Hiatal Hernia

What is Hiatal Hernia?

A hiatal hernia is a condition in which the upper part of the stomach pushes up through the opening in the diaphragm, called the hiatus, into the chest.^[1] The diaphragm is the main breathing muscle, and the esophagus normally passes through the hiatus on its way to the stomach.^[1] A hiatal hernia is a physical change in the body, and acupuncture, herbs or Ayurvedic care cannot repair it.

Common symptoms

Small hiatal hernias often cause no symptoms. When symptoms occur, they include heartburn, regurgitation, difficulty swallowing, chest pain and shortness of breath.^[1] Other reported symptoms are nausea, bloating and upper abdominal discomfort.^[2] Chest pain can have other causes, including the heart, so it should always be assessed by a physician.

Causes and risk factors

Age and a higher body mass index are key risk factors.^[2] The most common type is the sliding hernia, in which the junction of the esophagus and stomach moves up into the chest; in the less common paraesophageal types, part of the stomach moves up into the chest beside the esophagus.^[1] Smoking and being overweight are also associated with reflux symptoms in general.^[3]

How it is diagnosed and treated conventionally

Hiatal hernias are found with imaging or endoscopy, such as a barium swallow, endoscopy, manometry or CT scanning.^[2] Small hernias are often managed with medical treatment, while larger paraesophageal hernias usually need surgery.^[1]

Reflux from a hiatal hernia is treated with lifestyle changes and acid-reducing medicines.^{[2, 4]} Surgical repair is often combined with fundoplication, and a systematic review found that the evidence for the best surgical approach is mixed and based on studies with a high risk of bias.^[5] Decisions about surgery should be made with your surgeon.

Why Hiatal Hernia calls for a whole-person approach

The hernia itself is a structural problem, but how much it bothers a person depends on reflux, meal habits, weight, stress and how the esophagus and stomach move. Between 50 and 94 percent of people with GERD are reported to have a sliding hiatal hernia, so reflux care and hernia care overlap.^[1]

Supportive care can address some of these other factors. It does not change the hernia.

Reflux and the lower esophageal sphincter

A hiatal hernia displaces the lower esophageal sphincter, the valve that normally helps block reflux, and a loose valve lets stomach contents and acid back up.^[1]

Meals, weight and sleep position

Weight loss in people who are overweight, quitting smoking, avoiding late evening meals and raising the head of the bed each have support from trials and cohort studies in reflux.^[6]

Breathing and the diaphragm

The diaphragm surrounds the lower esophageal sphincter. In a small randomized study of patients with reflux confirmed by acid monitoring, diaphragmatic breathing raised sphincter pressure and reduced reflux events after a meal.^[7] This was studied in GERD, not specifically in hiatal hernia, and the trial did not find a difference in total acid exposure compared with sham.^[7]

Stress and the brain-gut link

An American Gastroenterological Association expert review advises that people with reflux symptoms learn about weight management, diet, relaxation strategies and the brain-gut relationship.^[8]

Acupuncture as supportive care in Hiatal Hernia

What the research shows

We found no clinical trials of acupuncture in people with hiatal hernia. The research is on reflux symptoms in GERD, which is often present with a hernia, and it is limited. A meta-analysis of 12 trials with 1,235 patients found better overall symptom improvement when acupuncture was added to Western medicine, with small samples and poor methods noted by the authors.^[9] A 2025 meta-analysis rated its evidence as very low to low certainty and did not recommend manual acupuncture alone as the main treatment for GERD.^[10]

A trial of 72 adults whose reflux continued on a daily PPI compared acupuncture plus a standard PPI dose with a double dose of PPI. Total reflux scores did not differ between groups, and there was no sham group.^[11] Whether the results apply to people with a large hernia is not known.

How acupuncture may work

Researchers propose that acupoint stimulation may act through the vagus nerve to improve how the esophagus and stomach move. In a small sham-controlled trial of electrical acupoint stimulation, vagal activity rose and was linked to sphincter pressure and esophageal contractions.^[12] These are proposed mechanisms in GERD from small studies, not proof of an effect on a hernia.

