Gastric and duodenal ulcer and chronic gastritis in modern medicine. Gastroptosis, gastric neurosis and prolapse of gastric mucosa can be treated according to the contents of this chapter.
Etiology and pathogenesis
The causes of epigastric pain include pathogenic factors attacking the stomach, disharmony between liver and stomach, deficiency and cold of spleen and stomach, etc.
1) Pathogens invading the stomach: exogenous cold pathogens, pathogens invading the stomach, or overeating and cold accumulation in the stomach all make the stomach cold and painful. In particular, people with spleen and stomach deficiency and cold are more likely to feel cold pathogens and produce pain; In addition, improper diet, gluttony, fat and sweet endogenous damp heat, or food stagnation can all cause heat pain or food pain.
2) disharmony between liver and stomach: depression and anger hurt the liver, and the liver qi is lost in powder, leading to epigastric pain. Stagnation of liver qi can turn fire. Fire evil can also hurt yin, aggravate pain or make the course of disease lingering.
3) Deficiency and cold of spleen and stomach: weakness, overwork, abnormal hunger, and chronic illness can all damage the yang of spleen and stomach, making the middle qi insufficient for cold and pain.
Although the causes of epigastric pain are not the same as those mentioned above, they all have the same way, that is, the so-called "impassability leads to pain." Obstruction of pathogenic factors and stagnation of liver qi all make the circulation of qi unfavorable and cause pain due to qi stagnation; Yang deficiency of spleen and stomach, loss of temperature in veins, or deficiency of stomach yin, which leads to acute pain in veins. If qi stagnation exists for a long time, it can cause blood coagulation and congestion, and the pain is more stubborn and difficult to heal.
Syndrome differentiation and treatment of epigastric pain
The syndrome differentiation of epigastric pain is mainly to distinguish whether it is caused by pathogenic factors (cold, heat, food stagnation, etc.). ) or visceral disorders (stagnation of liver qi and weakness of spleen and stomach); Liver disease, or spleen and stomach disease; Whether it is empirical (pathogenic obstruction, liver depression, liver fire) or deficiency (spleen and stomach yang deficiency or stomach yin deficiency); Whether it is qi stagnation or blood stasis. To treat this disease, "regulating qi and relieving pain" is a commonly used clinical method. However, it is necessary to further examine the evidence, seek the cause, and those who are unable to understand the evil spirits should be dismissed after arguing their evil spirits. Because the liver qi is stagnant, it is necessary to soothe the liver and relieve depression; Because of spleen and stomach deficiency and cold, it is appropriate to warm and dispel cold; If the pain lasts for a long time, it is often caused by fire, yin injury and blood stasis. When the condition is different, methods such as clearing fire, nourishing yin and removing blood stasis should be adopted.
1) Pathogenic blockage:
Main symptoms: epigastric pain, aversion to cold and warmth, local hot compress with little pain, thirst or hot drink, white fur and tight pulse.
Dialectics: Cold pathogen invades the stomach, or food is cold, and cold accumulates in the stomach. Yang Qi is bound by cold pathogen and cannot stretch, resulting in pain. The tongue coating is white and greasy and the pulse is tight and cold. Tight pulse is more common when the stomach hurts badly.
Treatment: dispelling cold and relieving pain
2) Stomach stagnation:
Main symptoms: bloating, even pain, rancidity and acid swallowing, vomiting and indigestion of food, pain relief after vomiting, or uncomfortable stool and thick and greasy fur.
Dialectical: excessive diet stops accumulation in the middle, so abdominal distension and pain are seen, and it is sour; After vomiting, stagnation can be eliminated and epigastric pain can be reduced. Thick and greasy tongue coating is a sign of food retention.
Treatment: digestion and stagnation.
3) Liver-qi attacking the stomach:
Main symptoms: epigastric fullness, fatigue, belching, thin stool and thready pulse.
Dialectics: the liver governs catharsis, emotional distress, stagnation of liver-qi, and upset stomach; The flank is the dividing line of the liver, and the qi disease often wanders, so the pain attacks the branches and connects the two flanks; The qi movement is unfavorable, and the stomach qi can't go down, resulting in fullness, belching, poor stool, liver qi attacking the stomach, and string pulse can be seen.
Treatment: soothing the liver and regulating qi.
4) Deficiency and cold of spleen and stomach:
Main symptoms: dull pain, spitting, pressing, tepid hands and feet, loose stool, pale white tongue, weak or heavy pulse.
Dialectics: spleen and stomach deficiency and cold, yang deficiency and water stop gathering, so the pain is not very good, spit water. People with spleen yang deficiency and excessive cold are afraid of cold and warmth, with tepid hands and feet and thin stools. Pale white tongue and weak or thin pulse are all manifestations of deficiency of middle qi and inability to distribute cold yang.
Treatment: warming the middle and dispelling cold.
5) Blood stasis:
Main symptoms: epigastric pain is localized, such as acupuncture or knife cutting, or hematemesis is purple-black. Blood in the stool is like ink, the tongue is purple and dark, and the pulse is fine and astringent.
Dialectics: It is difficult to heal the pain for a long time, because blood stasis is the further development of qi stagnation and deficiency cold, and its roots are deeper. Blood stasis is tangible, so the pain is localized, and the pain enters the collaterals for a long time, and the veins are damaged, so vomiting blood and black stool. The tongue is purple and dark, and the pulse is fine and astringent, which is a manifestation of poor blood circulation.
Treatment: removing blood stasis and dredging collaterals
Most of the syndromes of epigastric pain are acute pain; Patients with stagnation of liver qi and weakness of spleen and stomach are mostly chronic pain. Stagnation of pathogenic factors, stagnation of qi and fire, or weakness of spleen and stomach can all form blood stasis block. Therefore, the above syndromes are often not simple and unchangeable, and it is not uncommon to have firm teeth and mixed cold and heat, so we must master them flexibly in clinic.