By Shihan Mary Bolz
Master of Science Oriental Medicine
Doctoral Fellow, FBU
Master Martial Arts Instructor
GERD (gastro esophageal reflux disease) or acid reflux is a chronic condition leading to mucosal damage of the esophagus lining. When people experience acid reflux, acid is pushed up from the stomach into the esophagus, causing the esophagus to get red, irritated and sometimes ulcerated. If the acid continues to reflux into the esophagus, esophageal ulcers can form. Symptoms a person may experience are difficulty swallowing, a painful, burning sensation of the esophagus, nausea and heartburn.
The esophagus is the tube that leads from the throat to the stomach. When the esophagus is inflamed, swollen and irritated, it is referred to as esophagitis (the suffix -itis means inflammation, thus inflammation of the esophagus). In the term gastro-esophageal reflux disease, the prefix gastro-refers to the stomach, esophageal, the esophagus, and the rest is self explanatory. This condition is when partially digested food and liquids travel from the stomach back up into the esophagus. That traveling food is mixed with stomach acids, which can irritate the esophageal lining and eventually can cause an esophageal ulcer. It can lead to an eventual esophageal cancer in some cases.
What is the cause of GERD? For some people, acid reflux is related to the incorrect or partial functioning of the lower esophageal sphincter, a group of muscles that normally close off the esophagus from the stomach, keeping the food in the stomach. GERD can also be caused by asthma, especially if asthma started as an adult and does not seem to respond to asthma medication. Oppositely, GERD may be playing a role in the cause of asthma, especially if a person notices that their asthma symptoms may get worse after exercise, after a meal, at night or after lying down. What can cause shortness of breath? When acid enters the esophagus, a nerve reflex is triggered which can cause airways to narrow, therefore causing shortness of breath.
The esophagus can also get infected, raw and irritated due to a weakened immune system (HIV), medications such as corticosteroids, as well as by viruses such as herpes, candida infection or fungi. Other causes for an esophageal ulcer can occur after food poisoning, excessive vomiting, surgery or side effects of anticholinergic drugs and medications such as ibuprofen, aspirin and others. An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Acetylcholine transmits all parasympathetic signals to end organs by binding to muscarinic (M) receptors. The parasympathetic system is anabolic, which means it is more involved with conserving energy in the system, for example, the parasympathetic system decreases heart rate and stimulates gastrointestinal function. In the resting individual, the parasympathetic system dominates in most organs, resulting in a relatively slow heart beat, adequate secretions and appropriate bowel motility.
Anticholinergic drugs are muscarinic agonists and inhibit gastrointestinal secretions and peristalsis. Peristalsis is the movement of the tubular structure in the body (in this case, we are referring to the esophagus), characterized by waves of alternate circular contraction and relaxation of the tube by which the contents are propelled onward. In the case of the esophagus, the normal movement is downward, pushing the food we intake to the stomach. With anticholinergic drugs inhibiting the normal peristalsis and inhibiting the normal secretions, one can understand why they can cause GERD.
In TCM, the normal peristalsis is referred to as the normal Qi flow and the reflux is referred to as reverse Qi. This they realized centuries ago. Merely by understanding the normal flow of Qi in nature, they could define all the mechanisms in the body and treat medically according to this understanding. It works beautifully!
Allopathic (conventional Western) medicine treatment for GERD consists of 1) elevating the head while sleeping, 2) avoiding foods and beverages which stimulate acid secretion, such as coffee and alcohol, anticholinergic drugs, certain foods such as fats and chocolate, and smoking, 3) administering antacids after meals or at bedtime. If these measures are not sufficient, cholinergic agonists such as bethanecol or metoclopramide, and H2 agonists such as cimetidine, may be prescribed to increase sphincter pressure and reduce stomach acidity. If esophageal hemorrhage is massive or recurrent, it may require surgery. Esophageal strictures are treated by repeated dilation. Omeprazole (Prilosec is this), is often prescribed for this condition and is in a class of drugs called proton pump inhibitors (PPI) that block the production of acid by the stomach. This often does not solve the problem because overproduction of acid by the stomach is not the cause of the problem anyway, and it can worsen the condition because it is blocking a normal function. Any of the cholinergic agonists can be an aggravation in the long run, and are not necessarily a cure, although they can provide relief of the symptoms for a while.
What is Oriental medicineâ€™s view of GERD and how is it treated? The primary disease mechanism of this condition is liver invading spleen and/or stomach and the main mechanisms for the liver becoming excess are unfulfilled desires and/or anger, both of which damage the liver , overeating and eating excessively fatty and degenerated foods, and lack of exercise. If the liver becomes damaged, it may lose control over coursing and discharging. The Qi becomes stagnant and accumulates. Eventually, it must counterflow somewhere. Typically it counterflows horizontally to assail either or both the spleen and stomach. If the liver Qi invades the stomach, the stomach Qi loses its harmony and counterflows upward (reverse peristalsis). If the liver Qi invades the spleen, the spleen becomes vacuous and weak. If the spleen becomes weak, it will fail to upbeat the clear. If the spleen fails to upbeat the clear energy, the stomach Qi is less likely to down bear the turbid. Therefore, spleen Qi vacuity (deficiency) makes upward counterflow of the stomach all the more likely. In addition if the spleen loses control over the movement and transformation of liquids, these will collect and accumulate, transforming into dampness. If dampness obstructs the middle, it results in feelings of glomus and distention. Dampness is a factor in all overweight persons. Dampness excessively accumulated in the tissues and interstitial spaces affects the function of the stomach and spleen.
