Epigastric pain

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Textbook Prescriptions Digestive

Essentials of Chinese Acupuncture (Beijing, Shanghai and Nanjing Colleges of Traditional Chinese Medicine, 1980) — the standard prescriptions of the Chinese colleges.

Points

ST36 Zusanli bilateral

He-Sea of the Stomach; distal point that calms the stomach and stops pain
CV12 Zhongwan midline

Front-Mu of the Stomach; local point that calms the stomach and stops pain
- ⚠ Organ
- Pregnancy: caution
PC6 Neiguan bilateral

Links with the Yinwei vessel; opens the chest and stops vomiting

Needling Safety

Cited hazards for these points. Tick what applies to the patient to see the cautions that follow from it.

CV12 Zhongwan
- ⚠ Organ injury has been reported after needling this point. Wu J, Hu Y, Zhu Y, Yin P, Litscher G, Xu S 2015, Table 4 (Organ injury associated with acupuncture)

Treatment Principle

Calm the stomach and relieve pain by pairing a local point with distal ones.

Indications

Food retention: distending epigastric pain, worse with pressure and after meals, belching with a foul smell, no appetite; thick sticky coating, deep forceful pulseLiver qi attacking the stomach: episodic epigastric pain with distending hypochondriac pain, sometimes nausea, acidity, abdominal distension and poor appetite; deep wiry pulseStomach deficiency with cold: dull epigastric pain eased by pressure and warmth, tiredness, regurgitation of thin fluid; thin white coating, deep slow pulse

Method

Reducing method for food retention and for liver qi attacking the stomach, with needles retained 30 to 60 minutes. For deficiency with cold, even method combined with moxibustion.

⚠ Cautions

Epigastric pain can be cardiac (inferior myocardial infarction), or come from a perforated or bleeding ulcer, pancreatitis or biliary disease; sudden severe pain, rigidity, haematemesis or black stools need emergency care. CV12 lies over the stomach and left lobe of the liver; avoid deep needling.

About

The colleges' core prescription for epigastric pain, with secondary points chosen for each of three patterns.

Rationale

ST36 and CV12, the He-Sea and Front-Mu of the Stomach, are the distal and local anchors for calming the stomach and stopping pain. PC6, through its connection with the Yinwei vessel, relaxes the chest and checks nausea, which often accompanies the pain.

Clinical Notes

For food retention add LV13 and ST44 to aid digestion and relieve fullness. For liver qi attacking the stomach add LV3 and LV14 with reducing method to regulate the liver and relieve distension. For stomach deficiency with cold add BL20 and SP4 with moxibustion, and CV6 with moxibustion on a slice of ginger, which the book singles out for chronic cold-type stomach pain. The book links this pain with gastric and peptic ulcer, gastritis, gastric neurosis and liver, gallbladder and pancreatic disease, and also mentions cupping over the upper abdomen or back-shu points and an ear-acupuncture option.

Sources

Beijing College of Traditional Chinese Medicine, et al. Essentials of Chinese Acupuncture. Beijing: Foreign Languages Press, 1980. Chapter III, Epigastric pain, p. 355–356.

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