中医治疗胃痛，腹痛，便秘，腹泻

Treatment of stomach pain, nausea, diarrhea and constipation

by Chinese Medicine

 胃痛原因非常多。一般分为急性胃痛腹痛和慢性胃痛腹痛。

There are many reasons that can cause pain in stomach, nausea or vomiting, constipation or diarrhea. Generally speaking, we can separate them into either acute or chronic disorders.

Stomach-intestine pain syndrome

急性腹痛，如果是因为进食不洁或过多，过冷，病人上腹部胀满，恶心，或呕吐，一般用保和丸治疗。如果急性腹痛，腹泻，用香连丸治疗。如果是急性水样泄泻，用五苓散。 如果平素脾胃不佳，容易有胃病或肠炎，稍食过多或过冷即痛者，用连理汤。

For acute stomach pain, if it is due to eat of extraordinary food, which might not be clean, and if the patient feels pain, bloating in stomach and has nausea and vomit, we use herbal pill called Bao He Wan (Wan here means pills). If the patient has pain in stomach with acute diarrhea, use herb Xiang Lian Wan. If it is water-like diarrhea, use Wu Ling San (San here means herbal powder). If the patient usually has weak digestive system, which means he/she easily has stomach pain and diarrhea after eat little bit more amount, or little bit more hot/spicy food, this time we use Lian Li Tang (Tang means herbal decoction) for the treatment of his/her pain and diarrhea.

如果病人既有感冒症状，还有腹痛腹泻，比如说病人身热畏寒，头痛咽痛，咳嗽，还有腹痛腹泻时， 如果体质比较强壮，我们用葛根芩连汤，如果病人体弱或身有汗，我们用桂枝加芍药汤，或桂枝加大黄汤。如果大便带有脓血，伴有里急后重，这就是急性菌痢了，该白头翁汤治疗。如果大便主要是血，就用黄土汤。

If the patient has both symptoms of common cold, and the stomach-intestine problem, such as chilly or fever, headache or body pain, sour throat, cough, as well as stomach pain and diarrhea, we use Ge Gen Qing Lian Tang (for stronger body constitution); or use Gui Zhi plus Shao Yao Tang or Gui Zhi plus Da Huang Tang (for weak body constitution). If the stool is with pus and blood, and if the person has urgent feeling inside the anus after bowel movement, it is acute bacillary dysentery. We use Bai Tou Wen Tang for the treatment. If the bowel movement is mostly the blood in the stool, we use Huang Tu Tang.

慢性胃痛腹痛比较复杂。如果病人以胃痛为主，胃脘部位喜温喜按，喜欢喝温热水，用安中汤或附子理中汤（这种情况下吐酸水多，用吴茱萸汤）。如果痛时不喜欢按压，用小陷胸汤（这种情况下有恶心或呕吐，用竹茹温胆汤）。如果胃痛，喜欢热饮，却时时便溏下利，用黄连汤 （呕吐为主时用干姜芩连汤）。而胃痛伴有明显的口干，口渴，喜欢冷饮，口臭，噫气，便干，用胃热心火汤，清心解郁汤，或白虎加人参汤。

The condition for a chronic stomach disorder is much more complex. If the disorder is mostly the pain in the stomach, the patient likes to drink warm water and eat warm food, and likes to massage the stomach when the pain occurs, we use An Zhong Tang, or Fu Zi Li Zhong Tang. This is a Cold condition in the belly, according to the Traditional Chinese Medicine (TCM).

 If such patient has acid reflux, we may use Wu Zhu Yu Tang. If the patient does not like to massage the stomach when there is pain, or if the pain area is hard upon touch, we use Xiao Xian Xiong Tang. In this case, if the patient has nausea or vomit, we may use Zhu Ru Wen Dang Tang. This is a Fire condition, in TCM concept.

 If the patient has stomach pain, likes warm water drink, but has also loss bowel movement from time to time, we use Huang Lian Tang.   This is a condition, in which there is cold in the stomach, but fire in the intestine. In this case if the patient has nausea or vomit, we use Gan Jiang Qing Lian Tang.

For stomach fire condition, in which patient feels dry and thirsty in mouth, likes to drink cold or ice water, has belching, hard stool (defecate), we use Wei Re Xin Huo Ling, Qing Xin Jie Yu Tang, or Bai Hu plus Ren Shen Tang. Many western people has this type of stomach pain.   

