A hiatal hernia is a condition in which a part of the stomach protrudes upward into the chest through an opening in the diaphragm.  It is more common in people who are obese, particularly upper middle-aged people as well as in smokers.  Most of those with a hiatal hernia are asymptomatic, but in some, spasms in the esophagus can result in acid reflux and bloating after meals.  A special chiropractic adjustment technique can help relieve hiatal hernia.

Western Treatments

If you experience heartburn or acid reflux as a symptom of hiatal hernia, your doctor may prescribe medications that include the following:

• Antacids that neutralize stomach acid.  Over-the-counter antacids, such as Gelusil, Maalox, Mylanta Rolaids and Tums, may provide quick relief.
• Medications to reduce acid productions.  Called H-2 receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac 75).  Stronger versions of these medications are available as prescriptions.
• Medications that block acid production and heal the esophagus.  Proton pump inhibitors block acid production and give the esophageal tissue time to heal.  These inhibitors include lansoprazole (Prevacid 24HR), and omeprazole (Prilosec OTC).  Stronger versions of these medications are available as prescriptions.

Surgery

In a small number of patients, surgery is required to address hiatal hernia.  This option is generally reserved for emergency situations and for those who do not respond to medications meant to relieve heartburn and acid reflux.  Hiatal hernia repair surgery is often combined with surgery for gastro esophageal reflux disease.

An operation for a hiatal hernia may involve pulling your stomach down to your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac.  IN some cases, this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy).  In other cases, your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen.  The operation is then performed while your surgeon views images of the inside your body that are displayed on a video monitor (laparoscopic surgery).

A TCM Approach

To help move food through the digestive system and eliminate bloating, I have used a formula including the following:

• Poria sclerotium
• Coix seed
• Barley Shen Qu
• Magnolia Bark
• Angelica Root
• Pueraria root
• Plus eight other herbs

This mixture is sometimes combined with a formula including:

• Calcium carbonate
• Bupleurum root
• Ginseng root
• Ginger rhizome
• Pinellia rhizome
• Scute root
• Plus four other herbs

When phlegm signs are present, the following formula is useful:

• Pinellia rhizome
• Citrus peel
• Poria sclerotium
• Aurantium fruit
• Bamboo shavings
• Arisaema rhizome
• Plus three other herbs

To help address abdominal spasms, use:

• White Peony root
• Pueraria root
• Clematis root
• Spatholobus stem
• Licorice root
• Plus two other herbs

For spasms accompanied by loose stools, use the previous formula with the following:

• Bupleurum root
• Pueraria root
• Pinellia rhizome
• Cinnamon twig
• White Peony root
• Plus four other herbs

Herpes simplex is a virus than can cause inflammation and ulcers in the esophagus.  This leads to symptoms that include acid regurgitation and heartburn.  Acyclovir is an antiviral drug that is the most common treatment of the Herpes simplex virus.

Western Treatment

There is no cure for herpes.  Treatments with antiviral medications (such as Acyclovir) may:

• Help sores heal sooner during an outbreak
• Lessen the severity and duration of symptoms in recurrent outbreaks
• Reduce the frequency of recurrence
• Minimize the chance of transmitting the herpes virus to another

Popular antiviral medications include:

• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

These medications may be recommended by a doctor only during outbreaks, or on a daily basis.

TCM Treatment

I have found two herbal combinations to be effective against the herpes simplex virus.

Combination one contains the following and can be combined with the second:

• Isatis extract leaf and root
• Oldenlandia herb
• Lonicera flower
• Prunella herb
• Andrographis herb
• Laminaria leaf
• Viola herb
• Cordyceps fruiting body
• Licorice root

The second formula includes the following and should be combined with the first mixture when heat signs are present:

• Isatis extract leaf and root
• Astragalus root
• Bupleurum root
• Laminaria leaf
• Codonopsis root
• Epimedium leaf
• Lycium fruit
• Dioscorea root
• Ligustrum fruit
• Broussonetia fruit
• White Atractylodes rhizome
• Licorice root

If the patient has cold signs, combine the second mixture with the following:

• Red Ganoderma fruiting body
• Tremella fruiting body
• Poria sclerotium
• Polyporus sclerotium

