Volume 3, Number 3 | Fall 2008

Clinical Report 2

Severe Pain on the Right Side of the Chest andHypochondrium –No Abnormalities Found in Tests
Zen’ichiro Watanabe
Fuji Nikoniko Clinic

Case: 17 year-old female (2nd year student of juniorhigh school)
Chief complaint: Right side of the chest andhypochondrium regions
Present history: The patient began to have strong painon the right side of the chest and hypochondrium
regions half a year ago and had to take a leave ofabsence from school 3 to 4 days a week. She underwent
blood tests and even CT scan at the internal medicine,surgery, and gynecology of Y municipal hospital.
However, no abnormalities were found. She was told “noappendicitis” and “the cause of the pain was unknown.”
For treatment, Loxoprofen, Timepidium bromide, and
Lac-B were prescribed in case of the onset. She hadstomach medicines prescribed by other clinic. With thesemedicines, relief was not attained and she visited ourclinic.
Oriental medical findings
Objective-signs:
Inspection: Dark circles around her eyes. Auscultation
and Olfaction: No special mention. Tongue
diagnosis: Dark red tongue with dark spots and only afew sublingual veins. Pulse diagnosis: Strong-like,slippery, and rapid. Also, when chi-pulse (尺脈) is deeppressed in, will slightly wiry. Abdominal diagnosis:
Oppressive pain along the epigastric region to theright under-arm (the place of the pain complained).
Oppressive pain also in the right lower abdomen (thepoint of blood stasis).
Subjective-symptoms: Stressful (had to juggle bothstudies and activities of the brass band club). Latemenstruation sometimes. Sleep 3:00 to 6:00 without
dreaming. Normal defecation. Normal diet- 3times/day. No sensations of cold and heat.
Diagnosis: Liver qi stagnation and bad blood
circulation
Therapy: shigyakusan + keishibukuryogan (Tamura
Pharmaceutical Co., Ltd., 7.5 g each 3 times a day)Course: Relief of pain was observed on the secondvisit, 14th day from the commencement of theadministration, during which term the patientcommuted to school without a leave of absence. Mild
pain appeared only when she was tired. Pulse
became stable. The tongue still had spots but thecolor became light. The abdominal diagnosisindicated relief to the extent that the patient felt
only slight oppressive pain in the same regions
when oppressed strongly. The 14 days doses of thesame formula were prescribed and instructions
were given to the patient not to push herself beyond
the point of fatigue. Then the treatment completed
and thereafter no abdominal pain has occurred.
Discussion: The patient is a typical case of thestagnation of liver qi in terms of Kampo medicine.
Usually patients with liver qi stagnation do notpresent such strong pains that prevent them from
commuting to school. The patient was presumed tohave severs pains due to the presence of not only thestagnation of qi but also blood stasis. In sum, thepatient suffered severe stress because she tried totake balance between studies and club activities,
which induced the obstruction of the movement of
diaphragm qi, causing “stagnation-caused pain” –which was then followed by the non-circulation of
the blood, and symptoms such as late menstruation
periods, dark circles around the eyes, and dark
tongue spots appeared.
These conditions that Western medicine isunable to diagnose are often seen in functional
diseases rather than in organic diseases, and often
need a mental approach. For the case of the patient,
it was considered necessary to prioritize pain
procedures before providing counseling. The
prescribed shigyakusan removed the pain withbupleurum root that worked on soothing andregulating liver qi in combination with the added
younger immature bitter orange that worked on
breaking the stagnation of qi to promote the flow ofqi. And peony root and licorice root worked on
removing acute pain. Keishibukuryogan worked on
the circulation of qi and the blood with cassia barkand peony root; and on activating blood andresolving stasis with peach seed and tree peonybark; and on invigorating the spleen and calming
the mind with tuckahoe. The author considers that

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 3, Number 3 | Fall 2008

the combination drugs may have enabled thecirculation of qi and blood resulting in the prompt
relief of pain. “As long as circulation is being done,
there is no pain.”

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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)