"People demand freedom of speech to make up for the freedom of thought which they avoid."
- Soren Aabye Kierkegaard -

The purpose of the gastrointestinal (GI) tract is to digest nutrients from food sources so the body can absorb them to support life. I would estimate that up to half the people who come to my clinic suffer from some sort of digestive problem.  In such cases I must first identify and treat these conditions before I can focus on managing other health concerns. Digestive problems are often directly linked to improper dietary choices, already discussed in the previous section on nutrition. Beyond that, a comprehensive understanding of the GI system is your best bet for continued digestive health, so we are going to walk through it step by step and learn how to use herbs to repair digestive problems.
 
Our basic topics of discussion include:
• Understanding the digestive process
• Restoring digestive power
• Coating, soothing and healing irritated intestinal membranes
• Reducing intestinal acid and inflammation
• Reducing dampness and mucus in the intestinal tract
• Clearing toxic bacteria and fungi from the alimentary system
• Restoring balance to the intestinal flora

The Food Tube

The digestive tract is a continuous tube, running from the lips to the anus, which is embryologically derived primarily from the primary germ cell layer called the endoderm, and supported by a rich network of nerves, lymph tissue and blood vessels. It is lined with soft tissues and membranes that guide food as it passes through, breaking it down and finally absorbing the resultant nutrients into the bloodstream and passing out remaining wastes for elimination. Out-pouchings within this tube become the organs we all know, such as the lungs, the liver and the pancreas, which secrete substances necessary for digestion. Seen as a whole, the digestive tube is an intelligent nutrient absorption and transport system.  As we discussed in chapter ten, the tongue is the primary digestive sense organ and a very useful tool for diagnosing digestive problems. I always refer to tongue if I am unsure of an intestinal diagnosis. 

The integrity of the membranes lining the GI tract is another determining factor in overall GI health. Insults from dietary errors, diseases or various chemical or mechanical problems can erode this membrane.  It is an unfortunate fact that by the age of 85, two-thirds of the populations in Western countries suffer from diverticulosis (Larrson, 1997).  We tend to ignore many digestive problems such as pain, diarrhea and constipation, or to simply treat them symptomatically instead of resolving them permanently. Prompt identification and correction of GI problems is crucial to maintaining good health throughout life.

Hunger and Appetite

Hunger is a physiological desire for food after a period of fasting, while appetite is the learned or evoked desire awakened by the presence of food.  Someone who is extremely hungry may still not have an appetite for disliked foods. As well, someone who is not hungry may still have an appetite for delicious foods. Because hunger is controlled by physiological needs, and appetite is controlled by conditioned or mental factors, it is often important to distinguish these two.

Digestive Power

Most digestive problems are related to imbalances or changes in the digestive power. When the digestive power is strong, your appetite is regular, your system digests food easily and completely, and bowel movements are regular and complete. This combination of factors indicates that the various parts of the digestive system are working together smoothly.

Ayurvedic doctors point out that to maintain digestive power, it is very important to maintain regular meal times, choose healthy, well-prepared foods, and exercise portion control. Overeating, not eating enough, skipping meals, eating between means frequently, or indulging in foods that are overly sweet, greasy or stale can all stress the digestive function (Bajracharya, 1976).  Emotional stress can also weaken the digestive power. either directly by decreasing hunger, or indirectly by affecting appetite.

The Mouth

Digestion begins in the mouth where your teeth break down food and mix it with saliva, forming a bolus. Enzymes (amylase and ptyalin) are released which initiate fat and carbohydrate digestion. The saliva is important not only because of enzymes, but also because it contains nutrients and minerals important to remineralize your teeth and to lubricate and protect your mouth membranes.  Regular mouth cleaning (brushing and flossing) is important to remove bacteria-encouraging debris, and to slow formation of placques and tartar.

• Ayurveda offers a very useful custom of cleaning the tongue each morning with a metal scraping tool. These tools are available online or in various health food stores.
• Echinacea tincture stimulates saliva flow for dry mouth when mixed with water and swished around in the mouth. It is also valuable for stimulating secretory IgA, a protective immune system antibody.
• Haritaki fruit is an effective mouthwash, when mixed with cold water, for treating spongy gums and slowing down bacterial growth.



Stomach and Intestine Sensitivity

The stomach churns our food, emulsifies fats and continues the enzymatic breakdown of foods. In cases of extreme stomach or intestinal sensitivity and inflammation, even simple, gentle herbs can cause a negative reaction. In these cases, before I use the herbs mentioned above, I administer a simple combination of slippery elm bark and DGL licorice root, about two grams two or three times per day. This formula mechanically soothes and coats the intestines. It can be used for several weeks up to a few months to heal the intestinal lining, after which you can safely add other herbs. Another good choice along with the slippery elm and licorice is liquid chlorophyll, about 1 tablespoon once or twice per day. These herbs are so safe that they can be used even if you are not sure what your digestive problem is.

