The treatment for qi-depression is to regulate qi and relieve depression. qi-depression is mostly caused by the loss of liver wood due to unrestrained emotions, liver qi offends the stomach, resulting in liver and stomach qi stagnation and gastric distension and pain, or even distension and pain even in the hypochondrium, distension even after eating, warmth and yawning qi often made, red tongue with thin coating, string pulse. It can be used as Xiang Sha San Xian Liver Dredging San, or Chai Hu Liver Dredging San combined with Jin Ling Zi San. If it is accompanied by bitterness and acidity in the mouth, burning heat in the epigastrium, and thin yellow tongue coating, it is Qi depression and fire, and it is advisable to use Si-wei-san and Yueju-pill; if it is distended in the epigastrium after eating, with dullness and loose stools, light red tongue, white coating, and slow pulse, it is liver depression and spleen deficiency, and it is advisable to use Yi-yao-san and Jiao-san-sen; if it is a drinker, with distension and pain in the epigastrium and hypochondrium after drinking, with red eyes, thin yellow tongue coating, and smooth pulse, it is advisable to use Si-wei-san and Huang-lian and Sha-ren; if it is a woman with distension and pain in the epigastrium and hypochondrium with depression and discomfort, it is advisable to use Chai-hu Shu-li-san. In the case of a woman with hypochondriac pain accompanied by depression, it is advisable to use Chai Hu Dredging Liver San and Bai He Wu Yao Tang.
[Experimental case] Huang, female, 35 years old. She came to the clinic on September 23 for stomach distension and pain for more than 1 month. She complained of gastric and epigastric distension and pain after mental stimulation more than 1 month ago, unable to eat hard food, and could only sip thin porridge for half a bowl at each meal, belching with acidity, light red tongue, thin greasy moss, and thin string pulse. Gastroscopy suggested superficial erosive gastritis of the gastric sinus; pathological examination suggested mild atypical hyperplasia of the gastric sinus. He was given Xiang Sha San Xian Liver Dredging San, using: Chai Hu, Bai Shao 10g, Citrus Aurantium 15g, Chen Pi 10g, Xiang Fu 10g, Chuan Xiong 6g, Shen Qu, Fried Malt 15g, Calcined Corrugated 10g, Sha Ren 10g, Mu Xiang 6g, Licorice 6g.
The agent is finished, gastric distension and pain, warmth are reduced, tongue coating turned thin white, pulse thin, still panacid, afraid to enter hard food. The above is guarded by adding 10g each of hawthorn and hen’s nest, 15g of vinegar yanhuosuo, 15g of white peony, and 15g of calcined corrugated seeds. 14 more doses, all the evidence disappeared, and can already enter a little meal. The symptoms disappeared and he was able to eat and drink a little. The prescription was changed to Prosperity San San plus Jiao San Xian to improve the situation.
[Remark] The patient suffered from distension and pain in the stomach and epigastrium after mental stimulation, and acid reflux, which is the evidence of liver and stomach gas depression. We use Chai Hu Dredging Liver San with Xiang Shen and Yan Hu Suo in vinegar to remove the depression of liver qi, then the distension and pain can be removed; Jiao San Xian, Sha Ren and Chicken Nei Jin can regulate the congestion of spleen and stomach, then the food intake can be increased; corrugated seeds can control acidity and Sha Ren can benefit the spleen, then the spleen and stomach can be strengthened and the acidity can be stopped. The combination of all these medicines can help to relieve liver depression, regulate qi and harmonize the stomach.
