Chronic gastritis, characterised by the inflammation of the stomach lining persisting over time, poses a significant health challenge globally. Some individuals may have mild or no symptoms at all, while some have it so frequent that their quality of life is affected. While conventional medicine primarily focuses on symptom management and eradication of Helicobacter pylori (H. pylori), Traditional Chinese Medicine (TCM) offers a holistic approach that not only addresses symptoms but also aims to restore the body’s balance and prevent recurrence.
Common causes/risk factors:
Infection of Helicobacter pylori (H. pylori)
Long term use of non-steroidal anti-inflammatory drugs (NSAIDs)
Excessive consumption of alcohol
Stress or repeated vomiting
Pre-existing medical conditions
Poor dietary habits
Common symptoms often include:
Nausea
Heartburn
stomach pain
Bloating
Indigestion
Feeling full after eating a small amount
In TCM, chronic gastritis is understood through the principles of internal imbalances, typically involving the Stomach and Spleen meridians. According to TCM, factors such as improper diet, emotional stress, and constitutional weaknesses can disrupt the harmonious flow of Qi and Blood, leading to digestive disturbances and inflammation. Over time, this leads to deficiencies in the Spleen and Stomach, as well as the formation of phlegm and blood stasis.
Based on TCM’s symptom-based approach, chronic gastritis can be categorised under “泛酸”, “胃痛”, “嘈杂”, or “痞满”. Depending on the characteristics of the symptoms, the condition can be further classified into excess pattern (实证) or deficiency pattern (虚证). The early stages of gastritis tend to manifest as excess patterns. When the condition progresses over the years, it typically changes into a deficiency pattern, or mixed pattern of both excess and deficiency.
Excess Pattern
饮食内停证 Syndrome of Stagnation by Food: History of improper diet such as excessive consumption of food, leading to disruption of Qi flow and indigestion.
Symptoms include: bloating that is often tender upon palpation or worse with food intake, nausea, burping, acid reflux, passing gas frequently, often smelly, thick coating on tongue and slippery pulse.
TCM treatment principle: Promote digestion and harmonise the stomach, improve Qi circulation to remove stagnation.
痰湿中阻证 Syndrome of Phlegm and Dampness: Accumulation of phlegm dampness, can be triggered by intake of cold foods or environment.
Symptoms include: bloating, body heaviness, nausea/vomiting, lack of appetite and/or thirst, infrequent urination, thick coating on tongue, deep and slippery pulse.
TCM treatment principle: Clear dampness and phlegm, improve Qi circulation and harmonise stomach.
湿热阻胃证 Dampness-Heat Syndrome: Accumulation of dampness heat in the body, can be due to intake of spicy/heaty and oily foods, or the transformation of phlegm-dampness into heat.
Symptoms include: Discomfort at the stomach, nausea/vomiting, dryness in mouth but not thirsty, bitterness in mouth, reduced appetite, red tongue with yellow thick coating, pulse is slippery and fast.
TCM treatment principle: Clear heat and remove dampness, harmonise stomach.
肝胃不和 Disharmony Between Liver and Stomach Pattern: Often triggered or exacerbated by emotions and stress. People with this pattern typically tend to be in a high stress environment or tend to place pressure on themselves, consciously or not.
Symptoms include: bloating that is triggered by emotions, nausea, acid reflux, tend to sigh often or easily angered, bowels may be inconsistent, string-like pulse.
TCM treatment principle: soothe the liver and harmonise the stomach.
气滞血瘀 Qi Stagnation and Blood Stasis Pattern: Over time, untreated gastritis can lead to Qi and Blood stagnation.
Symptoms include: stomach pain, vomit blood, dull skin appearance, black stools, may present with growth in the stomach, purple tongue, or with ecchymosis/petechiae, pulse is rough/choppy.
TCM treatment principle: Improve Qi and Blood circulation.
Deficiency Pattern
Excess patterns that go untreated can develop into a deficiency pattern.
脾胃虚弱 Spleen and Stomach Deficiency Pattern: History of congenital spleen-stomach deficiency, or developed from excess pattern.
Symptoms include: bloating that gets better with palpation or warmth, poor appetite, soft stools, indigestion, fatigue, pale tongue, pulse is thin and weak.
TCM treatment principle: Tonify spleen and Qi, and harmonise stomach
胃阴不足 Stomach Yin Deficiency Pattern: History of over-eating spicy or heaty food, or developed from excess pattern.
Symptoms include: discomfort in stomach, bloating, acid reflux, heartburn, thirsty, dry mouth, constipation, red tongue with lack of coating, pulse is thin and fast.
TCM treatment principle: Nourish stomach and Yin
TCM Management Strategies
Based on your symptoms and medical history, our TCM physician will provide a care plan that is suited for you. For the case of chronic gastritis, we typically use herbal medication and/or acupuncture. Research has increasingly validated the efficacy of TCM interventions in managing chronic gastritis. Herbal formulas like Xiangsha Liujunzi decoction have shown anti-inflammatory properties and the ability to regulate gastric mucosal immunity (Chen et al., 2020). Acupuncture, another integral aspect of TCM, has been demonstrated to alleviate gastritis symptoms by modulating gastric acid secretion and enhancing mucosal repair (Yin et al., 2018).
Depending on the duration of your condition, herbal medication may require weeks to months to see efficacy. Acupuncture is done once to twice a week depending on the severity of your symptoms, and ten sessions is considered as one treatment course. Some cases may require a few courses of acupuncture to see effect.
In the meantime, we recommend following up with your healthcare provider on the relevant checks and scans (e.g. endoscope). This is crucial to exclude the possibility of gastric cancer– a condition that can develop silently and without noticeable symptoms. Routine monitoring allows us to identify any abnormal changes in the stomach’s lining promptly.
As the stomach is directly related to the intake and digestion of food, it is important to watch your diet. Ensure that you avoid excessive eating. In TCM, we recommend eating till your stomach is at 70% capacity, or until you first feel full. Try to eat at the same timings everyday. Avoid oily, spicy foods, cold foods and alcohol which may trigger or exacerbate your condition. For some people, eating a full meal can be difficult, so you may consider having small, frequent meals instead. Regulate your emotions and manage your stress levels. We encourage you to exercise to boost your immune system. For cases with active H.pylori infection, it is recommended to treat the infection promptly.
In conclusion, chronic gastritis is manifested as disharmony in the digestive system, influenced by factors such as diet, emotions and lifestyle. TCM not only aims to alleviate symptoms but also strives to restore harmony and strengthen the body’s natural healing mechanisms. Proper management of this condition will require the combination of TCM intervention as well as diet and lifestyle management, in complement with Western medicine protocols.
References:
Chen, H., Zhao, H., Zhang, X., Chen, Y., & Li, H. (2020). Anti-inflammatory and immune regulatory effects of traditional Chinese medicine Xiangsha Liujunzi decoction on chronic gastritis. Frontiers in Pharmacology, 11, 804. doi:10.3389/fphar.2020.00804
Yin, J., Bai, T., Chen, X., Liu, Z., Wang, X., & Wang, Z. (2018). The efficacy and safety of acupuncture for patients with chronic gastritis: A systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2018, 3728756. doi:10.1155/2018/3728756
Author: Physician Aw Ching Yi Eunice
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