Xie Tong ; Hypochondriac Pain

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XIE TONG (Hypochondriac Pain)

Definition

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DEFINITION

A syndrome marked by pains on one side or both sides of the hypochondriac region.

Where is the “hypochondriac region”?

It is the side of the chest wall, from the armpit to the edge of the 12th rib.

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XIE TONG (Hypochondriac Pain)
Possible orthodox equivalents

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POSSIBLE ORTHODOX EQUIVALENTS

Acute or chronic hepatitis, hepatic parasitosis, hepatic abscess, liver cirrhosis, liver cancer, acute and chronic cholecystitis, gallstones, ascariasis of the biliary tract, intercostal neuralgia, dry pleurisy, adhesive pleurisy

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XIE TONG (Hypochondriac Pain)

CAUSES AND PATHOLOGICAL MECHANISMS

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CAUSES AND PATHOLOGICAL MECHANISMS

The liver channel and the gallbladder channel go through the hypochondriac region. Pains in this region are therefore mostly related to the liver and the gallbladder. Pathological factors affecting the liver and the gallbladder and causing blockage or obstructions can result in pain.

There are transformations in the pathological mechanisms of Xie Tong. These include the transformation of qi stagnation to blood stasis, and from excess to deficiency.
• Qi stagnation leads to blood stasis, and blood stasis aggravates qi stagnation.
• Protracted excess can transform into heat, which in turn consumes yin and blood, leading to yin deficiency and blood deficiency.
• Persistent blood stasis hinders the production of new blood, leading to blood deficiency and yin deficiency of the liver and kidney (essence exhaustion)
• Yin deficiency makes it easier to transform into heat and blood stasis.
• Deficiency, with emotions, improper diets and exogenous evil invasion, can cause and aggravate qi stagnation, blood stasis and damp-heat, resulting in mixture of deficiency and excess.

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XIE TONG (Hypochondriac Pain)
Liver Qi Stagnation

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Liver Qi Stagnation

The liver is the “general”, controls conveyance and dispersing, likes spreading and hates bottling-up and emotional repression.

Emotional repression and sudden anger can injure the liver, causing stagnation of the qi mechanism. Spreading and dispersing will fail. Its channel and collaterals will be blocked and pain will result.

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XIE TONG (Hypochondriac Pain)
Blood Stasis

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Blood Stasis

Qi is the commander of blood and blood is the mother of qi. When qi moves, blood will move. When qi stagnates, blood will stagnate. Therefore, qi stagnation and blood stasis affect each other.

When liver fails to spread and disperse, qi stagnation will result. Protracted liver qi stagnation, or injury to the hypochondriac collaterals by exertion and lifting or carrying heavy objects, slow down and hinder qi and blood movements. Blood stasis and the blockage of the hypochondriac collaterals will result in pain.

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XIE TONG (Hypochondriac Pain)
Damp-Heat of the Liver and the Gallbladder

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. Damp-Heat of the Liver and the Gallbladder

Exogenous dampness, or improper diets injures spleen causing failure in transport of water and dampness. Dampness stagnates and transforms into heat. This damp-heat will then steam within. The liver and gallbladder will fail to spread and disperse, qi and blood movement will be hindered, resulting in hypochondriac pain.

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XIE TONG (Hypochondriac Pain)

Liver Yin Deficiency

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Liver Yin Deficiency

Chronic illnesses, overwork and sex can consume the essence and blood, resulting in yin deficiency. Deficient yin and lack of blood will fail to nourish the liver and its channel and collaterals, resulting in hypochondriac pain.

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XIE TONG (Hypochondriac Pain)

Bian Zheng Lun Zhi

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Main Bian Zheng Points

• Qi and Blood

Qi Stagnation Distending pain, moving, not persistent (sometimes minor and sometimes severe), related to emotional changes
Blood Stasis Stabbing pain, fixed, persistent, worse at night

• Excess and Deficiency

Pain History Palpation Figure Pulse
Excess Severe Short Dislike Strong Solid and strong
Deficiency Dull Long Like Weak Empty and weak


22.4.1 Lun Zhi

The aim of the treatments is to TONG (free flow of qi and blood). Using methods such as regulating qi, promoting blood movement, clear heat, resolving dampness and nourish yin and blood to achieve TONG.

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XIE TONG (Hypochondriac Pain)

Liver Qi Stagnation

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Liver Qi Stagnation

• Symptoms

Hypochondriac Pain: distending pain, moving from place to place, related to emotion
Other symptoms: chest distension, reduced food intake, frequent eructation with gas
Tongue and pulse: thin coating, wiry pulse

• Treatment

Principle: soothe the liver and regulate qi
Formula: Chai Hu Shu Gan San
Modifications: 1. Add qing pi, chuan lian zi, yu jin to reinforce regulation of qi and stopping pain. 2. With fire, take away chuan xiong, add mu dan pi, zhi zi, huang lian, chuan lian zi, yan hu; 3 with fire and yin deficiency, take away chuan xiong, add shou wu, zhi zi, mu dan pi, gou qi zi, ju hua.

