🌿 Folk Prescriptions

Gastric pain is a common clinical condition, primarily characterized by recurrent pain near the xiphoid process in the upper abdomen, often accompanied by poor appetite, belching, hiccups, abdominal distension, nausea, vomiting, and even hematemesis or melena. It commonly occurs in acute/chronic gastritis, gastric and duodenal ulcers, gastric ptosis, gastric spasm, and functional dyspepsia. Over the past decade, Western medicine has primarily relied on H2 receptor antagonists and proton pump inhibitors for peptic ulcer and chronic gastritis treatment, supplemented by mucosal protectants. These approaches effectively relieve patient discomfort and promote short-term ulcer healing, yet many unresolved issues remain. For example, about 5%–10% of patients fail to fully heal despite multiple treatment courses; coexisting antral gastritis persists; healed ulcers easily recur within months. Even after six months of treatment, 25%–30% of patients relapse within ten years. Additionally, long-term use of these drugs causes side effects like headache, thirst, delayed response, and gastrointestinal dysfunction due to excessive acid suppression, including upper abdominal pain, bloating, diarrhea, nausea, and vomiting. Therefore, how to utilize traditional Chinese medicine to improve cure rates, reduce recurrence, and minimize side effects is a crucial research topic.
The third batch of national veteran TCM experts, Director Chen Bao-gui, Chief Physician at Wuqing District Hospital of Traditional Chinese Medicine in Tianjin, has accumulated rich clinical experience in treating gastrointestinal diseases, achieving remarkable results. We are honored to study under and attend his clinic. Here we present his eight therapeutic principles and clinical medication strategies for gastric pain:
1. Liver-Qi Regulation and Stomach Harmonization Method
Ye Tian-shi said: “The liver is the origin of illness, the stomach the site of transmission.” The liver governs free flow and regulates qi movement, assisting the stomach and spleen in ascending and descending functions. Thus, liver-qi regulation and stomach harmonization is the fundamental method for eliminating gastric pain. Clinical presentation: Epigastric distension and pain, primarily distension, radiating to both sides of the ribs or epigastric fullness, worsening with anger or stress, belching brings relief, chest tightness, sighing, poor appetite, abdominal distension, irregular bowel movements, thin white or slightly yellow coating, wiry pulse. Prescription: Base on Chai Hu Shu Gan San: Bupleurum, Peony, Ligusticum, Cyperus, Citrus Peel, Fructus Aurantii, Licorice. Bupleurum disperses and ascends, excelling in regulating qi and relieving stagnation; it also guides other herbs into the liver. Fructus Aurantii promotes qi movement and eliminates stagnation; paired with Bupleurum, it creates a rising and descending effect to regulate liver and stomach function and remove blockages. Bupleurum combined with Peony, which soothes the liver and relieves urgency, achieves a balance between hardness and softness, mutually restraining each other—Peony reduces Bupleurum’s dryness, while Bupleurum mitigates Peony’s greasiness. Peony and Licorice together relieve spasms and ease pain, harmonizing the center. Cyperus and Citrus Peel regulate liver qi and strengthen the spleen. Ligusticum, a blood-moving herb, excels in dispersing stagnation and relieving pain. Together, these herbs form a formula for liver-qi regulation and stomach harmony.
When liver qi transforms into fire, causing upward surge of fire, additional symptoms appear: headache, head distension, red eyes, bitter taste, irritability, burning pain in the costal regions. Add Cortex Moutan, Coptis, Zuojin Wan. For severe distension, add Corydalis, Agarwood, Curcuma. For frequent belching, add Xuan Fu Dai Zhe Tang. For abdominal distension, add Magnolia Bark, Areca Seed. For chest oppression, add Buddha’s Hand, Citron, Cardamom, Trichosanthes.
