Chinese medicine for hiatal hernia
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
On this page
- Overview
- What is a hiatal hernia?
- Symptoms
- Causes and risk factors
- The TCM understanding
- Acupuncture
- Chinese herbal medicine
- Diet
- Lifestyle and self-help
- Supplements with evidence
- When to see a doctor
- Frequently asked questions
1. Overview
A hiatal hernia occurs when part of the stomach pushes through the diaphragm into the chest cavity. Small hiatal hernias are extremely common — affecting approximately 20% of adults — and the majority cause no symptoms. When symptoms do occur, they are driven by acid reflux and impaired gastro-oesophageal junction function, producing heartburn, regurgitation, chest pain and difficulty swallowing. Traditional Chinese medicine cannot reverse the structural hernia, but it can very effectively manage the symptomatic pattern of stomach qi rebelling upward. I am Dr (TCM) Attilio D’Alberto, with over 25 years of clinical experience.
2. What is a hiatal hernia?
The diaphragm has a natural opening (the hiatus) through which the oesophagus passes to reach the stomach. In a hiatal hernia, the upper part of the stomach pushes up through this opening into the chest cavity. There are two main types:
- Sliding hiatal hernia — by far the most common type. The gastro-oesophageal junction and a portion of the stomach slide up and down through the hiatus, particularly during pressure changes (lying down, straining). Often associated with reflux.
- Paraoesophageal hernia — less common but more concerning. Part of the stomach herniates alongside the oesophagus while the junction stays in place. Can lead to strangulation in severe cases.
3. Symptoms
- Heartburn (burning chest pain rising up)
- Regurgitation of food or sour fluid
- Chest pain (sometimes mistaken for cardiac pain — always investigate)
- Difficulty swallowing (dysphagia)
- Bloating and belching
- Hiccups
- Feeling of food sticking in the chest
- Cough or wheeze, particularly at night (from acid microaspiration)
- Hoarseness
- Sore throat
- Bad breath
4. Causes and risk factors
- Age (incidence rises sharply after 50)
- Obesity — abdominal pressure pushes the stomach up
- Chronic cough or constipation (straining)
- Pregnancy (transient hiatal hernia in late pregnancy)
- Heavy lifting
- Smoking (weakens the lower oesophageal sphincter)
- Trauma or surgery
- Genetic predisposition
5. The TCM understanding
The symptoms of a hiatal hernia in TCM reflect Stomach qi failing to descend — the stomach’s natural downward movement is disrupted, causing acid and food to rise. This is compounded by:
- Liver qi stagnation invading the Stomach — stress-related cases; emotional tension impairs the middle burner. Symptoms worsen with stress, often accompanied by sighing and chest tightness.
- Stomach heat — reflux burns, accompanied by thirst, preference for cold drinks, possibly bad breath, red tongue with yellow coating.
- Stomach yin deficiency — in chronic cases or after long PPI use; dry mouth, dry throat, hunger without appetite, red tongue with little coating.
- Phlegm-damp obstructing the middle burner — bloating, heaviness, sticky tongue coating, often with a sense of fullness in the chest.
- Spleen qi deficiency — underlying weakness; fatigue, loose stools, weak digestion.
6. Acupuncture
Acupuncture directly regulates gastric motility, increases the lower oesophageal sphincter tone and reduces visceral hypersensitivity. Research shows acupuncture significantly reduces reflux symptoms compared to PPIs in some studies, with no rebound effect. Key acupuncture points used include CV 12 (Zhong Wan), ST 36 (Zu San Li), PC 6 (Nei Guan) and LV 3 (Tai Chong). Most patients see meaningful change within 6–8 weekly sessions.
7. Chinese herbal medicine
Formulas used:
- Ban Xia Xie Xin Tang — harmonises the middle burner and descends rebellious qi; particularly useful in mixed cold-heat presentations
- Ban Xia Hou Po Tang — for the “plum stone” sensation (globus) and stress-related stuck feeling in the throat
- Zuo Jin Wan — for Liver fire invading the Stomach with bitter regurgitation
- Xiao Yao San — for Liver qi stagnation pattern
- Liu Jun Zi Tang — for Spleen qi deficiency with phlegm
I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, individually tailored.
