Understanding GERD from an Inner Alchemical Perspective

Chinese medicine follows the natural laws of physics. It deals with temperature, pressure, evaporation, momentum, tension, inertia...... Inner Alchemy is an ancient science developed by the Daoists who perceived and recorded the physical mechanisms inside a living body. Some people are convinced that Chinese medicine is pseudoscience, because modern Western science doesn’t have all of the tools to gauge it yet. But it has been proven in the clinic that Chinese medicine is capable of treating difficult disorders, even life-threatening diseases. The foundation of Chinese medicine is Daoist inner alchemy. The core belief is that our birth, growth, maturation, illnesses, and death are all governed by invisible life forces. The interactions among these forces are manifested as different physical perceptions as well as symptoms of diseases. The Daoist physicians believe that the mechanisms of the body’s internal environment and condition can be dramatically different from what we perceive in the external world.

How does our inner environment differ from the external environment? For example, water’s boiling point alters at different air pressure level. At sea level, water boils at 100 °C (212 °F). For every 152.4-metre (500 ft) increase in elevation, as air pressure decreases, water's boiling point is lowered by approximately 0.5 °C. On the contrary, in an environment with higher air pressure, water’s boiling point also increases. This is similar to the environment inside our GI tract — like a pressure cooker. Once the GI Sphincters are closed and sealed, the pressure inside the stomach increases, food is cooked inside our GI tract without having to reach 140-160F.

After food is completely cooked, it moves into the duodenum, in which not only the pressure is high, microbiomes also participate to assist the food to be processed into useable (nutrients) and unusable (feces) substances. Considering its complexity and efficiency, this process is an absolute miracle.

Even the process of creating fecal matter is a miracle. Turning fresh food into feces within 24 hours! What manmade machine can do it? And even if a machine can do it, can it do it as elegantly and efficiently as the body does? Lao Zi wasn’t joking when he said that “the Dao resides in feces and urine.” This is our body's wisdom and power that deserves our awe, that we shouldn’t carelessly mess with by excessively using antibiotics and other strong medications.

A healthy gut is the foundation of a person’s wellbeing. In order to treat chronic systemic disorders, a practitioner must support the patient’s digestive functions. From a biomedical perspective, GERD is a disorder of the upper GI tract, and it is not associated with the other organ systems. However, from a Chinese medical perspective, GERD may be the origin of the condition, but it can also be the aftermath of other health conditions. First of all, let’s look at the symptoms of GERD:

- Heartburn (a burning pain behind the breastbone), the most prominent symptom.

- Regurgitation, in which the stomach contents reach the esophagus and mouth.

- Sore throat, hoarseness, dry cough, or a sensation of a lump in the throat (globus sensation) if stomach contents reach the mouth.

- Cough and/or wheezing if stomach contents trickle into the lungs.

- Dysphagia (difficulty swallowing) — people with longstanding heartburn sometimes develop this.

For treating GERD, biomed primarily aims at lowering Lower Esophagus Sphincter (LES) pressure by using drugs such as antihistamines and proton pump inhibitors, which has the adverse effect of blocking the stomach’s acid production, making it harder for the digestive system to break down food, and potentially making the person more susceptible to bacterial infections because some pathogens might not be eliminated by stomach acid in a pressurized environment and move into the intestines. Biomedicine does not acknowledge the concept of “Stomach Qi,” which is one of the key concepts in Chinese medicine. The Stomach Qi has the natural tendency to descend and close. It locks the GI sphincters, allowing food to move downwards. Without the Stomach Qi the GI sphincters won’t close properly — it is like a pressure cooker on a hot stove without a safety valve, as the pressure increases in the stomach, food, water and stomach acid are pushed up into the esophageal.

Direct cause of GERD from a CM perspective:

Counterflow Stomach Qi & possible phlegm stagnation induced Chest Bi syndrome (blockage in the chest causing counterflow in the GI tract).

CM interpretation of GERD:

The biomedical GI tract is the physical aspect of the Yangming (Stomach and Large Intestine) organ systems. As stated in Huangdi Neijing (Yellow Emperor’s Inner Canon) “Yangming governs closing.” When Yangming function is compromised, it cannot create the internal pressure properly by locking the sphincters, which manifests as a loss of intrinsic sphincter tone and inappropriate transient relaxation of the lower esophageal sphincter. As an important organ system to transport body fluids (including discharge stomach acid into the small intestine) to the appropriate places, fluids may build up in the stomach and cause acid reflux.

Gas can also accumulate in the GI tract when the Stomach Qi fails to descend. In this case, the person may feel bloated or have abdominal distension and/or pain. When the Stomach Qi is blocked and cannot descend properly, it will flow backwards, adding pressure to the lower esophageal sphincter, forcing it to open, the acid erosion on the esophageal wall causes inflammation of the area, creating the sensation of epigastric pain under the xiphoid with gentle pressure.  The acid gushing out from the stomach into the esophagus causes the burning sensation of in the chest.

Food in the stomach also adds pressure to the LES to make the pain worse; lying down makes the acid counterflow more easily through the weakened LES, which also makes the pain worse at night. Some people wake up at night with cough because their esophagus is stimulated by the stomach acid.

When fluid distribution is hindered, the Stomach’s paired organ system, the Lung, aka “the delicate organ” described in the Chinese medical classics, is also affected. When the turbid dampness fails to be transformed and discharged from the body, the healthy body fluid cannot circulate into the chest to moist the Lung and cool the Heart. Heat generated by the Heart dries the lungs up, leading to dry cough. The throat chronically stimulated by acid can lead to hoarse voice. The blockage of the Qi mechanisms in the chest also manifests as thoracic back pain.

GERD can develop into esophagitis (long-term inflammation of the esophagus), peptic esophageal ulcer, esophageal stricture (narrowing of the esophagus), Barrett esophagus, and esophageal adenocarcinoma (esophageal cancer). It would be more beneficial to treat GERD as early as possible, before it has turned from a Qi mechanism issues (chronic inflammation) into a physical form issue (adenocarcinoma).

After understanding this physical mechanism of GERD, we are able to figure out how to assist the body's system back to its healthy balance.

Depending on the root cause of counterflow Qi and phlegm stagnation, a few formulas can be taken into consideration.

For example, for psycho-emotional reasons: Ban Xia Hou Po Tang; if presented with cold phlegm: Gua Lou Xie Bai Ban Xia Tang; if presented with more cold symptoms: Zhi Shi Xie Bai Gui Zhi Tang. There are also effective formulas from my lineage, and they are all based on the formulas from the medical bible, Shang Han Lun (Treatise on Cold Damage).

As I stated before, Chinese medicine is a science, an ancient science that employs metaphors and semiotics to describe the physiological and pathological mechanisms of the body. It should not be separated from biomedicine since both systems describe the same human body and its pathological manifestations. And it is important for modern scientists to keep exploring the great potential of Chinese medicinals.