5. Stomach Yin Deficiency Syndrome

Formula: Xiang Sha Liu Jun Zi Tang, with modifications: Dang Shen 15g, Bai Zhu 10g, Fu Ling 15g, Sha Ren 6g (added later), Mu Xiang 6g (added later), Ban Xia 10g, Chen Pi 6g, Sheng Jiang 6g, Zi Su Geng 10g, and Zhi Gan Cao 6g. In this formula, Dang Shen and Bai Zhu strengthen the spleen and tonify qi; Fu Ling strengthens the spleen and drains dampness; Ban Xia dries dampness and descends rebellious qi; Sha Ren and Chen Pi broaden the middle burner and harmonize the stomach; Zi Su Geng and Mu Xiang regulate qi and relieve pain, collectively achieving the effects of tonifying qi and strengthening the spleen, as well as harmonizing the stomach and descending rebellious qi. 5. Stomach Yin Deficiency Syndrome
Symptoms: Dull or burning pain in the epigastric region, especially worse in the afternoon, or noisy and irritable feelings, dry mouth and throat, poor appetite and reduced food intake, dry or hard stools. The tongue is red, with little or no coating, or dry and lacking moisture, and the pulse is fine and rapid. Treatment principle: Nourish yin and benefit the stomach, regulate qi and relieve pain.
Formula: Pei's Stomach-Nourishing Decoction, with modifications: Sheng Di 15g, Tian Hua Fen 10g, Sha Shen 15g, Mai Dong 10g, Shi Hu 15g, Bai Shao 15g, Yu Jin 10g, Yan Hu Suo 10g, Fo Shou 10g, and Gan Cao 6g. In this formula, Tian Hua Fen, Sha Shen, and Shi Hu nourish stomach yin; Mai Dong, Bai Shao, and Sheng Di nourish liver yin; Yu Jin, Yan Hu Suo, and Fo Shou soothe the liver and regulate qi to relieve pain. 6. Qi Deficiency and Blood Stasis Syndrome
Symptoms: Pale complexion, fatigue and weakness, shortness of breath and reluctance to speak, emaciation, dry mouth and throat, difficulty swallowing, pain behind the sternum, a pale and dark tongue, with petechiae along the edges, and a deep, sluggish pulse. Treatment principle: Tonify qi and strengthen the spleen, activate blood and remove stasis.
Formula: Si Jun Zi Tang combined with Dan Shen Yin, with modifications: Tai Zi Shen 6g, Fu Ling 6g, Bai Zhu 6g, Dan Shen 6g, Tan Xiang 6g, Sha Ren 6g, Yu Jin 6g, Zi Su Geng 10g, Chi Shao 15g, Chuan Xiong 6g, and Gan Cao 6g. In this formula, Tai Zi Shen, Fu Ling, and Bai Zhu tonify qi and nourish yin, strengthening the spleen; Dan Shen, Chuan Xiong, and Chi Shao activate blood and remove stasis; Tan Xiang, Zi Su Geng, and Sha Ren promote qi and clear turbidity, broadening the chest and regulating qi. Together, they achieve the effects of tonifying qi and strengthening the spleen, as well as activating blood and removing stasis. 5. Professor Pei Zhengxue's Analysis of Prescriptions
Professor Pei Zhengxue's first-choice basic formula for treating this disease is Si Ni San, as described in the "Shang Han Lun": "In Shaoyin diseases, if a person presents with four symptoms—coughing, palpitations, difficulty urinating, abdominal pain, or severe diarrhea—Si Ni San is the primary treatment." Si Ni San consists of Chai Hu, Zhi Shi, Bai Shao, and Zhi Gan Cao. In this formula, Chai Hu soothes the liver and resolves depression, Zhuo Shi promotes qi circulation and relieves stagnation, Bai Shao nourishes the liver and collects yin, and Zhi Gan Cao tonifies the spleen and harmonizes the stomach, collectively achieving the effects of soothing the liver and regulating qi, as well as harmonizing the stomach and descending rebellious qi. In clinical practice, if hiccups occur, Xuan Fu Dai Zhe Tang can be added; if there is upper abdominal distension, add Dan Shen 10g, Mu Xiang 6g, and Cao Dou Kou 6g; if there is pain behind the sternum, determine the nature of the pain—regulate qi if it's due to qi stagnation, activate blood if it's due to blood stasis—and use formulas that address both qi and blood, such as pairing Yan Hu Suo with Wu Yao, Dan Shen with Tan Xiang, and combining these with medications that suppress gastric acid, like 10g of Wa Leng Zi (calcined), 10g of Hai, and 10g of Bai Fan, which often yield good analgesic effects; for chest oppression, Guai Bai Ban Xia Tang can also be used. Guai Bai Ban Xia Tang is not only suitable for coronary heart disease—it can be used whenever the condition