Stomach Disease Patterns Summary
Stomach Disease Patterns
Physiological Characteristics and Functions of the Stomach
The Stomach is undeniably crucial for the generation of post-natal qi and blood, working in a vital partnership with the Spleen. Together, they form the 'root of post-natal qi' (后天之根), which is the foundation for all subsequent energy and substance production in the body, derived from digested food and drink.
Historically, the Stomach has been described using several significant terms that emphasize its role:
'sea of water and grains' (水谷之海): Highlighting its primary function as the initial receptacle for all consumed food and liquids.
'great granary' (大仓): Emphasizing its capacity to hold and store foodstuffs temporarily before processing.
Minister of Granary (仓之君): Ascribing a governing role in managing the body's essential input, similar to a minister overseeing a state's food supply.
Stomach channel anatomy (Yang Ming channel):
Begins at the lateral side of the ala nasi (side of the nose), ascends to the inner canthus of the eye, then descends to encircle the mouth and jaw, connecting with other facial channels.
Travels downwards through the neck, passes into the supraclavicular fossa (located above the clavicle), and descends internally through the diaphragm to enter the Stomach organ itself, then connects with the Spleen internally, signifying their profound interior-exterior energetic link.
A separate external descending branch from the supraclavicular fossa travels down the abdomen, continues along the anterior aspect of the thigh, descends along the lateral side of the tibia, and ultimately ends at the lateral side of the second toe (Stomach channel point ST45).
Relationship with the Spleen
Both organs are centrally located in the middle burner (middle Jiao), forming an indispensable interior-exterior relationship that is intrinsically linked to the Earth phase in Traditional Chinese Medicine (TCM) five-element theory.
Their physiological preferences are complementary yet opposite: The Stomach inherently wants moisture and disfavors dryness (requiring fluids for decomposition), while the Spleen prefers dryness and disfavors dampness (as dampness impedes its transformative function).
This delicate balance and coordination are essential for normal digestive function, allowing food transformation (Stomach) and nutrient extraction/transport (Spleen). They serve as the vital pivot for the body's entire qi circulation, influencing the ascent of clear qi (Spleen) and the descent of turbid qi (Stomach).
Physiological Characteristics of the Stomach
Due to its abundant qi and blood, and its primary role in receiving and processing food, Stomach patterns are notably more prone to manifesting as excess conditions. Deficient patterns, while possible, are less common and often develop from chronic excess or long-term improper care.
Ancient TCM texts profoundly state: Excess patterns predominantly belong to the Yang Ming channel (which the Stomach governs, alongside the Large Intestine), indicating their robust, often acute and energetic nature; while deficiencies are more often associated with the Tai Yin channel (governed by the Spleen and Lung), which tends towards chronic and languishing conditions.
Crucially, despite their deep interconnection, both organs maintain unique individual functions, affecting each other without losing their distinct roles or responsibilities within the body's physiological system.
Major Functions of the Stomach
Receiving food and drink
This is the initial and fundamental function of the Stomach, where ingested food and beverages are held. It acts as a temporary reservoir, ensuring a steady supply for subsequent digestion.
Decomposition
Known as "Rotting and ripening" (fa shú). This signifies the Stomach's crucial role in the initial breakdown and transformation of food. Through the action of Stomach qi and fluids, solid food is macerated, mixed, and partially digested, converting it into a semi-liquid chyme. This preparation is vital for the Spleen to efficiently extract the refined food essence (Gu Qi) for nourishing the entire body.
Governing Descending
Unlike the Spleen which governs ascent, the Stomach's qi movement is intended to descend. It transports the decomposed food (chyme) downwards to the Small Intestine, allowing for further separation of clear (nutrients) from turbid (waste) substances and subsequent nutrient absorption. A healthy descending function prevents symptoms such as nausea, vomiting, and belching.
Causes of Stomach Dysfunction
Improper Diet: This is a primary cause, directly impacting the Stomach's receiving and decomposing functions.
