The Introduction of Abdominal Pain
Abdominal pain refers to pain below the stomach and above the pubic symphysis.
Corresponding diseases in CWM
Abdominal pain is a common clinical symptom occurring in many digestive diseases, like enterospasm, pancreatitis, gastrointestinal neurosis, enteritis, and colitis. It caused by gynecological conditions will not be covered in this chapter.
- Cold congeals and leads to stagnation.
- Summer Heat combines easily with Damp to block Qi circulation.
- Anger and worry may cause Liver-Qi stagnation → LR overacts on SP → Blood stasis → abdominal pain.
- Too much spicy, heavy, flavored food → Damp-Heat.
- Too much cold, raw food → damages Spleen-Yang.
- Eating too much → food retention → abdominal pain.
- Chronic food retention in children → abdominal pain.
- Unclean food → food poisoning.
- Worms → generally Damp-Heat in character.
- Causes Blood stasis, which blocks abdominal meridians.
Yang deficiency constitution
- Fails to warm the Qi and Blood, creates internal Cold, which congeals Qi and Blood flow, leading to abdominal pain.
- Many Zang-Fu organs are located in the abdomen. Many meridians run through the abdomen: ST, SP, LR, GB, KI, CV, Dai Mai, and Chong Mai. Any Zang-Fu organ damage or meridian blockage may lead to abdominal pain. Blockage of Qi movement and the meridians is the chief pathology for excess patterns, while malnourishment of the Zang-Fu and meridians creates deficiency patterns. Overall, the most commonly seen causes of abdominal pain in the clinic are Cold invasion, Qi stagnation, and food retention.
- The organs involved in abdominal pain include SP and ST, LR and GB, KI and BL, SI, LI, TE.
- There is inter-transformation between excess and deficiency. For example, long-term Cold pain can turn into Heat; Qi stagnation can turn into blood stasis; deficiency pain is easily invaded by pathogenic factors; trauma/surgery leads to Blood stasis, which in turn leads to Qi stagnation if Blood blocks Qi passage.
How to Diagnose and differentiate Abdominal Pain (see Table 7)
Differentiation of disease
- Location of pain is higher — just below the Heart (abdominal pain is from below the stomach to above the pelvis.
- Accompanying symptoms include belching, acid regurgitation, nausea, and vomiting (abdominal pain uncommonly presents with belching and in this case many Zang–Fu could be involved).
- The main organ involved is ST and may relate to LR and SP.
- Often combines with abdominal pain.
- Accompanying symptoms: rectal tenesmus, and diarrhea mixed with red and white mucus.
- Is an infectious disease.
Abdominal pain caused by gynecological conditions is usually located in the lower abdomen. It is closely associated with Menstruation, Leukorrhea, and Pregnancy.
Key points for differentiation
- Severe pain.
- Accompanying symptoms caused by EPF, food retention, or parasites.
- Dull pain.
- Accompanying symptoms caused by internal injury or by Yang deficiency.
Table 7.Differentiation and treatment of abdominal pain
Basic points: CV 12, ST 25, CV 6, ST 36/37, SP 4.
- Likes pressure.
- Not fixed.
- Dull pain.
- Pain with hunger.
- Dislikes pressure.
- Severe pain.
- After meals.
- Severe acute pain and abdominal distension.
- Pain alleviated by cold.
- Acute pain, not intermittent.
- Aggravated by cold.
- Alleviated by warmth.
- Intermittent, distending abdominal pain.
- Wandering pain.
(8) Blood Stasis
- Stabbing pain like that caused by a knife, or colicky pain that is fixed in location.
- Blood stasis signs on the tongue and pulse.
(9)To determine the organ involved:
- Pain in the whole area (except epigastric) — SP, ST, LI, SI.
- Pain in the sides of the lower abdomen — LR.
- Pain directly below the umbilicus — KI, BL.
- Pain around the navel and vomiting of clear water — parasites (worms).
Principle of treatment
(1)Unblock the meridian
- Remove the pathogenic factor(s) for excess, e.g. clear Heat, transform Damp, regulate Qi, move Blood, or promote digestion.
- Tonify Zheng Qi for deficiency, e.g. warm the Middle Jiao, or tonify Qi and Blood.
- CV 6, 12
- ST 25, 36, 37
- SP 4
(2)Obstruction by cold
- SP 15
- LI 4
- CV, SP, ST, LI Meridians
- Reducing method and moxa
- LI 4, 11
- SP 6, 9
- BL 25
- TE 6
- CV 17
- PC 6
- GB 34
- LR 3
- PC, LR, GB, ST, and CV Meridians
- Even method
- PC 6
- SP 6, 10
- BL 17, 18
- LR 13
- BL 20, 21
- CV, Back Shu, Front Mu
- Tonify and moxa
Severe hypochondriac pain → LR 14.
Upper abdominal pain → CV 12.
Pain around the navel → CV 6, 10.
Acid regurgitation (GB 34).
Thirst (ST 44).
Cold limbs (moxa CV 8 to warm the body).
- Large Intestine
- Small Intestine
2 or 3 points.
Needles (10–20 min) or seeds.
- Around abdominal points and Back Shu points
- 3 or 4 points each time
- 1 or 2 times each day
Especially good for Cold or food accumulation.
For Cold pain:
Xiaohuixiang (9 g) + Wuyao (6 g)
For Qi stagnation:
Wuzhuyu (3 g) + Muxiang (2.5 g)
For Qi deficiency:
Huangqi (15 g) + Gancao (licorice) (5 g)
- Avoid cold, raw food, especially in summer.
- Avoid camping in cold, wet areas.
- Avoid strenuous exercise after meals.
- Eat regular meals.
- Clean and cook vegetables.
- Do not eat too much greasy food.
- Increase meal frequency to decrease meal size.
- Regulate emotions.