Qian Lin-chao, Zhou Ran-mi, Xi Sheng-yan

Department of Traditional Chinese Medicine, Medical College of Xiamen University, Fujian 361005, China

Forty-five Cases with Epigastric Pain Treated with Puncturing Hegu (LI 4)

Qian Lin-chao, Zhou Ran-mi, Xi Sheng-yan

Department of Traditional Chinese Medicine, Medical College of Xiamen University, Fujian 361005, China

Point, Hegu (LI 4); Acupuncture-moxibustion Therapy; Acupuncture Therapy; Acupressure; Epigastric Pain; Gastritis; Stomach Ulcer; Duodenal Ulcer

Epigastric pain, also known as stomach pain, is presented with frequently recurrent pain in the upper abdomen or stomach area, which is mainly caused by exogenous pathogen, improper diet or internal injuries due to seven emotions[1]. All 45 cases with epigastric pain caused by various factors were treated with mainly needling Hegu (LI 4) between November 2010 and November 2012, and the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria were accorded with the epigastric pain diagnosis in the Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine[2]. Epigastric pain is often accompanied by many symptoms such as stomach fullness or distention, eructation, acid regurgitation, gastric upset, nausea and vomit; its morbidity is associated with moodiness, improper diet, fatigue and catching a chill; barium X-ray examination of the upper gastrointestinal tract, fibergastroscope and biopsy examinations show mucosal inflammation or ulcer lesions of stomach or duodenum.

1.2 General materials

All 45 cases were outpatients, including 30 males and 15 females; was aged from 12 to 50 years old. Shortest duration was 1 d, while the longest one was up to 2 months. According to syndrome differentiation in traditional Chinese medicine (TCM), 20 cases were diagnosed as food retention, 8 cases were unclean diet, and 10 cases were liver and stomach qi stagnation, and 7 cases were cold pathogen attacking the stomach.

2 Treatment Method

Major acupoints: Bilateral Hegu (LI 4).

Operation: The patient was in a sitting or a supine position. After routine disinfection of the local skin, disposable sterile filiform needles of 0.32 mm in diameter and 40 mm in length were inserted perpendicularly 0.5-1 cun into the skin. After arrival of qi, even reinforcing-reducing manipulations were performed, so that there was local sense of soreness and distention, which can be radiated to ipsilateral thumb, index finger or forearm. The needles wereretained for 20-30 min each time, and the patients were treated once a day or once every other day according to the severity of disease, and seven times constituted a course of treatment. Meanwhile, the patients were asked to Qia-Pinch and An-Press Hegu (LI 4) from left to right hand by the thumb pulp 3-5 times a day after acupuncture treatment.

Syndrome differentiation treatment: For patients with cold food overeating or cold attacking the stomach, suspended moxibustion was applied to Shenque (CV 8) and bilateral Zusanli (ST 36) for 3-5 min till the skin became heat and flushing. Those patients who had a history of eating unclean food took 0.2 g Verberine Hydrochloride, 3 times a day, and the treatment lasted for 3 d. For patients with liver and stomach qi stagnation, Taichong (LR 3) and Zhongzhu (TE 3) were added to puncture. For patients with indigestion, Zhongwan (CV 12) and Tianshu (ST 25) were added to puncture.

3 Observation on Curative Effect

3.1 Criteria of therapeutic effect

With reference to the effect evaluation criteria of epigastric pain in the Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine[2].

Cure: Epigastric pain and other symptoms disappear.

Improved: Epigastric pain relief, pain attacks frequency decreases and other symptoms are relieved.

Failure: There is no improvement of symptoms.

3.2 Therapeutic results

Twenty-six cases were cured, accounting for 57.7%; fifteen cases were markedly effective, accounting for 33.3%; four cases showed no improvement, accounting for 9%; and the total efficacy rate was 91%.

3.3 Case study

A 36-year old male patient firstly visited on June 9, 2010, who was a teacher.

The chief complaint and history of present illness: The patient had over taken raw and cold fruits recently, and drank a cup of cold drink 1 h before epigastric pain occurred. He had vomited twice, and the pain repeated from time to time even though he took the painkillers. The pain gradually became severe and was accompanied by nausea and vomit after breakfast on the visiting day.

Physical examination: Acute suffering face, abdomen was soft; epigastric tenderness; Murphy’s sign was negative, and there was no Michael’s point tenderness and rebound tenderness; the tongue was pink with thick and greasy light yellow coating, and the pulse was wiry and slippery.

TCM diagnosis: Epigastric pain (the syndrome of cold pathogen attacking the stomach).

Western Diagnosis: Acute simple gastritis.

