E&P epigastric pain

Question 1

what are the possible etiologies of epigastric pn

Answer 1

external pathogenic factors of cold and damp
food(too much or too little, the nature of food, conditions of eating)
emotions
constitutional weakness

Question 2

what are the properties of cold in relation to epigastric pn (give tongue and pulse)

Answer 2

cold can invade the stomach directly. as cold contracts, it causes acute and severe pigastric pn usually accompnied with vomiting.
t- thick white coat
p- tight

Question 3

what are the properties of damp in relations to epigastric pn? (give tongue and pulse)

Answer 3

damp can iinvade the stomach directly and may be combined with cold or heat according to the season. damp obstructs the descending st qi and causes dull pn and nausea. it also causes oppresion and heaviness of the epigastrium.
T- sticky coat
P- slippery

Question 4

cold foods cause what

Answer 4

cold in the spleen and stomach and epigastric pn

Question 5

hot-spicy foods cuase what

Answer 5

stomach-heat, which may manifest as burning epigastric pn, thirst and a yellow tongue coat

Question 6

sugar and sweets cause what

Answer 6

damp and heat in the stomach

Question 7

greasy foods and dairy cause what

Answer 7

phlegm or dampness in the stomach

Question 8

anger cuases what

Answer 8

liver qi stagnation

Question 9

worry causes waht

Answer 9

stagnation of st qi and retention of food.

Question 10

what are the orgas most involved in the pathology of epigastric pn

Answer 10

stomach, spleen and liver

Question 11

what are the main full conditions causin epigastric pain ?

Answer 11

cold
heat
retention of food
dampness
phlegm
qi stagnation
blood stasis

Question 12

what are the main empty conditions causing epigastric pain?

Answer 12

qi deficiency
yang deficiency
yin deficiency

Question 13

what conditions cause dull pain

Answer 13

empty conditions

Question 14

what conditions cause severe epigastric pn

Answer 14

full conditions

Question 15

belching, vomiting, hiccups, nausea, vomiting and sour regurgitation are signs of what?
what kind of conditions would these symptoms be found in?

Answer 15

rebellious qi

found usually in full conditions but sometimes in empty

Question 16

what are the diagnostic parameters for epigastric pn

Answer 16

nature of pn 
time of pn
amel and aggravation of pn
thirst
taste
belching, regurgitation, nausea
distension, oppression stuffiness, fullness
palpation of the epigastrium

Question 17

what are the possible sx for nature of pn and what do the symptoms mean?
severe pn
dull pn
stabbing pn
distending pn
burning
fullness

Answer 17

severe pn= excess condition
dull pn= deficient condition
stabbing pn=blood stasis
distending pn= qi stagnation
burning= heat
feeling of fullness= dampness

Question 18

what do different times of pn mean?
morning
afternoon
evening

Answer 18

morning pn = deficiency
afternoon pain= stagnation of qi
night pn =blood stasis

Question 19

what do ameliorations and aggravations of pn mean
better after eating
worse after eating
better pressure
worse pressure
better with heat application or hot fluids
better with rest
better with slight exercise
better after vomiting
worse after vomiting

Answer 19

better after eating = deficiency
worse after eating = excess
better pressure =deficiency
worse pressure = excess
better with heat application or hot fluids = cold
better with rest =deficiency
better with slight exercise =stagnation of qi or blood
better after vomiting =excess condition
worse after vomiting =deficiency condition

Question 20

thirst sx and their meaning:
intense thirst with desire to drink cold fluids
dry mouth with desire to sip fluids
abscence of thirst
thirst without desire to drink

Answer 20

intense thirst w/ desire to drink cold fluid =full heat
dry mouth w/desire to sip fluid =empty heat /yin def
abscence of thirst =cold
thirst without desire to drink= damp

Question 21

taste sx and their meaning
sticky taste
bitter taste
sweet taste
sour taste
absence of taste

Answer 21

sticky taste = damp
bitter taste = heat
sweet taste =damp heat
sour taste = retention of food
absence of taste =spleen def.

Question 22

belching sx and their meaning
loud belching
quiet belching
better after belching

Answer 22

loud belching = excess condtion
quiet belching = deficient condition
better after belching = stagnation of qi

Question 23

regurgitation sx and their meaning
sour regurgitation
regurgitation of thin fluids

Answer 23

sour regurgitation =retention of food OR stagnant liver qi invading the stomach

regurgitation of thin fluids= deficient cold condition OR phlegm fluids in stomach

Question 24

what does a feeling of distension mean and how is it usually described by the pt?

Answer 24

distension means qi stagnation. described as bloated

Question 25

what does a feeling of oppression mean

Answer 25

phlegm or more severe qi stagnation

Question 26

what does a feeling of stuffiness mean?

Answer 26

stomach qi deficiency or stomach heat. it can NOT be felt objectively on palpation.

Question 27

there are 10 full patterns for epigastricd pn. what are they?

Answer 27

``` cold invading stomach retention of food liver qi invading stomach stomach heat stomach fire stomach phlegm fire stomache damp heat stomach and liver heat blood stasis in the stomach phlegm fluids in the stomach ```

Question 28

there are 2 empty patterns for epigastric pn, what are they?

Answer 28

stomach and spleen deficient and cold | stomach yin deficiency

Question 29

what are the clinical manifestations of cold invading the stomach?

Answer 29

``` acute severe epigastric pn with SUDDEN ONSET, chilliness, desire for warm applications on stomach area, NO THIRST, desire for warm drinks, Pain not alleviated by pressure, nausea, vomiting T- thick white tongue coat p- full and tight. ```

Question 30

what is the treatment principle for cold invading the stomach?

