Epigastric Pain

Epigastric pain is a common symptom , often characterized by repeatedrecurrence . 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 .