Gastric Symptoms of Cirrhotic Ascites 1999.1.30

Gastric Symptoms of Cirrhotic Ascites 1999.1.30

Patients with cirrhosis accompanied by ascites are in the late stage of the disease. Esophageal varices are only one manifestation of submucosal venous dilation in the gastrointestinal tract, while similar changes occur throughout the entire digestive mucosa. As a result, the entire gastrointestinal mucosa shows congestion, edema, and even inflammatory exudation. When such pathological changes occur in the gastrointestinal tract, its physiological functions also change accordingly: ① delayed gastric emptying; ② reduced absorption; ③ compensatory increase in secretion; ④ disruption of coordination between the stomach and intestines.

Based on these four functional disturbances, patients experience: ① epigastric distension, most pronounced after meals, sometimes extending to full abdominal distension; ② easy bleeding, with positive fecal occult blood indicating a potential for massive hemorrhage at any moment; severe epigastric pain suggests imminent massive bleeding, requiring immediate use of belladonna, atropine, or even pethidine; ③ decreased appetite, thick yellow greasy tongue coating indicating gastrointestinal infection and inflammation, possibly with ulcers on the mucosa; ④ postprandial pain indicates ulcer formation in the stomach or intestines; pain occurring 2 hours after eating suggests an ulcer in the duodenum; pain around 5 hours after eating suggests an ulcer in the intestine.

Considering these mechanisms, Western medicine can use metoclopramide and domperidone to promote gastric emptying; cimetidine and ranitidine to inhibit secretion; and belladonna tablets, atropine, scopolamine, and 6-542 to relieve spasm. In short, Western medicine has exhausted its options in treating gastrointestinal symptoms! Traditional Chinese medicine, on the other hand, mainly relies on Xiangsha Liujunzi Tang, Banxia Xiexin Tang, Xuanfu Daizhe Tang, Yang Liuxian Stomach Medicine, Danshen Yin, Dajianzhong Tang, Zhishu Tang, Shenglonggu, Oyster Shell, Sepia Officinalis, and Shaoyao Gancao Tang, with adjustments made according to individual cases. However, mastering clinical application is no easy task. Although the gastrointestinal tract is governed by the autonomic nervous system, its activities are organically coordinated rather than rigidly simultaneous. The stomach prefers acidity, while the intestines prefer alkalinity; the stomach prefers rest, while the intestines prefer activity; the stomach secretes more enzymes, while the intestines secrete more water; the stomach mainly digests and absorbs little, while the intestines mainly absorb and digest little. All these differences demonstrate that the stomach and intestines have vastly different characteristics, making it impossible for a single formula or medication to address all their needs. Ancient texts say, "If there is heat in the chest, cold in the stomach, and stagnation in the abdomen, use Huanglian Tang"; "If the abdomen is full and there is vomiting, food won't go down, and the abdomen hurts on its own... use Wumei Wan"; "If there is vomiting and fullness, thunder-like diarrhea, use Banxia Xiexin Tang." The formulas used, such as Huanglian Tang, Wumei Wan, and Banxia Xiexin Tang, all combine cold and hot properties, demonstrating the profound wisdom of ancient physicians in drug selection, which in some respects surpasses the efficacy of purely Western medicines!