ABDOMEN

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Chapter 71

ABDOMEN

Chapter contents

INTRODUCTION

Although the headings below refer primarily to pain in various areas of the abdomen, other sensations may be experienced in each of those areas; these are primarily distension, oppression, fullness or stuffiness.

The clinical significance of these sensations is briefly explained below. For a fuller explanation, see Part 2, Chapter 38.

PAIN

The regions of abdominal pain in Chinese medicine are as follows:

• area under the heart (this is the small area immediately below the xyphoid process extending approximately 2 inches and bordered by the ribs)

• epigastric (this is the area between the xyphoid process and the umbilicus but excluding the hypochondrial area)

• hypochondrial (these are the two areas below the rib cage)

• umbilical (this is the area around the umbilicus)

• central-lower abdominal (this is the central area of the abdomen between the umbilicus and the symphysis pubis)

• lateral-lower abdominal (these are the lateral areas of the lower abdomen).

Figure 16.7 on p. 145 illustrates these areas.

Area below the xyphoid process

Interrogation, Chapter 38

Rebellious Qi of the Penetrating Vessel

Pain below the xyphoid process with a feeling of tightness, a feeling of heat in the face, a feeling of a lump in the throat, palpitations, anxiety, a feeling of tightness of the chest, nausea, slight breathlessness, epigastric fullness or stuffiness, umbilical and abdominal fullness, irregular/painful periods, a feeling of energy rising in the abdomen to the chest, Firm pulse.

Stomach-Heat

Pain below the xyphoid process, burning epigastric pain, thirst, sour regurgitation, nausea, excessive hunger, foul breath, a feeling of heat, Red tongue with a yellow coating, Overflowing-Rapid pulse.

Stomach-Qi stagnation

Pain below the xyphoid process with a feeling of distension, epigastric pain and distension, belching, nausea, vomiting, hiccup, irritability, pulse Wiry on the right Middle position.

Heart-Qi stagnation

Pain below the xyphoid process with a feeling of distension, palpitations, a feeling of oppression of the chest, depression, a slight feeling of a lump in the throat, slight shortness of breath, sighing, poor appetite, chest and epigastric distension, a dislike of lying down, weak and cold limbs, slightly purple lips, pale complexion, tongue slightly Pale-Purple on the sides in the chest area, pulse Empty but very slightly Overflowing on the left Front position.

Retention of Food in the Stomach

Pain below the xyphoid process with feelings of fullness, fullness, pain and distension of the epigastrium which are relieved by vomiting, nausea, vomiting of sour fluids, foul breath, sour regurgitation, belching, insomnia, loose stools or constipation, poor appetite, thick tongue coating, Full-Slippery pulse.

Stomach- and Spleen-Qi deficiency with Heart-Heat

Pain below the xyphoid process with a feeling of stuffiness, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, an uncomfortable feeling in the epigastrium, loss of sense of taste, palpitations, thirst, mouth and tongue ulcers, mental restlessness, feeling agitated, insomnia, dream-disturbed sleep, a feeling of heat, red face, bitter taste, Red tongue with redder tip and yellow coating, Overflowing and Rapid pulse.

Phlegm in the Stomach

Pain below the xyphoid process with a feeling of oppression, a feeling of oppression in the epigastrium or the chest, nausea, sputum in the throat, nausea, Swollen tongue with sticky coating, Slippery pulse.

Qi stagnation and Phlegm

Pain below the xyphoid process with a feeling of oppression and distension, a feeling of oppression of the chest, a feeling of a lump in the throat, sighing, sputum in the throat, irritability, Swollen tongue, Wiry or Slippery pulse.

Clinical note

• In my experience, repressed feelings are often ‘stored’ in the area below the xyphoid process; this often manifests with a hardness in this area on palpation.

Epigastric pain

Interrogation, Chapter 38

Stomach- and Spleen-Qi deficiency

Dull epigastric pain that is alleviated by eating and pressure coming in bouts, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, lack of sense of taste, Pale tongue, Empty pulse.

