Integrative East-West Medicine for Reflux Disease

  • Malcolm B. TawEmail author


This chapter summarizes an integrative East-West medicine approach for the treatment of reflux disease. The conceptual framework of integrative East-West medicine, therapeutic effects of acupuncture based upon mechanistic and clinical studies, nutritional recommendations from a traditional Chinese medicine (TCM) perspective, and implications upon the brain-gut-microbiota axis are all described. The potential for a brain-naso-sinus-pharynx-larynx-microbiota axis is also discussed using TCM pattern diagnosis as a point of reference for translational investigative research.


Laryngopharyngeal reflux Gastroesophageal reflux disease Integrative medicine East-West medicine Traditional Chinese medicine Acupuncture Nutrition Complementary medicine Brain-gut-microbiota axis Brain-naso-sinus-pharynx-larynx-microbiota axis 


  1. 1. Accessed 8 Oct 2017.
  2. 2.
    Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001;111(8):1313–7.CrossRefGoogle Scholar
  3. 3.
    Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274–7.CrossRefGoogle Scholar
  4. 4.
    Yap L, Pothula VB, Warner J, Akhtar S, Yates E. The root and development of otorhinolaryngology in traditional Chinese medicine. Eur Arch Otorhinolaryngol. 2009;266(9):1353–9.CrossRefGoogle Scholar
  5. 5.
    Yin J, Chen JD. Gastrointestinal motility disorders and acupuncture. Auton Neurosci. 2010;157(1–2):31–7.CrossRefGoogle Scholar
  6. 6.
    Li H, He T, Xu Q, Li Z, Liu Y, Li F, Yang B-F, Liu C-Z. Acupuncture and regulation of gastrointestinal function. World J Gastroenterol. 2015;21(27):8304–13.CrossRefGoogle Scholar
  7. 7.
    Shuai X, Xie P, Liu J, Xiang Y, Li J, Lan Y. Different effects of electroacupuncture on esophageal motility and serum hormones in cats with esophagitis. Dis Esophagus. 2008;21(2):170–5.CrossRefGoogle Scholar
  8. 8.
    Chang FY, Chey WY, Ouyang A. Effect of transcutaneous nerve stimulation on esophageal function in normal subjects – evidence for a somatovisceral reflex. Am J Chin Med. 1996;24:185–92.CrossRefGoogle Scholar
  9. 9.
    Wang C, Zhou DF, Shuai XW, Liu JX, Xie PY. Effects and mechanisms of electroacupuncture at PC6 on frequency of transient lower esophageal sphincter relaxation in cats. World J Gastroenterol. 2007;13(36):4873–80.CrossRefGoogle Scholar
  10. 10.
    Li YQ, Zhu B, Rong PJ, Ben H, Li YH. Neural mechanism of acupuncture-modulated gastric motility. World J Gastroenterol. 2007;13(5):709–16.CrossRefGoogle Scholar
  11. 11.
    Ouyang H, Yin J, Wang Z, Pasricha PJ, Chen JD. Electroacupuncture accelerates gastric emptying in association with changes in vagal activity. Am J Physiol Gastrointest Liver Physiol. 2002;282(2):G390–6.CrossRefGoogle Scholar
  12. 12.
    Niu WX, He GD, Liu H, Qin XY. Effects and probable mechanisms of electroacupuncture at the Zusanli point on upper gastrointestinal motility in rabbits. J Gastroenterol Hepatol. 2007;22(10):1683–9.CrossRefGoogle Scholar
  13. 13.
    Noguchi E. Acupuncture regulates gut motility and secretion via nerve reflexes. Auton Neurosci. 2010;156(1–2):15–8.CrossRefGoogle Scholar
  14. 14.
    Lux G, Hagel J, Bäcker P, Bäcker G, Vogl R, Ruppin H, Domschke S, Domschke W. Acupuncture inhibits vagal gastric acid secretion stimulated by sham feeding in healthy subjects. Gut. 1994;35(8):1026–9.CrossRefGoogle Scholar
  15. 15.
    Tougas G, Yuan L, Radamaker JW, Chiverton SG, Hunt RH. Effect of acupuncture on gastric acid secretion in healthy male volunteers. Dig Dis Sci. 1992;37:1576–82.CrossRefGoogle Scholar
  16. 16.
    Jin HO, Zhou L, Lee KY, Chang TM, Chey WY. Inhibition of acid secretion by electrical acupuncture is mediated via beta-endorphin and somatostatin. Am J Phys. 1996;271(3 Pt 1):G524–30.Google Scholar
  17. 17.
    Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62(6):591–9. Review.PubMedGoogle Scholar
  18. 18.
    Mayer EA. Tillisch, Gupta. Gut/brain axis and the microbiota. J Clin Invest. 2015;125(3):926–38.CrossRefGoogle Scholar
  19. 19.
