1. STOMACHACHE Lee Chong Leng 1

2. STOMACHACHE

4. CONTENTS 1)Introduction5 2)Clinical Manifestations6 - 10 3)Essentials for Diagnosis11 4)Treatment with Tuina Therapy12 - 41 5)Cautions4242 4

5. STOMACHACHE  Pain in the epigastric region  Similar to gastrospasm, chronic and acute gastritis, gastric and duodenal ulcer, gastrointestinal neurosis and other functional disorders of the upper digestive tract in modern medicine 5

6. CLINICAL MANIFESTATIONS 1.Stagnation of pathogenic factors (1) Due to cold attack (2) Retention of food 2.Zangfu-organ disorder (1) Invasion of liver Qi into stomach (2) Deficiency cold of spleen & stomach 6

7. STAGNATION OF PATHOGENIC FACTORS (1) Due to cold attack  Sudden onset of vague or colic pain to be alleviated with warmth and worsened with cold  No thirst or preference for warm water, light and white tongue with coating, taut and tense pulse 7

8. STAGNATION OF PATHOGENIC FACTORS (2) Retention of food  Distention or even pain in the epigastric region, accompanied by belching, eructation with fetid odor, acid regurgitation or vomiting of indigested food  Alleviation after vomiting and breaking wind, anorexia, unsmooth defecation, yellowish or whitish greasy coating and slippery pulse 8

9. ZANGFU-ORGAN DISORDER (1) Invasion of liver Qi into stomach  Fullness in the stomach distending pain involving the hypochondrium  Frequent belching, unsmooth defecation, depression, or pain due to emotional changes, thin whitish tongue coating and taut pulse 9

10. ZANGFU-ORGAN DISORDER (2)Deficiency cold of spleen and stomach  Vague stomachache, profuse clear saliva, preference for warmth and pressure, alleviation with warmth and pressure, aggravation on empty stomach, improvement of pain after taking food  Poor appetite, lassitude, or even cold limbs, loose and thin stool, pale tongue, thin and whitish coating, weak soft pulse or slow pulse 10

11. ESSENTIALS FOR DIAGNOSIS 1. Often accompanied by oppression, distension, eructation and gastric upset 2. Often associated with emotion changes improper diet, overstrain, and cold attack 3. Through barium meal X-ray examination of upper digestive system and gastric endoscope, gastric duodenal mucositis and ulcer can be revealed 4. If stool and vomitus test is positive, it suggests gastrointestinal hemorrhage 5. B ultrasonic examination, liver function and gallbladder tract X-ray examination are helpful for differential diagnosis 11

12. TREATMENT WITH TUINA THERAPY Principle: Regulating Qi and stopping pain 12

13. TREATMENT WITH TUINA THERAPY Acupoints and location: Zhongwan (CV 12), Tianshu (ST 25), Qihai (CV 6),Zusanli (ST 36), Geshu (BL 17), Ganshu (BL 18), Pishu (BL 20), Weishu (BL 21),Sanjiaoshu (BL 22), Jianjing (GB 21), Shousanli (LI 10), Neiguan (PC 6), Hegu (LI 4) and hypochondriac region 13

14. TREATMENT WITH TUINA THERAPY Operation 1: (1)Patient - lateral recumbent position (2)Gently use one-finger pushing and rubbing manipulations to rub the epigastric region to direct warmth into the abdomen (3)Rub Zhongwan (CV 12), Qihai (CV 6), Tianshu (ST 25) and Zusanli (ST 36) for about 5 minutes 14

15. 15 Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

16. 16 Zusanli ( 足三里 )

17. TREATMENT WITH TUINA THERAPY Operation 2: (1)Patient - prone position (2)Press both sides of spine along the bladder meridian to Sanjiaoshu (BL 22) for 4-5 times (3)Alternatively press Geshu (BL 17), Ganshu (BL 18), Pishu (BL 20), Weishu (BL 21) and Sanjiaoshu (BL 22) for about 5 minutes 17

18. 18 Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

19. 19 Weishu ( 胃俞 )

20. 20 Sanjiaoshu ( 三焦俞 )

21. TREATMENT WITH TUINA THERAPY Operation 3: (1)Patient - sitting position (2)Grasp and hold Jianjing (GB 21) from the arm down to the elbow, (3)Press harder on Shousanli (LI 10), Neiguan (PC 6) and Hegu (LI 4) (4)Rub the shoulder and arm to smooth the meridians, wipe the rib-sides upwards and downwards for 5-6 minutes 21

22. 22 Jianjing ( 肩井 )

23. 23 Shousanli ( 手三里 )

24. 24 Neiguan ( 内关 )

25. 25 Hegu ( 合谷 )

26. MANIPULATIONS ACCORDING TO SYNDROME DIFFERENTIATION 26

27. (1) COLD ATTACK  Press strongly Pishu (BL 20), Weishu (BL 21) for about 2 minutes  Rub the left part of the back (T7 – T12) until it becomes warm 27

28. (2) RETENTION OF FOOD  Rub clockwise the abdomen, especially on Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST36) for 5 minutes  Rub Weishu (BL 21), Dachangshu (BL 25), Baliao for 5 minutes 28

29. 29 Shenshu ( 肾俞 ) ， Dachangshu ( 大肠俞 )

30. 30 Baliao ( 八髎 )

31. (3) INVASION OF LIVER QI  Press gently Tiantu (CV 22) down to Zhongwan (CV12), specially Danzhong (CV 17)  Rub and press Zhangmen (LR 13), and Qimen (LR 14)  Press strongly Ganshu (BL 18), Danshu (BL 19), Geshu (BL 17) 31

32. 32 Tiantu ( 天突 )

33. 33 Shanzhong ( 膻中 )

34. 34 Qimen ( 期门 ) ， Zhangmen ( 章门 )

35. 35 Danshu ( 胆俞 )

36. 36 Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

37. (4) DEFICIENCY COLD IN SPLEEN AND STOMACH  Rub gently Qihai (CV 6), Guanyuan (CV 4) and Zusanli (ST 36) for 2 minutes each  Rub vertically the governor vessel on the back  Rub horizontally the left side of the back (T7 – T12), Shenshu (BL 23) and Mingmen (GV) until it is warm in the local area. 37

38. 38 Guanyuan ( 关元 )

39. 39 Shenshu ( 肾俞 ) ， Dachangshu ( 大肠俞 )

40. 40 Mingmen ( 命门 )

41. (5) SEVERE STOMACHACHE  Press strongly Pishu (BL 20) and Weishu (BL 21) for 2 minutes continuously  After the pain is relieved, it can be treated according to syndrome differentiation 41

42. CAUTIONS 1. Tuina therapy is not available for those with gastrointestinal ulceration and hemorrhage 2. Have a regular daily life and pay more attention to mental state and diet 3. Better to take food that is easy to digest, avoid alcohol and pungent food 4. For chronic stomachache, take liquid or semi-liquid diet for a certain period 42

43. 43 THANK YOU