The treatment for blood depression is to activate the blood and move the depression. Blood depression is mostly caused by recurrent episodes of stomach pain, which leads to prolonged pain and stasis in the stomach ligament. The symptoms are vague pain or stabbing pain in the stomach and epigastrium, with fixed pain, which is worse at night, accompanied by distention and belching, loss of appetite, dark tongue or stasis on the edge of the tongue. Peach and Curcuma Siren San (Siren San plus Peach and Curcuma) or Lost Smile San can be used. If the symptoms of spleen qi weakness are associated with poor appetite and loose stools, tiredness and weakness, and a pale tongue, Tian Yu Chai Shao Liu Jun Zi Tang (Chai Shao Liu Jun Zi Tang with Tian San Qi and Yu Jin) should be used; if the symptoms of stomach yin deficiency are associated with burning in the epigastric region, hunger and lack of appetite, dry mouth and bowel movements, and little coating or flaking, Yi Zhi Tang should be used; if the stomach ligament is damaged, vomiting blood, black stools, yellow face with little food and lazy speech, Chai Shao Liu Jun Zi Tang with Bai He and Tian Qi should be used.
[Experimental case] He, male, 33 years old, was first diagnosed on September 2, 2000. He complained of recurrent epigastric pain for 6 years, aggravated for more than 10 years, now with fixed epigastric pain, loose stools, black stools, yellow face and body fatigue, light and dark tongue, white slightly greasy coating, thin pulse. He has a history of “gastric bleeding”. Stool occult blood test (++). I was given Chai Shao Liu Jun Zi Tang with added flavor. Medicine: Radix et Rhizoma Atractylodis Macrocephalae 10g, Atractylodes Macrocephalae 10g, Poria 15g, Radix et Rhizoma Chai Hu 10g, Radix et Rhizoma Paeoniae 20g, Pericarpium Citri Reticulatae 10g, Fructus Sempervis 6g, Radix et Rhizoma Bai 30g, Radix et Rhizoma Tinctoriae 15g (punching), Radix et Rhizoma Dioscorea 15g, Radix et Rhizoma Fragrans 10g, Radix et Rhizoma Glycyrrhiza Glabra 6g. 3 doses, epigastric pain, stool black are reduced; then into 4 doses, epigastric pain stopped, stool black removed, tongue coating turned white. Keeping the above in and out continued to enter the dose, the symptoms disappeared, during which the stool occult blood test was negative for 3 times. Changed the proposed Chai Shao Liu Jun Zi Tang plus lost laughing san after the good.
【Press release】This patient because of the stomach and epigastric long-term pain into the lobe, blood stasis stomach lobe damage, so see the symptoms of epigastric pain and black stool, less food and loose stool, yellow face and body tiredness, for qi with blood consumption. We use Six Gentlemen’s Tonic to strengthen the middle and strengthen the qi. The combination of these medicines is very effective.
The treatment for phlegm-depression is to resolve phlegm and open depression. Phlegm-depression is mostly due to the deficiency of earth and wood, resulting in the loss of harmony and descent of the stomach and the coalescence of water into phlegm, which is depressed in the middle jiao. The symptoms include distension and pain in the epigastric region, stuffiness in the chest and epigastric region, even vomiting, obstruction in the pharynx, white and greasy tongue coating, and slippery pulse. Sichichi Tang and Mustard Seed Wenzi Tang (Wenzi Tang with White Mustard Seed) can be used. If there is bitterness in the mouth with yellow coating and vomiting, the patient is suffering from phlegm and heat, so it is advisable to choose Xiao Shen Che Tang combined with Warm Gall Bladder Tang.
[Experimental case] Zhou, male, 16 years old, was first diagnosed on September 16, 2000. He had been suffering from gastric distension and vomiting for 4 months, the distension and vomiting was worse in the middle of the night, the vomit was sputum and white foam, and vomiting lasted 30 minutes each time he ate during the day. He was suffering from belching and acid reflux, with a yellow face and thin body, sunken eyes, a dark red tongue, greasy and flaky moss, and a fine pulse. He was diagnosed with duodenal bulb ulcer, gastric sinusitis, duodenal congestion, and reflux esophagitis on barium meal examination. He was given Xuanchao Qi Diaphragm San with additional flavor. Herbs: Salvia miltiorrhiza, Salvia miltiorrhiza 30g, Ulva lucidum 30g, Fructus saxifraga 10g, Malva lucidum 30g, Fructus sempervirens 20g, Hordeum vulgare 15g, Poria cocos 15g, Pestle and mortar bran 30g (cloth wrap), Peach kernel 10g, Radix et Rhizoma spinosae, Ochre 20g, Glycyrrhiza glabra 6g. After taking 7 doses, vomiting was reduced from 3-5 times a day to 1-2 times a day, and the distension and pain in the stomach was greatly reduced. The above formula was supplemented with 10g of persimmon, and 7 doses were taken. The vomiting was reduced to 2-3 times a week; 7 more doses were taken, and only one vomiting occurred during the dosing period, and the stomach pain was completely relieved; 14 more doses were taken, and no vomiting occurred during the dosing period, and the patient was able to eat noodles with occasional belching; 21 more doses were taken, and at the same time, coarse food was gradually introduced.
