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Stomach Pattern Differentiation in Chinese Medicine

Stomach Pattern Differentiation in Chinese Medicine

Etiology of Stomach Patterns

Diet

  1. Excessive consumption of foods that are too cold, too hot or too dry.
    1. "Excessive" depends on constitution, time of year, type of work done, climate.
    2. Hot foods: cause Heat in the stomach
      Cold foods: cause Cold in the stomach
    3. Dry foods (e.g. baked and broiled foods) can make Stomach too dry and eventually cause Stomach Yin Deficiency
  2. Regular food intake
    Best not to eat when Stomach has least energy (7-9 PM)
    Irregular eating can produce disorders. We should eat at regular times not overeat (prevents good digestion: food stagnates) not under-eat (or malnourish ourselves: causes Deficiency of the Spleen and Stomach)

    Eating Effect
    Eat a good breakfast Stomach has maximum energy 7-9 AM
    Don't eat too fast Stomach has no time to digest well: Retention of Food/Stagnation of Qi in the Spleen and Stomach
    Don't eat late at night Yin time of day: Stomach is obliged to deplete its Yin, causing Yin Deficiency
  3. Circumstances around eating

    Eating with... Effect
    Negative emotions Stomach will not digest, and its Qi will stagnate causing Food Retention
       
    Reading & eating: Depletes Stomach Qi (mental activity)

Emotions

  • Stomach is affected by excessive thinking and worry.
  • These can cause stagnation of Qi in the Stomach: signs include belching, nausea and irritation or burning pain in Stomach.
  • Excessive mental activity over a long time causes Stomach Qi Deficiency
  • Anger and frustration affect the Liver and cause Stagnation of Liver Qi. Liver then invades Stomach, causing belching, nausea, pain.

Climate

  • Cold can invade the Stomach directly causing acute pain and vomiting.

Stomach Qi Deficiency

Signs/Symptoms Due To
Epigastric Discomfort Deficient Stomach Qi fails to descend.
Mild pain Deficiency
Lack of appetite, lack of taste, loose stools, Spleen Qi affected by Stomach Qi Deficiency
Fatigue Especially in the Monring 7-9AM is Stomach time on Horary cycle
Weak limbs Food Essences not transported to the limbs
Tongue: Pale Deficiency of Qi
Pulse: Empty Pulse, Esp. Stomach position Deficiency of Qi

ANALYSIS: The Stomach begins the Qi production process. Food enters the Stomach and the Spleen extracts the pure essences which are sent onwards as Food Qi. If the Stomach is weak, Qi will be Deficient and other Organs may become affected (especially the Spleen, which is closely interrelated)

Etiology/Pathology:

  1. Diet lacking in nourishment/protein, or under-eating.
  2. Aftermath of chronic disease that weakens the Qi.

Treatment Principles:

  • Tonify Stomach Qi

Points:

Points: Notes:
ST-36 (Zusanli) Moxa especially effective
REN-12 (Zhongwan) Tonifies Qi of Stomach and Spleen
BL-21 (Weishu) Back Shu point of Stomach: moxa useful. Tonifies Stomach Qi
REN-6 (Qihai) "Sea of Qi" especially good if condition is chronic and accompanied by loose stools
Needling Method: Tonify. Moxa is applicable.

Stomach Qi Deficiency and Cold

Signs/Symptoms Due To
Discomfort in the Epigastrium: Worse after bowel movements Deficient type pain
Stomach and Large Intestine related
Better After Eating, or with massage.
No appetite.		 Deficient Cold condition
Stomach Deficient
Prefers warm drinks & foods
Vomiting of clear fluid
Loose stools
Lack of thirst
Cold limbs, fatique		 Internal Empty Cold
(Yang of Spleen Deficient)
Tongue: Pale, swollen Deficient Yang
Pulse: Deep, weak, ESP Stomach position Internal Cold

Etiology/Pathology:

  1. Dietary: faulty nourishment, lack of protein in diet accompanied by excessive consumption of cold foods and beverages, salads, ice water and ice cream.
  2. Result of prolonged illness which damages Spleen and Stomach Yang or any other cause of Stomach and Spleen Qi Deficiency, in conjunction with dietary irregularities
  3. Invasion of Exterior Cold

Treatment Principles:

  • Tonify and warm Stomach and Spleen Yang
Points Actions
ST-36 (Zu san li) Tonifies Stomach Qi
REN 12 (Zhong wan) Tonifies Stomach and Spleen Qi
BL-20 (Pi shu) Tonifies Spleen Qi
BL-21 (Wei shu) Tonifies Stomach Qi
REN 6 (Qi hai) Tonifies Qi. Moxa ideal.
Method: Tonification. Moxa essential.