Course of treatment: His bilateral Hegu (LI 4) were punctured. When the needles were inserted, he had a sense of soreness and distention in the local areas as well as a feeling radiation to ipsilateral thumb and index finger, and needles were retained for 20 min. The needles were manipulated 3 times to enhance the needling sensation during the retaining. Meanwhile, suspended moxibustion therapy was applied to bilateral Zusanli (ST 36) for 5 min until the acupoints’ skin turned to hot and flushing. The patient’s pain disappeared after acupuncture for 10 min, a variety of symptoms relieved. And the patient was asked to Qia-Pinch and An-Press Hegu (LI 4) by the thumb pulp from left to right hand after removing needles, 3-5 times a day, 3-5 min each time. The patient visited for the second time on June 10th, 2010. His epigastric pain relieved obviously, and recurred less frequently, and there were no symptoms such as stomach distention and fullness, nausea and vomit. And the patient was treated wit the method mentioned above including puncturing bilateral Hegu (LI 4) as well as suspended moxibustion on both Zusanli (ST 36). And the patient’s third visiting was on June 12, 2010, telling epigastric pain relief with poor appetite. He was also treated as before to strengthen the stomach and activate spleen.

4 Experiences

Epigastric pain in TCM includes acute and chronic gastric and duodenal mucosal inflammation, ulcer and other diseases in modern medicine, often due to improper diet, overeating or eating contaminated food or drinking too much cold water, or cold pathogen invading gastrointestine, or the improper emotions causing dysfunction of the liver in regulaing qi, thus the liver qi attacking the stomach and spleen. Puncturing Hegu (LI 4) for patients with epigastric pain is efficient, its prominent advantage is the significant analgesic effect and rapid efficacy, and sometimes, the pain can obviously relieve once the needle is inserted. Many patients have flatus after qi arrival of acupuncture, then epigastric pain and nausea instantly relieve.

Acupuncture can cure diseases due to its role to regulate yin and yang as well as to eliminate pathogen and strengthen vital qi, and puncturing the acupoints can improve the body’s resistance to disease[3]. Hegu (LI 4) is the Yuan-Primary acupoint of the Large Intestine Meridian of Hand Yangming, and the Large Intestine Meridian interlinks with the Stomach Meridian of Foot Yangming. Therefore, these two meridians qi can communicate with each other. The meridian also interrelates with the stomach and spleenby diaphragm. That is why Hegu (LI 4) is not only good at regulating the qi of the Large Intestine Meridian, but also can regulate the stomach qi and promote spleen invigoration. Thus puncturing Hegu (LI4) is able to remove the obstruction of Zang-fu organs and descend qi, as well as to regulate spleen and stomach to kill the pain. Some studies suggested that the mechanism was that puncturing Hegu (LI 4) leads to the activation and inhibition of the pain corresponding areas of brain function, regulation of interactions between nuclei and the neural pathway, and release of chemicals and hormones to the target organs through the changes of meridian substance, energy and information[3-4].

Because Zusanli (ST 36) is the He-Sea acupoint of the Stomach Meridian of Foot Yangming, moxibustion on Zusanli (ST 36) can improve the spleen’s transformation and transportation, as well as regulate the qi movement of the stomach. Besides, it can play a more important role in strengthening the foundation and cultivating the root, and can strengthen spleen and tonify stomach when accompanied by puncturing Hegu (LI 4). Taichong (LR 3) is the Yuan-Primary acupoint of the Liver Meridian of Foot Jueyin and Zhongzhu (TE 3) is the Shu-Stream acupoint of the Triple Energizer Meridian of Hand Shaoyang. The two acupoints can work together to dredge liver qi and relieve depression as well as to clear liver fire. They have an effect of smoothing the liver and regulating the stomach when accompanied by puncturing Hegu (LI 4). Patients who have the syndrome of eating unclean food are treated with oral Berberine Hydrochloride to clear away heat and toxic material, and eliminate dampness. Zhongwan (CV 12) and Tianshu (ST 25) are local acupoints. Puncturing them can enhance the digestion and absorption functions of the spleen and stomach. After acupuncture, patients are asked to Qia-Pinch and An-Press Hegu (LI 4), which is a kind of finger pressure therapies, and the method is simple and easy to operate, and can consolidate the curative effect by repeated stimulation to the acupoints to sustainably produce the effect. According to the previous reports, puncturing Hegu (LI 4) to treat acute simple gastritis was effective[5], this study confirmed that acupuncturing Hegu (LI 4) is effective for epigastric pain, thus it is worthy of clinical popularization and in-depth research.

[1] Fan YH, Fang XL. Clinical observation on treatment of gastralgia by superficial puncture. Shanghai Zhenjiu Zazhi, 2007, 26(11): 18-19.

[2] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 6.

[3] Zhang XT, Ji ZP, Huang JS. Research on Acupuncture and Acupuncture Anesthesia. Beijing: Science Press, 1986: 348-354.

[4] Xu JY, Wang FQ, Wang H, Shan BC, Lǚ J, Ma Y. Control study on effects of acupuncture at Hegu (LI 4) and Taichong (LR 3) points on fMRI cerebral function imaging. Zhongguo Zhenjiu, 2004, 24(4): 263-265.

[5] Qian LC. Twenty-two cases with acute simple gastritis treated with puncturing Hegu (LI 4). Shanghai Zhenjiu Zazhi, 2006, 25(7): 47.

Translator: Deng Ying

R246.1

B

Date: December 12, 2012

Author: Qian Lin-chao, bachelor, associate professor.

Zhou Ran-mi, bachelor, professor. E-mail: rmzhou@xmu.edu.cn