What treatment involves

Treatment uses fine, sterile, single-use needles at points on the abdomen, wrist and lower leg, usually left in place for about 20 to 40 minutes. A short course of visits, with reassessment along the way, is typical.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as soreness, bleeding or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, have recently had surgery, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Hiatal Hernia

The Ayurvedic view

Ayurveda does not describe a hiatal hernia as such. Reflux and burning after meals are described as Amlapitta, traditionally seen as an aggravation of Pitta, the principle linked to heat and digestion.^[14] These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Regular, moderate meals with cooling, bland foods and less very spicy, sour, fried or late-evening food, which fits the medical advice above^[6]
• Daily routine and relaxation practices such as slow breathing
• Herbs traditionally used for Amlapitta, such as licorice root (Yashtimadhu)^[15]
• Individually prescribed formulas from tested sources, since some Ayurvedic products contain heavy metals^[16]

Panchakarma procedures, especially vomiting or purgation therapies, are not appropriate for people with a hiatal hernia. They are also not appropriate in pregnancy, acute illness, frailty, or after recent surgery.

What the research shows

We found no clinical studies of Ayurvedic treatment in hiatal hernia. For reflux-type symptoms the evidence is very limited. A single-arm study of 30 patients with Amlapitta reported symptom relief after 28 days of individualized treatment but had no control group.^[14] A 40-patient study of two licorice-type roots reported less burning in the chest and throat in both groups, without a placebo arm.^[15]

Herbal medicine as supportive care in Hiatal Hernia

Herbs and formulas that have been studied

No herbal formula has been studied for hiatal hernia. Chinese herbal formulas, including Jianpi (spleen-strengthening) and Ligan Hewei (liver-soothing, stomach-harmonizing) approaches, have been studied for GERD.^[17]

What the research shows

The evidence for reflux symptoms is limited. A network meta-analysis of 17 trials with 1,441 participants suggested Jianpi and Ligan Hewei approaches, alone or with PPIs, may be useful complementary options, and called for better-designed trials.^[17] A double-blind trial in 204 people with nonerosive reflux found more complete symptom resolution with a herbal granule plus half-dose PPI than with a full-dose PPI, although the rate of sufficient relief did not differ significantly.^[18] These studies did not include people selected for hiatal hernia.

Safety and herb-drug interactions

In that trial, three people in the herb-plus-PPI group developed liver dysfunction, two of them moderate to severe.^[18] Tell us if you have liver or kidney disease, are pregnant or breastfeeding, take blood thinners, or have surgery planned. Herbs should be checked against all your medicines.

About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[16] Herbs should come from tested sources and be prescribed individually.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes reflux as stomach qi rising when it should descend. Researchers studying acupuncture look at things that loosely parallel this picture: vagal nerve activity, lower esophageal sphincter pressure and esophageal and stomach movement.^[12]

Ayurveda's aggravated Pitta describes heat and burning in the upper digestive tract.^[14] None of these concepts describes or treats the displaced stomach itself.

How this care fits with your medical care

A hiatal hernia needs medical evaluation, and larger hernias may need surgery. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop or change reflux medicines, or delay a surgical decision, because of anything we offer.

We do not diagnose hernias. Please bring your diagnosis, imaging or endoscopy reports, a list of medicines and supplements, and details of any planned or past surgery.

When to seek urgent medical care

A hernia that becomes trapped or twisted is an emergency, as are signs of bleeding.^[1]

• Sudden, severe chest or upper abdominal pain
• Repeated vomiting or retching with nothing coming up
• Inability to swallow food or liquid, or food that gets stuck
• Vomiting blood, material that looks like coffee grounds, or black or bloody stools
• Chest pain with shortness of breath, sweating, or pain spreading to the arm or jaw

If any of these occur, call 911 or go to the nearest emergency department.