2. Nourishing Yin and Benefiting the Stomach Method
Long-standing gastric pain leads to heat damaging yin, depriving the stomach of nourishment. Clinical presentation: Subtle or burning pain in the epigastrium, heartburn, dry mouth, dry stools, red tongue with little moisture or peeled coating, small cracks on the tongue surface, fine stringy or fine rapid pulse. Treatment: Nourish yin and benefit the stomach. Use Yi Wei Tang combined with Sha Yao Gan Cao Tang with modifications: Adenophora, Ophiopogon, Rehmannia, Polygonatum, Dendrobium, Peony, Licorice.
If there is heartburn and acid regurgitation, add Zuojin Wan. For yin deficiency with nausea and vomiting, add Bamboo茹, Reed Rhizome, Pinellia. For reduced gastric acid, add Prunus mume, Fermented Three Treasures. For difficult defecation, add Trichosanthes, Areca Seed, Rhubarb.
3. Strengthening the Spleen and Warming the Stomach Method
Irregular diet damages the spleen and stomach; prolonged gastric disease weakens spleen-stomach yang, leading to yang deficiency and cold formation, losing warmth of the stomach network; or pre-existing spleen-stomach deficiency can also cause gastric pain. Clinical presentation: Mild, dull pain in the epigastrium relieved by pressure, poor appetite, belching, hiccups, epigastric distension, pale complexion, fatigue, weight loss over time, loose stools, cold hands and feet, cold aversion, pale tongue with white greasy coating, deep weak pulse. Treatment: Warm and strengthen the spleen and stomach. Use Huang Qi Jian Zhong Tang combined with Si Jun Zi Tang with modifications: Fried Astragalus, Cinnamon Twig, White Peony, Codonopsis, Atractylodes, Poria, Citrus Peel, Pinellia, Licorice, Ginger, Jujube.
If epigastric distension is severe, add Sandalwood, Buddha’s Hand. For loose stools, add Patchouli, Chinese Yam, Nutmeg. For poor appetite, add Cardamom, Chicken Gizzard Membrane, Fermented Three Treasures. For cold epigastric pain, pair Corydalis with Evodia. For acid regurgitation, add Cuttlebone or Calcined Oyster Shell, Perilla.
4. Eliminating Food Stagnation and Opening the Stomach Method
Overeating and excessive drinking lead to food stagnation and obstruction of stomach qi, causing gastric pain. Clinical presentation: Epigastric distension and pain, aggravated by pressure, poor appetite, sour belching, acid regurgitation, nausea and vomiting, pain relieved after vomiting, or unsmooth bowel movements, thick greasy coating, stringy slippery pulse. Treatment: Digest food and eliminate stagnation, open the stomach and relieve pain. Use Bao He Wan with modifications: Hawthorn, Yeast, Pinellia, Citrus Peel, Poria, Forsythia, Radish Seed. Hawthorn, Yeast, and Radish Seed together eliminate meat, alcohol, wheat, and flour accumulations. Pinellia and Citrus Peel both disperse and resolve nodules and descend turbidity to regulate qi. Poria strengthens the spleen and removes dampness. Forsythia clears heat and resolves nodules with its cool nature. Together, these herbs form a formula to eliminate stagnation and open the stomach—once accumulation is removed, gastric pain naturally subsides.
If there is excessive gas and severe distension, add Fructus Aurantii, Cardamom, Areca Seed to promote qi movement and eliminate stagnation.
5. Clearing Heat and Cooling the Stomach Method
Liver qi stagnation transforming into heat over time, invading the stomach and causing gastric pain. Clinical presentation: Burning pain in the epigastrium, irritability, acid regurgitation, dry mouth and bitter taste, stringy rapid pulse. Prescription: Hua Gan Jian combined with Zuojin Wan with modifications. Green Tangerine Peel, Tangerine Peel, Cortex Moutan, Gardenia are used together to enhance bitter-cold purging heat and cooling the stomach, calming blood. A small amount of Evodia is added to leverage its pungent dispersion to open stagnation—this aligns with the principle of combining pungent opening with bitter descending. White Peony and Licorice are used to generate yin through sour and sweet flavors, relieving urgency and stopping pain—this prevents excessive heat from damaging stomach yin and enhances analgesic effects.
If nausea and vomiting occur, add Pinellia and Bamboo茹 appropriately. For acid regurgitation, add Cuttlebone or Calcined Oyster Shell.
