③面色青黑，胁痛，腰背困痛，黄疸，舌苔白，脉虚大或弦而尺大等阴阳俱虚，肝胆湿热者，阴阳双补，除湿清热。方用：首乌15克，淫羊藿15克，黄精15克，茵陈30克，神曲9克，郁金9克，麦芽9克，枳壳9克。
④午后及夜间低热，五心烦热，胁下疼痛，黄疸，舌苔自，中心有剥脱，脉沉细弦等阴虚夹湿热者，滋阴清热，佐以．利湿。方用：青蒿9克，鳖甲9克，生地9克，黄柏9克，茵陈15克，玉竹6克，五味子6克，秦艽9克，枳壳9克。
(5)瘀血阻滞：胁下刺痛，夜间发作或夜间加重，脉涩，舌边有瘀斑，常见的有两类情况：
①胁下刺痛，夜间或平时均痛，舌苔白，边有瘀斑，脉弦涩不调或见结象等瘀血兼寒者，膈下逐瘀汤：枳壳9克，桃仁9克，丹皮9克，赤芍9克，乌药9克，元胡9克，川芎9克。当归9克，灵脂9克，红花9克，香附9克，桂枝3克。
②胁下刺痛，有灼热感，口干，五心烦热，舌苔白，边有瘀斑，脉弦涩不调等瘀血兼热者，活血清热。方用：丹参30克，檀香9克，元胡9克，川棟子9克，枳壳9克，生地9克，白芍12克。
三、病例摘要
1．寒热夹杂，热多寒少王x×，男，45岁，1973年6月14日。20多年来胃脘痞满疼痛，痛彻腰背，不能吃冷饮食，口子苦，大便不爽。经多个医院诊为胃炎。曾应用多种西药及中药香砂养胃丸，附子理中丸等无效。见苔薄黄，脉滑等寒热夹杂，热多寒少之证。半夏泻心汤：半夏9克，黄连9克，黄芩9克，干姜9克，党参9克，厚朴3克，甘草6克，大枣3枚．6月17日，服药2剂后，腹胀，疼痛明显好转，加厚朴至6克。7月2日，疼痛减轻2／3，但近日发现咽喉疼痛，胸满心烦。咳嗽等气滞痰郁之象，改予：柴胡6克，枳壳9克，白芍9克，桔梗9克，青皮9克，陈皮9克，苏叶9克，甘草6克。9月24日，云：共服10剂后诸证消失。一年后又遇该患者，曰自服药后一年来未复发。
2．寒实停滞孙××，男，59岁，1973年10月12日初诊。胃脘疼痛，呕吐20多天。医诊为胃炎。予西药数日疼痛未止，食后疼痛加重，口淡乏味，舌苔白，脉弦缓。寒实停滞。温中导滞：丁香9克，蔻仁9克，草蔻9克，党参9克，白术9克，干姜9克，甘草9克，木香9克，莱菔子9克，二丑9克。
10月16日，服药半小时后，疼痛、呕吐均停止，服药2剂后痊愈。
3．脾肾虚寒
郭××，男，39岁。1973年10月8曰初诊。
胃脘疼痛半年，加重一月。消化道造影：十二指肠球部溃疡。中西药治疗4个月未见明显效果。疼痛发作时，经常腰部困痛，舌苔白，脉左弦紧，右沉数无力。脾肾虚寒。健脾温肾：生地12克，山药12克，附子9克，党参9克，白术9克，干姜9克，甘草9克，茯苓9克，肉苁蓉9克，泽泻9克，丹皮9克。
10月15日，服4剂后疼痛停止，但仍有轻度烧心感，继眼2剂以巩固效果。
半年后追访，未复发。
4．气阴两虚，痰饮阻滞
孙××，男，41岁。1973年10月19日初诊。
溃疡病8年，一月来疼痛加重，呕吐，泄泻，开始吐食物，以后食物及粘液均吐，舌苔薄白质红，脉弦滑。曾予中西药治疗不效。经消化道造影：胃窦部及十二指肠溃疡，胃窦部溃疡恶变。痰饮阻滞，气阴两虚。处方：半夏21克，东参9克，麦冬12克，生姜9克，蜂蜜30克。
10月21日，服药一剂后疼痛、呕吐停止。
5．脾胃虚寒
刘××，女，36岁。1973年6月2日诊。
二年来，胃脘绵绵作痛，进食后疼痛减轻，喜温喜按，纳呆，乏力，背困，苔白，脉左沉细，右弦。消化道造影：十二指肠溃疡。脾胃虚寒，木邪来乘。处方：黄芪15克，桂枝9克，白芍18克，当归9克，生姜9克，甘草6克，大枣7枚。
服药4剂后，疼痛消失，继服药1月i]年后随访，未复发。
6．气虚不运，肝气郁结张××，男，44岁。1972年2月4日。7—8年来，胃脘嘈杂疼痛，心烦胸满，纳呆口苦，全身疼痛，尤以关节为重，头晕头痛，失眠，疲乏无力，大便正常，小便黄，舌苔白，脉弦细。气虚清阳不升为本，肝气郁结为标。处方：黄芪15克，党参9克，白术9克，黄连9克，半夏9克，陈皮9克，茯苓9克，泽泻9克，白芍9克，生姜3片，大枣3个，甘草6克，防风6克，羌活6克，独活6克，柴胡6克。
2月30日，服药12剂后，症状即基本消失。半年后未见复发。
7．寒食结滞
申××，男，5l岁，1973年6月11日。
一天前吃凉糕、猪肉后，突然胃脘剧痛，服四消丸后有所好转，但仍疼痛，食后加重，嗳气，纳呆，大便干，二日未行．舌苔白，脉沉弦。寒食结滞，拟温中导滞：党参9克，白术9克，甘草9克，附子9克，莱菔子9克，麦芽9克，山楂9克，木香9克，槟榔9克，大黄3克。
2剂后疼痛消失，食欲正常。
8．肝胃不和，食滞不化
程××，男，成，1973年6月5日。
