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When pathogenic factors invade the interior and contend with healthy qi, abdominal pain results. The causes of pain vary. Abdominal pain belongs to Interior syndromes; the Taiyang channel area of the abdomen typically does not hurt. Shaoyang syndromes present with hypochondriac pain but no abdominal pain. If Yangming syndrome is present, there is abdominal fullness and urgent pain. This indicates an Interior Excess syndrome suitable for purgation, using Da Chai Hu Tang (Major Bupleurum Decoction) or Xiao Cheng Qi Tang (Minor Order the Qi Decoction). In the Three Yin channels, if there is diarrhea with undigested food accompanied by abdominal pain, it is due to Interior Cold. This summarizes the "Yin within Yang" aspect of the Taiyang channel; Si Ni Tang (Frigid Extremities Decoction) or Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) can be used to warm and tonify Yang qi.

Taiyin channel pathology presents with abdominal fullness and pain. There are two types: Excess pain and Deficiency pain. Pain accompanied by borborygmus and diarrhea is Deficiency pain. This specifically discusses the "Yang within Yin" aspect of the Taiyin channel; Xiao Jian Zhong Tang (Minor Construct the Middle Decoction), which is Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction plus Peony Root) with variations in Cinnamon Twig dosage, is indicated. If symptoms persist, Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Huang Qin removed and Shao Yao added as previously described is used. If abdominal fullness, constipation, and tenderness on palpation occur, this is Excess pain, treated with Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction plus Rhubarb), using one qian of Da Huang. Here, Deficiency refers to the gradual dissipation of Yang pathogenic factors, while Excess refers to robust Yang qi.

In Taiyang Shang Han (Cold Damage), if the pulse is choppy at the superficial position and wiry at the deep position, acute abdominal pain should occur. Initially administer Xiao Jian Zhong Tang; if ineffective, then administer Xiao Chai Hu Tang. (Cheng Wuji notes: A choppy superficial and wiry deep pulse with acute abdominal pain indicates Interior Cold-Deficiency, treat with Xiao Jian Zhong Tang to warm the middle and dispel cold. If unresponsive, it is not Interior Cold but rather pathogenic factors moving from exterior to interior causing Interior qi stagnation; use Xiao Chai Hu Tang minus Huang Qin plus Shao Yao to clear interior pathogens.)

Formula: Xiao Jian Zhong Tang
Gui Zhi (Cortex Cinnamomi, remove bark) 3 liang, Sheng Jiang (Rhizoma Zingiberis Recens, sliced) 3 liang, Bai Shao (Radix Paeoniae Alba) 6 liang, Zhi Gan Cao (Radix Glycyrrhizae Preparata) 2 liang, Da Zao (Fructus Jujubae, 12 pieces, split), Jiao Yi (Malt Sugar) 1 sheng.
Boil the above six ingredients in seven sheng of water to obtain three sheng, strain, add Jiao Yi, and simmer gently until dissolved. Take one sheng warm, three times daily. Do not use Jian Zhong Tang if vomiting occurs due to its sweetness. (The Nei Jing states: Liver qi arises on the left, Lung qi resides on the right, Heart is superior, Kidney is inferior, Spleen is Earth corresponding to the Center, governing the four viscera, producing Ying and Wei qi, and circulating body fluids. Dysregulation leads to deficiency of Ying/Wei and fluids; this decoction warms and strengthens the Middle Jiao, hence "Jian Zhong". Spleen desires relaxation; sweet flavors relax urgency. Tonifying Spleen requires sweet flavors; thus, Jiao Yi (sweet/warm) is the Sovereign herb. Gan Cao (sweet/neutral) is the Minister. Gui Zhi (pungent/hot) disperses and moistens deficient Ying/Wei. Shao Yao (sour/cold) astringes and directs fluids. Thus, Shao Yao and Gui Zhi are Assistant herbs. Sheng Jiang (pungent/warm) and Da Zao (sweet/warm): Stomach is the source of Wei, Spleen is the root of Ying. The Zhen Jing states: Ying originates from Middle Jiao, Wei from Upper Jiao. Wei is Yang, supplemented by pungent; Ying is Yin, supplemented by sweet. Pungent and sweet harmonize Spleen/Stomach and circulate Ying/Wei; thus, Ginger and Jujube are Envoy herbs. Some ask: Gui Zhi Tang releases the exterior with little Shao Yao; Xiao Jian Zhong Tang warms the interior with much Shao Yao. Why? Skin is close, so dosage is small; Heart/Abdomen are distant, so dosage is large. This explains the difference.)

