Zhang Xichun's Shenzhe Peiqi Tang for Treating "Ge Shi" (Gastroesophageal Reflux)
The disease caused by excessive contact of the gastroesophageal lumen with (or exposure to) gastric juice, producing clinical gastroesophageal reflux and injury to the esophageal mucosa, is called gastroesophageal reflux; ancient TCM called this disease "ye ge" (dysphagia) or "ge shi" (dysphagia due to obstruction). Patients often have symptoms such as heartburn, acid regurgitation, painful swallowing (sometimes the pain also radiates to the back, waist, shoulder, and neck, closely resembling angina pectoris) or difficulty swallowing, hoarseness, throat discomfort or a foreign-body sensation; when refluxed irritants are inhaled into the respiratory tract, cough and asthma can even occur.
The occurrence of gastroesophageal reflux and its complications is multifactorial. These include defects in the esophagus's own anti-reflux mechanisms, such as lower esophageal sphincter dysfunction and abnormal esophageal body motility; there are also dysfunctions of many extra-esophageal mechanical factors, and in some patients it may even be caused by esophageal cancer or gastric cancer.
Because I have long dealt with cancer patients, the gastroesophageal reflux I see is mostly caused by esophageal cancer, gastric cancer, and the like; in some patients, gastroesophageal reflux is caused by chemotherapy and by taking orally certain anti-cancer drugs that irritate the gastric and esophageal mucosa.
Most chemotherapy drugs and targeted drugs can cause gastroesophageal reflux; among Chinese medicines, some herbs that are highly irritating to the gastric mucosa, such as Moyao (Myrrh) and Banmao (Mylabris), can also cause gastroesophageal reflux. Therefore the author often urges patients, when taking Chinese patent medicines containing Moyao and Banmao that irritate the esophageal and gastric mucosa (such as Xihuang Wan and Compound Mylabris Capsules), to start from a small dose and increase the dose slowly. If there is acid regurgitation or heartburn, stop the medicine immediately for a day or two, and when resuming, control the dose well. This is also an important reason why many Chinese medicines cannot be given a standard dosage: because each patient's bodily tolerance differs, the dosage of Chinese medicine must also vary from person to person.
Western medicine treats gastroesophageal reflux mostly with proton pump inhibitors, such as omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. But for gastroesophageal reflux patients whose condition has already become severe enough to cause difficulty swallowing, the effect of proton pump inhibitors is limited. The renowned Republican-era physician Zhang Xichun had an empirical formula for treating "ge shi"—Shenzhe Peiqi Tang (Ginseng and Hematite Qi-Supporting Decoction)—which can relieve the patient's symptoms.
The composition of Shenzhe Peiqi Tang is: Ludangshen (Codonopsis) six qian; Tiandong (Asparagus Tuber) four qian; Sheng Zheshi (raw Hematite) eight qian (crushed fine); Qing Banxia (clean Pinellia) three qian;desalted Cistanche (Tanroucongrong) four qian; Zhimu (Anemarrhena) five qian; Dangguishen (Angelica body) three qian; Shishuangbing (persimmon-frost cake) five qian—dissolve it slowly in the mouth after taking the medicine. The Shishuangbing in this formula is made from persimmons on whose surface frost has already formed; in the north it is mostly made into preserved fruit or candied fruit. It is not put in the decoction; rather, after taking the decoction of the other herbs, the Shishuangbing is slowly dissolved in the mouth.
Patients with gastroesophageal reflux often have the symptom of dry stools like sheep pellets, so Zhang Xichun's formula uses Roucongrong (Cistanche; dancongrong is Cistanche not processed with salt), which has the action of moistening the intestines and freeing the stool.
Zhang Xichun explained the action of each herb in this formula as follows: "To treat this pattern, one should primarily greatly supplement the central qi; this is the Renshen (Ginseng) in the formula. As the assistant, to downbear counterflow and quiet the chong (penetrating) vessel; as the envoy, to clear phlegm and rectify qi—these are the Zheshi (Hematite), Banxia (Pinellia), and Shishuang (persimmon frost) in the formula. Further, worried that Renshen is hot in nature and Banxia is dry, he also added Zhimu, Tiandong, Danggui, and Shishuang to clear heat and moisten dryness, and to engender fluids and blood. Cistanche is used because it can supplement the kidneys, which in turn can secure the chong vessel; when chong qi does not ascend, stomach qi easily descends. Moreover, those with this pattern often have the worry of difficult bowel movement (i.e., constipation); Cistanche, used together with Angelica and Hematite, is also very effective in moistening the stool and freeing the accumulation. If, after taking several doses, there is no great effect, it must be because there is static blood at the cardia; one should add Sanleng (Sparganium) and Taoren (Peach Kernel), each two qian." Besides using the above herbs, Zhang Xichun would also add Xuanfuhua (Inula) for some patients with severe ye ge, and he believed that the Inula produced near Wuditai had the best effect.
Limited by the times, Zhang Xichun's explanation of the formula he created is not entirely scientific, but it is basically correct. The advantage of TCM lies in pattern differentiation and treating the manifestation; by the time ye ge has generally developed to the point of difficulty swallowing, the condition is already not light, and most are actually already esophageal or cardia cancer. At this point the patient is weak, and because of difficulty eating, has also begun to show nutritional deficiency; the patient will have obvious progressive emaciation and anemia, and support the righteous and expel the evil must both be considered.
Zhang Xichun's formula has herbs aimed at the problem of difficulty swallowing, such as Daizheshi (Hematite), Tiandong, Banxia, and Shishuang; it also has herbs that support the righteous and secure the root, such as Renshen and Danggui. Daizheshi is an iron ore; it can neutralize gastric acid and also has the action of nourishing blood, and is very good for raising red blood cells in patients with iron-deficiency anemia.
Zhang Xichun said: "If, after taking several doses, there is no great effect, it must be because there is static blood at the cardia; one should add Sanleng and Taoren, each two qian." Generally speaking, gastroesophageal reflux that has not progressed to esophageal and cardia cancer responds reasonably well to this formula. If it has progressed to esophageal and cardia cancer, it cannot be cured by this formula alone.
What Zhang Xichun called "static blood" is actually a tumor; both Sanleng and Taoren have anti-tumor effects. But this amount of medication is also insufficient to treat esophageal and cardia cancer. One can use Shenzhe Peiqi Tang as the base formula and, according to each patient's specific condition, select several anti-cancer Chinese medicines such as Weilingxian (Clematis), Donglingcao (Isodon), Banzhilian (Scutellaria Barbata), Baihua Shezhecao (Oldenlandia), Tengligen (Actinidia Root), Ezhu (Curcuma Rhizome), Banmao (Mylabris), and Xionghuang (Realgar) to add in.