[Remark] The patient’s distension and pain in the stomach and epigastric region, vomiting and rebellion, and greasy tongue coating are signs of phlegm and qi stagnation; the sunken eyes and florid tongue coating are signs of vomiting and rebellion for a long period of time, injuring fluid and depleting liquid; the dark red tongue is a sign of phlegm and stasis. This is a case of choking with phlegm and stagnation and damage to yin and fluids. Therefore, Qi Di San should be given to resolve phlegm and remove stagnation, open up depression and nourish yin. Because the disease was long and severe, the original formula was not strong enough to lower rebellion, resolve stasis and nourish yin, so he added spineflower, ochre, fenugreek and persimmon, peach kernel to remove stasis and maitong to nourish yin, and adhered to the formula for several months, the stubborn evidence was finally cleared.
The treatment of fire-depression is due to the release of fire and the dispersion of depression. Fire-depression is mostly caused by the transformation of fire into gas and heat in the stomach and intestines. The symptoms are burning pain in the stomach and epigastrium, bitter belching and acidity, or noisy stomach, dry mouth and stool, red tongue with yellow coating. Zuo Jin Wan and Hepatic Decoction can be used as appropriate. For those with phlegm-heat, Huang Lian Wen Bile Tang can be used; for those with stool knots, Hou Pu San Wu Tang can be used; for those with liver fire offending the lung, heat forcing blood flow and vomiting blood and spitting blood, it is appropriate to use Di Di Xin Tang combined with Rhizoma Di Huang Tang to cool the blood and disperse depression to stop bleeding.
[Experimental case] Chen, male, 28 years old, was first diagnosed on November 5, 2000. He complained of recurrent episodes of burning pain in the stomach and epigastric region and vomiting of blood for more than 1 year. This time, he had an attack after drinking a lot of alcohol, and saw hot pain in the stomach and epigastric region, dry mouth, vomiting fresh blood 4-6 times every morning, knotted stool, red tongue with yellow coating and string pulse. Barium meal was diagnosed as duodenal bulbitis; X-ray chest radiograph showed thickened texture in both lungs. He was given Diarrhea Heart Soup with Rhizoma Dihuang Tang with Addition, using the following herbs: Radix et Rhizoma Dihuang 15g, Peony Peel, Radix Paeoniae Alba 20g, Radix Scutellariae Sinensis 20g, Radix Scutellariae Sinensis 10g, Radix et Rhizoma Huanglian 4g, Radix et Rhizoma Rhizoma Rhizoma 5g, Radix Glycyrrhiza Glabra 6g, Radix et Rhizoma Tian Qi Powder 20g (for dosing). After taking 3 doses, the pain in the epigastrium was relieved and the vomiting of blood was greatly reduced; after 7 more doses, the pain in the epigastrium was relieved, the vomiting of blood was stopped, the stool was released, the tongue coating turned thin and the pulse was fine and slightly counted. After 3 months, he complained of hypochondriac pain and vomiting of blood because he came for treatment of cold.