    Fang J, Wang D, Zhao Q, Hong Y, Jin Y, Liu Z, Zhou K, Jing X, Yu X, Pan R, Chang A, Liu H, Zhu B. Brain-Gut axis modulation of acupuncture in functional dyspepsia: a preliminary resting-state fcMRI study. Evid Based Complement Alternat Med. 2015;2015:860463.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Hui KK, Marina O, Liu J, Rosen BR, Kwong KK. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Auton Neurosci. 2010;157(1–2):81–90.CrossRefGoogle Scholar
  21. 21.
    Zeng F, Qin W, Ma T, Sun J, Tang Y, Yuan K, Li Y, Liu J, Liu X, Song W, Lan L, Liu M, Yu S, Gao X, Tian J, Liang F. Influence of acupuncture treatment on cerebral activity in functional dyspepsia patients and its relationship with efficacy. Am J Gastroenterol. 2012;107(8):1236–47.CrossRefGoogle Scholar
  22. 22.
    Xu J, Zheng X, Cheng KK, Chang X, Shen G, Liu M, Wang Y, Shen J, Zhang Y, He Q, Dong J, Yang Z. NMR-based metabolomics reveals alterations of electro-acupuncture stimulations on chronic atrophic gastritis rats. Sci Rep. 2017;7:45580.CrossRefGoogle Scholar
  23. 23.
    Wagner Mackenzie B, Waite DW, Hoggard M, Taylor MW, Biswas K, Douglas RG. Moving beyond descriptions of diversity: clinical and research implications of bacterial imbalance in chronic rhinosinusitis. Rhinology. 2017;55(4):291–7.CrossRefGoogle Scholar
  24. 24.
    Cope EK, Goldberg AN, Pletcher SD, Lynch SV. Compositionally and functionally distinct sinus microbiota in chronic rhinosinusitis patients have immunological and clinically divergent consequences. Microbiome. 2017;5(1):53.CrossRefGoogle Scholar
  25. 25.
    Weihe E, Krekel J. The neuroimmune connection in human tonsils. Brain Behav Immun. 1991;5(1):41–54.CrossRefGoogle Scholar
  26. 26.
    Halum SL, Sycamore DL, McRae BR. A new treatment option for laryngeal sensory neuropathy. Laryngoscope. 2009;119(9):1844–7.CrossRefGoogle Scholar
  27. 27.
    Hamdan AL, Jabour J, Azar ST. Goiter and laryngeal sensory neuropathy. Int J Otolaryngol. 2013;2013:765265.CrossRefGoogle Scholar
  28. 28.
    Generoso MB, Trevizol AP, Kasper S, Cho HJ, Cordeiro Q, Shiozawa P. Pregabalin for generalized anxiety disorder: an updated systematic review and meta-analysis. Int Clin Psychopharmacol. 2017;32(1):49–55.CrossRefGoogle Scholar
  29. 29.
    Hou J. Traditional Chinese treatment for Otolaryngologic diseases. Beijing: Academy Press; 1997.Google Scholar
  30. 30.
    Dickman R, Schiff E, Holland A, Wright C, Sarela SR, Han B, Fass R. Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Aliment Pharmacol Ther. 2007;26(10):1333–44.CrossRefGoogle Scholar
  31. 31.
    Zhang CX, Qin YM, Guo BR. Clinical study on the treatment of gastroesophageal reflux by acupuncture. Chin J Integr Med. 2010;16(4):298–303.CrossRefGoogle Scholar
  32. 32.
    Ma TT, Yu SY, Li Y, Liang FR, Tian XP, Zheng H, Yan J, Sun GJ, Chang XR, Zhao L, Wu X, Zeng F. Randomised clinical trial: an assessment of acupuncture on specific meridian or specific acupoint vs. sham acupuncture for treating functional dyspepsia. Aliment Pharmacol Ther. 2012;35(5):552–61.CrossRefGoogle Scholar
  33. 33.
    Niva M. All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns. Appetite. 2007;48(3):384–93.CrossRefGoogle Scholar
  34. 34.
    Grotto D, Zied E. The standard American diet and its relationship to the health status of Americans. Nutr Clin Pract. 2010;25(6):603–12.CrossRefGoogle Scholar
  35. 35.
    Glanz K, Basil M, Maibach E, Goldberg J, Snyder D. Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. J Am Diet Assoc. 1998;98(10):1118–26.CrossRefGoogle Scholar
  36. 36.
    Barratt-Fornell A, Drewnowski A. The taste of health: Nature’s bitter gifts. Nutr Today. 2002;37(4):144–50.CrossRefGoogle Scholar
  37. 37.
    Sax PE. The Sanford guide – 46 editions later, still going strong. NEJM J Watch Infect Dis. 2016.Google Scholar
  38. 38.
    Gilbert DN, Chambers HF, Eliopoulos GM, Saag MS, Pavia AT. Sanford guide to antimicrobial therapy 2017. 47th ed. Sperryville: Antimicrobial Therapy, Inc.; 2017.Google Scholar
  39. 39.
    Koufman JA. Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann Otol Rhinol Laryngol. 2011;120(5):281–7.CrossRefGoogle Scholar
  40. 40.
