Indigestion
Definition
Western
Indigestion, also known as functional dyspepsia, is a type of body discomfort, which is characterised by upper abdominal pain or discomfort, fullness, bloating and nauseous sensation [1]. This is classified as one of the commonly seen gastrointestinal disorders, in which symptoms can occur without any structural abnormalities in the gastrointestinal tract [1].
Traditional Chinese Medicine (TCM)
Depending on the main symptoms displayed, indigestion can be diagnosed as abdominal pain (fu tong), bloating and fullness in the upper abdomen (pi man) and loss of appetite (na dai) [20-21]. Indigestion is usually caused by factors that cause the flow of energy in the stomach to be stagnant or slowed down. This can be due to infections by external pathogenic factors, inappropriate eating habits such as overeating and excessive intake of spicy, oily or cold foods, overconsumption of alcohol, loss of body fluids after seasonal febrile diseases or vomiting, or even mood fluctuations initiated by anger or depression [21].
Classifications or Symptoms Displayed in TCM Context
Acute condition – induced syndrome
Burning sensation in the abdomen, bitter taste in the mouth, thirst, dry stools and yellow urine and thick, yellow and greasy tongue coating [21].
Chronic condition – induced syndrome
Include depletion of stomach fluids, poor circulation or overworking of the Spleen and Stomach systems. These are characterised by abdominal pain which may be alleviated when pressure is applied to it, resulting in fatigue and pale red tongue with little or no coating [21].
Cold – induced syndrome
Characterised by aversion to cold, relieve abdominal pain when exposed to heat or worsening of pain when exposed to cold, bland taste in the mouth, preference for warm fluids and pale tongue [21].
Functional – induced syndrome
Presented as loss of appetite, nausea, foul taste in the mouth, alleviation of abdominal pain after vomiting and with thick and greasy tongue coating. At times, one may experience needle-like pain in the abdominal region which may worsen when pressure is applied and purplish tongue [21].
Mental – related syndrome
Characterised by abdominal pain at the sides of the abdomen which may worsen when one is under stress or triggered anger [21]. The pain may be relieved after belching and farting. Other symptoms include chest tightness and with a thin layer of white tongue coating [21]. Some patients may also experience Irritable Bowel Syndrome (IBS) [2], whereby abdominal pain and diarrhoea occur simultaneously after anger fits [21].
Causes and Risk Factors
Eating Habits
Excessive intake of spicy and greasy foods, eating too much or too fast [4].
Lifestyle
Emotional stress or nervousness, smoking and excessive intake of caffeine or alcohol [4].
Underlying Diseases
Gallstones, inflammations of the pancreas or stomach, resulting in gastric or duodenal ulcers [4].
Usage of certain medications
Use of certain drugs such as antibiotics, aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) [4].
Treatments
Herbs commonly used in prescriptions for indigestion includes:
1. Chen Pi – 陈皮
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English/ Common name
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Tangerine peel [5]]
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Latin species
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Citrus reticulate Blanco [19
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Park of plant used
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Hooks and stems [21]
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Action/s
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Helps to reduce duodenum spasms and promote peristalsis along gastrointestinal tract [7]
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Precaution/s
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No significant adverse side effects have been reported [3]. Some people may develop minor allergic reactions such as prolonged sneezing, cough, chest discomfort, and restlessness, but these side effects are rare [5].
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2. Zhi Qiao – 枳壳
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English/ Common name
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Trifoliate orange [8]
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Latin species
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Poncirus trifoliata [8]
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Park of plant used
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Dried shell of fruits [19]
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Action/s
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Helps to reduce duodenal spasms [7] and promote peristalsis in the small intestines [7].
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Precaution/s
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Pregnant patients should use with caution [19].
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3. Hou Po – 厚朴
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English/ Common name
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Hou Po [19]
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Latin species
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Magnolia officinalis Rehd. Et Wils. [19]
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Park of plant used
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Dried bark of tree, roots and stem [19]
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Action/s
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Helps to reduce spasms along the smooth muscles of small intestines [11]
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Precaution/s
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Generally safe when used in short term [12]. However, it should not be used in pregnancy as it may cause uterine contractions [12].
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4. Sheng Jiang - 生姜
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English/ Common name
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Ginger [14]
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Latin species
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Zingiber officinale Rosc. [19]
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Park of plant used
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Fresh rhizomes [19]
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Action/s
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Helps to speed up gastric emptying and stimulate gastrointestinal contractions [13]
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Precaution/s
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Some side effects include irritation or foul taste in the mouth, heartburn, belching, bloating and nausea have been reported. Individuals who have had ulcers, gallstones, inflammatory bowel diseases, or blocked intestines should avoid large amounts of ginger [14].
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5. Xiao Hui Xiang – 小茴香
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English/ Common name
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Fennel [16]
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Latin species
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Foeniculum vulgare Mill. [19]
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Park of plant used
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Dried fruits [19]
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Action/s
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Helps to inhibit helicobacter pylori infections that cause gastrointestinal disorders [15].
