Acupuncture for Epigastric Pain - Treatment Protocols

Acu Protocols

Below you will find some of the more common tcm diagnoses and acupuncture treatment protocols for epigastric pain. There are many ways to treat this condition with Eastern Medicine and our presentation is only one of many possible options.

• Etiology & Pathology:
  • Excess Etiologies:
    • Acute invasion of Cold in the ST - norwalk virus, vomiting, nausea.
    • Chronic retention of fluids due to Cold.
    • Retention of phlegm-damp, usually involving SP - epigastric pain.
    • Retention of food - either in ST or intestines, usually from overeating.
    • LV Qi overacting on the ST - anger a/or frustration.
    • Heat in the ST.
    • Phlegm/Heat in the ST.
    • Blood Stagnation - severe stabbing pain.
  • Deficiency Etiologies:
    • ST/SP Qi Deficiency
    • ST Yin Deficiency
  • Differentiation:
    • Acute invasion of Cold in the ST
      • Signs & Symptoms:
        • Sudden pain, usually severe, contracting, spasmodic, some distention that is worse with pressure, nausea, vomiting, feel chilled, pain is relieved with the application of heat.
        • Tongue: Moist white coat
        • Pulse: Tight
      • Treatment Principle:
        • Disperse the Cold.
        • Warm the ST (heat lamp a/or moxa).
        • Regulate the ST - move and descend the ST Qi.
      • Treatment Points:
        • Valaskatgis Point Selection:
        • CV 12 - ST Mu
        • ST 36 - with CV 12 - regulate the ST Qi
        • PC 6 - nausea, descend ST Qi, vomiting
        • SP 4 - epigastric pain and lower abdominal pain - Yin Wei Chong Mai w/PC 6
        • Maciocia Point Selection:
        • ST 21 - reinforce CV 12, moves excess in the middle jiao
        • ST 34 - Xi Cleft, severe pain.
        • SP 4 - epigastric pain and lower abdominal pain
        • CV 13 - cold in the ST, reinforces CV 12 to aid the descending of ST Qi, especially useful w/nausea a/or vomiting
    • Retention of Fluids Due to Cold
      • Signs & Symptoms:
        • Chronic condition, with signs of both excess & deficiency, usually from excessive consumption of cold a/or raw foods.
        • Nausea, intermittent pain relieved by the application of heat, borborygmus.
        • Patient has a lack of thirst and appetite.
        • Tongue: Greasy, white coat
        • Pulse: Tight, deep
      • Treatment Principle:
        • Disperse Cold.
        • Warm & Strengthen the ST.
      • Treatment Points:
        • Valaskatgis Point Selection:
        • UB 21 - ST Shu
        • CV 12 - ST Mu
        • CV 6 - tonify Qi in general, particularly SP
        • ST 36 - regulate ST function
        • ST 20 - regulate ST function, borborygmus (may not be applicable)
        • Maciocia Point Selection:
        • UB 20 & UB 21 - SP Shu & ST Shu respectively - tonify ST/SP
        • CV 12 - ST Mu
        • ST 36 - regulate ST Qi
        • CV 10 - direct food and fluids downward
        • CV 13 - rebellious Qi (may not be applicable) or CV 9 - abdominal water retention (may not be applicable)
    • Retention of Phlegm-Damp
      • Signs & Symptoms:
        • May arise from long-term SP Qi Deficiency a/or excessive consumption of cold/damp foods/environments.
        • Abdominal distention, fullness, nausea, poor appetite, possibly frothy vomiting, possibly loose stools, some thirst w/no desire to drink.
        • Dampness in the chest may also block the clear yang from rising to the head leading to symptoms of heavy headedness, fuzzy head, sinusitis.
        • Tongue: Pale w/white greasy coat
        • Pulse: Thin, empty or slippery
      • Treatment Principle:
        • Reinforce Qi
        • Disperse Phlegm/Damp
      • Treatment Points:
        • CV 14 - transform phlegm, alleviate nausea.
        • CV 12 - w/CV 14 to regulate Qi in the epigastric area
        • CV 6 - Strengthen Qi generally, especially SP Qi
        • UB 20 & UB 21 - SP Shu & ST Shu respectively - tonify ST/SP
        • SP 3 (host/yuan source) to tonify SP w/ST 40 (guest/luo connecting) to resolve phlegm
    • Retention of Food
      • Signs & Symptoms:
        • May effect either the ST or the intestines.
        • Can be acute or chronic, depending on dietary habits.
        • Usually from overconsumption of food, overeating when tired a/or contaminated food.
        • Persistient pain that is constant or colic-like, worse with pressure and eating, fullness and discomfort in the epigastric area, nausea, foul belching, vomiting of undigested food.