Overeating or undereating regularly can strain or weaken Stomach qi.
Excessive consumption of raw and cold foods can chill the Stomach, impeding digestion.
Greasy and rich foods can create dampness and phlegm, obstructing qi movement.
Hot, spicy, or physically dry foods can generate Stomach heat or consume Yin fluids.
High intake of alcohol and caffeine can also generate heat and damage Stomach Yin over time.
Exopathogens & Stress: External pathogenic factors and emotional states significantly disrupt Stomach functions.
Invasions of cold can contract Stomach qi, leading to pain and vomiting.
Heat can cause rapid, forceful digestion or burning sensations.
Dampness can obstruct qi flow, leading to bloating and nausea.
Dryness (often internal) can consume Stomach Yin.
Emotional stress, particularly anger, frustration, or worry, directly affects Liver qi, which can then transversely invade the Stomach/Spleen, disrupting qi flow and causing digestive upset.
Chronic Illness and Aging: These are additional predisposing factors:
Prolonged illness can exhaust Stomach qi and Yin.
Aging naturally leads to a decline in qi and blood, weakening digestive functions.
Pathological Changes & Clinical Manifestations
The most common pathological issue arising from Stomach dysfunction is Stomach qi failing to descend. This reversal of the normal qi flow leads to an array of symptoms, including stomach qi rebellion (qi moving upwards instead of downwards), impaired food decomposition, and inadequate reception of food and drink.
Symptoms of Stomach Qi Rebellion: This occurs when Stomach qi moves upward instead of descending.
Vomiting: Forceful expulsion of undigested or partially digested food.
Nausea: A sensation of needing to vomit.
Belching: Eructation of gas from the stomach.
Hiccups: Spasmodic contractions of the diaphragm.
Acid regurgitation: Stomach acid flowing back into the esophagus.
Etiology: These symptoms frequently stem from improper diet (e.g., overeating, consuming difficult-to-digest foods), emotional stress (e.g., anxiety affecting qi dynamics), chronic underlying issues, and even improper treatment of other conditions.
Pathomechanisms: The specific underlying causes often involve qi stagnation (impeded flow of stomach qi), phlegm retention (thick, viscous substances obstructing qi), damp stagnation (heavy, sticky pathogens impeding function), or a fundamental weakness in Stomach qi function preventing proper descent.
Food Aversion:
Manifests as a loss of appetite, a general disinterest in eating, or discomfort immediately after consuming food. This can directly stem from impaired decomposition (food not being processed efficiently) and compromised descending functions (food remaining in the stomach too long or not moving down properly).
Causes: Diverse factors can lead to food aversion, including a cold invasion (which slows digestion), food stagnation (undigested food blocking new intake), lack of Stomach moisture (inhibiting the 'rotting and ripening'), or various qi movement disorders (preventing proper gastric function).
Epigastric Bloatedness:
Characterized by a sensation of fullness, distension, or pressure in the epigastrium (upper abdomen) or general abdomen. This symptom is most commonly associated with qi stagnation within the Stomach and intestines, where the smooth flow of qi is disrupted.
Etiology: Causes are broad and include external pathogenic factors (like cold or dampness), improper diet (e.g., overeating, consuming gas-producing foods), emotional stress (e.g., Liver qi stagnation impacting the Stomach), and various chronic conditions that weaken digestive qi.
Other Signs Related to the Stomach
Beyond the primary symptoms, other indicators of Stomach imbalance include:
Excessive appetite: Often a sign of Stomach Fire or strong Stomach heat, leading to rapid digestion and constant hunger.
Bad breath (halitosis): Frequently associated with heat, food stagnation, or phlegm-heat in the Stomach.
Severe thirst: A common symptom of Stomach heat or Yin deficiency, as fluids are consumed or deficient.
Swollen and/or bleeding gums: Can indicate intense Stomach Fire ascending to the head.
