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Gastrointestinal bloating is a very common symptom, not a disease itself. The local cause of bloating is the abnormal fermentation of food in the stomach and intestines, producing gas. Common symptoms include a feeling of distension in the stomach or abdomen, frequent belching (burping), and flatulence (passing gas). Excessive gas in the gastrointestinal tract can push upwards, causing chest tightness and a foreign body sensation in the throat, which can easily be mistaken for heart or lung problems.

• In irritable bowel syndrome (IBS), 80-90% of patients experience abdominal bloating.
• The proportion of female patients is significantly higher than that of male patients, especially related to the menstrual cycle. This may be related to female hormones (such as progesterone) slowing intestinal motility and differences in pelvic anatomy.
• More common in adults, and the incidence increases with age due to weakened digestive function.
• Also prevalent among populations under high stress.

The severity of symptoms is not necessarily proportional to the objective amount of intestinal gas and is also related to individual subjective sensitivity.

Bloating is usually not a sign of a serious disease, but it affects quality of life, and severe cases can even impact social interactions.

Findings of Modern Medicine

Gastrointestinal bloating is mainly caused by the abnormal production, accumulation, or expulsion of gas. The primary source of gas is bacterial fermentation in the intestines. Common pathogenic factors are as follows:

• Eating too many gas-producing foods: Beans, cruciferous vegetables, whole grains, oats, onions, garlic, leeks, fruits, artificial sweeteners. Most of these are high FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) foods, which are short-chain carbohydrates poorly absorbed in the small intestine. They are rapidly fermented by bacteria in the large intestine, producing large amounts of gas. Most healthy people have no issues, but those with sensitive bowels may experience significant bloating and discomfort. Carbonated drinks can also cause bloating.
• Eating too quickly, gulping food, swallowing too much air.
• Lactose intolerance or fructose malabsorption: Leads to sugars being fermented by bacteria in the large intestine, producing gas.
• Gluten intolerance: Sensitivity to certain components in wheat and barley, leading to malabsorption and gas production.
• Gastroesophageal reflux disease (GERD): Patients often unconsciously swallow saliva frequently to relieve discomfort, thereby swallowing more air.
• Irritable bowel syndrome (IBS): This is one of the primary causes of chronic bloating. Its mechanisms include: gut-brain axis dysfunction, abnormal intestinal motility, visceral hypersensitivity.
• Poor function of the liver, gallbladder, stomach, intestines, or pancreas, leading to poor digestion of food.
• Small intestinal bacterial overgrowth (SIBO): Abnormal proliferation of colonic bacteria in the small intestine, prematurely fermenting food and producing large amounts of gas, accompanied by bloating, abdominal pain, diarrhea, or constipation.
• Constipation: Stool stays in the large intestine for too long, giving bacteria more time to ferment and produce gas.
• Certain medications or high-dose fiber supplements may cause or exacerbate bloating.
• Others: Pelvic tumors pressing on the abdomen, mistaken for gastrointestinal bloating.

This article only discusses simple functional bloating, not bloating indirectly caused by other diseases, such as tumor obstruction.

Modern Medical Treatment

For mild to moderate bloating, the following measures are usually effective:

• Adjust eating habits: Chew thoroughly and eat slowly, avoid overeating.
• Reduce high FODMAP foods, carbonated drinks, high-fat foods, and overly processed foods.
• Those with gluten intolerance, lactose intolerance, or fructose malabsorption should naturally avoid these foods.
• Moderate exercise, even walking, can promote intestinal motility.
• Stress management: Reduce stress through meditation, yoga, deep breathing, etc.

The following types of auxiliary medications can relieve symptoms.

