Module 5: Chest Pain, Hypochondriac Pain, and Epigastric Pain Flashcards
Chest yang can be suppressed by
pathogenic cold, blood stasis, or phlegm.
Pathogenic heat can damage
the channels and collaterals in the chest.
Zong qi is also called
Chest Qi, Ancestral Qi
severe stabbing chest pain with fixed location, worse at night.
Excess: Blood stasis
Worse at night from less movement (rest)
distending pain, may occur suddenly, can be induced by emotional stress,
frequent sighing.
Excess: Qi Stagnation
dull chest pain, stifling sensation in the chest, cough with profuse sputum
Excess: Phlegm obstruction
expectoration of yellow thick phlegm or pus, with blood and foul odor:
excess: lung abscess
Severe chest pain, sudden onset, pain may radiate to left arm and shoulder. Includes? (4 patterns)
Blood stasis
Qi stag
phlegm obstruction
lung abscess (heat)
Vague, chronic, mild pain includes
Qi xu, qi and yin xu
Palpitations, a feeling of distension or oppression of the chest, depression, a slight feeling of
lump in the throat, slight shortness of breath, sighing, poor appetite, weak and cold limbs,
slightly purple lips, pale complexion.
Tongue: slightly Pale-Purple on the sides in the chest area.
Pulse: Empty but very slightly Overflowing on the left Front position
Heart Qi Stagnation
Palpitations, shortness of breath with inability to lie down. depression, mental restlessness. a
flustered feeling, a feeling of oppression of the chest, stabbing or pricking pain in the heart
region that comes and goes and may radiate to the upper back or shoulder, pain aggravated by
exposure to cold and alleviated by heat, expectoration of phlegm, a feeling of heaviness, dislike
of speaking, cold hands, sighing, purple lips, face and nails.
Tongue: Purple on the sides in the chest area,
Swollen with a sticky coating.
Pulse: Wiry, Choppy or Knotted; Slippery if Phlegm
is predominant.
Heart Vessel Obstruction
Keys: Some signs of qi stag, some signs of blood stasis, some signs of phlegm
Palpitations, stabbing or pricking pain in the chest that may radiate to the inner aspect of the
left arm or to the shoulder, a feeling of oppression or constriction of the chest, cyanosis of lips
and nails. cold hands.
Tongue: Purple in its entirety or only on the sides in the chest area.
Pulse: Choppy, Wiry or Knotted.
Key symptoms: stabbing pain in the chest, cyanosis of lips, purple tongue.
Heart Blood Stasis
Cough, slight breathlessness, feeling of heat, chest ache, flaring of nostrils, thirst, red face
Tongue: Red with yellow coating
Pulse: Overflowing-Rapid.
Key symptoms: cough, feeling of heat. thirst, red tongue with yellow coating.
Lung Heat
Chronic cough coming in bouts with profusewhite sticky sputum that is easy to expectorate.
pasty-white complexion, a feeling of oppressionin the chest. phlegm in the throat. shortness of
breath, dislike of lying down, wheezing, nausea, a feeling of heaviness, muzziness and dizziness
of the head,
Tongue: Swollen tongue with a sticky white coating.
Pulse: Slippery or Soggy pulse
Damp Phlegm in the lungs
Palpitations, shortness of breath on exertion, tiredness, spontaneous sweating, a slight feeling
of stuffiness or discomfort in the heart region, feeling of cold, cold hands, bright-pale face.
slightly dark lips.
Tongue: Pale
Pulse: Empty
Heart Qi Xu
Slight shortness of breath, slight coughing, weak voice, dislike of speaking, bright-white
complexion, propensity to catch colds, tiredness, palpitations, depression, spontaneous
sweating, sighing.
Tongue: Pale
Pulse: Empty, especially on both front positions
Lung and Heart Qi Xu
Hypochondrial area is the house of what?
Liver and GB
The hypochondriac region is
traversed by
the Liver and Gallbladder channels
Obstruction or undernourishment of LV GB channels and organs may produce
hypochondriac pain
What does distention always mean?
Qi Stagnation
Severe and incessant pain can be caused by what 5 pathogens?
