Fu Ling Ze Xie Tang for Counter-Regurgitation with Thirst

Fu Ling Ze Xie Tang (Poria-Alisma Decoction) comes from the Jingui Yaolue (Essential Prescriptions from the Golden Cabinet). The original text reads: "In stomach counter-flow (fan wei), when there is vomiting and thirst with a desire to drink water, Fu Ling Ze Xie Tang governs." Fu Ling Ze Xie Tang is composed of six herbs: Fuling (Poria), Zexie (Alismatis Rhizoma), Gancao (Glycyrrhizae Radix), Guizhi (Cinnamomi Ramulus), Baizhu (Atractylodis Macrocephalae Rhizoma), and Shengjiang (Zingiberis Rhizoma Recens). The author's usual dosages are Fuling 15 g, Zexie 8 g, Gancao 4 g, Guizhi 4 g, Baizhu 6 g, and Shengjiang 3–5 slices. Nowadays, one and a half bowls of water are usually decocted down to half a bowl, taken before or after meals.

What kind of symptoms is the disease of "stomach counter-flow"? The ancients described it thus: "When the spleen is injured, it cannot grind; food eaten in the morning is vomited in the evening, food eaten in the evening is vomited in the morning, the retained food is undigested; this is called stomach counter-flow." In modern medical terms this is called insufficient gastric motility—insufficient peristaltic force of the stomach muscle due to various causes, leading to upper abdominal fullness, postprandial bloating, poor appetite, nausea, and vomiting.

Many common stomach diseases (such as superficial gastritis, atrophic gastritis, and gastric ulcer) and gastric cancer can cause these symptoms; cancer patients after radiotherapy and chemotherapy also easily develop such symptoms. What the patient eats in the morning is vomited in the evening; what is eaten in the evening is vomited the next morning, and the vomitus smells very foul.

Insufficient gastric motility causes gastric retention. With relatively much food and water retained in the stomach, this putrefies there, and the stomach becomes distended and painful. After a day or a night, this putrefied material can only be brought up by vomiting, so the patient shows "food eaten in the morning vomited in the evening, food eaten in the evening vomited in the morning." The patient frequently eructates, and the belched odor is extremely foul—so foul that the patient himself feels nauseated. At the same time the patient has heartburn and dry mouth, hence "thirst with a desire to drink."

Fu Ling Ze Xie Tang addresses this problem in two ways: first, it uses water-disinhibiting herbs Fuling and Zexie to drain out the water retained in the stomach; second, it uses stomach-warming herbs Guizhi, Baizhu, Gancao, and Shengjiang to promote gastrointestinal peristalsis. In this way, normal gastrointestinal function is restored; food and water can pass downward, and stomach counter-flow does not occur. Once the stomach is emptied, there is no more heartburn, and the patient no longer feels dry mouth.

Clinically, the disease of "stomach counter-flow" is very common, and this formula is very effective. Unfortunately, many doctors, as soon as they see a patient with dry mouth, think of yin-nourishing herbs such as Tianhuafen (Trichosanthis Radix) and Shihu (Dendrobii Caulis), and add some heat-clearing and detoxifying herbs; as a result the patient worsens with each dose. This is all due to being poisoned too deeply by the yin-yang doctrine and not understanding pathology.