        • LI symptoms - constipation a/or flatulence.
        • No desire to eat.
        • Tongue: Thick, greasy coat
        • Pulse: Full, slippery (which can indicate, phlegm, damp a/or pregnancy as well as stagnation of food)
      • Treatment Principle:
        • Resolve food stagnation.
        • Promote digestion.
      • Treatment Points:
        • Valaskatgis Point Selection:
        • CV 10 - direct Qi downwards
        • LV 13 - SP Mu, moves stuck food in the epigastric area
        • ST 36 - regulates ST Qi, tonifies Qi, can disperse excess above, descends the ST Qi
        • ST 44 - cools heat in the ST and conducts Qi downwards
        • LI 10 - arm equivalent of ST 36
        • Maciocia Point Selection:
        • CV 13 - useful w/vomiting a/or nausea
        • CV 10 - directs Qi downwards
        • ST 21 - excesses in the epigastric area, reinforces Cv 12
        • ST 20
        • ST 44
        • ST 45 - ST fire, possibly effecting the mind (may not be necessary)
        • ST 25 - LI Mu, epigastric pain, constipation
        • SP 4 & PC 6 - Yin Wei Chong Mai, move excesses in the epigastric area
    • LV Qi Overacting on the ST
      • Signs & Symptoms:
        • May arise from excessive anger or frustration a/or stress.
        • Intermittent pain directly related to emotional disturbances, pain is worse with pressure, fullness, distention of the epigastrium a/or hypochondrium, nausea, belching, heartburn, flatulence, acid regurgitation, variable appetite.
        • LV related signs - headache, plum pit throat, dysmenorrhea, depression, alternating constipation and diarrhea.
        • The LV can overact on the ST, SP or both.
        • Tongue: Normal or purplish
        • Pulse: Wiry
      • Treatment Principle:
        • Soothe the LV.
        • Harmonize the ST.
        • Promote digestion.
      • Treatment Points:
        • Valaskatgis Point Selection:
        • LV 3 - soothe LV Qi
        • LV 14 - LV Mu
        • ST 36 - harmonize ST
        • CV 12 - ST Mu, harmonize ST
        • PC 6 - nausea, benefits emotions
        • Maciocia Point Selection:
        • LV 14 - LV Mu
        • GB 34 - intead of LV 3, could use both especially with a strong LV component
        • ST 36 - harmonize ST
        • CV 12 - ST Mu, harmonize ST
        • PC 6 - nausea, benefits emotions
        • ST 21 - reinforce CV 12
        • Additional Points:
        • GB 40 instead of GB 34 - benefits acid regurgitation especially when related to LV imbalances.
        • Consider the Yin Wei Chong Mai - SP 4 & PC 6 instead of LV 14 or LV 3 if pain is more in the center
    • Heat in the Stomach
      • Signs & Symptoms:
        • Results from the excessive consumption of hot energy or spicy foods.
        • Pain is stong and colicky, worse with presure, burning sensation in the epigastric area, fullness and tightnes of the abdomen, thirst, voracious appetite, red face, constipation, dark urine.
        • With ST Heat - pain limited to the epigastric area.
        • With ST Fire - energy rises up & effects the face - mouth sores, bleeding gums, etc.
        • Tongue: Red, yellow coat
        • Pulse: Full, rapid or wiry, rapid (if LV is involved)
      • Treatment Principle:
        • Clear ST Heat.
        • Harmonize ST.
        • Promote Digestion.
        • Move Intestines (if necessary).
        • Clear LV Heat (if necessary).
      • Treatment Points:
        • Clear ST Heat with either ST 44 - ST water point or ST 43 - heaviness of the body, facial swelling.
        • CV 12 - ST Mu
        • ST 36 - harmonize ST
        • PC 6 - if nausea a/or vomiting are present
        • ST 45 - bleed for ST fire effecting the face - bleeding gums, mouth sores, etc.
        • TH 6 - clear heat in the intestines
        • GB 34 - w/TH 6 to move the intestines
        • LV 2 - clear LV heat
        • GB 34 - clear LV/GB heat
    • Phlegm/Heat in the ST
      • Signs & Symptoms:
        • Similar to Retention of Phlegm Damp but w/heat signs.
        • From over consumption of greasy foods a/or alcohol or by smoking.
        • Distention, fullness, nausea, vomiting is possible, diarrhea with mucus/blood along with a strong odor, burning anus.
        • ST signs - epigastric pain, signs of heaviness, bad breath.
        • Tongue: Red, thick yellow greasy coat
        • Pulse: Slippery, possibly rapid
      • Treatment Principle:
        • Resolve the Phlegm.
        • Clear Heat.
        • Harmonize the ST.
        • Promote Digestion.
