Stomach Ache - Wei Wan Tong

Wei Wan Tong is pain in the stomach which includes the western diseases of gastritis, gastric neurosis and ulcers.

Stomach Pain can be distended, burning, stabbing, dull, and bouts of acute severe pains. The pain can be accompanied by fullness in the abdomen, acid regurgitation, food retention, belching, flatulence, nausea, vomiting, poor appetite, irregular stools and general spleen deficient symptoms.

Western medicine Diagnosis – GI complaints, acute or chronic

Etiology (causes) of Stomach Pain:

1. Liver Qi attacks Stomach - anger/depression makes liver loose its soothing function which transversely attacks stomach blocking stomach Qi causing pain. Long term stomach Qi stagnation = a. blood stasis b. creates fire

2. Diet - over consumption of food, over consumption of one type of food (spicy, raw, greasy, sweet), irregular diet, poor quality = all will injure spleen Qi = cold or hot = blocks stomach functions

3. Congenital/Chronic illness - takes prescriptions for too long -weak stomach -cold blocks stomach Qi(causes pain) -yin def., deficient heat (causes pain) -spleen def., does not produce enough blood. (cause pain)

Differentiate Stomach Pain from:

Heat attack: pain in left side of chest and radiates to left shoulder and arm.

Stomach pain: pain in upper abdomen and stays in abdomen

Chinese Medicine Differentiation and Treatment of Stomach Pain:  

Cold Blocks Stomach Qi (sudden external invasion or sudden over consumption of cold) acute, severe stomach pain, relieved by warmth, aversion to cold. Tongue - white coating Pulse - wiry tense/retarded

Principle of Treatment: warm stomach, expel cold, promote Qi circulation to relieve pain  

Acupuncture points – sedate, Moxa, Ren, foot yangming, Ren 12 and Stomach 36 (Stomach pain), Spleen 4 and Pericardium 6 (abdomen) - severe pain – Stomach 34

Herbal Medicine Formula: Liang Fu Wan

Food Retention Distended stomach with aching, irregular diet history, fullness pain in stomach, dislike pressure, belching up of food, acid regurgitation, poor appetite, irregular stool, discomfort ameliorated by vomiting/diarrhoea Tongue - thick greasy coating Pulse - slippery  

Principle of Treatment: invigorate spleen/stomach Qi, promote digestion to relieve pain.  

Acupuncture points – foot yangming, Stomach 36 (lower he-sae), Stomach 25, Pericardium 6, Ren 10 (pyloric sphincter, digestion), Li Nei Ting (digestion, under Stomach 44)

Herbal Medicine Formula: Bao He Wan (base formula for food retention)

Liver Qi Stagnation distended fullness pain in stomach radiating to hypochondriac region, aggravated by anger, frequent belching, sighs a lot. May Turn To FIRE – bitter taste, dryness in mouth, heart burn, severe pain T- normal (no fire) P - wiry (no fire) T - red with yellow coat (fire) P - wiry rapid (fire)

Principle of Treatment: soothe liver, move liver Qi to relieve pain

Acupuncture points – foot jueyin, Stomach 36 and Ren 12, Liver 3 and 14 - belching – Pericardium 6, Ren 17

Herbal Medicine Formula: no fire - Chai Hu Shi Gan San Fire - Dan Zhi Xiao Yao San

Blood Stasis Chronic Stomach ache, stabbing pain or cutting pain (more severe), fixed pain, aggravated by pressure, severe cases = blood in vomit and stools (ulcer) T - purple P - un-even  

Principle of Treatment: promote blood circulation, remove blood stasis to relieve pain  

Acupuncture points – neutral, Ren, foot yangming, Ren 12, Stomach 36, Pericardium 6, Spleen 4, Bladder 17 and Liver 14, Spleen 6 - black tar-like stools – Spleen 10

Herbal Medicine Formula: Gu Xia Zhu Yu Tong, Shi Xiao San – alleviates pain

Spleen and Stomach Deficient Cold chronic dull pain in Stomach ameliorated by warmth and pressure, pain better after eating, poor appetite, nausea, clear-thin-watery vomit, soft stools, general whole body deficient cold symptoms. T - pale P - thin

Principle of Treatment: warm and nourish spleen to harmonize stomach

Acupuncture points – tonify, Moxa, Shu, Mu, Bladder 20, 21, Liver 13, Ren 12, Pericardium 6 and Spleen 4 (confluent, abdomen), Ren 4

Herbal Medicine Formula: Huang Qi Jian Zhong Tang (gui zhi tang + honey + huang qi)

Spleen and Stomach Yin Deficiency burning pain, dry symptoms, dry stools, dry throat, poor appetite T - red, scanty coating P -thin wiry/rapid

Principle of Treatment: nourish stomach yin to relieve pain

Acupuncture points – Shen, Mu, Bladder 20, 21, Liver 13, Ren 12, Stomach 36, Pericardium 6, Spleen 6, 10 - black tar-like stool – Spleen 1, Bladder 17

Herbal Medicine Formula: Zhu Ye Shi Gao Tang Liver Yin Def. – Yi Guan Jian

Accumulation of Stomach Heat acute attack feels like painful fullness is pressing from the inside outwards, chronic attacks feel like fullness and distension, difficult for patient to describe (just say feels irritable or heart burn), acid reflux, bitter taste or sticky, T- red with yellow coat, P- rapid

Principle of Treatment – purge Heat, relieve pain

Acupuncture points – sedate, foot yangming, Ren 13 (cardia sphincter, meeting of Stomach and Ren), Stomach 34 (Xi-cleft), Stomach 44, Large Intestine 4 and Liver 2 (purge Stomach Fire) - more Heat - Heart 8

Alternative Treatment Methods for Stomach Pain 

Ear Acupuncture – SP, ST, LR, sympathetic, shenmen, subcortex

7 star Needle– T5-T12, medium to strong stimulation

injection therapy – Huang Qi, Dang Gui/Chuan Xiong

electro Acupuncture – Stomach 36, Spleen 4 and Pericardium 6, Bladder 20, 21, low continuous sedating frequency

acupressure – clockwise

Ulcers

Quickly may become bleeding Create dark tarry stool

Herbal Formulas: Chai Hu Shu Gan San - Bu Zhong Yi Qi Tang - modify with stop bleeding herbs Pain may not be first complaint in the elderly because of the array of other disease with it When ulcer breaks it may infect the intestines (Emergency) - the abdomen gets hard and painful - peristalsis/abdominal sounds are almost non-existent (normally there are 1-2/minute)

Pain Herbal Formula: Shao Yao Gan Cao Tang - also use Qi blood tonics, stop bleeding, and detoxifying herbs until can be operated on May not know they have ulcers, figure it out after bloody bowel movements Advise to observe stool regularly Toilet bowl will have dark red blood in the toilet TCM – basic pattern

Spleen Qi deficiency, Stomach Yin deficiency with Liver attack.

*Look at big and 2^nd toe nails (spleen, stomach, liver)

 Herbal Formula: An Wei San (Ji Dan Ke – egg shell) -bake shells until turn yellow brown -grind until powder

-take 3-7 days/day -can stop pain for more than 2 hours, Hai Piao Xiao, Tian Qi (single herbs)

Acupuncture: back Shu (wei, dan, gan, pi, etc)