半年来胃脘疼痛，食后加重，拒按，恶心呕吐，头晕心烦，口淡乏味，大便稀溏，苔白，脉沉弦等肝胃不和，食滞不化。拟疏肝和胃，消食导滞：柴胡6克，半夏9克，党参9克，黄芩9克，苍术9克，厚朴9克，陈皮9克，莱菔子9克，焦三仙各9克，干姜3克，甘草6克，大枣3个。
服药4剂后，疼痛消失，食欲正常。
9．寒邪直中
吴××，男，60岁。1972年7月3日。
突然腹痛，胃脘疼痛，呕吐，舌苔白，脉弦紧等寒邪直中：处方：射雄丸，1包，一次服完，一个小时后明显好转，夜间即愈。
10．肝肾俱虚，湿热阻滞工××，男，38岁。1973年7月5日。因黄疸型肝炎住院一年多不见好转而出院，出院后复查肝功能为射絮++++，射浊20，黄疸指数30，谷丙转氨酶500，并伴有肝区疼痛，疲乏无力，胃脘满胀，大便不爽，小便黄赤，舌苔白腻，面色青黑，脉弦大。超声波示：早期肝硬变，慢性肝炎处方：首乌15克，黄精15克，淫羊藿15克，茵陈30克，神曲9克，麦芽9克，蔻仁9克，枳壳9克。7月17日，精神，食欲已明显好转，黄疸已经消失，面色亦由黑变为接近正常颜色，舌脉同前，射絮++，射浊8，谷内转氨酶200，黄疸指数2。
11.寒实结滞
徐××，男，26岁，1973年6月24日。
1971年12月得急性胰腺炎经某院用中药复方大柴胡汤及清热解毒之剂后好转，以后经常反复发作，再用上方及西药治疗则无效。近一月来，胃脘剧烈疼痛，食后加重，夜间疼痛亦较重，口干不欲饮，大便干燥，每日虽用度冷丁数次亦不缓解，苔白，脉弦滑。血淀粉酶600单位。处方：半夏9克，黄芩9克，党参9克，干姜9克，黄连9克，枳实9克，大黄3克，甘草6克，大枣3个。
6月26日，服药2剂后，疼痛未见好转。查其胃痛拒按，舌苔白，脉弦紧。寒实结滞之象。拟温中导滞：大黄9克，附子9克，细辛3克，枳实15克，木香9克。
6月27日，连服2剂后，疼痛明显减轻，大便日2行，但食欲仍差，舌脉同上。继服原方。
7月14日，前后共服药20剂，腹痛消失，食欲增加，体重增加，仅有胃脘轻微满胀，舌苔白，脉弦紧。血尿淀粉酶正常。处方：厚朴9克，陈皮9克，草蔻9克，木香9克，茯苓6克，大黄6克，附子6克，干姜3克，甘草3克，生姜3片。
一年以后，因感冒来诊云：服药4剂后，一年来一直正常，已恢复工作。
12．肝肾俱虚，气滞不畅
张××，男，47岁。1973年3月20日。
一个多月来右胁下绞痛，阵阵发作，发作时腰亦绞痛，纳呆，头晕，心烦。肝脾均未触及。经多个医院超声波、同位素等检查，右肾下降4。Oem，诊为游走肾，肾绞痛。中西药治疗效果不著。舌苔白，脉弦。肝肾俱虚，气滞不畅。拟滋补肝肾，佐以理肝。处方：柴胡6克，甘草6克，当归9克，白芍9克，白术9克，茯苓9克，陈皮9克，生地9克，山药9克，菟丝子9克，泽泻9克，丹皮9克，郁金9克，薄荷3克。
3月30日，服药6剂，疼痛明显减轻，绞痛仅发作一次，但比以前要轻的多。
4月20日，继服14剂后，绞痛未再出现，仅有轻微隐痛．食欲精神正常。
4月30日，服药7剂，症状同前，但近日发现夜间口干较重。阴液不足，改予一贯煎加减：沙参15克，麦冬15克，枸杞子15克，白芍12克，石斛15克，丹参12克，甘草6克，川棟子9克。
5月4日，服药2剂，疼痛明显好转。超声波，同位素检查：右肾下降2厘米。
5月10日，症状消失，恢复工作。一年后复查，正常。
13．气阴两虚，痰饮阻滞
金××，男，59岁。1974年5月20日。
胃脘疼痛十几年，近两个月疼痛加重，反复呕吐，PEn~物为食物及粘液，口干，大便于，小便正常。经消化道造影诊为十二指肠溃疡，胃扭转。舌苔白质微红，脉弦大。气阴两虚，痰饮阻滞。处方：半夏15克，人参9克，生姜9克，蜂蜜30克．
服药2剂后，呕吐疼痛好转。服药8剂后，疼痛基本消失，后又以少腹逐瘀汤2剂，疼痛呕吐完全消失。一月后一人来谈云：病已愈，表感谢。
14．瘀血阻滞
杨××，男，48岁。1971年4月20日。
十几年来胃脘疼痛反复发作，医诊溃疡病，近日疼痛日渐加重，夜间经常因疼痛不能入睡。舌苔白，脉弦沉涩不调。寒凝血滞。拟温中活血。处方：小茴香9克，炮姜9克，元胡9克，灵脂9克，没药9克，当归9克，蒲黄9克，官桂9克，赤芍9克。服药2剂疼痛停止，至1974年7月一直未复发。15．气血俱虚，瘀血阳滞
张××，女，35岁。1974年4月29曰。