NOTE: This is a chronic interior deficiency (Empty Cold) condition. A more severe version may present following exposure to cold or excessive consumption of cold food and drinks.

Cold Invasion of the Stomach

Signs/Symptoms Due To
Severe epigastric/abdominal pain with vomiting or clear fluid. Excess condition of Stomach
Cold
Tongue: Thick white coat Excess condition
Pulse: Deep, slow, and TIGHT Excess condition

Etiology/Pathology:

This is an Interior EXCESS cold condition and requires different points, specifically to dispel EXCESS cold in acute conditions.

Treatment Principles:

  • Expel Cold, warm the Stomach
Points Actions
ST-21 (Liang men) Expels Stomach cold if moxa used after needles
SP-4 (Gong sun) Expels Stomach cold, clears obstruction in Stomach
REN-13 (Shang wan) Stimulates descending of Stomach Qi
ST-34 (Liang qiu) Xi Cleft point: for acute painful patterns; Stops pain and clears obstructions from Stomach
Method: Sedation. Moxa applicable with needles.

Stomach Yin Deficiency

Signs/Symptoms Due To
Epigastric Pain
No appetite, feeling of fullness after eating		 Stomach Deficient
Fever or feeling warm in PM Yin Deficiency
DRY MOUTH esp. in afternoon
constipation with dry stools		 Signs of Dryness (Stomach is Origin of Fluids)
Tongue: Red & Peeled in Center or Coating &Quot;Without Root&Quot; (i.i. Can Be Scraped Away) Yin Deficiency of Stomach
Pulse: Floating/Empty on Right middle Yin Deficiency of Stomach

Treatment Principles:

  • Nourish Stomach Yin and Fluids
Points Actions
REN-12 (Zhong wan) Tonifies Stomach Yin
ST-36 (Zu san li) Tonifies Stomach Qi and Stomach Yin
SP-6 (San yin jiao) Tonifies Stomach Yin and nourishes Fluids
SP-3 (Tai bai) Nourishes Fluids
Method: Tonification. No moxa  

Etiology/Pathology:

Usually irregular diet and eating habits: eating late at nights, eating too quickly, worrying while eating, rushing back to work to soon. These habits deplete Stomach Qi. Over time they damage Stomach Yin.

Stomach Fire (Phlegm Fire in Stomach)

Signs/Symptoms Due To
Burning Sensation/Pain in Epigastric Area Excess Heat in Stomach
Nausea
Vomiting soon after eating
Sour regurgitation		 Excess Heat interferes with Stomach Qi descending
Halitosis Excess Heat in Stomach
Strong Thirst for Cold Drinks
Constipation 		Stomach Fire burns fluids (less if Phlegm present)
Constant hunger
Gum swelling, pain & bleeding		 Excess Heat in Stomach.
Heat rises in Stomach channel amd causes Blood to extravasate
Tongue: Red, Thick Yellow and Dry Coat (sticky if Phlegm present, or yellow prickles inside midline crack)  
Pulse: Full, Rapid (slippery if Phlegm)  

Treatment Principles:

  • Clear Stomach Heat, Stimulate Stomach descending function.

Points:

Points Actions
ST-21 (Liang men) Clears Stomach Heat; makes Stomach Qi descend
REN-13 (Shang wan) Subdues rebellious Stomach Qi
ST-44 (Nei ting) Clears Stomach Heat
ST-45 (Li dui) Clears Stomach Heat, calms Mind
SP-6 (San yin jiao) Nourishes fluids & calms Mind
REN-12 (Zhong wan) Clears Stomach Heat
PER-6 (Nei guan) Subdues rebellious Stomach Qi calms Shen

Etiology/Pathology:

Excessive consumption of hot energy foods and smoking.
If Phlegm present, this can be caused by excessive consumption of hot and greasy foods
(e.g. deep fried foods).