• Defoaming agents: Can change the surface tension of bubbles, causing small bubbles to merge into larger ones, making them easier to expel via belching or flatulence. Effective for bloating caused by bubbles, but has limited effect on "free gas" produced by bacteria.
• Probiotics: Supplement good bacteria, adjust the balance of intestinal flora, potentially reducing overgrowth of gas-producing bacteria and improving intestinal function. Effectiveness varies from person to person and requires consistent intake for several weeks to show results.
• Lactase enzyme: Can be taken by those with lactose intolerance before consuming dairy products.
• Alpha-galactosidase: An enzyme that breaks down oligosaccharides in beans and vegetables, helping to reduce gas production.

If the above methods are ineffective, or prescription drugs for specific diagnosed conditions:

• Medications that promote intestinal motility: Can accelerate gastric and intestinal emptying, reducing the retention of gas and contents. Suitable for gastroparesis or constipation-predominant IBS with slow motility.
• Treating small intestinal bacterial overgrowth (SIBO): Antibiotics can reduce the excessive bacteria in the small intestine, decreasing gas production.
• Medications that regulate visceral sensitivity: Target visceral hypersensitivity in IBS. These drugs (e.g., low-dose antidepressants) act on the brain-gut axis and can reduce the sensitivity of the intestinal nerves, making patients feel less bloated and painful from normal amounts of gas.
• Antispasmodic medications: Relax intestinal smooth muscles, relieving intestinal colic and spasms caused by bloating.

The Systemic View of Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) did not have the disease name "gastrointestinal bloating" in ancient times, but had similar disease names or symptoms.

TCM believes the key to bloating lies in the stagnation of qi dynamics, which refers to functional activities, meaning the operational function of the spleen, stomach, and intestines is obstructed. The spleen and stomach are located in the middle energizer and are the pivot for the ascending and descending of the body's qi dynamics. The spleen governs the ascending of the clear, and the stomach governs the descending of the turbid. Once the function of this pivot becomes impaired, it leads to "stagnation of qi dynamics in the middle burner," thereby producing distension and fullness. Its main etiologies can be summarized as:

• Damage from diet: Such as overeating, excessive consumption of raw, cold, or icy foods, indulgence in rich, sweet, and greasy foods, excessive alcohol consumption, etc. These easily lead to indigestion, food accumulation and stagnation, or the brewing of dampness-heat, obstructing qì jī and affecting gastrointestinal function.
• Emotional disharmony: Such as worry damaging the spleen, anger damaging the liver, directly or indirectly leading to stagnation of the spleen's qi dynamics, affecting its transportation and transformation function. Modern people commonly experience liver qi stagnation due to high stress, leading to dysfunction in the ascending and descending of the stomach and intestines.
• Spleen and stomach weakness: Congenitally poor spleen and stomach function, or depletion from chronic illness, or excessive fatigue damaging spleen qi. When the spleen and stomach are weak, their functions of transporting and transforming water and grains and distributing fluids decline, easily generating internal "dampness-turbidity" or "phlegm-rheum." These pathological products, in turn, obstruct qi dynamics, forming a complex situation of "deficiency in origin and excess in manifestation" (spleen-stomach weakness as the root, qi stagnation and damp obstruction as the branch).

TCM first analyzes the possible systemic state and macroscopic cause of the bloating. This macroscopic systemic pathological model is also called a "pattern". Below are several common ones:

