Appreciation of Professor Guan Youbo's Case of Cardiospasm (Ye Ge)
Professor Guan Youbo was a renowned TCM specialist in liver disease in China. During his lifetime he treated many difficult and complicated digestive disorders. One was a patient with cardiospasm; this case is recorded in the Guan Youbo Linchuang Jingyan Xuan (Selected Clinical Experience of Guan Youbo). From this case we can learn some of Professor Guan's therapeutic experience.
The patient, a 24-year-old woman surnamed Li, first visited on September 24, 1964, with a 4-year history of frequent choking and obstruction after eating. A hospital had diagnosed cardiospasm and recommended surgery, which the patient declined; she sought Professor Guan. At the visit she reported choking on food, epigastric discomfort, worse with dry foods, along with frequent belching, acid regurgitation, nausea and vomiting, paroxysmal severe pain that resolved after a moment, epigastric fullness, dry stool, normal urination, and menstruation ahead of schedule. She had a past history of stomach disease.
Barium meal X-ray showed marked narrowing at the cardiac end of the esophagus with rough margins; above and below the narrowed segment, the barium shadow was uneven in width because the barium could not pass. Western diagnosis: cardiospasm. TCM diagnosis: ye ge (dysphagia) due to qi stagnation and blood stasis, phlegm-blood concretion, and liver-stomach disharmony. Professor Guan decided to treat by pacifying the liver and harmonizing the stomach, and activating blood and resolving stasis.
The initial prescription was: Sheng Wa Leng (raw Arcae Concha) 30 g, Dao Dou (Canavaliae Semen) 30 g, Chi Shao (Paeoniae Radix rubra) and Bai Shao (Paeoniae Radix alba) each 30 g, Dang Gui (Angelicae Sinensis Radix) 12 g, Mu Gua (Chaenomelis Fructus) 12 g, Ou Jie (Nelumbinis Nodus rhizomatis) 12 g, Xuan Fu Hua (Inulae Flos) 10 g, Dai Zhe Shi (Hematitum) 10 g, Xing Ren (Armeniacae Semen) 10 g, Ju Hong (Citri erythrocarpae exocarpium) 10 g, Hong Hua (Carthami Flos) 10 g, Xiang Fu (Cyperi Rhizoma) 10 g, Mei Gui Hua (Rosae Rugosae Flos) 10 g, Sha Ren (Amomi Fructus) 4.5 g, Sheng Jiang (Zingiberis Rhizoma recens) 4.5 g.
After 8 doses the patient felt that choking on food had improved; belching, acid regurgitation and vomiting were all reduced. Following the principle that an effective formula should not be changed, he kept the base formula essentially unchanged, only removing Hong Hua and Mei Gui Hua, and adding Ji Nei Jin (Gigeriae galli endothelium corneum) 15 g, Dang Shen (Codonopsis Radix), Jiao Bai Zhu (parched Atractylodis Macrocephalae Rhizoma) and Ban Xia (Pinelliae Rhizoma) each 10 g, and Huang Tan (charred Coptidis Rhizoma) 3 g.
After dozens doses of the adjusted formula, the patient's subjective symptoms were no longer noticeable; diet and bowel and bladder function were normal. On April 3, 1965, re-examination at the original hospital by barium meal X-ray showed that narrowing at the cardiac end of the esophagus had markedly widened, the margins were smooth, and the uneven shadow caused by barium obstruction had disappeared above.
Cardiospasm, also called achalasia of the cardia, is a disorder of esophageal peristalsis or relaxation of the lower esophageal sphincter. It causes dysphagia, retrosternal pain and food regurgitation. A minority of cardiospasm patients may transform into esophageal cancer; most have a good prognosis. Western medicine treats it mainly with drugs or surgery.
In the TCM disease nomenclature, cardiospasm, like esophageal cancer, falls under ye ge. The Qing physician Xu Lingtai once divided ye ge into "true ye ge" and "false ye ge," stating that true ye ge was incurable while false ye ge was curable. Judging from Xu's descriptions of prognosis, his "true ye ge" corresponds to esophageal cancer, while "false ye ge" corresponds to diseases such as cardiospasm.
In treating this patient, Professor Guan drew on the Dai Zhe Shi Xuan Fu Tang approach: using Dai Zhe Shi and Xuan Fu Hua, plus Xing Ren, to treat the branch and relieve ye-ge symptoms. Mu Gua and Bai Shao both relieve pain and harmonize the stomach. He also used Wa Leng Zi (Arcae Concha) to soften hardness and dissipate nodules; Wa Leng Zi is mainly calcium carbonate and effectively neutralizes stomach acid—this patient had acid regurgitation, which Wa Leng Zi could relieve. Dao Dou, Mu Gua, Xiang Fu, Sha Ren and Mei Gui Hua are herbs that move qi and reduce distension; Hong Hua, Chi Shao, Bai Shao and Dang Gui activate blood, resolve stasis, and generate and nourish blood.
At the second visit, removing Hong Hua and Mei Gui Hua and adding Ji Nei Jin to aid digestion, adding Dang Shen and Bai Zhu to fortify the spleen and boost qi, adding Ban Xia to dissipate phlegm nodules, and adding charred Huang Lian to clear stomach fire also addressed root support and yuan supplementation.
Taken together, Professor Guan's approach combined pattern differentiation with disease differentiation, and combined supporting healthy root with dispelling pathogenic branch—a comprehensive therapeutic method.