Rebellious Stomach Qi

Signs/Symptoms Due To
Nausea, belching, hiccup, vomiting Stomach Qi fails to descend
Tongue: normal
Pulse: wiry or tight in Stomach position


Treatment Principles:

  • Subdue rebellious Qi, stimulate descending of Stomach Qi

Points:

Points Actions
REN-13 (Shang wan) When Stomach Qi fails to descend
REN-10 (Xia wan) When Stomach Qi fails to descend
PER-6 (Nei guan) Stimulate descending of Stomach Qi
SP-4 (Gongsun) Stimulate descending of Stomach Qi

Food Accumulation in the Stomach

Signs/Symptoms Due To
No Appetite,
Fullness/Distension of
Epigastrium) Relieved by Vomiting		 Food obstruction in Stomach prevents Stomach Qi from descending
Sour Regurgitation
Belching, Nausea & vomiting
Halitosis 		Fermented food in Stomach
Insomnia
obstructs Middle		 Prolonged retention of food in Stomach Burner and prevents Heart Qi from descending; disturbs Shen
Tongue: Thick Coating (white or yellow) Excess condition
Pulse: Full, slippery Heat and Food Retention

ANALYSIS: Interior Excess pattern - may be associated with either Cold or Heat (tongue coating either white or yellow)

Etiology/Pathology:

Overeating, eating too fast or while worrying.

Treatment Principles:

  • Remove retention of food, stimulate the descending of Stomach Qi
Points Actions
REN-13 (Shang wan) Subdues rebellious Stomach Qi
REN-10 (Xia wan) Stimulates descending of Stomach Qi
ST-21 (Liang men) Stimulates descending of Stomach
ST-44 (Nei ting) Resolves stagnant food and clears Heat
ST-45 (Li dui) Resolves stagnant food & calms mind in case of insomnia
SP-4 (Gong sun) Resolves stagnant food
PER-6 (Nei guan) Stimulates descending of Stomach Qi
Method: Reducing

Blood Stagnation in the Stomach

Signs/Symptoms Due To
Stabbing Pain in Epigastrium
(Intense, fixed pain,
worse with heat and pressure)		 Stasis of Blood
Excess condition
Stasis of Blood
Pain AFTER eating Excess condition
Vomiting of Dark Blood
Blood in the stools		 Stasis of Blood
Stomach related to Large Intestine
Tongue: Purple with purple spots (maybe just in center, Stomach position) Stasis of Blood
Pulse: Wiry or choppy  

Etiology/Pathology:

May be a chronic condition.
May be associated with Stomach Fire, Liver Qi invading Stomach or Retention of Food. May be caused by the above patterns or by long-standing Stagnation of Liver Qi from long term emotional problems involving anger and frustration.

Treatment Principles:

  • Removes stasis, stimulate the descending of Stomach Qi
Points Actions
REN-10 (Xia wan) Stimulates descending of Stomach Qi
ST21 (Liang men) Removes obstructions
ST34 (Liang qiu) XI Cleft point: moves Qi and Blood in channel
SP 10 (Xue hai) revives Blood, removes Stagnation
BL-17 (Ge shu) Removes Stasis, revives Blood (needle only)
BL-18 (Gan shu) Removes stagnation of Liver Blood
Method: Sedation. No moxa.

References Used

The TCM information presented here has been referenced from numerous sources; including teachers, practitioners, class notes from Five Branches University, the following books, as well as other sources. If you have benefited from this information, please consider supporting the authors and their works by purchasing the books below.

TCM Diagnosis Books/References

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General Diagnosis

Diagnosis Home Tongue Diagnosis in TCM 11 Treatment Methods in TCM

4 Pillars of Diagnosis

1. Looking 2. Listening 3. Asking 4. Pulse/Palpation The 29 Pulses Pulse Indications Table

Zang Fu Organ Patterns

Bladder Patterns Heart Patterns Kidney Patterns Large Intestine Patterns Liver Gallbladder Patterns Lung Patterns San Jiao Patterns Small Intestine Patterns Spleen Patterns Stomach Patterns Zang Zu Combined Patterns

Differentiation of Syndromes

By the 4 Levels By the 8 Principles (Ba Gong) By Qi, Blood, & Fluids By San Jiao Patterns By the Six Stages

TCM Gynecology

Amenorrhea Dysmenorrhea Early Menses Extended Menses Flooding & Trickling Menses Heavy Menses Irregular Menses Late Menses Scanty Menses Spotting Menses Associated Symptoms

General TCM

Symptoms & Diagnosis Yin & Yang Diagnosis Table