VII. Western Medicine Treatment

1. General Treatment

Balance work and rest, avoid overexertion, keep a cheerful and optimistic mood. Pay attention to abdominal muscle training to increase abdominal muscle tension and promote upward movement of the stomach, such as jogging, martial arts (Tai Chi, Bagua Quan), sit-ups, etc.

2. Dietary Treatment

It is one of the main treatment methods and deserves special attention:

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① It is advisable to consume a diet high in protein, calories, and sugar that is easy to digest, while also encouraging physical exercise to strengthen the body.

② Overeating can exacerbate gastric ptosis; therefore, one should avoid both overeating and extreme hunger. Smoking and alcohol consumption should be avoided, and spicy or irritating foods should be used with caution.

③ After meals, a brief period of rest in a supine position can help alleviate the downward pressure on the stomach.

3. Pharmacological Treatment

In addition to symptomatic treatment with Western medicines (such as antacids for acid reflux and digestive aids for indigestion), patients may be prescribed protein synthesis agents, insulin, adenosine triphosphate (ATP), and other drugs when necessary. These medications participate in the metabolism of fats, proteins, and sugars within the body, providing energy to promote fat deposition in the abdominal cavity and enhance the tone of the abdominal and gastrointestinal muscles. According to reports, intramuscular injection of ATP at 20 mg per dose, administered every 30 minutes between breakfast and lunch for a total of 25 days as one course, followed by a 5-day rest period before starting another course, has yielded relatively satisfactory results.

4. Abdominal Muscle Exercises

Performing abdominal muscle exercises not only strengthens the abdominal muscles but also increases the tension of the stomach itself and its visceral ligaments. X-ray barium meal examinations have confirmed that after more than six months of consistent abdominal muscle training, gastric ptosis can improve by 5–8 cm. Specific methods are as follows:

(1) Diaphragmatic breathing: Place both hands on the chest and abdomen, allowing the abdomen to move up and down with each breath. Each session lasts 2–3 minutes, which helps develop the diaphragm.

(2) Sit-ups: Extend both hands upward and sit up until your hands touch your toes, performing 3–5 minutes per session. This strengthens the abdominal muscles.

(3) Straight-leg raises: Raise both legs straight up to an angle of 45°–90°, holding for 3–5 minutes each time. This strengthens the iliopsoas and abdominal muscles.

(4) Leg cycling: Simulate pedaling with both legs raised, performing 3–5 minutes per session. This strengthens the iliopsoas, abdominal muscles, and pelvic floor muscles. Exercises should progress gradually from light to heavy and from weak to strong, avoiding overexertion. Perform once in the morning and once in the evening daily, maintaining this routine for 6–12 months.

5. Other Therapies

Wearing an abdominal support belt or using a wide waistband to secure the stomach above the line connecting the two iliac crests can facilitate the emptying of gastric contents and help restore the stomach to its original position. For a small number of patients whose symptoms worsen despite comprehensive treatment, surgical intervention may be considered.

VIII. Prognosis and Outcome

Gastric ptosis is closely related to the degree of emaciation in individuals. Patients often experience concurrent ptosis of organs such as the liver, gallbladder, spleen, small intestine, and colon. These issues can easily impair digestion, leading to malnutrition and further weight loss; the increasingly thin physique, in turn, can exacerbate gastric ptosis, creating a vicious cycle. However, with integrated traditional Chinese and Western medical treatments involving medication, dietary adjustments, and exercise, most patients can recover. Those whose condition is caused by genetic factors tend to respond less well and are prone to recurrence. A very small number of patients require surgical treatment.

Chapter VII: Gastric Neurosis

Section 1: Overview

Gastric neurosis, also known as gastric dysfunction, is often collectively referred to as gastrointestinal neurosis along with intestinal neurosis in clinical practice. This condition involves only disturbances in the motility and secretory functions of the stomach, without any organic changes. Clinical manifestations include pain or discomfort in the epigastric region, often accompanied by insomnia, forgetfulness, irritability, difficulty concentrating, and heightened nervous sensitivity.