Hemorrhoids are a common condition that can be caused or aggravated by diarrhea and constipation.  Hemorrhoids are varicose veins in the rectum, which can lead to rectal pain, bleeding, and itching.  They can also be relatively symptomless.  Occasionally, hemorrhoids can prevent the anus from closing fully, which can lead to the soiling of underwear.  The condition can also cause fissures in the skin around the anus.  External hemorrhoids are found outside of the anus and are often accompanied by pain unless they are prolapsed.  Prolapsing can close off the anus and can be extremely painful.  It’s important to note that bleeding from the rectum can also signal rectal cancer or polyps.  In the case of bleeding, you must have a medical diagnosis of the symptoms.  Surgery is necessary if a blood clot develops in a hemorrhoid.

Self Help

The mild pain, swelling and inflammation caused by hemorrhoids can often be treated at home.
• Sitz Bath: Dissolve 1/4 cup of Epsom salts into 4 inches of water in a bathtub.  Soak in this mixture for 10 minutes, 3 to 4 times a day for best results
• Add a comfrey or yarrow tea to the Sitz bath by first steeping 4 ounces of the dry herbs in 32 ounces of boiling water for 10 minutes
• Topical treatments.  Apply over-the-counter creams or suppositories containing hydrocortisone, or use pads containing witch hazel or a numbing agent
• Keep the anal area clean.  Baths are preferable to showers with this condition.  Cleanse the skin around the anus gently with warm water.  No soap is necessary and it may actually aggravate the problem.  Do not use alcohol based or perfumed wipes.  Gently dry the area with a hair dryer after bathing
• Don’t use dry toilet paper.  Use moist towelettes or wet toilet paper to clean the area after bowel movements
• Apply cold.  Apply ice packs or cold compresses to relieve swelling
• Take oral pain relievers.  Acetaminophen, aspirin or ibuprofen can temporarily help relieve discomfort.

Western Treatments

When Western medical treatment becomes necessary, there are a variety of options available.

• Medications.  When hemorrhoids produce only mild discomfort, your doctor may suggest creams, ointments, suppositories or pads.
• Rubber band ligation.  Your doctor places one or two tiny rubber bands at the base of each internal hemorrhoid.  With no circulation, the hemorrhoid withers and falls off within a week.
• Injection (sclerotherapy).  With this procedure, your doctor injects a chemical solution into the hemorrhoids tissue, which shrinks it.
• Coagulation (infrared, laser or bipolar).  These techniques use laser or infrared light or heat.  They cause small, bleeding, internal hemorrhoids to harden and shrivel.
• Surgical removal.  A hemorrhoidectomy is when a surgeon removes excessive tissue that causes bleeding.
• Hemorrhoidal stapling.  This technique blocks blood flow to hemorrhoidal tissue.  This procedure is generally less painful than a hemorrhoidectomy and allows an early return to regular activities.

A Case Study in TCM Treatment

A 32-year-old businesswoman complained of internal hemorrhoids, which caused burning, itching, and straining upon bowel movements.  She also experienced PMS, occasional vaginal yeast infections and she had a history of asthma.  Traditional Chinese diagnosis revealed that her pulse was superficial and wiry, and her tongue had red spots, was pale in the center and had a thin white coating.  She was advised to use over-the-counter remedies for hemorrhoids daily including ointment and witch hazel pads.  Initially, she was prescribed two herbal formulas.  The first contained Bupleurum root, Tang Kuei root, White Peony root, salvia root, poria sclerotium and White Atractylodes with a few other herbs in smaller quantities.  The second contained sanguisorba root, pulsatilla root, sophora flower, Rehmannia root (raw), Fraxinus cortex, phellodendron cortex and lonicera flower.  These two formulas helped bring the hemorrhoids and accompanying symptoms under control.  At this point, the second formula was discontinued and a third was added to treat the underlying condition, which was stress and anxiety.  This formula included biota seed, fu shen sclerotium, polygala root, zizyphus seed, ophiopogon tuber, codonopsis root, amber resin and a number of enzymes.

