radiate towards the right or left costal margin, only if it starts in the epigastric area (i.e. roughly
over the stomach) is it classified as epigastric pain.

Aetiology and Pathology

External Pathogenic Factors

Cold

External Cold can invade the Stomach directly, by-passing the skin and muscle energetic layers.
As Cold contracts, it causes an acute and severe epigastric pain usually accompanied by
vomiting. The tongue has a thick white coating and the pulse is Tight. This is an acute condition.

The "Simple Questions" in chapter 39 says: "Cold invades the Stomach and Intestines ... Blood
cannot move, the Connecting channels are blocked and hence pain results."1(371)

Dampness

External Dampness can also invade the Stomach directly. This may be combined with either
Cold or Heat according to season. During the summer months it is more likely to occur as
Damp-Heat.

Dampness obstructs the descending of Stomach-Qi and causes a dull pain and nausea. It also
causes a typical feeling of oppression and heaviness of the epigastrium. The tongue has a sticky
coating (white or yellow according to whether Dampness combines with Cold or Heat) and the
pulse is Slippery.

Dampness is a more frequent cause than Cold in acute stomach disorders, including food
poisoning and many bacterial or viral infections affecting the stomach (manifesting with
epigastric pain, fever, nausea and vomiting).

Diet

Diet is obviously the most important factor in Stomach disorders. The Stomach rots and ripens
food: the Spleen transforms and transports the refined Food Essence up towards the Lungs,
whilst the Stomach sends the waste down to the Intestines. The downward movement of
Stomach-Qi is coordinated with the upward movement of Spleen-Qi, and the two together are
absolutely crucial to ripen, transport and transform food essences and wastes in the Middle
Burner.