Hypochondriac Pain
Treatment
based on differentiation of symptoms and signs
Ⅰ.main
points of differentiation of symptomes and signs
1.
Differentiation of exterior and interior syndrome: i, e. internal injury
and affection by exopathogenic factors, hypochondriac pain due to affection by
exopathogens attackes more suddenly, and most of them are caused by damp-heat
pathogen attacking the liver and the gallbladder, clinically having often
exterior syndrome, marked by fever, aversion to cold, accompanied by vomiting,
jaundice, etc., floating and rapid or taut and rapid pulse, reddish tongue with
greasy, yellowish or white fur; hypochondriac pain due to internal injury
attackes slowly, without appearance of cold fever. There are more interior
syndrome and less exterior syndrome for hypochondriac pain.
2.
Differentiation of cold and
heat syndromes: Hypochondriac pain is marked by weakness, cold, tastlessness in
mouth, pale tongue with thin fur, preference for warmness, pain relieving after
warming and deteriorating after cold, taut, slow, deep and uneven pulse,
belonging to cold syndrome. Flushed face, strong constitution, bitter taste in
mouth, reddish tongue with yellowish or yellowish and greasy fur, preference for
cool, pain becomes more severe after heating on the affected part and taut, full
and rapid pulse, belong to heat syndrome.
3.
Differentiation of Qi and blood: acute disease is often caused by Qi, and
chronic disease damages blood, pain is not fixed on a
part. Distending pain is caused mainly by stagnation of Qi. Pain located
on a fixed part, exacerbating afternoon or night, the patient with ecchymosis on
the lip and the tongue belongs to blood stasis, more pain with less distention
or only pain with no distention, stabbing pain with a fixed or having history of
trauma also belongs to blood stasis.
4.
Differentiation of
deficiency and excess syndromes: acute disease and severe pain, strong
constitution, full and forceful
pulse, tenderness, belong to excess syndrome; chronic disease, weakness, vague
pain, thin, deep and weak pulse, prerefence for pressing, belong deficiency
syndrome. Clinically, deficiency syndrome is accompanied often by excess
syndrome, damp-heat with deficiency of blood or with retention of blood stasis
in the interior. Therefore, treatment should be given based on the principal and
the secondary, mild and severe aspects of disease.
Ⅱ.
Differential diagnosis
For pain syndrome, hypochondiac pain should be differentiated with epigastralgia, obstruction of Qi in the chest. Generally, they are differentiated with no difficulty from the parts of pain. Hypochondriac pain is mainly located on both hypochondrium, with differences of distending pain, stabbing pain, burning pain, vague pain, or with touch-able mass in the abdomin, or having had over drinking, pain being related with taking greasy food, at severe pain, the patient likes to change body position. Epigastragia has obvious pain on the topographical region below the xiphoid process, pain of deficiency type, preference for warmness and pressing, and pain of excess syndrome type has tenderness, often with acid regurgitation; pain due to obstruction of Qi in the chest is located on the chest, even on the back, occasionally on the left hypochondrium, beinly being vague pain, often accompanied by palpitation and short breath, etc.
Differentiation of hypochondriac pain, epigastragia and obstruction of Qi in the chest
|
Name of the Disease Differentiation |
Hypochondriac |
Epigastralgia |
Obstruction of Qi in the chest |
|
Parts |
Hypochondrium on one or two sides |
Gastric cavity |
Behind
the sternum or left-anterior
of the chest, or involving left hypochondrium and left shoulder and arm |
|
Specificities |
Distending pain, stabbing pain, vague pain, burning pain and colic
pain often seen,with preference For
changing body position at severe pain
|
Distention and fullness, stabbing pain, mass in the abdomin often
seen, for
pain of deficiency type, preference for pressing,and tenderness for pain of
excess type |
Fullness-pain as main,dislike to
change body position at pain |
|
Accompanying symptoms extremities |
Mass in the hypochondrium, of having had over-drinking |
Often
accompanied by vomiting nausea, acid
regurgitation |
Often accompanied by short breathing, oppressed feeling in chest,
cool palpitation,etc. |
|
Cause |
Affection by exopathogen, diet,seven emotional factors |
Diet,emotion, affection by cold |
Overeating,emotional fluctuation |
|
History of disease |
Diseases of the liver and the gallbladder |
Diseases of the spleen and the stomach |
Diseases of the heart |
|
diating parts |
Right shoulder and back |
The back |
Left shoulder and back |
Main points of therapeutic
principle
Soopthing the liver, purging the liver of pathogenic fire and nourishing
the liver are flexibly applied for relieving the depressed liver and regulating
the circulation of Qi, dredging the liver collaterals and clearing away
damp-heat in the liver channel, sufficincy of the liver-Yin and receving
nourishing in the liver collaterals, naturally leads to disappearence of
hypochondriac pain.