6. Removing Dampness and Strengthening the Stomach Method
Whether dampness obstructs the spleen and stomach or dampness arises internally due to spleen-stomach dysfunction, dampness cannot be ignored as a pathological factor and cause in spleen-stomach diseases. Clinical presentation of dampness-stagnation gastric pain: Dull, persistent epigastric pain, lingering without healing, bland taste or thirst without desire to drink, possibly accompanied by fatigue, heaviness in limbs, joint pain, loose stools, head feeling heavy as wrapped in cloth, pale tongue with greasy coating, deep fine or soft pulse. Treatment: Strengthen spleen and remove dampness. Use Er Chen Tang with additions: Pinellia, Citrus Peel, Poria, Licorice, Ligusticum, Atractylodes, Magnolia Bark, Patchouli. Atractylodes, Ligusticum, and Poria use fragrant drying and light diuresis together, enhancing Patchouli’s aromatic dispersion; enhancing the bitter-drying and descending actions of Citrus Peel, Pinellia, and Magnolia Bark to strengthen the stomach and remove dampness—forming a formula to eliminate dampness and strengthen the spleen and stomach.
If damp-heat accumulates, add Plantain Herb, Capillary Wormwood, Coptis.
7. Activating Blood Circulation and Regulating the Stomach Method
The stomach is the “sea of grains and blood,” so spleen-stomach diseases easily damage qi and blood, entering the stomach network and causing blood stasis. Clinical presentation: Sharp, needle-like pain in the epigastrium, fixed and persistent, worse at night, long-lasting, possibly with hematemesis or melena, dark purple tongue or ecchymoses, deep stagnant or fine stringy stagnant pulse. Treatment: Warm the center, regulate the stomach, activate blood circulation and resolve stasis. Use Tao Hong Jian Zhong Tang: Peach Kernel, Safflower, Cinnamon Twig, White Peony, Ginger, Jujube, Maltose, Licorice. Maltose nourishes spleen qi and nourishes spleen yin, warming the middle burner while relieving liver urgency. Cinnamon Twig warms yang, White Peony nourishes yin blood, Fried Licorice tonifies qi with its sweet-warm nature. Combined with maltose, ginger warms the stomach, jujube tonifies the spleen—this warms and tonifies the liver and spleen, promoting the rising of vital energy in the middle burner. Peach Kernel and Safflower activate blood and resolve stasis. All herbs work together to warm the center, tonify deficiency, harmonize the interior, relieve urgency, and resolve stasis—thus enabling the spleen to function properly, blood and qi to circulate freely, stomach qi to harmonize, and stomach vessels to be nourished, eliminating gastric pain.
If poor appetite and anorexia occur, add Chicken Gizzard Membrane, Fermented Three Treasures. For nausea and vomiting, add Bamboo茹, Pinellia. Master Chen particularly likes adding Bai Ji (White Peony Root) to his prescriptions. Its bitter, dry nature enters the lung and stomach meridians, acting on blood, with sticky properties. It stops bleeding, reduces swelling, heals wounds, and promotes granulation. It not only stops bleeding and resolves stasis, opens channels, and relieves pain, but also improves epigastric distension, heartburn, and other symptoms, promoting healing of gastric mucosal ulcers. It is thus considered a superior remedy for protecting mucosa and relieving pain. When bleeding is substantial, he often combines Yunnan Baiyao orally for pain and bleeding control.
