Stomach pattern identification

The process of diagnosing a morbid condition as a disease pattern of the stomach.

The stomach governs intake and the ripening and rotting of gain and water. These functions are closely related to the spleen, with which the stomach stands in exterior-interior relationship. Stomach qì bears downward, by contrast to spleen qì, which bears upward. Pathologies of the stomach are disturbances of these functions.

Pathomechanical Features

Insufficiency of Qì and Yīn

The stomach’s yáng qì and its yīn qì can become insufficient. Stomach blood vacuity is not discussed.

Susceptibility to Cold, Heat, Rheum, and Stagnation

Stomach patterns include the following:

• stomach cold;
• intense stomach heat;
• cold rheum collecting in the stomach;
• food stagnating in the stomach and intestines.

Stomach cold can take the form of repletion cold or vacuity cold. Some recent Chinese textbooks clearly distinguish two, although they are often poorly distinguished.

Decreased or Increased Rotting and Ripening Activity

These disturbances are a common feature of stomach patterns. Increased activity occurs in stomach heat patterns (stomach yīn vacuity and intense stomach heat), while decreased activity occurs in other patterns.

Impaired Harmony and Downbearing

All stomach patterns can result in impaired harmony and downbearing of stomach qì. A distinction is made between disharmony of stomach qì and stomach qì ascending counterflow:

• Disharmony of stomach qì (胃气不和 wèi qì bù hé) manifests in reduced eating and by distension and fullness in the stomach duct.
• Stomach qì ascending counterflow (胃气上逆 wèi qì shàng nì), which develops when the downbearing action of the stomach is severely compromised, manifests in belching, hiccup, upwelling of fluid from the stomach into the mouth (simply referred to as upwelling), nausea, and retching or vomiting.

Spleen and Stomach

The spleen and stomach are closely related in the process of digestion. The spleen’s functions of movement and transformation and of upbearing the clear stand in a mutually complementary relationship with the stomach’s functions of governing intake and of downbearing the turbid. The functions of the spleen and stomach often suffer simultaneous impairment.

Stomach intake and splenic movement and transformation: Both functions are vulnerable to dietary irregularities. When they are simultaneously disturbed, as is often the case, signs may include dull pain in the stomach duct, reduced eating or torpid intake, abdominal distension, and sloppy stool.

Upbearing of the clear and downbearing of the turbid are sometimes simultaneously affected. When this happens, the descent of clear qì causes clean stool containing undigested food (grain failing to transform), while failure of turbid qì to descend causes distension in the stomach duct and abdomen.

In the context of the relationship between the stomach and spleen, bear in mind that the spleen likes dryness and is averse to dampness, while the stomach likes moisture and is averse to dryness. Hence, insufficiency of yáng qì and water-damp predominate in spleen pathologies, while yīn vacuity and heat predominate in stomach pathologies.

Spleen and stomach patterns are often poorly distinguishable. However, two points are worth noting:

• Stomach patterns tend to be marked by pain and discomfort in the stomach duct, that is, the stomach proper; spleen patterns tend to be marked by pain in the stomach duct and abdomen.
• Stomach patterns are often characterized by stomach qì ascending counterflow (nausea, vomiting, hiccup, belching); many spleen patterns include sloppy stool and, in some cases, even diarrhea.

Stomach patterns include vacuity cold, vacuity heat, repletion cold, and repletion heat, as well as rheum and food stagnation patterns.

Stomach Signs

Stomach signs mostly involve appetite and digestion disorders but also notably include dental discomforts.

Stomach Duct and Abdomen

Pain in the stomach duct (胃脘疼痛 wèi wǎn téng tòng): Pain in the area of the stomach. Its significance is as follows.

• Pain that likes (is relieved by) pressure indicates vacuity.
• Pain that likes warmth indicates cold.
• Pain that refuses pressure indicates repletion.
• Pain that is not relieved by warmth or that is aggravated by heat indicates heat.
• Periodic or continuous dull pain indicates vacuity.
• Severe pain indicates repletion.

Pain and other discomforts clearly limited to the area of the stomach indicate stomach disordes. By contrast, pain over a wider area (stomach duct and abdomen) suggests a spleen problem.

Glomus and distension in the stomach duct (胃脘痞胀 wèi wǎn pǐ zhàng): A localized sensation of fullness, distension, and blockage that results from impaired harmony and downbearing of stomach qì. It is specifically associated with stomach qì vacuity or dampness encumbering the spleen.

