Library

(Small Abdominal Pain, Narrowness in the Abdomen, Pain around the Umbilicus)

Li Dongyuan stated: Various pains in the abdomen are mostly caused by excessive labor and irregular diet, which injure the Middle Qi (vital energy of the middle jiao). Cold pathogen takes advantage of the deficiency to invade. The obstruction of Yang Qi leads to pain.
Therefore, the pain occurs suddenly. The *Classic of Difficult Issues* (*Nan Jing*) states: "Pain ceases immediately upon receiving heat."
Pain at the Zhongwan (CV12) region belongs to Taiyin disease; treat with Lizhong Tang (Regulate the Middle Decoction).
Pain around the umbilicus belongs to Shaoyin disease; treat with Zhenwu Tang (True Warrior Decoction).
Small abdominal pain belongs to Jueyin disease; treat with Danggui Sini Tang (Angelica Sinensis Decoction for Reversal Cold) plus Wu Zhu Yu (Evodia Fruit).
If abdominal pain is caused by heat disease: for heat syndrome, use Shaoyao Gancao Tang (Peony and Licorice Decoction) or Huangqin Tang (Scutellaria Decoction); for cold syndrome, use Lizhong Tang.
For individuals with inherent Spleen-Stomach deficiency who cannot digest food, use Liujunzi Tang (Six Gentlemen Decoction) plus Xiangru (Amomum Fruit) and Sharen (Tsaoko Cardamom).
If accompanied by external contraction and retained food, use Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi).
If there is only hardness and fullness with pain in the lower abdomen, and urination is free, this is a Blood Stasis syndrome; treat with Taohé Chengqi Tang (Peach Kernel Decoction to Order the Qi).
If urination is difficult, this is a Urinary Obstruction syndrome; treat with Wuling San (Five-Atractylodes Powder).
If there is severe pain in the heart and abdomen, with an urge to vomit but unable to do so, and an urge to defecate but unable to do so, this is named Huoluan (Cholera-like disorder). Urgently administer salt water to induce vomiting.
Alternatively, clear phlegm stagnating in the chest and diaphragm, or food retention knotting in the intestines and stomach, can all cause abdominal pain.
If due to Phlegm, use Kongxian Dan (Draining Fluids Pill). If due to Food Retention, use Zhishi Daoshi Wan (Immature Bitter Orange Pill to Guide out Retention).
Generally, treating abdominal pain requires warm-dispersing herbs, such as Taixiong (Sichuan Lovage Rhizome), Cangzhu (Atractylodes Rhizome), Xiangfu (Cyperus Rhizome).
Baishao (White Peony Root) can treat blood-deficiency abdominal pain, suitable only when the pulse is wiry and accompanied by fever.
Its nature is sour, cold, and astringent, lacking warm-dispersing properties. If taken by those with Qi deficiency, it damages the Spleen and Stomach.
Dull pain that is constant without fluctuation, relieved by hot hand pressure, and preference for hot drinks, with a deep and slow pulse, indicates Cold. Treat with Lizhong Tang plus Rougui (Cinnamon Bark), Xiangru, and Sharen.
If warm medicines fail and pain worsens with constipation, mildly purge using Pingwei San (Maintain the Stomach Powder) plus Huoxiang (Patchouli), Banxia (Pinellia Tuber), Zisu (Perilla Leaf), Muxiang (Aucklandia Root), and Dahuang (Rhubarb Rhizome).
For deficient persons, use Renshen Yangwei Tang (Ginseng Decoction to Nourish the Stomach).
Intermittent pain, not relieved by hot pressure, with a surging and rapid pulse, indicates Heat. Treat with Erchen Tang (Two Aged Substances Decoction) plus Houpo (Magnolia Bark), Zhishi (Immature Bitter Orange), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Shanzhi (Gardenia Fruit).
Borborygmus (rumbling sound) in the abdomen indicates Fire agitating Water. Treat with Erchen Tang plus Huangqin, Huanglian, Muxiang, Zhishi, and Mutong (Akebia Stem).
For deficient persons, use Liujunzi Tang plus Xiangru, Sharen, Zhuling (Polyporus), and Zexie (Alisma Rhizome).
Pain caused by Summerheat, possibly with diarrhea/dysentery, presents with a vacuous and hollow pulse. Treat with Shiwei Xiangru Yin (Ten-Ingredient Patchouli Decoction).
Pain caused by Dampness, with urinary difficulty and loose stools, treat with Weiling Tang (Atractylodes and Poria Decoction).
If there is chronic heat and pain in the abdomen, this is Accumulated Heat. Purge with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction).
Pain caused by exogenous Cold presents with a wiry and slow pulse. Treat with Xiaojianzhong Tang (Minor Construct the Middle Decoction) plus Paojiang (Prepared Ginger).
If accompanied by Qi Stagnation with a deep pulse, add Taixiong, Cangzhu, and Xiangfu.
Pain caused by Heat presents with a rapid and hurried pulse. Treat with Erchen Tang plus Huangqin, Huanglian, and Baishao.
If pain is severe, add a small amount of Paojiang for counter-treatment (antidotal therapy).
If pain is intermittent, with dry mouth, nausea, dizziness, or vomiting yellow foam, this is Fire. Do not use Paojiang in the previous formulas; add Dahuang to mildly purge.
Deep, knotted, or hidden pulses indicate abdominal pain. Pain radiating to both hypochondria and shoulder/back, preventing flexion and extension, indicates Qi Stagnation. Treat with Erchen Tang plus Chuanxiong (Sichuan Lovage Rhizome), Muxiang, Zhike (Bitter Orange Peel), and Xiangfu.
If ineffective, there is Blood Stasis. Add Pengzhu (Curcuma Zedoaria Rhizome) and Chuanshanjia (Pangolin Scales).
Internal emotional constraint causing severe heart/abdominal colic, inability to eat, intermittent attacks, feeling like death during attacks: select Qiqi Tang (Seven Emotions Decoction).
Pain from Wine Retention: Qu Wan (Medicated Leaven Pill).
Pain from Food Retention: Baohe Wan (Preserve Harmony Pill).
Pain from Parasites:表现为 "Ao'ao" (restless discomfort) pain, moving up and down, with intervals of relief, palpable masses, and vomiting clear fluid during attacks. Treat as Parasitic Accumulation.
Pain caused by Hernia: necessarily radiating to the testicles, or a cord-like mass rising in the lower abdomen. Treat as Hernia.
Pain caused by contact with foul/toxic substances, worsening with hot drinks: this is Foul Toxin attacking upwards. See detailed discussion in this chapter.