[Remark] This patient’s burning pain in the stomach and epigastric region and vomiting of blood are caused by liver fire offending the lung and heat forcing blood to flow, thus she has burning pain in the stomach and epigastric region, vomiting blood in the mouth, knotted stool, red tongue with yellow fur and string pulse. It is advisable to cool the blood and disperse the depression, and to relieve the fire to stop the bleeding. The bitter cold of Laxin Tang is used to break down the fire, and Rhizoma Dihuang Tang is used to cool the Blood and disperse it, and Tian Qi Powder is added to stop the bleeding. Heat to stop the blood, it is appropriate to nourish the stomach yin, so use the benefit of the stomach soup after nourishing the stomach to prevent recurrence.
The treatment for food depression is to eliminate the food and reach the depression. Food depression is mostly caused by poor diet and gastric congestion. The symptoms include gastric and epigastric fullness and pain, feeling full and distended when eating, warmth and food reduction, or belching and swallowing acid, unpleasant stools, thick tongue coating and slippery pulse. The treatment can be used as appropriate, such as Eating and Stress Soup (Yueju Wan with Xiang Sha Ping Gastric San plus flavor), Baohe Wan, Shenzhu San (Ping Gastric San plus Sharen and Huo Xiang), Han Xia Di Xin Tang, and Hovenia Anti-Plaque Wan. After the stagnation has subsided, it is advisable to use Xiang Sha Liu Jun Zi Tang with Jiao San Xian to strengthen the spleen and help it to dissolve.
[Experimental case] Liu, female, 28 years old. She came to the clinic on January 6, 2001 due to vague pain in the epigastric distension after eating discomfort for more than 40 days. Now the stomach is full and distended, especially after eating, sometimes with vague pain and belching, with a light red tongue, thick white fur, and a thin smooth pulse. Gastroscopy diagnosed superficial (bulging) ‘erosive sinusitis. He was given Shen Shu San San combined with Jiao San Xian: Atractylodes 6g, Hou Pu, Chen Pi 10g, Sha Ren 10g, Mu Xiang 6g, Fa Han Xia 10g, Shen Qu 10g, Fried Hawthorn 10g, Fried Wheat Bud 15g, Chicken Nei Jin 10g, Xiang Shen 10g, Citrus aurantium 10g, Glycyrrhiza glabra. 7 doses were given and the vague pain in the epigastric distension disappeared, the tongue coating turned thin and white, the pulse was thin and slow, but still the stomach and epigastric discomfort after eating was slight, the stomach was mixed with miso, and the food was poor. The formula was changed to Six Junzi Tang with Jiao Sanxian and Gardenia Hou Zhu I Tang. The medicine used: 10g of yu zhu, 10g of fried atractylodes, 15g of poria, 15g of Chen Pi, 15g of Fa Xianxia, 10g of fried gardenia, 10g of Hou Pu, 10g of Shen Qu, 15g of fried hawthorn, 15g of fried malt bud, 10g of chicken naijin, 6g of licorice. 7 doses were taken, all symptoms disappeared, and food intake also increased; continued with the second diagnosis formula to remove gardenia, Hou Pu to improve.
[Remark] The patient’s stomach was full and distended, especially after eating, with a thick coating and slippery pulse, so the evidence belongs to food depression. With Shen Shu San San, Jiao San Xian and Chicken Nei Jin to move Qi and eliminate food, plus Fa Han Xia to lower the rebellion and stop belching, and Xiang Shen and Citrus aurantium to regulate Qi and reach depression, the Qi flow is unblocked and the stagnation is dispersed, so the pain of gastric distension is removed immediately.
Injury to the spleen and stomach due to uncontrolled diet, so use Six Junzi Tang and Jiao Sanxian to nourish the spleen and stomach to help digestion.
