As we are well into the season of late Summer, more cases are presenting at my clinic with Spleen and Stomach issues. One of my latest was a GERD client, whom I will call Bob. In his late 40s, Bob has had GERD for over 20 years and has tried everything. He currently is on two medications but still experiences terrible burning at night.

Most GERD cases I see are a combination of the patterns Cold Dampness in the Spleen and Liver Qi Stagnation. The Cold Dampness in the Spleen congests and slows digestion while the Liver Qi Stagnation attacks the Stomach, causing its contents to move upward instead of down. In this case we use Damp-dispelling and Qi-regulating herbs to clear the GERD.

Bob, however, presented with different patterns. He has Cold Dampness in the Spleen, yes, but with little Liver Qi stagnation, although he does lead a stressful life. Instead, he has many symptoms of Stomach Heat – a thick yellow coat in the center of his tongue, a big and fast stomach pulse, easily bleeding gums, some bad breath and of course, the acid reflux.

This pattern combination represents a different treatment approach, one of clearing Cold Dampness in the Spleen along with clearing Damp Heat from the Stomach. The formula of choice for this is Pinellia Combination. It contains pinellia to dry the Cold Damp in the Spleen and scute and coptis to dry the Damp Heat in the Stomach. Further, it includes ginseng to tonify Spleen Qi so Dampness doesn’t collect and congest.

After taking this formula for two weeks with excellent results, Bob ran out of the herbs. As he was on a camping vacation, he had to do without and his symptoms returned. Thus, we knew the formula was working effectively and could separate this from the other treatments we did in session together.

This case not only demonstrates how necessary it is to first make a differential diagnosis before automatically treating a health condition, but it further represents how important it is to treat the person who has the disease and not the disease itself. As has been so wisely stated before, “One disease, many formulas; one formula, many diseases.” Further, it shows how one may treat a combination of Heat and Cold factors by simultaneously using herbs that clear Heat and dispel Cold.

As a further note on GERD, along with taking the appropriate herbal formula, it’s important for long-term correction to make dietary changes of course, but also to “re-surface” the denuded linings of the stomach and esophagus. For the latter I recommend “Gastric Soothe” by Source Naturals (a zinc-based supplement) instead of using slippery elm or marshmallow, because these herbs are dampening, contraindicated in patterns with Dampness.

PINELLIA COMBINATION

(Stomach Purging Decoction with Pinellia)

Pinellia (Rhizoma Pinelliae, Ban Xia)
9-12 g

Dried Ginger (Rhizoma Zingiberis, Gan Jiang)
9-12 g 

Ginseng (Panax ginseng, Ren Shen)
6-9 g 

Scutellaria (Radix Scutellaria, Huang Qin)
6-9 g 

Baked Licorice (Glycyrrhizae praeparatae, Zhi Gan Cao)
3-6 g 

Coptis (Rhizoma Coptidis, Huang Lian)
3-6 g 

Jujube (Fructus Ziziphus, Da Zao)
3 g or 3 pcs 

Summer kicharee is not only great for detoxification, but it is also a light summer soup perfect for the hot months of year. It is balanced in protein and can include as many local vegetables as you wish. As well, you can easily cook up a big batch to eat over three days, or freeze for longer, so your time is spent in the garden or hiking, swimming and so on – you get the idea!

Some are surprised with the lightness of summer kicahree and yet how it fills and satisfies them. Many eat it just for breakfast, or for one other meal, while others eat it exclusively for several days or weeks to cool and clean toxins from their bodies. Have fun with it and explore! Your imagination is the limit here.

Here is a sample recipe to follow. You can make it as is, substitute what you have on hand, or change it to satisfy your tastebud desires. To keep it a summer kicharee suitable for this time of year, use only seasonal local vegetables and add light protein (if desired). I give several possibilities here.

Basic Summer Kicharee Recipe

Makes approximately 6 to 8 two-cup servings.