Ⅳ.
Treatment based on syndrome types
(Ⅰ)Stagnation
of the live-Qi
Main symptoms: Distending pain is main for hypochondriac pain, with no
fixed part, releiving or exacerbation of pain due to emotional fluctuation.
Accompanying symptoms: often complicated by distention and fullness in
the stomach, oppressed feeling in chest, frequent belching.
Tongue and pulse: thin fur on the tongue, taut palse.
Analysis: failure of normal circulation of the liver-Qi, and stagnation
of the liver-Qi in the collaterals in the hypochondium, so result in distenting
pain in the hypochondrium. Qi is flowing, so pain does not fix on a part,
wandering pain. Emotional changes are related closely with stagnation of Qi, so
pain is related to emotional changes. Failure of free flow of Qi induces
opperessed feeling in chest, and transverse inversion of the hyperactive live-Qi,
often attacking the spleen and stomach, cause anorexia and belching, and
distention and fullness in the stomach. Taut pulse is a sign of stagnation of
the live-Qi.
Therapeutic principle: Soothing the liver and regulating the circulation
of Qi.
(Ⅱ) Blood stasis
main symptoms: stabbing pain in hypochondrium with a fixed part, and more
severe in night .
accompanying symptoms: mass in hypochondrium.
Tongue and pulse: purplish dark tongue, or with ecchymosis, deep and
uneven pulse.
Analysis: pratracted stagnation of the liver-Qi stagnation of Qi and blood stasis, or drauma induce stasis of blood, obtruction of collaterals in the hypochondrium, so stabbing pain occurs with a fixed part and more severe pain in night. Accumulation of stagnation, protracted accumalation gradually form mass. Purplish dark tongue, ecchymosis, and deep and uneven pulse are signs of blood stasis.
Therapeutic principle: removing stasis and dredging collaterals.
(Ⅲ)
Dampness and heat in the liver and gallbladder
Main symptoms: tightening and fullness pain in hypochondrium.
Accompanying symptoms: oppressed feeling in chest and hypochondrium,
anorexia, nausea and vomiting; yellowish eyes and body, or with cold and fever,
difficulty in micturition, or vomiting roundworm.
Tongue and pulse: yellowish and greasy fur on the tongue, taut and rapid
pulse.
Analysis: stagnation of
dampness and heat in the liver and gallbladder, incoordination between the liver
collaterals, dysfunction of the gallbladder, so hypochondiac pain and bitter
taste in the mouth, stagnation of dampness and heat in middle-Jia lead to
fullness and oppressed in chest and stomach, anorexia, nausea and vomiting. The
liver has its specific body opening in the eye, flaming-up of the liver-fire, so
appearance of conjunctival congestion appears. Relation between dampness and
heat pathogens, bile goes out without circulation in normal tract, inducing
yellowish eyes and the body. Dampness and heat flow downward into the
gallbladder, leading to yellowish urine, or difficulty in micturition.
Stagnation of dampness and heat pathogens in the liver and the gallbladder,
incoordination between Shao Yang, bring about cold and fever;yellowish and
greasy fur on the tongue, taut and rapid pulse are signs of dampness and heat in
the liver and the gallbladder.
Therapeutic principle: Clearing away heat and eliminating dampness.
(Ⅳ)
Insufficiency of Liver-Yin
Main symptoms: Vague pain in hypochondrium.
Accompanying symptoms: Dry mouth and thoat, dysphoria with smothery
sensation, dizziness, tidal fever, night sweat, dysphoria with feverish
sensation in chest, palms and soles, soreness and weakness of waist.
Tongue and pulse: Reddish tongue with less fur, fine, taut and rapid
pulse.
Analysis: Fire-syndrome caused by protracted stagnation of the liver-Qi, impairing liver-Yin, or failure of nourishing the liver collaterals due to the impaired essence and blood induced by chronic disease with weakness, cause vague pain in hypochindrium. Yin-deficiency is in charge of internal heat, so dry mouth and thoat with dysphoria, soreness and weakness of waist, even tidal fever and night sweat, inability of nourishing upwards due to impaired essence and blood, lack of nutrient in senven orifices, give rise to dizziness. Reddish tongue with less fur, and fine, taut and rapid pulse are signs of internal heat due to Yin-deficiency.
Therapeutic principle: nourishing Yin and the liver.
Measures
for prevention and nursing care
1. Keep happy, and avoid restlessness and depression.
2. Proper diet, eat less pungent, greasy and sea food, do not drink wine .
3. Lead a regular life, pay attention to own hygiene, preventing from affection by exopathogen.
4. Finger-needling and massage are used in combination.
5. Properly do excerise, promoting the circulation of Qi and blood.
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