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Stomach Pattern Differentiation in Chinese Medicine

Etiology of Stomach Patterns

  1. Diet
    1. Excessive consumption of foods that are too cold, too hot or too dry.
      1. "Excessive" depends on constitution, time of year, type of work done, climate.
      2. Hot foods: cause Heat in the stomach
        Cold foods: cause Cold in the stomach
      3. Dry foods (e.g. baked and broiled foods) can make Stomach too dry and eventually cause Stomach Yin Deficiency
    2. Regular food intake
      Best not to eat when Stomach has least energy (7-9 PM)
      Irregular eating can produce disorders. We should eat at regular times not overeat (prevents good digestion: food stagnates) not under-eat (or malnourish ourselves: causes Deficiency of the Spleen and Stomach)

      Eat breakfast Stomach has maximum energy 7-9 AM
         
      Not snack
      Eat too fast
      Stomach has no time to digest well: Retention of Food/Stagnation of Qi in the Spleen and Stomach
         
      Not eat late at night Yin time of day: Stomach is obliged to deplete its Yin, causing Yin Deficiency

    3. Circumstances around eating

      Negative emotions Stomach will not digest, and its Qi will stagnate causing Food Retention
         
      Reading & eating: Depletes Stomach Qi (mental activity)

  2. Emotions
    Stomach is affected by excessive thinking and worry.
    These can cause stagnation of Qi in the Stomach: signs include belching, nausea and irritation or burning pain in Stomach.
    Excessive mental activity over a long time causes Stomach Qi Deficiency
    Anger and frustration affect the Liver and cause Stagnation of Liver Qi. Liver then invades Stomach, causing belching, nausea, pain.

  3. Climate
    Cold can invade the Stomach directly causing acute pain and vomiting.

Stomach Qi Deficiency

Signs:

EPIGASTRIC DISCOMFORT Deficient Stomach Qi fails to descend.
   
Mild pain Deficiency
   
lack of appetite, lack of taste, loose stools, Spleen Qi affected by Stomach Qi Deficiency
   
FATIGUE ESPECIALLY IN AM 7-9 Stomach time on Horary cycle
   
Weak limbs Food Essences not transported to the limbs
   
Tongue: Pale Deficiency of Qi
Pulse: EMPTY Esp. Stomach position Deficiency of Qi

ANALYSIS: The Stomach begins the Qi production process. Food enters the Stomach and the Spleen extracts the pure essences which are sent onwards as Food Qi. If the Stomach is weak, Qi will be Deficient and other Organs may become affected (especially the Spleen, which is closely interrelated)

Etiology/Pathology:

  1. Diet lacking in nourishment/protein, or under-eating.
  2. Aftermath of chronic disease that weakens the Qi.

Treatment Principles:

  • Tonify Stomach Qi

Points:

ST36 Zusanli Moxa especially effective
Ren 12 Zhongwan Tonifies Qi of Stomach and Spleen
BL 21 Weishu Back Shu point of Stomach: moxa useful. Tonifies Stomach Qi
Ren 6

Qihai

"Sea of Qi" especially good if condition is chronic and accompanied by loose stools
METHOD: TONIFICATION. Moxa is applicable

Stomach Qi Deficiency and Cold

Signs:

DISCOMFORT IN EPIGASTRIUM; worse after bowel movements Deficient type pain
Stomach and Large Intestine related
   
BETTER AFTER EATING,
or with massage. No appetite.
Deficient Cold condition
Stomach Deficient
   
Prefers warm drinks & foods
Vomiting of clear fluid
Loose stools,
Lack of thirst,
COLD LIMBS, FATIGUE
Internal Empty Cold
(Yang of Spleen Deficient)
   
Tongue: Pale, swollen Deficient Yang
Pulse: Deep, weak, ESP Stomach position Internal Cold

Etiology/Pathology:

  1. Dietary: faulty nourishment, lack of protein in diet accompanied by excessive consumption of cold foods and beverages, salads, ice water and ice cream.
  2. Result of prolonged illness which damages Spleen and Stomach Yang or any other cause of Stomach and Spleen Qi Deficiency, in conjunction with dietary irregularities
  3. Invasion of Exterior Cold

Treatment Principles:

  • Tonify and warm Stomach and Spleen Yang

Points:

ST36 Zusanli Tonifies Stomach Qi
Ren 12 Zhongwan Tonifies Stomach and Spleen Qi
BL 20 Pishu Tonifies Spleen Qi
BL 21 Weishu Tonifies Stomach Qi
Ren 6 Qihai Tonifies Qi. Moxa ideal.
METHOD: Tonification. Moxa essential

NOTE: This is a chronic interior deficiency (Empty Cold) condition. A more severe version may present following exposure to cold or excessive consumption of cold food and drinks.

Cold Invasion of the Stomach

Signs:

Severe epigastric/abdominal pain with vomiting or clear fluid. Excess condition of Stomach
Cold
   
Tongue: THICK WHITE COAT Excess condition
Pulse: deep, slow, and TIGHT Excess condition

Etiology/Pathology:

This is an Interior EXCESS cold condition and requires different points, specifically to dispel EXCESS cold in acute conditions.

