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HIATUS HERNIA

GENERAL

Clinical Manifestations
Treatment Principle
Herb Formulas	For complex or confusing patterns with multiple pathology: Yue Ju Wan + Zuo Jin Wan
Points	REN-14, REN-17, REN-22, ST-36

SPLEEN AND STOMACH QI STAGNATION

Clinical Manifestations	Chest and abdominal distention A stifling sensation in the chest and abdomen Fixed pain in the hypochondria Belching with a fetid odor Nausea Vomiting Epigastric and abdominal fullness and pain Acid reflux Mild coughing with copious sputum Reduced appetite Indigestion T: Normal C: Thin and white or Greasy or Slippery, P: Wiry and taut or Running
Treatment Principle	Regulates Qi in the Spleen and Stomach
Herb Formulas	Yue Ju Wan modified
Points

SPLEEN AND STOMACH QI/YANG DEFICIENCY

Clinical Manifestations	Intermittent or continuous abdominal distention, fullness and discomfort Distention is improved by warmth and pressure and worse when eating raw or cold foods Intermittent, chronic acid reflux and heartburn which are worse with hard to digest or raw foods, bending or any increase in abdominal pressure May wake during the night with heartburn Mild epigastric pain or discomfort which is better with warmth and pressure Hypersalivation Drooling Sour belching Poor appetite Easily satiated Fatigue Weak, tired limbs Loose stools or Diarrhea or A tendency toward sluggish bowel movements Puffiness around the eyes or in the fingers Rapid weight fluctuations A pale, sallow face and lips Shortness of breath Reluctance to speak A weak, soft voice Intolerance of Cold Cold extremities T: Pale or Pale and swollen with teeth marks C: White P:Weak and thready or Deficient or Big and Weak
Treatment Principle	Tonify Qi Strengthen the Spleen Facilitate the Raising of Qi and the descent of the turbid
Herb Formulas	Bu Zhong Yi Qi Tang modified Xiang Sha Liu Jun Zi Tang modified Chinese Patent Medicines: Bu Zhong Yi Qi Wan Xiang Sha Liu Jun Zi Wan Jian Pi Wan With Qi Stagnation: Xiang Sha Yang Wei Wan With Yang Deficiency: Li Zhong Wan With Excess acid: Wei Te Ling (combine with any of the above) For symptomatic relief: Xiang Lian Wan (combine with any of the above)
Points	LIV-13, REN-6, REN-12, SP-3, SP-6, SP-15, ST-25, ST-36, UB-20, UB-21 For severe distention: + SP-1 With Fluid retention and edema: + SP-9, ST-28 With Liver Qi Stagnation: + LIV-3, PC-6 PC-6, REN-12, REN-13, REN-17, SP-6, ST-36, UB-20, UB-21 With Phlegm-Damp: + PC-5, SP-3, ST-40 Ear: 1. Spleen, Stomach, Large Intestine, Small Intestine, Abdomen 2. Spleen, Stomach, Esophagus, Pylorus, Shenmen, Adrenal, Subcortex, Sympathetic

SPLEEN AND STOMACH QI DEFICIENCY WITH PHLEGM-DAMP AND LIVER QI STAGNATION

Clinical Manifestations	Focal distention and discomfort in the epigastrium and upper abdomen Distention worse after eating Anorexia Decreased sense of taste Only able to eat a little at a time Generalized weakness T: Pale C: Thick and white P: Slippery, deep and wiry
Treatment Principle	Strengthen the Spleen Harmonize the Stomach Dry Dampness Transform Phlegm Relieve distention
Herb Formulas	Xiang Sha Liu Jun Zi Tang modified
Points	LIV-13, REN-6, REN-12, SP-3, SP-6, SP-15, ST-25, ST-36, UB-20, UB-21 For severe distention: + SP-1 With Fluid retention and edema: + SP-9, ST-28 With Liver Qi Stagnation: + LIV-3, PC-6 Ear: Spleen, Stomach, Large Intestine, Small Intestine, Abdomen

SPLEEN AND STOMACH QI DEFICIENCY WITH HEAT AND COLD

Clinical Manifestations	A sensation of blockage, distention, fullness and discomfort in the epigastrium When palpated, feels soft and without pain Nausea Vomiting or Dry retching Borborygmus with diarrhea Poor appetite T: Normal C: Greasy and yellow P: Soft, slippery, slightly wiry and maybe rapid
Treatment Principle	Harmonize the Stomach Descend Qi Disperse Accumulation
Herb Formulas	Ban Xia Xie Xin Tang
Points	LIV-13, REN-6, REN-12, SP-3, SP-6, SP-15, ST-25, ST-36, UB-20, UB-21 For severe distention: + SP-1 With Fluid retention and edema: + SP-9, ST-28 With Liver Qi Stagnation: + LIV-3, PC-6 Ear: Spleen, Stomach, Large Intestine, Small Intestine, Abdomen

