Abdominal pain

Question 1

Excess Syndromes

Answer 1

1. Obstruction of cold evil
2. Retention of damp heat
3. Qi stagnation
4. Blood Stasis

Question 2

Deficency Syndromes

Answer 2

Deficent cold in middle jiao

Question 3

Obstruction by Cold Evil Signs and Symptoms

Answer 3

Sudden acute sharp abdominal pain which is aggrevated by cold and alleviated by warmth, chills, absence of thirst, loose stools or constipation, clear long urination

Question 4

Obstruction by Cold Evil Tongue and Pulse

Answer 4

Thin and white coating

Deep Tight

Question 5

POT Obstruction by Cold Evil

Answer 5

Warm the middle jiao to expel cold

Question 6

Obstruction by Cold Evil Points

Answer 6

SP 15

LI 4

Question 7

Retention of Damp Heat Signs and Symptoms

Answer 7

Sudden severe abdominal pain, on and off, abdominal distension, doesn’t like pressure, dry mouth, bitter taste in mouth, yellow scanty urine, fever, constipation or hesitant loose stools, fullness in chest and epigastrium, belching, acid regurgitation, nausea, vomiting

Question 8

Retention of Damp Heat Tongue and Pulse

Answer 8

Yellow greasy coating

P: Wiry and Rapid

Question 9

POT of Retention of Damp Heat

Answer 9

Clear damp heat

Circulate the intestine to remove stasis

Question 10

Retention of Damp Heat Points

Answer 10

UB 25
SP 6, 9
LI 11
SJ 6

Question 11

Basic Abdominal Pain Points

Answer 11

REN 12
ST 25
REN 6
ST 36
ST 37
SP 4

Question 12

Qi Stagnation Signs and Symptoms

Answer 12

Wandering abdominal distending pain which refers to epigastrium and hypochondrium or low abdomen, chest tightness, belching, sighing, pain aggrevated by stress

Question 13

Qi Stagnation Tongue and Pulse

Answer 13

Thin Coating

P: wiry or wiry thready

Question 14

POT for Qi Stagnation

Answer 14

Sooth liver and regulate Qi

Question 15

Qi Stagnation Points

Answer 15

REN 17
PC 6
GB 34
LIV 3

Question 16

Blood Stasis Signs and Symptoms

Answer 16

Stabbing fixed abdominal pain that doesn’t like pressure, chronic pain, may have injury history

Question 17

Blood Stasis Tongue and Pulse

Answer 17

Dark Purple Tongue

P: Thready and Choppy

Question 18

POT for Blood Stasis

Answer 18

Promote blood circulation to remove blood stasis

Question 19

Blood Stasis Points

Answer 19

PC 6
SP 10
UB 17
UB 18

Question 20

Deficient cold in the middle jiao

Signs and Symptoms

Answer 20

Lingering abdominal pain which is alleviated by warmth and pressure and aggrevated by hunger and overwork, comes on and off, loose stools, intolerance to cold, listlessness, SOB

Question 21

Deficient cold in the middle jiao Tongue and Pulse

Answer 21

Pale Tongue with white coating

P: Deep Thready

Question 22

POT for Deficient cold in the middle jiao

Answer 22

Tonify Qi, warm the middle jiao to expel the cold

Question 23

Deficient cold in the middle jiao Points

Answer 23

UB 20
UB 21
LIV 13

Question 24

Etiology

Answer 24

1. EPFs - cold/heat
2. Emotional Frustration - qi stag = blood stasis
3. Irregular diet- retention of food = damp heat
4. Parasites - worms in intestine
5. Trauma/surgery = blood stasis
6. Yang deficiency constitution - malnourishment of zang fu and meridians = accumulation of xie qi

Question 25

Chief Pathology

Answer 25

Excess: Blockage of Qi Movement and meridian by Xie Qi Deficiency: malnourishment of Zang Fu

Question 26

Organs Involved

Answer 26

``` Spleen Stomach Liver Gallbladder Kidney Urinary bladder Large intestine Small intestine SanJiao ```

Question 27

Disease Differentation

Answer 27

* get patient to palpate and show where it hurts* Stomachache vs Abdominal Pain - epigastric pain - more areas of pain - belching - no stomachache signs - hiccup - acid reflux - hrt burn Hypochondriac Vs. Abdominal Pain - liver/GB region Dysentery Vs. Abdominal Pain - Tenesmus - Blood/Pus Abdominal Masses Vs. Abdominal Pain - Masses/Lumps External: - fixed local pain - very severe pain - *Abdominal pain than fever* - painful on Palpation - decreased abdominal breathing, more chest breathing Internal: - * start fever first than abdominal pain* - subjective pain ( not many obj symptoms) - tender points not localized Gyno: - pregnancy - miscarriage - leukorrhea - pregnancy

Question 28

Abdominal Palpation Tips

Answer 28

- Palpating abdomen put pillow under knees because if legs straight abdominal muscles tighten - palpate opposite area of pain - palpate lower to upper - get patient to do deep slow tummy breathing - check for temp, masses, enlarged liver

Question 29

Abdominal Division

Answer 29

4 Division: 1. Upper right abdomen 2. Upper left abdomen 3. Lower right abdomen 4. Lower left abdomen ``` 9 Division: used more in clinic* #1 & # 3 hypochondriac abdomen # 5 Umbilicus abdomen # 2 Epigastric abdomen # 4 & # 6 Lumbar abdomen # 8 Small abdomen # 7 & # 9 Little abdomen All areas pain called "Big Abdomen" ```

Question 30

Pattern Differentiation

Answer 30

Excess Vs. Deficiency - Pain severe - Dull, lingering pain - No pressure - Like pressure - Feel lumps - pain when ST empty - Pain when stomach full Heat Vs. Cold - likes cold - Likes heat Qi Stag. Vs. Blood Stag - Distending/wandering - Fixed/Stabbing - Intermittent. - Bruised, purple skin - Lump ``` Location: Low abdomen (#8): Kidney, UB Umbilicus (#5): Parasites Hypochondriac (#1/3): Liver, GB Big abdomen (whole ab): Spleen, ST, Lrg Int, Sm Int ``` - factor in age, sex, medical history, diet, location, signs/symptoms

Question 31

Treatment Principle

Answer 31

*Pain due to blockage* 1. Excess remove xie Qi 2. Deficiency nourish 3. Herbal 4. Acupuncture Pts 5. Warming needle/ Moxa if cold/deficiency pattern 6. Auricular Acupuncture 7. Electro acupuncture for pain - 20 min

Question 32

Patient Education

Answer 32

1. Avoid EPF - especially in summer 2. Don't expose abdomen 3. Avoid running after meal 4. No overeating 5. Hygiene (parasites) 6. Emotions: don't worry/overthink 7. Diet: greasy food, alcohol, cold food/water, raw ~walking everyday you'll live till your 99~

Question 33

compare internal and external:

Answer 33

internal: fever---> ab pain, subjective pain, uncertain tender spots, moving pain external: ab pain---> fever, fixed/local pain, very severe, obvious tender spots

Question 34

compare excess and deficiency:

Answer 34

shi: sharp/sever pain, pressure is bad, worse on full stomach, nodules xu: dull/lingering pain, pressure is good, worse on empty stomach