Hypochondriac pain - Gallbladder pain

Hypochondriac pain is a subjective symptom commonly seen in the chnic. It maybe 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 andgallbladder.

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.

Acupuncture Prescription:

[LR14 - TH6 - GB34]. Or,
[LR14 - LR3 - TH6 - GB34 - ST36]

Supplementary points:

Nausea: RN12
Stagnation of blood: BL17, BL18, SP6, SP21
Stagnation of qi: LR3, GB40.
Damp/Heat: MH6, RN12, ST44

Explanation: The Shaoyang Meridian supplies the lateral aspect of the body, so TH6 and GB34 are used to relieve pain by regulating the qi of the Shaoyang Meridian. LR14, the metameric mu point of the Liver Meridian, eases the liver and relieves pain in the hypochondrum. LR3 and GB40 regulate the qi of the liver and gallbladder. BL17 and BL18 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.

Acupuncture Prescription:

[LR14 - BL18 - BL23 - ST36 - SP6 - LR3]. Or,
[BL18 - BL23 - LR14 - LR2 - ST36 - SP6]
Dizziness: DU20, GB20

Explanation: BL18, the metameric shu point of the liver, BL23, the metameric shu of the kidney, LR14, the metameric mu point of the liver, LR3, the yuan-source point of the Liver Meridian, used in combination, can nourish essence and blood, readjust the liver and relieve pain. ST36 and SP6 strengthen the function of the spleen and stomach which are the main source of producing qi and blood. LR14 & LR2 soothe Liver Qi, deficient Heat

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.

Alternative treatment methods

auricular – LR, GB, shenmen, chest, medium to strong stimulation
injection – Hua Tou Jia Ji with corresponding painful ribs, keep needle just above where sensation occurs and inject vitamin B12 or 10% glucose
electro – add to points chosen, continuous mild frequency, 10-15 minutes
7 star – on ashi points (Blood Stasis) then cup, also try scrapping