Treatment Principles:

  • Expel Cold, warm the Stomach

Points:

ST21 Liangmen Expels Stomach cold if moxa used after needles
SP 4 Gongsun Expels Stomach cold, clears obstruction in Stomach
Ren 13 Shangwan Stimulates descending of Stomach Qi
ST34

Liangqiu

Xi Cleft point: for acute painful patterns; Stops pain and clears obstructions from Stomach
METHOD: SEDATION Moxa applicable with needles

Stomach Yin Deficiency

Signs:

EPIGASTRIC PAIN
No appetite, feeling of fullness after eating
Stomach Deficient
   
Fever or feeling warm in PM Yin Deficiency
   
DRY MOUTH esp. in afternoon
constipation with dry stools
Signs of Dryness (Stomach is Origin of Fluids)
   
Tongue:

RED & PEELED IN CENTER or COATING "WITHOUT ROOT"(i.e. can be scraped away) Yin Deficiency of Stomach
Pulse: Floating/Empty on Right middle Yin Deficiency of Stomach

Treatment Principles:

  • Nourish Stomach Yin and Fluids

Points:

Ren 12 Zhongwan Tonifies Stomach Yin
ST36 Zusanli Tonifies Stomach Qi and Stomach Yin
SP 6 Sanyinjiao Tonifies Stomach Yin and nourishes Fluids
SP 3 Taibai Nourishes Fluids
METHOD: Tonification; no moxa

Etiology/Pathology:

Usually irregular diet and eating habits: eating late at nights, eating too quickly, worrying while eating, rushing back to work to soon. These habits deplete Stomach Qi. Over time they damage Stomach Yin.

Stomach Fire (Phlegm Fire in Stomach)

Signs:

BURNING SENSATION/PAIN IN EPIGASTRIC AREA Excess Heat in Stomach
   
Nausea
Vomiting soon after eating
Sour regurgitation
Excess Heat interferes with
Stomach Qi descending
   
Halitosis Excess Heat in Stomach
   
STRONG THIRST FOR COLD DRINKS
Constipation
Stomach Fire burns fluids (less if Phlegm present)
   
Constant hunger
Gum swelling, pain & bleeding
Excess Heat in Stomach.
Heat rises in Stomach channel amd causes Blood to extravasate
   
Tongue:

Red, THICK YELLOW and DRY COAT
(sticky if Phlegm present, or yellow prickles inside midline crack)
Pulse: FULL, RAPID (slippery if Phlegm)

Treatment Principles:

  • Clear Stomach Heat, Stimulate Stomach descending function.

Points:

ST21 Liangmen Clears Stomach Heat; makes Stomach Qi descend
Ren 13 Shangwan Subdues rebellious Stomach Qi
ST44 Neiting Clears Stomach Heat
ST45 Lidui Clears Stomach Heat, calms Mind
SP 6 Sanyinjiao Nourishes fluids & calms Mind
Ren 12 Zhongwan Clears Stomach Heat
Pe 6 Neiguan Subdues rebellious Stomach Qi calms Shen

Etiology/Pathology:

Excessive consumption of hot energy foods and smoking.
If Phlegm present, this can be caused by excessive consumption of hot and greasy foods
(e.g. deep fried foods).

Rebellious Stomach Qi

Signs:

Nausea, belching, hiccup, vomiting Stomach Qi fails to descend
   
Tongue: normal
Pulse: wiry or tight in Stomach position


Treatment Principles:

  • Subdue rebellious Qi, stimulate descending of Stomach Qi

Points:

Ren 13
Ren 10
Shangwan
Xiawan
Stomach Qi fails to descend
     
PE 6
SP 4
Neiguan
Gongsun
Stimulate descending of Stomach Qi

Food Accumulation in the Stomach

Signs:

No appetite,
FULLNESS/DISTENSION OF
EPIGASTRIUM) relieved by vomiting
Food obstruction in Stomach prevents Stomach Qi from descending
   
SOUR REGURGITATION
Belching, Nausea & vomiting
Halitosis
Fermented food in Stomach
   
Insomnia
obstructs Middle
Prolonged retention of food in Stomach Burner and prevents Heart Qi from descending; disturbs Shen
   
Tongue: THICK COATING
(white or yellow)
Excess condition
Pulse: Full, slippery Heat and Food Retention

ANALYSIS: Interior Excess pattern - may be associated with either Cold or Heat (tongue coating either white or yellow)

Etiology/Pathology:

Overeating, eating too fast or while worrying.

Treatment Principles:

  • Remove retention of food, stimulate the descending of Stomach Qi

Points:

Ren 13 Shangwan Subdues rebellious Stomach Qi
Ren 10 Xiawan Stimulates descending of Stomach Qi
ST21 Liangmen Stimulates descending of Stomach
ST44 Neiting Resolves stagnant food and clears Heat
ST45 Lidui Resolves stagnant food & calms mind in case of insomnia
SP 4 Gongsun Resolves stagnant food
PE 6 Neiguan Stimulates descending of Stomach Qi
METHOD: Reducing

Blood Stagnation in the Stomach

Signs:

STABBING PAIN IN EPIGASTRIUM
(Intense, fixed pain,
worse with heat and pressure)
Stasis of Blood
Excess condition
Stasis of Blood
   
Pain AFTER eating Excess condition
   
VOMITING OF DARK BLOOD
Blood in the stools
Stasis of Blood
Stomach related to Large Intestine
   
Tongue: Purple with purple spots
(maybe just in center, Stomach position)
Stasis of Blood
Pulse: Wiry or choppy  

Etiology/Pathology:

May be a chronic condition.
May be associated with Stomach Fire, Liver Qi invading Stomach or Retention of Food. May be caused by the above patterns or by long-standing Stagnation of Liver Qi from long term emotional problems involving anger and frustration.

Treatment Principles:

  • Removes stasis, stimulate the descending of Stomach Qi

Points:

Ren 10 Xiawan Stimulates descending of Stomach Qi
ST21 Liangmen Removes obstructions
ST34 Liangqiu XI Cleft point: moves Qi and Blood in channel
SP 10 Xuehai revives Blood, removes Stagnation
BL 17 Geshu Removes Stasis, revives Blood (needle only)
BL 18 Ganshu Removes stagnation of Liver Blood
METHOD: SEDATION, no moxa.