Epigastric Tenderness Upon Palpation: Epigastric Glomus Syndrome

Hello, I am Choi Yeon-seung, a Korean Medicine Doctor at Baengnokdam Korean Medicine Clinic.

The Trash Can of the Mind, the Epigastrium

There's a spot that invariably feels tight and painful when you're about to give an important presentation or something stressful comes up, even if you were fine just moments before. This is the pit of the stomach, or the area just below the epigastrium.

Many people visit our clinic due to this discomfort. Feeling frustrated, they even undergo gastroscopy, but the words they hear from doctors are mostly similar:

"It's nervous gastritis."
"It's stress-induced gastritis, so don't worry too much about it."

However, this situation – where it clearly hurts, yet examinations show no particular abnormalities – only makes us more frustrated.

Perhaps the reason is that we may have misunderstood the epigastric region all along.

The Epigastrium in Korean Medicine

In Korean medicine, the epigastric region is called 'Shimha (心下),' meaning 'just below the heart (or mind).' It is, literally, where the state of one's mind is most directly manifested.

This area is where undigested food can accumulate, but it can also become a 'trash can of the mind' where unresolved emotions build up.

The Question of Pain

Today's discussion begins from the perspective that pain below the epigastrium may not be a simple gastrointestinal issue, but rather a signal from our mind.

Why Does It Hurt When the Endoscopy is Clear?

But the biggest question is this: 'If it's a mental issue, why does the body hurt, specifically the epigastrium?' And 'Why isn't the cause visible through an endoscopy?'

The answer lies in the difference between 'structure' and 'function.' Gastroscopy is an excellent tool for viewing the 'structure' of the stomach.

The Difference Between Structure and Function

It is very accurate at identifying problems with the stomach's 'lining' or 'interior,' such as whether there are lesions on the stomach wall, inflammation or ulcers, or tumors.

However, there's something an endoscope camera cannot see. This is the realm of 'function' – how the stomach 'moves' and 'feels' in real-time.

The First Step in Diagnosis: Is it Tightness, or Pain?

So, how does Korean medicine diagnose these 'functional' issues? The first step begins with a very simple question.

"Does your epigastrium just feel tight and uncomfortable, or is it painful when pressed?"

If there's no pain, and it simply feels like a blockage or tightness, then this primarily indicates a problem with the flow of 'Qi (氣),' or functional communication.

However, if you feel distinct pain, enough to elicit a gasp, when pressing firmly on the area with your hand, then the situation is a bit different.

Shimhabi (心下痞) and Shimhabigyeong (心下痞硬)

In Korean medicine, there are ancient and precise diagnostic terms that distinguish these two states: 'Shimhabi (心下痞)' and 'Shimhabigyeong (心下痞硬).'

Shimhabi (心下痞)

First, Shimhabi (心下痞) literally means 'tightness/fullness (痞) below the epigastrium (心下).' This corresponds to the 'traffic jam' stage mentioned earlier.

Shimhabigyeong (心下痞硬)

On the other hand, Shimhabigyeong (心下痞硬) adds a sensation of 'hardness (硬)' to the existing tightness/fullness. This is akin to a prolonged traffic jam that has led to a 'minor collision.'

How Stress Attacks the Stomach: Ganulfanwi (肝鬱犯胃)

So, why do these conditions, 'Shimhabi' or 'Shimhabigyeong,' arise in the first place? And why do symptoms worsen particularly when experiencing stress?

In Korean medicine, the root cause is not sought in the 'stomach' itself, but rather in its neighboring organ, the 'Liver (肝).'

The Depth of Illness: The Tug-of-War Between Xu (虛, Deficiency) and Shi (實, Excess)

So, is 'Shimhabigyeong,' which is characterized by clumping and hardening, simply an 'Excess syndrome (實證)' where harmful substances accumulate? Not necessarily.

Here, an important concept for understanding the depth of an illness is 'Benxu Biaoshi (本虛標實),' or 'root deficiency with superficial excess.'

The Logic of Treatment: To 'Harmonize' or to 'Attack'?

So, how should this complex condition be treated? The approach in Korean medicine varies distinctly depending on the diagnosis.

Beyond the Stomach, Relieving Mental Tension

Today, we've explored the perspective that pain below the epigastrium may not be a simple gastric illness.

The pain in this area can be a signal from the body, caused by the accumulation of not only undigested food but also unresolved emotions and stress.

Therefore, the fundamental solution may not lie solely in taking stomach medication or protecting the stomach.

Clinic Information

- Clinic Hours -
Mon-Fri 10:00 AM - 7:00 PM
Lunch Break 1:00 PM - 2:00 PM

※ We do not offer individual consultations via the blog. For appointments and clinic-related inquiries, please refer to Naver Place or our official website.

Baengnokdam Korean Medicine Clinic, 3rd Floor, Songdo Dream City, 81 Convensia-daero, Yeonsu-gu, Incheon