Part 5 of 7 in the "digestive discomfort" series. Part 1 is what the TCM "spleen-stomach" is; part 2 is the five-situation table; part 3 is what counts as constipation and what the NHS gives as its causes; part 4 is how the theory explains it; part 6 is when to see a doctor first; part 7 is what an online consultation does.

That mouthful of acid in the small hours is one of the five. This part gives the practice first, then how reflux happens in each of the two accounts.

The short version

• Three of the NHS's items: smaller, more frequent meals; nothing to eat within 3 or 4 hours before bed; no clothes tight around the waist. The full list is in section I.
• Using wood, bricks or books to raise the head of the bed by around 10 to 20cm, so your chest and head are above your waist, the NHS says you "may find" it "helps relieve symptoms". Not extra pillows — those "can increase pressure on your belly and make your symptoms worse".
• If you keep getting heartburn, the NHS says speak to a pharmacist first. See a doctor if lifestyle changes and pharmacy medicines are not helping, if you have heartburn most days, or if there is food getting stuck in your throat, frequently being sick, or losing weight for no reason.
• The NHS says heartburn is stomach acid travelling up towards the throat; TCM theory says stomach qi is in order when it moves downward. Both accounts look at the same experience — something travelling upward.
• Vomiting blood means call 999 now, or go to the nearest hospital emergency department.

First, the things that cannot wait

⚠️ A safety note: TCM and Western medicine complement each other; it is not a choice between them. For heavy bleeding, severe abdominal pain, if you cannot poo or fart, or vomiting blood, call 999 now, or go to the nearest hospital emergency department. All four sit on the "call 999" lists of the NHS's rectal-bleeding and stomach-ache pages.

The full list, the reason for each, and which situations mean a same-day visit are in part 6.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. What to do: the NHS's items

① The habit items. The NHS advice is: "eat smaller, more frequent meals"; "do not eat within 3 or 4 hours before bed"; "do not wear clothes that are tight around your waist"; "do not smoke"; "do not drink too much alcohol"; "do not have food or drink that triggers your symptoms".

② Raising the head of the bed. The same page says you "may find that using wood, bricks or books to raise the head of your bed by around 10 to 20cm, so your chest and head are above your waist, helps relieve symptoms".

But "do not try to achieve the same effect by using additional pillows, as this can increase pressure on your belly and make your symptoms worse". That sentence matters as much as the one before it.

③ Who asks a pharmacist, who sees a doctor. If you keep getting heartburn, the NHS says speak to a pharmacist, who may recommend medicines called antacids.

See a doctor if "lifestyle changes and pharmacy medicines are not helping your heartburn", "you have heartburn most days", or "you also have other symptoms, like food getting stuck in your throat, frequently being sick, or losing weight for no reason". Food stuck in the throat or difficulty swallowing is in the same-day band on the NHS's dysphagia page.

If you are on medication, the NHS's own words are: "do not stop taking any prescribed medicine without speaking to a doctor first". Never stop your medication on your own. For Chinese herbs alongside Western medication, see Can Chinese herbs be taken with Western medicine.

II. How it happens: the two accounts

④ How the NHS explains it. The NHS definition is that heartburn is "a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux)".

The same page states that symptoms "are often worse after eating, when lying down and when bending over". So "do not eat within 3 or 4 hours before bed" has a reason behind it: lying down on a full stomach stacks two of those moments on top of each other.

The logic of raising the bed is on the same page: with your chest and head above your waist, it "can help stop stomach acid travelling up towards your throat".

⑤ How TCM theory explains it. The World Health Organization's TCM terminology standard describes "the stomach governs smooth downbearing" (胃主通降) as: "Stomach qi needs to be unobstructed and flows downward, so as to pass the primarily digested chyme down to the small intestine." The theory's stock phrase 「胃气以下行为顺」, stomach qi is in order when it moves downward, means this direction.

The last sentence of the standard's entry on stomach qi ascending (in its patterns chapter) states that it "often occurs when cold, heat, diet or emotions causes stomach qi to ascend". The theory reads reflux as stomach qi moving up against its proper direction; diet is one of the causes the standard names.

The two accounts look at the same experience: something travelling upward. One speaks of stomach acid and body position, the other of the direction of "qi". They are not translations of each other; each stands on its own.

That is why "what time did you eat, and how long after did you lie down" are questions both sides ask.

Three things about life in Malaysia

• Mamak suppers: the NHS says "do not eat within 3 or 4 hours before bed". The theory says an earlier, lighter dinner. In overtime season and exam season, say what time and how often at the consultation.
• Antacids from the pharmacy (Guardian, Watsons): if you keep getting heartburn, the NHS says ask a pharmacist first; the page states that antacids help symptoms in the short term and "should not be taken regularly for long periods".
• Chilli pan mee, curry, steamboat, durian season, festive meals: no need to give them up before the consultation. The NHS practice is to avoid "food or drink that triggers your symptoms" — the operative word is "your", so describe how you actually eat.

The words in this part

Two Western words from the NHS's heartburn page, one TCM term from the World Health Organization's TCM terminology standard.

