Stomach ache refers to a pain over the epigastrium, which is usually accompanied by epigastric upset, poor appetite, eructation and nausea.

Etiology and Pathogenesis

The common causes of stomach ache are immoderate eating and drinking, emotional upsets, psychic trauma, overstrain, affection of cold, etc. However, these causative factors lead to stomach ache only when the spleen and stomach are dysfunctioning. Although the spleen and stomach are the organs chiefly involved in this disorder, other organs may also be affected, particularly the liver.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differential diagnosis:

Stomach ache should be distinguished from angina pectoris, hypochondriac pain and abdominal pain. Although angina pectoris is a disorder of the heart meridians characterized by precordial pain, it occasionally manifests itself as an epigastric pain. In this case, it may be differentiated by the colicky character of its pain and its accompanying symptoms such as suffocative sensation, sweating, coldness of limbs, indistinct pulse, etc. Stomach ache caused by liver-qi attacking the stomach may manifest itself as a radiating pain to the hypochondria, but the epigastrium is the primary painful site. Abdominal pain may complicate with stomach ache, and the two disorders can be distinguished from each other by the analysis of their causes and the accompanying symptoms.

(b) Differentiation between asthenia and sthenia syndromes:

The asthenia-syndrome of stomache is characterized by a sudden onset, a prolonged course with intermittent relief and pain relievable by pressure and warmth. This type is mostly due to deficiency of spleen-yang and stomach-yang or insufficiency of stomach-yin and is difficult to cure. The sthenia-syndrome of stomach ache is marked by an insidious onset, a short course and pain associated with tenderness. This type usually results from retention of cold in the stomach, immoderate eating and drinking, an attack of liver-qi on the stomach or stagnation of blood in the stomach, and it responds well to medication. Moreover, cases with hemorrhage due to the involvement of collaterals by blood stasis commonly manifest themselves as a primary asthenia-syndrome and a secondary sthenia-syndrome.

B. Therapeutic principles

Regulating qi circulation and the stomach and arresting pain are the general therapeutic principles for stomach ache, which may be modified according to the cause and the presenting syndrome of the individual case.

Classification and Treatment

A. Retention of cold in the stomach

Manifestations: Sudden onset of stomach ache which can be relieved by warmth and aggravated by cold, preference for hot drink, thin, white tongue coating and wiry and tense pulse.

Therapeutic principles: Expel cold and relieve pain.

Prescription: The Modified Pill of Cyperi and Alpiniae Officinarum

Rhizoma Alpiniae Officinarum 10 g
Fructus Evodiae 5 g
Rhizoma Zingiveris Recens 10 g
Rhizoma Cyperi 10 g
Caulis Perillae 10 g

Remarks: Add Folium Perillae and Radix Ledebouriellae for cases complicated by superficial cold-syndrome such as fever, chilliness, etc. Add Fructus Aurantii Immaturus, Massa Fermentata Medicinalis and Rhizoma Pinelliae for those cases with eructation and anorexia due to retention of food and cold.

B. Retention of food

Manifestations: Stomach ache, abdominal distention and fullness, acid eructation or vomiting with undigested food, dyschesia, thick, greasy tongue caoting and smooth pulse.

Therapeutic principles: Relieve dyspepsia.

Prescription: The modified Pill for Promoting Digestion

Fructus Crataegi 10 g
Massa Fermentata Medicinalis 10 g
Poria 12 g
Fructus Forsythiae 10 g
Semen Raphani 10 g
Rhizoma Pinelliae 10 g
Pericarpium Citri Reticulatae 10 g

Remarks: Add Pericarpium Arecae, Fructus Aurantii Immaturus and Fructus Amomi for cases with abdominal distention. Add Radix et Rhizoma Rhei and Cortex Magnoliae Officinalis for those cases with constipation. Add Rhizoma Coptidis, Fructus Evodiae and Concha Arcae for those cases with bitter taste in the mouth and acid regurgitation.

C. Attack of liver-qi to the stomach

Manifestations: Distending pain over the epigastric and hypochondriac regions which is induced by emotional upsets, frequent eructation, dyschesia, thin, yellow tongue coating and wiry and smooth pulse.

Therapeutic principles: Soothe the liver, and regulate qi circulation and the stomach.

Prescription: The Modification of Bupleuri Powder for Dispersing the Depressed Liver-Qi

Radix Bupleuri 10 g
Pericarpium Citri Reticulatae 10 g
Rhizoma Chuanxiong 5 g
Radix Curcumae 10 g
Radix Paeoniae Alba 15 g
Rhizoma Cyperi 10 g
Fructus Aurantii 10 g

Remarks: Add Fructus Toosendan and Rhizoma Corydalis for cases with severe pain. Add Lignum Aquailariae Resinatum, Flos Inulae and Haematitum for those with frequent eructation. Add Fructus Gardeniae and Radix Scutellariae for those with stagnated liver-qi changing into fire. Add Radix et Rhizoma Rhei and fructus Aurantii Immaturus for those with constipation.

D. Stagnation of heat in the liver and stomach

Manifestations: Burning pain over the epigastric region, irritability, bitter taste in the mouth, acid regurgitation, gastric upset, red tongue with yellow coating and wiry and rapid pulse.

Therapeutic principles: Disperse the stagnated liver-qi, regulate the stomach, and arrest pain.

