Are there any herbs that function in a similar manner to an H2 antagonist like Pepcid? What would be a shorthand materia medica for gastritis? Already thinking of mucilage, but wondering beyond that. In this case baking soda helps their symptoms so I take that as a sign that their stomach is hyperchlorhydric

No, no herb works like an H2 Blocker. There are many herbs useful for hyperchlorhydria (Chamomile, Lemon Balm, Meadowsweet, Licorice, Slippery Elm, Marshmallow) but they work quite differently and which herbs depends on the case. The fact that baking soda helps someone DOES NOT mean they have too much stomach acid. Just like antacids help heartburn whether the person has hypochlorhydria or hyperchlorhydria, the same is true for baking soda. BTW taking baking soda regularly is not a good idea, it can mess up your electrolyte balance.

somewhat related to this - is there a test that you recommend for assessing hyper vs hypochlorhydria? Also somewhat related - are there herbs that are helpful for strengthening the lower esophageal sphincter? lastly, for someone who is developing chest symptoms, asthmatic type symptoms, chest tightness as a result of acid reflux, what kind of herbs might you use, given that it's acid entering into the respiratory system that is triggering the respiratory symptoms? THANK YOU!

there is the Heidleberg test (not sure if it is still used) to test for stomach acid, but far easier is looking at symptoms which I talked about when we did the glossary. Hyperacidity symptoms - heartburn, red, sometimes almost pointed tongue, red gums, little to no gas, bloating or borborygmus hypoacidity (achlorhydria) symptoms - heartburn, heavy white coat (moss) on tongue, scalloped edges on tongue, bloating, flatulence, borborygmus, may have low grade diarrhea or undigested food in stools as for strengthening the lower esophageal sphincter there are some herbs that may offer some benefits, but eating smaller meals, losing weight (if overweight) , slowing eating all, avoid eating 3 hours before bedtime, if a smoker stop smoking probably work better for this. The herbs used include prokinetics such as Yarrow, Angelica, Bai Zhu/Artactylodes, Artichole leaf, the Kanpo formula’s Rikkunshito or Daikenchuto, the TCM formula SI Mo Tang and there are esophageal exercises (see below). For respiratory irritation demulcent herbs (yin tonics) such as Licorice, Mai Men Dong/Ophiopogon, Tian Men Dong/Chines Asparagus root, Prince Seng, Solomon’s Seal, Shatavari, Marshmallow, Slippery Elm pr Goji Berry may be of some help. Annals of Physical and Rehabilitation Medicine Volume 61, Supplement, July 2018, Pages e381-e382 ISPR8-0979 Swallowing exercise for upper esophageal sphincter dysfunction in stroke patient with dysphagia: A systematic review

Would you recommend something like a chewable licorice extract? Or better in decoction or other form?

The chewable product is DGL licorice and it can be useful , although by itself it is not always enough to treat gastritis. You also want to know why the person has gastritis, is it H. pylori ? Aspirin ? NSAIDS ?, Alcohol. etc. If it is an irritant, stop using it and use herbs to heal the gastric mucosa like Slippery Elm, Aloe gel, Gotu Kola, Turmeric, Cat’s Claw, Yarrow, plantain leaf juice, Chamomile, etc. If it is H. pylori use the sam herbs along with herbs to inhibit H. pylori such as Thyme, Parsley, Goldenseal, Licorice (either form), Myrrh, garlic and Manuka honey

thank you so much for such for such a comprehensive response, David!

I have had a sleeve gastrectomy for weight loss and now have been cursed with GERD. I know that most likely my GERD is related to the new structure of my stomach and not necessarily hypochlorhydria or hyperchlorhydria. I have been on a proton pump inhibitor for nearly two years since my surgery and tried taking myself off of this PPI (pantoprazole) because of the long term effects of this medication. Not only for myself, but also for when I treat future clients -- do you have any guidance as to herbal remedies for GERD in this particular situation?

This is really tricky, because the GERD is most likely not caused by rebellious qi or hypochlorhydria but the surgery. You could try using DGL licorice, along with Chamomile, Meadowsweet, Marshmallow, Lemon Balm or Aloe gel to sooth and coat the esophagus and reduce acid, but is is symptomatic relief if it works.