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Etiology And pathology II > E&P epigastric pain > Flashcards

Flashcards in E&P epigastric pain Deck (58):

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)
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 ?

retention of food
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
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

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 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,
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
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
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
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)

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)


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
propensity to outbursts of anger
sour regurgitation
dry mouth
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
poor appetite
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