Everything About Epigastric Pain: The Truth Behind Squeezing, Burning, and Constricting Pain

Do you feel a stabbing pain in your epigastrium? Does it feel like a gripping or squeezing pain? Or is it a burning, searing pain?​
'Epigastric pain' encompasses a spectrum of sensations that a single phrase can hardly convey. You might have felt frustrated and anxious, unsure what this pain truly signifies. Many people, in such situations, simply dismiss it as 'indigestion' and take an antacid or digestive aid. However, that pain you casually overlooked could be a warning sign of a more serious underlying condition. The 'feeling' of the pain holds the key to its true cause.

Hello, I am Dr. Choi Yeon-seung, the director of Baengnokdam Korean Medicine Clinic, where I've helped countless patients find the 'true cause' of their epigastric pain over the past 15 years.

In this post, I will provide clear guidelines on what conditions to suspect based on the sensation of your pain, and when it is absolutely necessary to seek medical attention.

The 'Feeling' of the Pain Reveals its True Cause

Epigastric pain doesn't feel the same for everyone. Depending on how it hurts, the cause can be completely different. Take a moment to identify which sensation best describes your current pain.

1. If it's a gripping or squeezing pain → Suspect 'Gastric Spasms' (Stomach Cramps)

This is an intense pain in the epigastric region, feeling as if it's being wrung out, twisted, or coiled. It's often gastric spasms (stomach cramps) caused by excessive contraction of the stomach muscles, similar to a muscle cramp, triggered by stress or sudden dietary changes. It frequently accompanies back pain.

2. If it's a burning, searing pain → Suspect 'Reflux Esophagitis' or 'Gastritis'

This pain feels hot and burning, like chili powder has been sprinkled on it. It's a classic symptom of reflux esophagitis (GERD), gastritis, or gastric ulcer, caused by excessive stomach acid secretion or acid reflux damaging the esophageal lining. Heartburn and a globus sensation (feeling of a lump in the throat) may also be present.

3. If it feels severely blocked and distended → Suspect 'Food Stagnation (Sikjeok)' or 'Damjeok-byeong'

Rather than a sharp pain, the predominant feeling is a heavy, stuffy sensation, as if a stone is lodged in the epigastrium. This could be 'Sikjeok' (食積, food stagnation) caused by overeating or impaired digestion, where food remains undigested, or it could be a sign of 'Damjeok-byeong', a chronic condition where the stomach and intestines stiffen due to prolonged stagnation. Gas, belching, and indigestion are consistently present.

[Caution!] For these types of pain, you must go to the hospital

If, after a fatty meal, the pain extends to the right upper quadrant (below the right ribs), it could indicate a 'gallbladder issue'. Severe pain that radiates to the back and is only relieved by bending forward could be a sign of 'pancreatitis'. Pain with these characteristics requires immediate medical examination.

How does Korean medicine view these diverse types of epigastric pain from an integrated perspective?

In Korean medicine, the epigastric region is considered a crucial gateway where food passes from the stomach (胃) to the small intestine (小腸), and a central hub for the circulation of the body's vital energy (Qi). When this important intersection becomes severely blocked, it's inevitable that intense pain will arise. Korean medicine identifies three main causes that lead to this 'traffic jam'.

1. Sikjeok (食積, Food Stagnation): The 'Broken-Down Cargo Truck' Blocking the Road

This refers to undigested food remaining as a mass due to overeating or eating too quickly, completely blocking the pathway like a broken-down cargo truck in a narrow lane. It typically causes a heavy, distended pain, accompanied by severe indigestion and belching.

2. Dameum (痰飮, Phlegm-Fluid): The 'Oil Spill' Making the Road Sticky

If the body's fluid metabolism is not smooth, unnecessary fluid waste transforms into sticky 'Dameum' (Phlegm-Fluid). This is similar to an oil spill on the road, slowing down and gumming up the flow of Qi, primarily causing nausea, dizziness, and gas.

3. Giche (氣滯, Qi Stagnation): The 'Broken Traffic Light'

Stress can break down the 'traffic light' that regulates the flow of Qi in our bodies. This leads to repeated situations where cars suddenly stop at a red light (causing stagnation/blockage), or suddenly scramble as a green light appears (leading to spasms/cramps). This is a primary cause of gripping gastric spasm pain, headaches, and back pain.

Thus, Korean medicine doesn't simply treat the pain itself, but identifies whether the root cause of the 'traffic jam' is a 'broken-down vehicle,' a 'road issue,' or a 'traffic light problem,' and then provides tailored treatment accordingly.

A Comprehensive Guide for Pain Relief and Relapse Prevention

Now, let's explore practical steps you can take yourself.

Right Now! Emergency Relief Guide for Epigastric Pain

Don't panic when sudden pain strikes. Calmly follow these three steps:

1. Find a Comfortable Position: First, loosen your belt and any tight clothing. Then, curling up like a shrimp, with your back bent, can help relieve abdominal tension.
2. Apply Warmth: Apply a hot pack or warm towel to the area around your epigastrium. The gentle warmth will help relax tense stomach muscles.
3. Manage Pain with Acupressure: Gently pressing the 'Hapgok (LI4)' acupoint between your thumb and index finger, or the 'Joksamni (ST36)' acupoint, located four finger-widths below the kneecap, can also be effective in relieving pain.

Q. Can I drink water or plum tea when I'm in pain?

A. No, it's generally best to maintain an empty stomach until the pain subsides, as severe spasms can induce vomiting. Afterwards, sipping a small amount of warm tea may be helpful.

Q. What medication should I take? (Antispasmodics vs. Digestive Aids)

A. For 'chegi' (indigestion/feeling blocked), digestive aids or products like Gas Hwal Myung Su can be helpful, but their effect might be minimal for 'muscle spasm' pain. Antispasmodics, which directly relax stomach muscle spasms, are generally more effective, but you must consult a healthcare professional before taking them.

How to Safely Return to Your 'Regular Diet' After Gastric Spasms

Managing your diet after spasms subside is crucial for preventing recurrence.

1. Stage 1 (Stabilization: Immediately After Spasms ~ Day 1): Gently soothe your stomach with thin gruel (mi-eum) or clear porridge, which are very easy on the digestive system.
2. Stage 2 (Recovery: Days 2-3): Begin introducing soft white rice accompanied by easily digestible foods like steamed egg custard, steamed potatoes, or bananas. Absolutely avoid overeating.
3. Stage 3 (Ongoing Management): To prevent recurrence, it's best to avoid alcohol, coffee, greasy foods, overly cold foods, and highly acidic fruits.

Recurrent Pain: A 'Real' Signal from Your Body

Experiencing indigestion once or twice, or stomach pain when stressed, is something everyone can go through. However, if epigastric pain recurs several times a month and is accompanied by back pain or headaches, it's not a mere incident but a strong warning sign that your body's balance has been disrupted.

Relying on medications like antispasmodics or digestive aids is akin to having a hole in a dam and continuously wiping away the leaking water without plugging the hole. It's merely a temporary fix; the dam will continue to weaken and eventually lead to bigger problems.

The 'golden hour' for treating gastric spasms is before the pain becomes 'chronic'. If systemic symptoms begin to appear beyond simple indigestion, it's time to address the root cause without further delay.

Recurrent epigastric pain could be an early sign of Damjeok-byeong, a condition where the stomach stiffens and hardens. I will delve deeper into Damjeok and the after-effects of gastric spasms in a future post, should the opportunity arise.

Don't let sudden pain cause you anxiety any longer. By listening to your body's signals and addressing the fundamental causes, you can regain a comfortable daily life.

#EpigastricPain