Small Abdominal Pain
There are three types of small abdominal fullness/pain, all due to internal retention, not deficient Qi.
The center of the lower abdomen is the domain of the Shaoyin, Ren Mai (Conception Vessel), and Chong Mai (Penetrating Vessel). The sides are the domain of the Jueyin Liver Meridian.
First type: Dryness accumulation in the Large Intestine. Symptoms: Constipation for 5-6 days, hardness/fullness on palpation, pain surrounding the umbilicus, urine is free but yellow-red, pulse is rapid, excess, and forceful. This is Fu-organ Excess accumulation causing pain/fullness. Purge with Dachengqi Tang (Major Order the Qi Decoction).
If due to dryness from fluid/blood depletion: pulse is rapid but not vigorous. Use Mahuang Wan (Hemp Seed Pill) or Tongyou Tang (Unblocking the Source Decoction).
Idiopathic constipation with slight lower abdominal fullness, where the Chi (Cun Cun) pulse is rapid but weak: use Honey Suppository (Mi Jian Dao). In summer, use Pig Gallbladder Suppository. Strictly avoid purgatives, as they damage Stomach Qi and cause other diseases.
Second type: Heat accumulation in the Bladder. Symptoms: Urinary retention, fullness on palpation but not hard, resonant sound on percussion, pulse is rapid, abundant, and forceful, with irritability, thirst, and desire to drink. Worse during the day: treat with Wuling San. Worse at night: treat with Zhuling Tang (Polyporus Decoction).
Third type: Blood accumulation in the Bladder causing abdominal fullness. Symptoms: Forgetfulness resembling mania, or thirst wanting to rinse mouth but not swallow, or preference for hot drinks but unable to drink much. Urine is clear and free, or even more than usual, or frequent dribbling without clearing.
Generally, if pathogen knots in the Yang aspect of the Bladder, Heat injures Blood. Even with Blood Stasis, if True Yin is not deficient, urine remains clear, and Chi pulse is vigorous. Treat with Dai Dandang Wan (Substitute Dang Gui Pill).
If urine volume doubles the norm, it indicates Pathogen occupying the Lower Jiao and True Yang escaping externally. Modify the formula by removing Mangxiao (Mirabilite), reducing Dahuang, doubling Rougui, and adding Shufu Zi (Prepared Aconite Root) 0.6-0.9g to rescue.
If caused by intercourse after drunkenness/full meals, or forcing semen retention, injuring Shaoyin, Ren, and Du vessels, leading to Blood knotting in the Yin aspect: this is True Yin deficiency, causing difficult/frequent urination and fullness resembling strangury. Use Shengliao Jisheng Shenqi Wan (Raw Ingredients Jisheng Kidney Qi Pill), decocted with red wine.
In women, injury during intercourse during menstruation causes continuous leakage and lower abdominal fullness/pain: this is Chong Mai injury. Use Shiquan Dabu Tang (Ten Complete Tonifying Decoction) with doubled Rougui.
If there is a mass with colic, relieved by heat: this is Qi/Blood deficiency with Blood Stasis. Use Danggui Shengyang Roushou Tang (Angelica, Ginger, and Lamb Soup) plus Rougui, Wu Zhuyu, Fuling (Poria), and Baishao. If ineffective, add Renshen (Ginseng Root).
For those with inherent Lower Yuan deficiency, injured by forced labor, causing Blood Stasis in the lower abdomen with fullness/pain: this is Liver Meridian injury. Fullness appears predominantly on the left side. Use Tiaogan San (Regulate Liver Powder) or Dai Dandang Wan, selected based on severity.
However, right-sided predominance is often due to eating full then running, causing Spleen Yin to sink, with food retention and phlegm-dampness knotting. Seek treatment in the Food Retention chapter.
Foul toxin abdominal pain/vomiting: see Miscellaneous Diseases chapter.