一年多来，右胁下疼痛，头晕乏力，心悸，五心烦热，汗多，食欲不振，有时出现小出血点及衄血。经检查：心尖部可闻Ⅲ级收缩期吹风样杂音，脾在肋下五指，肝在肋下一指，肝功正常，Hb6．6克％，RBC276万／mm3，WBC325万／mm3，中性67％，Pts52000／mm3。诊为斑替综合征。面色皓白无华，舌苔白，质淡，脉弦。气血俱虚，血络瘀滞，中气不足。拟益气养血，活血通络，健补中气。处方：黄芪15克，鳖甲9克，地骨皮9克，青蒿9克，党参9克，茯苓9克，半夏9克，知母9克，白芍9克，柴胡6克，生地15克，肉桂4．5克，天冬12克。
5月4日，服药4剂，食欲增加，他证同前。去天冬，加牡蛎6克、麦冬12克。
5月13日，四天来腹胀，右胁痛较前加重，并出现里急后重感，舌苔白，质淡，脉沉细。4月29曰方加肉桂4．5克。
5月27日，腹痛、胁痛、精神、食欲均好转．脾较前软，胁下4指，肝肋下一指，血色素8。28％，红细胞368万／mm3，白细胞4650／mm3，中性76％，淋巴24％。舌苔白，质较前微红润，脉沉细。继按原方调理。
结语：
胃脘部的疼痛是很多疾病在胃脘部的一个症状。中医一般都在胃脘痛，心痛，胁痛中去讨论。
中医治疗胃脘部痛是根据辨证施治的原则来进行的。
胃脘部疼痛不但是局部的疼痛，而且是全身疾病的局部反应，因此在治疗时不但要看到局部，更重要的是要看到整体。
辨证论治不但要注意固定情况，而且要注意变化了的情况。
头痛
神经性头痛，初起者多实、多火，久病者多虚、多寒，然久久不瘥，多为虚实夹杂，寒热并见，此时治疗，尤应注意标本缓急。例如：郑××，男，成。神经性头痛，三叉神经痛8年多。近半年来日渐加重，久治无效。邀余诊视。审其证见头、眼眶、面颊疼痛，有时如闪电，有时钝痛，头晕耳聋，心烦心悸，纳呆食减，视力下降，口苦咽干，舌苔薄白，指趾厥冷，手心反热，脉沉弦而涩。余云：肝郁化火所致。某医问云：可否用丹栀逍遥散?患者云：前医以丹栀逍遥散20多剂无效。医又插语云：可否用龙胆泻肝汤?患者云：服用龙胆泻肝汤几剂后，不但头痛不减，反而出现腹痛、腹泻、气短等副作用。思之，头痛甚于颞侧、面颊、眼眶，并见耳聋、两眼胀痛，心烦易怒、口苦咽干等，显系肝火昕致。但肝火脉应弦数，此反沉弦而涩，且指趾厥冷，服苦寒败胃则腹痛，此必上火下寒、木郁失达之证。处方：柴胡1O克，半夏10克，黄芩10克，党参10克，生姜10克，桂枝15克，酒军3克，甘草6克，大枣5个，龙骨]5克，牡蛎15克。连进4剂，诸证俱减，继进4剂再无进展。再审其脉，虚弦而滑，此久病气阴大衰，痰热郁结之候。乃拟黄芪1]5克，当归9克，麦冬9克，五味子9克以益气养阴，竹茹9克，枳壳9克，半夏9克，陈皮9克，茯苓9克，甘草9克，菖蒲9克，远志9克，川芎9克，知母9克以化痰降火安神。服药6剂，头痛如失，他证亦减；又服12剂诸症消失七八，头痛未作，为巩固疗效，嘱其再服上方半月，冉以丸药调服之。
③ For patients presenting with a bluish-black complexion, hypochondriac pain, soreness and pain in the lower back and waist, jaundice, white tongue coating, and a pulse that is empty and large or wiry with a larger chi (cun-kou) position, indicating a syndrome of deficiency of both Yin and Yang combined with Damp-Heat in the Liver and Gallbladder, the treatment principle is to simultaneously tonify Yin and Yang, eliminate Dampness, and clear Heat. The formula used is: He Shou Wu (Polygoni Multiflori Radix Preparata) 15g, Yin Yang Huo (Epimedii Herba) 15g, Huang Jing (Polygonati Rhizoma) 15g, Yin Chen (Artemisiae Scopariae Herba) 30g, Shen Qu (Massae Medicamentosa Fermentata) 9g, Yu Jin (Curcumae Radix) 9g, Mai Ya (Hordei Fructus Germinatus) 9g, Zhi Qiao (Aurantii Fructus Immaturus) 9g.
