1. Acupuncture Treatment of Diseases Gastrology 1: Epigastric Pain 胃脘痛

2. Definition: 1.Characterized by repeated recurrence of pain in the upper abdominal region. 2.Pain is close to the cardiac region, its also called “cardiac pain”, “epigastric cardiac pain” or “inferior cardiac pain”. 3.Commonly seen in acute or chronic gastriris, peptic ulcers, gastro-intestinal neurosis and prolapsed gastric mucosa in western medicine.

3. Causes and Pathogenesis : Common causes is due to: A.Invasion of cold evil resulting in cold stagnation in the stomach. B.Irregular food intake resulting in food stagnation. C.Anxiety, anger and depression leading to failure of flow of liver qi which adversely attacks the stomach. D.Prolong stagnation of liver qi resulting in blood stasis and blockage of qi dynamics causing pain. E.Deficiency in the spleen and stomach leading to failure to warm or nourish the stomach. F.Stomach yin deficiency leading to failure to warm or nourish the stomach.

4. Clinical Manifestations: 1.Excess syndrome Chief symptoms: i.Abrupt onset ii.Severe pain in epigastric area iii.Aggravated after meals

5. Clinical Manifestations: 1.Excess patterns A.Pathogenic cold invasion type i.Pain relieve by warm and worsen by cold. ii.No thirst. iii.Preference to take warm drinks. iv.Light coloured tongue with thin white coating. v.Wiry, tight pulse.

6. Clinical Manifestations: B.Food retention type i.Sensation of fullness and distending pain. ii.Belching with foul smell. iii.Acid regurgitation. iv.Vomiting. v.Relief by passing gas. vi.Hesitated bowel movement. vii.Slightly reddish tongue. viii.Thick greasy coating ix.Slippery pulse.

7. Clinical Manifestations: C.Attack of stomach by liver qi type i.Distending pain radiated to the hypochondriac region. ii.Belching. iii.Acid regurgitation. iv.Sighing. v.Mood changes. vi.Hesitated bowel movement. vii.Slightly reddish tongue. viii.Thick white coating ix.Wiry pulse.

8. Clinical Manifestations: D.Liver qi stagnation and blood stasis type i.Constant local epigastric pain aggravated by pressure. ii.Dark purplish tongue with petechia iii.Thready, rough pulse.

9. Clinical Manifestations: 2.Deficiency syndrome Chief symptoms: i.Dull pain in epigastric region. ii.Prefer pressure. iii.Relief after eating.

10. Clinical Manifestations: 2.Deficiency syndrome A.Spleen-stomach deficiency cold type i.Watery regurgitation. ii.Loose stools. iii.Lassitude. iv.Cold hands and feet. v.Pale tongue with thin white coating. vi.Weak or slow pulse.

11. Clinical Manifestations: 2.Deficiency syndrome B.Stomach yin deficiency type i.Dull pain with burning sensation in the epigastric region. ii.Hunger but no desire to eat. iii.Dry mouth and throat. iv.Dry and hard stools. v.Red dry tongue with thin white coating. vi.Thready, rapid pulse.

12. Treatment : Generally principle for both excess and deficiency syndrome Regulate Qi and stop pain. Principle channels: 1.ST channel. 2.Conception Vessel. 3.PC channel.

13. Principle acupoints: 1.ST 36 Zusanli 足三里. 2.CV 12 Zhongwan 中脘. 3.PC 6 Neiguan 内关.

14. Prescription explanation (Principle acupoint): 1.ST 36 Zusanli 足三里 : He-Sea, Lower He-Sea point of the ST channel where qi of the channel congregates, chosen to regulate qi and stop the pain. 2.CV 12 Zhongwan 中脘 : Front-Mu point of stomach and Fu-Influential point, chosen to regulate qi and stop the pain.. 3.PC 6 Neiguan 内关. Luo-connecting acupoint of the PC channel and one of the Eight Confluent points, chosen specifically to treat gastric pain.

15. Principle of treatment Excessive syndrome: Pathogenic cold invasion type: Regulate qi and disperse cold evils. Principle acupoints: as stated Supplementary acupoints: 1.BL 21 Weishu 胃俞.

16. Principle of treatment Excessive syndrome: Food retention type: Regulate qi and stop pain. Principle acupoints: as stated Supplementary acupoints: 1.CV 10 Xiawan 丰隆. 2.ST 21 Liangmen 梁门.

17. Principle of treatment Excessive syndrome: Attack of stomach by liver qi type: Regulate qi and stop pain. Principle acupoints: as stated Supplementary acupoints: 1.LR 3 Taichong 太冲.

18. Principle of treatment Excessive syndrome: Liver qi stagnation and blood stasis type: Regulate qi and stop pain and invigorate blood. Principle acupoints: as stated Supplementary acupoints: 1.BL 17 Geshu 膈俞.

19. Principle of treatment Deficiency syndrome: Spleen-stomach deficiency cold type : Regulate qi, disperse cold and tonify spleen and stomach. Principle acupoints: as stated Supplementary acupoints: 1.CV 6 Qihai 气海. 2.CV 4 Guanyuan 关元． 3.BL 20 Pishu 脾俞. 4.BL 21 Weishu 胃俞.

20. Principle of treatment Deficiency syndrome: Stomach yin deficiency type : Regulate qi and nourish stomach yin. Principle acupoints: as stated Supplementary acupoints: 1.SP 6 Sanyinjiao 三阴交. 2.ST 44 Neiting 内庭．

21. TCM medical advises: 1.Good diet habit avoiding raw, cold and greasy, pungent and spicy food. 2.Stay away from allergic sources 3.Stop smoking and drinking. 4.Suitable exercise.