Control of Nausea and Vomiting

Abdominal stimulation by irritants or toxins can activate nausea and vomiting through mechano- or chemo-receptors found in the mucosa of the stomach, jejunum and ileum. Vomiting and nausea are natural protective responses of your digestive system to prevent intake of noxious substances, and should not be inhibited until the cause is removed, if known. However, vomiting can itself be a troublesome symptom as well if prolonged due to irritation rather than an immediate and true toxicity.

• The TCM combination of ginger root, agastache, pinellia tuber and tangerine peel offers simple nausea relief. Take 1-2 grams of concentrated extract powders before meals.
∑ Adding inula flower (xuan fu hua or Inula species) to the same formula often helps control vomiting. This flower has a strong downward action according to TCM doctors.

Gastric Ulcers
Continued weakness and inflammation of the gastrointestinal membranes can lead to the formation of ulcers.  Recent scientific evidence indicates that the H. pylori bacterium plays an influential role in ulcer formation.  However, we must remember that pathological organisms only flourish when conditions are favorable. For example, dental plaque can harbor a supply of H. pylori, which may allow continual re-infection (Dosai, et. al 1991).  In cases of gastric ulcers, we must first address diet, stress, food allergies, liver health and digestive power. It is sometimes possible to obtain symptomatic relief with cooked okra, cabbage juice or bananas. A few weeks or months of DGL licorice therapy can also serve to strengthen the stomach and intestinal membranes. This is very effective, even in some cases of H. pylori infection. In stubborn cases that do not respond to simple therapy, research indicates that mastic gum (Pistacia lentiscus) is emerging as a beneficial anti-ulcer therapy (Huwez, et. al 1998).

Digestive Acid and Heat
When the stomach nerves are overactive, often as a result of tension or stress, the stomach produces more acid. Normally, foods should remain in the stomach for four or five hours, and will not pass down through the pylorus (a muscular tissue which controls outlet from the stomach) until they are completely digested. However, in this hyperactive condition, incompletely processed foods pass down through the opening early—one of the physical causes of indigestion and diarrhea. For example, rapid gastric emptying often occurs from pylorus muscle weakness caused by hypoglycemia (Stobo et al., 1996).  The rapid but incompletely processed and acidic downflow weakens the duodenum, which is alkaline in its function. If it cannot neutralize the acidity, weakening (irritation or erosion) of the duodenal membrane will ensue.
If stress is the cause of the hyperacidity and consequential weakness, dealing with the cause of the stress is the best solution.  Herbs that can be useful in this capacity as adjunct therapy are those known to calm agitation, such as scullcap, kava root, or bupleurum root, along with herbs that reduce acidity like cardamom seeds (Amomum species) or dried cuttlefish bone (Used in TAM and TCM, a good source of calcium).
General systemic inflammation can also cause stomach acidity because it leads to increased blood circulation and heat in the digestive organs. This heat stimulates the digestive fire.  In this condition, there are higher levels of acid in both the stomach and the rest of the intestine, including the duodenum. This causes the general symptoms of gastritis with constipation or duodenitis with diarrhea, usually accompanied by an increase in appetite.  The heat in the stomach causes a reduction in the digestive and blood fluids that can lead to excessive thirst and craving for cold liquids. Additionally, heat in the colon causes an increased absorption of fluids out of the colon, leading to constipation.
Laxatives like rhubarb root can be useful for initially purging this heat.  If the patient is weak, I mix rhubarb root with an equal part of triphala, which has tonic qualities less likely to further weakness. The herbs are given for 1-2 days at bedtime at dosages enough to cause 2-3 bowel movements the following day. Cooling herbs (heat reducing group) can also neutralize these problems, including those that remove heat from the liver. TCM doctors often use coptis root, which is very cold in action, to treat heartburn and microbial diarrhea.  I use it most frequently in these cases, along with dandelion root and scute root. Boswellia gum and phellodendron root are two other very important herbs for treating intestinal inflammation.

Dampness and Mucus
Eating too many fatty, oily, cold or difficult-to-digest foods can create conditions of dampness and mucus, which weaken digestion.  It is also important to understand that conditions of weak digestion can create dampness and mucus. The increased mucus (sometimes called phlegm) accumulates and inactivates or neutralizes the stomach acidity and the alkaline reaction in the intestines. This results in slowed digestion, which affects all the natural functions of the digestive system.  Symptoms of dampness and mucus include a sensation of heaviness, abdominal distention, nausea and sometimes diarrhea.  There will often be a greasy coating or tooth marks on the tongue.
Treatment of these conditions requires herbs that warm and stimulate digestive function along with herbs that break up mucus and/or help to move the stagnant energy. Poria mushroom, pinellia tuber, black atractylodes, magnolia bark, sausurrea root (mu xiang or S, lappa) and tangerine peel are especially effective.   Additional useful treatments include ginger root, black or long pepper, coriander seeds and amla fruit, among others. In cases of extreme nausea, use warming aromatic herbs like agastache, magnolia bark and fresh ginger root.   Patience is a true virtue when treating these cases, because conditions of dampness and mucus often take months to completely resolve if they are chronic.