Introduction: Incorporating certain insect-based drugs into the treatment formulas for stomach and esophageal diseases can often improve therapeutic outcomes.

On the Use of Insect-Based Medicines for Stomach Diseases

Author/Jingfan Xu

Compiled/Weimin Lu, Danhua Xu, Feihe Luo

The stomach is connected to the esophagus, and the pathogenesis often involves qi stagnation. Prolonged qi stagnation can affect the blood, leading to blood stasis and obstruction of the collaterals. Insect-based drugs generally have the functions of promoting blood circulation, resolving stasis, and unblocking collaterals. Incorporating certain insect-based drugs into the treatment formula based on syndrome differentiation can often enhance therapeutic efficacy. Based on personal experience, several commonly used insect drugs are summarized for reference.

(1) Aspongopus

The dried body of the stink bug (Aspongopus chinensis) from the Pentatomidae family has a salty and warm nature and flavor, and is particularly effective in regulating qi, unblocking collaterals, and relieving pain. The daily dosage of the decoction is 5–10g. Its indications include the following:

(1) For chronic and recurrent epigastric pain with a relatively fixed location, which may radiate to the lower chest, back, or flanks when severe, stink bug can be used in combination.

(2) For uncomfortable epigastric distension and fullness, sometimes with a sensation of blockage in the epigastrium, where the distension may extend to the lower chest and abdomen, and belching or passing gas does not provide relief, and general qi-regulating medications are ineffective, stink bug can be added.

(3) For esophagitis, reflux esophagitis, or achalasia, with a dull pain or discomfort below the sternum, often accompanied by gastric discomfort, nausea, food regurgitation, or even vomiting, and when general medications are ineffective, this herb can be used in combination.

Precautions:

This medication has blood-activating properties. For gastric conditions with a history of upper gastrointestinal bleeding, generally within the past 2 months, use Jiuxiangchong with caution or avoid it. In cases of severe stomach yin deficiency accompanied by qi stagnation and blood stasis, with a burning pain in the gastric region and a red, dry tongue, Jiuxiangchong is not suitable.

(2) Dung Beetle

The dried whole insect of the scarab beetle, belonging to the family Scarabaeidae. It has a salty and cold nature and flavor, and is particularly effective in breaking blood stasis, dispersing nodules, attacking toxins, and promoting circulation through the meridians. The daily dosage in decoction is typically 5–10g, and in necessary short-term cases (within 3–5 days), 15g may be used. It is suitable for:

(1) For sensations of obstruction or poor flow in the middle to lower esophagus, difficulty swallowing, or dry and scanty stools, dung beetle can be added to the syndrome differentiation formula.

(2) For incomplete pyloric obstruction with gastric distension, gurgling sounds, vomiting of gastric contents, or even morning food vomited in the evening or evening food vomited in the morning, dung beetle can be added according to the syndrome. Medication should be taken after vomiting, or a gastric tube can be inserted to aspirate retained gastric fluid, followed by instillation of the medication through the tube. After removing the tube, the patient should lie on their right side with the hips and lower back slightly elevated, and avoid eating or drinking for 1 hour.

(3) For gastric polyps that are difficult to remove (or ablate), presenting with symptoms such as epigastric fullness and dull pain, dung beetle can be added according to the syndrome, with a heavy dose of coix seed. The medication should be decocted to a concentrated form. After taking it, the patient should lie down for half an hour, adjusting their position based on the location of the polyps to maximize the medication's effect on the affected area. For multiple polyps, change positions every few minutes while lying down.

(3) Earthworm

Earthworm, also known as Lumbricus, has a salty and cold nature and flavor, with the functions of clearing heat, calming the liver, unblocking collaterals, and activating blood circulation. The common daily dosage of decoction is 10–15g. It is suitable for:

(1) Chronic gastritis and esophagitis, characterized by dull or burning pain in the epigastric region or behind the sternum, slightly red tongue, dry mouth, and prolonged unhealed condition, which belongs to the syndrome of liver-stomach stagnant heat. Earthworm can be added in combination.

(2) Esophageal dysfunction, discomfort in the throat accompanied by dull pain, or accompanied by food reflux, with poor response to other medications. Earthworm can be added in combination.

(3) Gastric disease accompanied by the syndrome of liver yang hyperactivity or liver yang transforming into wind, manifesting as gastric pain, distension, dizziness, and a wiry pulse. Earthworm can be added in combination according to the syndrome.

Precautions: Earthworm should not be used in cases of spleen-stomach qi deficiency with internal cold, cold pain in the epigastric and abdominal regions, and loose stools.

(IV) Cicada Slough

Cicada slough, also known as cicada exuviae, is the molted shell of the cicada Cryptotympana pustulata after metamorphosis. It has a sweet, salty, and cool nature and flavor, and is particularly effective in dispersing wind-heat, diffusing the lung, and calming convulsions. The common daily dosage of decoction is 3–6g. It is suitable for:

(1) Epigastric fullness, distension, and dull pain accompanied by an itching sensation. Itching is attributed to wind, and cicada slough can be added according to the syndrome pattern. If itching is severe and accompanied by blood stasis syndrome, Yunnan Baiyao can be added separately and taken with the decoction.

(2) When stomach pain occurs suddenly, with a sensation of spasmodic contraction, or even severe pain requiring bending over and pressing the upper abdomen, and the abdominal wall is soft, cicada slough can be added according to the syndrome.

(3) For esophageal dysfunction or inflammation, discomfort behind the sternum, and a sensation of obstruction and dryness in the throat, which belongs to phlegm-qi with stagnant heat, cicada slough can be added according to the syndrome.

(4) When gastric discomfort occurs or worsens, accompanied by urticaria triggered by allergic factors, cicada slough can be added.

(5) Ground beetle

Ground beetle, also known as ground turtle insect, belongs to the family Corydiidae. It has a salty and cold nature and flavor, with the functions of dispelling stasis, breaking masses, unblocking collaterals, and promoting blood circulation. The common daily dosage of decoction is 5–10g. It is suitable for:

(1) Severe esophageal dysfunction, with discomfort or poor passage behind the sternum during swallowing, or dull pain, or even vomiting small amounts of food. This herb can be added according to the syndrome.

(2) Achalasia of the cardia, with discomfort or stabbing pain in the xiphoid region, possibly accompanied by nausea and vomiting. Ground beetle can be added.

(3) A history of trauma to the upper abdomen, followed by frequent dull pain in the stomach with a fixed location, and prolonged treatment without cure, indicating internal blood stasis obstruction. Ground beetle can be added, along with Dalbergia odorifera.

If symptoms such as urticaria or subcutaneous purpura occur after using the aforementioned medications, including Aspongopus, dung beetle, and ground beetle, they should be discontinued immediately. Patients with a history of allergic purpura should avoid or use these medications with caution.