④ For patients presenting with low-grade fever in the afternoon and at night, five-palm heat (heat sensation in the palms, soles, and chest), hypochondriac pain, jaundice, white tongue coating with peeling in the center, and a deep, fine, and wiry pulse, indicating a syndrome of Yin deficiency complicated by Damp-Heat, the treatment principle is to nourish Yin and clear Heat, assisted by promoting diuresis to drain Dampness. The formula used is: Qing Hao (Artemisiae Annuae Herba) 9g, Bie Jia (Testudinis Carapax et Plastrum) 9g, Sheng Di Huang (Rehmanniae Radix) 9g, Huang Bo (Phellodendri Cortex) 9g, Yin Chen (Artemisiae Scopariae Herba) 15g, Yu Zhu (Polygonati Odorati Rhizoma) 6g, Wu Wei Zi (Schisandrae Chinensis Fructus) 6g, Qin Jiao (Gentianos Macrophyllae Radix) 9g, Zhi Qiao (Aurantii Fructus Immaturus) 9g.
(5) Blood Stasis Obstruction: Pricking pain in the hypochondrium, occurring or worsening at night, choppy pulse, blood stasis spots on the tongue edges. There are two common scenarios:
① For patients with pricking pain in the hypochondrium, painful at night or during the day, white tongue coating, blood stasis spots on the tongue edges, and a wiry, choppy, irregular pulse or bound pulse, indicating Blood Stasis combined with Cold, the Ge Xia Zhu Yu Tang (Decoction for Expelling Blood Stasis from Below the Diaphragm) is used: Zhi Qiao (Aurantii Fructus Immaturus) 9g, Tao Ren (Persicae Semen) 9g, Dan Pi (Moutan Cortex) 9g, Chi Shao (Paeoniae Radix Rubra) 9g, Wu Yao (Linderae Radix) 9g, Yuan Hu (Corydalis Rhizoma) 9g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 9g, Dang Gui (Angelicae Sinensis Radix) 9g, Ling Zhi (Trogopterori Faeces) 9g, Hong Hua (Carthami Flos) 9g, Xiang Fu (Cyperi Rhizoma) 9g, Gui Zhi (Cinnamomi Ramulus) 3g.
② For patients with pricking pain in the hypochondrium with a burning sensation, dry mouth, five-palm heat, white tongue coating, blood stasis spots on the tongue edges, and a wiry, choppy, irregular pulse, indicating Blood Stasis combined with Heat, the treatment principle is to invigorate Blood and clear Heat. The formula used is: Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 30g, Tan Xiang (Santalum Album Lignum) 9g, Yuan Hu (Corydalis Rhizoma) 9g, Chuan Lian Zi (Meliae Fructus) 9g, Zhi Qiao (Aurantii Fructus Immaturus) 9g, Sheng Di Huang (Rehmanniae Radix) 9g, Bai Shao (Paeoniae Radix Alba) 12g.
III. Case Summaries
1. Mixed Cold and Heat, Heat Predominant over Cold. Patient Wang XX, Male, 45 years old, First visit June 14, 1973. For over 20 years, he has suffered from epigastric fullness and pain, radiating to the lower back, intolerance to cold food and drink, bitter taste in the mouth, and unsatisfactory bowel movements. Diagnosed as gastritis by multiple hospitals. Multiple Western medicines and Chinese patent medicines such as Xiang Sha Yang Wei Wan and Fu Zi Li Zhong Wan were ineffective. Examination revealed thin yellow tongue coating and slippery pulse, indicating a syndrome of mixed Cold and Heat, with Heat predominant. Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) was prescribed: Ban Xia (Pinelliae Rhizoma) 9g, Huang Lian (Coptidis Rhizoma) 9g, Huang Qin (Scutellariae Radix) 9g, Gan Jiang (Zingiberis Rhizoma Recens) 9g, Dang Shen (Codonopsis Radix) 9g, Hou Po (Magnoliae Officinalis Cortex) 3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Da Zao (Jujubae Fructus) 3 pieces. On June 17, after taking 2 doses, abdominal distension and pain improved significantly; Hou Po was increased to 6g. On July 2, pain reduced by two-thirds, but recent onset of sore throat, chest fullness, irritability, and cough indicated Qi stagnation and Phlegm depression. The prescription was changed to: Chai Hu (Bupleuri Radix) 6g, Zhi Qiao (Aurantii Fructus Immaturus) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Jie Geng (Platycodonis Radix) 9g, Qing Pi (Citri Reticulatae Pericarpium Viride) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Su Ye (Perillae Folium) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g. On September 24, the patient reported that after taking 10 doses in total, all symptoms disappeared. One year later, upon meeting the patient again, he stated that he had not relapsed since taking the medicine.
2. Cold Excess Stagnation. Patient Sun XX, Male, 59 years old, First visit October 12, 1973. Epigastric pain and vomiting for over 20 days. Diagnosed as gastritis. Several days of Western medicine failed to stop the pain, which worsened after eating. Mouth was bland and tasteless, tongue coating white, pulse wiry and slow. Syndrome of Cold Excess Stagnation. Treatment: Warm the Middle and guide out stagnation. Prescription: Ding Xiang (Caryophylli Flos) 9g, Kou Ren (Cardamomi Fructus) 9g, Cao Kou (Gratiae Fructus) 9g, Dang Shen (Codonopsis Radix) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Gan Jiang (Zingiberis Rhizoma Recens) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 9g, Mu Xiang (Aucklandiae Radix) 9g, Lai Fu Zi (Radishi Semen) 9g, Er Chou (Evodiae Fructus / Phaseoli Volubilis Semen - Note: "Er Chou" usually refers to Qian Niu Zi) 9g.
On October 16, half an hour after taking the medicine, pain and vomiting stopped. After taking 2 doses, he was cured.
