Epigastric Pain
Epigastric pain is a common symptom , often characterized by repeated
recurrence . Since the pain is close to the cardia , it was also named
cardio - abdominal pain or cardiac pain in ancient times .
Etiology and Pathogenesis
- Irregular food intake , preference for raw and cold food and hunger injure
the spleen and stomach , causing failure of the spleen in transportation and
transformation and failure of the stomach qi in descending , then pain
appears .
- Anxiety , anger and mental depression damage the liver , causing failure of
the liver in dominating free flow of qi , adversely attacking the stomach ,
impeding its activity and hindering its qi descending , then pain appears .
- Generally lowered functioning of the spleen and stomach , due to invasion
of pathogenic cold , which is stagnated in the stomach , causes failure of the
stomach qi in descending , then pain occurs .
Differentiation
- Retention of food :
Main manifestations : Distending pain in the epigastrium , aggravated on
pressure or after meals , belching with fetid odour , anorexia , thick , sticky
tongue coating , deep , forceful or rolling pulse .
Analysis : Retention of food in the stomach makes the stomach qi fail to
descend , then distending pain in the epigastrium and belching with fetid
odour occur . Retention of food is an excess condition , pain is therefore
aggravated upon pressure . Since the stomach is injured by retention of food ,
pain becomes worse after meals and anorexia appears . Thick , sticky tongue
coating , deep , forceful or rolling pulse are the signs of retention of
food .
- Attack of the stomach by the liver qi :
Main manifestations : Paroxysmal pain in the epigastrium , radiating to the
hypochondriac regions , frequent belching accompanied by nausea , vomiting ,
acid regurgitation , abdominal distension , anorexia , thin , white tongue
coating , deep , string - taut pulse .
Analysis : Stagnation of the liver qi makes the liver fail to dominate the
free flow of qi . If the depressed liver qi attacks the stomach , pain in the
epigastrium appears . As the Liver Meridian locates along both hypochondriac
regions , the pain is wandering and may be referred to both hypochondriac
regions . In case of stagnation of the qi , belching occurs , even symptoms
like nausea , vomiting , acid regurgitation , abdominal distension and anorexia
may appear . Thin , white tongue coating and deep string - taut pulse are the
signs of attack of the stomach by the perversive liver qi .
- Deficiency of the stomach with stagnation of cold :
Main manifestations : Dull pain in the epigastrium , which may be relieved
by pressure and warmth , general lassitude , regurgitation of thin fluid ,
thin , white tongue coating , deep , slow pulse .
Analysis : Lowered function of the spleen and stomach with cold invasion
retards transportation and transformation , so dull pain appears in the
epigastrium . The spleen dominates the limbs . If the spleen yang is weak ,
general lassitude occurs , as well as the regurgitation of thin fluid . Since
the condition is due to deficiency and cold , pain is relieved on pressure
and by warming . rhin , white coating and deep slow pulse are the signs of
lowered function of the spleen and stomach with cold stagnation .
Treatment
- Retention of food :
Method : The Front - ( Mu ) point of the stomach and the points of the
Yangming Meridian of Foot are selected with reducing method applied to
remove retention , pacify the stomach and relieve pain .
Prescription : Jianii ( Ren II ) , Neiguan ( P 6 ) , Zusanii ( S 36 ) , Inner - Neiting
( Extra ) .
Explanation : Zhongwan ( Ren 12 ) is the Front - ( Mu ) point of stomach , Zusanli
( S 36 ) , the Lower He - ( Sea ) point of the Stomach and Neiguan ( P 6 ) , a
Confluent Point . They are indicated in stomach , heart and chest disorders ,
and used in combination to pacify the stomach and relieve pain . Inner - Neiting
( Extra ) is an empirical point to treat retention of food .
- Attack of the stomach by the liver qi :
Method : Points of Jueyin and Yangming Meridians of Foot are selected as
the principal points with the reducing method applied to remove the stagnation
of liver qi , to pacify the stomach and to relieve pain .
Prescription : Qimen ( Liv 14 ) , Zhongwan ( Ren 12 ) , Neiguan ( P 6 ) , Zusanii
( S 36 ) , Taichong ( Liv 3 ) .
Explanation : Qimen ( Liv 14 ) is the Front - ( Mu ) point of the liver and
Taichong is the Yuan - ( Primary ) point of the Liver Meridian . The two are used
in combination to remove the stagnation of liver qi , regulate the flow of qi
and relieve pain . Zusanii ( S 36 ) , Zhongwan ( Ren 12 ) and Neiguan ( P 6 ) are
applied to pacify the stomach , relieve pain and check vomiting .
- Deficiency of the stomach with stagnation of cold :
Method : The Back - Shu points and points of the Ren Meridian are selected
as the principal points with both acupuncture and moxibustion to warm up the
middle jiao , dispel cold and regulate the flow of qi and relieve pain .
Prescription : Zhongwan ( Ren 12 ) , Qihai ( Ren 6 ) , Pishu ( B 20 ) , Neiguan ( P
6 ) , Zusanli ( S 36 ) , Gongsun ( Sp 4 ) .
Explanation : Acupuncture and moxibustion at Zhongwan ( Ren 12 ) and Zusanli
( S 36 ) warm the middle jiao , dispel cold , regulate the flow of qi and
relieve pain . Neiguan ( P 6 ) and Gongsun ( Sp 4 ) , the Confluent Points , are
indicated to treat stomach disorders . Moxibustion on Pishu ( B 20 )
strengthens the spleen , pacifies the stomach , dispels cold and relieves
pain . Indirect moxibustion with ginger on Qihai ( Ren 6 ) is most desirable in
the treatment of chronic gastric pain due to cold of deficiency type , as
ginger and moxa together have the function of dispelling cold .
Remarks
Epigastric pain is a symptom found in peptic ulcer , gastritis , gastric
neurosis and diseases of the liver , gallbladder and pancreas .
Cupping : Cupping is applied with large or medium - sized cups mainly to the
upper abdomen or Back - Shu points for ten to fifteen minutes .
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