Answer 30

scatrer cold, warm stomach , stop pain

Question 31

what are the clinical manifestations of retention of food?

Answer 31

dull epigastric pn that is worse with presure feeling of distension and fullness belching, sour regurgitation foul breath vomiting undigested food, amel from vomiting loose stools or constipation T- thick, sticky coating in the center and root P- slippery

Question 32

treatment principle for retention of food

Answer 32

dissolve accumulation, eliminate stagnation and restore descending of stomach qi

Question 33

important points to dissolve accumulation of food, and to descend st qi

Answer 33

st 20 dissolves food accumulation and resolves fullness cv10 descends st qi st25 (front mu of li) also resolves accunulation byt promoting bowel movement

Question 34

clinical manifestations of Liver Qi invading the stomach

Answer 34

epigastric distension and pain radiating towards the right or left hypochondrium. belching, sighing irritability uncomfortable feeling of hunger pn comes in bouts clearly related to emotional tension T- normal body, slight red sides P- wiry

Question 35

treatment principle for liver -Qi invading the stomach

Answer 35

soothe liver and regulate qi

Question 36

liver poin to harmonize lv and st

Answer 36

lv 14

Question 37

clnical manifestation of liver heat

Answer 37

``` burning epigastric pn thirst irritability sour regurgitation T- yellow, and dry caot. body may be red P- slightly rapid, overflowing in middle pulse ```

Question 38

treatment principle of stomach heat

Answer 38

clear stomach heat, restore the descending of st qi

Question 39

main distal st point to clear heat

Answer 39

st 44

Question 40

clinical manifestations of stomach fire

Answer 40

``` Burning peigastric pn thirst with desire to drink cold water dry mouth severe irritability bleeding gums vomiting blood red face constipation T: red or dark red body, yellow dry coat P: rapid deep full ```

Question 41

Treatment principle of stomach fire

Answer 41

drain stomach fire, protect stomach yin, restore the descending stomach qi

Question 42

how does stomach fire differe from stomach heat? | 3 main says

Answer 42

1. fire dries up more (so there are dry stool, dry mouth and dry tongue) 2. fire causes bleeding by agitating the blood in the vessels (so there are bleeding gums, and vomiting blood) 3. fire affects the mind more (so severe irritability)

Question 43

clinical manifestations of phlegm fire

Answer 43

``` any of the sx from stomach fire, PLUS: feeling of oppression in the epigastrium dry mouth but no desire to drink mucus in stools nausea and vomiting mental restlessness mania in severe cases insomnia in severe cases T: red and very sticky or slippery yellow coating P: slippery rapid overflowing ```

Question 44

Treatment principle of phlegm fire

Answer 44

harmonize the stomach, clear fire, resolve phlegm and calm the mind

Question 45

clnical manifestations of dampness in the stomach and spleen

Answer 45

``` feeling of oporession in the chest, dull epigastric pn dry mouth and no desire to drink bitter taste, or a sticky taste nausea and vomiting maybe a frontal headache T- red and sticky yellow coat P- slippery and rapid ```

Question 46

treatment principle of dampness in stomach and spleen

Answer 46

resolve damp, harmonize the stomach, restore the descending of stomach qi and ascending of spleen qi

Question 47

clnical manifestations of damp heat in stomach and spleen

Answer 47

``` feeling of oporession in the chest, dull epigastric pn dry mouth and no desire to drink bitter taste, or a sticky taste nausea and vomiting maybe a frontal headache T- red and sticky yellow coat P- slippery and rapid ```

Question 48

treatment principle of damp heat in stomach and spleen

Answer 48

clear heat, resolved damp harmonize stomach

Question 49

clnical manifestations of stomach and liver heat

Answer 49

``` burning epigastric pn irritability propensity to outbursts of anger sour regurgitation dry mouth thirst bitter taste ```

Question 50

treatment principle of stomach and liver heat

Answer 50

soothe liver, clear heat, harmonize the stomach

Question 51

clnical manifestations of blood in the stomach

Answer 51

``` stabbing epigastric pn that is wrose with pressure and after eating palpable masses in epigastrium vomiting of dark blood or coffee grounds dark complexion pn may be worse at night may have blood in stool T:purple, possibly only in center P-choppy, wiry or firm ```

Question 52

treatment principle of blood in the stomach

Answer 52

invigorate (move) blood, eliminate stasis, harmonize stomach, stop pain

Question 53

clnical manifestations of phlegm fire in the stomach

Answer 53

``` epigastric fullness and distension nausea and vomiting of watery and frothy fluid dry tongue and mouth with no desire to drink splashing sound in stomach feeling of fullness in chest loose stool loss of weight lethargy, dizziness full frontal headache T-swollen with a sticky coat P-slippery or wiry ```

Question 54

treatment principle of phlegm fluid in the stomach

Answer 54

resolve phlegm, harmonize the stomach, tonify the spleen

Question 55

clinical manifestations of stomach and spleen deficient and cold (empty pattern)

Answer 55

``` dull epigastric pn thats better with pressure, eating and application of heat vomiting of thin fluids fatigue poor appetite chilly loose stool plae complexion T: plae white coat P-deep weak ```

Question 56

treatment principle of stomach and spleen deficient and cold

Answer 56

warm the middle, strengthen the spleen and stomach

Question 57

clinical manifestation of stomach yin deficiency

Answer 57

dull epigastric pn dry mouth with desire to sip fluids dry throat dry stool slight nausea feeling of heat, night sweating T- normal color, dry no coat scattered cracks or a central crack P- floating, empty in the rt middle position ( might also have 5 palm heat, malar flush red tongue and rapid pulse)

Question 58

treatment principle of stomach yin deficiency

Answer 58

nourish yin, benefit the stomach, stop pain