• Complications

1. Liver qi invades the spleen transversely (Disharmony between Liver and Spleen): hypochondriac pain, noisy intestine and diarrhoea, abdominal distension and poor appetite – use Tong Xie Yao Fang to harmonise liver and spleen.
2. Liver qi invades the stomach transversely (Disharmony between Liver and Spleen): hypochondriac and epigastrium distending pain, nausea and vomit, frequent eructation – use Si Qi Tang to regulate liver and stomach qi.
3. Protracted liver qi stagnation: hypochondriac and abdominal moving and attacking pain, depression and worry – use Mu Xiang Shun Qi San (mu xiang, xiang fu, chen pi, qing pi, zhi ke, hou po, sha ren, wu yao, chuan xiong, cang zhu, rou gui, gan cao) with modifications.

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XIE TONG (Hypochondriac Pain)

Blood Stasis

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Blood Stasis

• Symptoms

Hypochondriac Pain: stabbing pain, fixed, worse at night
Other symptoms: masses under the rib
Tongue and pulse: dull purple tongue, deep and uneven pulse

• Treatment

Principle: promote blood movement, remove stasis and free up the collaterals
Formula: Xuan Fu Hua Tang (xuan fu hua, xin jiang (use qian cao as substitute), cong)
Modifications: 1. Add yu jin, tao ren, yan hu, dang gui to reinforce effects; 2. For severe cases, add Fu Yuan Huo Xue Tang (tao ren, hong hua, da huang, shan jia, dang gui, chai hu, tian hua feng, gan cao).

• Complications

1. With masses: use Da Qi Qi Tang (san leng, e zhu, chen pi, qing pi, xiang fu, huo xiang, rou gui, yi zhi, jie geng, gan cao, sheng jiang, da zao) and Shi Xiao San.
2. With blood stasis in chest – use Xue Fu Zhu Yu Tang.
3. With spleen blood stasis: hypochondriac and abdominal pain, large abdomen with ascites, varicose veins in abdomen, dull black complexion as if smoked, dull purple lips, spider naevi in neck, chest, upper arms and head and liver palms (palmar erythema) – use Tiao Ying Yin (chuan xiong, dang gui, chi shao, e zhu, chen pi, da fu pi, bing lang, yan hu, sang bai pi, fu ling, ting li zi, qu mai, da huang, xi xin, rou gui, gan cao).

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XIE TONG (Hypochondriac Pain)

Liver and Gallbladder Damp-Heat

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Liver and Gallbladder Damp-Heat

• Symptoms

Hypochondriac Pain: quite severe
Other symptoms: bitter mouth, chest distension, poor appetite, nausea and vomit, red and swollen eyes, with or without jaundice, dark and yellow urine
Tongue and pulse: yellow and greasy coating, wiry slippery and rapid pulse

• Treatment
Principle: clear heat and drain dampness
Formula: Long Dan Xie Gan Tang
Modifications: 1. Take away dang gui, sheng di huang, add chuan lian zi, yu jin, chen pi, ban xia; 2. Heat more than damp, constipation, add da huang, mang xiao; 3 damp more than heat, take away greasy herbs, add bai zhu, fu ling, yi yi ren, sha ren.

• Complications

1. Jaundice: add Yin Chen Hao Tang (see Huang Dan)
2. With gallstones: use Da Chi Hu Tang.
3. With ascariasis, use Wu Mei Wan.

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XIE TONG (Hypochondriac Pain)

Liver Yin Deficiency

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Liver Yin Deficiency

• Symptoms

Hypochondriac Pain: dull pain, aggravated by overwork and exertion
Other symptoms: dry mouth and throat, vexation, dizziness and blurred vision, tired
Tongue and pulse: red with little coating, wiry and thready or rapid pulse

• Treatment

Principle: nourish yin and soften the liver
Formula: Yi Guan Jian
Modifications: 1. Bad vexation, add zhi zi, suan zao ren; 2. Severe dizziness and blured vision, add huang jing, nu zhen zi, ju hua, gou teng.

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XIE TONG (Hypochondriac Pain)
a. Please describe the pathological relationships between 1. qi stagnation and blood stasis and 2. excess and deficiency in the context of Xie Tong.
b. What are the main symptoms of and how do you treat the following types of Xie Tong: qi stagnation and yin deficiency?

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