meets the criteria of "a deep and slow pulse at the cun position, with a small, tight, and rapid pulse at the guan position." Alternatively, add Hou Pu 10g and E Zhu 10g to disperse stagnation; for frequent belching, add Chen Xiang 6g (added later) and Bai Dou Chu 6g (added later) to calm the qi and descend rebellious qi; for those with burning sensations behind the sternum or below the xiphoid process, add Huang Lian 6g and Pu Gong Ying 15g to clear stomach heat; for more severe pain, add Guai Wei 15g and Yan Hu Suo 10g (with vinegar) to enhance the effect of soothing the liver and relieving pain; for abdominal bloating and constipation, add Hou Pu 10g and Sheng Da Huang 10g to clear the bowels and release heat; for those with fullness and lack of appetite, add Mu Xiang 6g and Sha Ren 6g to awaken the spleen and stimulate appetite; for those with difficulty swallowing, add Zhe Bei Mu 10g, San Leng 10g, and E Zhu 10g to promote qi and dissolve phlegm, soften hard masses, and disperse stagnation; for those with cough, add Xing Ren 10g, Zi Su Zi 10g, and Jie Geng 10g to relieve cough and transform phlegm; for those with abdominal fullness and lack of appetite, add Cang Zhu 10g, Shan Yao 15g, and Bai Ren 6g to dry dampness and strengthen the spleen; for those with cold pain in the stomach who prefer warmth and pressure, add Gan Jiang 10g, Fu Zi 6g, Gui Zhi 6g, or take Huang Qi Jian Zhong Tang to warm the body and dispel cold; for those with both qi and yin deficiency, add Huang Qi 15g, Dang Shen 15g, and Shan Yao 15g to tonify qi and strengthen the spleen; for those with dry stools, add Huo Ma Ren 30g to lubricate the intestines and facilitate bowel movements; for those with severe fluid loss, add Mai Dong 10g, Xuan Shen 10g, and Sheng Di 10g to increase fluid and moisten dryness; for those with severe yin deficiency and internal heat, add Bai He 30g, Sheng Di 15g, and Zhi Mu 10g to nourish yin and clear heat; moreover, "the six fu organs function best when they are unobstructed," so whether bowel movements are smooth or not is an important factor in clearing the bowels and descending rebellious qi. When treating this disease, Sheng Da Huang should be prioritized to clear the bowels and descend rebellious qi, and when paired with Shi and Hou Pu, it can further strengthen the effect of harmonizing the stomach and descending rebellious qi, thus expelling evil and ensuring the body's stability. 6. Clinical Case Examples by Professor Pei Zhengxue
Case 1: Mr. Wang, male, 52 years old. Chief complaint: Burning sensation behind the sternum for over a month, worsening with pain for one week. The patient reported that a month ago, after consuming a large amount of sweets, he experienced a burning sensation behind the sternum, which he did not pay much attention to. One week ago, the above symptoms worsened with pain, accompanied by irritability, dry and bitter mouth with an unpleasant taste, thirst but unwillingness to drink, excessive sweating and weight loss, fatigue and weakness, a dull and gloomy appearance, insomnia, dry stools, normal urination, a dark red tongue without coating, and a fine, rapid pulse. A gastroscopy at the First Hospital of Lanzhou University revealed: the mucosa of the middle and lower esophagus showed strip-like and patch-like erosion; the gastric antral mucosa was red and white, predominantly red, with congestion and edema; the C14 breath test showed: Helicobacter pylori (-).
[Western Medical Diagnosis] Reflux Esophagitis.
[TCM Syndrome Differentiation] Qi and Yin Deficiency Syndrome.
[Treatment Principle] Tonify qi and nourish yin, descend rebellious qi and resolve depression.
[Prescription] Pei's Stomach-Nourishing Decoction, Gallbladder-Pancreas Combination Formula, and Modified Ban Xia Xie Xin Tang: Sheng Di 15g, Tian Hua Fen 10g, Sha Shen 15g, Mai Dong 10g, Shi Hu 15g, Chai Hu 10g, Zhi Shi 10g, Bai Shao 10g, Da Huang 6g, Huang Lian 6g, Huang Qin 10g, Mu Xiang 10g, Ban Xia 6g, Gan Jiang 6g, Dang Shen 10g, Sheng Long Gu 15g, Sheng Mu Li 15g, Hai 15g, Xuan Fu Hua 10g, Dai Zhe Shi 15g. All ingredients are decocted in water, taken twice daily, for a total of 7 doses, administered orally.