• Heartburn (烧心) — the NHS's definition: "a burning feeling in the chest caused by stomach acid travelling up towards the throat". This is the word you will hear at a pharmacy.
• Acid reflux (胃酸倒流) — the NHS uses it for stomach acid travelling up towards the throat itself; the same page states that symptoms are often worse after eating, when lying down and when bending over.
• The stomach governs smooth downbearing (胃主通降) — the standard's definition: "Stomach qi needs to be unobstructed and flows downward, so as to pass the primarily digested chyme down to the small intestine." The theory's account of reflux is the reverse of this one.

Frequently asked

Can I take antacids all the time? The NHS states that antacids help symptoms in the short term and "should not be taken regularly for long periods"; if you keep getting heartburn, it says speak to a pharmacist first. If lifestyle changes and pharmacy medicines are not helping, or you have heartburn most days, see a doctor. If you are on medication, never stop your medication on your own — the NHS's own words are "do not stop taking any prescribed medicine without speaking to a doctor first".

What time should dinner be? The NHS gives an interval, not a clock time: "do not eat within 3 or 4 hours before bed". So the answer follows your bedtime. The theory's side says an earlier, lighter dinner.

Do not: stack the pillows and count it as done — the NHS says plainly that it makes things worse.

The other six parts

• Part 1: Digestive discomfort, how TCM sees it: first, which part of "stomach trouble" you mean
• Part 2: Five situations in one table: what the theory says, the usual practice, when to see a doctor first
• Part 3: How long before it counts as constipation? What stool shape says, and the NHS's causes
• Part 4: How TCM theory explains constipation: the route from intake to exit, and an ordinary week
• Part 6: When to see a doctor first — each sign, and what it can indicate
• Part 7: What an online consultation does, and what needs an in-person visit or a doctor

👉 If you are unsure where to even start describing your digestive situation, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in part 6 applies, see a doctor first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• NHS, Heartburn and acid reflux, page last reviewed 20 November 2023 — https://www.nhs.uk/conditions/heartburn-and-acid-reflux/
• World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 — https://www.who.int/publications/i/item/9789240042322
• NHS, Dysphagia (swallowing problems), page last reviewed 02 May 2023 — https://www.nhs.uk/conditions/swallowing-problems-dysphagia/
• NHS, Stomach ache, page last reviewed 26 May 2023 — https://www.nhs.uk/conditions/stomach-ache/
• NHS, Bleeding from the bottom (rectal bleeding), page last reviewed 12 April 2023 — https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/

本文是「肠胃不舒服」系列的第 5 篇，共 7 篇。第 1 篇讲理论里的「脾胃」是什么，第 2 篇是五种情况的对照表，第 3 篇讲便秘怎么算、西医说成因是什么，第 4 篇讲理论怎么解释便秘，第 6 篇讲什么时候要先看医生，第 7 篇讲线上问诊会做什么。

半夜那一口酸，是五种情况里的一种。这一篇先说做法，再说它在两套说法里各自怎么发生。

一分钟看完

• NHS 的做法里的三项：少量多餐、睡前 3 到 4 小时不进食、不穿腰部过紧的衣服。整份清单在第一节。
• 用木块、砖或书把床头垫高约 10 到 20 厘米，让胸和头高过腰，NHS 说可能有助缓解症状。不要用叠枕头的方式——那会增加腹部压力，反而加重。
• 一直有烧心的，NHS 建议先向药剂师咨询。生活调整与药剂行的药物都没帮助、多数日子都烧心，或伴随食物卡喉、经常呕吐、体重无故下降——请看医生。
• NHS 说烧心是胃酸向上走到喉咙；中医理论说胃气宜下行。两套说法看的是同一个经验——东西往上走。
• 呕血，请立刻拨打 999，或前往最近的医院急诊部。

先说不能等的几件事

⚠️ 安全提醒：中医与西医是互相补位的关系，不是二选一。若出现大量出血、严重腹痛、无法排便也无法排气，或呕血，请立刻拨打 999，或前往最近的医院急诊部。这四项都列在 NHS 便血页与腹痛页的「立刻拨打 999」清单上。

完整的清单、每一项的理由，以及哪些情况要当天看医生，见第 6 篇。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、怎么做：NHS 列的几项

