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[Symptoms of Internal Injury Epigastric Pain] Not caused by external contraction of the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire), but occasionally due to dietary injury, causing food to block the Tai Cang (Stomach), with stuffiness and pain in the chest. This is a Food Stagnation pattern.

Pain accompanied by profuse sweating indicates Heat Accumulation. Clear and free urination and defecation, cold extremities, spitting of saliva, and worsening after drinking cold beverages indicate Cold Accumulation. Onset triggered by emotional fluctuations, or pain radiating and attacking, or凝 condensation causing distension, indicates Qi Stagnation. Lighter during the day and heavier at night, or making chirping sounds, pain worsened by cold and temporarily relieved by heat, indicates Dead Blood (Blood Stasis) pain. Vomiting clear water, white spots on the face, red lips with ability to eat, and occasional expulsion of roundworms indicate Parasite Accumulation. Thus it is said that internal injury pain has seven types.

[Etiology of Internal Injury Epigastric Pain] Irregular diet damages the stomach opening, disrupting the ascending and descending functions of the Taiyin (Spleen and Lung), leading to condensation and obstruction, resulting in Food Stagnation pain; if the Spleen and Stomach are inherently weak, daily intake of food and water cannot be digested and absorbed, stagnating in the Zhongwan region, forming Phlegm-Fluid and causing pain; the fire of the Seven Emotions and Six Desires often stirs internally, and the heat from rich foods and fried/grilled items accumulates inside day by day, turning into dryness over time, resulting in Heat Accumulation pain. Insufficient Stomach Yang, internal injury from frozen/cold drinks, leads to Yin-Cold condensation, resulting in Yin Cold Accumulation pain. Anger causes Qi to rise, excessive thinking causes Qi to knot; accumulated worry and thought hinder Qi movement, leading to Qi Stagnation and pain. If the Blood level is inherently hot and one prefers spicy foods, damaging Yin-Blood, stagnation occurs in the middle, forming Dead Blood pain. The Earth element governs the generative function; careless diet generates internal Damp-Heat, leading to Parasite Accumulation pain.

[Pulse Patterns of Internal Injury Epigastric Pain] A deep and forceful pulse indicates Food Stagnation; a deep and slippery pulse indicates much Phlegm; a rapid and large pulse indicates Heat; a slow and delayed pulse indicates Cold; Qi Stagnation presents with a deep pulse; Dead Blood presents with a choppy pulse.

[Treatment of Internal Injury Epigastric Pain] Pingwei San (Calm the Stomach Powder) should be used as a base formula with modifications. For Food Stagnation pain, Sanleng Wan (Burreed Bulb Pill) is used. For Phlegm-Fluid pain, Erchen Tang (Two-Aged Decoction) or its pill form is used. For Qi Stagnation pain, Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction) is used. For Dead Blood pain, Honghua Taoren Tang (Safflower and Peach Kernel Decoction) is used. If there are excess signs requiring purgation, Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) is used. For Parasite Accumulation pain, Pingwei San is used.

