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stomachache

This is a mind map about stomach pain, mainly including: diagnosis, clinical evidence, syndrome differentiation and treatment, differential diagnosis, etiology and pathogenesis, and concepts. The knowledge is sorted out clearly, very practical and worth collecting.

Edited at 2025-01-06 18:51:24

Mason·Carter

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stomachache

Mason·Carter

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stomachache

concept

Also known as stomach pain, it is a disease that mainly involves pain in the heart of the stomach

Western medicine: acute gastritis, chronic gastritis, functional indigestion, stomach and duodenal ulcers, etc.

Causes and pathogenesis

Causes

External evil attack

Diet and not serene

Emotional disorder

Long-term illness and physical deficiency

Pathogenesis

Basic pathogenesis: stomach qi stagnation, loss of harmony and decline, pain if it is not smooth

Pathological factors: mainly qi stagnation, and food accumulation, cold congestion, heat depression, dampness obstacle, blood stasis, etc.

diagnosis

The main symptoms are pain near the heart skull of the gastric hospital. Pain can manifest as swelling, tingling, burning, hidden pain, severe pain, stuffy pain and other different properties

Often accompanied by symptoms such as loss of appetite, nausea and vomiting, noisy pantothenic acid, and heater swallowing

Most of them are middle-aged and young people, and they have a history of repeated attacks. There are obvious causes before the onset of the disease, such as weather changes, anger, fatigue, overeating, hunger, eating raw, cold, hard, spicy and mellow wine, or a history of unreasonable medication.

Gastroscopy, upper gastrointestinal angiography, Helicobacter pylori examination, etc. can help diagnose this disease

Differential diagnosis

Really painful

True heartache is a serious syndrome of chest pain, which is more common in the elderly and often has a history of chest pain. The typical symptoms are stuffy, tingling or colic in the chest, severe pain, pain leads to the shoulders and back, and are often accompanied by palpitations and shortness of breath, Symptoms such as sweating, cold limbs, cyanosis of the lips and nails, and the condition is critical. Some patients also often show gastric pain, so it is particularly easy to be confused with stomach pain, resulting in misdiagnosis.

Flank pain

Flank pain is located in the liver and gallbladder, which is related to the spleen and stomach. The clinical manifestations are mainly pain in the flank ribs, which may also be accompanied by gastric discomfort and even gastric pain, which is often accompanied by anorexia, fullness of chest and flanks, bitter mouth, or fever and evil Cold and other symptoms

Stomach pain is located in the stomach, which is related to the liver and spleen. It is mainly caused by stomach pain. Some patients can attack and rush the two flanks, and even with chest and flanks, which are often accompanied by abdominal distension, fullness, and noisy swallowing.

Dialectical treatment

Key points of diagnosis

Distinguish the real and false

People with deficiency often have long courses of illness, like to press the pain in the pain, and the pain is caused when hungry, and the pain is reduced after the inhalation, and the body is weak and the pulse is weak. Those with deficiency should further distinguish between qi deficiency, yang deficiency and yin deficiency

In the case of solid patients, the course of the disease is short and the pain is refused to be pressed. The pain is mild when hungry, the pain increases after absorption, and the body is strong and the pulse is strong. Those who are true should further identify different pathological factors as diseases

Distinguish cold and heat

If the stomach pain is severe when it encounters cold, and the warm pain is reduced, and the vomiting of clear water is a cold syndrome

Those who have burning pain in the stomach, urgent pain, like coolness and hate heat, and vomit sour water, are fever symptoms

Cold and heat are both different from deficiency and excess

Distinguishing Qi and Blood

Generally, the first disease is in qi, and the long-term disease is in blood

Those with qi stagnation tend to experience swelling and pain, with no fixed location, or attacking and escaping the two flanks. Pain is closely related to emotional factors.

For blood stasis, the pain area is fixed and persistent, which will worsen at night, the tongue is dark or there are ecchymosis, or vomiting of blood and bloody stools.

Treatment rules and regulations

Regulate qi and stomach pain

When using the "common" method, we cannot be limited to a narrow "common" method. We should adopt corresponding treatment methods based on different symptoms.

For those with a symptom of the disease, cold congestion, food accumulation, qi stagnation, stomach heat, and blood stasis should be distinguished. The treatment methods should be given to dispel cold and relieve pain, digest food and relieve stomach, relieve liver and stomach, clear the liver and stomach, unblock the meridians and remove blood stasis.

For those with deficiency syndrome, you should distinguish between deficiency and cold and yin deficiency. Treat them separately for warming the stomach and strengthening the middle or nourishing the yin and nourishing the stomach.

