of Qi and retention of food.

Over-Exertion

Physical over-exertion weakens the Stomach and Spleen and may lead to a dull epigastric pain,
tiredness and weak muscles. It usually causes Stomach-Qi deficiency.

Overwork

Mental overwork, working long hours and eating irregularly over several years cause deficiency
of Stomach-Yin. This can manifest with cracks such as shown in Figure 12.3(374) in the chapter
on "Tiredness" (Chapter 12). After many years, the tongue will lose its coating entirely and
become Red.

Constitutional Weakness

An inherited constitutional weakness of the Stomach is obviously a potential cause of stomach
disorders. Such an inherited weakness manifests with digestive problems in early childhood such
as poor appetite, vomiting or diarrhoea, and possibly also with weak and flabby muscles, low
energy and a crack such as that shown in Figure 12.3(375) mentioned above.

Wrong Treatment

When used wrongly, Chinese herbs can injure the Stomach and Spleen. An excessive or wrong
use of bitter-cold or moving-downward herbs can injure Stomach-Qi or Stomach-Yin and lead to
epigastric pain.

Of course, the side-effects of very many Western drugs are also a frequent cause of epigastric
pain. Anti-inflammatory agents used for rheumathoid arthritis are a particular case in point.

Diagnosis

Diagnostic symptoms and signs in epigastric pain include the nature, time and amelioration or
aggravation of the pain.

Nature of Pain

• Severe: Excess condition


• Dull: Deficiency condition


• Stabbing: stasis of Blood