Pingwei San: Cangzhu (Atractylodis Rhizoma), Nongpu (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
Sanleng Wan: Jingsanleng (Sparganii Rhizoma), Zhike (Aurantii Fructus), Nongpu (Magnoliae Officinalis Cortex), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
Erchen Tang (Two-Aged Decoction) and Daotan Tang (Phlegm-Resolving Decoction): See Phlegm Symptoms section.
Qingwei Tang (Clear the Stomach Decoction): See Toothache section.
Shenxiong Tang: Dahuang (Rhei Radix et Rhizoma), Huangqin (Scutellariae Radix), Heiqian Niu (Pharbitidis Semen), Huashi (Talcum), Bohe (Menthae Haplocalycis Herba), Chuanxiong (Ligustici Chuanxiong Rhizoma).
Doukou Wan: Caodoukou (Alpiniae Katsumadai Semen), Wuzhuyu (Evodiae Fructus), Yizhiren (Alpiniae Oxyphyllae Semen), Qingpi (Citri Reticulatae Pericarpium Viride), Jianghuang (Curcumae Longae Rhizoma), Maiya (Hordei Fructus Germinatus), Shenqu (Massa Medicata Fermentata), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
Suzi Jiangqi Tang: Zisu Zi (Perillae Fructus), Banxia (Pinelliae Rhizoma), Qianhu (Peucedani Radix), Nongpu (Magnoliae Officinalis Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Chenxiang (Aquilariae Lignum Resinatum), Danggui (Angelicae Sinensis Radix).
Honghua Taoren Tang: Honghua (Carthami Flos), Taoren (Persicae Semen), Danggui Wei (Angelicae Sinensis Radix Caudex), Chi Shaoyao (Paeoniae Radix Rubra), Zelan Ye (Leonuri Herba), Zharon (Crataegi Fructus), Danpi (Moutan Cortex), Shanzhi (Gardeniae Fructus).
Tao Ren Cheng Qi Tang: Taoren (Persicae Semen), Dahuang (Rhei Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Guizhi (Cinnamomi Ramulus), Mangxiao (Natrii Sulfas), Zhike (Aurantii Fructus), Guiwei (Angelicae Sinensis Radix Caudex).
Wanying Wan: Maiya (Hordei Fructus Germinatus), Shenqu (Massa Medicata Fermentata), Leiwan (Oxyuris Vermiformis), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Jingsanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Binglang (Arecae Semen), Wuyi (Meliosmae Fructus), Heshi (Chrysanthemi Indici Flos), Shijunzi (Quisqualis Fructus).
Jiami Baohe San: Cangzhu (Atractylodis Rhizoma), Nongpu (Magnoliae Officinalis Cortex), Banxia (Pinelliae Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus), Xian Maiya (Fresh Hordei Fructus Germinatus), Zharon (Crataegi Fructus), Xiangfu (Cyperi Rhizoma), Binglang (Arecae Semen), Gange (Puerariae Radix), Laifuzi (Raphani Semen). Grind into fine powder, mix well with radish juice and bamboo sap, moisten, dry, and grind into fine powder. Take with warm water.
Jiami Xiaojian San: Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Binglang (Arecae Semen), Zhishi (Aurantii Fructus Immaturus), Xiangfu (Cyperi Rhizoma), Haishi (Aragonitum). For upper Jiao Pi Ji (accumulations), add Cangzhu (Atractylodis Rhizoma) and Nongpu (Magnoliae Officinalis Cortex); for lower Jiao Pi Ji, add Qingpi (Citri Reticulatae Pericarpium Viride) and Zhike (Aurantii Fructus).
Zhilian Erchen Tang plus Zhuru (Bambusae Caulis in Taenia) and Gange (Puerariae Radix): Treats vomiting with pain.
Guntan Wan: Treats Phlegm-Pi Ji pain.

Epigastric pain must be distinguished into frequent and infrequent pain; one must also carefully examine whether the pain is severe or mild. If pain occurs immediately after eating and is accompanied by frequent belching, it is Dietary Injury; use Jiami Baohe San. If pain is accompanied by nausea and vomiting, and relief follows the expulsion of phlegm-saliva, it is Phlegm-Fluid pain; use Pingwei Daotan Tang. If there is a mass in the epigastrium with constant unceasing pain, it is Pi Ji pain; use Jiami Xiaojian San. If pain comes and goes, accompanied by sweating, it is Fire. If there is heat without stagnation, clearing heat is urgent; use Qingwei Tang. If there is heat with stagnation, resolving stagnation takes precedence; use Zhilian Baohe San. If pain is severe at night and triggered by cold, with palpable masses, or if food entering the stomach flows down only one side, it is Blood Stasis pain; first use Sanleng Wan, then Tao Ren Cheng Qi Tang. If pain allows eating and is relieved by food, with frequent passage of worms, use Pingwei San plus Shijunzi (Quisqualis Fructus). If there is a palpable mass in the stomach, extreme tenderness upon pressure, and nightly fever, this is Stomach Abscess pain. Whenever seeing pain symptoms, one must guard against the development of toxic sores; regardless of location in the chest, hypochondrium, waist, or back, press the painful area. If pressing increases pain and there is nightly fever, one must guard against internal...