Rumbling intestines (肠鸣 cháng míng): Also called borborygmus. Any sound made by food in the intestines. It occurs in food stagnating in the stomach duct, in cold strike (cold directly striking the interior in cold damage), center qì vacuity, and liver qì invading the spleen.

Stomach qì ascending counterflow

Belching, hiccup, nausea, and vomiting reflect stomach qì ascending counterflow, which frequently occurs in stomach disease.

Belching (嗳气 ài /ǎi qì): Expulsion of gas from the stomach via the mouth. It is a sign of stomach qì ascending counterflow. It occurs in spleen-stomach vacuity (spleen/stomach qì/yáng vacuity), food stagnating in the stomach duct, and liver qì invading the stomach. In food stagnating in the stomach duct, it is associated with a sour-putrid smell.

Hiccup (呃逆 è nì): Repeated production of short sharp sounds in the throat. It is a sign of stomach qì ascending counterflow. It occurs in stomach qì vacuity, stomach cold, stomach yīn vacuity, stomach heat, and spleen-kidney yáng vacuity.

Nausea (恶心 ě xīn): Desire to vomit. It is a sign of stomach qì ascending counterflow. It occurs in stomach cold, stomach heat, stomach yīn vacuity, liver-stomach disharmony, and food stagnating in the stomach duct. It is sometimes described as upwelling and nausea (泛恶 fàn ě), emphasizing the upward movement of qì from the stomach.

Vomiting (呕吐 ǒu tù), retching and vomiting (呕吐 ǒu tù): Vomiting is the expulsion of the stomach contents via the mouth; retching is the same action with the expulsion of little or no matter. It is a sign of stomach qì ascending counterflow. Vomiting (or retching) occurs in stomach cold, stomach heat, stomach yīn vacuity, liver-stomach disharmony, and in food damage (food stagnating in the stomach duct and intestines). It can also occur in external contractions such as wind-cold or summerheat.

Dry retching (干呕 gān ǒu): Vomiting with little or no vomitus. It is a sign of stomach qì ascending counterflow. It is most commonly a sign of stomach yīn vacuity but can also occur in stomach cold.

Vomiting of blood (吐血 ǒu xuè): Expulsion from the stomach of vomitus containing fresh blood or dark-purple clots. It is a sign of stomach heat or liver fire invading the stomach, possibly with static blood in the stomach.

Stomach Heat Signs

Several signs, especially when appearing together, are indicative of intense stomach heat.

Scorching pain in the stomach duct (胃脘灼痛 wèi wǎn zhuó tòng): A burning pain in the stomach itself. If the pain is intense, it is caused by intense stomach heat; if it is dull, it is caused by stomach yīn vacuity.

Clamoring stomach (嘈杂 cáo zá): A sensation described as being like hunger but not hunger and like pain but not pain. It occurs in stomach yīn vacuity, intense stomach heat, liver-stomach disharmony, and worms accumulating in the intestinal tract.

Immediate vomiting of ingested food (食入即吐 shí rù jí tù): Vomiting shortly after eating. It is observed in intense stomach heat, malign obstruction (恶阻 è zǔ), and dysphagia-occlusion (噎膈 yē gé).

Swift digestion with rapid hungering (消谷善饥 xiāo gǔ shàn jī): The appearance of hunger shortly after eating. It occurs in intense stomach heat, in strong stomach and weak spleen (stomach heat with spleen cold), in dispersion-thirst, or in goiter.

Acid swallowing (吞酸 tūn suān): Upwelling of acid fluid into the mouth that is swallowed before it can be spat out. It is caused by stomach qì ascending counterflow. It occurs not only in intense stomach heat but also in food stagnating in the stomach duct and in depressed liver qì affecting the stomach (liver-stomach disharmony).

Fetid mouth odor (口臭 kǒu chòu): Bad breath. If not the result of poor oral hygiene, it can be attributed to stomach heat, phlegm-heat congesting the lung with pulmonary welling-abscess, or food stagnating in the stomach duct.

Bleeding gums (牙龈出血 yá yín chū xuè): Bleeding from the juncture of the gums with the teeth. It is most commonly attributable to stomach heat, spleen failing to control the blood, or kidney yīn vacuity.

Painful swollen ulcerating gums (牙龈肿痛溃烂 yá yín zhǒng tòng kuì làn): Mainly caused by intense stomach heat.

Toothache (牙齿痛 yá chǐ tòng, 牙痛 yá tòng): Pain felt in the teeth. Toothache is most commonly caused by tooth decay, a rotting away of the teeth, that the ancient Chinese ascribed to the work of worms. Where decay is absent, Chinese medicine attributes toothache to wind-fire, wind-cold, stomach heat, kidney vacuity, or qì vacuity.