In Shang Han, if there is heat in the chest, pathogenic factors in the stomach causing abdominal pain and desire to vomit, treat with Huang Lian Tang (Coptis Decoction). (Cheng Wuji notes: Dampness patients purged incorrectly develop tongue coating due to heat in Lower Jiao and cold in Upper Chest, indicating interior pathogens causing lower heat/upper cold. Here, Shang Han pathogens transmit to interior causing lower cold/upper heat. Pathogens in stomach disrupt Yin-Yang interaction; Yin fails to ascend, causing lower cold and abdominal pain; Yang fails to descend, causing upper heat and desire to vomit. Huang Lian Tang regulates Yin-Yang qi.)

Formula: Huang Lian Tang
Huang Lian (Rhizoma Coptidis) 3 liang, Zhi Gan Cao (Radix Glycyrrhizae Preparata) 3 liang, Pao Gan Jiang (Rhizoma Zingiberis Preparata) 3 liang, Gui Zhi (Cortex Cinnamomi, remove bark) 3 liang, Ren Shen (Radix Ginseng) 2 liang, Ban Xia (Rhizoma Pinelliae Preparata, half sheng, washed) 12 pieces, Da Zao (Fructus Jujubae, 12 pieces, split).
Boil the above seven ingredients in ten dou of water to obtain six sheng, strain, take one sheng warm, three times daily and twice at night. (Upper heat is drained by bitter Huang Lian to descend Yang; lower cold is dispersed by pungent Gui/Zhi/Gan/Jiang/Ban Xia to ascend Yin. Spleen desires relaxation; sweet Ren Shen/Gan Cao/Da Zao tonifies Stomach.)

After five to six days of Shang Han or Feng Zhong (Wind Strike), presenting with alternating chills and fever, hypochondriac fullness, silent anorexia, irritability, and frequent vomiting, or chest irritability without vomiting, thirst, abdominal pain, hypochondriac stiffness, epigastric palpitations, dysuria, slight fever without thirst, or cough, administer Xiao Chai Hu Tang.

Two Yang channels combined disease: Initial Taiyang disease treated with incomplete sweating transmits to Yangming, continuing with slight sweating and no aversion to cold. If Taiyang signs persist, do not purge; induce slight sweating. If face is persistently red, Yang qi is constrained in the exterior; resolve via release or fumigation. If sweating was incomplete, causing restlessness, unknown pain location (sometimes abdominal, sometimes limbs, unpressable), shortness of breath, repeat sweating to cure, identified by choppy pulse. (Gui Zhi Tang for non-aversion to cold; Da Chai Hu Tang for slight sweating; consider Ge Gen Tang or Gui Zhi Ma Huang Ge Ban Tang or Ma Huang Jia Gui Zhi Tang.)

Yangming disease: Constipation for five to six days, periumbilical pain, periodic irritability, indicates dry feces preventing bowel movement. (Cheng Wuji notes: Five to six days of constipation implies dry feces. Stomach dryness/excess blocks qi descent, causing periumbilical pain and periodic irritability.) After severe purgation, if constipation persists for six to seven days with unresolved irritability and abdominal fullness, dry feces are present due to retained food. Treat with Da Cheng Qi Tang (Major Order the Qi Decoction). (Post-purgation weak stomach cannot digest; retained food consolidates after six to seven days, causing irritability/fullness/pain. Da Cheng Qi Tang purges them.) If sweating fails to resolve the condition and abdominal fullness/pain occurs, urgently purge.

