ABDOMEN

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Chapter 71

ABDOMEN

Chapter contents

INTRODUCTION

Although the headings below refer primarily to pain in various areas of the abdomen, other sensations may be experienced in each of those areas; these are primarily distension, oppression, fullness or stuffiness.

The clinical significance of these sensations is briefly explained below. For a fuller explanation, see Part 2, Chapter 38.

PAIN

The regions of abdominal pain in Chinese medicine are as follows:

• area under the heart (this is the small area immediately below the xyphoid process extending approximately 2 inches and bordered by the ribs)

• epigastric (this is the area between the xyphoid process and the umbilicus but excluding the hypochondrial area)

• hypochondrial (these are the two areas below the rib cage)

• umbilical (this is the area around the umbilicus)

• central-lower abdominal (this is the central area of the abdomen between the umbilicus and the symphysis pubis)

• lateral-lower abdominal (these are the lateral areas of the lower abdomen).

Figure 16.7 on p. 145 illustrates these areas.

Area below the xyphoid process

Interrogation, Chapter 38

Rebellious Qi of the Penetrating Vessel

Pain below the xyphoid process with a feeling of tightness, a feeling of heat in the face, a feeling of a lump in the throat, palpitations, anxiety, a feeling of tightness of the chest, nausea, slight breathlessness, epigastric fullness or stuffiness, umbilical and abdominal fullness, irregular/painful periods, a feeling of energy rising in the abdomen to the chest, Firm pulse.

Stomach-Heat

Pain below the xyphoid process, burning epigastric pain, thirst, sour regurgitation, nausea, excessive hunger, foul breath, a feeling of heat, Red tongue with a yellow coating, Overflowing-Rapid pulse.

Stomach-Qi stagnation

Pain below the xyphoid process with a feeling of distension, epigastric pain and distension, belching, nausea, vomiting, hiccup, irritability, pulse Wiry on the right Middle position.

Heart-Qi stagnation

Pain below the xyphoid process with a feeling of distension, palpitations, a feeling of oppression of the chest, depression, a slight feeling of a lump in the throat, slight shortness of breath, sighing, poor appetite, chest and epigastric distension, a dislike of lying down, weak and cold limbs, slightly purple lips, pale complexion, tongue slightly Pale-Purple on the sides in the chest area, pulse Empty but very slightly Overflowing on the left Front position.

Retention of Food in the Stomach

Pain below the xyphoid process with feelings of fullness, fullness, pain and distension of the epigastrium which are relieved by vomiting, nausea, vomiting of sour fluids, foul breath, sour regurgitation, belching, insomnia, loose stools or constipation, poor appetite, thick tongue coating, Full-Slippery pulse.

Stomach- and Spleen-Qi deficiency with Heart-Heat

Pain below the xyphoid process with a feeling of stuffiness, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, an uncomfortable feeling in the epigastrium, loss of sense of taste, palpitations, thirst, mouth and tongue ulcers, mental restlessness, feeling agitated, insomnia, dream-disturbed sleep, a feeling of heat, red face, bitter taste, Red tongue with redder tip and yellow coating, Overflowing and Rapid pulse.

Phlegm in the Stomach

Pain below the xyphoid process with a feeling of oppression, a feeling of oppression in the epigastrium or the chest, nausea, sputum in the throat, nausea, Swollen tongue with sticky coating, Slippery pulse.

Qi stagnation and Phlegm

Pain below the xyphoid process with a feeling of oppression and distension, a feeling of oppression of the chest, a feeling of a lump in the throat, sighing, sputum in the throat, irritability, Swollen tongue, Wiry or Slippery pulse.

Clinical note

• In my experience, repressed feelings are often ‘stored’ in the area below the xyphoid process; this often manifests with a hardness in this area on palpation.

Epigastric pain

Interrogation, Chapter 38

Stomach- and Spleen-Qi deficiency

Dull epigastric pain that is alleviated by eating and pressure coming in bouts, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, lack of sense of taste, Pale tongue, Empty pulse.

Stomach-Yin deficiency

Dull epigastric pain, poor appetite, poor digestion, retching, gnawing hunger, loss of sense of taste, dry mouth, dry lips, dry stools, thin body, sallow complexion with possibly a red tip of the nose, night sweating, tongue with transversal cracks on the sides, Weak or Floating-Empty pulse.

Liver-Qi invading the Stomach

Epigastric pain and distension extending to the hypochondrium, irritability, a feeling of oppression of the epigastrium, sour regurgitation, hiccup, belching, nausea, vomiting, sighing, weak limbs, normal-coloured tongue (or slightly Red on the sides in severe cases of Liver-Qi stagnation), pulse Wiry on the left and Weak on the right.

