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The Treatment of Digestive Problems with Acupuncture and Herbs

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The Treatment of Digestive Problems with Acupuncture and Herbs The Treatment of Digestive Problems with Acupuncture and Herbs Giovanni Maciocia FEELING OF DISTENSION, OPPRESSION, FULLNESS, STUFFINESS A feeling of DISTENSION (zhang 胀) indicates stagnation of Qi. This type of sensation will be seldom referred to as "distension" by Western patients: more often than not patients will call it a feeling of “bloating”, "bursting", "being blown-up", etc. A feeling of distension is both subjective and objective. The patient feel bloated subjectively, and distension is also objective in that it can be seen and palpated. On palpation it feel like an over-inflated balloon, it resists on palpation and “rebounds”. Subjective Can be seen Objective Can be palpated (like balloon) A feeling of distension indicates Qi stagnation: it is the cardinal symptom of Qi stagnation which usually affects the Liver. Remember, however, that it affects also other organs: in the context of digestive disorders, it affects the Stomach, Intestines and Spleen. Note that Qi stagnation does not always derive from anger (whether repressed or not) but it frequently derives from worry or guilt. Please note that English-speaking patients would not say “distension” but most probably “bloating”. - Liver-Qi stagnation: abdominal and/or epigastric bloating, related to emotional state. Pulse all Wiry or Wiry on left. - Stomach-Qi stagnation: epigastric bloating, not much related to emotional state. Alleviated by burping. Pulse Wiry on right Guan. - Spleen-Qi stagnation: lower abdominal bloating, loose stools. Alleviated by passing gas and by rest. Pulse slightly Wiry on left and Weak on right. Wiry Weak - Intestines Qi stagnation: abdominal distension and pain, borborygmi, constipation. Alleviated by passing gas. Pulse Wiry on both Chi position. Distension of epigastrium: Ren-10 Xiawan, Ren-12 Zhongwan, ST- 21 Liangmen, ST-34 Liangqiu, ST-40 Fenglong, GB-34 Yanglingquan. Distension of lower abdomen: ST-25 Tianshu, SP-15 Daheng, GB-34 Yanglingquan, Ren-6 Qihai. A feeling of FULLNESS (man 满 ) indicates retention of food or Dampness. A feeling of fullness is different than a feeling of distension. One literally feels full and slightly nauseous. It may affect the epigastriun or abdomen. The feeling of fullness is subjective and objective. Subjectively, the patient feels full. It is felt objectively on palpation but not seen on observation. On palpation, the abdomen feels hard and not elastic as in the feeling of distension. A feeling of an actual mass (on palpation) indicates stasis of Blood. Subjective Objective Can be palpated (feels hard) Epigastric fullness: ST-19 Burong, ST-21 Liangmen, Ren-10 Xiawan, SP-4 Gongsun/P-6 Neiguan (Chong Mai), ST-34 Liangqiu. Abdominal fullness: ST-25 Tianshu, ST-27 Daju, SP-4 Gongsun/P-6 Neiguan (Chong Mai), ST-37 Shangjuxu, ST-39 Xiajuxu. A feeling of OPPRESSION (men 闷 ) denotes Phlegm or also more severe stagnation of Qi. The translation of this term cannot adequately convey the image evoked by its Chinese character: this depicts a heart constrained by a door and, besides the physical sensation, it also implies a certain mental anguish associated with this feeling. 闷 门 心 Men Door Heart A feeling of oppression is purely subjective and it is experienced mostly in the chest. Some patients would describe it as a “weight” on the chest. In Western patients too, a feeling of oppression of the chest reflects emotional stress especially to do with sadness, grief, worry, shame and guilt. Feeling of oppression of the chest: Ren-17 Shanzhong, P-6 Neiguan, LU-7 Lieque, ST-40 Fenglong. A feeling of STUFFINESS (pi 痞) usually indicates Stomach-Qi deficiency with Stomach-Heat. Contrary to the previous two sensations which can be felt objectively on palpation (e.g. a distended or full abdomen feels so on touch), the sensation of stuffiness is only subjective and the abdomen feels soft on touch. The feeling of stuffiness is usually in the epigastrium. DISTENSION FULLNESS OPPRESSION STUFFINESS Subjective/objective Both Both Subjective Subjective Symptoms Bloating Full, nausea Weight Mildly full Chinese Zhang 张 Man 满 Men 闷 Pi 痞 Objective on what Visually and On palpation Soft on palpation palpation Pattern Qi stagnation Dampness Phlegm Deficiency and ST-Heat AETIOLOGY OF DIGESTIVE DISEASES DIET Excessive consumption of sugar, sweets, dairy Excessive consumption of sugar, sweets, dairy foods leads to Dampness or Phlegm. Excessive consumption of cold foods Excessive consumption of cold foods (raw vegetables, fruit, cold drinks, ice-cream) leads to Cold in Stomach or Intestines. Excessive consumption of hot foods Excessive consumption of spicy foods and alcohol leads to Heat