½ cup barley (rice or quinoa)

½ cup green split peas (aduki beans)

½ cup yellow split peas (mung dahl)

½ cup lentils (other dahls)

2 quarts chicken stock

2 tblsp ghee

1 tblsp cumin powder

1 large onion

4 stalks celery

2 big carrots

garnish with ½ lemon per serving of soup and season to taste

Directions:

(Optional but wise first step: Soak grain and beans in water for 12 hours. Strain.)

Place grain and beans in stock and simmer for 30 minutes. In meantime, brown cumin in ghee, then add vegetables one at a time and sauté. Add this mix to grain and beans after the first 30 minutes and simmer all together for another half hour. Eat as is, or add various garnishes, additional protein and so on. Ideas are given below.

Ingredient Descriptions:

Barley is used because it is cool and eliminates dampness, both perfect for the summer heat and balancing the Spleen and Stomach organs, which flourish and rule this season (July to mid-September).

Split peas and lentils are lighter to digest than heavier beans and actually need less soaking time. All are alkalinizing.

Ghee, or clarified butter, is a pure oil that sparks digestion without being too heating. It also doesn’t go rancid without refrigeration.

Cumin is neutral in energy and helps digestion.

Lemon is alkalinizing, cooling and helps digestion.

Substitution Possibilities:

GRAIN: Use brown rice or quinoa instead of barley. (Be sure to soak the brown rice for 12 – 24 hours first to eliminate its outer kernel and make it far more digestible.) Both are cooling and alkalinizing.

BEANS: Use aduki beans (adzuki beans), mung dahl or mung beans. Aduki beans assist kidney function; June through July is when Kidney energy is lowest (this is the opposite time of year from the Kidney/Urinary Bladder time of year, in winter). Mung dahl and mung beans are cooling and detoxifying.

STOCK: You may use a different stock or water instead of chicken stock. Chicken stock is lighter than other stocks and provides additional protein that is easily digestible.

OIL: Try coconut oil instead of ghee. It is light, reduces fat accumulation, is more water soluble and so breaks down more quickly and is immediately used by the liver for energy (see upcoming blog on this!).

SPICES: Try cumin seeds instead of the powder, or also add coriander seeds or power and turmeric. Try other spices according to your individual health needs such as the following (all of which promote good digestion): basil (cooling), fennel (warming, moves Qi), ginger (warming), garlic (warming, anti-parasitical), onions (warming), mustard seeds (warming).

VEGETABLES: Onions, celery and carrots are always a good way to add flavor to a soup pot, but feel free to substitute or add other vegetables as desired. Ideas include: summer squashes, red bell peppers, eggplant, string beans, artichoke hearts, potatoes and tomatoes.

GARNISHES: Try adding yogurt, cilantro, parsley and/or gomasio (sesame salt).

PROTEINS: If you need or desire to increase the protein of this soup and provide more warming energy to your body, add any of the following (all are lighter proteins and easier to digest for the summer months): hard-boiled eggs, sardines or other fish, chicken or pork pieces, chicken sausage, or buffalo (very low fat for a red meat).

It's no secret that acid reflux is a widespread condition. Just think of all the antacid, Nexium or Prilosec advertisements you've seen lately. Some people eat Tums, an alkalinizing form of calcium, like candy.

But you don't have to resort to taking expensive prescription drugs or chewing bushels of antacids. If any condition is made to be treated by herbal therapy, it is acid reflux (or GERD, or heartburn).