8. Opening Orifices and Awakening the Stomach Method
The heart governs spirit and is the master of all zang-fu organs. TCM holds that “heart and brain are connected.” *Wu Medical Collection* states “The power of the stomach lies in the heart,” clearly indicating the stomach’s functional activities are governed by the heart and brain. *Plain Questions: Pulse Explanation* says “Yangming collateral connects to the heart,” further proving the connection between stomach and heart-brain. If heart-spirit disorder (including post-stroke) occurs, it affects spleen-stomach function, causing phlegm-dampness to obstruct the spleen, manifesting as poor appetite, epigastric distension and dull pain, loose stools, etc. Conversely, spleen-stomach dysfunction can also impact the heart-spirit. Master Chen believes this mutual interaction between spleen-stomach and heart-spirit is clinically significant. He proposed the “Heart (Brain)-Stomach Correlation Theory,” applying the “opening orifices and awakening the stomach” method, personally formulating the “Opening Orifices and Awakening Stomach Decoction,” combined with his self-made Hui Shen Dan granules (benefiting kidneys, activating blood, removing phlegm, opening orifices) for treatment. Ingredients: Kudzu Root, Pinellia, Citrus Peel, Star Anise, Fructus Aurantii, Poria, Calamus, Polygala, Peach Kernel, Cardamom, Chicken Gizzard Membrane, Fermented Three Treasures.
Besides the above eight basic methods, Master Chen emphasizes improving diagnostic and therapeutic efficacy for gastric pain. Recognizing the diversity of etiology and pathogenesis, and the variability and complexity of concurrent symptoms, he offers the following insights in drug formulation:
1. Master Chen consistently stresses “adhering strictly to disease mechanisms, assigning each case to its proper category,” diagnosing and treating based on syndrome differentiation. Gastric pain is a major symptom of various gastric diseases. Integrating TCM syndrome differentiation with disease identification, incorporating modern research findings, and reconstructing normal physiological functions of the spleen and stomach can further enhance TCM efficacy. The spleen governs transformation and transportation, its nature rises and clears, being a yin organ that favors dryness and dislikes dampness—diseases often develop from cold. The stomach receives and digests food, its qi descends, being a yang organ that favors moisture and dislikes dryness—diseases often develop from heat. When spleen and stomach are diseased, their ascending-descending functions fail, cold and heat become imbalanced, and transformation and transportation falter, leading to dampness obstruction, damp-heat accumulation, phlegm-food interlocking, clinically presenting as gastric pain, distension, fullness, heartburn, etc. Master Chen emphasizes reconstructing the physiological functions of the spleen and stomach, with treatment goals focused on restoring normal function, achieving yin-yang harmony, ascending-descending coordination, and moist-dry balance.
(1) Adjusting Qi Movement: For cases involving spleen deficiency with qi sinking and qi stagnation with reversal, presenting with belching, vomiting, lower abdominal prolapse, loose stools, even rectal prolapse, commonly use combinations like升麻 with 沉香, 柴胡 with 枳壳, 藿香 with 半夏, 荷叶 with 茯苓, 菖蒲 with 厚朴.
(2) Balancing Blood Activation: Initially, stomach diseases affect qi; long-standing ones invade the collaterals—a common rule. Yet Master Chen adds one or two blood-acting herbs even when treating qi-level stomach diseases, such as Salvia, Red Peony, Ligusticum, Peach Kernel, Safflower, Angelica. Because chronic gastritis often features gastric mucosal congestion, edema, or erosion and bleeding, causing local hypoxia and nutritional impairment. TCM holds that qi warms, blood nourishes. Adding a bit of blood-acting herbs to qi-acting herbs helps improve gastric wall perfusion and promotes recovery.
(3) Combining Tonification and Elimination, Moisture and Dryness, Activity and Rest: Maintain tonifying the spleen without stagnating qi, e.g., 黄芪 with 陈皮, 白术 with 枳壳; since stomach dryness and spleen dampness coexist, nourish the stomach without aiding dampness, e.g., 石斛 with 藿香, 麦冬 with 半夏, 花粉 with 薏苡仁, 芦根 with 荷叶. Also, when using pungent-warm, aromatic, drying herbs, adhere to principles: don't forget to soothe the stomach while liberating the liver, and avoid injuring yin while regulating qi. For cases with cold and deficiency mixed with real excess, prefer mild tonics like 扁豆, 山药, 太子参. For real syndromes treated with elimination, weigh the severity and urgency, reflecting the principle of light, agile prescriptions that protect the spleen and stomach.