Shaoyin disease: Unresolved after two to three days, progressing to four to five days with abdominal pain, dysuria, heavy/painful limbs, and spontaneous diarrhea indicates Water Qi retention. Accompanying symptoms may include cough, vomiting, diarrhea, or patent urination. Treat with Zhen Wu Tang (True Warrior Decoction). (Cheng Wuji notes: By day four-five, pathogens are deep. Kidney governs water; kidney failure leads to water retention. Abdominal pain is internal cold-damp; limb heaviness/pain is external cold-damp; dysuria/diarrhea is dampness overwhelming separation of fluids. Nei Jing: Dampness causes loose stools. Zhen Wu Tang tonifies Yang and disperses cold-damp.) Shaoyin disease with diarrhea of undigested food, Interior Cold with Exterior Heat, cold extremities, faint/almost imperceptible pulse, paradoxical absence of aversion to cold, and red complexion, or abdominal pain, dry heaving, sore throat, or cessation of diarrhea with absent pulse, treat with Tong Mai Si Ni Tang (Pulse-Restoring Frigid Extremities Decoction). (Diarrhea/cold extremities/faint pulse indicate Interior Cold; fever/no aversion/red face indicate Exterior Heat. This is Interior Yin excess repelling Exterior Yang. Tong Mai Si Ni Tang disperses Yin and unblocks Yang.) Shaoyin disease with cold extremities, or cough, palpitations, dysuria, abdominal pain, or sensation of rectal heaviness during diarrhea, treat with Si Ni San (Frigid Extremities Powder). (Si Ni refers to cold extremities. Yang channel diseases have hot hands/feet; Taiyin has warm hands/feet; Shaoyin has cold extremities due to deep heat; Jueyin has cold extremities, worse than Si Ni. Si Ni San disperses transmitted heat.) Shaoyin disease progressing from two-three to four-five days with abdominal pain, dysuria, persistent diarrhea with pus/blood, treat with Tao Hua Tang (Peach Blossom Decoction). (Deep interior cold; abdominal pain is Interior Cold; dysuria is fluid/food separation failure; persistent diarrhea/pus/blood is intestinal weakness and lower Jiao insecurity. Tao Hua Tang secures intestines and stops diarrhea.)

Taiyin disease: Presents with abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and spontaneous abdominal pain. Purging will cause sub-xiphoid hardness. (Use Li Zhong Tang/Wan if not thirsty; Si Ni Tang etc. otherwise.) Originally Taiyang disease, incorrectly purged by physician, leading to abdominal fullness and intermittent pain belonging to Taiyin, use Gui Zhi Jia Shao Yao Tang. For severe Excess pain, use Gui Zhi Jia Da Huang Tang (see previous section).

Jueyin disease: Shang Han after four-five days with abdominal pain and gas moving downward toward the lower abdomen indicates impending diarrhea. (Pathogens transmit to interior; abdominal pain and gas moving down indicate Interior Deficiency meeting Cold, causing Cold to descend and spontaneous diarrhea. Use Fu Zi Gan Jiang Tang or Si Ni Tang.)

Yun Qizi states: Shang Han pathogens in Three Yin fail to communicate internally, causing abdominal pain. Hand-Foot channels converge at the abdomen. Wiry pulse with abdominal pain indicates Foot Jueyin Liver and Hand Taiyin Lung channels; puncture Tai Chong, Tai Yuan, Tai Ling. Deep pulse with abdominal pain indicates Foot Taiyin Spleen, Shaoyin Kidney, and Hand Jueyin Pericardium channels; puncture Tai Xi, Tai Ling. Deep-thin pulse with pain indicates Foot Taiyin Spleen and Hand Shaoyin Heart channels; puncture Tai Bai, Shen Men, Yin Jiao. This is the acupuncture method for abdominal pain.

