Pain in Hypochondriac Region
Hypochondriac pain is a subjective symptom commonly seen in the chnic . It may
be unilateral or bilateral . The classic book Miraculous Pivot points out :
Pathogenic factors in the liver give rise to hypochondriac pain .
Chapter 22 of Plain Questions says : When the liver is diseased , it causes
pain below the ribs on both sides , and then refers to the lower abdomen .
As the meridian of the liver supplies the hypochondriac regions , and the liver
is externally and internally related with the gallbladder , the occurrence of
hypochondriac pain is mostly concerned with disorders of the liver and
gallbladder .
Etiology and Patbogenesis
The liver is situated in the hypochondriac region . Its meridians supply
bilateral hypochondriac regions . If it is diseased , it will cause
hypochordriac pain . The liver is the organ in the category of wind and wood of
Five Elements , and prefers to be in a harmonious state with free flow ofqi .
Emotional depression may restrain the liver function , causing poor circulation
of qi in the meridians , often resulting in hypochondriac pain .
The prolonged stagnation of the liver qi , or traumatic injuries such as
sprain and contusion may cause stasis of blood in collaterals , resulting in
hypochondriac pain .
Poor health associated with chonic disease , overstrain and stress , may
cause deficiency of essence and blood , which in turn produces poor nourishment
of the liver and its collaterals , resulting in hypochondriac pain .
Differentiation
Excess type :
Stagnation of qi :
Main manifestations : Distending pain in the costal and hypochondriac
region , stifling sensation in the chest , sighing , poor appetite , bitter
taste in the mouth , thin white tongue coating , string - taut pulse . Severity
of the symptoms varies with the changes of emotional state .
Analysis : Distending pain in the costal and hypochondriac region suggests
obstruction of the collaterals due to failure of the liver in maintaining
the free flow of qi . Severity of the symptoms varies with the emotional
state because of the close relationship between emotional changes and
stagnation of qi . Stifling sensation in the chest and sighing indicate
uneven qi activity . Poor appetite shows that the spleen is being attacked by
the liver qi . Thin white tongue coating and string - taut pulse are the signs
of depression of the liver .
Stagnation of blood :
Main manifestations : Fixed stabbing pain in the hypochondriac region ,
intensified by pressure and at night , dark purplish tongue proper , deep and
hesitant pulse .
Analysis : Fixed stabbing pain in the hypochondriac region is caused by
stagnation of blood following stagnation of qi in the hypochondriac region .
Pain intensified at night suggests that blood as a yin factor is apt to
stagnate at night which is the yin time of a day . Pain due to stagnation of
blood is a condition of excess , so it is aggravated by pressure . Dark
purplish tongue proper , and deep , hesitant pulse are signs of blood
stagnation .
Deficiency type :
Main manifestations : Dull pain lingering in the costal and hypochondriac
region , dryness of the mouth , irritability , dizziness , blurring of vision ,
red tongue with little coating , - weak , or rapid and thready pulse .
Analysis : Dull pain in the costal and hypochondriac region indicates
deficiency of essence and blood which causes poor nourishment of the
collaterals of the liver . Dryness of the mouth and irritability suggest
deficiency of yin with endogenous heat . Dizziness and blurring of vision are
due to the shortage of essence and blood . Red tongue with little coating ,
and weak or rapid and thready pulse are signs of deficiency of essence and
blood with endogenous heat .
Treatment
Excess type :
Method : Points are mainly selected from Jueyin and Shaoyang Meridians of
Foot to remove the stagnation of liver qi and the obstruction in the
collaterals . Needling with reducing method is to be applied .
Prescription : Qimen ( Liv 14 ) , Zhigou ( S J 6 ) , Yanglingquan ( G 34 ) .
Supplementary points : Stagnation of qi : Taichong ( Liv 3 ) , Qiuxu ( G 40 ) .
Stagnation of blood : Geshu ( B 17 ) , Ganshu ( B 18 ) .
Explanation : The Shaoyang Meridian supplies the lateral aspect of the
body , so Zhigou ( S J 6 ) and Yanglingquan ( G 34 ) are used to relieve pain by
regulating the qi of the Shaoyang Meridian . Qimen ( Liv 14 ) , the Front - ( Mu )
point of the Liver Meridian , eases the liver and relieves pain in the
hypochondrum . Taichong ( Liv 3 ) and Qiuxu ( G 40 ) regulate the qi of the liver
and gallbladder . Geshu ( B 17 ) and Ganshu ( B 18 ) can activate blood
circulation and remove stasis .
Deficiency type :
Method : Nourish essence and blood , invigorate circulation ofqi , and
relieve pain by applying reinforcing method to points of the Foot - Jueyin
Meridian and Back - ( Shu ) points .
Prescription : Qimen ( Liv 14 ) , Ganshu ( B 18 ) , Shenshu ( B 23 ) , Zusanii ( S
36 ) , Sanyinjiao ( Sp 6 ) , Taichong ( Liv 3 ) .
Explanation : Ganshu ( B 18 ) , the Back - ( Shu ) point of the liver , Shenshu ( B
23 ) , the Back - ( Shu ) point of the kidney , Qimen ( Liv 14 ) . the Front - ( Mu )
point of the liver , Taichong ( Liv 3 ) , the Yuan - ( Primary ) point of the Liver
Meridian , used in combination , can nourish essence and blood , readjust the
liver and relieve pain . Zusanii ( S 36 ) and Sanyinjiao ( Sp 6 ) strengthen the
function of the spleen and stomach which are the main source of producing qi
and blood .
Remarks
Hypochondriac pain is seen in diseases of the liver and gallbladder ,
contusion of the hypochondriac region , intercostal neuralgia and costal
chondritis .
Application of Huatuojiaji points of the corresponding segments gives
gratifying effect to relieve pain in the treatment of intercostal neuralgia .
Cutaneous needling : Tap the skin over the affected hypochondriac area , and
then apply cupping . This method is indicated in hypochondriac pain due to
sprain or contusion . It has the action of removing stasis and relieving pain .
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