2. Drug selection is also crucial: Commonly used for harmonizing the stomach: White Peony, Lotus Leaf, Citrus Peel; for benefiting the stomach: Dendrobium, Polygonatum, Adenophora; for nourishing the stomach: Ophiopogon, Buddha’s Hand, Patchouli; for clearing the stomach: Green Tangerine Peel, Cortex Moutan, Coptis; for warming the stomach: Cinnamon Twig, Evodia, Fine Ginger; for strengthening the stomach: Atractylodes, Poria, Chinese Yam, Atractylodes; for opening the stomach: Cardamom, Magnolia Bark, Grass Cardamom.
3. Master Chen also emphasizes the importance of “treating the middle burner like a balance—only when level can stability be achieved.” Clinically, this means adjusting the medicinal properties to correct pathological imbalances based on the patient’s deficiency, excess, cold, or heat tendencies, restoring normal balance in spleen-stomach function. Simultaneously, considering the contradictory yet unified physiological characteristics and functions of the middle burner, drugs must be balanced without bias. Master Chen points out that although each case has unique pathology, the guiding principles in prescriptions should always include: simultaneous tonification and elimination, coordinated ascending and descending, balanced moistening and drying, combined cold and heat, and concurrent treatment of qi and blood with dynamic and static integration.
Typical Case One
Zhou, male, 45 years old, initial visit on March 12, 2002. Recurrent gastric pain for 15 years, often exacerbated by cold exposure or fatigue. Fiberoptic gastroscopy confirmed chronic superficial gastritis. Recently, symptoms recurred due to cold exposure. Presenting with epigastric distension and stabbing pain, fixed location, paroxysmal aggravation, irregular pain pattern, pain relieved by warmth, reduced appetite, fatigue, slightly loose stools, dark tongue with ecchymoses, thin white coating, wiry fine pulse. This is due to spleen-stomach deficiency, insufficient spleen yang, impaired function of the middle burner, and long-standing disease leading to qi stagnation and blood stasis. Treatment: Warm the center, tonify deficiency, activate blood circulation, relieve pain. Prescription: Tao Hong Jian Zhong Tang with modifications. Ingredients: Peach Kernel 10g, Safflower 10g, Cinnamon Twig 10g, White Peony 20g, Ginger 3 slices, Jujube 5 pieces, Maltose 30g, Fried Licorice 6g, Chicken Gizzard Membrane 10g, Fermented Three Treasures 10g each. After 7 doses, gastric pain significantly reduced, appetite improved, spirits better. Continue original prescription for another 7 doses; symptoms markedly improved, tongue turned ruddy. No change in prescription; treatment for half a month, total 15 doses, gastric pain completely disappeared. Follow-up gastroscopy showed complete recovery. One-year follow-up revealed no recurrence.
Typical Case Two
Liu, male, 75 years old, initial visit on August 18, 2003. Chief complaint: poor appetite, sticky mouth, epigastric distension and dull pain, occasional hiccups. Despite multiple treatments, no significant improvement. One year prior, suffered cerebral infarction. Examination: dark tongue, thin white coating, stringy slippery pulse. Patient’s condition stems from phlegm-dampness obstructing the spleen-stomach after stroke. Treatment: Open orifices and awaken the stomach, assist with blood activation. Prescription: Self-formulated Opening Orifices and Awakening Stomach Decoction. Ingredients: Kudzu Root 20g, Calamus 20g, Cardamom 10g, Pinellia 10g, Citrus Peel 10g, Fermented Three Treasures 10g each, Chicken Gizzard Membrane 10g, Radish Seed 10g, Lingzhi 5g, Peach Kernel 10g, Buddha’s Hand 10g, Citron 10g, Licorice 10g. After 7 doses, stickiness in mouth significantly reduced, appetite slightly increased, occasional hiccups remained. Added Forsythia 15g and Curcuma 10g to enhance qi movement and resolve nodules. After another 7 doses, symptoms markedly improved—no noticeable epigastric dull pain or distension, normal appetite, no mouth stickiness or hiccups. Tongue pale red, thin white coating, stringy pulse. No change in prescription; continued for 7 doses, concurrently taking self-made Hui Shen Dan granules. Since then, no recurrence.