This is really interesting because the type of treatment is so odd and obscure, and what is even more incredible, symptoms completely disappeared years after treatment. Apparently your condition had a name change? Centrally mediated abdominal pain syndrome (CAPS), formerly known as abdominal pain syndrome (FAPS)
Functional abdominal pain syndrome treated with Korean medication
Integrative Medicine Research
Korea Institute of Oriental Medicine
Functional abdominal pain syndrome treated with Korean medication
Chang-Gue Son
Abstract
A 37-year-old female patient with chronic and stubborn abdominal pain had been hospitalized five times in three Western hospitals, but no effects were observed. No abnormalities were found in blood tests, gastrointestinal endoscopy, sonogram, and computed tomography of the abdomen, except mild paralytic ileus. The patient decided to rely on Korean medicine as an inpatient. She was diagnosed with functional abdominal pain syndrome, and her symptom differentiation was the “Yang deficiency of spleen and kidney.” A herbal drug, Hwangikyeji-tang, along with moxibustion and acupuncture, was given to the patient. Abdominal pain and related symptoms were reduced radically within 16 days of treatment. This report shows a therapeutic potential of Korean medicine-based treatment for functional abdominal pain syndrome.
1. Introduction
Abdominal pain, either mild or severe, is a common symptom that everyone experiences. Most cases are benign and self-limiting, but more serious cases may require urgent intervention.1 Abdominal pain can be acute or occur over months in a chronic pattern. Ten percent of school-going children and adolescents experience chronic abdominal pain, which is prevalent in children and women.2 Abdominal pain can have numerous causes; therefore, diagnosing the cause can be difficult. In particular for chronic abdominal pain cases, doctors find it difficult to yield a diagnosis based on patients’ medical histories, physical examinations, and laboratory tests.3
Some cases of chronic abdominal pain involve physiologic illnesses, where the remaining cases are related to functional disorders. In particular, functional abdominal pain syndrome (FAPS) represents chronic abdominal pain with features that differentiate it from other painful functional gastrointestinal disorders, such as irritable bowel syndrome and functional dyspepsia, by the lack of a symptom relationship to food intake or defecation.4, 5 The prevalence of FAPS has been estimated to be 0.5–2.0%; it is more common in women.6 A wide range of therapeutics including antidepressants, anticonvulsants, psychotherapy relaxation techniques, and complementary therapies are being used; however, FAPS frequently raises serious medical problems and economic burden.7
From a Korean medicine (KM) point of view, chronic abdominal pain including FAPS belongs to the category of cold-associated pains. Accordingly, the main treatment strategy for FAPS is to expel the coldness.8 In order to promote the development of therapeutics for FAPS, this study reports a case of a refractory FAPS patient who was cured by KM-based therapeutics, including Hwangikyeji-tang, in an oriental hospital.
2. Case report
2.1. Characteristics of the patient and medical history
A 37-year-old woman having chronic abdominal pain visited an oriental hospital; the complications included weight loss (3.0 kg in the past 1 year) and serious fatigue. The patient had been suffering complex discomforts of the gastrointestinal tract such as bearable pain in the whole abdomen, feeling of flatulence, severe dyspepsia, belch, occasional burning sensation, and cold sweat. The symptoms had been continuing for 1 year, and the pain pattern was not related to defecation or eating. She was usually susceptible to stress and had to quit her job because of untreated abdominal pain.
The patient had been hospitalized five times (during April 2011–May 2012) in three Western hospitals, but no abnormality or improvement of abdominal pain was observed. Immediately after the last discharge from a Western hospital, she decided to visit an oriental hospital (May 2012). The patient had no previous history of alcohol or drug abuse, or smoking, and had no specific family and past history. Her husband had passed away suddenly, and no other causes for her symptoms were detected.
2.2. Diagnosis, treatment, and course of symptom
The patient had been examined thoroughly in previous Western hospitals and an oriental hospital. The gastroendoscopy, abdominal computed tomography, biochemistry, complete blood counts, and urinalysis revealed no significant abnormality. Simple abdomen X-ray showed a mild pattern of paralytic ileus as a slight accumulation of gas in the gastrointestinal tract. The patient was diagnosed with FAPS according to the diagnostic criteria for FAPS (Table 1).7 Physical features of the patient included a thin body type (body mass index 17.5, height 155 cm, and body weight 42 kg), cold hands and feet, anorexia, dyspepsia, nausea, mild headache, dizziness, and lassitude. Her tongue had a mild white-colored coating, and pulsation was weak and rapid. Accordingly, the symptom differentiation was diagnosed as “Yang deficiency of spleen and kidney.” Using the Sasang Constitution Classification II this diagnosis belonged to the Soeumin classification type.
Diagnostic Criteria for Functional Abdominal Pain Syndrome.
As an inpatient, the patient was administered a herbal drug, Hwangikyeji-tang (Table 2), three times a day. In addition, acupuncture treatment (mainly at CV12, HT7, LI4, and SP3 twice daily for 20 minutes with 0.25 mm × 30 mm needles purchased from DongBang Co., Seoul, Korea), indirect moxibustion (at KD1, CV4, and CV8 for 30 minutes daily with 3.5 g of wormwood fiber on the top of a salt basement inside a bamboo; diameter: 30 mm, length: 40 mm, purchased from KyeGoo Inc., Incheon, Korea), and Miso-pack (application of 150 g of soybean paste on the middle abdomen for 20 minutes every day) were given to the patients. From the 3rd day in hospital, abdominal pain started to decrease notably. Moreover, other related symptoms including anorexia, dyspepsia, nausea, headache, and dizziness were improved moderately. Her abdominal pain disappeared completely within 16 days of treatment; the scores on a self-reporting numerical rating scale (0 means no pain, whereas 10 implies the worst severity) were 5 on Hospitalization Day 7 and 2 on Hospitalization Day 14.9 In addition to almost complete disappearance of the white-colored coating on the tongue and improvement of pulsation, she had gained about 1 kg of body weight during hospitalization. It was confirmed that FAPS did not recur for 1 year when the patient was interviewed via telephone (Fig. 1).
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