Stomachache

　　Common causes of stomachache include cold-evil attacking the stomach, dietary injury to the stomach, liver qi attacking the stomach, and weak spleen and stomach. The stomach is responsible for receiving and digesting food, if cold-evil invades the stomach, it will congeal and not disperse, block the flow of Qi, leading to disharmony of stomach Qi and pain, or due to irregular diet, overeating, or overindulgence in sweet and greasy foods, food retention and indigestion, Qi flow is blocked, and the stomach loses its harmony and descent, causing stomachache; the liver has a draining and releasing effect on the spleen and stomach, if due to anger and depression, Qi stagnation injures the liver, the liver loses its smoothness, it invades the stomach horizontally, and stomachache can also occur; if due to internal injury from overwork and exhaustion, or chronic illness with weak spleen and stomach, or insufficient endowment, deficiency of middle Yang, the stomach loses warmth and nourishment, internal cold grows, and the middle burner is虚寒 and painful; there are also cases where Qi stagnation persists for a long time, blood stasis internally, Qi stagnation and blood stasis, blocking the Qi flow of the middle burner, leading to the onset of stomachache. In summary, the pathogenesis of stomachache is divided into two extremes, the实证 (manifestation) is Qi stagnation, blockage leads to pain; the 虚证 (deficiency) is the stomach losing warmth or nourishment, lack of nourishment leads to pain.

　　The causes of abdominal pain include: first, due to worry, anger, and liver qi disorder, which leads to horizontal invasion of the stomach, so the treatment method is to relieve the liver and regulate the qi. Second, it is caused by the spleen not being healthy and the stomach losing harmony, so it is advisable to use warm and permeating, and moderate methods to restore the function of the spleen and stomach. There are many causes of abdominal pain, including overwork, irregular eating, working or exercising immediately after eating, excessive alcohol consumption, eating too spicy, often eating indigestible food, and so on. Abdominal pain may have several factors, but most are caused by gastroesophageal reflux. That is, the liquid originally in the stomach reverses into the esophagus. These digestive juices contain hydrochloric acid (hydrochloric acid), which is used in industry to clean metal. Although the stomach has a protective layer to prevent erosion by gastric acid, the esophagus lacks this protective layer. Due to worry, anger, and liver qi disorder, leading to the treatment method is to relieve the liver and regulate the qi. Second, it is caused by the spleen not being healthy and the stomach losing harmony, so it is advisable to use warm and permeating, and moderate methods to restore the function of the spleen and stomach.

　　Taking painkillers when abdominal pain occurs cannot relieve the symptoms and may even worsen the condition, leading to serious upper gastrointestinal complications such as gastric ulcer, gastric hemorrhage, and gastric perforation. The acidic digestive fluid in the stomach takes the opportunity to invade the gastric wall, causing ulcers, erosions, and even leading to gastric perforation. In addition, some symptoms accompany abdominal pain:

　　1. Abdominal pain accompanied by hemoptysis suggests thoracic diseases: such as bronchiectasis, inflammation, tuberculosis, foreign body injury, abscess, tumor, parasites, cystic silicosis, in situ cancer and metastatic cancer, pulmonary congestion and pulmonary infarction. Bronchopleural fistula, hemopathy, esophageal disease, nephrotic syndrome. Idiopathic pulmonary hemosiderosis, endometriosis, and so on.

　　2. Abdominal pain accompanied by hematemesis often suggests esophageal and gastric, duodenal, upper jejunum gallbladder, and systemic diseases, such as portal hypertension, bleeding esophagitis, cholecystitis, acute hemorrhagic gastritis due to foreign body injury, gastric and duodenal polyps, gastric prolapse, stress ulcer, advanced bleeding from gastric tumors, duodenal vascular disease, systemic diseases, and hemolytic diseases, etc.

　　3. Abdominal pain accompanied by fever, abdominal pain accompanied by fever indicates inflammatory lesions in the visceral cavity of the stomach, such as acute gastritis, appendicitis, pancreatitis, etc.; if fever occurs before abdominal pain, it may suggest internal diseases such as pneumonia, primary pneumonia, pleurisy, tuberculous pleurisy, epidemic hemorrhagic fever, primary gastric mucosa, and so on.

　　4. Abdominal pain accompanied by abnormal urination, such as abdominal pain with oliguria and anuria, or frequent urination, urgency, hematuria, purulent urine, often suggests urinary system inflammation. Causes may include trauma, calculi, tumors, congenital diseases, etc. For example, various traumatic diseases may lead to abdominal pain with acute renal failure, nephritis, renal and ureteral bladder calculi, tuberculosis, benign and malignant tumors of the urinary system, wandering kidney, and so on.

