The pattern of stomach heat, also known as the pattern of intense exuberant stomach fire, refers to a series of symptoms caused by excessive stomach heat due to indulging in spicy and rich foods, overacting of five minds leading to fire and heat, or external pathogens transforming into heat and attacking the stomach. This results in the overabundance of stomach heat, which leads to the rapid digestion of food and the steaming of stomach qi, manifesting primarily as swift digestion with rapid hungering and thirst with fetid mouth odor.

The main clinical manifestations include: excessive eating with frequent hunger, thirst with a preference for cold drinks, epigastric pain or a burning sensation, foul breath, constipation, swollen and painful gums, a red tongue with yellow coating, and a pulse that is rapid and forceful.

The pattern of stomach heat is commonly seen in diseases such as "epigastric pain," "consumptive thirst," "swollen and painful gums," and "vomiting."

This syndrome should be differentiated from the "yangming meridian pattern" and the "yangming fu-organ pattern."

bubble_chart Differentiation and Treatment

Heat and fire both belong to yang pathogen (yang exuberance causing heat), with only slight differences in degree. Extreme heat becomes fire, hence both share the characteristics of fire: rapid onset, a tendency to flare upward, and a high likelihood of damage to yin. The stomach is a dry earth element, "preferring moisture and disliking dryness," and the Stomach Meridian of Foot Yangming is rich in both qi and blood. When the Yangming is affected by pathogenic factors, it is most prone to transforming into heat. Therefore, the pattern of stomach heat is a common internal heat pattern in clinical practice, but its manifestations vary across different diseases.

1. In the context of epigastric pain, the pattern of stomach heat may present with burning and intermittent pain in the stomach region, accompanied by thirst with a preference for cold drinks, constipation, and dark urine. This is due to pathogenic heat injuring the stomach, leading to excessive stomach fire, obstructed qi movement, and the scorching of body fluids by pathogenic heat, resulting in the loss of moisture in the large intestine. Treatment should focus on clearing heat and calming the stomach, using the Minor Chest Bind Decoction (from the "Treatise on Cold Damage Diseases") with modifications.
2. If the pattern of stomach heat appears in consumptive thirst (middle consumptive thirst), symptoms may include excessive eating and hunger, weight loss, accompanied by excessive drinking, frequent urination, dry stools, and general lack of strength. This is often caused by long-term indulgence in rich, sweet, and spicy foods, damaging the spleen and stomach, impairing their transportation and transformation functions, leading to internal heat accumulation in the middle energizer and excessive stomach fire. This results in rapid digestion and other clinical manifestations. The fire-heat can also consume and damage fluids and blood, leading to muscle wasting and progressive emaciation. Treatment should focus on clearing stomach fire, enriching yin, and promoting fluid production, using the Jade Lady Decoction (from Jingyue Quanshu) and the Consumptive Thirst Formula (from Danxi Xinfa) with modifications. If the pattern of stomach heat is seen in gum swelling and pain, clinical manifestations may include swollen and painful gums, even ulceration, and fetid mouth odor. This is caused by stomach fire ascending along the Yangming meridian, scorching and corroding the tissues. Treatment should focus on clearing heat and purging fire, using the Stomach-Clearing Powder (from Lanshi Micang).
3. In cases of vomiting with the pattern of stomach heat, clinical manifestations may include sudden onset, vomiting immediately after eating, large amounts of vomitus with a foul smell, accompanied by dry stools and dark urine. This is due to excessive stomach fire, leading to the failure of stomach qi to descend and its upward rebellion. Treatment should focus on purging fire, lowering rebellion, and stopping vomiting, using the Bamboo Leaf and Gypsum Decoction (from the "Treatise on Cold Damage Diseases") with Ginseng removed and Hematite added.

Due to excessive stomach heat and the scorching of fluids by fire-heat, secondary symptoms of insufficient body fluids may arise, leading to a complex deficiency/excess condition (excess with underlying deficiency). If the condition persists without improvement, stomach heat damages fluids, transforming into stomach yin deficiency pattern, manifesting as yin deficiency with effulgent fire. Thus, it is evident that excess fire and deficiency fire are mutually causative.

bubble_chart Differentiation of Similar Patterns

1. Yangming Meridian Pattern and Pattern of Stomach Heat: The cause of Yangming Meridian Pattern is mostly due to exterior pathogens entering the interior and transforming into heat, leading to heat damaging the Yangming Jingmai. The main clinical symptoms are characterized by body heat, profuse sweating, great thirst, and a surging pulse, without swift digestion with rapid hunger; the pathogenic heat of Pattern of Stomach Heat is mostly internally generated, without body heat and sweating, but with swift digestion with rapid hunger, thirst, and fetid mouth odor. Pattern of Stomach Heat is simply stomach heat, while Yangming Meridian Pattern is the diffusion and steaming of intangible fire-heat pathogens, which can be distinguished accordingly.
2. Yangming Fu-Organ Pattern and Pattern of Stomach Heat: Yangming Fu-Organ Pattern arises from the transmission and transformation of external pathogens, where external pathogens transform into heat and enter the interior, leading to heat accumulation in the stomach and intestines, and the struggle between fire pathogens and intestinal waste. The clinical manifestations are more severe than those of Pattern of Stomach Heat, characterized by abdominal distension and fullness with tenderness, dysphoria and delirious speech, late afternoon tidal fever, and severe constipation. The difficulty in defecation is also different from the dry stool in general Pattern of Stomach Heat, but is due to the binding of internal heat fire pathogens with dry stool, causing discomfort in the fu-organ qi, hence accompanied by abdominal distension and fullness with tenderness; delirious speech and dysphoria are caused by the intense fire-heat, carrying filthy turbidity qi to attack and disturb the mind; in the late afternoon, when the Yangming meridian qi is at its peak, the heat rises accordingly. These two should be distinguished based on these characteristics.
3. Stomach Yin Deficiency Pattern and Pattern of Stomach Heat: (see Stomach Yin Deficiency Pattern)

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bubble_chart Documentation

1. Lingshu-Dahuo Lun："Heat remains in the stomach, stomach heat then consumes grain, grain consumed thus often hungry."
2. 《Bi Hua Medical Mirror》："Heat in the stomach, lips and tongue red, fetid mouth odor, the pulse at the right guan must be surging and rapid..."