The treatment for dampness is to benefit the dampness and promote depression. The evidence of dampness is mostly due to cold and dampness or dampness and warmth, and the dampness obstructs the middle jiao and injures the stomach membrane. Symptoms include distention and pain in the chest, abdomen and abdomen, greasy mouth and dullness, heavy body and body fatigue, unpleasant stools, greasy coating and moist pulse. The treatment is to promote dampness and promote depression. If the dampness is in the middle and upper jiao, use San Ren Tang; if it is in the middle and lower jiao, choose Stomach Ling Tang combined with Si Wei San; if the dampness is diffuse in the middle jiao, use Huo Pu Xia Ling Tang; if the dampness is cold in the surface and see vomiting and diarrhea, use Huo Xiang Zheng Qi San. Dampness can be drained and dispersed, but left with spleen deficiency can not be transported, it is appropriate to use the seven flavors of Atractylodes macrocephala to strengthen the spleen and transport dampness.
[Experimental case] Zhang, female, 15 years old. She came to the clinic on March 17 due to distension and vague pain in the chest and epigastric region for more than 10 days. The symptoms are: distension and discomfort, vague pain at times, chest and hypochondrium, light and sticky, heavy body, tiredness, dullness, loose stools, white and greasy tongue coating, moistened pulse with San Ren Tang with flavor, using: 10g of almond, 20g of coix seed, 10g of cardamom seed, 10g of Fah Xian Xia, 6g of white Tong Cao, 15g of slippery stone, 6g of wood incense, patchouli, 10g of Shen Qu. 7 doses were taken, and all symptoms basically disappeared, except for feeling stuffy and less food, loose stools; changed to The patient was treated with Seven Flavors of Atractylodes with Hou Pu and Sha Ren to improve the situation.
[Remark] The patient was suffering from vague pain in the stomach and epigastrium with distension and chest congestion, greasy mouth and dullness, heavy body and body fatigue, white fur and moist pulse, so the evidence belongs to dampness in the upper and middle jiao. Therefore, San Ren Tang was given as a treatment. In the formula, patchouli and bitter almond are bitter and pungent to lightly open lung qi, cardamom kernel is aromatic to move qi and dissolve dampness, coix seed, white tongcao and slippery stone are lightly permeable to benefit dampness, thick park, fenghuang and muxiang move qi to disperse fullness, remove dampness and eliminate lumpiness, and Shen Qu strengthens the spleen to help dissolve. The combined use of all the drugs, the Xuan Shang smooth the middle and infiltrate the lower, strengthen the spleen to help the transformation, dampness and depression are naturally resolved.
Xiong’s treatment of gastric and epigastric pain from the six depressions is not only detailed in identifying the evidence, flexible and accurate in dispensing prescriptions and drugs, but also based on the viewpoint of “all diseases are born of qi” in Huangdi Neijing, he believes that gastric pain is a disease of six depressions, with qi depression being the first. Therefore, in treating blood, phlegm, fire, food and dampness, Xiong chose to add qi-regulating herbs, such as Chen Pi, Mu Xiang, Jin Ling Zi San and Si Wei San. In addition, in the course of treatment, he often gives the patient guiding advice according to the cause of the disease, such as in the case of food depression, advise the patient not to be hungry and full, and in the case of qi depression, advise the patient not to think and rage too much, and advise the patient to eat and drink in a disciplined manner and to live and work at the same time, so that the symptoms and the essence of the disease can be obtained together”, then the disease can be easily cured.
Stomach pain deficiency evidence must be examined yin and yang deficiency evidence stomach pain is characterized by long duration, slow onset, recurrent attacks, painful situation and happy to press, mostly due to weakness of the spleen and stomach, or tiredness and injury to the spleen, or long-standing illness, damage to stomach yin, or improper use of drugs, damage to the spleen and stomach over time. The main treatment is to nourish the deficiency. Because of the deficiency of the spleen and stomach in the earth, the transport and transformation of the spleen and stomach is out of order, and can often be mixed with congestion, forming a deficiency in the real evidence, and should be treated both deficiency and real.