有些时候病人会觉得腹中冷，而且剧烈疼痛。我们当用乌头煎，或大黄附子汤温经散寒来治疗。 如果腹中冷痛，关节也冷痛，该考虑用乌头桂枝汤。

Sometimes, patient feels very cold and very painful in the stomach-intestine. We use Wu Tou Jian (Jian means herb decoction), or Da Huang Fu Zi Tang. If the stomach-intestine feels cold and pain, as well as joints, we may use Wu Tou Gui Zhi Tang. This is a kind of Cold condition in the body.

许多时候病人并没有明显的胃痛腹痛，恶心呕吐腹泻，只是胃脘部位隐隐不适，似乎食物不能消化，胃肠不运转。这种时候多是气机不顺，我们用香苏散开胃气。这种病人多伴有心情不佳，易生气，易性急焦躁，也容易有便秘。精神病人多有内热便秘。

Many times, people have no clear stomach or intestine pain, or bloating, or nausea, or diarrhea, but just kind of slight discomfort. The stomach-intestine seems does not working, not moving, not digesting food.  In TCM, it means that the stomach Qi does not move smoothly inside. To improve the stomach qi movement, we use Xiang Su Sang. People with such dull discomfort in stomach-intestine system usually also have irritable emotion (stress or easy to feel upset), anxiety and impetuousness, and also easy to have hard stool (or constipation). People with psychosis also tend to have constipation.

慢性胃痛到晚期，病人可能只是觉得胃脘作痛，泛酸，一点东西都不敢吃，一吃就胃痛，伴有口干，两侧肋下也隐隐作痛，这种情况多属于西医的萎缩性胃炎。用黄芪建中汤, 养阴汤，或一贯煎治疗。

In the later stage of stomach disease, patient may feel consist discomfort and pain in the stomach, may have belching and acid reflex. They feel stomach pain with even very little eat.  They may have dry mouth, slight and dull pain in the upper side of the belly. This condition usually belongs to atrophic gastritis in western medicine. In TCM, we use Huang Qi Jian Zhong Tang, Yang Yin Tang or Yi Guan Jian to solve this problem.

Stomach-intestine bloating

有些病人主要症状是胃胀或者腹部胀满不适。 如果腹部持续胀满不适，时时恶心或肠鸣腹泻，用半夏泻心汤，干姜泻心汤，或甘草泻心汤。如果腹胀而身热，用三黄泻心汤；如果身冷，用附子泻心汤。如果以胃胀，打嗝噫气为主，用旋复代赭石汤。

Many times, the main problem is just continuous bloating (fullness feeling) in the stomach. If the bloating feeling occurs together with nausea, vomit, intestine noise, or diarrhea, we use various Xie Xin tang, such as Ban Xia Xie Xin Tang, Gan Jiang Xie Xin Tang, or Gan Cao Xie Xin Tang. If the bloating is with body hot feeling (the body temperature may not be high), we use San Huang Xie Xin Tang. If the body feels cold, use Fu Zi Xie Xin Tang. If the stomach bloating is with belching, or if it is mostly the problem of continuous belching, we try the Xuan Fu Dai Zhe Shi Tang.  

如果仅仅为腹胀满，平素胃肠功能差，稍食不慎即胃痛胃痛腹泻者，用厚姜夏草人参汤。而腹胀身热，也许该用调胃承气汤。腹胀满，大便不畅，或矢气多却不大便，用小承气汤。小承气汤就是活动胃肠，让胃肠道通畅的。如果腹满而硬，压之痛，拒按，数日不大便，要考虑是否该用大承气汤了。

If the problem is most the stomach-intestine bloating per se, and if the person usually has weak stomach-intestine function (e.g. with easy stomach pain or diarrhea), we use Hou Jiang Xia Cao Ren Shen Tang. If the bloating is with body fever, we may use Tiao Wei Cheng Qi Tang. If the bloating is with uneasy bowel movement, or is with frequent flatus (gas from anus), we use Xiao Cheng Qi Tang to enhance the intestine movement, so as to solve the bloating. However, if the stomach bloating is with very much pain, the belly feels hard upon touch and press, and if the person did not have bowel movement for several days, we must consider the use of Da Cheng Qi Tang. This is a dangerous condition, an urgent treatment is needed.

如果腹满伴有肝大，脾大等，寒证者用温脾汤，热证者用桂枝加大黄汤，越婢加术加芒硝汤等。

If the stomach bloating is with enlarged liver or spleen, for Cold condition, we use Wen Pi Tang and for Fire condition, we use Gui Zhi plus Da Huang Tang, or Yue Bi plus Cang Zhu plus Mang Xiao Tang, etc.