Prescription: Decoction for Releasing the Stagnated Liver-Qi

Radix Paeoniae Alba 15 g
Fructus Cardeniae 10 g
Pericarpium Citri Reticulatae 6 g
Rhizoma Coptidis 3 g
Cortex Moutan Radicis 10 g
Pericarpium Citri Reticulatae Viride 6 g
Fructus Evodiae 3 g

Remarks: Add Pericarpium Citri, Fructus Citri Sarcodactylis and Fructus Aurantii Immaturus for cases with distension over the abdomen and hypochondriac region. Add the Decoction of Coptidis and Rhei for Purging Stomach-Fire for those with bleeding due to impairment of stomach collaterals by heat. Add Semen Raphani, Fructus Crataegi (fried), Fructus Hordei Germinatus (fried) and fructus oryzae Germinatus (fried) for those with dyspepsis.

E. Blood Stasis

Manifestations: Localized stabbing pain and tenderness over the epigastrium (whichis aggravated by food intake), hematemesis or hematochezia, dark, purplish tongue and thready and unsmooth pulse.

Therapeutic Principles: Activate blood circulation, eliminate blood stasis, and arrest pain.

Prescription: Powder for Dissipating Blood Stasis and Salviae Miltiorrhizae Decoction

Pollen Typhae 10 g
Radix Salviae Miltiorrhizae 10 g
Radix Glycyrrhizae 5 g
Faeces Trogopterori 10 g
Fructus Amomi 5 g
Radix et Rhizoma Rhei Carbonisatus 6 g

Remarks: Add Radix Paeoniae Alba and Radix Angelicae Sinensis for cases with severe stabbing pain. Add Radix Notoginseng and Rhizoma Bletillae for those with continuous bleeding. Add Radix Rehmanniae, Cortex Moutan Radicis and Colla Corii Asini for those with bleeding due to yin-deficiency and blood-heat. For cases with sthenia-syndrome changing into asthenia-syndrome and failure of the spleen to control blood circulation, apply Decoction of Ignited Yellow Earth to warm the spleen and control blood circulation.

F. Deficiency of stomach-yin

Manifestations: Dull pain over the epigastrium, dryness of mouth and throat, feverish sensation, constipation, red and dry tongue and thready and rapid pulse.

Therapeutic principles: Nourish stomach-yin.

Prescription: Yiguan Decoction with Paeoniae and Glycyrrhizae Decoction

Radix Adenophorae Strictae 10 g
Radix Rehmanniae 15 g
Fructus Toosendan 10 g
Radix Glycyrrhizae 5 g
Radix Ophiopogonis 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba 15 g

Remarks: Add Pericarpium Citri, Fructus Aurantii and fructus Citri Sarcodactylis, and omit the drugs with sweet taste and cold nature for cases with fullness of stomach and anorexia. Add Zuojin Bolus for those with gastric upset and eructation. Add Radix Stellariae, Cortex Moutan Radicis and Cortex Lycii Radicis for those with afternoon fever and feverish sensation over palms, soles and the chest.

G. Deficiency of the spleen-yang and stomach-yang

Manifestations: Dull pain over the epigastrium (relievable by warmth, pressure and food intake and aggravated by hunger), fluid eructation, mental fatigue, poor appetite, cold limbs, loose stool, pale, corpulent tongue with white, greasy coating and feeble or slow and deep pulse.

Therapeutic principles: Warm middle jiao, and invigorate the spleen.

Prescription: Astragali Decoction for Warming the Middle Jiao

Radix Astragali Praeparata 15 g
Radix Glycyrrhizae Praeparata 5 g
Rhizoma Zingiberis (dried) 5 g
Radix Paeoniae Alba 15 g
Ramulus Cinnamomi 6 g
Pericarpium Citri Reticulatae 10 g

Remarks: Add Rhizoma Pinelliae, Poria and Rhizoma Zingiberis Recens for cases with vomiting of large amounts of fluid. Add Fructus Evodiae and Concha Arcae Usta for those cases with acid regurgitation. Add Radix Codonopsis Pilosulae and Fructus Aurantii Immaturus for those cases with bearing-down sensation and distention of the abdomen or prolapse of rectum. Apply the Pinelliae Decoction for Purging Stomach-Fire for the chronic cases with coexistence of cold and heat syndromes.

Experiential Prescriptions

A. Radix Angelicae Dahuricae (30 g) and Radix Glycyrrhizae (15 g); prepared as decoction; indicated for stomach ache due to deficiency-cold.

B. Os Sepiellae seu Sepiae (500 g), Bulbus Fritillariae Thunbergii (120 g), Radix Glycyrrhizae (120 g); prepared as powder; 3 grams taken three times daily; indicated for cases of peptic ulcer with acid regurgitation.

C. Radix Glycyrrhizae (50 g) and Concho Arcae Pulvis (100 g); prepared as powder; taken 3 grams three times daily; applicable to cases of peptic ulcer with acid eructation.

D. Os Sepiellae seu Sepiae (150 g), Fructus Toosendan (120 g), Bulbus Fritillariae Thunbergii 9100 g) and Rhizoma Corydalis (120 g); prepared as powder; 3 grams taken three times a day; applicable to acute cases with marked stomach ache.

E. Os Sepiellae seu Sepiae (500 g), Bulbus Fritillariae Thunbergii (120 g) and Radix et Rhizoma Rhei (60 g); prepared as powder; 3 grams taken three times a day; applicable to cases of peptic ulcer with acid eructation, constipation or hematochezia.

F. Os Sepiellae seu Sepiae 9150 g), Rhizoma Bletillae (120 g), Ophicalcitum (120 g), Radix Sanguisorbae Carbonisatus 910 g) and Concha Ostreae Usta 9120 g); prepared as powder; 3 grams taken three times daily; applicable to cases of peptic ulcer complicated by hematesis or hematochezia.

Copyright 1995 Hopkins Technology