0D Chinese Internal Medicine 2 Theory Epigastric Pain

Etiology of Epigastric Pain 1-2

1.Cold pathogenic qi attacking the Stomach, obstructing the circulation of qi and blood: •External cold invading (environmental cold pathogen) •Internal cold due to yang deficiency 2.Improper diet and eating habits impairing the Stomach: •Excessive hunger, over-feeding, or eating irregularly •Over-eating cold, raw, rich, fatty, hot-spicy, and sweet foods •Unhygienic diet

Making a diagnosis

1.Distinguish cold from heat 2.Distinguish excess from deficiency 3.Distinguish qi stagnation from blood stasis 4.Determine the site of disease (organ involvement)

Treatment Strategies

1.Regulate the qi: (Liver or Stomach) 2.Harmonize the stomach, improve digestion 3.Descend the stomach rebellious qi 4.Expel evil qi 5.Tonify the deficiency

Etiology of Epigastric Pain 3-6

3.Transverse rebellion of Liver qi overacting on the Stomach: •Emotional problems (anger, worry, pensiveness, etc) 4.Over-exertion 5.Constitutional weakness 6.Improper treatment damaging the Stomach: •Over-usage of bitter-cold substances •Over-usage of aromatic and drying substances •Pharmaceutical agents

Epigastric pain (Wei tong - stomach pain)

A painful sensation located between the lower margin of the sternum and the infracostal margins The pain may radiate to the hypochondriac region or back, and may be associated with indigestion, belching, acid reflux, nausea, vomiting, abdominal distention, lack of appetite, indeterminate gnawing hunger, constipation, or diarrhea

For Exam 2: a. Cold invading formula b. Shaoyang and yangming syndrome symptoms c. Stomach yin deficiency symptoms and formulas d. Blood stasis formulas e. Spleen yang deficient formula

In the Epigastric Formulas set.

Abdominal pain - Wood overacts on Earth

LV ascends with SP; GB descends with ST •Earth qi turns and Wood qi spreads - no pain Cold Water damp Earth, SP qi sinks and ST qi rebellious, LV and GB stagnate - pain SP sinks and LV's branches can't spread above - lying below to overact on SP - lower abdominal pain Rebellious ST and GB's root cannot nurture below - lying above to overact on ST - heart and chest pain

Pathology of Epigastric Pain

•The site of disease is the Stomach, and it is intimately related to the Spleen and Liver. •Excess: Cold, food retention, Liver qi stagnation, blood stasis, damp-heat •Deficiency: Stomach yin, Spleen and Stomach Yang

Yin and Yang pathways

•V/GB channels spreads the hypochondria and ribs •3 yang disorders manifest in channels •3 yin disorders manifest in yin organs Yin exuberant in interior and yang exuberant in exterior Pain in yin and yang organs - jueyin evil Pain in hypochondria and ribs - shaoyang evil Naval pain - depleted middle qi, Wood evil attacks interior - more severe

Wind vs Heat

•Wood stagnates to create Wind and Heat •Pain below - more Wind and less Heat •Pain above - more Heat and less Wind •The root is always Damp and Cold