Patient's question:
Irregular eating habitsDoctor's answer:
Analysis of the Condition: The common causes of stomach pain include invasion of cold pathogen into the stomach, dietary injury, liver qi invading the stomach, and spleen-stomach deficiency. The stomach governs reception and transformation of food and drink. If cold pathogen invades the stomach, cold stagnation fails to dissipate, obstructing qi flow, it can lead to stomach qi disharmony and pain. Alternatively, irregular diet, excessive hunger or fullness, or overeating greasy and sweet foods can cause food stagnation, obstruct qi flow, and lead to stomach pain due to the stomach failing to descend harmoniously. The liver has a regulatory function on the spleen and stomach. If due to anger or depression, qi stagnation damages the liver, the liver failing to flow smoothly, and transversely invading the stomach, stomach pain may also occur. If due to overexertion or internal injury, chronic spleen-stomach deficiency, or congenital insufficiency, middle yang deficiency, the stomach failing to be warmed, internal cold arises, and middle jiao coldness causes pain. There is also qi stagnation for a long time, blood stasis accumulating internally, qi stagnation and blood stasis obstructing middle jiao qi flow, leading to stomach pain. In summary, the pathogenesis of stomach pain is divided into two aspects: excess patterns are characterized by qi flow obstruction, where pain occurs due to blockage; deficiency patterns are characterized by the stomach failing to be warmed or nourished, where pain occurs due to lack of nourishment.There are two main causes of stomach pain:
1. Due to worry, anger, or emotional distress, liver qi dysfunction occurs, transversely invading the stomach, hence the treatment focuses on soothing the liver and regulating qi.
2. Due to spleen deficiency and impaired stomach descent, methods such as warming and tonifying should be used to restore the functions of the spleen and stomach.
Many factors can cause stomach pain, including excessive work stress, irregular eating times, working or exercising immediately after meals, excessive alcohol consumption, overeating spicy foods, and frequently consuming indigestible foods. Stomach pain may be caused by several factors, but most are due to acid reflux, where the liquid originally in the stomach flows backward into the esophagus. These digestive fluids contain hydrochloric acid, which is a corrosive substance used industrially to clean metal. Although the stomach has a protective lining to prevent acid erosion, the esophagus lacks this protection.
Guidance for Treatment: To treat stomach pain, first identify the nature of the pain—whether it is excess, deficiency, cold, or heat—as well as whether the condition involves qi or blood. Then, examine the symptoms to determine the cause and provide appropriate treatment. Generally, acute, severe pain with localized tenderness is often excess; chronic, dull pain with relief from pressure is often deficiency. Cold-pattern pain is relieved by warmth and worsened by cold, while heat-pattern pain is relieved by coolness and worsened by heat. (distending pain) or pain radiating to the chest and flanks, which varies with emotional changes, is often qi stagnation. Fixed, stabbing pain is often due to chronic blood stasis. If there is restlessness, a red tongue with little coating or moisture, it may indicate insufficient stomach yin.
The ancient principle of "pain relief through unobstruction" is followed, but treatment is not limited to this method. During clinical practice, the four diagnostic methods and eight principles should be carefully applied to determine the appropriate treatment based on the patient's specific condition.
### 1. Liver qi invading the stomach
This pattern can be divided into three types: qi stagnation, fire stagnation, and blood stasis.
(1) Qi stagnation
Main symptoms: Distending pain in the stomach area, pain radiating to both sides of the rib cage, frequent belching, relief after belching or passing gas, thin white tongue, and wiry pulse.
Analysis: Emotional distress and qi stagnation lead to liver qi transversely invading the stomach, causing stomach dysfunction and pain. Qi pain often moves, and the liver governs the flanks, so pain radiates to the sides. Stomach qi ascending causes frequent belching; after belching or passing gas, qi inversion temporarily subsides, so pain also reduces. A thin white tongue and wiry pulse indicate liver qi stagnation.
Treatment principle: Soothe the liver, regulate qi, and harmonize the stomach to relieve pain.