• Spleen-Stomach Weakness: Low spleen and stomach function, poor motility and digestive power. Symptoms include poor appetite, easily fatigued. Treatment method is to boost qi and strengthen the spleen, invigorating the energy and motility of the stomach and intestines.
• Food Accumulation and Stagnation: The patient eats too much at once, or doesn't chew food properly, causing the stomach and intestines to struggle to digest, leading to food accumulation and fermentation producing gas. Often accompanied by frequent belching with a sour, foul odor of food. Treated with formulas and herbs that aid digestion and absorption and promote motility.
• Cold-Dampness Encumbering Spleen: The patient frequently or occasionally consumes too many raw, cold foods or cold drinks, causing the stomach and intestines to become cold, leading to reduced motility and absorption. The patient may also experience nausea, thirst but no desire to drink, or abdominal pain, loose stools, frequent flatulence, but none very foul-smelling. The pulse may be tight, or slow (low frequency). Treated with formulas and herbs that warm the stomach and intestines, invigorate their function, and promote motility.
• Spleen-Stomach Dampness-Heat: The patient frequently eats spicy, grilled, fried, or greasy foods, and after one episode of overeating, the stomach and intestines become distended. The patient may also have a burning sensation in the abdomen, and usually may be prone to mouth ulcers, bad breath, thirst. If there is diarrhea, it is also loose and has a burning sensation. Frequent flatulence, often very foul-smelling. Treated with formulas and herbs that clear heat and eliminate dampness.
• Liver Qi Invading Stomach / Liver Depression and Spleen Deficiency: Symptoms include distension and fullness in the epigastrium and abdomen, or migrating pain extending to the flanks, relief after belching, worsening with emotional fluctuations. Adopt methods to soothe the liver, harmonize the stomach, and strengthen the spleen, regulating qi, tonifying deficiency, and reducing distension.

Liver Qi Invading Stomach and Liver Depression with Spleen Deficiency are two related patterns with different emphases, like two branches stemming from the same root (Liver Qi Stagnation). Commonly seen in modern people under stress:

• Liver Qi Invading Stomach: The key is the "Stomach," with "qi counterflow" (upward counterflow) as the main manifestation, symptoms are more "acute," leaning towards excess pattern. Symptoms include distending pain or migrating pain in the epigastrium, chest, and flanks, belching, hiccups, nausea, acid regurgitation, irritability. Symptoms are strongly related to emotions, often triggered immediately during stress. Treated by soothing the liver and regulating qi, descending counterflow.
• Liver Depression with Spleen Deficiency: The key is the "Spleen," with "impaired transportation and transformation" (functional weakness) as the main manifestation, symptoms are more "chronic," leaning towards deficiency pattern. Symptoms include distension and fullness in the epigastrium and abdomen, but pain is not severe, poor appetite, indigestion, loose stools or alternating dry and loose stools, low mood, frequent sighing, with signs of deficiency like fatigue and weakness coexisting with signs of stagnation like abdominal distension and poor appetite. Treated by soothing the liver + strengthening the spleen.

Clinically, Liver Qi Invading Stomach and Liver Depression with Spleen Deficiency often coexist and are difficult to completely separate. Because transverse counterflow of liver qi often affects both the stomach and spleen functions simultaneously, just with different emphasis. The initial stage may manifest as "Liver Qi Invading Stomach," primarily with rebellious qi and distending pain in the stomach. If it persists long-term without resolution, continued liver depression damaging the spleen earth leads to gradual consumption of spleen qi, transforming into "Liver Depression with Spleen Deficiency." Therefore, "Liver Depression with Spleen Deficiency" can be seen as a chronic stage of "Liver Qi Invading Stomach" that involves deficiency damage.

Bloating Caused by Wind, Cold, and Dampness

There is another specific digestive system pathology, which is gastrointestinal bloating caused by external contraction of wind, cold, and dampness. The characteristic of such patients is that their usual gastrointestinal function is already not great, and their skin is also intolerant to wind and cold, belonging to a "deficiency pattern." When encountering cold weather, air conditioning, or damp environments, as soon as the skin gets cold or damp, the stomach and intestines become bloated, and bowel movements become irregular. The pulse in this case would be floating and tight (from cold) or floating and moderate/slow (from dampness). Once it warms up or the dampness recedes, the gastrointestinal symptoms sometimes resolve on their own.