Common Stomach Disease Patterns
As the source of post-natal qi and blood, and a Yang organ in nature, the Stomach is particularly prone to developing excess patterns due to its robust activity and frequent exposure to dietary influences. While deficiency patterns are rarer, they are significant. Patterns are broadly categorized as:
Deficiency Patterns:
Stomach Yin Deficiency (lack of fluids and nourishment in the Stomach).
Stomach Deficiency Cold (insufficient Yang qi to warm and activate the Stomach).
Excess Patterns:
Stomach Fire (exuberant heat in the Stomach).
Cold Invading the Stomach (external cold pathogen affecting the Stomach).
Blood Stagnation in the Stomach (impeded blood flow within the Stomach).
Food Stagnation (undigested food accumulation).
Stomach Yin Deficiency Pattern
This pattern involves a fundamental lack of nourishment and lubrication within the Stomach due to insufficient Yin fluids. Without adequate Yin, the Stomach's inner lining becomes dry, leading to a sensation of heat and impaired function. This can easily lead to Stomach qi rebellion and other symptoms.
Clinical Manifestations:
Epigastric burning pain: A sensation of heat and dryness, rather than acute or colicky pain.
Hunger without appetite: A key differentiating symptom; the person feels an empty gnawing sensation but has no desire or ability to eat, often due to the Stomach's dryness and inability to process food.
Epigastric discomfort: A vague, dull ache or feeling of emptiness.
Dry mouth and throat, especially in the afternoon or evening: Reflects the systemic lack of Yin fluids.
Dry stools: Due to lack of fluids in the intestines.
Red tongue with little or no coating: A classic sign of Yin deficiency and internal heat.
Thready and rapid pulse: Indicates fluid deficiency and heat.
Etiology: Commonly caused by chronic high fever (consuming Yin), prolonged emotional stress (Liver heat consuming Stomach Yin), improper diet (excessive consumption of hot, spicy, or dry foods that deplete fluids), or overuse of certain drying foods and herbs.
Stomach Deficiency Cold Pattern
This pattern results from a weakened Stomach yang function, leading to a lack of warmth and inability to properly digest and move food. It is characterized by accompanying cold symptoms affecting the stomach.
Symptoms:
Dull, persistent discomfort or pain in the epigastrium: Often relieved by applying warmth or consuming warm foods/drinks.
Preference for warm foods and drinks: The body instinctively seeks warmth to counteract the internal cold.
Vomiting clear fluids or undigested food: Due to the Stomach's inability to 'rot and ripen' and its qi failing to descend.
Cold limbs: A sign of overall Yang deficiency.
Fatigue, lack of energy: Due to insufficient qi production.
Pale tongue with white, moist coating: Indicative of cold and dampness.
Deep, slow, or weak pulse: Reflects the deficient and cold state.
Distinction Between Patterns
Stomach Yin Deficiency vs Spleen Yin Deficiency: This differentiation is crucial for accurate diagnosis.
Stomach symptoms tend to occur more acutely, with a strong focus on the epigastrium and a distinct 'hunger but no desire to eat' (due to dry stomach). The tongue is typically red without coating.
Spleen Yin Deficiency is generally more chronic, affecting overall Spleen function of transformation and transportation, leading to symptoms like abdominal distension, loose stools, and lack of energy. A key differentiator here is "no hunger" at all, as the Spleen's inability to extract essence means a genuine lack of desire to eat. Tongue may be pale or light red with little coating.
Stomach Fire Pattern
This is an excess heat pattern where robust heat disrupts the Stomach's normal functions of receiving and descending. The heat can dry fluids and accelerate metabolism.
Symptoms:
Burning pain in the epigastrium: More intense and localized than Yin deficiency fiery sensation.
Excessive appetite and consuming large amounts of food: The heat causes food to be digested rapidly, leading to constant hunger.
Severe thirst, especially for cold drinks: To quench the internal heat.