The incidence of gastric neurosis is quite high, making it a common disease, particularly among young and middle-aged adults, especially women. Prolonged unresolved stress from work, family conflicts, marital disputes, and emotional confusion can disrupt normal central nervous system activity. Once the central nervous system becomes dysregulated, it inevitably affects the autonomic nervous system under its control, thus leading to gastric neurosis. In addition, suggestion or self-suggestion is also an important contributing factor. For example, hasty diagnoses by doctors, inconsequential test results, or inappropriate behavior and expressions from physicians can leave psychological scars in some patients. Furthermore, self-suggestion arising from relatives or friends suffering from serious illnesses can also trigger gastric neurosis.

Section 2: Diagnosis

I. Diagnostic Key Points

(1) The onset is usually gradual, with a long disease course; some cases present as continuous symptoms, while others manifest as intermittent episodes.

(2) Clinical presentation is primarily localized to the epigastric region, though it may also involve the pharynx, esophagus, or stomach, often accompanied by other common symptoms of neurosis.

① Globus Hysteria. Patients perceive a foreign object lodged in the throat, unable to spit it out or swallow it, yet eating and drinking do not cause any obstruction. Traditional Chinese Medicine refers to this condition as "plum-bone qi." It is commonly seen in postmenopausal women.

② Nervous Vomiting. Often occurs suddenly shortly after eating, with small amounts of vomit that do not affect appetite or food intake. There is a tendency toward exaggeration and theatricality, making it highly susceptible to suggestion. Episodes occur abruptly, with complete normalcy during remission periods.

③ Nervous Belching, also known as aerophagia. Patients experience recurrent, persistent belching, attempting to relieve what they believe is abdominal distension and discomfort caused by gas in the gastrointestinal tract. In reality, however, excessive, involuntary swallowing of air leads to incessant belching. This condition carries a hysterical component and tends to occur in the presence of others.

④ Nervous Anorexia. Characterized by loss of appetite, severe weight loss, and amenorrhea, yet without any organic pathology. Most patients are adolescent females, often grappling with familial and interpersonal relationship conflicts, harboring deep-seated pathological attitudes toward eating and obesity. Refusal to eat is frequently driven by a desire to maintain a slim figure through dietary restriction. Prolonged under-eating can lead to a weight loss of 40%–60% of initial body weight, resulting in cachexia.

(3) Exclude all organic diseases of the epigastric region that could cause the aforementioned symptoms.

It must be emphasized that diagnosing gastric neurosis requires great caution. Before making such a diagnosis, organic diseases—especially malignant tumors—must be ruled out. Many patients with these conditions are emotionally tense, presenting with lengthy, rambling accounts during consultations, sometimes even writing down their symptoms to ensure nothing is overlooked. Others appear mysterious, insisting on private consultations with the physician. When encountering such patients, doctors should patiently listen to their complaints, conduct thorough examinations, and perform necessary laboratory tests. In fact, if this process proceeds smoothly, coupled with negative test results and clear, patient explanations from the physician, it itself serves as an effective form of psychological therapy. The author once encountered a patient who, following an argument, developed bitter taste in the mouth, gastric distension, loss of appetite, and occasional nausea. Local tests revealed mild elevation of transaminases, leading local doctors to diagnose "hepatitis," thereby imposing a mental burden on the patient. As treatment progressed, symptoms only worsened, prompting the patient to travel thousands of miles to the provincial capital. After listening carefully to the patient's account and conducting a thorough examination, including repeat liver function tests and surface antigen testing, all results came back normal. The physician then reassured the patient: there is no hepatitis; the symptoms are simply due to anger damaging the spleen and stomach, requiring only some herbal medicine to regulate the condition. The physician took the patient's pulse and examined the tongue, prescribing a formula to soothe the liver and harmonize the stomach, while also engaging in casual conversation. Ultimately, the patient left feeling much better, with all symptoms dissipating and returning to normal.