For those with acute and painful stomach, emergency and pain relief methods can be used

Certification of syndromes and treatments

Cold evil guest stomach

symptom

Main certificate

Stomach pain is severe, cold and painful, cold and cold, cold and warm, warm and painful, worsen when cold, no thirst mouth, like hot drinks, have a history of cold or eating cold

Moss vein

Thin white moss, stringy and tight pulse

Summary of the Certificate

Cold evil attracts the stomach, violently curbs yang energy, and stagnation of qi

Treatment

Warm the stomach and dispel cold, regulate qi and relieve pain

Main side

Liangfu Pills

Common medicines

Gaoliang ginger and amomum villoss warm the stomach and dispel cold

Xiangfu, tangerine peel, and wood fragrance promote qi and relieve pain

Addition and subtraction

If the cold evil is more serious, add ginger, Sichuan pepper, and cinnamon

For those with cold symptoms such as cold and headache, add Suzao Leaf and Guizhi

Cold evil is depressed for a long time and turns into heat, and cold and heat are mixed. Use Banxia Xiexin Decoction to add and subtract it

Diet and stomach damage

symptom

Main certificate

The stomach pain in the stomach, fullness and reluctance to press, warm and soreness, or vomiting and indigestion of food, its taste is rotten, the pain is reduced after vomiting, no food, unhappy stool, a little relieved after getting angry, and a little relieved after taking stool, and a little drunk after drinking History of binge eating

Moss vein

Thick and greasy tongue coating, smooth pulse

Summary of the Certificate

Dietary stagnation, blocking stomach qi

Treatment

Eliminate food and guide stagnation, and relieve pain

Main side

Baohe Pills

Common medicines

Shenqu, hawthorn, and Lai take Zi to eliminate food and guide stagnation

Poria cocos, Pinellia ternata, Tangerine peel and stomach dampness

Forsythia scatters and clears heat

Addition and subtraction

If the abdominal distension is severe, add Citrus aurantium, Muxiang and betel nut.

If the food accumulates and heat, warms, sour and odor, add Coptis chinensis and Gardenia

For those with stomach distension and pain and constipation, please use Xiaochengqi Decoction

If the stomach pain is severe and the pressure is refused, accompanied by yellow and dry moss and constipation, the food accumulates and heat becomes dry, so it is combined with Dachengqi Decoction.

Liver Qi invades the stomach

symptom

Main certificate

Stomach pain, or attack and support, pull back and forth, emotional fluctuations may cause aggravation of pain, heating and arrow air will cause pain, chest tightness and sigh, and stool will be poor

Moss vein

Thin white tongue coating, stringy pulse

Summary of the Certificate

Liver qi stagnation, skew, and stomach qi block

Treatment

Relieve liver and qi, harmonize stomach and relieve pain

Main side

Chaihu Shugan San

Common medicines

Chaihu, Chuanxiong, Xiangfu, Tangerine peel and Chinese

White peony and licorice relieve emergency and relieve pain

Citrus aurantium, Buddha's hand, and green-caly plums regulate qi and relieve depression without damaging yin

Addition and subtraction

If the liver and stomach qi are protruding, stomach pain or flank pain, add Chrysanthemum and Yanhusuo

For those with frequent heating, add Pinellia, Solidum, Ochre, etc. and stomach reduction.

For those with pantothenic acid, add squid bones, fritillaria, calcined corrugated seeds, and Zuojin Wan

Hepatopathy

symptom

Main certificate

Stomach pain, irritability, heat and anxiety, swelling and discomfort, pancreatic acid and noisy, dry mouth and bitter mouth, red tongue

Moss vein

Yellow moss, stringy or rapid pulse

Summary of the Certificate

Liver depression turns into fire, heat damages the stomach

Treatment

Relieve liver and relieve heat, and relieve stomach pain

Main side

Hualien decoction

Liver Green Peony Dan Gardenia, Alisma Fritillaria and Tangerine

Common medicines

Danpi and Gardenia clear liver fire

White peony and licorice soften the liver and relieve pain

Green peel and tangerine peel relieve liver and stomach

Fritillaria zhexi and Alisma clear and depressed fever

Coptis chinensis and Everrucidae relieve liver and stomach

Addition and subtraction

If the chest and flanks are full, and are irritable, add Chaihu, Xiangfu, Chuanxiong and other liver to relieve liver and regulate qi

For those with bitter mouth and dry mouth, add Bupleurum, Scutellaria baicalensis, Ophiopogon japonicus, etc. to relieve depression and clear heat, nourish yin and produce salivation

For those with excessive stomach heat, burning pain in the stomach, fullness, and poor bowel movements, use Dahuang Huanglian Xiexin Decoction

Humid heat resistance

symptom

Main certificate

Burning pain in the stomach, noisy vomiting, abdominal distension, nausea, thirst and unable to drink water, yellow urine, and poor bowel movements

Moss vein

Red tongue, yellow and greasy coating, smooth and rapid pulse

Summary of the Certificate

Dampness and heat accumulation, stomach qi stagnation

Treatment

Clear heat and dampness, regulate qi and stomach

Main side

Qingzhong Soup

Common medicines

Coptis chinensis and gardenia clear heat and dry dampness

Pinellia ternata, Poria cocos, and cardamom to remove dampness and strengthen the spleen

