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 LRer, causing failure of the LRer 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 LRer 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 LR qi makes the LRer fail to dominate the free flow of qi. If the depressed LRer qi attacks the stomach, pain in the epigastrium appears. As the LRer 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 LRer 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 (RN II), Neiguan (P 6), Zusanii (ST 36), Inner - Neiting (Extra).

    Explanation: Zhongwan (RN 12) is the Front - (Mu) point of stomach, Zusanli (ST 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 LRer 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 LRer qi, to pacify the stomach and to relieve pain.

    Prescription: Qimen (LR 14), Zhongwan (RN 12), Neiguan (P 6), Zusanii (ST 36), Taichong (LR 3).

    Explanation: Qimen (LR 14) is the Front - (Mu) point of the LRer and Taichong is the Yuan - (Primary) point of the LRer Meridian. The two are used in combination to remove the stagnation of LRer qi, regulate the flow of qi and relieve pain. Zusanii (ST 36), Zhongwan (RN 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 RN 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 (RN 12), Qihai (RN 6), Pishu (B 20), Neiguan (P 6), Zusanli (ST 36), Gongsun (Sp 4).

    Explanation: Acupuncture and moxibustion at Zhongwan (RN 12) and Zusanli (ST 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 (RN 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 LRer, 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.