　　5. Stomachache accompanied by abnormal defecation, non-defecation and non-flatus is common in various types of intestinal obstruction; stomachache with diarrhea is common in acute gastroenteritis and dysentery; stomachache accompanied by melena is seen in pediatric intussusception, adult colitis, polyp pain, appendicitis, ulcer, etc.; accompanied by melena is common in mesenteric vascular thrombosis or embolism, strangulated intestinal obstruction, intestinal vascular tumor rupture, necrotizing enteritis, etc.

　　6. Stomachache accompanied by nausea and vomiting is common in various types of intestinal obstruction (obstruction torsion, intussusception, perforation into the pylorus of the stomach, gastritis. Ulcer, cancer torsion, perforation), cardia inflammation tumor, hemorrhage, spasm, etc. In addition, there are acute gastritis, gastric and duodenal ulcer, duodenitis, acute gastroenteritis, acute appendicitis, acute pancreatitis, acute cholecystitis and cholangitis, and gallstone cholangitis, acute bilious jaundice, etc.

　　Stomachache is a common symptom in clinical practice, often seen in acute and chronic gastritis, gastric and duodenal ulcer diseases, and gastric neurosis. It is also seen in diseases such as gastric mucosal prolapse, gastric ptosis, pancreatitis, cholecystitis, and cholelithiasis. Symptoms such as belching, bloating, nausea, vomiting, diarrhea, chest tightness, etc. Since each disease has different symptoms, chest tightness, heartburn, regurgitation of acid, and belching, etc.

　　(1) Liver Qi attacking the Stomach:Stomach distension and pain, attack and pain, pain in the chest connects with the ribs, chest tightness and belching, liking to sigh deeply, constipation, relief after belching and flatus, pain exacerbates or becomes severe when encountering烦恼 and anger, thin white coating, wiry pulse.

　　(2) Food Stagnation:Stomach pain, distension and resistance to palpation, belching and swallowing acid, or vomiting undigested food, with a foul smell, pain decreases after vomiting, loss of appetite, loose stools, relief after flatus and defecation, thick and greasy coating, slippery pulse.

　　(3) Stagnation of Liver and Stomach Heat:Stomach pain with burning sensation, urgent pain, irritability, acid regurgitation, dry and bitter mouth, red tongue with yellow fur, and wiry and rapid pulse.

　　The mechanism and symptoms of stomachache: 1. The location of the pain: The stomach is located in the upper abdomen, below the sternum, and above the navel (close to the heart窝). If the abdomen is divided into four areas to look at, the pain in the upper middle part of the left side is most likely to be stomachache. However, it may also be caused by diseases such as esophagitis, duodenal ulcer, gallbladder, liver, or pancreas, so the time of pain and accompanying symptoms should also be used as a criterion for judgment. 2. The time of pain: Is stomachache after or before meals? After eating certain foods? Or in situations of overeating or under-eating? Since most stomach discomfort is closely related to eating, using the time, habits, content, and type of diet as a criterion for differentiation is also relatively accurate. 3. Observation of symptoms: Stomach discomfort is accompanied by a variety of symptoms, such as belching, bloating, nausea, vomiting, diarrhea, chest tightness, etc. Since each disease has different symptoms, if accompanied by chest tightness, heartburn, regurgitation of acid, belching, and other symptoms, it may be esophageal disease; if accompanied by空腹 pain, fullness and hunger pain, belching with acid taste, or even vomiting blood, it may be gastric ulcer. However, if there are symptoms such as belching, jaundice, and fever, they may be unrelated to the stomach or a problem with the gallbladder. Therefore, the various symptoms accompanying abdominal pain cannot be ignored.

　　1. Pay attention to daily diet and health care, and pay attention to exercise and rest.

　　2. Have a regular diet, prevent overeating and overdrinking, and eat easily digestible foods. Avoid cold, coarse, hard, sour, and spicy foods that irritate the stomach.

　　3. Try to avoid stress and anxiety, and maintain an optimistic mood.

　　4. Massage and acupressure: Every day, knead the lower leg, location: the muscle part on the medial 1/3 of the lower leg (medial edge of the gastrocnemius). Method: Use the hands to grasp the above-mentioned part of the muscle, with the thumb and four fingers facing each other, apply moderate pressure, and feel a strong ache. Press from top to bottom, then from bottom to top. Generally, 15-30 times each is appropriate. Adjust according to the pain situation. It can be done 1-3 times a day.

　　5.漱口：Close the mouth, use the tongue to move along the edge of the teeth to the left and right for 24 times, then close the mouth, pucker the cheeks, and perform the rinsing action. When the saliva in the mouth is full, swallow it slowly in three sips. This method, if practiced regularly, can benefit the stomach, aid digestion, and enhance gastrointestinal function.

