[ Thinking about a medical cases ] Distending pain in the left upper abdomen | ultrasound and CT normal | taking medicine no useful | Auckland Acupuncture and Chinese Medicine Clinic

Patient, female, 55 years old, European.

She comes to see me and wants to let me help her digestive problem with Chinese Medicine.

She told me that it may be a pancreas problem.

pressure pain in the left upper abdomen for 20 years, the pain 5/10

In the early stage, the left upper abdomen pain occurred once every two weeks or once a month, there was pain once several months in the following more than ten years, but she felt worse in the half year, there was pain every day.

The pain radiates to the side of the left chest.

Her stomach is a little bloated

Ultrasound and CT for the abdomen were normal.

Taking medicine for the stomach is not useful.

First, the machine examination was normal, and taking medicine was of no use, Second, her pain radiates to the side of the left chest, so I thought that it might be a nerve problem.

Then I did sensory and Tinel’s sign examinations.

The area controlled by T7 and 8 spine nerves is diminished sensation

More tenderness in the T7 and 8 on the left side

She feels a little tingling in the left upper abdomen, Tap the tenderness point next to the T7 and 8 on the left side

So I think it is an intercostal neuralgia ( neuritis duo to the soft tissue inflammation)

Doing Acupuncture and cupping.

It was also recommended that she undergo a CT examination centered on thoracic vertebrae 7 and 8. To rule out organic diseases of the spine, such as tumors, disc herniation, etc.

I will let you know the treatment effect sooner

She sent a message this morning on 19/09/2024, that the back pain has subsided, but the left upper abdomen pain is still obvious. She has made a second treatment appointment today.

Situation during the second follow-up on September 24, 2024.

Symptom Improvement:

Pain in the left chest and back has almost disappeared.

No pain at night anymore.

The area of pain in the left upper abdomen has reduced from a large area to a small localized area.

The left upper abdominal pain is now intermittent.

Examination during the second follow-up:

Tenderness remains at the left sides of T7 and T8 but is significantly reduced.

There is still an area of diminished sensation at the left sides of T7 and T8.

Tinel’s sign has disappeared.

Video from the second follow-up.

【My Thinking:】

1, Why might it be a nerve problem?

First, imaging and other tests came back normal, and medication was ineffective. Second, her pain radiates from the left upper abdomen to the side of the left chest, which led me to consider a nerve issue.

A simple sign or symptom can lead to different conclusions. Pain starting in the left upper abdomen, radiating to the left chest, and then to the mid-back—especially with a ‘band-like’ sensation—suggests the possibility of nerve or muscle injury.

I performed a nervous system examination, and the results aligned with my suspicion.

2, Why has it been considered a digestive tract problem for 20 years?

Because her pain is mainly in the left upper abdomen, doctors have consistently and easily suspected digestive tract issues, such as problems with the stomach or pancreas.

Additionally, she experiences bloating in the upper abdomen, which is indeed a symptom of digestive tract problems. However, such symptoms can also occur with other issues, like the nervous system or even skin conditions.

The doctors who treated her lacked experience in the nervous system, so they did not perform nerve system examinations, such as checking sensory responses or Tinel’s signs.

3, Without a correct diagnosis, there cannot be correct treatment, which is why she has been in pain for 20 years.

Every doctor has a primary area of focus: some specialize in digestive system diseases, others in nervous system disorders, or skin problems. However, we must also devote attention to other systems to avoid making further mistakes in clinical practice.

4, How should a Chinese medicine practitioner operate in modern society?

I believe that a Chinese medicine practitioner should not only master traditional Chinese medicine but also have a broad understanding of modern medicine. A TCM practitioner should deeply study the fundamental knowledge, diagnosis, and treatments of a specific modern medical field, and combine both approaches to help patients in clinical practice.

5, As pure traditional Chinese medicine practitioners, how do they practice for the case?

They will practice based on the previous doctors’ guidance and the patient’s symptoms, the diagnosis, and treatment depending on the TCM, in Chinese medicine, it is called 【 stomach area pain】, and acupuncture in local points, distal points of the stomach channel, and experience points.

6, My acupuncture.

I have utilized not only everything that pure TCM practitioners do but also combined modern medical diagnosis. Therefore, I will perform acupuncture at points beside T7, T8, and T9 using the mini-knife needle.