II. Differential Diagnosis

(1) Nervous vomiting must be differentiated from chronic gastritis, pregnancy-related vomiting, uremia, and other conditions, with particular emphasis on ruling out intracranial space-occupying lesions, especially brain tumors.

(2) Nervous anorexia must be distinguished from gastric cancer, early pregnancy reactions, and hypofunction of the pituitary gland or adrenal cortex.

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Section 3 Integrated Traditional Chinese and Western Medical Treatment

The key to treating gastric neurosis lies in alleviating patients' psychological concerns and regulating organ function. Treatment should be comprehensive, incorporating suggestion therapy as well. Traditional Chinese medicine excels in addressing this condition, offering a wide range of therapeutic approaches.

I. Traditional Chinese Medicine's Understanding of Gastric Neurosis

Since gastric neurosis is rooted in psychological factors, it generally falls under the category of "stagnation syndrome" in TCM, involving dysfunction of the liver-gallbladder and spleen-stomach systems. As we know, the liver governs the free flow and regulation of the seven emotions—joy, anger, sorrow, worry, grief, fear, and surprise. Interpersonal and societal conflicts first lead to dysfunction of the liver and gallbladder, which TCM refers to as "liver (gallbladder) qi stagnation." Moreover, since the liver and gallbladder belong to the Wood element in the Five Elements theory, while the spleen and stomach belong to the Earth element, according to the natural law of Wood overcoming Earth, the spleen and stomach normally rely on the free-flowing function of the liver and gallbladder to carry out their transformation and transportation functions. If the liver (gallbladder) qi becomes stagnant and its free-flowing function is impaired, the spleen and stomach cannot receive the necessary assistance, naturally resulting in the pathological state of "liver-stomach disharmony" and "liver-spleen disharmony" (commonly seen in intestinal neurosis). Liver qi rising against the flow and phlegm-dampness accumulating in the throat, unable to be spat out or swallowed, is what is known as "plum-bone qi." In short, liver qi stagnation is the core pathogenesis of this condition, and soothing the liver and regulating qi is the fundamental principle for treating it. With this understanding, treating gastric neurosis becomes straightforward.

II. Syndrome Differentiation and Treatment

(I) Globus Hysteria

① Symptoms: Depression, emotional instability, chest tightness, flank distension and pain with shifting locations, sensation of something stuck in the throat that cannot be swallowed or spat out, white greasy coating on the tongue, and wiry slippery pulse.

② Treatment: Soothe the liver and reverse the upward flow of qi, transform phlegm and disperse nodules.

③ Prescription: Modified Banxia Houpu Tang. Ingredients: Houpu 10 g, Chaihu 10 g, Suge 10 g, Banxia 10 g, Fuling 10 g, Shengjiang 10 g, Xiangfu 10 g, Zhike 10 g, Hangbaishao 12 g, Gancao 6 g. Decoct twice, mix well, and take in two doses daily.

④ Note: What Western medicine calls "globus hysteria" is referred to as "plum-bone qi" in the "Yizong Jinjian." According to TCM differentiation, this condition falls under the category of "liver qi ascending against the flow." Banxia Houpu Tang originates from Zhang Zhongjing's "Jin Gui Yao Lue," where it is written: "For women experiencing a sensation of a small piece of meat stuck in the throat, Banxia Houpu Tang is the primary prescription." Clinical practice has proven that if "plum-bone qi" is correctly diagnosed, organ pathology has been ruled out through specialized examination, and Banxia Houpu Tang is used with appropriate modifications, combined with patient counseling and explanation, the therapeutic effect is guaranteed. However, relapses are common. Postmenopausal women are most susceptible to this condition. When using Banxia Houpu Tang clinically, adjustments can also be made based on the following situations: If dampness and qi stagnation coexist with chest and epigastric fullness, belching, and greasy coating, add Xiangfu, Foshou slices, and Cangzhu to regulate qi and remove dampness; if phlegm accumulates and turns hot, causing irritability and red tongue with yellow coating, add Zhuru, Gualou, Huangqin, and Huanglian to clear phlegm and heat; if the condition persists for a long time and blood stasis appears, with stabbing pain in the flanks, purple-dark tongue or petechiae and ecchymoses, and a涩 pulse, add Yujin, Danshen, Jiangxiang, and Jianghuang to invigorate blood circulation and dissolve stasis.

