6.26 Hypochondriac Pain
6. 26. 1 What is the Hypochondriac Pthn?
Hypochondriac pain is chiefly manifested as pain of hypochondriac regions by one side or two sides. Hut it is a common kind of self sensationaI syrnptom chnically.

6. 26. 2 Try Lo describe the etiology and pathogenesis of the hypochondriac pain.
(1) Stagation of the liver-Qi Emotional depression or rage injuririg the liver can cause dysfunction oi the liver to sprcad out freely, and disorder in governing the flow of Qi as well. Thus hypochoudric pain occurs due to obsrruction of the liver-Qi and blockage of the collaterals.
(2)Blocking of blood circulation by blood stasis If the stagnation of the liver Qi continues for a long period, blood circulation will he bk-eked and bkxd stasis accumulated. So hypochondriac pain appears due in the obstrncon of hynchondriac collaterals. The injury of hypochondriac collaterals caused by overload leading to blood stasis, which may obstruct the hypochojndriac collaterals and cause bypochondriac pain.
(3 )Defidency of the live- Yin The morbid condition is caused by chronic illness, overstrain or hyperemsia. The deficiency of esscnce and blood can leid to deficiency of the liver- Yin, so that the liver and its channels can riot be nourished b1oc1, This condition will result in hypochondriac pain in the end.
(4) Dampness-heat in the liver and the gallbladder under the circumstances of invasion by exopathogens or improper diet, dysfunction of the spleen in transporting, distributing and transforming the nut Hents can lead to stagnation of phlegm-darnpness and generation of heat induced by stagnancy of the Liver-Qi , which results in disorder of the liver and gallbladder to spread our freely, that the hypochondriac pain appears.

6. 26. 3 How many common syndromes does the hypochondriac pun cover? What arc the main points of differ.eniiarion in each?

(1 )Stagnaiion of the liver-Qi
[Main points of differentiation] Hypochondriac distention with wandering pain and its onset relating to emotional factors.
(2)Blood stasis
[Math points of differentiation]Stabbing pain in the hypochondrium with a fixed position and its aggravation especially at night.
(3 )Deficiency of the liver- Yin
[Main points of differentiation] Vague pain in hypochondrium, dry throat and vexation, red tongue with a little fur,
(4.)Dampness and heat in the liver and gallbladder
[Main points of differentiationI Hypochondriac pain, bitter taste, yellowish eyes, body and urine, yellowish greasy fur and rapid and slippery pulse.
6. 26-4 What are the clinical characters of the stagnation of the liver-Qi in the hypochondriac pain? How to treat it?
[Symptoms] Hypochondriac distention by left side, by right side or by two sides is characterized by wandering pain. It varys along with emotionaL changes and s combined with chest distress, dyspnea, poor appetite and frequem beRthing. Thin whitish fur with wiry pulse or wiry-thready pulse is common manifestations.
[Treanrient] Soothing the liver and regulating the circulation of [Recipe] Chai Hu Shu Gan San

6. 26.5 Acupuncture treatment
(1) Depression of liver Qi
[Treatment]
Select poiivs on the Jueyin and Shczoy-sng meridians as main points and points on the Rei meridians and back Shu points as secondary one. The reducing method of neecUing is used.
[Prescnprion]
Ganshu, Qimen Xiaxi and Neiguan
(2) Damp heat
[Treatment]
Select points on the Foot-jueyin, Sand-Shaoyang and FootShang meridians as main points. The reducing method of needling is used.
[Prescription]
Qimen, Riyue, Zhigou Yanglingquan and Taichong
(3) Blood stasis
[Treatment]
Select points on the Foot-Jueyin and Shaoyang meridians as main points and points on the Foot-Taiyin and back Shu points as secondary one The reducing meyhod of needling is used.
[Prescription]
Xingjian , Geshu, Sanyinjiao, Yanghngquan and Riyue
(4) Yin deficiency
[Treatmeny]
Sclect back Shu points arid points on the Foot-jueyin and Taiyin meridians as main points. The reinforcing method is used.
[Prescription]
Qlmen, Ganshu, Xuehai, Shenshu and Sanyinjiao

6.27 Jaundice

6. 27. What is jaundice? Try to descrice its etiology and pathogenesis.
Jaundice is the morbid condition chiefly manifested as icteric selera, xanthochromia and dark brownish urine. Among then, the ictenc scieras an important character of this illness.
[Etidogy and pathogeneses]
(1) Exopathic factor This type of jaundice occurs as a result of exogenous affection of seasonal pathogens or pathogenic damp-heat so that exopathogens accumulate in the body, stagnate in the middleJiao and result in dysfunction of the stomach and the spleen in trans.porting, distributing and transforming the ntarients which will cause endogenous damp-he&. In this circumstances , irnerrwinement of exogenous dampness with endogenous heat affect the liver and gallbladder R. that bile overflow to muscle, skin and the urinary bladder, which is manifested as ictedc sciera, yellowish skin and brownish Urine.
(2) Improper diet The stomach and spleen can be impaired by wihygienic food, too much eating or hunger, or too much drinking so that dysfunction of the stomach and spleen cause pathogenic dampness being generated internally. Moreover, stagnation of pathogenic
dampness leads to damp-hear occurrence which affects the liver and gaLlbladder resuLting in circulation of bile abnormally and overflow to muscle and skin, so that jaundice occurs.
(3) Insufficiency-cold of the spleen and stomach The impaired spleen ind stomach Yang due to insufficiency in natural endowment or after illness will cause pathogenic dampness obstructing internally and dampness-cold being generated. When dampness-cold accumulates in the middle-i iao, bile circulation is obsiructed, and bile overflows to muscle and skin leading to jaundice in the end.
(4) Transforming from accumulation syndrome When biliary trace is obstructed by stagnation of blood stasis due to syndrome of accumuLation for a long duration, bile overflows Leading to jaundice; while pathogenic dampness obstructing circulation of Qi, stagnation of a and blood stasis may generate many kinds of symptoms of Uood stasis.

