or heartburn combined with nausea, feeling full or blocked in the upper abdomen, varying appetite and a combination of heat and cold characteristics. The stool may change or be thin.
Examples of Western disorders: GERD, gastritis, functional dyspepsia and gal reflux.
Spleen- and Stomach-Qi-deficiency
Here more emphasis is placed on weakened digestion. The Stomach has insufficient strength to maintain its normal downward movement, and moisture and nutrition are processed less efficiently.
Common symptoms: recurrent reflux, numbness or full feeling in the upper abdomen, bloated feeling after eating, low appetite, fatigue, weak limbs and a tendency to loose stools. Heat and light pressure on the abdomen may feel pleasant.
Examples of Western disorders: chronic reflux, functional dyspepsia, gastritis and reflux in a diaphragm fracture.
Stomach-Yin-deficiency
In case of prolonged stomach upset, the nourishing and moistening function of the Stomach may weaken. Reflux is often associated with dryness and a sensitive or irritated stomach.
Common symptoms: chronic reflux, burning or nagging in the upper abdomen, dry mouth or throat, low appetite despite sometimes empty or gnawing sensations, dry stools and sometimes feeling warm or night sweats.
Examples of Western diseases: chronic GERD, reflux oesophagitis, chronic or atrophic gastritis.
Qi-stagnation and Blood stasis
Blood stasis plays a role in long-term, persistent complaints. Pain and discomfort are often more clearly localized and less variable than with normal Qi-stagnation. This pattern requires extra attention to possible structural causes of chronic complaints.
Common symptoms: prolonged reflux, fixed or stabbing pain in the upper abdomen or behind the sternum, pain that may be worse at pressure, and other signs of stagnation. Bitter taste or nausea may remain present in galreflux.
Examples of Western disorders: chronic reflux oesophagitis, scarring or narrowing of the oesophagus, chronic gastritis and symptoms after surgery in the upper abdomen.
Acid reflux and galreflux
Acid reflux and galreflux can give similar symptoms, but are not the same. In acid reflux, acidic stomach contents mainly flow towards the esophagus. In galreflux, bile flows back from the small intestine to the stomach and possibly further up.
A bitter taste, yellow-green bile in vomiting and pain or burning in the upper abdomen may occur with gall reflux, but are not in itself sufficient to diagnose it. Sour and gall reflux can also exist side by side.
Within TCM, therefore, the starting point remains not only what is rising, but above all what disturbs normal digestive movement. In galreflux, the Liver and Gallbladder usually get more attention, while in both forms Stomach-Qi which is not falling sufficiently is central.
Outlook
The course of treatment varies from one person to another. Reflux that has not been in existence for a long time and is clearly related to, for example, nutrition or stress may react differently than complaints that have been present for years.
In case of chronic reflux, a diaphragm fracture, damage or narrowing of the esophagus, prolonged gastritis or galreflux after surgery may be necessary. In the initial phase, treatment is often done approximately once a week; in case of severe complaints more frequently can be appropriate. If the symptoms improve steadily, the frequency can usually be reduced. These are guidelines and not a fixed treatment time.
Nutrition, meal size, time of food and other factors triggering reflux may be important for the treatment outcome. Reflux medication should not be reduced or stopped without consultation with the prescribing physician.
Contact
Do you regularly experience reflux, heartburn, acidic or bitter regurgitation or other complaints of the upper abdomen? During an intake we look at your symptoms, possible trigger factors and the overall pattern according to Chinese medicine. On this basis we discuss which treatment suits your situation.