Epigastric Pain for 6 months

Record of first visit

Date of first visit: 01/09/2008

Name: Ms.Fan

Gender: female

Age: 42

Chief complaints: Epigastric Pain for 6 months

Descriptions (4 diagnostic methods)

A: Asking

Current condition:

This patient claims that she has abdominal distending pain for nearly 6 months. She took Chinese herbal medicine before and felt better.

After that the pain came back again. She has indigestion although her appetite is good. She has lots of gas, especially when she eats those food contains proteins. In the afternoon she feels very tiredness.

No chills and fever. No headache, no sweating, no thirsty, prefer warm drinking. Normal urination. Normal defecation. Sleeping is good but sometime nightmare dream.

Past history: Palpation when little, thyroid,

Life style: Single mum with busy working,

Family history: Father has liver and GB problem- Gall Bladder stone,

Menstruation: 12, 6-7 / 28, with dark color clots, dizziness at he first 2 days,

B: Inspection

General: Both eyes are swollen due to Thyroid,

Others: NAD

Tongue: Dim, little teeth marks,

C: Auscultation/ Olfaction

Sound: NAD

Odour: NAD

D: Palpation

Body area: NAD

Pulse: slippery and weak,

Case Summary

Diagnosis

A) Diagnosis: epigastric pain,,

B) Syndrome differentiation: Liver qi stagnation attack spleen, underlying spleen qi deficiency,

C) Explanation:

Due to emotional changes, the liver qi stagnated. The liver qi stagnation attacks the spleen and stomach. The liver meridian goes through the hypochondriac, so it causes hypochondriac pain, indigestion, poor appetite, heaviness of the body, tiredness, loose stool, and gas.

Treatment

(A)Treatment principles

Soothe the liver, strengthen the spleen, harmonize the stomach,

(B) Treatment Methods

Zhong wan, Ri yue, Tai chong, Nei guan, Zu san li, Nei Guan,

Reducing and reinforcing,

(C) Explanation

Zhong wan(CV12) is to strengthen the spleen, harmonize the stomach.

Ri yue is to release the liver qi stagnation on the hypochondriac.

Tai Chong (LR 3) is to soothe the liver qi. Nei guan is to descend the rebellious stomach qi and harmonize the stomach.

Zusanli (ST36) is to regulate the flow of qi and blood.

(D) Life style advice

Balance the emotions and control the temper, think always positive and broadminded.

TCM

Epigastric pain, refers to a syndrome manifested by frequent pain over the epigastric region and close to the cardiac, so in ancient time, it was named “ cardiac pain”. It is commonly seen in acute and chronic gastritis, stomach or duodenal ulcer, functional stomach pain in modern medicine.

Etiology and pathogenesis

1, irregular food intake, raw and cold food and hunger injure the spleen and stomach, causing failure of the spleen in transportation and transformation and failure of stomach qi in descending, then the pain appears.

2, anxiety, anger and mental depression damage the liver, causing failure of the liver in dominating free flow of qi, adversely attacking the stomach, impeding is activity and hindering its qi descending, then the pain appears.

3,General lowered functioning of the spleen and stomach, due to invasion of pathogenic cold, which is stagnated in the stomach, causes failure of the stomach qi in descending, then the pain occurs.

Differentiation

2, Attack of the stomach by the liver-qi,

Manifestation: paroxysmal pain in the epigastrium, radiating to the hypochondriac region, frequent belching, nausea, acid regurgitation, abdominal distension, anorexia, thin, white tongue coating, deep, taut pulse.

Treatment

Principle: The points of liver and stomach meridians are selected as the primary points with the reducing manipulation to remove the stagnation of liver qi, to pacify the stomach and relieve the pain.

Prescription: Nei guan, Qimen, Tai chong, Zhong wan, Zu san li,

Explanation:

Qi men is the front Mu point of the liver and Tai chong is the yuan –primary point of the liver meridian. This combination is used to remove the stagnation of liver-qi, regulate the flow of qi and relive pain.

Zu san li and Nei guan and Zhong wan are to pacify the stomach, relieve pain, descend perversive qi and stop vomiting.

Case Conclusion

This patient has excessive thyroid signs when I diagnosed her, and her emotional changes are not normal due to her marriage life. Sometime she falls into sadness and sometimes gladness. Always she is easy to criticize things. And her digestion problem is related to her emotions. She came only one treatment. So I need to trace her for the result. I will use this method to treatment Liver qi stagnation attacking stomach. From this case I have learned that we not only treat patient’s physical problem but also their emotional problems.