Second Visit: The patient's burning sensation behind the sternum has eased, his appetite has slightly improved, but he still experiences pain behind the sternum, poor sleep, constipation, a red tongue, a yellow coating, and a fine, rapid pulse. Based on the initial prescription, add Suan Zao Ren 15g, Fu Shen 10g, and increase Da Huang to 15g, then decoct in water, taking one dose per day for a total of 30 doses, administered orally.
Third Visit: The patient reports that after taking the above prescription, the pain behind the sternum and constipation have significantly alleviated. Over the past two months, he has self-administered this prescription more than 50 times, and now he feels no obvious discomfort, his complexion and spirit are back to normal, and the gastroscopy shows: the mucosa of the middle and lower esophagus is light red, smooth and soft, with clearly visible capillary networks. Therefore, based on the original prescription, reduce Da Huang to 6g and continue taking 30 doses to consolidate the therapeutic effect.
Case 2: Ms. An, female, 48 years old. Chief complaint: Acid regurgitation and heartburn, along with epigastric distension for over half a month. Half a month ago, after an argument with someone, she developed acid regurgitation and heartburn, epigastric distension, a feeling of obstruction in the throat, fullness and oppression in the chest and diaphragm, frequent belching, dry mouth and throat, difficult bowel movements, a thin white tongue coating, and a wiry, slippery pulse.
Gastroscopy revealed: the lower esophageal mucosa showed strip-like and patch-like erosion, while the gastric mucosa was red and white, predominantly red, with congestion and edema.
[Western Medical Diagnosis] Bile Reflux Esophagitis.
[TCM Syndrome Differentiation] Liver Stagnation and Spleen Deficiency, Phlegm-Qi Stagnation.
[Treatment Principle] Soothe the liver and strengthen the spleen, regulate qi and transform phlegm.
[Prescription] Ban Xia Hou Pu Tang combined with Yue Ju Wan, with modifications: Ban Xia 10g, Hou Pu 10g, Zi Su Geng 10g, Sheng Jiang 6g, Fu Ling 10g, Chuan Xiong 6g, Xiang Fu 10g, Shan Zhi Zi 10g, Cang Zhu 10g, Shen Qu 10g, Dan Shen 10g, Sha Ren 6g, Yu Jin 10g, Guai Wei 15g, and Sheng Gan Cao 6g. All ingredients are decocted in water, taken once daily, for a total of 15 doses, administered orally.
Second Visit: After taking the medication, the patient's acid regurgitation and heartburn have disappeared, the epigastric pain has lessened compared to before, and her appetite remains poor. Since the effect is not significant, continue taking 15 doses, following the same dosage and administration method as before.
Third Visit: The patient feels that all symptoms have disappeared, the therapeutic effect is remarkable, and Pei's Stomach Health Preservation Decoction is being used to consolidate the therapeutic effect. 7. A Collection of Ancient and Modern Theories
"The Plain Questions · The Great Treatise on Supreme Truth" states: "All cases of vomiting and acid regurgitation... belong to heat," suggesting that acid regurgitation is a manifestation of stomach heat.
"The Treatise on the Origins and Symptoms of Various Diseases" explains: "The cause of acid regurgitation lies in the accumulation of phlegm in the upper burner and chronic cold in the spleen and stomach, resulting in inability to digest food. When food is not digested, it causes bloating and rebellious qi, leading to the desire to vomit acid."
During the Jin and Yuan dynasties, Liu Wansu still emphasized that this condition was caused by heat, while Li Dongyuan argued that it was caused by cold. Zhu Danxi believed that the "Plain Questions" referred to the root cause of heat, whereas Li Dongyuan focused on the consequences of cold.
In "The Complete Works of Jingyue · Vomiting and Acid Regurgitation," it is stated: "Li Dongyuan's theory is correct, while Hejian's theory is incorrect," advocating that "when treating vomiting and acid regurgitation, one must carefully distinguish between deficiency and excess, as well as the strength and weakness of vital energy. For excess conditions, treat the symptoms; for deficiency conditions, treat the root cause."
In "Zhang's Medical Compendium · Vomiting and Acid Regurgitation," it is said: "If dampness accumulates in the stomach and forms a mass, the dampness will generate heat, which transforms into acid regurgitation through the wood element. If left unchecked for a long time, the liver wood will become increasingly rampant, while the stomach earth will gradually weaken. Therefore, one should pacify the liver and support the stomach, using Xiao Yao San and Zu Jin Wan."