① 习惯那几项。 NHS 的建议是：少量多餐；不要在睡前 3 到 4 小时内进食；不要穿腰部过紧的衣服；不吸烟；不过量饮酒；避开会引发症状的食物和饮料。

② 床头垫高。 NHS 同一页说，用木块、砖或书把床头垫高约 10 到 20 厘米，让胸和头高过腰，可能有助缓解症状。

但不要用叠枕头的方式达到同样效果，那会增加腹部压力，反而加重。这一句和上一句一样重要。

③ 谁先问药剂师，谁先看医生。 一直有烧心的，NHS 建议先向药剂师咨询，药剂师可能推荐抗酸剂之类的药物。

生活调整和药剂行的药物没有帮助、多数日子都烧心，或伴随食物卡喉、经常呕吐、体重无故下降——请看医生。食物卡喉或吞咽困难，按 NHS 吞咽困难页的分级，当天求医。

正在服药的，NHS 的原话是：未先咨询医生，不要停用任何处方药。切勿自行停药。 中药与西药同用的问题，另见：中药和西药可以一起吃吗。

二、它是怎么发生的：两套说法

④ NHS 怎么解释。 NHS 的定义是：烧心是胸口的灼热感，由胃酸向上走到喉咙引起，也就是胃酸倒流。

同一页写明，症状常在进食后、躺下时和弯腰时加重。所以「睡前 3 到 4 小时不进食」有它的道理：吃饱就躺，是把两个加重的时机叠在一起。

床头垫高的原理也在同一页：让胸和头高过腰，可以帮助阻止胃酸向上走到喉咙。

⑤ 中医理论怎么解释。 世界卫生组织中医术语标准对「胃主通降」的说明是：胃气须通畅下行，把初步消化的食糜送往小肠。理论常说的「胃气以下行为顺」，指的就是这个方向。

标准在「胃气上逆」这一条（在证候一章）的末句写明：常发生在寒、热、饮食或情志使胃气上逆的时候。理论把反酸读作胃气逆着该走的方向往上；饮食，是标准点名的原因之一。

两套说法看的是同一个经验——东西往上走。一边讲的是胃酸和体位，一边讲的是「气」的方向。它们不是互相翻译，各自成立。

所以「几点吃、吃完多久躺」这两个问题，两边都会问。

大马生活里的三件事

• mamak 宵夜：NHS 说不要在睡前 3 到 4 小时内进食。理论说的是晚餐早一点、少一点。加班季、考试季的宵夜，几点吃、多常吃，看诊时一并说明。
• 药剂行（Guardian、Watsons）的抗酸剂：一直有烧心，NHS 建议先问药剂师；该页写明抗酸剂短期缓解症状，不宜长期常规服用。
• 辣椒板面、咖喱、火锅、榴莲季、年节大餐：不必为了问诊先戒掉。NHS 的做法是避开会引发您症状的食物和饮料——重点是「您的」，所以如实说明您平常怎么吃。

这篇出现的几个词

两个西医的词来自 NHS 的反酸页，一个中医的词来自世界卫生组织的中医术语标准。

• 烧心（heartburn）——NHS 的定义：胸口的灼热感，由胃酸向上走到喉咙引起。您在药剂行会听到这个词。
• 胃酸倒流（acid reflux）——NHS 用它指胃酸向上走到喉咙这件事本身；同一页写明症状常在进食后、躺下时和弯腰时加重。
• 胃主通降（the stomach governs smooth downbearing）——标准的定义：胃气须通畅下行，把初步消化的食糜送往小肠。理论解释反酸，用的就是这一条的反面。

常见问题

抗酸剂可以一直吃吗？ NHS 的说法是，抗酸剂短期缓解症状，不宜长期常规服用；一直有烧心的，它建议先向药剂师咨询。若生活调整和药剂行的药物都没有帮助，或多数日子都烧心，请看医生。正在服药的，切勿自行停药——NHS 的原话是，未先咨询医生，不要停用任何处方药。

晚餐到底几点吃？ NHS 给的是一个间隔，不是一个钟点：不要在睡前 3 到 4 小时内进食。所以答案跟着您的睡觉时间走。理论那一边说的是晚餐早一点、少一点。

不要这样做： 不要只把枕头叠高就算做了——NHS 明确说那会加重。

这个系列的另外六篇

• 第 1 篇：肠胃不舒服，中医怎么看？先分清「肠胃不好」指的是哪一件事
• 第 2 篇：五种情况一张表：理论怎么说、一般怎么做、什么时候先看医生
• 第 3 篇：便秘多久算便秘？大便形状怎么说，西医说成因是什么
• 第 4 篇：中医理论怎么解释便秘：从进到出的那条路，和一个普通的星期
• 第 6 篇：什么时候要先看医生——每一项信号，以及它可能意味着什么
• 第 7 篇：线上问诊会做什么，什么需要亲诊或看医生

👉 如果您不确定「我这种肠胃情况，该从哪里说起」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有第 6 篇列出的情况，请先看医生。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• NHS，Heartburn and acid reflux，页面最后审阅 2023 年 11 月 20 日 — https://www.nhs.uk/conditions/heartburn-and-acid-reflux/
• 世界卫生组织，WHO international standard terminologies on traditional Chinese medicine，2022 — https://www.who.int/publications/i/item/9789240042322
• NHS，Dysphagia (swallowing problems)，页面最后审阅 2023 年 5 月 2 日 — https://www.nhs.uk/conditions/swallowing-problems-dysphagia/
• NHS，Stomach ache，页面最后审阅 2023 年 5 月 26 日 — https://www.nhs.uk/conditions/stomach-ache/
• NHS，Bleeding from the bottom (rectal bleeding)，页面最后审阅 2023 年 4 月 12 日 — https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/