Patients with pre-existing gastric issues who contract hepatitis may see worsening of their gastric condition; those without prior gastric problems may develop gastric and duodenal mucosal lesions due to viral hepatitis, known as hepatic gastric disease. Common manifestations include gastric pain, acid reflux, belching, nausea, and vomiting. Clinical observations show an increasing trend in hepatic gastric disease. One report found that among 56 patients with acute icteric hepatitis, endoscopic examination revealed a gastric and duodenal mucosal injury rate as high as 92.86%, including 34 cases of superficial gastritis, 11 duodenal bulb ulcers, 4 simple duodenitis, 2 atrophic gastritis, and 1 gastric ulcer. Another study on 15 liver disease patients confirmed HBsAg presence in gastric mucosa via biopsy, particularly in those with “big three positives,” where the gastric mucosal HBsAg positivity rate reached 80%–100%.
Modern medical research suggests possible mechanisms for hepatic gastric disease include: (1) Hepatitis virus has a wide tropism and exists in gastric mucosa; immune complexes deposit in microvessels beneath the gastric and duodenal mucosa, causing local immune reactions; (2) Reduced liver function impairs hormone inactivation, leading to endocrine and autonomic nervous system disorders, damaging gastric and duodenal mucosa, facilitating Helicobacter pylori infection, further damaging the gastric mucosal barrier; (3) Gastric and bile reflux easily cause inflammatory changes in the stomach and duodenum, resulting in various gastrointestinal symptoms and lesions.
Traditional Chinese medicine holds that the stomach is the sea of grains and fluids, requiring smooth flow rather than stagnation. After hepatitis infection, damp-heat and epidemic toxins accumulate in the liver, impairing liver function, leading to disharmony between liver and stomach, manifesting as epigastric and rib pain, acid regurgitation, nausea, and vomiting; earth (spleen) fails to nourish wood (liver), causing liver qi stagnation and spleen deficiency, manifesting as poor appetite and abdominal distension; chronic spleen qi deficiency leads to blood stasis, compounded by liver qi stagnation and internal heat, obstructing nutritive and defensive qi, resulting in blood stasis, causing gastric mucosal erosion or ulcers, with fixed pain and damaged blood vessels visible as hematemesis or melena. Clinical treatment of viral hepatitis requires considering the spleen and stomach; only when the spleen transports and the stomach harmonizes can vital energy recover, immunity strengthen, and liver disease heal faster. Hepatic gastric disease can be treated through the following aspects:
One, Liver-Gastric Damp-Heat Type: Commonly seen in acute icteric hepatitis and chronic active hepatitis. Symptoms include dry mouth and bitter taste, acid regurgitation, poor appetite, nausea, epigastric fullness, constipation or loose stools, red tongue with yellow or greasy coating, wiry slippery pulse. Treatment: Clear liver and harmonize stomach. Formula: Self-designed Hu Yin Tang with modifications, using herbs like Tiger Tail, Yinchen, Gardenia, Dandelion, Prepared Pinellia, Poria, Rhubarb, and Licorice. Add Curcuma and Red Peony if jaundice is severe; add White Cardamom and Coix Seed if dampness is prominent; add Coptis, Evodia, and Calcined Oyster Shell if acid regurgitation is present.
Two, Liver-Gastric Disharmony Type: Commonly seen in chronic hepatitis, cirrhosis, and acute hepatitis. Symptoms include distension or pain in the epigastrium and flanks, belching, acid regurgitation, poor appetite, nausea, vomiting, pale red tongue with thin white or slightly yellow coating, wiry slippery pulse. Treatment: Soothe liver, relieve depression, harmonize stomach, and descend rebellious qi. Formula: Free and Easy Wanderer Powder with modifications, using herbs like Bupleurum, Cyperus, Prepared Pinellia, Tangerine Peel, Citrus Aurantium, White Peony, Poria, and Licorice. Add Chinese Toon Seed and Agarwood if flank pain is severe; add Lodestone and Bamboo Shavings for hiccups; add Fried Millet Sprout, Fried Barley Sprout, and Radish Seed for food stagnation and distress.
Three, Liver Depression and Spleen Deficiency Type: Commonly seen in chronic hepatitis, cirrhosis, and recovery phase of severe hepatitis. Symptoms include distension and fullness in the flanks, dull epigastric pain, poor appetite, fatigue, postprandial distension, loose stools or unsatisfactory bowel movements, pale red tongue with thin white coating, deep wiry pulse. Treatment: Soothe liver, relieve depression, strengthen spleen, and harmonize stomach. Formula: Free and Easy Wanderer Powder combined with Xiang Sha Liu Junzi Tang with modifications, using herbs like Codonopsis (use Prince Ginseng if abdominal distension is severe), Atractylodes, Bupleurum, Poria, White Peony, Amomum, Tangerine Peel, Sandalwood, and Licorice. Add Astragalus and Jujube if fatigue and qi deficiency are prominent; add Chicken Gizzard Membrane, Fried Millet Sprout, Fried Barley Sprout, and Sandalwood if poor appetite and abdominal distension exist; add Coix Seed and Yam if stools are loose.
Four, Qi Stagnation and Blood Stasis Type: Commonly seen in chronic hepatitis and cirrhosis. Symptoms include sharp, fixed pain in the flanks and epigastrium, dark complexion, black stool or positive occult blood in stool, purple-dark tongue with ecchymosis or petechiae, or prominent sublingual veins, wiry and涩pulse. Treatment: Activate blood, resolve stasis, and unblock meridians. Formula: Xuefu Zhuyu Tang with modifications, using herbs like Bupleurum, Angelica, Citrus Aurantium, Red Peony, Safflower, Liuji Nu, and Licorice. Add Corydalis and Five Spirit Resin if pain is severe; add Codonopsis, Astragalus, and Salvia if palpitations and shortness of breath occur; add Softshell Turtle Shell and Wang Bu Liu Xing if liver and spleen enlargement; add Raw Rhubarb, White Cattail, and Sanqi Powder if hematochezia or hematemesis occurs.
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