What causes acid reflux? Among common causes are the following:

• an imbalanced diet, too high in irritating, hot, spicy and acidic foods (not including vinegar or lemons, however)
• stress and worry
• eating too fast
• not chewing well enough (chewing allows your saliva to predigest the food before it even reaches your stomach)
• erratic eating habits
• not enough water (especially after a meal)
• insufficient stomach acid

The most prevalent reason by far is insufficient stomach acid. When we don’t have enough digestive secretions in our stomach, food is allowed to stay in the gut too long with resultant fermentation and gas. This is one reason that just about every culture in the world has its own bitters recipe. For example, I often recommend the Italian liqueur called Fernet-Branca to patients as a digestive bitters. A tablespoon before and/or after meals stimulates the secretion of saliva, bile and stomach acid, which in turn aids digestion. Ayurvedic medicine has a traditional wine called Draksha used for a similar purpose.

The old standby of a teaspoon each of pure, undistilled apple cider vinegar and raw honey stirred together in a small glass of warm water is a very effective treatment for about 85% of the cases of GERD.

In Ayurveda, a primary formula to aid digestion is called Avipattikar Churna. It consists of trikatu herbs (black and long pepper and ginger), cyperus, cardamom, cinnamon leaf, clovers trivit (Operculina turpethum), vidanga (Embelia ribes) and raw sugar. It is specific for hyperacidity, heartburn, biliousness, vomiting, indigestion, dropsy, rheumatism -- in other words, for any pitta (fire) type disorder. One to four grams or two to eight tablets are taken two or three times daily, after meals with warm water. This remedy is commonly available from Ayurvedic supply companies such as Bombay Bazaar of India in Berkeley or Banyan Botanicals.

Planetary Herbals has two products that can be used to aid digestion: Digestive Comfort Tablets and Digestive Grape Bitters.

If you have money to burn, you can try the pharmaceutical alternatives to the above simple remedies listed above. You may already know that pharmaceutical companies get to have an exclusive right to the sales of the products they produce for a period of seven years. When this term expires, other companies can manufacture similar products as ‘generics’ at a greatly reduced cost. The heartburn drug Prilosec is one of the best-selling prescription medicines in history. Sales in the past five years alone amount to $26 billion. The reason is not only its popularity but its steep price: about $4 per pill.

As it so happens, the patent for Prilosec expired April of 2001. Still there is no inexpensive generic on the market to take its place. This is because in 1995, a team of lawmakers and scientists, aptly called (I kid you not) “Shark Fin,” seeing the end of its Prilosec cash cow coming, began a list of nearly 50 possible solutions to the patent-expiration disaster facing the company.

One list item was to find a new heartburn remedy that would work better. No, it’s not apple cider vinegar and honey, nor Digestive Comfort, nor a digestive bitters and not even Avipattikar Churna. It is the successor to Prilosec known as Nexium, and like its predecessor was originally sold for $4 a pill, but you can find it available at varying discount market prices averaging around $1 a pill. Now the successor to Prilosec and Nexium is called Prevacid and it is sold for, you guessed it: $4 a pill.

The fact is all of these products produce pretty much the same results. None of them are curative in any way; in fact, by suppressing digestive acids, it’s a question as to whether they will ever treat the underlying cause of the disease.

The problem is that an otherwise simple-to-treat condition like acid reflux is often mismanaged or allowed to linger so long as to cause physical damage that takes a lot longer to repair.

Those with an advanced case of GERD may find pharmaceutical products necessary (but shop around for generics and check off-shore sales on the internet). If your esophagus is not badly eroded, it is possible to eventually heal your condition. For some, the questionable choice of laparoscopic anti-reflux surgery is an option. Ironically, assuming all goes well with the surgery, for the rest of your life you will have to eat very slowly and smaller than usual amounts -- something that should have been done before GERD ever became a degenerative, chronic condition.

How do you know you have bad digestion even before you experience heartburn? Bloating, swollen abdomen after meals, and sometimes a lot of gas. Charcoal tablets are the most immediate remedy to stop farting and gas but they are not a true fix. If these problems are allowed to persist, you may eventually end up having to treat the more serious condition of GERD.

The moral of this blog is: If you have digestive problems of any sort, don't wait until they cause damage that is impossible to reverse. Give the natural remedies suggested here a try or visit your local herbalist.