Library

The Yellow Emperor said: I wish to hear about the sudden pain in the five zang organs of humans; what qi causes this? Qibo replied: The flow of qi and blood in the meridians is ceaseless, circulating around the body without rest. When cold qi enters the meridians, its movement becomes sluggish, stagnant, and obstructed. If it lodges outside the vessels, blood volume decreases; if it lodges inside the vessels, qi circulation becomes blocked. Therefore, sudden pain occurs.

Regarding pain in the heart and abdomen, there are distinctions among the Upper Jiao (Upper Burner), Middle Jiao (Middle Burner), and Lower Jiao (Lower Burner). Pain in the Upper Jiao is located above the diaphragm, which is also known as epigastric pain (Wei Wan Tong); pain in the Middle Jiao is located at Zhongwan (CV12), indicating pathology between the spleen and stomach; pain in the Lower Jiao is located below the umbilicus, indicating pathology of the liver and kidneys. However, these pains must be distinguished as deficiency or excess patterns, a differentiation that cannot be overlooked. The method for differentiation is to observe whether the patient allows pressure: patterns allowing pressure are deficiency, while those rejecting pressure are excess. Chronic illnesses are mostly deficiency patterns, while acute/sudden illnesses are mostly excess patterns. Pain that slightly alleviates after eating indicates deficiency, while abdominal distension with aversion to food indicates excess. Pain that is slow and mild, with an indistinct location, indicates deficiency; pain that is severe and hard, with a fixed location, indicates excess. Once deficiency and excess are clearly determined, treatment principles can be established.

The syndrome of abdominal pain arises from the conflict between pathogenic factors and healthy qi, striking against the organ qi. It may involve cold, heat, intestinal parasites, or food stagnation. As long as pattern differentiation is accurate, treatment will be effective.

For pain accompanied by cold, the complexion may be cyanotic or pale. In cases of severe cold, the complexion is dull, and the lips, mouth corners, and fingernails turn cyanotic. This indicates extreme deficiency-cold of the spleen qi. For mild cases, Danggui San (Angelica Powder) is used; for severe cases, Shaopi San (Scorched Spleen Powder) is used; if vomiting and diarrhea are present, Baotong Wan (Child-Protecting Pill) is indicated.

For pain accompanied by heat, the face is red with high fever, the limbs are restless, and the palms and soles are hot. Six-Shun Qingliang San (Six-Compliant Cooling Decoction) added with Qingpi (Green Tangerina Peel) and Zhike (Aurantii Fructus) is suitable. If constipation is present, Muxiang Binglang Wan (Costus and Areca Nut Pill) is used. If bowel movements are normal, Shaoyao Gancao Tang (Peony and Licorice Decoction) is used.

For pain due to food stagnation, the breath has a sour odor, the complexion is yellow with pale lips, the eyes lack luster or show excessive sclera, the child is sleepy and averse to food, and stools are sour and foul-smelling. Sanleng Wan (Curcuma Pill) is suitable; for severe cases, Xiaoji Wan (Eliminate Stagnation Pill) is used, followed by Liujunzi Tang (Six Gentlemen Decoction) for regulation after purgation.

For parasitic pain (intestinal worms), the face is white with red lips, the six pulses are surging, there is pain in the heart and abdomen, saliva and clear fluid issue from the mouth, and masses form within the abdomen, feeling like a raised ridge upon palpation. Children with weak spleen and stomach qi are most prone to this syndrome. Wumei Wan (Mume Pill) is indicated.

Abdominal pain that prefers manual pressure and hot compresses indicates deficiency or cold patterns; warm tonification should be applied promptly. Abdominal pain that cannot tolerate touch or pressure indicates excess patterns; purgation should be applied promptly.