8. Diet
- Smaller, more frequent meals — large meals stretch the stomach and worsen reflux
- Avoid eating within 3 hours of bedtime — lying down with a full stomach is the single biggest dietary trigger
- Reduce common reflux triggers — coffee, alcohol, chocolate, peppermint, citrus, tomatoes, fatty/fried food, spicy food
- Reduce ultra-processed food — correlates strongly with reflux symptoms
- Eat warm cooked foods — cold raw foods weaken the Spleen and Stomach in TCM terms
- Eat slowly and chew thoroughly — aids gastric emptying
- Stay upright after meals for at least 30–60 minutes
- Limit fluids during meals — drink between meals instead
9. Lifestyle and self-help
- Raise the head of the bed by 15–20 cm using bed risers (not just extra pillows, which bend the body and worsen symptoms)
- Sleep on the left side — reduces nocturnal reflux
- Reduce abdominal pressure — avoid tight belts, achieve healthy weight, treat constipation
- Stop smoking — weakens the lower oesophageal sphincter
- Manage stress — meditation, breathwork, yoga; chronic stress drives the Liver-invading-Stomach pattern
- Diaphragmatic breathing exercises — emerging evidence for strengthening the diaphragmatic crura around the hiatus
- Avoid heavy lifting immediately after meals
10. Supplements with evidence
- D-limonene — orange peel extract; some evidence for reflux symptoms
- Deglycyrrhizinated liquorice (DGL) — soothes oesophageal lining
- Slippery elm or marshmallow root — demulcent herbs that coat the oesophagus
- Melatonin — some evidence for nocturnal reflux
- Probiotic — supports digestive function generally
- Magnesium — supports lower oesophageal sphincter function
- B12 — particularly important if on long-term PPI
11. When to see a doctor
See your GP urgently for any of the following:
- Difficulty swallowing or food sticking
- Unintentional weight loss
- Vomiting blood or coffee-ground material
- Black tarry stools (suggests upper GI bleeding)
- Iron deficiency anaemia
- Severe persistent chest pain (always exclude cardiac cause first)
- Symptoms not responding to PPI treatment
- New onset over the age of 50
12. Frequently asked questions
Can Chinese medicine cure a hiatal hernia?
Chinese medicine cannot reverse the structural hernia — the anatomy of the hiatus does not change with herbal treatment. What it can do, very effectively, is manage the symptoms (reflux, regurgitation, chest discomfort, globus sensation) by addressing the underlying TCM pattern of Stomach qi rebelling upward.
Does acupuncture help acid reflux?
Yes. Multiple studies show acupuncture significantly reduces reflux symptoms and improves lower oesophageal sphincter tone. Some research has found acupuncture comparable to PPI therapy for symptom control, with no rebound effect.
What is the best Chinese herbal formula for hiatal hernia?
Most commonly Ban Xia Xie Xin Tang for mixed cold-heat presentations or Ban Xia Hou Po Tang for the plum-stone sensation. The right formula depends on the individual TCM pattern.
What foods should I avoid with a hiatal hernia?
Coffee, alcohol, chocolate, peppermint, citrus, tomatoes, spicy and fatty/fried foods, large meals, eating within 3 hours of bed, and ultra-processed food. Reduce dairy if it produces phlegm and worsens symptoms.
Can stress make a hiatal hernia worse?
Yes — stress is one of the most consistent triggers of symptoms in patients with hiatal hernia. In TCM terms, chronic stress causes Liver qi to invade the Stomach, disrupting its descending function and worsening reflux. Stress management is central to lasting improvement.
Should I stop my PPI to take Chinese medicine?
Never stop PPI medication abruptly — rebound acid hypersecretion can be severe. Chinese medicine works alongside PPI therapy, and many patients gradually reduce PPI use as TCM treatment establishes symptom control. Any reduction should be discussed with your GP.
To discuss digestive health, contact me or book a consultation at my Wokingham, Berkshire clinic.