[Diagnosis]
Yin-wiry, fine, tight, and urgent pulses all indicate abdominal pain.
Slippery pulse indicates Phlegm-Fluid. Wiry pulse indicates Cold Food.
Yin-wiry or tight pulses suit warming methods. Deep-wiry-slippery-excess pulses suit purging methods.
Deep-hidden pulse indicates Qi Stagnation.
Fine-tight-urgent pulse with stabbing abdominal pain, Tight Chi pulse indicates pain below the umbilicus.
Wiry-rapid pulse indicates small abdominal pain.
Hidden Chi pulse indicates Jia-mass (accumulation) pain.
Fine-slow pulses are easy to treat.
Hard-large-rapid pulses, Rapid-tight pulses, Floating-large-long pulses indicate mismatch between disease and pulse; these are difficult to treat.
Severe pain with panting, urgent large pain below the umbilicus, blackening of the philtrum: fatal prognosis.

Narrowness in the Abdomen
Obese individuals: Wet-Phlegm retention, Qi ascent/descent dysfunction. Regulate Qi and dry dampness. Yueju Wan (Regulating Depression Pill) and Pingwei San are primary.
Thin individuals: Yin deficiency with Fire hyperactivity steaming the Zang-Fu. Xiaoyao San (Free and Easy Wanderer Powder) and Zuojin Wan (Support Metal Pill) to descend Fire and resolve depression.
Obese individuals with borborygmus: Treat as Phlegm. Erchen Tang and Erzhu (Two Atractylodes) are primary. Add Renshen for Qi deficiency.

Pain around the Umbilicus
Umbilical pain indicates Kidney deficiency and Ren Mai disease. Use Liuwei Wan (Six-Ingredient Pill) plus Guiban Hui (Tortoise Shell Ash).
In Cold Damage, if Yang pulse is choppy and Yin pulse is wiry, acute abdominal pain is expected. This is due to root deficiency with Cold invasion. Harmonize with Xiaojianzhong Tang.

Yu Hengde treated a strong young man who fished in cold water in winter. Hungry and exposed to cool air, he ate porridge and suffered severe abdominal pain for two days/nights. Doctors used Dahuang Wan (Rhubarb Pill) without success, then Chengqi Tang to purge fecal water, worsening pain. Pulse was deep, hidden, and excess. Complexion was blue-black. This was Major Cold with dry stool in the Lower Jiao. First, gave Zhizhong Tang (Regulate the Middle Decoction) plus Dingxiang (Clove) and Fuzi (Aconite) for one dose. Moxibustion on Qihai (CV6) for 21 cones reduced pain by half. Then made pills with Badou (Croton Seed), Chenxiang (Agarwood), and Muxiang, size of mung beans. Taken with ginger soup, 5-7 pills per dose. After 5-7 bowel movements, cured.

He also treated another person who fished in deep water in June. By late autumn rain/coolness, midnight severe lower abdominal pain with profuse sweating. Pulse was deep, wiry, fine, and excess; heavy pressure felt like touching a knife edge ("ze ze"). Deep-wiry-fine-excess pulse with knife-edge sensation indicates Yin pathogen consolidation. Sweating should not occur. Profuse sweating indicates Blood Stasis retention, Ying Qi failing to hold internally and leaking out. Wiry pulse also indicates Liver Blood injury. Gave Dachengqi Tang plus Guizhi (Cinnamon Twig) twice. Mild purgation reduced pain. On subsequent days at Wei/Shen hours (1-5 PM), hardness returned, intolerable to touch. Added Tao Ren (Peach Kernel) paste to previous formula. Passed over a sheng of purple blood; pain stopped. Pulse slightly improved but knife-edge sensation remained. Added Chuan Fuzi (Sichuan Aconite) to previous formula. Passed 4-5 stools, including 2 sheng of purple-black blood like broken cotton; cured.

Wang Shishan treated an old woman with abdominal pain. Started with cold right fingers ascending to head like cold water pouring, with severe abdominal pain. Body became hot during pain, pain ceased when heat subsided. Pain occurred regardless of eating or fasting. Frequency increased from 1-2 times/year to every 2-3 days recently. Previous treatments with Siwu Tang, Sijunzi Tang, Erchen Tang, Qiqi Tang failed. Wang diagnosed weak, almost imperceptible pulses, with interruptions (every 2-3 beats or 4-5 beats). This indicated Major Yang Deficiency. Used Dushen Tang (Single Ginseng Decoction) 5 qian with Chenpi (Tangerine Peel) 0.7 fen, decocted and taken. Cured after ~10 doses. Limbs are the root of Yang; Head is the meeting of Yang. Classic says: "Yang deficiency leads to aversion to cold." Finger cold ascending to head confirms Yang deficiency/Yin excess. Yang deficiency fails to move/nourish, causing severe pain. Pain followed by heat is "extreme reverses." When Yin/Yang Qi decline and cease fighting, heat stops and pain rests. Thus, tonify with Dushen Tang. Years of illness cured.