3. Spleen and Kidney Deficiency Cold. Patient Guo XX, Male, 39 years old. First visit October 8, 1973. Epigastric pain for half a year, aggravated for one month. Gastrointestinal contrast study: Duodenal bulb ulcer. Four months of Chinese and Western medicine treatment showed no obvious effect. During pain attacks, frequent soreness and pain in the lower back, white tongue coating, left pulse wiry and tight, right pulse deep, rapid, and weak. Syndrome of Spleen and Kidney Deficiency Cold. Treatment: Strengthen Spleen and warm Kidney. Prescription: Sheng Di Huang (Rehmanniae Radix) 12g, Shan Yao (Dioscoreae Rhizoma) 12g, Fu Zi (Aconiti Lateralis Radix Praeparata) 9g, Dang Shen (Codonopsis Radix) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Gan Jiang (Zingiberis Rhizoma Recens) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 9g, Fu Ling (Poria) 9g, Rou Cong Rong (Cynomorii Herba) 9g, Ze Xie (Alismatis Rhizoma) 9g, Dan Pi (Moutan Cortex) 9g.
On October 15, after taking 4 doses, pain stopped, but mild heartburn remained. Continued with 2 doses to consolidate the effect. Follow-up half a year later showed no relapse.
4. Qi and Yin Deficiency, Phlegm-Fluid Obstruction. Patient Sun XX, Male, 41 years old. First visit October 19, 1973. Ulcer disease for 8 years, pain aggravated for one month, vomiting, diarrhea. Initially vomited food, later vomited food and mucus. Tongue coating thin white, tongue body red, pulse wiry and slippery. Previous Chinese and Western medicine treatments were ineffective. Gastrointestinal contrast study: Gastric antrum and duodenal ulcers, malignant transformation of gastric antrum ulcer. Syndrome of Phlegm-Fluid obstruction, Qi and Yin deficiency. Prescription: Ban Xia (Pinelliae Rhizoma) 21g, Dong Shen (Glehniae Radix) or Dang Shen (Codonopsis Radix - Text says "Dong Shen" but context suggests Codonopsis/Ginseng family, WHO term for Dong Shen is Glehniae Radix, for Dang Shen is Codonopsis Radix. Given "Dong Shen" literally, I will use Glehniae Radix, though clinically Dang Shen is common in this combo. Let's stick to literal translation of entity name provided in text "Dong Shen"): 9g, Mai Dong (Ophiopogonis Radix) 12g, Sheng Jiang (Zingiberis Rhizoma Recens) 9g, Feng Mi (Mel) 30g.
On October 21, after taking 1 dose, pain and vomiting stopped.
5. Spleen and Stomach Deficiency Cold. Patient Liu XX, Female, 36 years old. Visit June 2, 1973. For two years, continuous epigastric pain, relieved by eating, prefers warmth and pressure, poor appetite, fatigue, back soreness, white tongue coating, left pulse deep and fine, right pulse wiry. Gastrointestinal contrast study: Duodenal ulcer. Syndrome of Spleen and Stomach Deficiency Cold, Wood Evil invading. Prescription: Huang Qi (Astragali Radix) 15g, Gui Zhi (Cinnamomi Ramulus) 9g, Bai Shao (Paeoniae Radix Alba) 18g, Dang Gui (Angelicae Sinensis Radix) 9g, Sheng Jiang (Zingiberis Rhizoma Recens) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Da Zao (Jujubae Fructus) 7 pieces.
After taking 4 doses, pain disappeared. Continued taking medicine for 1 month. Follow-up after one year showed no relapse.
6. Qi Deficiency with Failure of Movement, Liver Qi Stagnation. Patient Zhang XX, Male, 44 years old. Visit February 4, 1972. For 7-8 years, epigastric discomfort and pain, irritability, chest fullness, poor appetite, bitter taste, generalized pain, especially in joints, dizziness, headache, insomnia, fatigue, normal bowel movements, yellow urine, white tongue coating, wiry and fine pulse. Root cause is Qi deficiency with failure of Clear Yang to ascend; branch is Liver Qi stagnation. Prescription: Huang Qi (Astragali Radix) 15g, Dang Shen (Codonopsis Radix) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Huang Lian (Coptidis Rhizoma) 9g, Ban Xia (Pinelliae Rhizoma) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Fu Ling (Poria) 9g, Ze Xie (Alismatis Rhizoma) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 3 pieces, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Fang Feng (Saposhnikoviae Radix) 6g, Qiang Huo (Notopterygii Rhizoma et Radix) 6g, Du Huo (Angelicae Pubescentis Radix) 6g, Chai Hu (Bupleuri Radix) 6g.
On February 30 (Note: Calendar error in source, likely meant March or specific lunar date), after taking 12 doses, symptoms basically disappeared. No relapse seen half a year later.
7. Cold and Food Stagnation. Patient Shen XX, Male, 51 years old. Visit June 11, 1973. Suddenly developed severe epigastric pain after eating cold cake and pork the previous day. Took Si Xiao Wan and felt some improvement, but pain persisted, worsened after eating, belching, poor appetite, dry stool, no bowel movement for two days. White tongue coating, deep and wiry pulse. Syndrome of Cold and Food Stagnation. Plan: Warm the Middle and guide out stagnation. Prescription: Dang Shen (Codonopsis Radix) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 9g, Fu Zi (Aconiti Lateralis Radix Praeparata) 9g, Lai Fu Zi (Radishi Semen) 9g, Mai Ya (Hordei Fructus Germinatus) 9g, Shan Zha (Crataegi Fructus) 9g, Mu Xiang (Aucklandiae Radix) 9g, Bing Lang (Arecae Semen) 9g, Da Huang (Rhei Radix et Rhizoma) 3g.
After 2 doses, pain disappeared, appetite normalized.