Stomach-Related Diseases

Stomach-related diseases are essentially digestive disorders.

Gān accumulation (疳积 gān jī): Often translated as malnutrition. A disease of infancy or childhood marked by emaciation, dry hair, heat effusion, abdominal distension with visible superficial veins, yellow facial complexion, and lack of vitality (devitalized essence-spirit). It arises when dietary factors, evils, or worms damage the spleen and stomach.

Worm patterns (虫证 chóng zhèng): Also called worm accumulations (虫积 chóng jī). Disease patterns caused by worms (intestinal parasites). Traditionally, worms were diagnosed on the basis of signs such as clamoring stomach, intermittent abdominal pain, desire for strange foods, passing of worms in stool, vomiting of worms, yellow face, emaciation, grinding of the teeth in sleep, itchy nose, white patches on the face, and blue patches on the whites of the eyes (sclera). Sometimes there are sudden episodes of abdominal pain with a palpable rope-like mass in the abdomen. Severe pain may be accompanied by reversal cold of the limbs.

Malign obstruction (恶阻 è zǔ): A condition marked by aversion to food, nausea, and vomiting during pregnancy, which is called morning sickness or emesis gravidarum in biomedicine. These symptoms are caused by counterflow ascent in the thoroughfare (chōng) and controlling (rèn) vessels affecting the harmonious downbearing of stomach qì. This condition is not considered untoward unless it severely affects food intake. However, the term malign obstruction implies a severity of the condition that deserves attention.

Stomach Patterns

Stomach qì vacuity (胃气虚 wèi qì xū): Glomus and fullness in the stomach duct with dull pain that likes pressure; reduced eating; qì vacuity signs. It results from dietary irregularities, especially irregular eating; taxation fatigue; enduring illness; disease in other bowels and viscera.

Simple Patterns

Stomach cold (胃寒 wèi hán): This can take the form of stomach yáng vacuity (stomach vacuity cold) or cold stagnating in the stomach and intestines (repletion cold). The two are often poorly distinguishable. See next two items.

• Stomach vacuity cold (胃阳虚 wèi yáng xū): Continual cold pain in the stomach duct relieved by warmth and pressure; vacuity cold signs. It is caused by raw and cold foods, spleen vacuity affecting the stomach, or enduring illness.
• Stomach repletion cold (寒滞胃肠 hán zhì wèi cháng): Acute cold pain in the stomach duct and abdomen, triggered by exposure to cold. Catching cold in the stomach or excessive consumption of raw or cold foods. It is attributed to constitutional yáng vacuity or stomach yáng vacuity may be a predisposing factor.

Stomach yīn vacuity (胃阴虚 wèi yīn xū): Dull scorching pain in the stomach duct; hunger with no desire to eat; clamoring stomach; yīn vacuity signs. It results from damage to the stomach in advanced-stage warm-heat disease; affect-mind disturbances causing qì to become depressed and transform into fire that damages stomach yīn; damage to liquid through vomiting and diarrhea; predilection for deep-fried and aromatically spiced foods, which are drying; excessive consumption of warm dry medicinals.

Intense stomach heat (胃热炽盛 wèi rè chì shèng): Scorching pain in the stomach duct that refuses pressure; clamoring stomach; swift digestion with rapid hungering; painful swollen and ulcerating gums; general repletion heat signs. It results from predilection for hot, spicy, acrid, sweet, or fatty foods or liquor, all of which foster heat (the most common cause); affect-mind disturbance causing liver depression transforming into fire, which in turn invades the stomach; invasion of evil heat.

Cold rheum collecting in the stomach (寒饮停胃 hán yǐn tíng wèi): Distension and fullness in the stomach duct, with the sound of moving water; vomiting of clear drool, gurgling sound of water in the intestines, and dizziness. It results from dietary irregularities, especially excessive consumption of fluids; taxation fatigue damaging the spleen and stomach, impairing splenic movement and transformation, and causing water to collect in the form of rheum.

Food stagnating in the stomach and intestines (食滞胃肠 shí zhì wèi cháng): Distension and pain in the stomach duct; belching of putrid gas; acid swallowing; aversion to food. It results from dietary irregularities, such as voracious eating and drinking, unclean food, or excessive consumption of rich fatty food.

Combined Patterns

Liver-stomach disharmony (肝胃不和 gān wèi bù hé): Distension and scurrying pain in the stomach duct and rib-side; belching; and acid swallowing. It arises when affect-mind frustration and depressed anger damage the liver, causing depressed liver qì that moves cross-counterflow to invade the stomach.