Hypochondriac pain describes pain, aching or discomfort over and beneath the costal margin. The area is primarily influenced by the Liver and Gall Bladder and their channels.
Liver Qi Stagnation
Frustration, anger, resentment, prolonged emotional turmoil, repressed emotions and stress disrupt the circulation of Liver qi, which accumulates in the Liver causing pain. Qi stagnation is frequently complicated by a variety of other disorders that can also cause pain. Chronic qi stagnation can generate Heat, which, depending on the duration and intensity, can develop into stagnant Heat or the more severe Fire. Long term qi stagnation can also lead to Blood stagnation. Stagnant Liver qi can disrupt the Spleen, weakening it and leading to the development of Dampness, which may then combine with any Heat in the system causing Damp Heat.
Damp Heat
There are two types of Damp Heat that causes hypochondriac pain – external and internal. The external variety of Damp Heat is a common seasonal pathogen in hot humid climates. Damp Heat has an affinity with several systems, particularly the Liver and Gall Bladder, urinary Bladder and Intestines. In this case, the Liver and Gall Bladder are primarily affected, the presence of Damp Heat interrupting the circulation of qi and Blood at the level of the hypochondrium, causing pain. This type is usually acute and often follows symptoms of an external Wind attack.
Damp Heat is generated internally by simple overeating, or over consumption of rich, greasy or spicy foods and especially alcohol, or by the accumulation of Dampness, which occurs if the spleen is already weakened. Prolonged stagnation of Dampness easily produces Heat. This type is chronic and develops slowly.
Liver Yin and Blood deficiency
Liver yin deficiency may be primary or, perhaps more commonly, secondary to Kidney yin deficiency. Liver yin deficiency may be an extension of Liver Blood deficiency, or follow any Liver Heat pattern, especially Liver Fire. Liver Blood deficiency can reult from decreased production of Blood (due to Spleen qi deficiency_, blood loss following trauma or childbirth, or overuse of the eyes. Long term stagnation of Liver qi can also damage Liver qi Blood, or, if stagnant Heat is generated, Liver yin.
Stagnant Blood
The stagnant Blood type hypochondriac pain may be acute or chronic. When acute, it is due to traumatic injury. When chronic, it is usually due to other prolonged Liver diseases such as Liver qi stagnation or Damp Heat that can be secondarily lead to Blood stasis. Stagnant Blood is a common complicating feature of other prolonged Liver pathology.
Diagnosis
Pain
> Intermittent aching or distending pain, difficult to localise and clearly related to emotions – Liver qi stagnation
> Fixed, stabbing pain that is easy to localise and is worse with pressure and at night – Blood stagnation
> Dull ache, which is relieved by pressure and worse when stressed or fatigued – Liver yin deficiency
> Continuous severe pain and fullness, worse with pressure – Damp Heat
Aggravation
> Emotions and stress – Liver qi stagnation, yin (Blood) deficiency
> With palpation – Blood stagnation, Damp Heat, qi stagnation
Some Biomedical Causes of Hypochondriac Pain
> Acute and chronic hepatitis
> Cirrhosis of the Liver
> Cholecystitis
> Gallstones
> Intercostal neuralgia
> Shingles
> Parasitic diseases of the Liver
> Liver cancer
> Gastric ulcer disease
> Alcoholic Liver disease
> Leaking duodenal ulcer
> Acute pancreatitis
> Coronary thrombosis
> Pyelonephritis
> Renal colic
> Trauma