All the diseases and syndomes induced by lesion of the liver and
gallbladder, and incoordination between Qi and blood, marked mainly by pain in
hypochondiac region on one or both sides, are called as hypochondiac pain.
Clinically, it is often accompanied by distending pain in the stomach, mass of
In western medicine, diseases of liver and the gallblader, such as acute
and chronic bypatitis, cirrhosis of liver, infection of biliary tract,
cholecystitis, gallstones, dry or exudative pleurisy, intercostal neuralgia,
costal perichondritis, etc. marked mainly by hypochondiac pain, can refer to the
treatment of this disease based on differentiation of symptoms and signs.
Causes of disease and pathogenesis.
The liver is located in the hypochondium, and its channel and collateral
distribute on hypochondrium of both sides, and the gallblader attaches to the
liver and its channel and collateral travel along the hypochondrium, so
hypochondriac pain is caused mainly by the diseases of the live and the
gallblader. Because blood stores in the liver, the liver is in charge of
soothing and regulating the circulation of Qi, and likes soothing. Bile stores
in the gallblader and it flows with the liver-Qi, so emotional disorder,
stagnation of the liver-Qi in the interior, or protracted stagnation of Qi,
stagnation of Qi and blood stasis; or consumption of essence and blood,
insufficiency of liver-Yin, lack of nourishing channels and collaterals, or
dysfunction of the spleen in transport and transformation, accumulation of
dampness and heat pathogens in the interior, and hypofunction of dispelling, all
can induce hypochondiac pain. The causes of disease and pathogenesis are
described in the following.
Stagnation of the liver-Qi: mental depression, or violent anger injuring
the liver,disorder of the liver-Qi, hypofunction of dispelling, obstruction of
collaterals by stagnation of Qi induces hypochondriac pain.
Blood stasis: protracted
stagnation of Qi,failure in free circulation of blood, blood stasis, failure in
free flow of Qi in the collaterals on hypochondrium, hypochondriac pain appears,
or strong load, sudden trauma, lesion of hypochondiac collaterals, stasis of
blood, obstruction of hypochondriac collaterals, leads to hypochondriac pain.
Dampness and heat in the
liver and the gallbladder: external dampness pathogen invading the interior, or
impairment by overeating, dysfunction of the spleen in transport, stagnation of
phlegm in the middle-Jiao, stagnation of Qi producing heat, stagnation of
dampness and heat in the liver, gallblader, spleen and stomach, failure of the
liver and the gallblader in soothing, lead to hypochondriac pain.
Insufficiency of the
liver-Yin: Chronic disease with weakness, or overwork, consumption of essence
and blood, insufficiency of the liver-Yin, and unability to nourish the liver
due to deficiency of blood ,inducing lack of nourishing collateral-vessels, also
can cause hypochondriac pain.
Fluid retention in hypochondium: Fluid retention in chest and
hypochondium, obstruction in channels and blood vessels, hypofunction of
ascending and descending of Qi of the liver and lung, leads to
Stagnation of pathogens in a half exterior and a half interior:
Exopathogenic factors can not be removed and be stagnated in a half exterior and
a half interior, hypofunction of Shao-Yang gallbladder-Qi,results in
In short, pathological change of hypochondial pain is mainly in the liver
and the gallbladder, both internal injury and affection by exopathogenic factors
can cause hypochondriac pain, and its causes of disease and pathgenesis are
related with the spleen, stomach, lung and kidney. Because failure of free flow
of Qi of the liver and gallblader, not only attacking the spleen and the
stomach, also invading the lung along channels, leading to disorder of the liver
and the lung in ascending and descending, and because the liver and the kidney
have same resource, insuffciency of the kidney-Yin can not nourish the liver,
resulting in hypochondriac pain due to deficiency of the liver. In the chapter,
former four kinds of hypochondriac pain are mainly discussed. Hypochondriac pain
has deficiency syndrome and excess syndrome, with excess syndrome often seen.
Excess syndrome has mainly stagnation of Qi, blood stasis and damp-heat,with
stagnation of Qi being main; deficiency syndrome, in most cases, belongs to
deficiency of Qi and blood; in addition, injury of Yin by production of heat due
to protracted excess syndrome can induce Yin-deficiency of the liver and kidney,
deficiency syndrome accompanied by excess syndrome is also seen.