ZHANG JI QIU Senior Physician
Abdominal Bloating
Having been in clinical practice for 25 years, I see patients of all ages seeking care for abdominal bloating. The common complaints are belching, hiccups, abdominal bloating and pain, and frequent flatulence around mealtime.
The main function of the digestive tract is assimilation and absorption of food through peristalsis and enzyme activity. However, it doesn’t always do its job without difficulty. Almost everybody has experienced indigestion, bloating and diarrhoea at some point. Most of these symptoms are self-limiting. When the symptoms worsen or become recurring, and affect daily activities, one should seek professional help.
Do not ignore abdominal bloating, as it is a symptom for many serious illnesses, including gastritis, gastroptosis, dilatation of the stomach, gastric outlet obstruction, gastric ulcer, gastric cancer, dysentery, intestinal tuberculosis, gastroenteritis, bowel obstruction, hepatitis, cirrhosis, liver cancer, cholecystitis, gall stones, and pancreatitis.
Lifestyle can have an effect on bloating as well:
-Life gets busy. You may swallow excess air if you talk while you eat or eat too fast. Excess air in your stomach can result in bloating.
-Stress, emotional tension, and other bad habits can reduce enzyme secretion and cause indigestion and bloating.
-Ingest large amounts of fermentable food, such as beans, peanuts, and sweet potato.
In addition, some people have food sensitivities that makes them gassy and bloated. Clinically, we also frequently see bloating due to dysbiosis from chronic antibiotic use.
TCM Differential Diagnosis
Establishing the correct diagnosis for bloating is essential in forming an effective treatment plan. Clinically, TCM categorizes bloating into five types, and treat accordingly.
-Mixed cold and heat type: This type is most commonly seen. The patient presents with epigastric or lower abdominal bloating that worsens in the afternoon and evening. Bloating is worse with any food intake. Other signs and symptoms are bitter taste in the mouth, bad breath, nausea, belching, digestive cold intolerance, prefer cold drinks and food but cannot tolerate them, constipation or diarrhoea, and frequent flatulence.
-Stagnation type: It presents as abdominal bloating and pain, foul-smelling belch, vomiting sour fluid, intolerant to the smell of food, excessive flatulence, and rotten-egg smelling stool.
-Spleen and stomach deficiency type: The symptoms include intermittent stomach and abdominal bloating that varies in intensity, and is relieved by warm drinks or food. The patient prefers warm food, and pressure on the abdomen. He/she can also experience fatigue, weakness and decreased appetite.
-Heat and dampness type: It presents as stomach and abdominal bloating, nausea, vomiting, anxiety, dry mouth but not craving fluid intake, excessive sweating, diarrhoea, and dark yellow urine.
-Heat type: the symptoms include persistent abdominal bloating, pain in lower abdomen or around the belly button, constipation, sweaty palms and soles, fever and delirium. It is worth noting that these symptoms can be seen in bowel obstruction, which is a medical emergency.
Case Study
Male, 44. He was having intermittent bloating for about a year. 6 months ago, he visited his medical doctor due to severe stomach pain, and was diagnosed with acid reflux. The pain was relieved with medication, but the bloating persisted. He also continued to have burning sensation in his stomach. He felt hungry all the time, but couldn’t eat very much, or he’d felt bloated. If he missed a meal, he would experience palpitation, sweating, anxiety, and insomnia. His pulse was deep and taut, and his tongue was red without coating. His differential diagnosis is mixed cold and heat type, due to a weak digestive system that’s overridden by the liver system. He was prescribed modified BanXia XieXin Tang, which includes herbs such as pinellia tuber (ban xia), baical skullcap root (huang qin), dried ginger, asiabell root (dang shen), tumeric root (yu jin), and tangerine peel. The bloating was significantly reduced after being on the herbal prescription for 2 weeks. His sleep quality also gradually improved with continued use of a modified version of the prescription.
Prevention and wellness care
To prevent bloating, one should control portion size, eat slowly, and avoid carbonated soft drinks. Additionally, avoid fermentable food like tofu, mung bean sprouts, soy bean sprouts, cabbage, Chinese cabbage, chives, coconut, sweet potato, milk and high protein food. Mint tea, green tea and fennel tea can aid digestion after meals.
Health tips:
-Eat yogurt regularly: This is helpful in supporting the good bacteria in the guts.
-Eat congee regularly: If you are bloated or have a burning sensation in your stomach, drinking small amounts of rice soup can be helpful.
-Drink diluted vinegar: If the bloating is due to indigestion, ingest diluted vinegar 2-3 times a day. Take a spoonful of rice vinegar and mix it with a cup of cold water. One cup of lemon water in the morning may serve the purpose, too.
-Exercise regularly: If the illness is not severe or serious, speed walking, other aerobic exercises, and gentle ab exercises may help reduce bloating.
Culinary medicine recipe
-Tangerine peel tea: Take 50g of fresh tangerine peels, and break them into small pieces. Make tea with the peels and sweeten it with sugar. This is useful in the case of mild abdominal bloating.
-Chinese bayberry wine: Rinse and dry the Chinese bayberry. Soak completely in sorghum wine, and seal the bottle for 3 months. Drinking a small amount of it with meals can effectively increase appetite and relieve bloating.
-Chinese hawthorn malt tea: Simmer 15g raw hawthorn and 15g fried malt to make tea. Divide the tea in half and drink it twice a day for several days. If you continue to have indigestion and bloating, continued use can relieve symptoms faster.
Last but not least, I would like to reiterate the importance of emotional health. There are many clinical conditions that are associated with emotional triggers, such as insomnia, chest pain, anxiety, and bloating. Emotional health is the foundation of physical health. Hope every day is an enjoyable day!