Cold in the Stomach

Severe, sudden-onset, spastic epigastric pain that is alleviated by drinking warm liquids and aggravated by drinking cold liquids, a feeling of cold, cold limbs, preference for warmth, vomiting of clear fluids (which may alleviate the pain), nausea, feeling worse after swallowing cold fluids (which are quickly vomited), preference for warm liquids, thick white tongue coating, Deep-Tight-Slow pulse.

Stomach-Heat

Burning epigastric pain, thirst, sour regurgitation, nausea, excessive hunger, foul breath, a feeling of heat, Red tongue with a yellow coating, Overflowing-Rapid pulse.

Stomach-Fire

Burning epigastric pain, intense thirst with a desire to drink cold liquids, mental restlessness, dry mouth, mouth ulcers, bleeding gums, dry stools, sour regurgitation, foul breath, nausea, vomiting soon after eating, a feeling of heat, sour regurgitation, tongue Red with a thick, dry dark-yellow coating, Deep-Full-Rapid pulse.

Cold-Dampness in the Stomach

Epigastric pain that is aggravated by drinking cold liquids and ameliorated by drinking warm liquids, poor appetite, a feeling of fullness or cold in the epigastrium, a feeling of heaviness of the head and body, a sweetish taste or absence of taste, no thirst, loose stools, tiredness, lassitude, nausea, oedema, dull-white complexion, excessive white vaginal discharge, Pale tongue with sticky white coating, Slippery-Slow pulse.

Damp-Heat in the Stomach

Epigastric pain, a feeling of fullness of the epigastrium, a feeling of heaviness, facial pain, stuffed nose or thick sticky nasal discharge, thirst without a desire to drink, nausea, a feeling of heat, dull-yellow complexion, a sticky taste, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Blood stasis in the Stomach

Severe, stabbing epigastric pain that may be worse at night, a dislike of pressure, nausea, vomiting, possibly of blood, or food looking like coffee grounds, Purple tongue, Wiry pulse.

Phlegm-Heat in the Stomach

Burning epigastric pain, thirst without a desire to drink, mental restlessness, bleeding gums, dry stools, dry mouth, mouth ulcers, sour regurgitation, nausea, vomiting soon after eating, excessive hunger, foul breath, a feeling of heat, a feeling of oppression of the chest and epigastrium, insomnia, tongue Red in the centre with a sticky yellow coating and a Stomach crack with a rough, sticky yellow coating inside it, Slippery-Rapid pulse.

Retention of Food

Epigastric pain, distension and fullness which are relieved by vomiting, nausea, vomiting of sour fluids, foul breath, sour regurgitation, belching, insomnia, loose stools or constipation, poor appetite, thick tongue coating, Full-Slippery pulse.

Liver-Fire invading the Stomach

Burning epigastric pain, distension and fullness, irritability, sour regurgitation, hiccup, belching, nausea, vomiting, sighing, weak limbs, tongue Red on the sides, pulse Wiry-Rapid and Weak on the right.

Phlegm-Fluids in the Stomach

Dull epigastric pain, abdominal fullness and distension, nausea, vomiting of watery fluids, dry mouth without a desire to drink, shortness of breath, dizziness, a feeling of oppression of the chest, swelling of the limbs, expectoration of thin watery sputum, inability to lie down, Swollen tongue with sticky coating, Deep-Wiry or Deep-Slippery pulse.

Clinical note

• Liver-Qi invading the Stomach is probably the commonest cause of epigastric pain.

Hypochondrial pain

Interrogation, Chapter 38

These are the two lateral areas of the upper abdomen below the rib cage.

Liver-Qi stagnation

Hypochondrial pain and distension without a fixed location and coming and going according to the emotional state, irritability, moodiness, a feeling of a lump in the throat, premenstrual tension, Wiry pulse.

Liver-Blood stasis

Stabbing hypochondrial pain with fixed location which is worse at night, painful periods, dark and clotted menstrual blood, masses in the abdomen, purple nails and lips, purple or dark complexion, Purple tongue, Wiry or Firm pulse.

Damp-Heat in Liver and Gall-Bladder

Hypochondrial pain distension and fullness, bitter taste, poor appetite, nausea, a feeling of heaviness of the body, yellow vaginal discharge, vaginal itching, mid-cycle bleeding/pain, burning on urination, dark urine, yellow complexion and eyes, vomiting, Red tongue with redder sides and unilateral or bilateral sticky yellow coating, Wiry-Slippery-Rapid pulse.

Liver-Yin deficiency

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