Tuesday, April 1, 2014

DIAGNOSTIC DIFFERENTIATION OF DIGESTIVE SYMPTOMS

In this blog post, I will discuss the diagnostic differentiation between various digestive symptoms and specifically, a feeling of distension, fullness, oppression and stuffiness.

A feeling of  DISTENSION (zhang 胀) indicates stagnation of Qi.  This type of sensation will be seldom referred to as "distension" by Western patients: more often than not, patients will call it a feeling of “bloating”, "bursting", "being blown-up", etc.

A feeling of distension is both subjective and objective.  Subjectively, the patient feels bloated, and objectively, it can be seen and palpated.  On palpation it feels like an over-inflated balloon, it resists on palpation and “rebounds”.

A feeling of distension indicates Qi stagnation: it is the cardinal symptom of Qi stagnation which usually affects the Liver.  Remember, however, that it affects also other organs: in the context of digestive disorders, it affects the Stomach, Intestines and Spleen.

Note that Qi stagnation does not always derive from anger (whether repressed or not) but it frequently derives from worry or guilt.

The pulse reflects where the stagnation is centered. We can distinguish Liver-Qi stagnation, Stomach-Qi stagnation, Spleen-Qi stagnation and Qi stagnation in the Intestines.

- Liver-Qi stagnation: abdominal and/or epigastric bloating, related to emotional state. Pulse all Wiry or Wiry on left.


- Stomach-Qi stagnation: epigastric bloating, not much related to emotional state.  Alleviated by burping. Pulse Wiry on right Guan.


- Spleen-Qi stagnation: lower abdominal bloating, loose stools. Alleviated by passing gas and by rest. Pulse slightly Wiry on left and Weak on right.


- Intestines Qi stagnation: abdominal distension and pain,  borborygmi, constipation.  Alleviated by passing gas. Pulse Wiry on both Chi position.


Distension of epigastrium: Ren-10 Xiawan, Ren-12 Zhongwan, ST-21 Liangmen, ST-34 Liangqiu, ST-40 Fenglong, GB-34 Yanglingquan.

Distension of lower abdomen: ST-25 Tianshu, SP-15 Daheng, GB-34 Yanglingquan, Ren-6 Qihai.

A feeling of FULLNESS (man 满 ) indicates retention of food or Dampness. A feeling of fullness is different than a feeling of distension.  One  literally feels full and slightly nauseous.   It may affect the epigastriun or abdomen.

The feeling of fullness is subjective and objective.  Subjectively, the patient feels full and slightly nauseous.  It is felt objectively on palpation but not seen on observation. On palpation, the abdomen feels hard but not elastic as in the feeling of distension.

Epigastric fullness: ST-19 Burong, ST-21 Liangmen, Ren-10 Xiawan, SP-4 Gongsun/P-6 Neiguan (Chong Mai), ST-34 Liangqiu.

Abdominal fullness: ST-25 Tianshu, ST-27 Daju, SP-4 Gongsun/P-6 Neiguan (Chong Mai),  ST-37 Shangjuxu, ST-39 Xiajuxu.

A feeling of OPPRESSION (men 闷 ) denotes Phlegm or severe Qi stagnation.

A feeling of oppression is purely subjective and it is experienced mostly in the chest.  Some patients would describe it as a “weight” on the chest.  A feeling of oppression indicates Phlegm or also more severe stagnation of Qi.  The translation of this term cannot adequately convey the image evoked by its Chinese character: this depicts a heart constrained by a door and, besides the physical sensation, it also implies a certain mental anguish associated with this feeling.

In Western patients too, a feeling of oppression of the chest reflects emotional stress especially to do with sadness, grief, worry, shame and guilt.

Feeling of oppression of the chest: Ren-17 Shanzhong, P-6 Neiguan, LU-7 Lieque, ST-40 Fenglong.

A feeling of STUFFINESS (pi  痞) indicates Stomach-Qi deficiency or Stomach-Heat.  Contrary to the previous two sensations which can be felt objectively on palpation (e.g. a distended or full abdomen feels so on touch), the sensation of stuffiness is only subjective and the abdomen feels soft on touch.

The feeling of stuffiness is usually in the epigastrium.






DISTENSION
FULLNESS
OPPRESSION
STUFFINESS
Chinese
Zhang
Man 滿
Men 
Pi 
Subjective/objective
Both
Both
Subjective
Both
Objective on what
Palpation and observation
Palpation

Palpation
Symptom
Bloating
Feeling full, nausea
Feeling of weight
Mildly full
Pattern
Qi stagnation
Dampness
Phlegm
Deficiency and Stomach-Heat


13 comments:

  1. Gracias maestro por brindar luminosidad en el camino.

    Un abrazo!

    ReplyDelete
  2. Hi, great article as usual. Hard to find any places not in Chinese with informed information.

    You mention liver with wiry on left and stomach with on right. Anatomically the organs are generally on opposite sides to that. Do you have any information regarding the causes of this phenomenon?

    ReplyDelete
  3. Hi, great article as usual. Hard to find any places not in Chinese with informed information.

    You mention liver with wiry on left and stomach with on right. Anatomically the organs are generally on opposite sides to that. Do you have any information regarding the causes of this phenomenon?

    ReplyDelete