Written by Marc Wasserman Ph.D. L.Ac.
Eating is one of the pleasures of life. Flavors and textures and temperatures of our favorite foods delight and the joys of sharing a meal are the hallmark of community and culture. Yet the complexities of diet can bring both health and disease. When acute and chronic pathological changes to the digestive system arise, our goal through treatment is to return the system to its harmonious state. The body’s innate ability to heal itself and its drive toward homeostasis can be leveraged through medication and diet, yet we should also beware of long-term reliance on medications which may counteract these mechanisms.
Acid Reflux Causes
Reflux comes down to one basic principle…
Stomach acid belongs in the stomach.
We’ve two muscles at the stomach entrance and exit responsible for this job, the lower esophageal sphincter and the pyloric sphincter respectively. There is also some assistance from the diaphragm in supporting the lower esophageal sphincter from above. When stomach acid makes an escape into the esophagus we get heartburn, nausea, and with prolonged exposure erosion of tissue which signifies GERD and Barrett’s esophagus.
Healthy Digestion vs. GERD
The healthy mechanisms for digestion in the stomach should sequence as follows:
- The lower esophageal sphincter loosens to allow swallowed food and drink to enter
- Stomach acid is secreted to break down food
- The stomach expands like a balloon to accommodate food volume
- Timing and acidity markers initiate the opening and pulsation of pyloric sphincter for food to exit into the small intestine
Whereas acid reflux might look like any of the following:
- The lower esophageal sphincter doesn’t close fully after food enters the stomach, allowing for reflux
- Stomach acid is secreted in too high a concentration resulting in more severe irritation to the esophagus
- Stomach acid is secreted in too low a concentration resulting in delayed gastric emptying
- The stomach is overstretched due to overeating, creating pressure which forces contents back up through the lower esophageal sphincter
- Delayed emptying of the stomach (gastroparesis) builds up pressure which can reverse stomach contents back through the lower esophageal sphincter
- Irregular pulsing of the pyloric sphincter reverses stomach contents back through a weakened lower esophageal sphincter
- Weakening of the diaphragm allows the head of the stomach to bulge up into the chest (hiatal hernia)
Acid Reflux Symptoms
Everyone has heartburn and indigestion occasionally. Additionally if you are discontinuing ppi, h2 blocker, or antacid medications a short period of rebound symptoms is expected.
Nonetheless if you experience frequent or ongoing symptoms or if you have any heartburn pain and discomfort that wakes you from sleep or are disruptive of normal daily activities, these are signs you should get in to see your doctor soon.
A comprehensive summary of symptoms of GERD can be found on the IFFGD website.
Conventional treatment of GERD and acid reflux
For many years now prescriptions of proton pump inhibitors, H2 receptor blockers, and antacids have been on the rise. A variety of OTC and prescription dosages are now available in the United States. For a list check out the Mayo Clinic website .
Acute side effects of these medications primarily manifest as other imbalances in the digestive system, such as diarrhea, constipation, abdominal pain, nausea, etc. Long term side effects from prolonged use are also beginning to be recognized and they include an increased risk of fractures, pneumonia, dementia, and deficiency of B12 vitamin and other nutrients.
Herbal Medicine and Acupuncture Treatment
Acupuncture and Chinese herbal medicine treatments are effective in treating both the symptoms and underlying causes of GERD. The first step is correctly diagnosing the mechanism after which the doctor will give a customized prescription for acupuncture and herbal medicine. Let’s go through the causes of reflux mentioned above and look at what treatment might be prescribed for each case.
- Weakening of the lower esophageal sphincter is what is known in Chinese medicine as “stomach deficiency with qi reversal.” XiangShaLiuJunZi Tang is a common prescription, and acupuncture focuses primarily on the stomach channel and large intestine channel. The combined effect strengthens and engages the sphincter muscle as well as calms the stomach.
- Excessive stomach acidity is known as “exuberant liver fire”. Some common prescriptions for this include, HuangLianWenDan Tang, SiNiSan, BanXiaXieXin Tang, HaiPiaoXiao, etc. Acupuncture primarily focuses on sedating the liver and pericardium channels. The combined effect is to decrease stomach acid secretion and to relieve sensation of burning in the throat and chest.
