🌿 Folk Prescriptions

For patients with pre-existing gastric conditions, concurrent hepatitis infection can exacerbate gastric disease; in those without prior gastric issues, viral hepatitis patients may develop mucosal lesions in the stomach and duodenum, a condition known as hepatogenic gastric disease. Common clinical manifestations include epigastric pain, acid regurgitation, belching, nausea, and vomiting. Clinical observations indicate an increasing trend in hepatogenic gastric disease. A report on 56 cases of acute icteric hepatitis found that the rate of gastric and duodenal mucosal injury reached as high as 92.86% via endoscopy: 34 cases of superficial gastritis, 11 duodenal bulb ulcers, 4 cases of isolated duodenitis, 2 cases of atrophic gastritis, and 1 case of gastric ulcer. In another study, gastric mucosal biopsy was performed on 15 liver disease patients, confirming the presence of HBsAg in gastric mucosa among serum HBV-positive individuals, particularly in "big three positives," where the positive rate of HBsAg in gastric mucosa ranged from 80% to 100%.
Modern medical research suggests that the pathogenesis of hepatogenic gastric disease may involve three factors: (1) due to the broad tropism of hepatitis virus, which resides in gastric mucosa, immune complexes deposit in the microvasculature of gastric and duodenal mucosa, causing local immune reactions; (2) impaired liver function reduces hormone inactivation, leading to endocrine disorders and autonomic nervous system dysfunction, damaging gastric and duodenal mucosa and facilitating Helicobacter pylori infection, further impairing the gastric mucosal barrier; (3) gastric acid and bile reflux easily cause inflammatory changes in the stomach and duodenum, resulting in various gastrointestinal symptoms and lesions.
In traditional Chinese medicine, the stomach is regarded as the Sea of Grains and Liquids, requiring smooth descent rather than stagnation. After hepatitis infection, damp-heat combined with epidemic toxins accumulate in the liver, impairing liver's function of free flow, leading to disharmony between liver and stomach, manifesting as epigastric and costal pain, heartburn, acid regurgitation, nausea, and vomiting; earth failing to nourish wood, wood stagnating and not spreading freely, leads to liver depression and spleen deficiency, presenting with poor appetite and abdominal distension; prolonged illness weakens spleen Qi, causing blood stasis, coupled with liver Qi stagnation and internal heat disturbance, obstructing nutritive and defensive Qi, resulting in blood stasis, causing gastric mucosal erosion or ulceration, fixed pain, and damage to blood vessels visible as hematemesis or melena. Clinically, when treating viral hepatitis, syndrome differentiation and medication should consider the spleen and stomach. Only when spleen transportation and stomach harmony are restored can vital energy recover, immunity improve, and liver disease heal faster. Hepatogenic gastric disease can be treated based on the following four syndromes:
I. Liver-Gastric Damp-Heat Type: Commonly seen in acute icteric hepatitis and chronic active hepatitis. Symptoms include dry mouth and bitter taste, heartburn, poor appetite, nausea, epigastric fullness, constipation or loose stools, red tongue with yellow or greasy coating, wiry and slippery pulse. Treatment aims to clear liver and harmonize stomach. Use self-formulated Hu-Yin Decoction with modifications: rhubarb, capillary wormwood, gardenia, dandelion, processed pinellia, poria, raw rhubarb, licorice, etc. Add turmeric and red peony if jaundice is severe; add white cardamom seed and coix seed if dampness is prominent; add Coptis, Evodia, and calcined oyster shell if acid regurgitation occurs.
II. Liver-Gastric Disharmony Type: Commonly seen in chronic hepatitis, cirrhosis, and acute hepatitis. Symptoms include distension or pain in epigastrium and flanks, belching, acid regurgitation, poor appetite, nausea, vomiting, pale red tongue with thin white or slightly yellow coating, wiry and slippery pulse. Treatment aims to soothe liver, relieve depression, harmonize stomach, and descend rebellious Qi. Use Chaihu Shugan San with modifications: bupleurum, cyperus, processed pinellia, tangerine peel, citrus aurantium, white peony, poria, licorice, etc. Add chinquapin and aloes if flank pain is severe; add hematite and bamboo juice if hiccups occur; add fried sprouted rice, fried barley, and radish seed if food stagnation and heartburn are present.
III. Liver Depression and Spleen Deficiency Type: Commonly seen in chronic hepatitis, cirrhosis, and recovery phase of severe hepatitis. Symptoms include distension and dull pain in flanks, dull epigastric pain, poor appetite, fatigue, postprandial distension, loose stools or unsatisfactory bowel movements, pale red tongue with thin white coating, deep and wiry pulse. Treatment aims to soothe liver, relieve depression, strengthen spleen, and harmonize stomach. Use Xiao Yao San combined with Xiang Sha Liu Jun Zi Tang with modifications: ginseng (use太子参 for bloating), white atractylodes, bupleurum, poria, white peony, sand ginger, tangerine peel, safflower, licorice, etc. Add astragalus and jujube if fatigue and qi deficiency are prominent; add chicken gizzard lining, fried sprouted rice, fried barley, and sandalwood if poor appetite and abdominal distension exist; add coix seed and yam if stools are loose.
IV. Qi Stagnation and Blood Stasis Type: Commonly seen in chronic hepatitis and cirrhosis. Symptoms include stabbing pain in flanks and epigastrium with fixed location, dark complexion, black stool or positive occult blood in stool, purple-dark tongue or ecchymoses, or prominent sublingual veins, wiry and涩pulse. Treatment aims to activate blood circulation, resolve stasis, and unblock meridians. Use Xue Fu Zhu Yu Tang with modifications: bupleurum, angelica, citric fruit, red peony, safflower, litchi seed, licorice, etc. Add Corydalis tuber and five-lingzhi if pain is severe; add ginseng, astragalus, and salvia if palpitations and shortness of breath occur; add softshell turtle shell and mother-in-law’s tongue if hepatosplenomegaly exists; add raw rhubarb, baiji, and sanqi powder if bleeding occurs.