慢性腹泻

Chronic diarrhea

慢性腹泻，病人平素喜欢温饮，喜暖，手脚易冰，大便溏泻不成形者， 用理中汤，附子理中汤，甚至四逆汤，白通汤；如果大便稀薄如水，得用真武汤。如果长期腹泻，病人口干，喜欢冷饮，却容易腹泻，用干姜芩连汤，甚至乌梅汤。对于肠道激惹综合征，病人时而腹泻，过几天又连续便秘。这种情况亚省多见，多用乌梅汤治疗，效果还是很不错的。

For chronic diarrhea, if the patient usually likes to drink warm water, to stay in warm room, and if his or her hands are usually cold, the stool is not in form (loss stool), we use Li Zhong Tang, Fu Zi Li Zhong Tang, even Si Ni Tang for the treatment, so as to warm up his or her stomach-intestine system. If the stool is as thin as water and the stool is without strong  or high smell, we will use Zheng Wu Tang for such patient. If the patient feels dry in mouth and throat, likes to drink cold water, but easily has diarrhea, we use Gan Jiang Qin Lian Tang, or even Wu Mei Tang. This is Cold-Fire mixture condition. For the irritable bowel syndrome, in which the patient has diarrhea some days and constipation in some other days, we use Wu Mei Tang. It works very well. The irritable bowel syndrome is very common seen in Alberta.  

呕吐的治疗

Nausea and vomit

如果是食入就吐，多为实证热证，用大半夏汤。如果是食毕才吐，用大黄甘草汤。如果是晨食暮吐，暮食朝吐，多为寒证，虚证，用理中汤，金匮肾气丸，茯苓泽泻汤，吴茱萸汤，或乌梅汤治疗。如果是饮水则吐，用五苓散，苓桂术甘汤或茯苓饮治疗。

If patient has vomit right after eating, we use Da Ban Xia Tang. If the vomit is the food is the food ate in last meal, we use Li Zhong Tang, Jin Kui Shen Qi Wang, Fu Ling Ze Xie Tang, Wu Zhu Yu Tang or Wu Mei Tang, depending on the more specific symptoms of the patient.

If patient vomit water right after drink, but not food, we use Wu Ling San, or Ling Gui Zhu Gan Tang, or Fu Ling Yin for the treatment.   

最后提一下反酸的治疗。泛酸也要判断是寒证反酸还是热证反酸。治疗方法不同。寒证者，病人喜欢热饮，进热食好转，饮冷则加剧。用理中汤，附子理中汤，或吴茱萸汤治疗。热证者相反。用白虎加人参汤，黄连上清丸，或越婢加术汤加二花连翘石膏治疗。当然还可以参考其他症状综合判断。如果属于寒热错杂者，多用乌梅汤，干姜芩连汤或黄连汤治疗。埃德蒙顿地区这种以反酸为主的病人很多，但他们都不知道中医可以治疗反酸。

Lastly, we need to mention the treatment of acid reflex syndrome, which is very common in western people. It is also needed to diagnose if the acid reflex syndrome belongs Cold or Fire condition, which is important to decide which herbal formula needed to be used. If the patient with the acid reflex also likes to drink warm water and eat warm food, and the acid reflex may become worse after eating cold food, we use Li Zhong Tang, or Fu Zi Li Zhong Tang, or Wu Zhu Yu Tang for the treatment. For the Fire condition, the clinic picture is opposite, and we use Huang Lian Shang Qin Wan, Bai Hu Jia Ren Shen Tang, Qin Ren Jie Yu Tang, or Yu Bi Jia Zhu jia Er Huan Lian Qiao Shi Gao Tang for the treatment.  If the  condition belongs the mixture of Cold and Fire condition, we mostly use Wu Mei Tang, Gan Jiang Qin Lian Tang, or Huang Lian Tang. Many people do not know that TCM is very good in the treatment of acid reflex.

可见，胃肠道疾病的临床表现非常复杂，证型多端。中医可用的方剂也非常多，治疗手段多。这表明中医对于胃肠道疾病的观察更仔细，认识更深入。如果辩证正确，治疗效果也比西医好很多。

Apparently, the clinic symptoms of the stomach-intestine system are very complex and also there are lots of herbal formula that can be used for the treatment. It implies that the doctors in the TCM observe the clinic conditions very carefully and also understand the conditions much more in detail. If the TCM diagnosis is correct, the result and consequence of the treatment is also very satisfied. There are many patients with such stomach-intestine diseases in China. It is hard to believe that a TCM doctor can work well in China if he/she has no ability to solve the gastric diseases.  