- Insufficient secretion of stomach acid can be treated with prescriptions such as BanXiaBaiZhuTianMa Tang or XiangShaLiuJunZi Tang or ping wei san, or individual herbs such as ShanZha, MaiYa, etc. Acupuncture treatment focuses on tonifying the stomach and spleen channels. The combined effect increases the secretion of digestive enzymes and improves breakdown and delivery of nutrition.
- Overeating and bloating is often treated with BaoHe Wan, as well as distal acupuncture on points such as LiNeiTing or the well points of the stomach and large intestine channel. The acupuncture treatment can quickly alleviate the full feeling and combined with the prescription helps food digest more efficiently.
- Gastroparesis can be treated with ShengJiangXieXin Tang to increase the secretion of digestive enzymes and propagate the downward movement of food in the digestive tract. The same acupucnture protocol as for overeating will be effective.
- Spasms of the pyloric sphincter can be treated with BanXiaHouPo Tang and acupuncture points NeiGuan (PC 6) and TaiChong (LV 3). Stimulation of these two points quickly alleviates muscle spasms, tightness, and pain in the chest and abdomen.
- Hiatal hernia can be treated with FuLingZeXie Tang or FuLing Yin. Accordingly acupuncture should be performed with tonifying stimulation or moxibustion and focus on ZuSanLi (ST 36), YinLingQuan (SP 9), HeGu (LI 4), etc. This improves muscle tone and clearance of the stomach contents.
Home remedies for heartburn
Breathing with the diaphragm
Performing abdominal breathing can help to strengthen the diaphragm which in turn helps to strengthen the musculature above the stomach pressing downwards.
The following sequence can be used several times a day to help alleviate symptoms. This also has the added benefit of calming the mind, increasing focus, and energizing the body.
- Sit upright with the spine straight and shoulders relaxed
- Breathe in slowly through your nose
- Direct your inhalation down to your belly (you can place a hand on your navel to feel the belly fill to capacity as you do this)
- Once completely filled hold the breath for a few seconds
- Swallow what saliva you have in your mouth
- Begin to exhale the air through your nose by compressing the abdomen (again use a hand to feel the movement of the belly as needed)
- Repeat 7-10 times
Fermented foods (probiotics)
Foods high in probiotics promote a healthy digestive environment. Some good choices include sauerkraut, miso, fermented tofu, yogurt, some soft cheeses, etc.
Carrot, Daikon, Ginseng
Many foods help to neutralize stomach acid. The alkaline nature of these three make them a good choice. Additionally they all promote secretion of saliva which further neutralizes stomach acid and washes any lingering reflux from the esophagus. A good trick is to take a slice of raw carrot or daikon or ginseng and hold it in your mouth as a chew, slowly swallowing any saliva and replacing as needed.
Other food choices to neutralize stomach acid include cabbage, beets, cucumber, celery, broccoli, etc.
Sleep on your left side
Lying on your left side helps keep stomach contents from backing up into the throat.
Press your NeiGuan
Acupressure on this point can quickly alleviate the acute symptoms of heartburn pain. To find the point, place three fingers on the medial side of the wrist. NeiGuan is located between the two tendons at the distance of three fingers above the wrist.
Use your thumb while gripping the wrist to apply strong steady pressure and combine with the breathing technique explained above for best results.
Find digestive homeostasis
Healthy digestion relies on the complex process of physical, chemical, and bacterial systems working in coordination. Irregularity in any of these systems can lead to GERD or other digestive problems. Likewise treatment should focus on the problem at hand and beware of creating imbalances in the other two systems of digestion.
Seek the advice of qualified medical professionals
Having a correct diagnosis from your health care provider is essential. As illustrated above there are many different ways in which GERD manifests and accordingly many different treatments. In order to get the fastest and most effective results a correct diagnosis is necessary.
Pay attention to your body
With treatment and lifestyle changes pay attention to what works for you. In addition to what you’ve read here you’ll find a perpetual list of suggestions elsewhere for how to fix heartburn and acid reflux. Judge for yourself, take what works for you, and use it.
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