In my last two articles, I discussed simple formula combinations for gan mao and gynecological pathologies. In this month's column, I will examine clinically effective formula combinations for common gastrointestinal complaints. Many chronic diseases develop due to a poorly functioning digestive system.

One of the most common gastrointestinal pathologies is gastroesophageal reflux disease (GERD). This condition typically manifests with symptoms such as loss of appetite, abdominal pain, sore throat and burning sensations in the throat or stomach due to the reflux of stomach acid into the esophagus. Some of the most common TCM patterns found in GERD presentations are: liver depression qi stagnation, stomach fire, stomach yin vacuity, food stagnation and spleen qi vacuity. In chronic cases, it's not uncommon to have two or more of these patterns overlap and/or evolve into other patterns such as damp heat, phlegm and yin-vacuity heat. The following formula combinations can be very effective if modified according to the patient's unique disease expression.

• Liver Depression Qi Stagnation with Stomach Yin Vacuity:Chai Hu Shu Gan Wan/Shu Gan wan + Yi Guan Jian/Yu Quan Wan
• Liver Depression Qi Stagnation with Stomach Fire: Chai Hu Shu Gan Wan/Shu Gan Wan + Qing Wei San/Huang Lian Jie Du Wan/Xiang Lian Wan
• Liver/Spleen Disharmony + Stomach Yin Vacuity: Xiao Yao Wan + Yi Guan Jian
• Liver/Spleen Disharmony + Stomach Fire: Jia Wei Xiao Yao Wan + Qing Wei San Wan
• Liver/Spleen Disharmony + Food Stagnation: Xiao Yao Wan + Bao He Wan (If excess heat signs are also present Da Huang Jiang Zhi Wan can be added.)
• Liver Depression Qi Stagnation + Phlegm: Chai Hu Shu Gan Wan/Shu Gan Wan + Er Chen Wan/Ban Xia Hou Po Wan (Xiang Lian Wan can be added if heat signs are present.)
• Liver/Spleen Disharmony + Damp Heat + Food Stagnation: Jia Wei Xiao Yao Wan/Yue Ju Wan + Bao He Wan

These are just some of the possible pattern combinations which could potentially occur in common GERD presentations. The clinician must decide which patterns are overlapping and strive to understand potential pattern evolutions in order to efficiently address the patient's unique disease expression.

Another common gastrointestinal complaint is irritable bowel syndrome (IBS). Symptoms typically include chronic and frequent diarrhea or constipation (usually accompanied by pain), abdominal bloating and pain, nausea, loss of appetite and depression. The most common TCM patterns seen in the standard IBS presentations are liver depression qi stagnation, spleen qi vacuity, liver depression with depressive heat, damp heat and food stagnation. Chronic disease can damage the liver and kidneys. It's not uncommon to see these patterns evolve into yin vacuity, vacuity heat, blood vacuity and blood stasis. The following formula combinations can be very effective if modified according to the patient's unique disease expression.

• Liver Depression Qi Stagnation + Damp Heat: Chai Hu Shu Gan Wan/Shu Gan Wan + Bi Xie Sheng Shi Wan
• Liver/Spleen Disharmony + Damp Heat: Xiao Yao Wan/Tong Xie Yao Fang Wan + Bi Xie Sheng Shi Wan
• Liver/Spleen Disharmony + Depressive Heat + Food Stagnation: Jia Wei Xiao Yao Wan/Yue Ju Wan + Bao He Wan
• Liver/Spleen Disharmony + Stomach Yin Vacuity + Blood Stasis:Xiao Yao Wan + Yi Guan Jian (Both formulas contain dang gui which invigorates blood. The latter contains sheng di huang, which also invigorates the blood.)
• Liver/Spleen Disharmony with Severe Diarrhea and Cramping:Bu Zhong Yi Qi Tang + Tong Xie Yao Fang (This combination can be extremely effective for acute attacks and can be combined with Huo Xiang Zheng Qi Wan.)
• Liver/Spleen Disharmony with Depressive Heat and Vacuity Heat: Jia Wei Xiao Yao Wan + Er Zhi Wan

These are just a few of the possible pattern variations that might appear in IBS pathologies. Both GERD and IBS are complex conditions with potentially severe outcomes. The purpose of this short article was not to discuss the etiology or pathology of these conditions in depth, but to provide some clinical suggestions on TCM pattern management. Please refer to appropriate medical texts for background and diagnostic information on GERDand IBS. It's also important to keep in mind important dietary issues germane to both of these conditions, such as food allergies, food sensitivities, trigger foods and improper food combinations.

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