TCM believes: The internal zang-fu organs extend to the body surface through the meridians. The body surface meridians being affected by wind, cold, and dampness can affect the function of the internal organs. Inferring based on existing modern medical knowledge: Nutrients absorbed from gastrointestinal digestion are transmitted to the heart via blood vessels and lymphatic vessels, and then pushed to the micro-vessels throughout the body, a large portion of which are distributed on the skin surface. Additionally, one-third of body water is excreted through the skin surface and respiratory tract. When the body surface is exposed to cold, its micro-vessels, lymphatic vessels, and other micro-pathways constrict, affecting the flow of body fluids on the skin and the normal metabolism of water, creating considerable resistance to the entire nutrient distribution channel. This resistance is transmitted back to the gastrointestinal tract. When the nutrient delivery pathway is obstructed, it affects its digestive and absorptive capacity, leading to gastrointestinal discomfort symptoms.

This type of bloating is a simple matter for TCM: On one hand, use warm-natured exterior-releasing medicinals to dispel the cold from the body surface, reopening the micro-pathways on the body surface and restoring their patency; on the other hand, use qi-tonifying herbs to strengthen the function of the stomach and intestines. Using the cheapest and simplest medicinals, the effect is both fast and good.

Acupoint Massage

Massage the following acupoints, pressing for 3-5 minutes each time until a sore, numb, or distending sensation is felt. This helps to regulate the gastrointestinal qi dynamics.

• Zhongwan (CV12): Located 4 cun directly above the center of the umbilicus (approximately the width of five fingers). The Front-Mu alarm point of the Stomach, it is an important point for treating stomach diseases.
• Tianshu (ST25): 2 cun lateral to the center of the umbilicus (approximately the width of three fingers). The Front-Mu alarm point of the Large Intestine, it can regulate the intestinal organs, regulate qi, and disperse stagnation.
• Zusanli (ST36): 3 cun below the outer depression of the knee (lateral to the patellar ligament), one finger-breadth lateral to the anterior border of the tibia. An important point for strengthening and health preservation, it can strengthen the spleen and harmonize the stomach, tonify the middle and boost qi.
• Taichong (LR3): On the dorsum of the foot, in the depression anterior to the junction of the 1st and 2nd metatarsal bones. The Source yuan point of the Liver Channel, it can soothe the liver and relieve depression, regulate and smooth qi dynamics, especially suitable for bloating caused by stress and emotions.
• Neiguan (PC6): On the forearm, 2 cun proximal to the wrist crease, between the tendons of palmaris longus and flexor carpi radialis. It can soothe the chest and regulate qi, harmonize the stomach and descend counterflow, and stop vomiting.

Health Preservation and Wellness

• Dietary Moderation:
  • Eat regularly and in moderate amounts, chew thoroughly and eat slowly, 70% full is appropriate.
  • Avoid raw, cold, icy, greasy, spicy, and overly sweet foods.
  • Choose foods according to constitution. For example, those with spleen-stomach deficiency-cold can consume moderate amounts of ginger, scallion, and garlic to warm the middle and dispel cold.
• Emotional Regulation: Maintain a happy mood, appropriately relieve stress, such as listening to music, walking, meditating, and avoid excessive worry and anger.
• Appropriate Exercise: Moderate exercise like walking, Tai Chi, or Ba Duan Jin can promote the circulation of qi and blood throughout the body, helping the spleen and stomach in transportation and transformation.
• Abdominal Massage (Rubbing the Abdomen): Rub palms together to warm them, then gently massage the abdomen with the navel as the center in a clockwise direction, using soft pressure. Clockwise massage follows the direction of colon peristalsis, helping to promote intestinal motility and gas expulsion. Perform for 5-10 minutes each time.

Summary

Traditional Chinese Medicine views gastrointestinal bloating as a systemic issue, not just a problem of the intestines and stomach themselves. It is closely related to emotions, diet, constitution, and even the external environment. Treatment starts by regulating the functions of organs like the liver, spleen, and stomach, combining Chinese medicinals, acupuncture, massage, and health preservation practices. The aim is to restore the balance and smooth flow of the body's qi dynamics, fundamentally and thoroughly curing gastrointestinal bloating.