8. Liver-Stomach Disharmony, Food Stagnation Not Transforming. Patient Cheng XX, Male (Age missing/typo), Visit June 5, 1973. For half a year, epigastric pain, worsened after eating, aversion to pressure, nausea, vomiting, dizziness, irritability, bland taste, loose stools, white tongue coating, deep and wiry pulse. Syndrome of Liver-Stomach Disharmony, Food Stagnation. Plan: Soothe Liver and harmonize Stomach, digest food and guide out stagnation. Prescription: Chai Hu (Bupleuri Radix) 6g, Ban Xia (Pinelliae Rhizoma) 9g, Dang Shen (Codonopsis Radix) 9g, Huang Qin (Scutellariae Radix) 9g, Cang Zhu (Atractylodis Rhizoma) 9g, Hou Po (Magnoliae Officinalis Cortex) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Lai Fu Zi (Radishi Semen) 9g, Jiao San Xian (Fried Hawthorn, Medicated Leaven, and Barley Sprout) 9g each, Gan Jiang (Zingiberis Rhizoma Recens) 3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Da Zao (Jujubae Fructus) 3 pieces.
After 4 doses, pain disappeared, appetite normalized.
9. Direct Invasion of Cold Pathogen. Patient Wu XX, Male, 60 years old. Visit July 3, 1972. Sudden abdominal pain, epigastric pain, vomiting, white tongue coating, wiry and tight pulse. Syndrome of Direct Invasion of Cold Pathogen. Prescription: She Xiong Wan (Shexiong Pill - Note: Likely typo for Shu Jiao Wan or similar warming pill, translating as Shexiong Pill based on text): 1 packet, taken at once. Significant improvement after one hour, cured that night.
10. Liver and Kidney Dual Deficiency, Damp-Heat Obstruction. Patient Gong XX (Likely Wang XX typo), Male, 38 years old. Visit July 5, 1973. Hospitalized for over a year for Jaundice Hepatitis with no improvement, discharged. Post-discharge liver function tests: Thymol Turbidity +++, Thymol Cloudiness 20, Jaundice Index 30, ALT 500. Accompanied by liver area pain, fatigue, epigastric fullness, unsatisfactory bowel movements, yellow-red urine, white greasy tongue coating, bluish-black complexion, wiry and large pulse. Ultrasound: Early cirrhosis, chronic hepatitis. Prescription: He Shou Wu (Polygoni Multiflori Radix Preparata) 15g, Huang Jing (Polygonati Rhizoma) 15g, Yin Yang Huo (Epimedii Herba) 15g, Yin Chen (Artemisiae Scopariae Herba) 30g, Shen Qu (Massae Medicamentosa Fermentata) 9g, Mai Ya (Hordei Fructus Germinatus) 9g, Kou Ren (Cardamomi Fructus) 9g, Zhi Qiao (Aurantii Fructus Immaturus) 9g. On July 17, spirit and appetite significantly improved, jaundice disappeared, complexion returned to near normal, tongue and pulse same as before, Thymol Turbidity ++, Thymol Cloudiness 8, ALT 200, Jaundice Index 2.
11. Cold Excess Stagnation. Patient Xu XX, Male, 26 years old. Visit June 24, 1973. Acute pancreatitis in December 1971, improved with Da Chai Hu Tang and heat-clearing drugs, but frequently recurred. Subsequent treatment with the same formula and Western medicine was ineffective. For the past month, severe epigastric pain, worsened after eating, worse at night, dry mouth but no desire to drink, dry stool, pethidine (Dolantin) several times daily provided no relief. White tongue coating, wiry and slippery pulse. Blood amylase 600 units. Prescription: Ban Xia (Pinelliae Rhizoma) 9g, Huang Qin (Scutellariae Radix) 9g, Dang Shen (Codonopsis Radix) 9g, Gan Jiang (Zingiberis Rhizoma Recens) 9g, Huang Lian (Coptidis Rhizoma) 9g, Zhi Shi (Aurantii Fructus Immaturus) 9g, Da Huang (Rhei Radix et Rhizoma) 3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Da Zao (Jujubae Fructus) 3 pieces.
On June 26, after 2 doses, pain did not improve. Examination showed aversion to pressure in stomach pain, white tongue coating, wiry and tight pulse. Signs of Cold Excess Stagnation. Plan: Warm the Middle and guide out stagnation. Prescription: Da Huang (Rhei Radix et Rhizoma) 9g, Fu Zi (Aconiti Lateralis Radix Praeparata) 9g, Xi Xin (Asari Radix et Rhizoma) 3g, Zhi Shi (Aurantii Fructus Immaturus) 15g, Mu Xiang (Aucklandiae Radix) 9g.
On June 27, after 2 consecutive doses, pain significantly reduced, bowel movements 2 times/day, but appetite still poor, tongue and pulse same. Continue original formula.
On July 14, after a total of 20 doses, abdominal pain disappeared, appetite increased, weight gained, only slight epigastric fullness remains, white tongue coating, wiry and tight pulse. Blood and urine amylase normal. Prescription: Hou Po (Magnoliae Officinalis Cortex) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Cao Kou (Gratiae Fructus) 9g, Mu Xiang (Aucklandiae Radix) 9g, Fu Ling (Poria) 6g, Da Huang (Rhei Radix et Rhizoma) 6g, Fu Zi (Aconiti Lateralis Radix Praeparata) 6g, Gan Jiang (Zingiberis Rhizoma Recens) 3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices.
One year later, visited for a cold, stated that after taking 4 doses, he had been normal for a year and had resumed work.
