Hypochondriac Pain - Xie Tong
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Definition
A syndrome marked by pains on one side or both sides of the hypochondriac region, located on the side of the chest wall, from the armpit to the edge of the 12th rib.
Causes and Pathological Mechanisms
The Liver channel and the Gall Bladder channel go through the hypochondriac region. Pains in this region are therefore mostly related to the liver and the gall bladder. Pathological factors affecting the liver and the gallbladder and causing blockage or obstructions can result in pain.
There are transformations in the pathological mechanisms of Xie Tong. These include the transformation of Qi Stagnation to Blood Stasis and from Excess to Deficiency.
- Qi Stagnation leads to Blood Stasis and blood stasis aggravates qi stagnation.
- Protracted Excess can transform into Heat, which in turn consumes Yin and Blood, leading to a Yin Deficiency and Blood Deficiency.
- Persistent Blood Stasis hinders the production of new blood, leading to a Blood Deficiency and Yin Deficiency of the Liver and Kidney (Essence exhaustion)
- Yin Deficiency makes it easier to transform into Heat and Blood Stasis.
- Deficiency with Emotions, Improper Diet and Exogenous Evils invasion can cause and aggravate Qi Stagnation, Blood Stasis and Damp Heat resulting in mixture of Deficiency and Excess.
Patterns
- Symptoms: Hypochondriac Pain: distending pain, moving from place to place, related to emotions. Other symptoms: chest distension, reduced food intake and frequent eructation with gas.
- Tongue: Thin coating
- Pulse: Wiry
- Treatment strategy: Soothe the liver and regulate qi
- Formula: Chai Hu Shu Gan San
- Acupoints:
- Symptoms: Hypochondriac pain: stabbing pain, fixed, worse at night with masses under the rib.
- Tongue: Dull purple tongue
- Pulse: Deep and Uneven
- Treatment strategy: Promote blood movement, remove stasis and free up the collaterals
- Formula: Xuan Fu Hua Tang
- Acupoints:
Damp Heat in the Liver and the Gall Bladder
- Symptoms: Hypochondriac pain: quite severe. Bitter mouth, chest distension, poor appetite, nausea and vomit, red and swollen eyes, with or without jaundice, dark and yellow urine.
- Tongue: Yellow and greasy coating
- Pulse: Wiry, Slippery and Rapid
- Treatment strategy: Clear heat and drain dampness
- Formula: Long Dan Xie Gan Tang
- Acupoints:
- Symptoms: Hypochondriac Pain: dull pain, aggravated by overwork and exertion. Dry mouth and throat, vexation, dizziness and blurred vision and tired.
- Tongue: Red with little coating
- Pulse: Wiry and Thready or Rapid
- Treatment strategy: Nourish yin and soften the liver
- Formula: Yi Guan Jian
- Acupoints:
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