在诊断方面，判断病情的性质是寒还是热非常重要。一般来说，如果病人胃肠道不舒服，喜欢按压腹部，喜欢热饮，大便偏溏，不成形，多属于寒证。如果腹部不舒服，但是不喜欢按压按摩，喜欢冷饮，大便偏干或硬，多属于热证。很多情况下会是既有寒证的表现也有热证的表现，用药也就需要寒热并用。这里要注意的是多长时间大便一次，并不重要，重要的是大便是否溏泻不成形，或便硬难解。如果数日一便，但是大便软，不成形，也不为便秘。相反，如果一天一便，大便也是硬而难解，也算是便秘。可见中医和西医对于什么是便秘的概念是很不一样的。

In the diagnosis, it is very important to verify if the gastric condition belongs to Cold or Fire. Generally speaking, if the patient likes to massage the stomach area, likes to drink warmer water or eat warmer food, tends to have loss (not formed) stool, the condition is more likely a Cold condition. Otherwise, if the patient does not like massage on the stomach, likes cold water or cold food, and has hard stool that is difficult to pass during bowel movement, the condition is more likely a Fire condition. Many time, the patient may have some symptoms that belongs to Cold and others belongs to Fire. In this case, we need to use both Cold and Warm herbs for the treatment.

It should be pointed out that it is not important for how long time you may have a bowel movement, but how hard the stool is. If the stool is hard, it belongs to constipation even if you have the bowel movement once every day. On the other side, if the stool is soft or not formed (no shape), it may belong to diarrhea, even if you may have the bowel movement once every 3 to 7 days. Clearly, the concept of constipation in the Chinese medicine is different from that in western medicine.

这里介绍的是平常常见的胃肠道本身的病变，并不包括由于肝，胆道，肾脏，膀胱，子宫，卵巢等器官病变导致的腹胀腹痛，也不包括由于肿瘤，结石（如胆道结石，肾结石，膀胱结石等），或蛔虫等导致的阻塞性疾病引起的疼痛。

Here what we discussed and introduced are the commonly seen gastric disorders in clinic, not including the disorders that are due to the disease in the liver, kidney, gall bladder, urine bladder, ovary, or uterus. It is neither including the disease of any kind tumor or cyst, or block (such as the block by stone or by roundworms).

这里要提一下慢性胃痛的饮食。一遍来说，胃痛，人们以为该吃流食或半流食，比如说多吃汤类饭，如稀饭面条之类食物，觉得这些流食半流食会减少对胃肠道的刺激，所以对病情有利。其实，我们建议吃一些烤面包，将面包烤黄，在嘴里慢嚼，用口中的唾液将面包慢慢咽下。这对于慢性胃炎的恢复比流食类食物要好。有慢性胃炎的病人不妨试一试。

We need also to talk about the diet of people with chronic gastric diseases. Generally speaking, whenever have pain in the stomach, we may think that we should eat fluid or semi-fluid food, such as soup, or to eat more vegetables. We thought that such fluid or semi-fluid food might cause less stress to the stomach so as to be good for the recovery of the gastric diseases. We recommend that you can try to eat coasted bread pieces with your mouth saliva. It works much better than the fluid or semi-fluid food.

针灸也常用来治疗胃肠道疾病。依据是胃病还是肠道疾病导致的疼痛，是便秘还是腹泻，是寒证还是热证等等，针灸需要选用的穴位都很不一样。但是原则上讲，针灸的治疗效果还是很好的。 常用的穴位有中脘，下脘，天枢，气海，足三里，上巨虚，下巨虚，丰隆，合谷，解谿，陷谷，内庭，太白，公孙，三阴交等等。

Acupuncture can also be used for the treatment of gastric disorders. The acupuncture spots are different depending on the conditions belong to Cold or Fire, on if it is mostly pain, bloating, constipation or diarrhea. Basically we can say that acupuncture works, though the healing effect may be variable among practitioners. The commonly used acupuncture points are on the belly, on the back of the body, and on the legs.

对于虚寒性胃肠道疾病，我们还可用拔罐疗法，主要在背部和腹部拔罐。对于难以按时就医的人来说，这也是一种可以自己在家里治疗的安全有效的方法。

For Cold and weak condition of gastric diseases, we also use cupping therapy. We apply the cup on the back and also on the belly mostly. For those of people who have no chance to go to a doctor, this is also a highly recommend way for people to do something at home by his or her self. It is safe if the cups are not kept on the skin for too long time.