Bad breath (halitosis): Due to the heat putrefying food in the Stomach.
Acid regurgitation, vomiting soon after eating: Stomach qi is rebellious upwards due to heat.
Red tongue with a thick, possibly dry, yellow coating: Strong indication of excess heat.
Flooding, rapid, or strong pulse: Reflects the robust heat and excess condition.
Cold Invading the Stomach
This pattern results from an external invasion of cold, typically due to consuming raw/cold foods and drinks, or direct exposure of the stomach to cold environmental factors. The cold contracts the Stomach qi and vessels, causing acute pain.
Symptoms:
Severe, acute, colicky epigastric pain: Sharp, cramping pain that is intense.
Pain exacerbated by cold and relieved by warmth: A hallmark sign of cold-type pain.
Nausea and vomiting of clear watery fluids: Due to the inability of the Stomach to process and descend contents.
Cold limbs, feeling chilled: Systemic signs of cold.
Thin, white, moist tongue coating: Indicative of external cold.
Tight or wiry pulse: Reflects the contraction from cold.
Food Stagnation Pattern
This pattern arises when the Stomach's capacity is overwhelmed by improper food intake, leading to accumulation and inability to process. It is a common excess pattern.
Symptoms:
Epigastric fullness, distension, and bloating: Feeling of being overly full and pressure in the upper abdomen.
Sour regurgitation or vomiting of undigested, foul-smelling food: Relieves the discomfort temporarily. The smell is often distinctly putrid.
Lack of appetite or aversion to food: Due to the existing stagnation.
Belching and acid reflux with a rotten smell: A characteristic symptom.
Constipation (obstipation) or difficult bowel movements: Due to stagnation affecting overall digestion.
Thick, greasy tongue coating (often yellow or white): Indicates accumulation and dampness.
Slippery or full pulse: Reflects the presence of stagnation.
Blood Stagnation in the Stomach
This is a more severe Stomach pattern involving impeded blood flow within the Stomach lining, often due to chronic disease, trauma, or persistent qi stagnation leading to blood stasis.
Symptoms:
Severe, fixed, stabbing epigastric pain: The pain is sharp, localized, and constant, often worse at night.
Pain not relieved by food, pressure, or warmth: Unlike qi or cold pain, blood stasis pain is often unrelenting.
Nausea and possibly vomiting (especially of dark blood or coffee-ground substance): Indicates internal bleeding.
Black or dark purple tongue with possible petechiae/ecchymosis: A strong sign of blood stasis.
Dark, tarry stools (melena): Due to digested blood in the stool.
Wiry or choppy pulse: Reflects the impeded blood flow.
Summary Table of Stomach Disease Patterns
Key patterns and their distinguishing features include:
Stomach Yin Deficiency: Characterized by internal dryness and a hollow feeling; symptoms include epigastric burning pain, the unique 'hunger without appetite,' dry mouth/throat, and a red tongue with little or no coating.
Stomach Deficiency Cold: Caused by insufficient warmth; presents with dull, persistent pain in the epigastrium (relieved by warmth), a clear preference for warm foods, and vomiting clear fluids, alongside a pale tongue with a white, moist coating.
Cold Invading the Stomach: An acute external invasion; manifests as severe, colicky epigastric pain (worse with cold, better with warmth), nausea, and vomiting clear fluids, with a white, moist tongue coating.
Stomach Fire: Exuberant internal heat; symptoms include intense burning pain, excessive appetite, severe thirst for cold drinks, bad breath, and a red tongue with a thick yellow coating.
Food Stagnation: Due to accumulation of undigested food; causes epigastric bloating and distension, sour regurgitation or vomiting of foul-smelling food, and a thick, greasy tongue coating.
Blood Stagnation in the Stomach: A serious condition with impeded blood flow; marked by severe, fixed, stabbing epigastric pain (worse at night, not relieved by typical means), possibly dark stools, and a dark purple tongue.