Selected acupoints: Liver Shu (BL18), Spleen Shu (BL20), Stomach Shu (BL21), Zhongwan (CV12), Liangmen (ST25), Zhangmen (ST13), Shousanli (LI11), and Zusanli (ST36).
Recommended techniques: Heavy massage on the back and waist for pain relief, twisting and manipulating Shu points for qi regulation, pinching and kneading the back muscles for qi regulation, and rubbing the abdomen for digestion. If pain is severe with belching and vomiting, add bilateral Neiguan (PC6) and Neiting (LI4) to regulate qi and relieve pain. If there is frequent vomiting of sour water and constant discomfort, and since the liver and gallbladder are mutually exterior-exteriorly related, liver heat may cause gallbladder fire ascending, leading to dry mouth and bitter taste. A yellow tongue and wiry, rapid pulse indicate liver-gastric heat stagnation.
Treatment principle: Soothe the liver, drain heat, and harmonize the stomach.
Selected acupoints: Liver Shu (BL18), Stomach Shu (BL21), Sanjiao Shu (BL22), Da Chang Shu (BL25), Zhangmen (ST13), Shousanli (LI11), and Zusanli (ST36).
Recommended techniques: Heavy massage on the back and waist for pain relief, pinching and kneading the back for qi regulation, rubbing the abdomen for digestion, pressing Yangming for heat clearance, and adding distant-induced pain relief (simultaneously stimulating bilateral Neiguan (PC6), Laogong (LI8), Liangqiu (ST34), and Neiting (LI4)). If vomiting and bloody stools persist, medication should be the primary treatment, and manual techniques can be applied only after the condition stabilizes.
(3) Blood stasis
Main symptoms: Fixed pain with tenderness, often stabbing, worsening after meals, or hematemesis and melena, severe cases with a purple tongue and stasis-poor pulse.
Analysis: Chronic pain leads to collateral damage, causing hematemesis and melena. Stasis is an objective substance, so pain is fixed and tender. Food combining with stasis worsens pain after meals. Stasis obstructing blood flow causes a purple tongue and stasis-poor pulse.
Treatment principle: Activate blood circulation and resolve stasis to unblock collaterals and relieve pain.
Selected acupoints: Liver Shu (BL18), Spleen Shu (BL20), Stomach Shu (BL21), Zhangmen (ST13), Neiguan (PC6), Laogong (LI8), Liangqiu (ST34), and Neiting (LI4).
Recommended techniques: Heavy massage on the back and waist for pain relief, twisting and manipulating Shu points for qi regulation, pinching and kneading the back muscles for qi regulation, rubbing the upper abdomen to dispel cold; additionally, pressing Yangming for heat clearance and distant-induced pain relief (simultaneously stimulating bilateral Neiguan (PC6), Laogong (LI8), Liangqiu (ST34), and Neiting (LI4)). If vomiting and bloody stools persist, medication should be the primary treatment, and manual techniques can be applied only after the condition stabilizes.
### 2. Pathogen obstruction
(1) Dietary obstruction
Main symptoms: Distending pain in the stomach area, belching with a (rotten) odor, anorexia or vomiting, pain relief after vomiting, thick greasy tongue, and slippery, substantial pulse.
Analysis: Food stagnation in the stomach disrupts transmission, causing stomach pain and distension. Dietary stagnation leads to stomach qi failing to descend and instead ascending, causing belching or vomiting. Pain relief after vomiting occurs when accumulated stagnation is removed. Food stagnation fumes cause a thick greasy tongue. Stomach qi and retained food clash, so the pulse is slippery and substantial.
Treatment principle: Resolve food stagnation.
Selected acupoints: Spleen Shu (BL20), Sanjiao Shu (BL22), Liangmen (ST25), Tianhu (ST25), Shousanli (LI11), and Zusanli (ST36).
Recommended techniques: Pinching and kneading the spine for qi regulation, rubbing the abdomen for digestion, pinching and trembling for stagnation resolution, combined with pressing the back and waist for pain relief and pressing Yangming for heat clearance.