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Precaution/s
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Occasional side effects include allergic reactions, such as atopic dermatitis and photosensitivity and epileptic seizures, but these rarely occur [16].
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Other treatments include acupuncture [9, 17] and therapeutic massage [10].
Tests & Diagnosis
The doctor first asks about the patient’s symptoms, medical history, followed by a physical examination [18]. Blood, breath or stool tests may be performed if indigestion is suspected to be caused by helicobacter pylori, which is one of the causation of peptic ulcer [18]. Other tests such as X-rays and endoscopy are also performed to check for structural defects and biopsies to check for tissue damage [6].
Home Remedies
Lemon juice + ginger juice + honey
a) Squeeze lemon to extract juice.
b) Grind ginger and squeeze out juice.
c) Add lemon juice, ginger juice and honey in a glass of lukewarm water.
d) Mix them well and drink immediately.
References
1. Kumar, P.J., Clinical medicine 7th ed. ed. 2009: Saunders Elsevier. 1,343 p.
2. National Digestive Diseases Information Clearinghouse (NDDIC) What I need to know about Irritable Bowel Syndrome. [Cited July 2010; Available from: http://digestive.niddk.nih.gov/ddiseases/pubs/ibs_ez/].
3. Healthline. Tangerine: Information on Uses, Dosage and Side Effects. [Cited July 2010; Available from: http://www.healthline.com/natstandardcontent/tangerine#H7].
4. MedlinePlus Medical Encyclopedia. Indigestion [cited June 2010; Available from: http://www.nlm.nih.gov/medlineplus/ency/article/003260.htm].
5. Alternative Medicine Encyclopedia. Tangerine Peels. [Cited June 2010; Available from: http://www.answers.com/topic/tangerine-peel-1].
6. Medicinenet. Dyspepsia (Upset Stomach, Indigestion) Causes, Symptoms, Diagnosis and Treatment. [Cited July 2010; Available from: http://www.medicinenet.com/dyspepsia/article.htm].
7. Guan, F.L., Study of Molecular Mechanism of Chen Pi and Zhi Qiao on Gastrointestinal Movement in Guangzhou University of Chinese Medicine. 2002.
8. Trifoliate Orange (Poncirus trifoliata). [Cited June 2010; Available from: http://www.duke.edu/~cwcook/trees/potr.html].
9. Ouyang, H. and J.D.Z. Chen, Therapeutic roles of acupuncture in functional gastrointestinal disorders. Alimentary Pharmacology & Therapeutics, 2004. 20(8): p. 831-841.
10. Zheng, Q.S., Massage treatment for functional dyspepsia. Journal of Chinese Manipulation & QiGong Therapy, 2006. 22(4): p. 23.
11. Chan, S.S.K., et al., Magnolol and honokiol account for the anti-spasmodic effect of Magnolia officinalis in isolated guinea pig ileum. Planta Medica, 2008. 74(4): p. 381-384.
12. WebMD. Magnolia: Uses, Side Effects, Interactions and Warnings [Cited July 2010; Available from: http://www.webmd.com/vitamins-supplements/ingredientmono-188-MAGNOLIA.aspx?activeIngredientId=188&activeIngredientName=MAGNOLIA&source=3].
13. Wu, K.L., et al., Effects of ginger on gastric emptying and motility in healthy humans. European Journal of Gastroenterology & Hepatology, 2008. 20(5): p. 436-440.
14. MedlinePlus Supplements. Ginger (Zingiber officinale Roscoe) [cited July 2010; Available from: http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginger.html#Safety].
15. Mahady, G.B., et al., In vitro susceptibility of Helicobacter pylori to botanical extracts used traditionally for the treatment of gastrointestinal disorders. Phytotherapy Research, 2005. 19(11): p. 988-991.
16. Healthline. Fennel: Information on Uses, Dosage and Side Effects. [Cited July 2010; Available from: http://www.healthline.com/natstandardcontent/fennel#H1].
17. Wong, R.K., et al., Acupuncture Therapy Improves Bloating in Functional Dyspepsia Patients: A Randomized Controlled Trial of Sham vs. Real Acupuncture. Gastroenterology, 2009. 136(5): p. A182-A182.
18. National Digestive Diseases Information Clearinghouse (NDDIC). Indigestion. [Cited July 2010; Available from: http://digestive.niddk.nih.gov/ddiseases/pubs/indigestion/#diagnosis].
19. Gao, X.M., 中药学. 1st Ed. 2002: 中国中医药出版社.
20. Zhu, W.F., 中医诊断学.辨脏腑证候. 2007: 中国中医药出版社. 294.
21. Zhou, Z.Y., 中医内科学. 2 ed. 2007: 中国中医药出版社. 521.