Modern TCM scholars have different views on the diagnosis and treatment of this disease. Here are a few examples:
Lu Wensheng uses the method of harmonizing the stomach and descending rebellious qi to treat bile reflux esophagitis of the type where gallbladder qi invades the stomach, employing a self-formulated traditional Chinese medicine granule called "Left Rotation Granules" (containing Huang Lian, Wu Zhu Yu, Xuan Fu Hua, Dai Zhe Shi, Sheng Jiang, Ban Xia, Ren Shen, Gan Cao, etc.), achieving remarkable therapeutic results.
Li Xu and others use fried Cang Zhu, fried Xiang Fu, Chuan Xiong, Zhuo Shi, fried Shan Zhi Zi, Shen Qu, and other ingredients to form a basic formula, regulating the liver and clearing the stomach to treat reflux esophagitis.
Guo Liyuan and others use a formula for clearing the liver and harmonizing the stomach (containing Wu Zhu Yu, Huang Lian, Tai Zi Shen, Mai Dong, Fa Ban Xia, Chuan Lian Zi, Fo Shou, Chen Pi, Wu Zei Gu, calcined Wa Leng Zi, and Zhi Gan Cao), treating reflux esophagitis. The overall effective rate of the treatment group, as well as the degree of relief for certain symptoms (such as belching and difficulty swallowing), were superior to those of the control group treated solely with Western medicine, and no adverse reactions were observed.
Li Qixiu and others use Hao Qin Qing Dan Tang to treat reflux esophagitis, with the drug composition including Qing Hao, Huang Qin, Zhu Ru, Ban Xia, Chen Pi, Sheng Ke, Chi Fu Ling, Bi Yu San, and other ingredients.
The results show that in terms of improvement in symptom scores and overall syndrome scores, clinical efficacy of the syndrome, and gastroscopic outcomes, all aspects were significantly better than those of the Western medicine group.
Tang Jianguang uses a traditional Chinese medicine granule called "Esophageal Safety Granules" to treat the condition, and symptoms such as belching, epigastric distension or fullness, stabbing pain in the chest and diaphragm, profuse mucus expectoration, heartburn, acid regurgitation, and constipation have all been significantly improved.
Song Junjian uses a formula for descending rebellious qi, transforming phlegm, and removing stasis, composed of Ban Xia, Zi Su Geng, Chen Pi, Tu Ling, Xuan Fu Hua, Dai Zhe Shi, Tao Ren, Chi Shao, and other ingredients, effectively eliminating phlegm, dispersing stagnation, descending rebellious qi, and broadening the middle burner, with remarkable therapeutic effects.
Anatomical, physiological, and pathological aspects
The stomach is the largest part of the digestive system, connecting to the esophagus above and continuing into the duodenum below. Normally, when the stomach is moderately filled, most of it is located in the left hypochondriac region, with a smaller portion in the upper abdomen. The proximal end of the stomach, where it connects to the esophagus, is called the cardia, while the distal end, where it connects to the duodenum, is called the pylorus. The stomach has two major physiological functions: movement and secretion. Through its acceptance and storage of food, it grinds, mixes, and thoroughly blends the food with gastric juices, initiating preliminary digestion and forming chyme, which is gradually released into the duodenum in portions.
Pathologically, acute gastritis, as seen on gastroscopy, shows redness, congestion, and edema of the mucosa, with mucus adhering to it, or even erosion. Chronic gastritis, as seen on gastroscopy, shows congestion and edema of the gastric mucosa, appearing red, sometimes accompanied by punctate bleeding and erosion, with gray-yellow or gray-white mucous exudates covering the surface. Under the microscope, lesions are mainly located in the superficial layer of the mucosa, specifically in the upper third, presenting either as focal or diffuse distribution.

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Gastric mucosal congestion, edema, and superficial epithelial necrosis with desquamation; the lamina propria shows chronic inflammatory cell infiltration, including lymphocytes and plasma cells. Most cases can be cured with treatment or appropriate dietary adjustments, while a small number progress to chronic atrophic gastritis. Under endoscopy, peptic ulcers typically appear round or oval, with thickened, congested, and edematous ulcer margins and a clean base covered by grayish-white fibrinous exudate. Deep ulcers may involve the muscular layer; if they penetrate the serosa, perforation can occur. When the ulcer base is eroded by blood vessels, especially arteries, massive hemorrhage may result. Under light microscopy, an ulcer can be divided into four layers: ① the surface consists of white fibrinous exudate containing numerous leukocytes and erythrocytes; ② beneath it lies an eosinophilic fibrinous necrotic band; ③ the third layer is inflammatory granulation tissue rich in blood vessels; ④ the ulcer base is a dense fibrous scar.