      • Treatment Points:
        • Valaskatgis Point Selection:
        • ST 40 - resolve phlegm
        • Yin Wei Chong Mai - SP 4 & PC 6 - nausea, vomiting, influence Chong Mai
        • ST 44 - clear ST heat
        • ST 21 - disperse ST excess
        • CV 12 - harmonize ST
        • Maciocia Point Selection for Phlegm Fire differentiation:
        • Stronger emotional components - mania, insomnia, etc. along with ST phlegm/heat effecting the head - bleeding gums, mouth ulcers, etc.
        • CV 12 - ST Mu
        • ST 21 - disperse ST excess, reinforce CV 12
        • CV 13 - direct ST Qi downwards, vomiting
        • PC 5 - resolve phlegm effecting mind
        • ST 40 - resolve phlegm in ST
        • PC 7 - resolve phlegm, clear mind
        • ST 44 - clear ST Fire
        • GB 13 - clear the mind
    • Blood Stagnation in the ST
      • Signs & Symptoms:
        • May be a further development of Phlegm/Heat in the ST, ST cancer is another possiblity.
        • Strong pain that is fixed a/or stabbing, pain is worse with pressure and eating, palpable masses are possible, vomiting of a coffee like substance (indicates blood in the ST that has congealed and dried), black stools possible, dark face, purple lips.
        • Tongue: Purplish w/purple in the ST area
        • Pulse: Wiry, choppy (blood stagnation)
      • Treatment Principle:
        • Move the Blood & Qi
        • Relieve the pain
      • Treatment Points:
        • Valaskatgis Point Selection:
        • UB 17 w/SP 6 - together help to move Blood anywhere in the body
        • Pigun (extra point 3-1/2 cun lateral to L1) - useful for masses
        • Yin Wei Chong Mai - SP 4 & PC 6 - influence the chong mai, sea of Blood
        • ST 21 - clear ST excess
        • LV 13 - SP Mu, disperse congealed Blood a/or massses in the abdomen
        • UB 18 - LV Shu, move Qi and Blood
        • Maciocia Point Selection:
        • CV 10 - conduct Qi downwards
        • ST 22 - descend ST Qi, disperse accumulations in the epigastrium
        • ST 34 - Xi Cleft, acute ST pain, more for breast pain but useful in this situation
        • SP 10 - Sea of Blood
        • UB 17 & UB 18 - move Qi and Blood in the area
    • ST/SP Qi Deficiency
      • Signs & Symptoms:
        • Due to overconsumption of cold/raw food, poor dietary habits (eating too late, too fast, too much, etc.), excessive mental work a/or a weak constiution.
        • Pain is dull in nature, pain is better with the application of pressure a/or heat, nausea, no appetite, fatique after eating.
        • ST Symptoms - dull epigastric pain.
        • SP Symptoms - lower abdominal distention, loose stools.
        • Tongue: Pale, swollen w/teeth marks
        • Pulse: Empty
      • Treatment Principle:
        • Tonify ST/SP.
        • Tonify Qi.
      • Treatment Points:
        • UB 20 - SP Shu
        • UB 21 - ST Shu
        • ST 36 - Tonify Qi, ST/SP
        • SP 6 - Tonify ST/SP
        • CV 6 - Tonify Qi
        • CV 12 - ST Mu
    • ST Yin Deficiency
      • Signs & Symptoms:
        • Caused by poor dietary habits (eating too much, too fast, too late, w/strong emotions), overwork, after a fever (depletes Yin) or prolonged illness w/vomiting a/or diarrhea.
        • Usually leads to KD Yin Deficiency.
        • Continuous dull pain, pain is worse after eating, difficulty swallowing, no appetite, dry heaves, belching, dry mouth, small masses possible in the ST, constipation, emaciation.
        • Yin Deficiency signs - malar flush, heat in the five hearts, night sweats.
        • Tongue: Dry, red or Mirrored (shiny, peeled across whole tongue, very severe), peeled (more likely) in ST area - or coating may not be rooted on the tongue.
        • Pulse: Thin, rapid
      • Treatment Principle:
        • Tonify ST Yin & Qi.
        • Promote Digestion.
      • Treatment Points:
        • CV 12 - ST Mu
        • ST 36 - tonify ST/SP
        • SP 6 - tonify ST/SP, origin of fluids
        • PC 6 - nausea
        • KD 3 or KD 6 - tonify KD Yin
        • CV 4 - nourish KD Yin which effects the ST Yin
        • CV 6 - tonify Qi
        • ST 44 - ST Water Point, clear empty heat

The information on our site is drawn from our own lecture notes and clinical experience. The following lecture notes were consulted within this section:

• St. John, Meredith: New England School of Acupuncture, Etiology and Pathology Lecture Notes
• Valaskatgis, Peter: New England School of Acupuncture, Etiology and Pathology Lecture Notes