Gastroesophageal reflux disease (GERD) is a common disorder where the gastric contents flow into the esophagus causing symptoms such as heartburn, acid reflux and pain behind the sternum. It affects about 20–30% of the population worldwide.

In modern medicine it is sub-classified into 3 types:

• Non-erosive Reflux Disease (NERD)
• Reflux Esophagitis (RE)
• Barrett Esophagus (BE)

Standard treatment in modern medicine is Proton Pump Inhibitors (PPI’s) which give relief in symptoms for around 75% of patients. However about 50% of NERD patients fail to respond to PPI’s, and two-thirds will have relapse after cessation of medication. Further, long-term use of PPI’s has been associated with serious side effects including Chronic Kidney Disease and Dementia. Therefore, Traditional Medicine and can play an important role in this increasingly common disorder.

Traditional Medicine Treatment

In Essence, it is a disharmony between Liver and Stomach/Spleen. In general, we can divide into Hot types and Cold/Phlegm/Damp types. In the former, Liver excess is dominant, while in the latter, Spleen weakness is more pronounced. But successful treatment needs to address both. So even with Spleen weakness and Damp, a little Bitter medicine to drain or “purge” the Liver is often added, and this is manifest in traditional formulas used to treat the disease, and in trials involving modern combinations.

The other important aspect is “Rising Qi”, that is, the irregular movement of Qi upwards. This is also as a result of Liver / Spleen disharmony. While there are special medicines to lower Qi, in general this effect can be achieved with warming, aromatic medicines that regulate Qi while stimulating digestion, evident by formulas like Peptic Powder.

In Chinese Medicine, 2 main pathologies exist:

• Stomach attacked by Liver
• Spleen Deficiency

There are secondary pathologies associated, such as Heat, Qi Stagnation, or Damp, but the above 2 pathologies can be viewed as the predominant types.

Reviewing a number of Chinese trials, the most commonly used Chinese herbs include:

It will be noted that these herbs are distributed between those that clear Heat, those that strengthen and harmonize Stomach and Spleen, and those that move or regulate Qi.

Diet

Diet is strongly associated with onset and relapse of Reflux and GERD. Foods that can aggravate or trigger include: fatty, fried, and spicy foods, citrus, tomato, alliums (e.g., onion, garlic), coffee, carbonated beverages, and alcohol. Which foods are associated with specific cases can be ascertained by keeping a food diary.
Regular meals, chewing more and eating less, and avoiding large meals at the end of the day are all good advice.

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Special Formula

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Gastroesophageal Reflux-induced Chronic Cough

A major symptom associated with chronic GERD is chronic Cough.

Wu Ji San

Atractylodes Bai Zhu
  Ephedra Ma Huang
  Citrus Chen Pi
  Pinellia Ban Xia
  Ginger (Gan Jiang)
  Cinnamon twig (Gui Zhi)
  Dang Gui
  Jujube (Da Zao)
  Licorice (Gan Cao)
  Paeonia Bai Shao
  Angelica dahurica Bai Zhi
  Poria Fu Ling
  Citru aurantii Immaturus Zhi Shi
  Ligusticum Chuan Xiong
  Magnolia Hou Po
  Platycodum Jie Geng
  Cyperus rotundus Xiang Fu
This is one of the most commonly prescribed formulas in Korea for digestive disorders. In a trial it was taken with Sheng Mai San (Ophiopogon Mai Men Dong, Ginseng and Schisandra Wu Wei Zi). This treatment was found effective. (see here)

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Research

–Different Traditional Herbal Medicines for the Treatment of Gastroesophageal Reflux Disease in Adults
Herbs:
–Anti-Inflammation and Protective Effects of Anethum graveolens L. (Dill Seeds) on Esophageal Mucosa Damages in Reflux Esophagitis-Induced Rats.
–Myrtle (Myrtus communis L.) fruit syrup for gastroesophageal reflux disease in children: A double-blind randomized clinical trial.
Formulas
–Efficacy and safety of the Chinese herbal formula Hewei Jiangni recipe for NERD with cold-heat complex syndrome: study protocol for a double-blinded randomized controlled trial.
–Modified Xiaochaihu Decoction for gastroesophageal reflux disease: A randomized double-simulation controlled trial.
–New treatment for gastroesophageal reflux disease: Traditional Chinese medicine Xiaochaihu decoction