Posted by Dong Won Shin, MD @ Physicians Herbal Formula on February 13, 2014
Functional Dyspepsia Is the major category of chronic indigestion, bloating, gas, and nausea. It is defined as > 3 months of postprandial fullness, early satiety, epigastric pain or burning with the first symptom onset at least 6 months prior before the diagnosis, and no organic causes found for dyspepsia. Biomedicine proposes 4 pathogenetic mechanisms. #1) Gastroesophageal reflux due to lower lower esophageal sphincter tone explains heartburn or burning epigastric pain but not the major symptoms of functional dyspepsia. #2) Altered Gastric Motility such as delayed gastric emptying as found in diabetic gastroparesis, or impaired fundus relaxation after eating causing bloating. #3) Visceral Afferent Hypersensitivity may work with altered gastric motility to produce the symptoms: Functional dyspepsia may be felt in some people in response to fundic distention after meals to much lower pressures than in the controls. #4) Psychological make ups are thought to play a significant role in producing the symptoms. The insufficiency of this model is that 1) there simply are too many people with functional dyspepsia with apparent normal psyche make ups, and 2) Koreans appear to suffer from indigestions oftener than westerners, but not the mental illnesses.
Physicians Herbal Formula believes that altered gastric motility is one of the major mechanisms of dyspepsia. There are 2 major kinds. 1) Deficient Bioenergy ( Stomach and Spleen QI ) is caused by years of faulty diet, chronic emotional and mental spending such as worrying or overthinking, etc. Deficient Qi ( including autonomic nervous system output) is supplied to gastric submucosal microvessels, neuronal circuitry, and smooth muscles. This shortage of supply of bioenergy results in hypotonia of gastric muscles and hypocontractility and hypoproduction of pepsinigens, and indigestion and bloating. 2) Blocked Bioenergy flows are caused by A) stagnation of Qi ( activation of sympathetic nervous system causes gastric hypomotility and increased spincter tones,etc, B) phlegm damp pathogens ( disturbed water and electrolytes metabolism results in gastric submucosal edema or inflammation and interferes with secretions of acids and pepsinogens and motility of smooth muscles ) ,C) cold or hot external pathogens ( eating a huge quantity of ice creams or peppers alarms the visceral sensory receptors and produce vasoconstrictions or vasodilation with local heat.),
There are 2 other biomedical mechanisms producing functional dyspepsia. 1) Abnormal Reflux of Bile Acids into the stomach : This is thought to occur mainly in postgastrectomy or postcholecystectomy or with a large antral ulcer. According to eastern herbal medicine, reflux of bile acids occur often in persons with normal anatomy, causes gnawing epigastric pain, nausea, vomitting, indigestion, bitter taste, and yellow sticky tongue coating. The pathogenesis is Stagnant Liver Qi invading Stomach and Spleen causing dyspepsia, and even cancer of esophagus/ stomach if years of liver Qi stagnation develops into blood stagnation. 2) Atrophy of gastric mucosa and intestinal metaplasia is thought to be the outcome of years of H. Pylori induced chronic gastritis or pernicious anemia related autoimmune gastritis. However, many elderlies have mucosal atrophy and metaplasias with hypoproduction of protective mucus, hypochlorhydria ( low production of acids), digestive enzymes,etc, and have indigestion ,vague epigastric pain, and dry mouth with lack of coatings on the tongue. This is Stomach Yin Deficiency whose dyspepsia will not respond to proton pump inhibitors( nexium, prilosec,), because of hypochlorhydria.