I Can Hear the Heart's Voice of Traditional Chinese Medicine-Chapter 83 - 46: Diagnosis and Treatment of Bile Reflux Gastritis After Gastrectomy

Chapter 83: Chapter 46: Diagnosis and Treatment of Bile Reflux Gastritis After Gastrectomy

"Due to the fear that symptoms will worsen after eating, many patients will reduce their food intake, leading to weight loss, diarrhea, malnutrition, and even anemia, dizziness, fatigue, and weakness in the whole body and limbs, sweating, and other symptoms."

"However..."

"However, what?"

Lu Xuan shifted the topic, glanced at the few people in the consultation room, and said: "In traditional Chinese medicine, there is no concept of reflux gastritis as such, but these types of illnesses are included under the concepts of ’stomach ache’, ’acid regurgitation’, and ’rumbling’ in Chinese medicine.

Its pathology is often related to the liver’s failure to disperse and descend, which results in horizontal disharmony overcoming earth and attacking the stomach; when gallbladder qi reverses upward with liver qi, it leads to excessive belching, dry mouth, and a bitter taste.

However, the burning sensation and regurgitation of bitter and sour water that occurs after a gastrectomy are simply the result of the loss of pyloric function or incomplete closure of the pylorus after surgery. Additionally, local inflammatory changes at the anastomosis can also cause abdominal distension, stomach pain, and bile regurgitation."

At this point, Lu Xuan pondered for a moment and continued: "Ancient medical texts, such as in the ’Discussion of Normal Air of Average People’ in Suwen, have stated: ’The normal qi of average people is endowed by stomach qi; the stomach is the normal qi of average people. A person without stomach qi is said to be in reverse, and those in reverse will die.

Those without stomach qi only obtain the true visceral pulse without attaining the stomach qi.

Furthermore, in the ’Theory of the Spleen’ in the Spiritual Pivot, it mentions that there are five gateways associated with the stomach’s qi: the esophageal gate, the cardiac gate, the pyloric gate, the respiratory gate, and the soul gate.

In ancient times, it was believed that food entered through the mouth, and passed through the esophagus, cardiac gate, stomach, pyloric gate, small intestine, large intestine, and finally reached the anus. If there were issues in any segment, it would affect digestion and excretion.

Some ancient records have documented that when dealing with these symptoms, early methods included surgeries such as skin incision, muscle separation, pulse determination, sinew binding, brain knowledge extraction, barren handling, claw curtain techniques, frying and cleansing of the stomach and intestines, and swilling and purging with the technique of the Five Victories. However, later residual symptoms were not recorded, and these medical techniques have long been lost. Nowadays, no one knows them."

Speaking of this, Lu Xuan couldn’t help but sigh. 𝙛𝒓𝓮𝒆𝔀𝒆𝙗𝓷𝒐𝙫𝒆𝙡.𝒄𝓸𝓶

The reason traditional Chinese medicine has declined in modern times is partly because Western medicine has risen too quickly and partly because many medical techniques have been lost, especially those involving the content of Chinese surgical procedures. The loss in this area is the greatest, making it difficult for Chinese medicine to compete with Western medicine in surgical techniques.

Li Yuquan was taken aback for a moment, then sighed: "Such a pity. If those techniques had been preserved, it would have been a boon for many patients."

At this point, Li Yuquan couldn’t help but look at Lu Xuan: "However, I didn’t realize Dr. Lu knew so much. No wonder his medical skills are so impressive."

"Elder, you overpraise me."

Lu Xuan instinctively cupped his fist in gratitude.

Li Yuquan pondered for a moment and asked: "Dr. Lu, in your opinion, what is my condition like?"

Upon hearing this, Su Kenan also perked up her exquisite ears, listening intently.

Lu Xuan pondered for a moment and said: "From the perspective of traditional Chinese medicine, bile reflux gastritis after gastrectomy can be divided into four types.

The first type is spleen and stomach weakness. Those with weak spleen and stomach often have spleen qi that cannot ascend, and stomach dampness cannot descend, while turbid bile fluid reflux into the stomach leads to upper abdominal distension, burning pain, nausea, and vomiting of sour water.

For those with weak spleen and stomach, the first consideration should be to strengthen the spleen and nourish qi. The spleen governs transportation and transformation, and the stomach governs reception. If spleen qi is deficient, transportation is weak, so the power to excrete stomach contents is diminished or stagnant, leading to putrid dampness.

Bile descending smoothly is the norm. If interrupted by stomach dampness, bile cannot descend and will surely reverse into the stomach, combining putrid dampness to cause burning pain.

Therefore, these patients need to replenish qi and strengthen the spleen to restore the mechanism of ascent and descent, allowing putrefied substances within the stomach to descend naturally and smoothly, thus addressing both cause and symptom."

Li Yuquan listened, frowning slightly, clearly not quite understanding.

After all, he wasn’t a medical student, nor did he know much about traditional Chinese medicine. He could understand roughly what Lu Xuan was saying, but it wasn’t possible for him to fully comprehend it.

On the other hand, Su Kenan knitted her embroidered eyebrows slightly, her charming face showing a hint of excitement.