If liver depression endures for some time or is extreme, it may transform into heat. Such transformation heat is all the more likely if the patient eats or drinks food or beverages which also create excess heat internally. The liver heat may also mutually engender stomach heat. Thus, the person gets a burning type of pain when this occurs. If heat is severe, it may force the blood to move frenetically outside its channels, thus resulting in bleeding. If heat endures for some time, it may damage and consume stomach fluids. If Qi stagnation endures for some time, it may result in generalized systemic blood stagnation. Since food is moved and transformed by the Qi (energetic reactions), which is slowed down, since the Qi is stagnant, the food becomes stagnant, i.e. it is not digested properly. Blood stagnation further shuts off the supply of fresh, good blood to the liver and the whole cycle keeps getting worse and worse. Since the digestive process (the spleen, stomach, liver organs of which are main), slows down with the aging process, the liver Qi stagnation tends to get worse in middle aged adults who are at a time in their life where they have a lot of emotional stress with work and family.
Treatment in TCM or TOM (Traditional Oriental Medicine) of all conditions/diseases is based on pattern discrimination. Whereas allopathic medicine has names of diseases as their diagnoses, TOM uses a discrimination of the patterns causing the imbalance(s) in the system.
In the case of GERD, the main patterns usually found are: 1) Liver Disharmony mixed with cold dampness pattern, 2) Liver disharmony mixed with yin-deficient heat, 3) liver disharmony with deficiency of the stomach and. or spleen, 4) liver disharmony with stomach and intestine excess. These may sound all too similar to the layperson; but to a trained TCM doctor, these patterns are very important to distinguish to be able to treat the condition effectively. Thus, diagnostic skills of the practitioner are paramount. Once the pattern is understood, then the practitioner can make the acupoint prescription and the traditional Chinese herbal prescription which will treat the patient effectively. Acupuncture and proper TCM herbal formulas are very effective at treating this. In addition, it is important that the patient follow the dietary and lifestyle recommendations made by their TCM practitioner.
Here is what some researchers in Japan have found. At Kawasaki Internal Medicine University in Kurashiki City, Dr. Haruma did some tests on students there during their sleep. They used a tube and inserted some excess acid in the esophagus, this acid did not go past the pyloric sphincter and into the stomach, and it stopped short there. Then they did some tests of measurement in three subjects. In one student they measured the pulse rate and found that it went from his normal 87 to 100 beats per minute within 20 minutes after insertion the excess acid. In a second subject they measured the blood flow in the carotid artery and found that it greatly increased. In a third subject they measured the blood flow in his point finger and found that it was greatly decreased. These tests showed physiological changes in reaction to the excess esophageal acid.
At the Kagoshima University in Kyushu, Dr. Miwawaki, an oral surgeon did studies on students during their sleep and found that a subject that constantly clenched his teeth was causing more acid in the esophagus and it was noted that the subject would involuntarily swallow while he was sleeping. Dr. Miwawaki found this curious and wanted to know why. He further did in vitro (test tube) testing with acid and human saliva. He took one test tube of acidic solution and injected human saliva. After mixed with human saliva, the solution turned orange-pink; indicating that this neutralized the acid. Then he took a test tube of alkaline solution which was purple, added the human saliva and it turned the solution clear; again indicating that the solution became more neutralized; neither too acid nor too alkaline. The results of this study showed that human saliva has the ability to neutralize. This indicates the natural mechanism of saliva production from the mouth and swallowing that saliva autonomically is keeping the homeostasis of the esophageal environment. From this study we can appreciate the need for chewing our food, because chewing releases the enzyme salivary amylase in the mouth which is the first step in the digestive process.
The Japanese studies gave the following causes of GERD:
1) Lack of saliva
2) Poor posture (can include kyphoses and stooped shoulders from osteoporosis in older people).
3) Weak abdominal muscles and weak smooth muscle (of internal organs), weakening pyloric sphincter.
5) Drugs which decrease the saliva-producing process in the mouth.
What can you do yourself to prevent and help cure GERD?
1) Exercise. When you exercise, you also help the integrity of the smooth muscles as well as the skeletal muscle.
2) Eat small, balanced meals throughout the day. Eat only until you are 80% full. Do NOT overeat.
3) Within 3 hours of going to bed, avoid any foods or liquids.
4) Maintain a healthy weight.
5) Avoid smoking, alcohol, coffee, sodas, chocolate and fatty foods, as all these items tend to relax the esophageal sphincter and are overly acidic.
6) Chew, chew, and chew your food. Produce the saliva needed for the first stage of the digestive process before the food goes into your stomach. Your own saliva takes care of the problem.
7) Keep healthy and avoid using prescription drugs as much as possible.
8) Keep happy, have a balanced thought pattern and donâ€™t get overly stressed. Too much stress causes an angry liver and an angry liver overacts on the stomach.
Your Oriental medicine practitioner can be a key role player in your cure. The TCM practitioner is well trained to take care of this problem both through herbal prescriptions and acupuncture. Acupuncture can also provide immediate relief. You CAN get rid of your GERD!