Tangerine peel and licorice regulating Qi and Chinese

Addition and subtraction

If the dampness is severe, add Atractylodes and Agastache

For those with severe heat, add dandelion, scutellaria baicalensis, and scutellaria

Those with nausea and vomiting, add Zhuru, Suye and stomach to reduce reversal

For those with constipation and disorders, add rhubarb (late to lower back) to clear the viscera

For those with qi stagnation and abdominal distension, add Parsa citrus and Citrus aurantium

If the damp heat is accumulated and becomes poisonous, the stomach is burning and painful, the abdomen is full, and the tongue is red and yellow, use Xian Gong to detoxify and disperse knots

Internal stopping blood stasis

symptom

Main certificate

Stinging pain in the stomach, there is a certain point of pain, and the pain is severe when pressed, and the pain is prolonged and repeatedly, which is aggravated after eating, especially at night, and even black stools or vomiting of blood

Moss vein

Purple or ecchymn, and astringent pulse

Summary of the Certificate

Stasis of stomach and collaterals, veins stagnation

Treatment

Removing blood stasis and unblocking meridians, regulating qi and stomach

Main side

Thunderbolt and Salvia miltiorrhiza drink plus or subtract. In the front, promote blood circulation and stasis, disperse nodules and relieve pain, regulate qi and remove blood stasis in the back.

Common medicines

Puhuang, Wulingzhi, and Salvia miltiorrhizae to relieve blood stasis and relieve pain

Sandalwood and Amomum villoss regulate qi and relieve pain

Addition and subtraction

If the stomach is severe, add Yanhusuo, turmeric, Jiuxiangworm, Muxiang, and Citrus aurantium to promote qi, promote blood circulation and relieve pain.

If bleeding occurs such as vomiting and black stool, stop bleeding should be the first step. Sandalwood and Amomum villossum are removed, and rhubarb, madder root, and Panax notoginseng powder (take it)

Spleen and stomach deficiency and cold

symptom

Main certificate

Stomach pain in the stomach, endless, severe pain on the empty stomach, slow food, like warmth, like to press, and attack or worsen after fatigue or cold, vomit clear water, eat less and take a dull stool, loose stools, fatigue, and lack of warm limbs

Moss vein

Pale tongue, white coating, weak pulse

Summary of the Certificate

Deficiency and cold in the middle burner, stomach failure to nourish

Treatment

Warm the middle and strengthen the spleen, harmonize the stomach and relieve pain

Main side

Huangqi Jianzhong Decoction

Common medicines

Astragalus and Atractylodes macrocephala replenish qi and strengthen spleen

Guizhi warms the stomach and dispels cold

White peony, ginger, jujube, and licorice relieve emergency and pain

Addition and subtraction

If you vomit acid water, add Everrucidum and calcined corrugated seeds to make acid and relieve pain

Spit more clear water, or there is a sound of water in the stomach, add dried ginger, Pinellia ternata, Tangerine peel, and Poria, or use Linggui Shu Gan Tang Tongyang Hua Drink

Cold is better than severe pain, vomiting and cold limbs, and Liuzhong Wan, or use Dajianzhong Decoction instead

For those with spleen and stomach deficiency, stomach pain, loss of appetite, nausea and vomiting, use Xiangsha Liujunzi Decoction

Insufficient stomach yin

symptom

Main certificate

The stomach yard is faintly burning, sometimes noisy and hungry, or hungry, dry mouth and throat, dry stool

Moss vein

Red tongue, less fluid, or light peeling without coating, stringy and thin pulse

Summary of the Certificate

Insufficient stomach yin, moisturize and reduce the body

Treatment

Nourishing yin and nourishing the stomach, and relieve pain

Main side

Yiwei Decoction

Yiwei Decoction can nourish the stomach yin, decoction of rock sugar, samadhi and ginseng, Ophiopogon japonicus, raw rehmannia, and take it together, sweet, cool, moisturizing and nourishing the stomach

Common medicines

Northern Salvia ginseng, Ophiopogon japonicus, Rehmannia glutinosa, Viagra, and Dendrobium sweet and cool to nourish the stomach yin

Buddha's hands and green-caly plums regulate qi and relieve pain

Addition and subtraction

If the stomach acid is significantly reduced, add black plum, croquette, chicken gizzard, etc.

For severe stomach pain, use Shaoyao Licorice Decoction to relieve emergency and relieve pain

Those with severe bloating and pain in the stomach and stagnation of the stomach should add Magnolia officinalis, Chuanlianzi, and Yanhusuo.

Hot constipation, add sesame seeds, Trichosanthes and dandelions

Those with deficiency of Qi and Yin, fatigue and weakness, and do not want to eat, add Prince ginseng and yam

If the stomach pain recurs and is difficult to cure, those with yin deficiency and poison accumulation, add Forsythia, Zhecao, Curcuma zedo, Coix seed, Half-branch lotus, and White-flowered snake tongue grass

Clinical certification requirements

Treat the liver and calm the stomach

Pay attention to "avoid hardness and softness"

Use blood-activating and blood-removing drugs

Prevent changes after long pain