12. Liver and Kidney Dual Deficiency, Qi Stagnation Not Flowing Smoothly. Patient Zhang XX, Male, 47 years old. Visit March 20, 1973. For over a month, colicky pain in the right hypochondrium, paroxysmal, with colicky pain in the waist during attacks, poor appetite, dizziness, irritability. Liver and spleen not palpable. Ultrasound and isotope scans at multiple hospitals showed right kidney descended 4.0 cm, diagnosed as wandering kidney, renal colic. Chinese and Western medicine treatments were ineffective. White tongue coating, wiry pulse. Syndrome of Liver and Kidney Dual Deficiency, Qi Stagnation. Plan: Tonify and nourish Liver and Kidney, assist with regulating Liver. Prescription: Chai Hu (Bupleuri Radix) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Dang Gui (Angelicae Sinensis Radix) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Fu Ling (Poria) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Sheng Di Huang (Rehmanniae Radix) 9g, Shan Yao (Dioscoreae Rhizoma) 9g, Tu Si Zi (Cuscutae Semen) 9g, Ze Xie (Alismatis Rhizoma) 9g, Dan Pi (Moutan Cortex) 9g, Yu Jin (Curcumae Radix) 9g, Bo He (Menthae Haplocalycis Herba) 3g.
On March 30, after 6 doses, pain significantly reduced, colic occurred only once, much lighter than before.
On April 20, after continuing 14 doses, no more colic, only slight dull pain, appetite and spirit normal.
On April 30, after 7 doses, symptoms same as before, but recently found severe dry mouth at night. Yin fluid insufficiency. Changed to Yi Guan Jian (One Glance Decoction) modified: Sha Shen (Glehniae Radix or Adenophorae Radix - Text says Sha Shen, usually Glehniae or Adenophorae) 15g, Mai Dong (Ophiopogonis Radix) 15g, Gou Qi Zi (Lycii Fructus) 15g, Bai Shao (Paeoniae Radix Alba) 12g, Shi Hu (Dendrobii Caulis) 15g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 12g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Chuan Lian Zi (Meliae Fructus) 9g.
On May 4, after 2 doses, pain significantly improved. Ultrasound and isotope scan: Right kidney descended 2 cm.
On May 10, symptoms disappeared, resumed work. Follow-up one year later was normal.
13. Qi and Yin Deficiency, Phlegm-Fluid Obstruction. Patient Jin XX, Male, 59 years old. Visit May 20, 1974. Epigastric pain for over ten years, aggravated for two months, repeated vomiting, vomitus consisting of food and mucus, dry mouth, dry stool, normal urination. Gastrointestinal contrast study diagnosed duodenal ulcer and gastric torsion. White tongue coating, slightly red tongue body, wiry and large pulse. Syndrome of Qi and Yin Deficiency, Phlegm-Fluid Obstruction. Prescription: Ban Xia (Pinelliae Rhizoma) 15g, Ren Shen (Ginseng Radix et Rhizoma) 9g, Sheng Jiang (Zingiberis Rhizoma Recens) 9g, Feng Mi (Mel) 30g.
After 2 doses, vomiting and pain improved. After 8 doses, pain basically disappeared. Then took Shao Fu Zhu Yu Tang (Decoction for Expelling Blood Stasis from the Lower Abdomen) 2 doses, pain and vomiting completely disappeared. One month later, someone came to say the illness was cured and expressed gratitude.
14. Blood Stasis Obstruction. Patient Yang XX, Male, 48 years old. Visit April 20, 1971. Recurrent epigastric pain for over ten years, diagnosed as ulcer disease. Recently pain gradually worsened, often unable to sleep at night due to pain. White tongue coating, deep, wiry, choppy, irregular pulse. Cold coagulation and Blood Stasis. Plan: Warm the Middle and invigorate Blood. Prescription: Xiao Hui Xiang (Foeniculi Fructus) 9g, Pao Jiang (Zingiberis Rhizoma Preparatum) 9g, Yuan Hu (Corydalis Rhizoma) 9g, Ling Zhi (Trogopterori Faeces) 9g, Mo Yao (Myrrha) 9g, Dang Gui (Angelicae Sinensis Radix) 9g, Pu Huang (Typhae Pollen) 9g, Guan Gui (Cinnamomi Cortex) 9g, Chi Shao (Paeoniae Radix Rubra) 9g. After 2 doses, pain stopped. No relapse until July 1974.
15. Qi and Blood Dual Deficiency, Blood Stasis Obstruction. Patient Zhang XX, Female, 35 years old. Visit April 29, 1974. For over a year, right hypochondriac pain, dizziness, fatigue, palpitations, five-palm heat, excessive sweating, poor appetite, occasional small bleeding points and epistaxis. Examination: Grade III systolic blowing murmur at apex, spleen palpable 5 fingers below costal margin, liver 1 finger below costal margin, normal liver function, Hb 6.6 g%, RBC 2.76 million/mm³, WBC 3.25 million/mm³ (Note: Source value likely erroneous, typically thousands), Neutrophils 67%, Platelets 52,000/mm³. Diagnosed as Banti's Syndrome. Pale complexion without luster, white tongue coating, pale tongue body, wiry pulse. Syndrome of Qi and Blood Dual Deficiency, Blood Collateral Stasis, Middle Qi Insufficiency. Plan: Tonify Qi and nourish Blood, invigorate Blood and unblock collaterals, strengthen and tonify Middle Qi. Prescription: Huang Qi (Astragali Radix) 15g, Bie Jia (Testudinis Carapax et Plastrum) 9g, Di Gu Pi (Lycii Cortex) 9g, Qing Hao (Artemisiae Annuae Herba) 9g, Dang Shen (Codonopsis Radix) 9g, Fu Ling (Poria) 9g, Ban Xia (Pinelliae Rhizoma) 9g, Zhi Mu (Anemarrhenae Rhizoma) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Chai Hu (Bupleuri Radix) 6g, Sheng Di Huang (Rehmanniae Radix) 15g, Rou Gui (Cinnamomi Cortex) 4.5g, Tian Dong (Asparagi Radix) 12g.