6.27. 2 Try to dcscrbe the differentiation among Yang jaundice, Yin jaundice and acute jaundice.
In yang jaundice, the illness course is shorter, its skin presents bright yellowish color, and belongs to heat syndrome or excess syndrome; while in Yin jaundice, the course is longer, its skin presents dark and gloomy yellowish color, and belongs to cold syndrome or de
ficienty syndrome. TCM beheves that in a certain condition, Yang jaundice may transform into Yin jaw idice and vice versa may take place.
In acute jaundice, jaundice presenting golden color with sudden onset, characterized by a rapid aggravating brown yellowish pigmentation of the skin and selera, high fever, po[ydpsia, hypochondriac pain with feeling of fullness in the abdomen, coma, delihrium, epistaxis, bloody urine, skin ecchymosis.
Try to describe the main symptoms treatment and recipe of the Yang jaundice.
(1 )Heat syndrome combined with dampness syndrome while the former being dominant.
[Symptoms] The skin and sclera presenting bright yellowish color, fever with thirst, or heartburn, abdominal distension, dry mouth with bitter taste, nausea with vomiting, constipation, obguria with dark urine, greasy yellowish fur with wiry-rapid pulse.
[Treatment] Clearing away hear and promoting diures{s, detox cating and resolving mass.
[Recipe] Yin Chen Hao Tang
(2) Damp syndrome accompanied with heat syndrome while the former being dominant.
[symptorns] The skin and sciera presenting yellowish color bu t not bright, recessive fever, heavyness in the head and limbs, feeling 0f fullness in the chest and upper ahdomen, poor appetite, thirst but nor to drink much, nausea with vomiting, abdominal distension, loose difficult stool, scanty dark urine, greasy, thick, light, yellowish fur, wiry, slippery pulse or soft and floating, moderate pulse.
[Treatment] Removing dampness by diuresis to eliminate turbid pathogens, removing heat to expel jaundice.
[Recipe] Yin Oten Wu Ling San with Gun Lu Xiao Du Dan with modification.
6.28 Tympanitcs

6.28. 1 What is tyiripanises?

Tympanites is a morbid state manifested as abdominal distention like a drum, sallow complexion and visible blood vessels.

6.28.2 Try to describe the pathogeneses and main types of tympanites.

(1) Improper diet Addiction to alcohol or fat, sweet and greasy food generates dampness and hear whose accumulation in the middle-jiao causes a mixture of clear and turbid qi and the failure of food essence to he transported, leading to the transformation from internalIy accumulated turbid dampness into tympanites.
(2) Emotional itnpairmern Anxiety, depression and anger irnpairs the liver and spleen, leading to dysfunction of the liver in purgation and stagnation of Qi , if this continues for a period of time, blood stasis and obstruction of channels and collaterals occur. The dysfuricton of the liver iii promoting the free flow of qi invades the spieen and stomach and makes the spleen fail in transport. This in turn, generates retention of water within the body, and tyrnpanitcs is convurted from the stagnation of Qi blood and water.

(3) Infected by poison oi schistome Infect ion of schisosomepoison without timely treatment impairs the liver and spleen causing obstruction of the channels and collaterals to hold up functional activitcs of Qi and making disturbance in ascending and descending, and mixing clen-Qi up with turbid-Qi. I panites is thus gradually formed.
(4) Deuteropathy Tyrnpanites is likely tr, occur after other diseases impair the liver and spleen, leading to dysfunction of the Liver in purgation and dysfunction of the spleen in transport, e. g. Lasting jaundice iniparis the liver and spleen and blocks the circu[ation of Qi and blood causing stagnation in channels and coilaterals which results in tympanites that will get larger and larger to worsen the state of obstructed functional activities of Cli and may well bring about the stagnation of dampness.
There are six types; stagnation of qi and dampness, cold-dampness blocking the spleen, accumulation of damp-heat pathogen, Nood stasis in the liver and spleen, ;nsufficicy of the spleen- Yang arid the kidney-Yang deflciency of the liver- Yin and kidney- Yin


6. 28.3 Try 10 describe the main symptoms, treatments and recipes of tympanites types of cold-dampness blocking spleen, accumulation of damp-heat and deficiency of the liver- Yin and
(1) Cold-dampness blocking spleen
[Symptoms I Abdominal distention as a water bladder if pressed, in severe case, the face showing slight general edema, the lower limbs having general edeni?1, stuffiness in epigastrium relieved when heated, listlessness, aversion to cold, being disinclined to move about, oliguna, lcse stool, whitish and greasy fur, and moderate pulse.
[Treatment] Warming the middle-jiao to strengthen the spleen, and pronioting the circular ion of Qi to induce diuresis.
[Recipel] Shu Pi Yin

(2) Ac-cumulation of damp-heat pathogen
[Symptoms] Hard, full and distend ing abdomen, dysphoria with smothery sensation, bitter taste, thirst with no desire for drinking, sallow complexion and skin, difficult and dark urine, constipation or loose stool, redness on the tip and margin of the tongue, yellowish and greasy fur or mixed with gray and black color, and wiry and rapid pulse.
[Treatment] Clearing away heat, eliminating dampness, and purging the turbid fluid,
[Recipe] Zhong Man Pen Xiao Wan with Yin Chen Han Tang