E&P epigastric pain Flashcards
know the etiologies of epi- pn know the properties of the etiologies know the patterns and treatment principles of epigastric pn
what are the possible etiologies of epigastric pn
external pathogenic factors of cold and damp
food(too much or too little, the nature of food, conditions of eating)
emotions
constitutional weakness
what are the properties of cold in relation to epigastric pn (give tongue and pulse)
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
what are the properties of damp in relations to epigastric pn? (give tongue and pulse)
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
cold foods cause what
cold in the spleen and stomach and epigastric pn
hot-spicy foods cuase what
stomach-heat, which may manifest as burning epigastric pn, thirst and a yellow tongue coat
sugar and sweets cause what
damp and heat in the stomach
greasy foods and dairy cause what
phlegm or dampness in the stomach
anger cuases what
liver qi stagnation
worry causes waht
stagnation of st qi and retention of food.
what are the orgas most involved in the pathology of epigastric pn
stomach, spleen and liver
what are the main full conditions causin epigastric pain ?
cold heat retention of food dampness phlegm qi stagnation blood stasis
what are the main empty conditions causing epigastric pain?
qi deficiency
yang deficiency
yin deficiency
what conditions cause dull pain
empty conditions
what conditions cause severe epigastric pn
full conditions
belching, vomiting, hiccups, nausea, vomiting and sour regurgitation are signs of what?
what kind of conditions would these symptoms be found in?
rebellious qi
found usually in full conditions but sometimes in empty
what are the diagnostic parameters for epigastric pn
nature of pn time of pn amel and aggravation of pn thirst taste belching, regurgitation, nausea distension, oppression stuffiness, fullness palpation of the epigastrium
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
severe pn= excess condition dull pn= deficient condition stabbing pn=blood stasis distending pn= qi stagnation burning= heat feeling of fullness= dampness
what do different times of pn mean?
morning
afternoon
evening
morning pn = deficiency
afternoon pain= stagnation of qi
night pn =blood stasis
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
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
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
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
taste sx and their meaning sticky taste bitter taste sweet taste sour taste absence of taste
sticky taste = damp bitter taste = heat sweet taste =damp heat sour taste = retention of food absence of taste =spleen def.
belching sx and their meaning
loud belching
quiet belching
better after belching
loud belching = excess condtion
quiet belching = deficient condition
better after belching = stagnation of qi
regurgitation sx and their meaning
sour regurgitation
regurgitation of thin fluids
sour regurgitation =retention of food OR stagnant liver qi invading the stomach
regurgitation of thin fluids= deficient cold condition OR phlegm fluids in stomach
what does a feeling of distension mean and how is it usually described by the pt?
distension means qi stagnation. described as bloated
what does a feeling of oppression mean
phlegm or more severe qi stagnation
what does a feeling of stuffiness mean?
stomach qi deficiency or stomach heat. it can NOT be felt objectively on palpation.
there are 10 full patterns for epigastricd pn. what are they?
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
there are 2 empty patterns for epigastric pn, what are they?
stomach and spleen deficient and cold
stomach yin deficiency
what are the clinical manifestations of cold invading the stomach?
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.
what is the treatment principle for cold invading the stomach?
scatrer cold, warm stomach , stop pain
what are the clinical manifestations of retention of food?
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
treatment principle for retention of food
dissolve accumulation, eliminate stagnation and restore descending of stomach qi
important points to dissolve accumulation of food, and to descend st qi
st 20 dissolves food accumulation and resolves fullness
cv10 descends st qi
st25 (front mu of li) also resolves accunulation byt promoting bowel movement
clinical manifestations of Liver Qi invading the stomach
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
treatment principle for liver -Qi invading the stomach
soothe liver and regulate qi
liver poin to harmonize lv and st
lv 14
clnical manifestation of liver heat
burning epigastric pn thirst irritability sour regurgitation T- yellow, and dry caot. body may be red P- slightly rapid, overflowing in middle pulse
treatment principle of stomach heat
clear stomach heat, restore the descending of st qi
main distal st point to clear heat
st 44
clinical manifestations of stomach fire
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
Treatment principle of stomach fire
drain stomach fire, protect stomach yin, restore the descending stomach qi
how does stomach fire differe from stomach heat?
3 main says
- fire dries up more (so there are dry stool, dry mouth and dry tongue)
- fire causes bleeding by agitating the blood in the vessels (so there are bleeding gums, and vomiting blood)
- fire affects the mind more (so severe irritability)
clinical manifestations of phlegm fire
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
Treatment principle of phlegm fire
harmonize the stomach, clear fire, resolve phlegm and calm the mind
clnical manifestations of dampness in the stomach and spleen
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
treatment principle of dampness in stomach and spleen
resolve damp, harmonize the stomach, restore the descending of stomach qi and ascending of spleen qi
clnical manifestations of damp heat in stomach and spleen
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
treatment principle of damp heat in stomach and spleen
clear heat, resolved damp harmonize stomach
clnical manifestations of stomach and liver heat
burning epigastric pn irritability propensity to outbursts of anger sour regurgitation dry mouth thirst bitter taste
treatment principle of stomach and liver heat
soothe liver, clear heat, harmonize the stomach
clnical manifestations of blood in the stomach
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
treatment principle of blood in the stomach
invigorate (move) blood, eliminate stasis, harmonize stomach, stop pain
clnical manifestations of phlegm fire in the stomach
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
treatment principle of phlegm fluid in the stomach
resolve phlegm, harmonize the stomach, tonify the spleen
clinical manifestations of stomach and spleen deficient and cold (empty pattern)
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
treatment principle of stomach and spleen deficient and cold
warm the middle, strengthen the spleen and stomach
clinical manifestation of stomach yin deficiency
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)
treatment principle of stomach yin deficiency
nourish yin, benefit the stomach, stop pain
