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Stomachache(and gastric discomfort with acid regurgitation)

General Introduction

Pain in the gastric cavity caused by impairment of the spleen and stomach and by derangement of qi and blood is called stomachache or epigastralgia. The gastric cavity, generally divided into upper, middle and lower parts, refers to the trapezoid area from the line connecting the lowest edges of ribs on both sides to the xiphoid process.

In ancient literature, stomachache used to be replaced by cardiac pain. In fact, they are different and should be strictly differentiated. In clinical practice ,it is not difficult to distinguish them from cause of illness, clinical manifestations, physical signs and necessary physiochemical examinations. This is extremely important for the treatment and prognosis of stomachache.

The main symptom of stomachache is various kinds of pain in the stomach, often accompanied with fullness and distention in the stomach, eructation, regurgitation of acid and food from the stomach, anorexia, hypochondriac and abdominal distention, and other symptoms. Stomachache frequently relapses. It is difficult for stomachache to be cured by long-term treatment, even with hematemesis, melena, dysuria with incessant vomiting and other symptoms.

Stomachache in acute and chronic gastritis, digestive ulcer, gastroneurosis, carcinoma of stomach as well as some diseases of the liver, gallbladder and pancreas in western medicine can be diagnosed and treated in reference to this disease.

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Etiology and Pathology

Stomachache at its onset largely belongs to excess syndrome with the disease mainly in the stomach and sometimes in the liver. Lingering stomachache often belongs to deficiency syndrome with the disease mainly in the spleen. Sometimes, deficiency syndrome is complicated with excess syndrome with the disease in the spleen and the stomach or in the liver and spleen. Ancient people often said: “Yangming disease occurs in strong persons while Taiyin disease in weak persons.” It is the same with stomachache.

The common causes of stomachache can be summarized as invasion of the stomach by exopathogen, improper diet, emotional depression and feeble spleen and stomach. They are described as follows:

1. Invasion of the stomach by exopathgen: Among exopathogens, cold most easily affects the stomach, and summer-heat and dampness can also invade the stomach. Impairment of the stomach-qi due to invasion of the stomach by exopathogen causes qi stagnation in mild cases and failure of the stomach-qi to descend in serious cases, leading to stomachache. Colicky pain is mainly caused by cold stagnation, summer-heat often leads to burning pain, and dampness frequently gives rise to oppressing pain.
2. Improper diet: The stomach receives food with the mouth as its opening. Overeating, excessive starvation, exposure to cold or heat, addiction to wine and cigarette, or overdose of stomach-impairing drugs can make the stomach-qi fail to ascend and descend to cause stomachache. In clinical practice at present, excessively taking fat and sweet food is the commonest cause for stomachache. Fat food, cigarette smoke and wine, damp and hot in nature, staying in the stomach can consume body fluid and impair the spleen.
3. Emotional depression: Emotional depression affecting functions of the liver and the spleen can also cause stomachache. For example, Depression and anger impairing the liver makes hyperactive liver-qi invade the spleen and stomach to cause incoordination between the liver and the stomach or between the liver and the spleen and stagnation of qi and blood, thus leading to gastropathy. Anxiety impairing the spleen makes it fail to transport and transform nutrients and makes the spleen-qi fail to ascend and descend normally, thus also leading to gastropathy.
4. Feeble spleen and stomach: Excessive fatigue, too much bleeding or lingering illness without cure can impair the spleen and the stomach. Feeble body, weak spleen and stomach, failure to transport and transform nutrients, disorder of qi in ascending and descending, and qi stagnation can give rise to gastropathy. The illness condition can be further aggravated in those patients with sinking of qi in the middle jiao. Spasmodic stomachache can be caused by yang deficiency of the spleen and the stomach, endogenours yin-cold, and failure to warm and nourish channels and collaterals. In those cases with ligering gastropathy, stomachache can be caused by consumption of yin-fluid, failure to moisten and nourish the stomach, and disorder of qi.

To sum up the above-mentioned description, stomachache is most closely related to the stomach, liver and spleen. Stomachache at its onset has its source mainly in the stomach, and sometimes in the liver. Lingering stomachache has its source mainly in the spleen and stomach or in the liver and spleen. The stomach corresponds to yang-earth, likes moisture and dislikes dryness. Its function is mainly to receive food and transform food into chyme. It is appropriate for the stomach-qi to descend. When impaired, the stomach-qi can stagnate and adversely rise. This means that stagnation of the stomach-qi can cause stomachache. Stagnation of the stomach-qi can be caused by exopathogen and indigestion and by transverse invasion of the stomach by hyperactive liver-qi. Qi governs blood circulation, so stagnation of qi for a long time can lead to blood stasis. In addition, “excessive qi becomes fire”, meaning that long-term disorder of qi can become heat. The fire is in the stomach or in both the liver and stomach. Fire can impair yin-fluid, or blood stasis makes blood not to generate. Deficiency of yin-blood can be caused by deficiency of stomach-yin, or by deficiency of the spleen and stomach, or by yin deficiency of the liver and stomach, or by yin deficiency of the liver and spleen. Lingering gastropathy can affect the spleen. The spleen corresponds to yin-earth, prefers dryness, and is averse to dampness. Its function is to transport and transform fluid and nutrients. It is appropriate for the spleen-qi to ascend. Impairment of the spleen-qi causes deficiency of qi in the middle jiao and failure of the spleen to transport and transform nutrients in mild cases, sinking of qi in the middle jiao and disorder of sending up or down essential substances in moderate cases, and yang deficiency of the spleen and stomach, endogenous yin-cold and failure to warm and mourish stomach-col-lateral in serious cases. In short, in spite of the above-mentioned differences in the causes of stomachache, and despite different syndromes of deficiency, excess, cold heat, qi system and blood system in its pathology, there is a point in common, which is so-called “stagnation causes pain”. No treatment or mistreatment of stomachache impairs blood vessels with hematemesis, hemafecia and other symptoms.

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DIFFERENTIATION AND TREATMENT OF COMMON SYNDROMES

Differentiation of Stomachache and Angina Pectoris:

1. Stomachache: most have history of stomach disease, pain in the stomach part, belching, acid regurgitation, lost appetide, abnormal stool and other symptoms. Most of them can be clearly diagnosed by combination with barium meal examination and gastroscopy of upper digestive tract.
2. Angina Pectoris: most have history of heart disease, with pain on the scrobiculus cordis, commonly seen in the patient of over mid-ages, often with oppressed feeling in chest, palpitation, dyspnea, dizziness, tinnitus, purple-dim lip and nail, stagnation pulse, etc. Most of them can be clearly diagnosed by combination with electrocardiogram and biochemical examinations.

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Therapeutic Principle

Soothing the live and activating Qi, Promoting blood circulation to resolve stasis and to relieve pain, Warming the middle-jiao to dispel cold, strengthening the spleen Qi, Killing the H. pylor.

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Recipe

Ginseng, Bupleurum root, Nutgrass flatsedge rhizome, White peong root, Liquorice, Red sage root, Sandawool, Amomun fruit, Galangal rhizome, Lindera root, Tubeimu tube, Tropoptorus dung, White atractylodes, Cuttle bone, Hyacinth bletilla & etc.

This herbal Drink is suitable for stomachache of deficiency type at remission stage.

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