Shao Yang
Fluid retention
Liver Qi Stag
Blood Stag
Damp heat in the liver and GB
Vague, chronic and mild hypochondrial pain
Liver Yin Xu
mild pain or discomfort in hypochondriac region fixed in location, alternating
chills and fever.
excess: Shao Yang pattern
unilateral pain with distention which makes it painful to twist the body, pain
aggravated by breathing.
excess: Fluid Retention (Tan Yin Disorder)
distending pain without fixed location, induced or aggravated by emotional
stress.
excess: Liver Qi Stagnation
stabbing pain which is fixed in location and worse at night, or with fixed masses
in hypochondrium that are resistant to pressure.
excess: Blood Stagnation (GIO LV BLOOD STASIS 510)
severe hypochondriac pain that may be accompanied by burning and stifling
sensation, bitter taste in the mouth.
excess: Damp-heat in the Liver and Gallbladder (GIO LV/GB DAMP HEAT 766)
chronic, persistent, dull and vague hypochondriac pain.
deficiency: Liver yin deficiency (GIO LV YIN XU 521)
Alternation of shivers (or cold feeling) and fever (or a feeling of heat) a bitter taste, dry throat,
blurred vision, hypochondrial fullness and distension. lack of desire to eat or drink, irritability,
nausea, vomiting.
Tongue: unilateral thin white coating
Pulse: Wiry-Fine pulse.
Shaoyang Stage Disease
Liver Qi Stag
Hypochondrial pain, fullness and distension, nausea, vomiting, inability to digest fats, yellow
complexion, scanty and dark yellow urine, fever, thirst without a desire to drink, bitter taste,
dizziness, yellow sclera, tinnitus, irritability, a feeling of heaviness of the body, numbness of the
limbs, swelling of the feet, burning on urination, difficulty in urinating, excessive yellow vaginal
discharge, loose stools or constipation, alternation of hot and cold feelings, a feeling of heat,
genital papular skin rashes and itching, swelling and heat of the scrotum.
Tongue: thick sticky yellow coating, either bilateral or on one side only.
Pulse: Slippery-Wiry-Rapid.
Damp-Heat in the Liver/Gallbladder
5 phlegm patterns in lungs:
Damp cold
Damp phlegm
Phlegm fluids
Phlegm heat
Phlegm dry
Hypochondrial pain, abdominal pain, vomiting of blood, epistaxis, painful periods, irregular
periods, menstrual blood dark and clotted, infertility, masses in abdomen, purple nails, purple
lips, purple or dark complexion, dry skin (in severe cases), purple petechiae.
Tongue: Purple especially, or only, on the sides. In severe cases, there will be purple spots on
the sides.
Pulse: Wiry or Firm
Liver Blood Stasis
Dizziness, numbness or tingling of limbs, insomnia, blurred vision, ‘floaters’ in eyes, dry eyes,
diminished night vision, scanty menstruation or amenorrhoea, dull-pale complexion without
lustre but with red cheekbones, muscular weakness, cramps, withered and brittle nails, very dry
hair and skin, depression, a feeling of aimlessness.
Tongue: normal colored without coating or with rootless coating.
Pulse: Floating-Empty.
Key symptoms: blurred vision, dry eyes, and tongue without coating.
Empty-Heat: malar flush, anxiety, a feeling of heat in the evening. night sweating, five-palm
heat, thirst with desire to drink in small sips, heavy menstrual bleeding.
Tongue: Red without coating.
Pulse: Floating-Empty and slightly Rapid.
Liver Yin Xu
The epigastric region is the upper half of the upper abdomen and is related to the
Stomach
The physiological function of the Stomach is to
govern reception, decomposition, and
descending
excruciating pain with sensation of cold, pain relieved by warmth.
excess: cold in the middle burner (GIO COLD INVADES ST 627)
severe epigastric burning pain.
excess: heat in the middle burner (GIO ST HEAT 625)
epigastric and abdominal pain, pain that is relieved by bowel movements.
excess: food stagnation (GIO FOOD STAG 631)
distending pain that comes and goes, no fixed location, pain can radiate to the
hypochondrium or lower abdomen.
excess: qi stagnation GIO ST QI STAG 623
sharp and fixed in location, may be accompanied by hematemesis.
excess: blood stasis (GIO ST BLOOD STASIS 633)
Acute Onset, short duration, severe pain with distention, worse after eating, resistant to
pressure.