　　6. Abdominal massage: After each meal, one can take a leisurely walk, then lie down or sit, and use the hands to massage the abdomen. First, warm the hands, and then, with the left and right hands, rub in a clockwise or counterclockwise direction, rubbing the upper abdomen for about 30 times. This method can enhance gastrointestinal function and has a certain effect on the treatment of gastrointestinal diseases.

　　1. Routine examination: Observe the symptoms during stomach pain, such as chest tightness, heartburn, vomiting acid water, hiccups, which may indicate esophageal disease; if accompanied by empty stomach pain, satiety, hunger pain, hiccups with acid taste, or even vomiting blood, it may be gastric ulcer; use the time of pain as the basis for judgment, stomach pain 30 minutes to 2 hours after meals may be gastric ulcer.

　　2. The manifestations of early gastric cancer, which have been found for many years to be similar to symptoms of peptic ulcer disease or gastritis, also include acid regurgitation, nausea, and anorexia. With the intensification of pain, body weight decreases progressively, and symptoms such as emaciation and anemia may occur. When there is initial stomach pain, discomfort in the stomach area, or gastrointestinal discomfort, one should go to the hospital in a timely manner to undergo gastroscopy, barium meal, CT, color Doppler ultrasound, and tests such as desquamated cell and occult blood in stool.

　　3. Gastroscopy and biopsy: Gastroscopy combined with direct visual biopsy is the main method for diagnosing chronic gastritis. Surface gastritis is often most prominent in the antrum, usually diffuse, with the gastric mucosal surface showing alternating red and white or patterned changes, sometimes with scattered erosions, and often with white or yellowish exudates. The mucosa of atrophic gastritis is often pale or grayish, with the folds becoming thinner or flattened, and due to the thinning of the gastric mucosa, the submucosal vessels can be seen through as purple-blue, with the lesions being diffuse or mainly in the antrum.

　　4. Serum parietal cell antibody test and serum gastrin measurement: In most corpus gastritis, serum parietal cell antibody is often positive, and serum gastrin is often elevated. Conversely, in antrum gastritis, serum parietal cell antibody is often negative, and serum gastrin is decreased.

　　5. X-ray barium meal examination shows no abnormalities in most chronic gastritis.

　　Gastric cell scraping examination is a relatively simple diagnostic method. Under the direct vision of gastroscopy, scraping cells from suspicious areas in the stomach for cytological examination can help in differential diagnosis.

　　1. First, correct poor eating habits. Eat more light foods and less fatty and sweet foods and various刺激性 foods, such as foods containing alcohol and spices. Be careful of overly sour, sweet, salty, bitter, and spicy foods in food, and do not let the five flavors be biased. Patients with a smoking habit should be cautious.

　　2. Eat more fresh fruits and vegetables, such as melons, pears, bitter melon, persimmons, bananas, watermelons, and duckweeds.

　　3. Pay attention to nutritional balance. The diet should provide foods rich in vitamins to protect the gastric mucosa and enhance its defensive ability, and promote the repair of local lesions.

　　4. Diet should be regular and quantitative. For patients with long-term stomachache, three meals a day or additional meals should be regular, with reasonable intervals. For patients with acute stomachache, they should try to eat less and more frequently, and should eat less or no snacks in their daily life to reduce the burden on the stomach.

　　5. Diet should be soft, warm, and comfortable. Cooking methods should include steaming, boiling, stewing, and braising, and eat less hard and rough foods. Eat slowly and calmly, allowing food to be fully chewed in the mouth and mixed with saliva before slowly swallowing, which is beneficial for digestion and post-disease repair. Pay attention to the adjustment of dietary temperature in all seasons, especially for those with spleen and stomach deficiency and cold, who should avoid cold and raw foods. Those with liver depression and qi stagnation should avoid eating immediately after getting angry.

　　(1) Potassium Bicarbonate Citrate 240mg + Erythromycin 500mg + Metronidazole 400mg + Omeprazole 20 mg.

　　(2) Potassium Bicarbonate Citrate 240mg + Tetracycline 500mg + Metronidazole 400mg + Omeprazole 20 mg. Twice a day.

　　(3) Potassium Bicarbonate Citrate 240mg + Amoxicillin 750mg + Metronidazole 400mg + Omeprazole 20 mg.

　　You can choose to take a group of drugs from the above, each drug is taken twice a day (once in the morning and once in the afternoon) according to the above dosage, 7-14 days as a course of treatment. After the course of treatment is over, continue to take Potassium Bicarbonate Citrate alone for 6 weeks, with the same dosage and method as before. Pay attention to the skin test for Amoxicillin.