Wu Qiu states: Abdominal pain that can be pressed/massaged is Internal Deficiency; pain that cannot be pressed is Internal Excess. Wang Hai Cang states: Zhong Wan pain belongs to Spleen Earth; deep-thin pulse with Internal Cold uses Li Zhong Tang or Fu Zi Li Zhong Wan. Superficial choppy/deep wiry pulse uses Xiao Jian Zhong Tang. Lower abdominal pain belongs to Jueyin channel; use Dang Gui Si Ni Tang plus Wu Zhu Yu. Cold extremities use Si Ni Tang plus Wu Zhu Yu. Severe Excess, abdominal fullness/pain, periumbilical stabbing pain, constipation, and solid pulse use Da Cheng Qi Tang to purge. Tidal fever, constipation, hardness/fullness/pain from epigastrium to lower abdomen, intolerant to touch, use Da Xian Xiong Tang to purge. Wiry pulse, abdominal pain, no heat/cold, use Shao Yao Gan Cao Tang. Wiry pulse, bitter taste, fever, abdominal pain, use Xiao Chai Hu Tang minus Ren Shen plus fried Bai Shao. Alternating chills/fever with abdominal pain adds Rou Gui and Shao Yao. More cold with pain removes Huang Qin and doubles Rou Gui/Shao Yao. Shaoyin fever, cold extremities, abdominal pain use Si Ni San plus Fu Zi, Rou Gui, fried Shao Yao, Wu Zhu Yu. Fever, surging-wiry pulse, abdominal pain use Shao Yao Huang Qin Tang. Generally, abdominal pain has Deficiency/Excess and Cold/Heat; differentiate by pulse/symptoms. Blood stasis also causes abdominal pain, intolerant to touch (see specific section). Spontaneous diarrhea, abdominal pain, clear urine require warming; choose Li Zhong or Si Ni Tang based on severity; mild cases use Wu Ji San, severe use Si Ni Tang, pulseless use Tong Mai Si Ni Tang to retreat Yin and restore Yang. Abdominal pain with desire to vomit/diarrhea and restlessness often involves Sha Du (sand poison); worldly practice pierces Wei Zhong. Wiry-micro pulse, lower abdominal pain (Jueyin) puncture Tai Chong, Tai Yuan, Tai Ling, moxa Gui Lai, Guan Yuan. Deep pulse, umbilical pain (Shaoyin) puncture Tai Bai, Shen Men, Yin Jiao, moxa Zhong Wan.

Tao Hua states: Shang Han abdominal pain relieved slightly by cold water indicates Heat; use cooling herbs. If ineffective with periumbilical hard pain, constipation, irritability/thirst, it is Dry Feces pain; urgently purge with cold herbs. Food stagnation pain is treated similarly. Lower abdominal hard pain, patent urination, black stool, yellow eyes/body indicate Blood Stasis pain; treat similarly adding blood-moving herbs to purge black matter for self-healing. These three follow the principle "pain decreases with relief." Pain worsened by drinking water indicates Cold; use warming herbs. If ineffective with cold extremities, abdominal pain, vomiting, diarrhea, urgently use hot herbs. Verify pulse strength. Liu Shi used ash packs to moxa abdominal pain.

Pang An Shi states: Combined diseases requiring moxibustion but neglected lead to Cold stagnation rushing to the Heart and death.

Luo Yi (Huoren Shu) states: No high fever, irritability/thirst, solid stool, or abdominal fullness/rash treated with Tiao Wei Cheng Qi Tang or Huang Lian Ju Pi Tang.

Abdominal pain with headache, fever, body ache, vomiting/diarrhea is Huo Luan ( cholera-like illness); desire to vomit/diarrhea but unable is Gan Huo Luan (dry cholera). See Miscellaneous Diseases Huo Luan section for methods.