Keywords: Chinese medicine, Chinese herbal medicine, postgastrectomy bile reflux esophagitis, Xiao Chai Hu Tang (Minor Bupleuru m Decoction)

Xiao Chai Hu Ta n g (Minor Bupleurum Decoction) is one of my favorite formulas. Although it is categorized as the premier defensive and constru c t ive h a rmonizing formula, this formula also harm onized the liver and spleen, liver and stomach, and spleen, stomach, and intestines. Because it both clears the exterior as well as the interior, it can also be described as a dually resolving formula. In any case, this formula has wide scope of application as the following summary of an article written by Liu Dao-xi hopefully will show. The title of the original article was "The Treatment of 80 Cases of Po s t ga s t r e c t o my Bile Reflux Esophagitis with Xiao Chai Hu Ta n g (Minor Bupleuru m D e c o c t i o n ) ." It appeared on page 38 of issue #7, 2003 of Jiang Xi Zhong Yi Yao (Jiangxi Chinese Medicine & Medicinals).

Sixty-six of the patients enrolled in this study were male and 14 were female. They ranged in age from 37-70 years of age, with an average age of 46 years. Among these, 24 cases had had a first grade gastrectomy and 56 had second grade surgery. There was also a comparison group of 78 patients, 68 males and 10 females aged 38-69 years, with an average age of 47. Twenty-eight of these patients had a grade one gastrectomy and 50 had a grade two. All these patients had burning heat in their stomach duct region, distention and fullness, and aching and pain which radiated to the rib-sides. There was panting qi, clamoring stomach, nausea, a dry mouth with a bitter taste, and lack of strength. These patients' tongues were red with yellow fur, and their pulses were bowstring and vacuous. Gastroscopy revealed inflammation of the gastric mucosa with a large amount of ye l l ow-colored gastric fluids. Diagnostic procedures ruled out atrophic gastritis in all these cases.

The members of the treatment group received Xiao Chai Hu Tang which consisted of: Radix Bupleuri (Chai Hu), 12g, Radix Scutellariae Baicalensis (Huang Qin), 10g, Rhizoma Pinelliae Ternatae (Ban Xia), 10g, Radix Panacis Ginseng (Ren Shen), 10g, uncooked Rhizoma Zingiberis Off icinalis (Sheng Jiang), 10g, Fructus Zizyphi Jujubae (Da Zao), 4 pieces, and Radix Glycyrrhizae Uralensis (Gan Cao), 6g. If there was yin vacuity, 10 grams each of Herba Dendrobii (Shi Hu), Tuber Ophiopog o n i s Japonici (Mai Men Dong), and Radix Glehniae Littoralis (Sha Shen) and 25 grams of Radix Dioscoreae Oppositae (Shan Yao) were added. If there was blood stasis, 10 grams of Radix Salviae Miltiorrhizae (Dan Shen) were added. If there was damp heat, six grams of Rhizoma Coptidis Chinensis (Huang Lian ) and 12 grams of Radix Gentianae Scabrae (Long Dan Cao) were added. If abdominal distention and fullness were severe, 10 grams of Fructus Citri Aurantii (Zhi Ke) were added. One packet of these medicinals wa s decocted in water and administered per day, with four weeks administration equaling one course of treatment. The members of the comparison group were treated with Western medicine. Four weeks also equaled one course of treatment for the comparison group, and both groups received repeat gastroscopies after a single course.

Cure was defined as complete disappearance of the clinical symptoms, disappearance of bile reflux on gastroscopy, and either disappearance or marked reduction in stomach mucosa inflammation. Improvement was defined as marked decrease in clinical symptoms, marked decrease in bile reflux, and decrease in stomach mucosa inflammation. No effect meant that there was either no improvement in symptoms or even worsening and no improvement or worsening in bile reflux and mucosal inflammation. Based on these criteria, in the treatment group, 22 cases were judged cured, 53 improved, and five got no effect. In the comparison group, 10 were cured, 53 improved, and 20 got no effect. Therefore, the total effectiveness rate was calculated as 93.75% in the treatment group and only 74.36% in the comparison group.

According to Dr. Liu, based on the clinical symptoms of this condition, it is categorized as stomach duct pain, clamoring stomach, and nausea and vomiting in Chinese medicine. After surgery, the stomach qi has suffered detriment. If the liver qi is depressed and bound and not able to obtain discharge, it easily counterflows horizontally to assail the stomach. Thus the stomach loses its harmony and downbearing and the qi mechanism becomes obstructed and stagnant. This leads to aching and pain radiating to the rib-side, nausea, vomiting, hiccup or belching, distention and fullness. If liver depression endures for days, it may transform heat. If heat evils assail the stomach, there will be depressive heat in both the liver and stomach. This typically counterflows and surges or thrusts upward. This then results in clamoring stomach and bu rning heat (or heart bu rn ) . Because the liver and gallbladder share and inte-rior-exterior relationship, liver heat mixes with gallbladder fire ascending and attacking. Hence there is a dry mouth with a bitter taste. The red tongue with yellow fur also evidence interior heat, while the lack of strength and vacuous pulse evidence central qi vacuity we a k n e s s . Therefore, treatment should course the liver and harmonize the stomach at the same time as clearing heat and fortifying the spleen. Xiao Chai Hu Tang doses all these things. Within it, Chai Hu is the main medicinal for coursing the liver and resolving depression. Huang Qin, bitter and cold, drains fire. Ban Xia and Sheng Jiang harmonize the stomach and downbear counterflow, while Ren Shen, Da Zao and Gan Cao supplement the center and boost the qi, thus further regulating and protecting the stomach qi. When all these medicinals are used together, they are extremely effective for repressing wood and banking earth.