Hypochondriac+Pain

=Hypochondriac Pain / Xié Tòng= Hypochondriac Pain/Xié Tòng refers to unilateral or bilateral pain in the lateral costal regions or it for costal regions. A subjective symptom, hypochondriac painmay be accompanied by distention and pain in the epigastrium or by palpable masses in the infracostal regions. The degree of pain differs from case to case; chronic cases generally exhibit dull or indistinct pain, while acute cases or severe medical conditions can exhibit excruciating pain.

Relevant Biomedical Conditions
-Cholecystitis -Cholelithiasis -Hepatitis -Hepatosplenomegaly -Gallbladder cancer -Hepatic cancer -Acute pancreatitis -Chronic pancreatitis -Pleurisy -Intercostal neuralgia -Costochondritis -Costal trauma

Etiology and Pathology

 * Emotional Stress:** emotional stress, particularly anger, frustration, and depression, is one of the major factors contributing to hypochondriac pain because it interferes with the Liver’s ability to direct the free flow of Qi.
 * Blood Stasis**: Blood stasis may result from prolonged Liver Qi stagnation or from traumatic injury to the hypochondriac region, obstructing the Liver channel and causing pain.
 * External Damp-Heat or Improper Diet:** external Damp-Heat invasion may obstruct the flow of Liver Qi causing pain. Additionally, Dampness may arise from improper diet injuring the Spleen; this Dampness over time may generate Heat and become Damp-Heat. Either scenario can result in Damp-Heat in the Liver, causing Liver Qi stagnation with pain.
 * Chronic illness, excessive sexual activity:** these factors exhaust Yin/Essence and Blood, causing lack of nourishment to the Liver in its channels, resulting in pain.

Diagnosis
-Pain accompanied by aversion to cold and fever, nausea, vomiting, and jaundice -Usually related to Damp-Heat attacking the Liver and Gallbladder || -Gradual onset -No exterior symptoms ||
 * **Exterior Patterns** || **Interior Patterns** ||
 * -Acute

-Cold intolerance, absence of thirst -Pain relieved by warmth, aggravated by cold -Pulse is slow, deep, choppy, or wiry || -Strong constitutions -Red face, bitter taste in the mouth, thirst -Pain relieved by cold, aggravated by warmth -Pulse is rapid, abrupt, bounding, or wiry ||
 * **Cold Patterns** || **Heat Patterns** ||
 * -Weak constitutions

-Pain is distending and migratory || -Related to prolonged illness (unless due to trauma) -Pain is fixed, stabbing, and worse at night -Tongue may be purple or show ecchymoses ||
 * **Qi Stagnation** || **Blood Stasis** ||
 * - Acute onset

Stagnation of Liver Qi
[Chai Hu (Bupleurum Root) 6g, Bai Shao Yao (White Peony Root) 9g, Xiang Fu Zi (Cyperus Root) 6g, Chuan Xiong (Ligusticum Root) 6g, Chen Pi (Tangerine Peel) 6g, Zhi Ke (Bitter Orange) 6g, Zhi Gan Cao (Honey-fried Licorice Root) 3g]
 * Main Symptoms:** Distending pain in the costal region that worsens with emotional stress
 * Additional Symptoms**: Oppressive sensation in the chest, frequent sighing, bitter taste in the mouth, acid regurgitation, poor appetite, irritability, emotional depression, symptoms worse with emotional stress
 * Tongue:** Thin, white coating
 * Pulse:** Wiry
 * Treatment Principles:** Soothe the Liver, regulate Qi, relieve pain
 * Acupuncture Treatment:** Basic Points + BL18, GB40, LI4
 * Herbal Treatment:** Chai Hu Shu Gan Wan (Bupleurum Liver-Coursing Powder)

