II. Syndrome Differentiation and Treatment

II. Syndrome Differentiation and Treatment

(1) Spleen Deficiency and Qi Sinking Type

① Symptoms: pale complexion, thin build, fatigue, shortness of breath and reluctance to speak, lack of appetite, fullness and bloating in the epigastric region after eating, belching and discomfort, or mid-abdominal distension and heaviness, vomiting clear water and phlegm, pale tongue with white coating, slow and weak pulse.

② Treatment: tonify the middle qi, lift and raise the clear qi.

③ Prescription: Modified Buzhong Yiqi Tang combined with Zhishi Tang. Ingredients: 15 g of Codonopsis pilosula, 30 g of Astragalus membranaceus, 15 g of Atractylodes macrocephala, 10 g of Citrus reticulata peel, 10 g of Citrus aurantium fruit, 3 g of Bupleurum chinense, 3 g of Cimicifuga foetida, 10 g of Angelica sinensis, 5 g of Glycyrrhiza uralensis. Decoct twice, mix well, divide into three doses, take one dose daily.

④ Note: Qi sinking syndrome is a pathological state where qi is weak and organs are simultaneously ptotic. Astragalus is the main herb for tonifying the middle qi, sweet and warm in nature, treats qi stagnation and clear qi sinking, has warming and invigorating functions, often used together with Codonopsis. At the same time, Astragalus has surplus yang energy, leaning towards the yang aspect, making it most suitable for those with qi deficiency and yang deficiency who need to lift and raise. Some people use Buzhong Yiqi Tang to lift and raise, only focusing on the lifting effects of Cimicifuga and Bupleurum, while neglecting the basic roles of Astragalus and Codonopsis—this is not comprehensive enough. Adding Zhishi Tang to Buzhong Yiqi Tang is based on the classic prescription in “Jin Gui Yao Lue” that “a hard mass under the heart, as big as a plate, with edges like a hanging plate—Zhishi Tang is the main remedy”; moreover, long-term clinical practice has proven that adding Citrus aurantium fruit to Buzhong Yiqi Tang indeed improves the clinical efficacy in treating gastric ptosis. Modern pharmacological research confirms that Citrus aurantium fruit stimulates gastrointestinal smooth muscle, increasing the rhythm and intensity of gastrointestinal contractions. This is precisely the fundamental reason why ancient physicians achieved success using Citrus aurantium fruit to treat this disease. Some domestic scholars believe that gastric ptosis is a condition of weakened belt ligaments, favoring the use of Schisandra, Ginkgo biloba, and Cuttlefish Bone to tighten the belt ligaments. In addition, when using Buzhong Yiqi Tang, one can also adjust the formula according to the specific combination of deficiency and excess: for those who vomit and refuse to eat, add Pinellia ternata, Poria cocos, and fresh ginger, or combine with Xuanfu Daizhe Tang to reverse the flow and soothe the stomach; for those with qi stagnation, add Agarwood; for those with poor appetite, add malt and chicken gizzard to strengthen the spleen and aid digestion; for those with blood stasis, add safflower, peach kernel, and Salvia miltiorrhiza; for those with phlegm-dampness and a constant dripping sound between the intestines, combine with Linggui Zhushugan Tang or use Xiao Banxia plus Poria cocos Tang.

(2) Spleen-Stomach Qi-Yin Dual Deficiency Type

① Symptoms: fatigue, shortness of breath and reluctance to speak, slightly flushed complexion, red and dry lips, bitter taste and bad breath, thirst, frequent belching, or nausea and vomiting, fullness and discomfort in the epigastric region after eating, dry stools, red tongue with little coating, weak pulse.

② Treatment: tonify qi and nourish yin.

③ Prescription: Modified Ye’s Stomach-Nourishing Soup combined with Shenmai Yin, adjusted as needed. Ingredients: 10 g of American Ginseng, 10 g of Ophiopogon japonicus, 10 g of Schisandra, 10 g of Mulberry leaves, 10 g of Polygonatum odoratum, 10 g of Dendrobium, 10 g of Adenophora, 10 g of Rehmannia glutinosa, 10 g of Mung bean, 5 g of Glycyrrhiza uralensis. Decoct twice, mix well, divide into three doses, take one dose daily.

④ Note: If you look through “Clinical Guide to Medical Cases,” you’ll find that Ye Tianshi’s “Stomach-Nourishing Soup” was never intended to treat epigastric pain—it was listed under “Spleen and Stomach,” treating “stomach deficiency and poor intake, earth unable to generate metal, low voice and spiritlessness”—which is somewhat similar to the clinical symptoms of gastric ptosis. However, clinically, those with stomach yin deficiency often also have middle qi deficiency, essentially meaning spleen-stomach qi-yin dual deficiency, so regardless of how the clinical presentation changes, gastric ptosis always involves the key pathogenesis of middle qi deficiency. In the above adjusted formula, malt can be added to help with transformation and generation; if vomiting is severe, combine with Orange Peel and Bamboo Shoot Soup; when qi deficiency is obvious, add Astragalus.

Since gastric ptosis is caused by obvious changes in the stomach’s shape and position, along with traction, twisting, and compression of blood vessels, leading to impaired venous return in the stomach wall, coupled with mechanical compression of surrounding organs causing blood stasis (relative ischemia), therefore, in treatment, regardless of the syndrome type, one should always add blood-circulating and stasis-resolving herbs, such as Curcuma wenyujin, Chuanxiong, safflower, and raw hawthorn, which can shorten the course of treatment and improve efficacy. The renowned modern physician Zhang Xichun once said that Curcuma wenyujin, when used together with ginseng, Atractylodes, and Astragalus, can greatly stimulate appetite and harmonize qi and blood—truly a testament to experience.