Epigastric pain is a type of abdominal pain that is located in the upper middle part of the abdomen, just below the ribcage. This area is known as the epigastric region, and it is bounded by the nipples, the umbilicus, and the lower ribs. Epigastric pain can radiate to other areas of the abdomen, such as the hypochondriac region (below the ribs) or the back. This type of pain may be accompanied by other symptoms, such as indigestion, bloating, nausea, vomiting, acid reflux, and dark or sticky stools.
In Chinese medicine, the epigastric region is influenced by several organ systems, including the stomach, spleen, liver, and the conception and penetrating vessels. Most epigastric pain is believed to be caused by disorders of the stomach and/or liver. It is important to differentiate epigastric pain from other types of abdominal pain, such as abdominal pain (pain in the lower part of the abdomen) and hypochondriac pain (pain in the lower ribs).
External cold is a common cause of acute epigastric pain. This can be introduced into the body through wind or by consuming cold foods, drinks, or medications. It directly impacts the yang ming Stomach and bypasses the surface, causing pain. The susceptibility to invasion by external cold is increased when there is a preexisting weakness in the middle burner qi and/or yang.
Internal cold is caused by a deficiency in the Spleen and/or Kidney yang, leading to a predominant yin cold in comparison to the warming, active yang. The severity of the pain will vary depending on the degree of deficiency and cold. When the deficiency is prevalent, the pain is mild, dull, and relieved by both warmth and pressure. However, when there is a predominance of yin cold, the pain can be severe and cramping, relieved by warmth but made worse by pressure.
External heat can invade the yang ming Stomach directly, or it can follow a viral, unresolved hot or cold exterior disorder. The heat or cold that transforms into heat as it penetrates deeper into the body pushes through the surface or shao yang level, lodging in the yang ming, causing acute pain and discomfort. There may also be an occasional residue of phlegm-heat in the stomach from a febrile illness.
Internal heat is generated by a variety of factors, such as consuming heating foods, chronic liver qi constraint, prolonged worry, anxiety, or a sudden shock that retards movement of heart qi. The resulting accumulation of qi creates a focus of pressure in the chest, leading to heart fire, which can influence and heat the stomach. Internal heat can also be caused by yin deficiency, as the stomach requires an egress of moisture for efficient operation and can easily be dried out and heated up by a systemic increase in heat from yin deficiency.
Consuming spoiled or unclean food can trigger sharp pain similar to an external cold or heat attack. The overindulgence in cold-natured or raw food weakens the strength of the yang energy in the Spleen and Stomach. Certain medications, such as those that are cold in nature, can also weaken the middle burner and harm the yang energy in the Spleen and Stomach. A lack of food intake due to strict dieting or prolonged starvation can severely damage the yang energy of the Spleen. On the other hand, excessive consumption of rich, heating, or sweet foods can lead to heat or damp-heat in the stomach and result in food stagnation, a common cause of epigastric pain. Heating foods like chilies, spices, alcohol, coffee, and chocolate can accumulate heat in the stomach, damaging its yin energy. The rising nature of heat can cause acid reflux, leading to esophageal erosion and pain. Sugar and dairy products can also produce dampness and phlegm.
Many herbal and pharmaceutical medications, whether legal or recreational, can contribute to epigastric pain. The most common include cold-natured drugs like nonsteroidal anti-inflammatory agents, purgative laxatives, and antibiotics. Excessive use of these drugs can damage the stomach lining. On the other hand, heating or dispersing drugs like corticosteroids, alcohol, and caffeine can harm the yin energy in the stomach.
Chronic stress, emotional tension, or suppressed anger can lead to constraint in the liver qi, causing spasm or tension in the muscles and restricting the circulation of qi and blood in the affected areas. Prolonged worry, anxiety, or shock can affect the movement of heart qi and generate heart fire, which can then be transmitted to the stomach. A sedentary lifestyle, poor diet, and excessive thinking can weaken the Spleen and Stomach qi, making it vulnerable to liver qi invasion and further damage.
Acute epigastric pain caused by blood stasis may occur after gastric trauma or surgery or develop gradually over time due to long-term stomach issues like liver qi constraint or yin deficiency. Regardless of the cause, if a pathology lasts long enough, it can lead to blood stasis or involve elements of blood stasis. Cold pathogens can cause blood stasis by constricting and slowing the circulation of blood vessels, while hot pathogens can increase the viscosity and stickiness of blood.