in the Stomach or Intestines. Irregular eating habits These include: - Eating in a hurry - Eating at one’s work-desk - Eating standing up - Eating while discussing work/business - Eating late at night These habits lead to Stomach-Yin deficiency Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao EMOTIONAL STRESS Anger Anger affects the Liver and the Heart. It causes rebellious Liver-Qi to invade the Stomach and/or Spleen. This is a frequent cause of epigastric pain (if it affects the Stomach) or abdominal pain (if it affects the Spleen). Anger that is expressed tends to affect the Stomach more (with Qi rebelling horizontally), while anger that is repressed tends to affect the Spleen more (Qi stagnation). Expressed anger Nausea, belching, acid regurgitation ST LIV SP Loose stools Repressed anger Worry and pensiveness Worry and pensiveness also affect the Liver causing Liver-Qi stagnation. This may affect the Stomach or Intestines. Worry and pensiveness also affect the Spleen which will affect the Intestines causing loose stools and/or abdominal pain and distension. Guilt Guilt may also affect the Liver causing Liver-Qi stagnation leading to epigastric or abdominal pain. ST-40 FENGLONG 1. Subdues rebellious ST-Qi 2. All Full conditions of the Stomach 3. Opens the chest (with LU-7 or P-6) 4. Calms the Mind 5. Regulates the Heart Yao Cheng Wen, A Vernacular Explanation of the Discussion on Stomach and Spleen Pi Wei Lun Bai Hua Jie, Three Qin Publishing House, Xian, 2002, p. 206. Citing Acupuncture Channels of the Yellow Emperor Huang Di Zhen Jing 黄 帝 针 经. “The Large Intestine and the Small Intestine pertain to the Stomach Yang Ming. The point of the Small Intestine is ST-39 Xiajuxu and that of the Large Intestine is ST-37 Shangjuxu, both below ST-36 of the Stomach Yang Ming. The Large Intestine controls the Jin fluids and the Small Intestine the Ye fluids. The Small and Large Intestine receive Ying Qi from the Stomach and send the Jin-Ye fluids to the Upper Burner where they irrigate the skin and hair and fill the Cou Li space.” Practically the same quote is in chapter 2 of the Ling Shu. What this quote is saying is that the Small and Large Intestine, in the field of digestive diseases, come under the sphere of influence of the Stomach. It also confirms the importance of ST-39 and ST-37 for intestinal diseases. Note the location of ST-37 and ST-39 in relation to ST-40: the former is above it and the latter below. ST-40 is the Luo point and the Great Luo of the Stomach is called Xu Li 虚 里. XU LI . ST-37 Shangjuxu- Upper Great Void . ST-40 .ST -39 Xiajuxu- Lower Great Void The Small and Large Intestine are different than other organs in so far as their channels have a physiology and pathology that is quite distinct from that of their organs (the Triple Burner is also like this). CHAPTER 2 LING SHU HE-SEA POINTS After listing all the Shu points of each channel, the Ling Shu has an interesting statement: “These are the Shu points of the 5 Zang and 6 Fu, 25 and 36 respectively. The 6 Fu exit at the three Yang of the leg and connect upward with the arm.” This statement is saying that all the He-Sea points of the Yang channels are in the leg (because of the Lower He points ST-37, ST-39 and BL-39, Lower He points of Large Intestine, Small Intestine and Triple Burner respectively). These are the “real” He-Sea points, the ones in the arm being “connections”. The Arm Yang channels probably have Lower He-Sea points in the legs because of the anomaly of their channels being in the arm and their related organs in the lower abdomen (Intestines and Triple Burner). Lower He-Sea points of Large Intestine, Triple Burner and Small Intestine .. LI-11, TB-10, SI-8 . BL-39 . ST-37 . ST-39 Ren-12: tonifies ST- Qi, resolve Ren-13: Dampness, subdues tonifies all rebellious Fu . ST-Qi ST-21: . Full conditions . Ren-10: of ST stimulates the descending of ST-Qi Note that “subduing rebellious Qi” (Ren-13) and “stimulating the descending of Qi” (Ren-10) are not the same thing DIAGNOSIS There are some aspects of diagnosis which particularly apply to abdominal pain. a) nature of pain b) reaction to pressure c) reaction to food d) reaction to bowel movement a) NATURE OF PAIN A dull pain is due to an Empty condition, whilst a severe pain is due to a Full condition. A distending pain indicates stagnation of Qi. Patients often describe this as a "bloated" sensation. A stabbing, fixed and intense pain indicates stasis of Blood, especially if it is associated with a fixed abdominal mass. A feeling of fullness (which is more intense than "distension"), in Chinese called man, indicates Dampness or retention of food. b) REACTION TO PRESSURE If an abdominal pain is eased by pressing the area of pain this indicates an Empty condition. If it is aggravated by pressure this indicates a Full condition.
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