What Lu Xuan said, she had learned much of, but nobody had ever explained it in such a systematic and detailed way before.

Understanding one thing leads to understanding many.

Su Kenan quickly grasped the meaning.

"And the second type?" Although Li Yuquan couldn’t fully understand, he knew the first type mentioned by Lu Xuan likely had no relation to himself, so he continued to ask.

"Phlegm-dampness obstructing the stomach."

Lu Xuan recalled and continued: "The ’Discourse on the Secret Treatise of the Divine Orchid’ in Suwen says: The stomach, being the official of warehouses and granaries, is where the five flavors emerge.

Now, with total gastrectomy, the warehouse’s normal reception of grains is lost due to failure of pyloric closure function, with the pyloric orifice relaxed, facilitating bile reflux into the stomach. Additionally, a smaller stomach capacity and local traumatic inflammation cause greatly reduced spleen and stomach function, easily leading to damp obstruction in the central province.

With prolonged dampness, concentration into phlegm is easy; prolonged damp turbidity leads to heat transformation, so patients of this type often experience burning nausea and vomiting, with bile mixed with foul-smelling food residue.

The reason is simple: the gallbladder governs storing souls, with weak gallbladder qi unable to contain the spirits, causing irritability, insomnia, and disturbing dreams, leading to inner irritation.

Dampness obstructing the central province with abnormal liver-spleen ascent and descent function and impaired receiving functions causes upper abdominal bloating and discomfort.

Stools are formed, but due to the excessive damp-heat turbidity, they naturally become foul-smelling.

Treatment involves strengthening the spleen, eliminating dampness, and clearing heat to such a degree that the spleen being healthy will dispel turbidity and dissolve it.

The gallbladder being the lesser yang fire requires descending of gall qi, eliminating heat and damp transforming, purging the phlegm, and thus enabling the clear turbid to be deciphered.

Treating phlegm-damp obstruction stomach type bile reflux gastritis patients, the first choice is Rhizoma Coptidis Wendan Decoction with modifications.

Rhizoma Coptidis, Bamboo Shavings clear heat, promote bile and stomach harmony; White Atractylodes, Fuling, processed Pinellia, Amomum fruit, Massa Medicata Fermentata strengthen the spleen and nourish qi, expelling dampness, and also adjusts intestinal activity, increasing intestinal tension and affecting bile flow while promoting gastrointestinal motility and enhancing gastric emptying strength.

Danggui, White Peony root, White Mulberry root, and licorice, when paired, not only protect the mucosa at the incision but also decreases the vagal nerve’s excitability, increasing the tension of the pyloric sphincter to control bile reflux, while Cyperus rotundus enhances the internal Qi amidst spleen-strengthening, damp-removing, heat-clearing, and phlegm-resolving functions. This prescription has remarkable effects on phlegm-damp obstruction in the stomach and post-operative symptoms of gastric cancer."

Li Yuquan listened more and more intently, amazed: "To think our traditional Chinese medicine could be so profound! I’ve heard before that traditional Chinese medicine views patients holistically, seeing them as an entire entity, and I was a bit skeptical. Now, it seems I’ve underestimated the treasure of our own nation."

Li Yuquan likely just thought Lu Xuan was a wealth of knowledge, as most of the content he merely listened to in awe, without fully understanding much of it.

But it was different for Su Kenan. She was a medical student, studying at a university of Chinese medicine, and naturally understood how important what Lu Xuan said is for a Chinese medicine practitioner.

Such an opportunity wouldn’t be possible to have in school.

Professors wouldn’t explain in such detail, or perhaps, the professor might not be as knowledgeable as Lu Xuan, knowing not as much as Lu Xuan, thus unable to convey it.

She quickly typed this information into a document on her computer, storing the part she couldn’t finish typing into her mind, and had already turned on her phone recording, planning to properly digest it later.

This experience was invaluable.

Put bluntly, just today’s lesson is enough to benefit any traditional Chinese medicine practitioner for a lifetime.

Nowadays, how many people have gastric cancer?

Too many to count.

And of the patients who have gastric cancer, if not all, the vast majority eventually undergo gastrectomy surgeries, and post-operatively, quite a few experience bile reflux.

If one can absorb everything Lu Xuan mentioned, just this skill alone is enough to carve out a niche in the field of traditional Chinese medicine.

These teachings cannot be learned in school.

Even if one goes to a large Traditional Chinese Medicine Hospital, who knows if anyone even understands, and even if someone truly understands, it doesn’t necessarily mean they would give any guidance.

Teaching a student may lead to starving a master, such situations occur too often in the field of traditional Chinese medicine.

Of course, not just in traditional Chinese medicine, but in other fields as well, including Western medicine.

There will always be those unwilling to pass on their knowledge to others, resulting in many techniques becoming lost.

However, this is something that cannot be helped; after all, humans are inherently self-interested.

In a sense, Lu Xuan is truly generous.

He not only explained it but explained it very clearly without holding anything back.

Traditional Chinese medicine practitioners willing to share everything like Lu Xuan are rare, but they do exist.

At this moment, a brighter light shone in Su Kenan’s eyes as she looked at Lu Xuan.

What else does he know?