Spleen & Stomach Outpatient Department, Mianyang Hospital of Chinese Medicine, Sichuan, China: May 2016
We arrived on the floor at 2:30pm, just after the hospital lunch break from 12 – 2:30pm. The whole hospital shuts down for two and a half hours, the lights go down, the doctors go eat and then have a nap, the patients just sit quietly and wait. Can we have siestas built into our schedule in Canada please?
At 2:30pm, the floor was busy and one room in particular was full of people – patients and white coated students, plus Dr Pi (the doctor we are assigned to observe) sitting at the main desk.
Dr Pi, a solid broad faced man who looks to be in his 50s, is a respected doctor here. He has at least 30 years of experience. He told me that he specialized in digestive issues because both he and his mother suffered from chronic gastritis. He said that Chinese Medicine cured his gastritis, and he wanted to help others that way. Over time he developed his own herbal formula ‘Bing Qu Wan’ for gastritis which is sold locally. He says it works well for Fatty Liver conditions too.
We sat behind Dr Pi and watched his process for the next three hours. Within that time, Dr Pi proceeded to see 60 patients. 60!
Dr Pi had a long line up of people waiting to see him, all with similar digestive complaints. Note, privacy is non-existent.
Common types of stomach and digestive difficulties
What were people mostly here to see Dr Pi for? A certain portion of people were here to see him for recurring diarrhea, sometimes alternating with constipation (described as the Chinese medicine pattern of disharmony between the spleen and the stomach). Others had bloating / distension and an uncomfortable feeling after eating. Others had burning feelings in the stomach with acid regurgitation, but no major changes in appetite or the stool (Qi stagnation in the stomach).
Finally, there was a portion of patients who were here to see Dr Pi for help with fatigue, bloating, difficulty digesting certain foods and a lack of appetite (spleen qi deficiency). Many of these patients brought with them gastroscope or blood test results. These patients had common diagnoses of ‘stomach inflammation’, plus many cases of stomach polyps, acid regurgitation and the occasional ulcer.
We saw a lot tongues in that 3 hour period, and what stood out was how the people here commonly had a relatively puffy, tender tongue with little coating and the presence of teeth marks. The climate here in Sichuan is very humid and damp, and the food they eat is very spicy which can deplete the yin over time. Thus from a Chinese medicine view, their their tongues reflected the patterns of dampness accumulation and yin deficiency as well as spleen and stomach deficiencies.
Stomach problems in China versus Canada
I asked Dr Pi at the end of the session why in Canada we seem to see so many people with digestive issues that are related to stress (liver overacting on spleen/stomach), whereas here in Mianyang there appeared to be more issues related to diet and climate. He agreed that diet and climate were the major factors here, but also that people did suffer from the stresses of work and modern life. In those cases he said he adds the herbs Chai Hu (Bupleurum root) and Bo He (mint) to his overall formula to relieve this ‘liver qi stagnation’ aspect of stress affecting the stomach.
In Calgary where I live, it is very dry, and our food is very rich (sweet and high in fat) – we likewise see a lot of of acid reflux, stomach inflammation and ulcers in the west. We might not eat as many spicy Sichuan peppers in Calgary, but we are affected by alcohol, sugar, lots of meat and overeating.
A Chinese Herbal formula for stomach/spleen conditions:
The following ‘base formula’ is what Dr Pi prescribed as the starting point for about 60% of patients (including cases of stomach inflammation, acid regurgitation, burning in the stomach, vomiting, dry bitter taste in the mouth and a feeling of qi stagnation in the throat.) From this base he added extra herbs or deleted particular herbs.
This is ‘tweaking’ of individual herbs is an example of Chinese Medicine treating individuals based on their body’s unique situation. Even though two people may have the same western medical diagnosis of ‘stomach inflammation’ their Chinese medicine patterns and resulting treatments may be very different.
Please note that this formula is being shared as an example of how formulas are put together. This formula should not be taken without guidance from a Chinese Medicine practitioner. An Oriental Medicine doctor will always prescribe herbal formulas based on your individual body condition. Taking Chinese herbal medicines of any kind without proper diagnosis and assessment could cause more harm than good.
The basic principles of Dr Pi’s base line formula for stomach / spleen conditions:
- Huang Lian – clears heat & fire, dries damp, stops bleeding, bitter and cold,
- Bai Dou Kou – warm, aromatic, transforms damp, moves qi, strengthens stomach, stops vomiting.
- Fa Ban Xia – dries dampness, transforms phlegm and directs rebellious qi downward, stopping vomiting.
- Yan Hu Suo – regulates and invigorates the blood, alleviates pain, warms.
- Xie Bai – garlic chives – regulates qi, unblocked the yang and disperses turbid phlegm, directs qi downward.
- Wa Leng Zi – cockle shell – absorbs asides, alleviates pain, dissolves phlegm, dissipates nodules, activates blood.
- Ji Shi Teng – removes wind and dampness, stops pain, move blood to reduce swelling.
- Bing Lang – betel nut – kills parasites, promotes qi movement, dissipates stagnation, promotes urination.
- Ge Shan Qiao – a local herb, whose function I did not catch.
- Lai Fu Zi – radish seed – disperses food stagnation and distension, descends qi, reduces phlegm.
- Mu Xiang – regulates qi, stops pain, regulates stagnant qi in the intestines, strengthens spleen.
- E Zhu – activates blood, breaks up blood stasis, relieves pain, dissolves accumulations.
Modifications to the basic prescription:
Here are some examples of how the basic formula was modified. Again these are just to demonstrate the multifaceted complexity and malleability of a herbal formula, and thus the necessity to adapt it to each individual’s circumstances:
- For a patient who also had stomach heat and insomnia he added Ku Shen and Shi Gao.
- For a patient who also had chest pain and a burning sensation on the mid back he added Shi Gao, Chai Hu, Bai Shao, Zhi Tian Nan Xing.
- For a woman in her 50s who had burning hands and feet and gets ‘allergies’ on her face from the sun, he added Di Gu Pi to the base formula. (for Yin deficiency attributed to menopause)
- For a man in his 70s whose tongue was dry, greasy and dark in the middle, with a poor appetite and digestion, he added Zi Su Gen and Yin Chen.
- For a man about 60 years of age, with a pale tongue, painful distension, some hiccups and inability to eat spicy food, he added 60g of Lai Fu Zi.
- For a woman about 45 years old complaining of hiccups (and probably more which I couldn’t hear) he added Mu Xiang, Bo He, Fang Feng, Huang Qin.
Questions to the Doctor:
At the end of the session, Susan my classmate said she noticed that there was very rarely Gan Cao (liquorice root) in these formulas. She wondered why, as Gan Cao is commonly used as a harmonizer in many formulas. Dr Pi replied that for ‘excess’ cases, which most of these stomach inflammation, stagnation cases were, Gan Cao should not be used due to its tonifying nature. But for cases of deficiency, we can add Zhi Gan Cao (honey fried licorice root), to boost qi.
Dr Pi’s Overall Approach to Stomach Problems:
Dr Pi said with spleen and stomach diseases it is a matter of regulating the proper rising and descending of qi – it is about bringing back to balance any abnormal flow in the regular physiology of these organs. He described his treatment principle as using bitter herbs to descend the ‘turbid’ so that the clear and clean qi /nutrition can ascend. The main treatment principle is to promote qi flow, and reduce and purge dampness.