(II) Nervous Vomiting

① Symptoms: Vomiting with acid regurgitation and frequent belching, chest and flank fullness and pain, restlessness and discomfort. Every time emotional stimuli occur, vomiting and acid regurgitation become more severe. Red edges of the tongue, thin greasy coating, and wiry pulse.

② Treatment: Harmonize the stomach and reverse the upward flow of qi.

③ Prescription: Modified Banxia Houpu Tang combined with Zuojin Wan. Ingredients: Jiangbanxia 10 g, Houpu 10 g, Suge 10 g, Fuling 10 g, Huanglian 6 g, Chao Wuyu 10 g, Shengjiang 10 g, Gancao 6 g. Decoct twice, mix well, and take in multiple doses daily.

④ Note: Nervous vomiting falls under the category of "stomach qi ascending against the flow" in TCM. Normally, the stomach descends to maintain harmony, and when this descending function is disrupted, the stomach rises instead, leading to nausea and vomiting. When applying prescriptions clinically, adjustments are generally made according to the following principles: If constipation and blockage of the bowels occur, add Dahuang to clear the bowels and release heat; if fire stagnates and damages yin, resulting in dry mouth and throat, burning sensation in the stomach, and a red tongue with little coating, use fewer pungent and drying herbs, adding Sha Shen and Shihu to nourish stomach yin; if the stomach qi is weak and vomiting and belching often occur due to emotional stimulation and mental tension, use Xuanfudai Zhe Shi Tang to tonify deficiency and reverse the upward flow, harmonizing the stomach and stopping vomiting. As for the "bile vomiting" symptom of bitter vomit, it should be cleared by draining bile fire and calming the stomach to stop vomiting, using Erchen Tang (Banxia, Chenpi, Fuling, Shengjiang) supplemented with Huangqin and Huanglian.

(III) Nervous Belching

① Symptoms: Frequent belching, chest and flank fullness and distension, triggered by depression and anger, slightly relieved when emotions are calm, occasionally accompanied by nausea, thin greasy coating on the tongue, and wiry pulse.

② Treatment: Descend qi and dispel stagnation, harmonize the stomach and stop belching.

③ Prescription: Modified Xuanfudai Zhe Shi Tang. Ingredients: Xuanfuhua (packaged) 10 g, Daizhe Shi 15 g, Banxia 10 g, Yujin 10 g, Chuanlianzǐ 10 g, Shengjiang 10 g, Gancao 5 g. Decoct twice, mix well, and take in three doses daily.

④ Note: Nervous belching is caused by liver-stomach disharmony. It is commonly seen in postmenopausal women or those with relatively low education levels—what people colloquially call "narrow-minded" women. The author once encountered a female patient who was normally introverted. After entering menopause, she became suspicious and paranoid all day long. One day, after an argument with her husband, she began belching incessantly, gradually developing a habit of belching whenever she touched any part of her body, leaving her whole family baffled. She herself felt anxious, dizzy, and suffered from insomnia. The author cured this case using modified Xuanfudai Zhe Shi Tang.

III. Acupuncture Treatment

Acupuncture is also one of the comprehensive treatment measures, sometimes yielding unexpected effects for patients with nervous vomiting and belching.

Main acupoints: Neiguan; accompanying acupoints: Zusanli, Gongsun, Yanglingquan, Ganyu, Zhongwan, Taichong. First needle the main acupoint, using medium-strong stimulation technique.

