A. Syndrome differentiation
(a) Differential diagnosis:
Stomach ache should be distinguished from angina pectoris, hypochondriac pain and abdominal pain. Although angina pectoris is a disorder of the heart meridians characterized by precordial pain, it occasionally manifests itself as an epigastric pain. In this case, it may be differentiated by the colicky character of its pain and its accompanying symptoms such as suffocative sensation, sweating, coldness of limbs, indistinct pulse, etc. Stomach ache caused by liver-qi attacking the stomach may manifest itself as a radiating pain to the hypochondria, but the epigastrium is the primary painful site. Abdominal pain may complicate with stomach ache, and the two disorders can be distinguished from each other by the analysis of their causes and the accompanying symptoms.
(b) Differentiation between asthenia and sthenia syndromes:
The asthenia-syndrome of stomache is characterized by a sudden onset, a prolonged course with intermittent relief and pain relievable by pressure and warmth. This type is mostly due to deficiency of spleen-yang and stomach-yang or insufficiency of stomach-yin and is difficult to cure. The sthenia-syndrome of stomach ache is marked by an insidious onset, a short course and pain associated with tenderness. This type usually results from retention of cold in the stomach, immoderate eating and drinking, an attack of liver-qi on the stomach or stagnation of blood in the stomach, and it responds well to medication. Moreover, cases with hemorrhage due to the involvement of collaterals by blood stasis commonly manifest themselves as a primary asthenia-syndrome and a secondary sthenia-syndrome.
B. Therapeutic principles
Regulating qi circulation and the stomach and arresting pain are the general therapeutic principles for stomach ache, which may be modified according to the cause and the presenting syndrome of the individual case.