"The third type, liver qi invading the stomach."

Lu Xuan smiled slightly and began to discuss the third scenario of bile reflux gastritis following a gastrectomy.

"These patients often have poor emotional health, leading to long-term depression. The liver qi inversely invades the stomach, suppressing the spleen earth. This disrupts the stomach's reception function, causing upper abdominal pain, belching, and acid regurgitation. Additionally, when they become angry, their diet is unsettled, which can easily trigger upper gastrointestinal bleeding."

Hearing this, Li Yuquan knew that his condition probably belonged to the fourth type.

Liver qi invading the stomach was likely unrelated to him. Although he had cancer, his emotions were generally well-managed, and he rarely got angry.

When talking about liver qi invading the stomach, Lu Xuan also specially glanced at Li Yuquan.

Li Yuquan's condition was actually quite serious. Fortunately, he was open-minded and did not become mired in depression because of his cancer diagnosis. Otherwise, his condition might have worsened much sooner.

Thinking of this, Lu Xuan continued, "In traditional Chinese medicine, the liver governs the dispersion, prefers smoothness, and dislikes depression. The liver dominates the wood element, and when depression hinders smoothing, the liver qi inverts and suppresses the spleen earth, causing disruption in ascend and descend functions.

Furthermore, the liver and gallbladder are internally and externally related. The gallbladder lies attached to the liver, related to mild fire. If liver stagnation is unresolved, it easily transforms into fire and generates heat. The qi of the liver and gallbladder is prone to upward invasion, resulting in upper abdominal bloating, bitter and dry mouth, difficulty sleeping at night, and frequent unsettling dreams.

When wood fire and spleen dampness meet, damp-heat knot together, and sour-bitter fluids in the stomach often surge upward and vomit out.

Also, due to partial gastrectomy, poor healing commonly occurs at the gastroduodenal anastomosis. The reduced stomach capacity, compounded by impaired liver and stomach qi circulation, causes bile and acidic fluids to reflux. This results from unresolved liver qi stagnation, inability to disperse and descend, and bile reflux upward."

"So how is it treated?" Su Kenan rarely took the initiative to ask.

Hearing her question, Lu Xuan was surprised, glanced back at her, and then smiled, "The approach should be soothing the liver and moving qi, harmonizing the stomach and descending counterflow.

Chaihu, Citrus Peel, Xiangfu, Danggui, and Baishao are used to smooth the liver, benefit the gallbladder, harmonize the stomach, and descend counterflow. Red ochre, Inula, Fuling, and Baked Licorice help to descend counterflow and harmonize the stomach. Bai Ji protects the gastric mucosa. Later, if needed, Dried Astragalus Root may be added to tonify qi and promote wound healing, aiming to support the righteous qi."

After speaking, he glanced at the pondering Su Kenan, "If there's anything you don't understand, you can note it down, and we will discuss it later."

Su Kenan returned to her senses and nodded obediently, "Okay."

Lu Xuan turned his head to Li Yuquan, saying, "Old Mr. Li's condition belongs to the fourth type, a qi stagnation and blood stasis type of bile reflux gastritis."

"Qi stagnation and blood stasis?" Li Yuquan frowned deeply.

"Yes."

Lu Xuan explained, "Qi stagnation and blood stasis refer to a pathological mechanism where prolonged qi stagnation leads to blood stasis. In TCM concepts, the normal circulation of blood depends on the propulsion of qi. If qi fails to circulate smoothly, blood cannot move and hence stagnates, resulting in stasis.

'The Preservation of Life' mentions: Qi is the commander of blood. When qi moves, blood moves. When qi stops, blood stops. When qi is warm, blood flows smoothly. When qi is cold, blood congeals. A momentary pause in qi movement leads to a momentary arrest in blood circulation.

The 'Blood Disease Theory' also states: Qi binds and blood congeals.

Qi stagnation and blood stasis interchange as causation and result. Qi stagnation leads to blood stasis, and blood stasis aggravates qi stagnation.

Since the liver governs dispersion and stores blood, the dispersing function of liver qi plays a crucial role in smoothing the qi mechanism. Therefore, qi stagnation and blood stasis are closely tied to liver dysfunction."

Stopping briefly, Lu Xuan continued, "Thus, for treating the qi stagnation and blood stasis type of bile reflux gastritis, we prioritize moving qi and activating blood, resolving stasis, and fortifying the body. Old Mr. Li's condition is directly treatable with an altered Recovery Blood Circulation Decoction.

In this prescription, Chaihu smooths liver and gallbladder qi, Danggui nourishes and activates blood, Mountain Armor breaks stasis and unblocks collaterals, Peach Kernel and safflower remove stasis and generate new tissue, Tribulus Root lubricates dryness and disperses blood, licorice relieves pain and relaxes, with heavy use of rhubarb to purge congealed stasis and tainted blood.

Combining these herbs, qi and blood circulate, liver channels unblock, and the stomach's reflux naturally lightens.

Zhang Bingcheng observed: When the old disperses and the new generates, pain eases spontaneously, and the source revives. Hence the formula is named 'Recovery.'"

Li Yuquan kind of understood after thinking for a while, showing an awkward smile, "Forget it, I don't get it, not my area. Dr. Lu, just prescribe the medicine for me."

Lu Xuan smiled slightly, wrote down the prescription, and then advised, "After taking the medicine, if reflux symptoms persist, continue the treatment for a period of time.

At that time, just bring the prescription to get the medicine. If you're still worried, coming for a follow-up is also fine."

...

After Li Yuquan and his daughter left, Lu Xuan checked the time subconsciously and found that almost half an hour had passed.

If he hadn't started the consultation half an hour in advance, by now, the waiting patients outside might have been complaining.

However, even so, the mother-daughter pair who just entered the consultation room seemed somewhat annoyed, especially the mother, mumbling about something.

Yet when they saw Lu Xuan, her brows instantly relaxed, and she greeted with a smile, "Hello, Dr. Lu."

"Hello." Lu Xuan nodded politely.

"Who's feeling unwell?" he asked.

Wang Yuanfeng pulled the girl from behind and began, "Dr. Lu, this is my daughter. Recently, for some reason, her menstruation comes a day early each time. The amount is not only small, but the color is also very light, taking over a week to finish. Each period comes with lower abdominal pain, dizziness, and general fatigue and lethargy.

Recently she hasn't been sleeping well at night, saying she often dreams."

Listening to her, Lu Xuan finally turned his gaze to the girl's face.

Her complexion was pale and lacked luster, giving the impression of extreme exhaustion, as if she hadn't slept for days.

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