IV. Massage Therapy

1. Self-Massage

Self-massage can regulate gastrointestinal nerve function, alleviate subjective symptoms, and improve digestion. The method is as follows:

① Abdominal massage. The patient lies on their back with knees bent. Place both palms on the abdomen, centered around the navel, and massage clockwise in the middle and lower abdomen for about 5 minutes, aiming for a warm sensation in the abdomen. Start with gentle pressure and gradually increase intensity, then expand the area to massage the entire abdomen for 2 minutes.

② Lumbar-sacral rubbing. The patient sits with the waist flexed forward. Bring both hands together, palms tightly pressed against the lumbar region, and rub vigorously toward the sacrum, repeating continuously for about 1 minute, until the skin feels slightly warm and there is a warming sensation.

These two self-massage techniques should be performed 1–2 times daily, continuing for 24 days. Afterwards, depending on the condition, treatment can be reduced to once every other day until symptoms disappear.

2. Family Massage

Family massage can also help treat gastric neurosis. The method is as follows:

① Forehead massage. The patient lies on their back, and family members place the thumbs of both hands on the center of the forehead, gently massaging from inside to outside for about 2 minutes.

② Grasping technique. The patient lies on their back, and family members place the thumbs and remaining four fingers on the center of the patient’s abdomen, applying force in a pincer-like manner—grabbing and releasing repeatedly. The force should be smooth and gentle, with moderate strength. Generally, the ideal intensity is when the patient feels a slight soreness and tingling during grasping, followed by comfort upon relaxation. Repeat this grasping motion 5–7 times.

③ Acupoint pressing. The patient lies on their back. Family members use the thumb or middle finger to press firmly against the skin, targeting Zhongwan, Qihai, Tianzhu, and Zusanli acupoints. Press each point for about half a minute, gradually increasing pressure until the patient feels a slight soreness and numbness.

④ Spinal pinching. The patient lies face down, exposing the spine and relaxing the muscles. Family members naturally curl their hands into a loose fist, with the thumb extended in the palm and the index and middle fingers resting on the patient’s tailbone. Lift the skin, alternating between the two hands along the Du Meridian, moving toward the neck. Pinch and push simultaneously, repeating three times. During each push-and-pinch cycle, lift the skin slightly upward after every three pushes. If you hear a crisp "de la" sound, it indicates proper technique. This helps regulate organ function.

V. Western Medicine Treatment

To stabilize nerve function and ensure adequate sleep, sedatives such as Librium, Valium, Chlorpromazine, Phenobarbital, Gamma-Oryzanol, and Vitamin E can be administered (dosage determined based on individual circumstances). For patients with depressive tendencies, Amitriptyline or Imipramine can be used, at a dosage of 25–50 mg, taken 2–4 times daily.

VI. Prognosis

After improvement, gastric neurosis tends to recur easily, though it generally does not severely affect overall health. However, when severe malnutrition caused by nervous anorexia leads to cachexia characterized by "head tilted forward, deeply staring eyes, and extreme wasting of flesh," the prognosis becomes poor.

Chapter VIII: Biliary Ascariasis

Section 1: Overview

Biliary ascariasis refers to acute abdominal pain caused by intestinal roundworms migrating upward and entering the biliary tract, representing one of the most common complications of intestinal ascariasis. In Traditional Chinese Medicine, it is known as "ascaris-induced syncope." With the continuous improvement of urban living standards in China and the widespread promotion of health education, the incidence of intestinal ascariasis has significantly decreased, consequently reducing the incidence of biliary ascariasis as well. However, in remote rural areas, biliary ascariasis remains relatively common among children and young adults. Due to the sudden onset of biliary ascariasis and the severe abdominal pain experienced by patients, the condition can change rapidly, necessitating close attention from patients, families, and especially physicians. Once detected, the condition must be closely monitored, and effective treatment should be initiated promptly.

Section 2: Diagnosis