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Hypochondriac Pain

General Introduction

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 hypochondiac.

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.

1.      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.

2.       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.

3.       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.

4.       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.

5.      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 hypochondriac pain.

6.      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 hypochondriac pain.

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.

Diagram of causes of disease and pathogenesis of hypochon