Fecal incontinence is the inability to control bowel movements–a truly unpleasant condition for those who have experienced it first hand.  It is commonly seen among seniors when the muscles and ligaments that control defecation become less efficient.  A similar loss of control can be the result of abscess or inflammation in the rectum, anus, or perianal area, or from the trauma, injury, or surgery, as well as a nervous disorder like diabetic gastroparesis.  Chronic diarrhea may also be a contributing factor.  To address this condition, a bowel training program can be implemented, which involves sitting on the toilet at a certain time every day.  It is also a good idea to increases dietary fiber in the diet so that more normal stools are produced.  Biofeedback, self-hypnosis and surgery may also be helpful.

Self Help

It is important to talk to your doctor about fecal incontinence as the underlying causes could be serious.

Western Treatments

The treatment of fecal incontinence varies depending on the causes and symptoms.

• Anti-diarrheal drugs
• Laxatives, if chronic constipation is the cause
• Medications to decrease the spontaneous motion of your bowels
• Dietary changes –  Stool consistency is dependent on what you eat and drink so your doctor might recommend eating foods high in fiber, or drinking plenty of fluid, for example
• Exercise – Exercise can help fecal incontinence caused by muscle damage as it can restore muscle strength, sphincter control, and awareness of the urge to defecate
• Bowel training – Making a conscious effort to have a bowel movement at specific time of day can help establish greater control
• Sacral nerve stimulation – Implanting a device that sends small electrical impulses continuously to the nerves that control your pelvis can strengthen muscles in the bowels (this is usually done only after other treatments have failed)

Surgery

Fecal incontinence may require surgery to correct an underlying problem such as rectal prolapse, or sphincter damage.  The types of surgery available include:

• Sphincteroplasty - A procedure that repairs a damaged or weakened anal sphincter.
• Treating rectal prolapse, a rectocele or hemorrhoids - This sort of surgical correction will likely reduce or eliminate fecal incontinence.
• Sphincter replacement - An anal sphincter can be replaced with an artificial one, which is essentially an inflatable cuff placed in the anal canal.  It remains inflated until an external pump deflates the device and releases stool during defecation.
• Sphincter repair - This surgery takes muscle from the inner thigh and wraps it around the sphincter, restoring muscle tone.
• Colostomy - With a colostomy, stool is diverted through an opening in the abdomen into a special bag which collects it.  This is usually a last resort.

A Case Study in TCM Treatment

A 78-year-old patient first experienced incontinence after chemotherapy treatments for stomach cancer.  She confided that she was very worried about her adult son, who was a drug addict.  Traditional Chinese diagnosis found her pulse to be sinking and thin, and her tongue pale, flabby, and red at the tip.  She was prescribed a formula containing ailanthus cortex, baked astragalus root, White Ginseng root, White and Red Atractylodes rhizomes, poria sclerotium and a number of other herbs.  After four weeks, the patient observed she no longer experienced spontaneous evacuations, which greatly improved her self-esteem.

It is commonly thought among holistic healthcare professions that Candida yeast infections can cause, or can contribute to, all digestives symptoms and can induce a plethora of other unwanted symptoms such as fatigue, headaches, joint and muscle aches and some menstrual irregularities.  This idea is not held by many Western doctors who often have the opinion that candidiasis is only a problem with vaginal yeast infection, thrush and Candida esophagitis.

Candida is a resident member of our intestinal tract, which is normally kept from getting out of control by healthy intestinal bacteria, the right acid/alkaline balance and a properly working immune system.  Immune suppressive drugs such as antibiotics, hormones (including birth control pills), steroids, and chemotherapy can result in yeast overgrowth.

I have found through my own experience that dietary supplements, herbs and an anti-yeast diet can go a long way in treating digestive disorders.  This holds particularly true among patients who have a past history of using the drugs mentioned above–especially antibiotics–and if there are accompanying signs such as a history of vaginal yeast infections, athlete’s foot, jock itch, or fungal infections of the nails or skin.  Symptoms that worsen in damp weather or in moldy buildings, and cravings for sweets and yeast-containing foods (beer, wine, bread and cheese, for example) are among other indicative symptoms.  Physicians can administer tests that can detect excess levels of Candida, but they are expensive.  It’s also important to consider that a patient can have a sensitivity to normal levels of yeast.