    Maciocia G. The foundations of Chinese medicine: a comprehensive text for acupuncturists and herbalists. 2nd ed. Philadelphia: Elsevier; 2005.Google Scholar
  41. 41.
    Taché Y, Bonaz B. Corticotropin-releasing factor receptors and stress-related alterations of gut motor function. J Clin Invest. 2007;117:33–40.CrossRefGoogle Scholar
  42. 42.
    Mittal RK, Stewart WR, Ramahi M, Chen J, Tisdelle D. The effects of psychological stress on the esophagogastric junction pressure and swallow-induced relaxation. Gastroenterology. 1994;106:1477–84.CrossRefGoogle Scholar
  43. 43.
    Lyte M, Vulchanova L, Brown DR. Stress at the intestinal surface: catecholamines and mucosa-bacteria interactions. Cell Tissue Res. 2011;343:23–32.CrossRefGoogle Scholar
  44. 44.
    Dockray GJ. Enteroendocrine cell signalling via the vagus nerve. Curr Opin Pharmacol. 2013;13(6):954–8. Review.CrossRefGoogle Scholar
  45. 45.
    Azuma K, Zhou Q, Niwa M, Kubo KY. Association between mastication, the Hippocampus, and the HPA Axis: a comprehensive review. Int J Mol Sci. 2017;18(8):1687.CrossRefGoogle Scholar
  46. 46.
    Soffer EE, Summers RW, Gisolfi C. Effect of exercise on intestinal motility and transit in trained athletes. Am J Phys. 1991;260(5 Pt 1):G698–702.Google Scholar
  47. 47.
    Matsuzaki J, Suzuki H, Masaoka T, Tanaka K, Mori H, Kanai T. Influence of regular exercise on gastric emptying in healthy men: a pilot study. J Clin Biochem Nutr. 2016;59(2):130–3.CrossRefGoogle Scholar
  48. 48.
    Wang Y, Kondo T, Suzukamo Y, Oouchida Y, Izumi S. Vagal nerve regulation is essential for the increase in gastric motility in response to mild exercise. Tohoku J Exp Med. 2010;222(2):155–63.CrossRefGoogle Scholar
  49. 49.
    Willcox BJ, Willcox CD, Suzuki M. The Okinawa program: how the World’s longest-lived people achieve everlasting health – and how you can too. New York: Three Rivers Press; 2001.Google Scholar
  50. 50.
    Buettner D. The blue zones: lessons for living longer from the people Who’ve lived the longest. Washington, DC: National Geographic Society; 2010.Google Scholar
  51. 51.
    Walthouwer MJ, Oenema A, Candel M, Lechner L, de Vries H. Eating in moderation and the essential role of awareness. A Dutch longitudinal study identifying psychosocial predictors. Appetite. 2015;87:152–9.CrossRefGoogle Scholar
  52. 52.
    Partridge SR, McGeechan K, Bauman A, Phongsavan P, Allman-Farinelli M. Improved eating behaviours mediate weight gain prevention of young adults: moderation and mediation results of a randomised controlled trial of TXT2BFiT, mHealth program. Int J Behav Nutr Phys Act. 2016;13:44.CrossRefGoogle Scholar
  53. 53.
    Mishima Y, Amano Y, Takahashi Y, Mishima Y, Moriyama N, Miyake T, Ishimura N, Ishihara S, Kinoshita Y. Gastric emptying of liquid and solid meals at various temperatures: effect of meal temperature for gastric emptying. J Gastroenterol. 2009;44(5):412–8.CrossRefGoogle Scholar
  54. 54.
    Sun WM, Penagini R, Hebbard G, Malbert C, Jones KL, Emery S, Dent J, Horowitz M. Effect of drink temperature on antropyloroduodenal motility and gastric electrical activity in humans. Gut. 1995;37(3):329–34.CrossRefGoogle Scholar
  55. 55.
    Yang YX, Metz DC. Safety of proton pump inhibitor exposure. Gastroenterology. 2010;139(4):1115–27.CrossRefGoogle Scholar
  56. 56.
    Vaezi MF, Yang YX, Howden CW. Complications of proton pump inhibitor therapy. Gastroenterology. 2017;153(1):35–48.CrossRefGoogle Scholar
  57. 57.
    Carroll TL, Werner A, Nahikian K, Dezube A, Roth DF. Rethinking the laryngopharyngeal reflux treatment algorithm: evaluating an alternate empiric dosing regimen and considering up-front, pH-impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease. Laryngoscope. 2017;127(Suppl 6):S1–S13.CrossRefGoogle Scholar
  58. 58.
    Lin RJ, Sridharan S, Smith LJ, Young VN, Rosen CA. Weaning of proton pump inhibitors in patients with suspected laryngopharyngeal reflux disease. Laryngoscope. 2018;128(1):133–137.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.UCLA Center for East-West Medicine, UCLA Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA

Personalised recommendations