Dyspepsia is characterized by anorexia, indigestion, abdominal distention, acid regurgitation or vomiting and abnormal bowel movement and usually occur in children.

Etiology and Pathogenesis

Dyspepsia is caused by improper food intake which leads to accumulation of food in the middle-jiao and dysfunction of the spleen and stomach, resulting in a sthenia-syndrome. It may also be due to deficiency of the spleen and stomach with impairment of digestive function and retention of food, leading to an asthenia-syndrome complicated by sthenia-syndrome.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

a) Differentiation between cold and heat, asthenia and sthenia syndromes: Cases with abdominal hotness, distention and tenderness, restlessness at night, thirst, foul stool, deep-colored urine, red tongue with thick, yellow and greasy coating, and smooth and rapid pulse are attributed to sthenia and heat syndrome; those with abdominal coldness and distention, preference for warmth and pressure, pale or sallow complexion, fatigue, loss of appetite, loose stool, clear urine, pale lips and tongue with thick, white and greasy coating and thready and weak pulse are attributed to asthenia and cold syndrome.

(b) Differentiation between anorexia and dyspepsia: Anorexia can be distinguished from dyspepsia by the significant loss of appetite, absence of abdominal distention and abnormal bowel movement, its longer course and its influence on the growth and development of the child.

B. Therapeutic principles

The therapy of promoting digestion and regulating the spleen and middle-jiao is recommended for cases caused by improper diet leading to dysfunction of the spleen. For those due to spleen deficiency leading to retention of food, the therapy of strengthening the spleen and regulating middle-jiao should be adopted and that of promoting digestion should be supplemented.

Classification and Treatment

A. Retention of milk and food

Manifestations: Vomiting of milk, no desire for feeding, abdominal distention and pain and discharge of foul stool in cases with retention of milk; vomiting of undigested food, abdominal distending pain and tenderness which is relieved after bowel movement, restlessness, discharge of foul stool, fever, thick, greasy tongue coating and wiry and smooth pulse in cases with retention of food.

Therapeutic principles: Promote digestion, and regulate middle-jiao.

Prescription for retention of milk: The Modified Pill for Relieving Milk Dyspepsia

Fructus Hordei Germinatus 6 g
Massa Fermentata Medicinalis 6 g
Rhizoma Cyperi 3 g
Fructus Amomi 3 g
Pericarpium Citri Reticulatae 5 g
Radix Glycyrrhizae Praeparata 3 g

Remarks: Add Radix Aucklandiae (3 g) for cases with severe abdominal pain and crying at night. Add Rhizoma Coptidis (1.5 g) and Semen Coicis (6 g) for those with diarrhea. Add Fructus Aurantii (5 g) and Semen Raphani (5 g) for those with constipation.

Prescription for retention of food: Pill for Promoting Digestion

Massa Fermentata Medicinalis 10 g
Fructus Crataegi 10 g
Semen Raphani 10 g
Rhizoma Pinelliae 6 g
Poria 10 g
Pericarpium Citri Reticulatae 6 g
Fructus Forsythiae 10 g

Remarks: Add Semen Arecae (10 g) and Radix Aucklandiae (3 g) for cases with severe abdominal pain. Add Cortex Magnoliae Officinalis (6 g) and Fructus Aurantii Immaturus (6 g) for those with marked abdominal fullness. Add Rhizoma Atractylodis Macrocephalae (10 g) for those with discharge of loose stool. Add Rhizoma Coptidis (6 g) for those with heat formation. Add Rhizoma et Rhizoma Rhei (5 g, decocted later) and Natrii Sulfas Exsiccatus (5 g, mixed with the decoction) for those with constipation.

B. Dyspepsia due to spleen deficiency

Manifestations: Sallow complexion, fatigue, restlessness at night, anorexia, abdominal distention with preference for pressure, vomiting, discharge of loose stool containing undigested food, pale lips and tongue with white, greasy coating and thready and weak pulse.

Therapeutic principles: Invigorate the spleen, and promote digestion.

Prescription: Pill for Strengthening the Spleen

Radix Codonopsis Pilosulae 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Massa Fermentata Medicinalis 10 g
Fructus Hordei Germinatus 10 g
Fructus Crataegi 10 g
Pericarpium Citri Reticulatae 6 g
Fructus Aurantii Immaturus 6 g

Remarks: Add Rhizoma Pinelliae (6 g), Flos Caryophylli (3 g) and Rhizoma Zingiberis Recens (3 pcs) for cases with vomiting. Add Radix Aucklandiae (3 g), Rhizoma Zingiberis (dried, 1.5 g) and Radix Paeoniae Alba (10 g) for those with severe abdominal pain due to retention of cold.

Experiential Prescriptions

A. Endothelium Corneum Gigeriae Galli (30 g); dried by heating on a piece of tile and prepared as powder; one to two grams taken orally thrice a day; applicable to cases caused by retention of milk and food.

B. Massa Fermentata Medicinalis (6 g), Fructus Hordei Germinatus (6 g) and Semen Arecae; prepared as decoction; three doses taken daily; applicable to cases caused by retention of milk and food.

Copyright 1995 Hopkins Technology