Self Help

• Pau D’arco tea (6 cups daily) has anti-Candida properties and is an excellent beverage for those undergoing anti-Candida therapy
• Garlic has antifungal properties, but should not be used by persons with hot constitutions or with a sensitivity to garlic (dosage is 1 or 2 cloves a day)
• Yeast Guard is a homeopathic suppository that can be used
• Citrus seed extract (use as directed) can be considered

Western Treatment

Western medicine commonly treats Candidiasis with antifungal medications also known as antimycotics.  Some of the most common are found below:

• Nystatin is an antifungal medication with over forty years on the market.  It comes in cream, ointment, suppository, tablet, and powder forms.  The powder has several advantages as it can be used in a gargle, douche or enema for rapid effect.  Nystatin is safe for long-term usage, but physician’s dosage recommendations should be followed closely.  When starting antifungal medication, symptoms may worsen, this is known as a die-off reaction.  Rebound reactions, in which the yeast infection recurs with severe intensity when a drug is discontinued also occur.
• Nizoral (ketoconazole) is a broad-spectrum antifungal drug.  Some patients tolerate Nizoral better than Nystatin, however, a small percentage experience liver problems from the use of this drug.  Any patient with a history of liver issues or who intends on taking the drug for more than three months should have their liver function monitored.
• Diflucan (fluconazole) is more effective than NIzoral at combating yeast infections.  It works faster and is not harmful to the liver.  However, it can cost 5 to 10 times more than Nizoral.
• Sporanox (itraconazole) appears to be more effective than Nizoral.  Some patients may be intolerant of Diflucan, but better able to tolerate Sporanox and vice versa.

A Case Study in TCM Treatment

A 45-year-old man, a cook by profession, presented with numerous health complaints including sinusitis, frequent ear infections, chronic sore throat, frequent and burning urination, fatigue, low back pain, poor sleep, joint pain, tinnitus, hypertension, poor digestion, constipation and chronic cold hands and feet.  After being diagnosed with chronic fatigue syndrome by a medical doctor, he was placed on antifungal drugs including Nystatin and Diflucan.  He was also prescribed acupuncture, vitamins and homeopathics.  These remedies helped, but the patient reported being so tired, he could “barely make it through the day.”  Despite some improvements, he still had many of the same complaints.

Traditional Chinese diagnosis found his pulse to be racing and his tongue purplish with a thick coating on the sides.  He had heat signs in the Upper Burner and kidney yang deficiency.  The treatment principle was to tonify the yang and remove pathogenic heat and dampness.   He was recommended that he abstain from alcohol, reduce his intake of sugar (including fruit sugar) and increase his protein intake.  As the patient was ejaculating several times a day, he was urged to limit this since ejaculation is said to deplete the kidney Essence, causing fatigue, low back pain, weakness and frequent urination.

He was prescribed two herbal formulas.   The first contained coptis rhizome, lophatherum herb, bupleurum root, raw rehmannia root, tang kuei root, White Peony root, and several other complementary herbs.  The second contained isatis leaf extract leaf and root, astragalus root, bupleurum root, laminaria leaf, codonopsis root and more.  Two weeks later, he reported slightly more energy and less burning with urination.  His pulse was not as excessive and his face less red.  His daily dose of the first formula was reduced by one third daily and a third mixture containing ginseng root, poria sclerotium, White Atractylodes rhizome, zizyphus seed, salvia root, and amber resin among others was added.

After one month on the second protocol, the patient reported more energy, and no longer had burning with his urination.  His pulse was hollow and slightly irregular, but his tongue was normal.  At this point, the first mixture was discontinued but because his fatigue was still a problem, he was recommended another mixture containing  Red Ganoderma fruiting body, tremella fruiting body, poria sclerotium and polyporus sclerotium, which caused some digestive discomfort.  Despite this, because he indicated he experienced an increase in energy, he opted to remain on the original dosage rather than lower it, or stop it completely.  Although his treatment protocol varied over the next nine months, most of the patient’s symptoms disappeared completely through herbal therapy.