A 48-year-old woman with a three-year history of severe heartburn and acid regurgitation triggered by emotional stress was managed using a Liver-soothing and Stomach-harmonizing herbal strategy.

Case ID: CHC-0044

Case Summary

This case describes a 48-year-old woman who presented with a three-year history of intermittent heartburn and acid regurgitation that worsened with emotional stimulation. The original report documented a conventional diagnosis of chronic non-atrophic gastritis and a TCM assessment of Acid Regurgitation (Tu Suan) driven by Liver Qi stagnation and Stomach disharmony. The patient was managed through a herbal approach based on a modified Chaihu Shugan San designed to soothe the Liver, clear localized heat, and physically restore the digestive tract’s downward motility.

Patient Presentation

• Patient: 48-year-old female (Surname: Zeng).
• Main Complaint: Intermittent heartburn and acid regurgitation for three years, worsening with emotional distress.
• History: The patient sought consultation on September 8, 2021. For the past three years, she suffered from recurrent heartburn and acid reflux that noticeably flared up following emotional stimulation. Over the past month, her symptoms intensified, accompanied by a sensation of stuffiness and fullness in the stomach (epigastrium) and frequent belching. She had a five-year history of chronic non-atrophic gastritis. Associated symptoms included a slightly dry mouth, poor appetite, poor sleep, irritability, and unsmooth bowel movements. Her urination was normal.

Examination and Diagnosis

• Conventional Diagnosis: Chronic non-atrophic gastritis.
• TCM Tongue and Pulse: The tongue was dark red with a thin, yellow coating. The pulse was stringy (脉弦).

TCM Assessment

The original practitioner interpreted the presentation as Acid Regurgitation driven by Liver Qi Stagnation and Stomach Disharmony (吐酸病 – 肝气郁结，胃失和降).

According to the core principles of yin and yang Chinese Medicine the Liver governs the smooth flow of emotions, while the Stomach is responsible for sending digested food and fluids downward. In this patient, chronic emotional distress caused her Liver Qi to stagnate. This trapped Liver energy eventually “overacted” on her Stomach, disrupting its natural downward descent.

Consequently, the Stomach Qi rebelled upward, physically manifesting as her frequent belching, heartburn, and severe acid regurgitation. Furthermore, the trapped Liver Qi generated internal heat, which objectively presented as the dark red tongue, thin yellow coating, slightly dry mouth, and irritability. The stringy pulse is the classic hallmark of Liver pathology and emotional constraint.

Treatment Approach

The primary treatment principle was to soothe the Liver, regulate Qi, harmonize the Stomach, and descend rebellious Qi (疏肝理气，和胃降逆). The strategy aimed to clear the emotional stagnation to remove the pressure on the Stomach, while simultaneously stopping the upward rebellion of stomach acid.

Herbal Formulas and Modifications

• Initial Formula (September 8, 2021): A customized 11-herb decoction drawing upon the structure of Chaihu Shugan San (Bupleurum Liver-Soothing Powder) and Xiao Chai Hu Tang (Minor Bupleurum Decoction).
  • Soothing Liver and Clearing Heat: Chai Hu (Bupleurum, 12g) and Huang Qin (Scutellaria, 6g) formed a classic pair to vent stagnant Liver Qi and clear the trapped heat from the digestive tract.
  • Moving Qi and Relieving Stagnation: Xiang Fu (Cyperus, 20g), Yu Jin (Curcuma, 12g), Fo Shou (Finger Citron, 15g), and Qing Pi (Green Tangerine Peel, 12g) were heavily utilized to aggressively soothe Liver constraint, move stagnant Qi, and relieve the stomach distension.
  • Descending Rebellious Qi and Acid: Zhi Shi (Immature Bitter Orange, 15g) and Wu Zhu Yu (Evodia, 10g) strongly directed rebellious Qi downward to stop the belching and acid reflux.
  • Calming the Mind: He Huan Hua (Albizia Flower, 10g) and Shi Chang Pu (Acorus, 20g) were added to soothe the spirit, resolve emotional distress, and improve her sleep.
  • Clearing Heat and Detoxifying: Pu Gong Ying (Dandelion, 20g) was included to clear localized stomach inflammation and heat.
• Administration: 7 doses were prescribed, boiled in water to extract 300ml, and taken warm twice daily, two hours after breakfast and dinner.

Follow-Up

• September 15, 2021 (Second Visit): After consuming the initial 7 doses, the source reported a rapid improvement. The patient’s heartburn and acid regurgitation were significantly reduced, her stomach distension disappeared, and her appetite returned to an acceptable level. The practitioner instructed her to take an additional 7 doses of the exact same formula to consolidate the treatment.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is its approach to treating chronic acid reflux (GERD-like symptoms) without relying on heavy antacids. In conventional medicine, heartburn is often treated by chemically neutralizing or suppressing stomach acid.

However, the original practitioner recognized that the acid reflux was merely a mechanical symptom of a reversed flow of Qi, triggered by the Liver (emotions). The commentary notes that “heartburn’s treatment should be evaluated alongside other symptoms… and one must never blindly overuse acid-suppressing agents.” By utilizing Chai Hu and Huang Qin (borrowing the logic of Xiao Chai Hu Tang) to “untie” the Liver, and pairing them with strong downward-moving herbs like Zhi Shi and Qing Pi, the treatment successfully stopped the physical spasms and reversed the upward flow of acid, curing the mechanical root of the problem.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Guangdong Provincial Administration of Traditional Chinese Medicine / Qingyuan Maternal and Child Health Hospital
• Original title: 【以案说医】曾宪进：疏肝和胃法治疗吐酸病案
• Practitioner: Professor Zeng Xianjin (曾宪进)
• Publication date: September 19, 2024
• Original language: Chinese
• Source link: View original page
• ChineseHerb.org version: English translation and editorial adaptation