Stasis of Liver Blood
Herbal Treatment: Ge Xia Zhu Yu Tang (Infradiaphragmatic Stasis-Expelling Decoction) [Wu Ling Zhi (Flying Squirrel droppings) 9g, Dang Gui (Tangkuei) 9g, Tao Ren (Peach Kernel) 9g, Hong Hua (Carthamus Flower) 9g, Chuan Xiong (Ligusticum Root) 6g, Mu Dan Pi (Moutan Root Bark) 6g, Wu Yao (Lindera Root) 6g, Xiang Fu Zi (Cyperus Root) 4.5g, Chi Shao Yao (Red Peony Root) 6g, Zhi Ke (Bitter Orange) 4.5g, Yan Hu Suo (Corydalis Tuber) 3g, Gan Cao (Licorice Root) 9g]
 * Main Symptoms:** Stabbing pain in the costal region that intensifies at night and with pressure
 * Additional Symptoms:** possible mass under ribs
 * Tongue:** Dark, purplish, purple spots
 * Pulse:** Deep, wiry, choppy
 * Treatment Principles:** Rectify Qi, dispel blood stasis, relieve pain
 * Acupuncture Treatment:** Basic Points + BL17, BL18, LI4, SP6, GB25, SP21

Damp Heat in the Liver and Gallbladder
Herbal Treatment: Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) [Long Dan Cao (Gentian Root) 6g, Huang Qin (Scutellaria Root) 9g, Shan Zhi Zi (Gardenia Fruit) 9g, Ze Xie (Alisma Tuber) 12g, Mu Tong (Mutong Stem) 9g, Dang Gui (Tangkuei) 3g, Che Qian Zi (Plantago Seed) 9g, Sheng Di Huang (Rehmannia Root) 9g, Chai Hu (Bupleurum Root) 6g, Gan Cao (Licorice Root) 6g]
 * Main Symptoms:** Severe costal pain
 * Additional Symptoms:** Bitter taste in the mouth, oppression in the chest, loss of appetite, nausea, vomiting, jaundice in some cases, dark urine
 * Tongue:** Red
 * Pulse:** Rapid, slippery
 * Treatment Principles:** Clear heat, resolve damp, relieve pain
 * Acupuncture Treatment:** Basic Points + GB24, SP9, GV14, ST36, CV12

Vacuity of Liver Yin
Herbal Treatment: Yi Guan Jian (All-the-way-through Brew) [Bei Sha Shen (Glehnia Root) 9g, Mai Men Dong (Ophiopogon Tuber) 9g, Dang Gui (Tangkuei) 9g, Sheng Di Huang (Rehmannia Root) 30g, Gou Qi Zi (Lycium Berry) 12g, Chuan Lian Zi (Toosendan Fruit) 4.5g]
 * Main Symptoms:** Dull or indistinct costal pain which is aggravated by over exertion and alleviated by pressure
 * Additional Symptoms:** Dizziness and vertigo, irritability, dry mouth and throat, thirst, restlessness, hot sensation in the chest, blurred vision
 * Tongue:** Red, scanty coating
 * Pulse:** Thin, wiry, rapid
 * Treatment Principles:** Nourish Yin, soothe the Liver, relieve pain
 * Acupuncture Treatment:** LV14, BL18, BL23, KI3, SP10, SP6

Acupuncture and Moxibustion Treatment
//Excess Patterns// //Deficiency Patterns//
 * Basic Points:** LV14, TB6, GB34, LV3
 * Stagnation of Liver Qi:** BL18, GB40, LI4
 * Stasis of Liver Blood:** BL17, BL18, LI4, SP6, GB25, SP21
 * Damp Heat in the Liver & Gallbladder:** GB24, SP9, GV14, ST36, CV12
 * Vacuity of Liver Yin:** LV14, BL18, BL23, KI3, SP10, SP6

Clinical Tips
Clinically, patterns of Hypochondriac Pain/Xié Tòng are often complicated. Excess and deficiency patterns may mutually transform: chronic Qi stagnation may lead to Blood Stasis; Blood Stasis or Damp-Heat accumulation can block the flow of Qi; any of the preceding factors can generate Heat which may injure Yin; deficiency may lead to Qi stagnation.

Liver Qi stagnation is the predominant pathogenesis for Hypochondriac Pain/Xié Tòng and can progress to other patterns. Herbs that soothe the Liver and regulate Qi are added to selected formulas to enhance the therapeutic effect. However, herbs that regulate the Qi are acrid and drying and may injure Liver Yin. Therefore, acrid and neutral Qi regulators are recommended.