This is more common in men over 40. The epigastric pain has a sudden onset and is severe,
gradually increasing. It may radiate to the back. There is also nausea, retching and vomiting
which is relieved by sitting up and bending slightly forward.
The patient looks distressed and under shock and in 25% of cases there is jaundice from pressure
of the head of the pancreas on the common bile duct.
Cancer of the Pancreas
This is more common in men between 50 and 70. The epigastric pain starts as a dull ache which
is worse lying down and at night. The patient is increasingly tired and there is vomiting, anorexia
and loss of weight.
Large Intestine
Appendicitis
In a few cases, appendicitis may start with epigastric pain. However, it soon extends to the lower
abdomen or umbilical area. For a description of the symptoms and signs see under "Abdominal
pain" (Chapter 16).
Irritable Bowel
More than a proper diagnosis, this term tends to be a catch-all for all cases of abdominal pain
which do not have another explanation. It is important to remember, however, that in about 42%
of cases, irritable bowel may present with epigastric pain (see also Chapter 16 on "Abdominal
pain"). However, it is equally important to bear in mind that, from the perspective of Chinese
diagnosis, if the pain is in the epigastric region, it definitely indicates a Stomach pathology, and,
in any case, the Stomach is closely related to the Large Intestine within the Bright Yang.
Gall-Bladder
Gall Stones
Impaction of a gall stone sometimes presents with severe epigastric pain and vomiting. Sooner or
later, however, the pain shifts to the right hypochondrial region.