Treatment of Epigastric Pain 1999.2.8

Treatment of Epigastric Pain 1999.2.8

Epigastric pain caused by ulcers and chronic gastritis accounts for 90% of cases. Clinically, the main manifestations are epigastric distension and pain, with postprandial distension and nausea indicating poor gastric emptying, and pain occurring 0.5–1 hour after eating suggesting a problem in the stomach. Traditional Chinese medicine offers several formulas for treating stomach distension and pain: ① Glehnia littoralis, Ophiopogon japonicus, Polygonatum odoratum, Dendrobium candidum, Flos Farfarae, Mulberry leaves, Broad beans, Salvia miltiorrhiza, Aucklandia lappa, Amomum kravanh, Zhishi, Houpu, Dahuang, processed frankincense, and myrrh; ② Codonopsis pilosula, Atractylodes macrocephala, Dry Ginger, Aconitum, Banxia, Aucklandia lappa, Zhishi, Glycyrrhiza, Salvia miltiorrhiza, Amomum kravanh; ③ Trichosanthes kirilowii, Allium tuberosum, Banxia, Salvia miltiorrhiza, Sandalwood, Amomum tsao-ko, Aucklandia lappa, Baishao, Dang Gui, and Melia azedarach; ④ Banxia, Huanglian, Huangqin, Dry Ginger, Codonopsis pilosula, Salvia miltiorrhiza, Aucklandia lappa, Amomum kravanh; ⑤ Dang Gui, Baishao, Chuanxiong, Huangjing, Alpinia officinarum, processed frankincense, and myrrh.

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Among the five formulas mentioned above: ① is suitable for patients with a red tongue and scant coating, accompanied by epigastric pain and burning sensation; ② is suitable for those with a swollen, large tongue and white, greasy coating, along with epigastric distension; ③ is suitable for individuals experiencing chest and epigastric fullness and discomfort; ④ is appropriate for patients with a yellow, greasy coating and burning, painful epigastric symptoms; ⑤ is indicated for those with long-standing epigastric pain and ecchymotic spots on the tongue. Adjustments to the prescriptions include: adding Panax notoginseng, white peony root, and cuttlefish bone for bleeding; adding Swertia japonica, raw cinnabar, pinellia, and fresh ginger for nausea; adding cloves, persimmon calyx, perilla leaves, and cardamom for hiccups; adding pinellia and tangerine peel for bloating; adding alum, Corydalis yanhusuo, Melia toosendan, processed frankincense, myrrh, and Cyperus rotundus for pain; adding Citrus aurantium immaturus and Atractylodes macrocephala for poor gastric emptying; adding Sichuan pepper and dried ginger for intestinal rumbling; adding Bupleurum, Citrus aurantium immaturus, Cyperus rotundus, and Curcuma wenyujin for bilateral rib pain; adding Rheum palmatum for dry stools; adding fennel seeds, fenugreek, Corydalis yanhusuo, and Melia toosendan for postprandial pain occurring four hours after meals, indicating severe intestinal involvement; adding cinnamon, Sichuan pepper, dried ginger, Piper longum, and Alpinia officinarum for nocturnal pain that awakens patients from sleep, as these herbs are believed to stimulate the sympathetic nervous system and thereby relieve spasms. Traditional Chinese medicinal flavorings are mostly warm in nature and possess the effects of dispelling cold and eliminating pathogenic factors, which can be described as promoting qi circulation and relieving pain.