The treatment for Yin deficiency is to nourish Yin and benefit the stomach Yin deficiency type is mostly seen in chronic atrophic gastritis. The symptoms are vague burning pain in the stomach and epigastrium, more hunger and less food, dry mouth and throat, dry stool, red tongue with little coating and lack of fluid, and thin pulse. The treatment is to sweeten and cool the stomach, nourish Yin and generate fluid. The formula is based on Yigang Tang with Paeonia lactiflora and Glycyrrhiza glabra, plus and minus. If the stomach is less acidic, add umeboshi and hawthorn to sour and sweeten the fluid; if the pain is obvious, combine with jinlingzi san to move qi and relieve pain; if constipated, add xuan ginseng to increase water and move the boat; if the gas in the epigastrium is stagnant, add a little Chenpi and sandy nuts to prevent stagnation of qi.
A woman, 42 years old, was first diagnosed on February 4, 1991. She has been suffering from vague pain in the stomach and epigastric region for more than 4 years. She complained of vague pain in the stomach and epigastric region, easy hunger but no desire to eat, dry throat and mouth, gradually losing weight, red tongue without moss, and thin pulse. He had taken many Chinese and Western drugs, but the treatment was not effective and was suspected to be terminal. Two gastroscopies were performed, suggesting chronic atrophic gastritis. He was given Yigang Tang with Paeoniae and Glycyrrhiza glabra soup with flavour. Herbs: Radix Salviae Miltiorrhiza 30g, Radix Madecassus 30g, Rhizoma Polygonati 15g, Radix Rehmanniae 15g, Radix Paeoniae 20g, Dendrobium 12g, Neem 10g, Radix Glycyrrhiza Uralensis. After 15 doses of medicine, the pain was gradually relieved and a little thin moss was seen on the tongue; after keeping the prescription for another month, the tongue moss gradually increased, the tongue became light red, the diet increased significantly, the stomach pain and hunger symptoms were all removed, and the body constitution was strengthened.
[Remark] This case is a case of stomach pain due to deficiency of stomach yin. Therefore, the main treatment is to nourish the stomach with yin and nourish the stomach by combining Yigong Tang with Paeoniae and Licorice Tang, and to relieve pain with neem.
Yang deficiency should be treated by warming the middle and stomach. Yang deficiency type is mostly seen in people who have been ill for a long time and have a weak body in old age. The symptoms include unrelenting stomach pain, vague pain, warmth and pressure, pain when hungry, slowing down after eating, or vomiting clear water, loose stools, fatigue, less color, unheated hands and feet, pale tongue, white moss and weak pulse. The treatment is to warm the middle and strengthen the spleen, harmonize the stomach and relieve pain. The formula is based on Xiao Jian Zhong Tang and Rei Zhong Tang plus or minus. In case of nausea and vomiting, Xiao Hanxia Tang can be used in combination with Xiang Sha Liu Jun Zi Tang with dry ginger to strengthen the spleen and warm the middle of the stomach to relieve pain.
A man, 50 years old, was first diagnosed on May 3, 2000. He had been taking western drugs such as ranitidine and bismuth aluminate tablets for 10 years, but still had recurrent attacks. Now he has vague pain and fullness in the stomach and epigastric region, loose stools, fatigue, and a pale red tongue with thin white fur and thin pulse. Gastroscopy revealed chronic superficial gastritis and duodenal bulb ulcer. Xiang Sha Liu Jun Zi Tang with dry ginger was given for internal use. Herbs: Radix Codonopsis Pilosulae 15g, Atractylodes Macrocephala 10g, Poria 15g, Pericarpium Citri Reticulatae 10g, Fructus Sempervis 10g, Mucuna Pruriens 6g, Radix Ginger 6g, Ocimum sanctum 10g, Radix Glycyrrhiza Uralensis 6g. 15 doses, symptoms greatly reduced, diet improved, continued with Xiang Sha Liu Jun Zi Tang for 1 month, symptoms disappeared.
This case was caused by Yang deficiency in the spleen and stomach. Yang deficiency is a further development of Qi deficiency, therefore, Xiang Sha Liu Jun Zi Tang was used to strengthen the spleen and benefit Qi, and dry ginger and Wu Yao were added to warm the middle and disperse cold.