Heartburn, a Burning Sensation in the Esophagus: How Does Traditional Chinese Medicine View It?

A middle-aged friend walked into the consultation room with a furrowed brow and said, "Doctor, recently after I eat, there's a burning sensation in my chest, a fiery heat in my esophagus, like a ball of fire pushing upward that even drinking water can't suppress." He asked in confusion, "Is this a stomach problem or an esophagus problem? Should I eat cold foods to put out the fire?" Such scenes are not uncommon in TCM clinical practice. Heartburn, this seemingly simple symptom, often conceals complex bodily signals behind it.

Where Does the Fire Come From? First Distinguish Deficiency from Excess

Heartburn, a burning sensation in the esophagus, is often categorized in TCM under "gastric upset" (caoza) and "acid regurgitation" (tusuan). But fire has true and false distinctions—is it excess fire at work, or deficient fire flaring upward? The Huangdi Neijing states: "All vomiting of acid, sudden violent downward rushing, all belong to heat." This suggests that heat pathogen is a common trigger. Yet clinically, not everyone has true "heat." Some people have yellow, thick tongue coating, dry mouth, and bitter taste—this is excess heat. Others have a red tongue with little coating and hot palms and soles—this is deficient heat. If one fails to distinguish deficiency from excess and indiscriminately uses cold and cooling substances, it may instead damage the spleen and stomach, making the fire burn even stronger.

Why Do Some People Not Get Heartburn After Eating Spicy Food?

Here's the question: since heartburn is related to heat, why do some people feel better after eating pungent and stimulating foods? This is precisely the subtlety of TCM pattern differentiation. Heartburn, a burning sensation in the esophagus, is sometimes not true heat in the stomach, but rather "cold-heat complex" or "qi movement stagnation." For example, in people with spleen-stomach deficiency cold, transportation and transformation are weak, food stagnates and generates heat, forming "cold wrapped around fire." At this time, pungent substances like fresh ginger and pepper can instead warm the middle and dispel cold, promote qi movement, and allow the constrained heat to dissipate. Thus, one cannot look only at surface phenomena.

Stomach Qi Reversing Upward Is the Core Pathomechanism

Regardless of deficiency or excess, the burning sensation of heartburn in the esophagus always involves the key link of "stomach qi reversing upward." The stomach prefers descending as its normal direction. If, due to improper diet, emotional constraint, or constitutional weakness, stomach qi fails to descend and instead rises, the acid and decomposing contents in the stomach surge upward with the qi, scorching the esophageal mucosa. The Jingui Yaolue mentions: "For belching that does not cease, Xuanfu Daizhe Tang governs it." This reminds us that in treating heartburn, one must not focus only on "fire," but pay even more attention to the ascending, descending, exiting, and entering movements of "qi." When qi flows smoothly, fire naturally has nowhere to hide.

In understanding stomach qi reversing upward, TCM often mentions an acupoint—Zusanli. Zusanli, also known as Xialing or Sanli, is located on the anterior-lateral aspect of the lower leg, 3 cun below Dubi, one finger-breadth from the anterior crest of the tibia. It belongs to the Foot Yangming Stomach Meridian and is the He-Sea point of the Stomach Meridian and the lower He-Sea point of the stomach. The Lingshu states: "When pathogen is in the spleen and stomach, then disease manifests as muscle pain... all are regulated at Zusanli." This point is closely related to the descending and receiving functions of stomach qi, and is an important node where the meridian qi of the Stomach Meridian converges and penetrates deeply into the viscera. Understanding Zusanli helps to understand why stomach qi "fails to descend and instead rises."

The Fire of Emotions Cannot Be Ignored

Clinically, many people with heartburn also experience anxiety, irritability, or excessive rumination. The liver governs free coursing. When emotions are constrained, liver qi becomes depressed and attacks the stomach transversely, and stomach qi subsequently reverses upward. Heartburn in this group tends to worsen under high pressure and emotional fluctuations. TCM has the saying "wood depression transforms into fire." When liver fire and stomach fire intermingle, the burning sensation in the esophagus becomes especially pronounced. At this point, simply clearing stomach fire is like trying to stop water from boiling by stirring it; soothing the liver and resolving depression is the true remedy of removing the firewood from under the cauldron.

When mentioning soothing the liver and resolving depression, Taichong is an acupoint that cannot be overlooked. Taichong, also known as Dachong, is located on the dorsum of the foot, between the first and second metatarsal bones, in the depression anterior to the junction of the metatarsal bases. It belongs to the Foot Jueyin Liver Meridian and is the Yuan-Source point of the Liver Meridian. The liver governs free coursing, prefers free-flowing activity and dislikes depression. As a key gateway for the flow of qi and blood in the Liver Meridian, Taichong is closely related to liver qi depression patterns. The existence of this acupoint gives the pathological process of "wood depression transforming into fire" a concrete correspondence at the meridian level.

Dietary Regulation Emphasizes "Harmony"

For heartburn, a burning sensation in the esophagus, how should one attend to diet? The Shoushi Baoyuan points out: "When food and drink double, the intestines and stomach are injured." Overeating, excessive sweetness, and excessive greasiness all increase the burden on the stomach. But one need not give up eating for fear of choking—completely prohibiting a certain food may instead lead to nutritional imbalance. The key lies in "harmony": eat small meals frequently, chew carefully and swallow slowly, and avoid lying down immediately after meals. As for cooling herbal teas, bitter melon, and other cold and cooling items, if the constitution tends toward deficiency, a small amount suffices; excess will damage yang qi.

Daily Care Must Be Individualized

Some ask: can drinking a little soda water or eating a few crackers relieve heartburn? This can indeed temporarily neutralize stomach acid, but it treats the branch, not the root. TCM places greater emphasis on constitutional regulation: if the tongue coating is thick and greasy and stools are sticky, this is mostly damp-heat brewing internally, and the diet should be light; if the tongue is pale and swollen and diarrhea is easy, this is mostly spleen-stomach deficiency cold, and one should warmly nourish the middle burner. Heartburn, a burning sensation in the esophagus, is more commonly seen in people who stay up late long-term and sit for prolonged periods with little movement, because such habits consume yin fluids and obstruct qi movement. Adjusting one's daily rhythm and engaging in appropriate activity is often more lasting than temporary medication.

The Beauty of Pattern Differentiation Lies in "Treating the Same Disease with Different Methods"

For the same heartburn, a burning sensation in the esophagus, some people find relief with methods that clear stomach fire, while others require warming the middle and dispelling cold, and still others need to soothe the liver and regulate qi. This is precisely the essence of TCM's "treating the same disease with different methods." Clinically, a licensed TCM physician must, through inspection, auscultation and olfaction, inquiry, and palpation, comprehensively assess tongue coating, pulse manifestations, bowel and bladder information, and other details to determine whether the disease location is in the stomach, liver, spleen, or a combination of all three. One must never arbitrarily apply a "universal formula" found online, lest the timing for proper regulation be delayed.

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