8 Inquiry of chest and abdomen
The chest and abdomen are the regions where viscera are located. The disorder of the viscera may bring about various symptoms over the chest and abdomen. The following is a brief discussion.
1.3.3.8.1 Chest oppression
Chest oppression is a subjective sensation of discomfort and fullness in the chest, usually due to inhibited circulation of qi in the heart, lung and liver.Chest oppresioon with cough and profuse sputum is caused by internal retention of phlegmatic dampness and obstruction of pulmonary qi; chest oppression with palpitation and shortness of breath is usually caused by asthenia of heart and pulmonary qi and inaction of chest yang; chest oppression with frequent sighing is often due to emotional upsets and stagnation of liver qi.
1.3.3.8.2 Palpitation
Palpitation refers to subjective feeling of quick heart beating and throbbing, usually a sign of the disorder of the heart or the heart spirit. If palpitation is caused by fright or palpitation accompanied by anxiety, it is called fright palpitation, indicating mild pathological condition. If the heart is beating rapidly from the chest to the navel with longer duration, it is called severe palpitation, indicating serious pathological condition and the further development of palpitation and fright palpitation. Fright disturbs qi, that is why the heart spirit is in disharmony;, asthenia of blood leads to the malnutrition of the heart; yin asthenia leads to exuberance of fire which disturbs the heart spirit; asthenia of the heart qi and yang deprives the heart of warmth and nutrition; asthenia of spleen and kidney yang results in hydraulic qi invading the heart; obstruction of the heart vessels prevents blood from free circulation. These conditions all may cause palpitation, fright palpitation and severe palpitation, which should be analyzed according to the characteristics of palpitation and the accompanied symptoms.
1.3.3.8.3 Hypochondriac distension
Hypochondriac distension refers to distension and discomfort over one side or both sides of hypochondriurn, usually seen in disorders of the liver and gallbladder. Hypochondriac distension with susceptibility to anger is usually due to emotional upsets and stagnation of liver qi; hypochondriac distension with bitter taste in the mouth and yellowish greasy tongue fur is usually caused by damp heat in the liver and gallbladder.
1.3.3.8.4 Epigastric distress
Epigastric mass refers to subjective feeling of oppression and discomfort in the epigastrium, usually seen in disorders of the spleen and stomach. Epigastric mass with acid regurgitation is often due to retention of food in the stomach; epigastric oppression with reduced appetite and loose stool is usually caused by weakness of the spleen and stomach.
1.3.3.8.5 Abdominal distension
Abdominal distension refers to subjective sensation of distension and discomfort in the abdomen, usually due to weakness of the spleen and stomach, internal retention of sthenic heat, mingling of qi, blood and fluid. Palpable abdominal distension is of asthenia syndrome due to weakness of the spleen and stomach which fail to perform the normal functions of transportation and transformation; unpalpable abdominal distension is of sthenia syndrome due to retention of food in the stomach and intestines or internal retention of sthenic heat which obstructs the circulation of qi. Tympanites with abdominal distension accompanied by bulgy veins on the abdominal wall may be caused by various factors, such as qi stagnation, retention of dampness and blood stasis in the abdomen.
1.3.3.8.6 Borborygmus
Borborygmus may be caused by asthenia of splenic qi, asthenia of splenic yang, internal exuberance of cold dampness, disharmony of the liver and spleen, internal retention of fluid and disharmony of qi activity in the intestines. Borborygmus with diarrhea, continuous abdominal pain and preference for warmth and pressure is caused by asthenia of splenic yang; borborygmus with abdominal prolpase sensation is caused by prolapse of gastrosplenic qi; borborygmus with thunderous noise, accompanied by abdominal cold pain, preference for warmth, cold body and limbs, is usually caused by invasion of exogenous cold and dampness; borborygmus with gurgling noise is caused by retention of fluid in the intestines.
Chest pain, hypochondriac pain, epigastric pain and abdominal pain are the commonly encountered symptoms over the chest and abdomen, which is discussed in detail in the part of inquiry of pain. Besides, attention should be paid to the inquiry of other subjective symptoms, such as nausea, heartburn and dysphoria, etc.