On May 4, after 4 doses, appetite increased, other symptoms same. Removed Tian Dong, added Mu Li (Ostrea Concha) 6g, Mai Dong (Ophiopogonis Radix) 12g.
On May 13, for four days, abdominal distension, right hypochondriac pain worsened, tenesmus appeared. White tongue coating, pale tongue body, deep and fine pulse. Added Rou Gui (Cinnamomi Cortex) 4.5g to the April 29 formula.
On May 27, abdominal pain, hypochondriac pain, spirit, and appetite all improved. Spleen softer than before, 4 fingers below hypochondrium, liver 1 finger below costal margin, Hemoglobin 8.28 g%, RBC 3.68 million/mm³, WBC 4650/mm³, Neutrophils 76%, Lymphocytes 24%. White tongue coating, slightly redder tongue body than before, deep and fine pulse. Continue conditioning according to the original formula.
Conclusion:
Pain in the epigastric region is a symptom of many diseases manifesting in that area. In Traditional Chinese Medicine, this is generally discussed under the categories of Epigastric Pain, Heart Pain, and Hypochondriac Pain.
The treatment of epigastric pain in TCM is conducted based on the principle of Syndrome Differentiation and Treatment.
Epigastric pain is not only local pain but also a local reaction to systemic disease. Therefore, during treatment, one must not only focus on the local aspect but, more importantly, view the patient as a whole.
Syndrome differentiation and treatment require attention not only to fixed conditions but also to changing circumstances.
Headache
Neurasthenic headache: Initially, it is mostly excess type and fire-type; in chronic cases, it is mostly deficiency type and cold-type. However, if it persists for a long time without healing, it is often a mixture of excess and deficiency, with both cold and heat signs present. At this stage of treatment, particular attention should be paid to addressing the root and branch, and prioritizing urgent versus non-urgent issues.
For example: Patient Zheng XX, Male (Age missing). Neurasthenic headache, Trigeminal Neuralgia for over 8 years. In the past six months, it has gradually worsened, and long-term treatment has been ineffective. I was invited to examine him. His symptoms included pain in the head, eye sockets, and cheeks, sometimes like lightning strikes, sometimes dull pain, dizziness, deafness, irritability, palpitations, poor appetite, decreased food intake, declining vision, bitter taste in the mouth, dry throat, thin white tongue coating, cold fingers and toes, yet hot palms, and a deep, wiry, and choppy pulse. I stated: This is caused by Liver Qi stagnation transforming into Fire. Another doctor asked: Can we use Danzhi Xiaoyao San? The patient replied: Previous doctors used Danzhi Xiaoyao San for over 20 doses with no effect. The doctor interjected: Can we use Longdan Xiegan Tang? The patient replied: After taking a few doses of Longdan Xiegan Tang, not only did the headache not decrease, but side effects such as abdominal pain, diarrhea, and shortness of breath appeared. Upon reflection, the headache is severe in the temporal regions, cheeks, and eye sockets, accompanied by deafness, distending pain in both eyes, irritability, anger, bitter taste, and dry throat, which clearly indicates Liver Fire. However, the pulse for Liver Fire should be wiry and rapid, whereas here it is deep, wiry, and choppy. Moreover, the fingers and toes are cold, and taking bitter-cold herbs damages the Stomach causing abdominal pain. This must be a condition of upper heat and lower cold, with Wood (Liver) Qi stagnation failing to flow freely. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Huang Qin (Scutellariae Radix) 10g, Dang Shen (Codonopsis Radix) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 10g, Gui Zhi (Cinnamomi Ramulus) 15g, Jiu Jun (Wine-processed Da Huang) 3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Da Zao (Jujubae Fructus) 5 pieces, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostrea Concha) 15g. After taking 4 doses continuously, all symptoms decreased. After another 4 doses, there was no further progress. Re-examining the pulse, it was deficient, wiry, and slippery. This indicates that after a long illness, Qi and Yin are severely depleted, and Phlegm-Heat is stagnant and knotted. Therefore, I prescribed Huang Qi (Astragali Radix) 15g, Dang Gui (Angelicae Sinensis Radix) 9g, Mai Dong (Ophiopogonis Radix) 9g, Wu Wei Zi (Schisandrae Chinensis Fructus) 9g to tonify Qi and nourish Yin; Zhu Ru (Bambusae Caulis in Taenia) 9g, Zhi Ke (Aurantii Fructus Immaturus) 9g, Ban Xia (Pinelliae Rhizoma) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Fu Ling (Poria) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 9g, Shi Pu (Acori Tatarinowii Rhizoma) 9g, Yuan Zhi (Polygalae Radix) 9g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 9g, Zhi Mu (Anemarrhenae Rhizoma) 9g to resolve Phlegm, descend Fire, and calm the Spirit. After taking 6 doses, the headache disappeared as if lost, and other symptoms also decreased. After taking another 12 doses, seven or eight of all symptoms disappeared, and the headache did not recur. To consolidate the curative effect, he was instructed to continue taking the above prescription for half a month, followed by pill medication for regulation.