SPLEEN AND STOMACH DEFICIENCY COLD

Clinical Manifestations	Severe, unrelenting or intermittent abdominal distention that is progressively worse as the day goes on which may be difficult to bear in the evening The abdomen may appear swollen or the patient may feel that the clothing is tight The distention is worse with eating, exposure to Cold and when fatigued Mild constant epigastric or abdominal pain which is relieved by warmth and pressure Cold intolerance Anorexia Easily satiated Abdominal pain and fullness after meals Nausea / vomiting Loose, unformed stools or Diarrhea with undigested food in the stools or Sluggish bowel movements with no urge to defecate Excessive salivation Cold limbs Fatigue Lassitude Weakness Exhaustion Sallow or pale, dull complexion Puffiness around the eyes or in the fingers Quick weight fluctuations Maybe edema Maybe scanty urination Maybe clear, watery, copious vaginal discharge T: Pale or Pale and swollen with teethmarks C: White and greasy P: Deep, thready and forceless or Deep, weak and slow
Treatment Principle	Warm Yang Strengthen the Spleen Warm the Center Dispel Cold
Herb Formulas	Zhi Shi Li Zhong Wan Chinese Patent Medicines: Fu Zi Li Zhong Wan Li Zhong Wan
Points	Moxa or moxa needle DU-4, REN-4, REN-6, REN-12, SP-6, SP-15, ST-25, ST-36, UB-20, UB-21, UB-23 With severe distention: + SP-1 With fluid retention and edema: + REN-9, SP-9 With Liver Qi Stagnation: + LIV-3, PC-6 Ear: Spleen. Stomach, Large Intestine, Abdomen, Adrenal

STOMACH QI DEFICIENCY WITH TURBID PHLEGM OBSTRUCTION

Clinical Manifestations	Severe, constant abdominal distension Relentless belching Severe hiccup Relentless acid reflux Unremitting regurgitation Unremitting nausea and vomiting of saliva and Phlegm Vomiting soon after eating Hard epigastric distention Poor appetite Edema Chest and hypochondriac distension Dizziness Thirst but doesn't wish to drink Maybe no thirst Palpitations Shortness of breath Frequent salivation Frequent urination T: Pink C: Thick, white and slippery or White and smooth P: Slippery and full and maybe wiry or Wiry and deficient or Wiry, taut and feeble
Treatment Principle	Eliminate Dampness Resolve Phlegm Descend Qi
Herb Formulas	Xuan Fu Dai Zhe Tang
Points	ST-40, SP-6, SP-9, SJ-6, PC-6, UB-13, UB-20, UB-23

STOMACH AND LIVER YIN DEFICIENCY

Clinical Manifestations	Chronic acid reflux, hyperacidity and heartburn Symptoms may be worse in the evening and with stress The patient may wake with symptoms during the night which may be temporarily relieved by eating Mild, dull epigastric or hypochondriac pain or discomfort Anorexia or Intermittent gnawing hunger Dry mouth and throat Dry stools or Constipation T: Red and dry C: Little or None P: Thready, wiry and rapid
Treatment Principle	Nourish and supplement Liver and Stomach Yin Regulate Qi Descend Qi Harmonize the Stomach
Herb Formulas	Yi Guan Jian modified Chinese Patent Medicines: Gu Ben Wan With Excess acid: Wei Te Ling (combine with any of the above) For symptomatic relief: Xiang Lian Wan (combine with any of the above)
Points	KI-9, LIV-13, PC-6, REN-12, ST-36, UB-20, UB-21 Ear: Esophagus, Pylorus, Spleen, Liver, Stomach, Shenmen, Subcortex, Sympathetic

PHLEGM AND HEAT ACCUMULATION BENEATH THE HEART

Clinical Manifestations	Focal distention in the chest and epigastrium with or without nodules which is painful when pressed Coughing up yellow, viscous sputum Constipation A bitter taste in the mouth T: Normal C: Yellow and greasy P: Slippery and floating or Slippery and rapid
Treatment Principle	Clear Heat Transform Phlegm Expand the chest Dissipate Stagnation
Herb Formulas	Xiao Xian Xiong Tang
Points