Cold in middle burner
heat in middle burner
food stag
qi stag
blood stasis
Chronic onset, long duration, vague pain, induced or aggravated by hunger, relieved by
eating, relieved with pressure.
Stomach yin xu
Spleen and stomach qi xu
pain with burning sensation, epigastric discomfort, hunger without desire to eat, dry
heaves, hiccups
deficiency: Stomach yin deficiency (GIO ST YIN XU 622)
persistent vague pain with empty feeling, consumption of cold food will induce or
aggravate the pain, there is a desire for warm food.
deficiency: Spleen and Stomach Qi deficiency with cold (GIO SP/ST QI XU COLD 620)
Sudden severe pain in the epigastrium, a feeling of cold, cold limbs, preference for warmth,
vomiting of clear fluids (which may alleviate the pain), nausea, feeling worse after swallowing
cold fluids, which are quickly vomited, preference for warm liquids
Tongue: thick white coating.
Pulse: Deep-Tight-Slow.
Key symptoms: sudden pain in epigastrium, vomiting, a feeling of cold, Deep-Tight Pulse.
Cold invades the stomach
Burning epigastric pain, intense thirst with a desire to drink cold liquids, mental restlessness,
bleeding gums, dry stools, dry mouth, mouth ulcers, sour regurgitation, nausea, vomiting soon
after eating, excessive hunger, foul breath, a feeling of heat.
Tongue: Red in the centre with a dry yellow or dark-yellow (or even black) coating.
Pulse: Rapid and slightly Overflowing on the right Middle position.
Key symptoms: burning sensation in the epigastrium, thirst with a desire to drink cold liquids,
thick yellow coating, Red tongue.
Stomach Fire
Fullness, pain and distension of the epigastrium that are relieved by vomiting, nausea, vomiting
of sour fluids. foul breath, sour regurgitation, belching, insomnia, loose stools or constipation,
poor appetite
Tongue: thick coating (which could be white or yellow).
Pulse: Full-Slippery.
Key symptoms: epigastric fullness, sour regurgitation, thick tongue coating.
Food Stag
Severe, stabbing epigastric pain that may be worse at night, dislike of pressure, nausea,
vomiting, possibly vomiting of blood. vomiting of food looking like coffee grounds.
Tongue: Purple.
Pulse: Wiry.
Key symptoms: stabbing pain in the epigastrium vomiting of dark blood.
Stomach Blood Stasis
Epigastric pain and distension. belching, nausea, vomiting, hiccup, irritability.
Tongue: no particular signs on the tongue except that in severe cases it may be Red on the sides
in the central section.
Pulse: Wiry on the right Middle position.
Stomach Qi Stag
No appetite or slight hunger but with no desire to eat, constipation (dry stools), dull or slightly
burning epigastric pain, dry mouth and throat especially in the afternoon with a desire to drink
in small sips, a slight feeling of fullness after eating.
Tongue: without coating in the centre, or with rootless coating, normal body colour.
Pulse: Floating-Empty on the right Middle position.
Key symptoms: dull epigastric pain, dry mouth, tongue without coating or with rootless coating
in the centre.
Stomach Yin Xu
Discomfort or dull pain in the epigastrium, better after eating and better with pressure or
massage, no appetite, preference for warm drinks and foods, vomiting of clear Ouid, lack of
thirst, cold and weak limbs, tiredness, pale complexion.
Tongue: Pale and wet.
Pulse: Deep-Weak-Slow, especially on the right Middle position.
Key symptoms: discomfort in the epigastrium that is better after eating. tiredness, cold limbs.
Spleen and Stomach qi xu and cold
Cause of pain?
Lack or nourishment or obstruction causing lack of flow
Stomach stagnation pathogens
cold, heat, food, blood stasis, or phlegm
Chronic onset, long duration, vague pain, induced or aggravated by hunger, relieved by
eating, relieved with pressure.
Xu
Acute Onset, short duration, severe pain with distention, worse after eating, resistant to
pressure.
Excess