LIVER QI STAGNATION INVADES THE STOMACH

Clinical Manifestations	Recurrent acid reflux (worse when emotionally upset) Epigastric pain (worse when emotionally upset) Frequent belching with acid regurgitation Nausea in the morning Vomiting Anorexia Hypochondriac or epigastric distention, pain, tenderness ache or discomfort Epigastric or abdominal bloating Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Moodiness Anxiety Frequent worrying Inappropriate anger Dizziness Tension headaches Shoulder and neck tension Cold fingers and toes Irregular menses Dysmenorrhea Breast distention and pain before and during menses Alternating constipation and loose stools T: Pink or Darkish C: Thin and white P: Wiry
Treatment Principle	Soothe the Liver Harmonize the Stomach Descend Stomach Qi
Herb Formulas	Si Ni San modified Chai Hu Shu Gan Tang modified For women: Xiao Yao San + Zuo Jin Wan Chinese Patent Medicines: Chai Hu Shu Gan Wan Xiao Yao Wan With epigastric pain: Shu Gan Wan With stagnant Heat: Jia Wei Xiao Yao Wan For symptomatic relief of heartburn: Wei Te Ling (combine with other appropriate formulas)
Points	LIV-13, LIV-14, PC-6, REN-12, ST-36, ST-44 GB-34, LIV-3, LIV-5, LIV-13, PC-6, REN-6, REN-12, ST-25 For calming the Shen: + DU-19, DU-24, Yintang For Blood or Yin Deficiency: + SP-6, ST-36, UB-18, UB-23 For Phlegm or plum pit Qi Stagnation: + PC-5, SP-3, ST-40 For fat intolerance, pale or pasty stools, and right side hypochondriac pain and distention: + Dannangxue, GB-24, GB-40 PC-6, REN-12, ST-36 LIV-13, LIV-14, PC-6, REN-12 LI-10, LIV-3, PC-6, REN-12, REN-13, REN-17, ST-36, UB-18, UB-19, UB-21 With lateral headaches and neck tension: + GB-34 With hypochondriac pain: + LIV-14 With Gall Bladder involvement: + Dannangxue, GB-24, GB-40 With Heat in the Liver: + LIV-2 With Spleen Deficiency: + UB-20 With Phlegm or Plum-Pit Qi Stagnation: + PC-5, SP-3, ST-40 With dizziness: + GB-20 With Shen disturbance: + one or two of the following: DU-19, DU-24, HT-7, Yintang GB-34, LI-10, LIV-3, LIV-13, PC-6, REN-12, ST-36, UB-18, UB-19, UB-21 With lateral headaches and neck tension: + GB-21 With hypochondriac pain: + LIV-14 With Gall Bladder involvement: + Dannangxue, GB-24, GB-40 With Heat in the Liver: + LIV-2 With Spleen Deficiency: + UB-20 With Phlegm or Plum-Pit Qi Stagnation: + PC-5, SP-3, ST-40 With dizziness: + GB-20 With Shen disturbance: + one or two of the following: DU-19, DU-24, HT-7, Yintang Ear: 1. Esophagus, Pylorus, Liver, Spleen, Stomach, Shenmen, Subcortex, Sympathetic 2. Liver, Stomach, Subcortex, Sympathetic, Shenmen

LIVER QI STAGNATION INVADES THE STOMACH WITH HEAT

Clinical Manifestations	Hypochondriac pain and distention Indeterminate gnawing hunger Epigastric distention and pain Vomiting Acid regurgitation Belching Bitter taste Dry mouth Nausea Dry lips Hiccups T: Red C: Yellow P: Wiry and rapid
Treatment Principle	Clear Liver Heat (Fire) Descend Rebellious Qi Stop vomiting
Herb Formulas	Zuo Jin Wan Jia Wei Xiao Yao San modified
Points

LIVER QI STAGNATION: PHLEGM AND QI STAGNANT AND BLOCKED

Clinical Manifestations	Feeling of obstruction in throat as if a slice of roast meat were stuck there which cannot be coughed up nor swallowed down. This sensation becomes more prominent during emotional upset and subsides when relaxed Recurrent acid reflux, heartburn or regurgitation Distention and pain in the sides or flanks Suffocating sensation in the chest and epigastrium Belching Nausea Vomiting Dry mouth and throat Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white or Greasy and white P: Slippery and wiry (slippery due to Phlegm)
Treatment Principle	Spread Qi Resolve Phlegm
Herb Formulas	Qi Ge San modified
Points	LI-18, LIV-3, PC-5, SI-17, SJ-6 LI-10, LIV-3, PC-6, REN-12, REN-13, REN-17, ST-36, UB-18, UB-19, UB-21 With lateral headaches and neck tension: +GB-34 With hypochondriac pain: + LIV-14 With Gall Bladder involvement: + Dannangxue, GB-24, GB-40 With Heat in the Liver: + LIV-2 With Spleen Deficiency: + UB-20 With Phlegm or Plum-Pit Qi Stagnation: + PC-5, SP-3, ST-40 With dizziness: + GB-20 With Shen disturbance: + one or two of the following: DU-19, DU-24, HT-7, Yintang Ear: Esophagus, Pylorus, Liver, Spleen, Stomach, Shenmen, Subcortex, Sympathetic