Stomach-Yin deficiency

Dull epigastric pain, poor appetite, poor digestion, retching, gnawing hunger, loss of sense of taste, dry mouth, dry lips, dry stools, thin body, sallow complexion with possibly a red tip of the nose, night sweating, tongue with transversal cracks on the sides, Weak or Floating-Empty pulse.

Liver-Qi invading the Stomach

Epigastric pain and distension extending to the hypochondrium, irritability, a feeling of oppression of the epigastrium, sour regurgitation, hiccup, belching, nausea, vomiting, sighing, weak limbs, normal-coloured tongue (or slightly Red on the sides in severe cases of Liver-Qi stagnation), pulse Wiry on the left and Weak on the right.

Cold in the Stomach

Severe, sudden-onset, spastic epigastric pain that is alleviated by drinking warm liquids and aggravated by drinking cold liquids, a feeling of cold, cold limbs, preference for warmth, vomiting of clear fluids (which may alleviate the pain), nausea, feeling worse after swallowing cold fluids (which are quickly vomited), preference for warm liquids, thick white tongue coating, Deep-Tight-Slow pulse.

Stomach-Heat

Burning epigastric pain, thirst, sour regurgitation, nausea, excessive hunger, foul breath, a feeling of heat, Red tongue with a yellow coating, Overflowing-Rapid pulse.

Stomach-Fire

Burning epigastric pain, intense thirst with a desire to drink cold liquids, mental restlessness, dry mouth, mouth ulcers, bleeding gums, dry stools, sour regurgitation, foul breath, nausea, vomiting soon after eating, a feeling of heat, sour regurgitation, tongue Red with a thick, dry dark-yellow coating, Deep-Full-Rapid pulse.

Cold-Dampness in the Stomach

Epigastric pain that is aggravated by drinking cold liquids and ameliorated by drinking warm liquids, poor appetite, a feeling of fullness or cold in the epigastrium, a feeling of heaviness of the head and body, a sweetish taste or absence of taste, no thirst, loose stools, tiredness, lassitude, nausea, oedema, dull-white complexion, excessive white vaginal discharge, Pale tongue with sticky white coating, Slippery-Slow pulse.

Damp-Heat in the Stomach

Epigastric pain, a feeling of fullness of the epigastrium, a feeling of heaviness, facial pain, stuffed nose or thick sticky nasal discharge, thirst without a desire to drink, nausea, a feeling of heat, dull-yellow complexion, a sticky taste, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Blood stasis in the Stomach

Severe, stabbing epigastric pain that may be worse at night, a dislike of pressure, nausea, vomiting, possibly of blood, or food looking like coffee grounds, Purple tongue, Wiry pulse.

Phlegm-Heat in the Stomach

Burning epigastric pain, thirst without a desire to drink, mental restlessness, bleeding gums, dry stools, dry mouth, mouth ulcers, sour regurgitation, nausea, vomiting soon after eating, excessive hunger, foul breath, a feeling of heat, a feeling of oppression of the chest and epigastrium, insomnia, tongue Red in the centre with a sticky yellow coating and a Stomach crack with a rough, sticky yellow coating inside it, Slippery-Rapid pulse.

Retention of Food

Epigastric pain, distension and fullness which are relieved by vomiting, nausea, vomiting of sour fluids, foul breath, sour regurgitation, belching, insomnia, loose stools or constipation, poor appetite, thick tongue coating, Full-Slippery pulse.

Liver-Fire invading the Stomach

Burning epigastric pain, distension and fullness, irritability, sour regurgitation, hiccup, belching, nausea, vomiting, sighing, weak limbs, tongue Red on the sides, pulse Wiry-Rapid and Weak on the right.

Phlegm-Fluids in the Stomach

Dull epigastric pain, abdominal fullness and distension, nausea, vomiting of watery fluids, dry mouth without a desire to drink, shortness of breath, dizziness, a feeling of oppression of the chest, swelling of the limbs, expectoration of thin watery sputum, inability to lie down, Swollen tongue with sticky coating, Deep-Wiry or Deep-Slippery pulse.

Clinical note

• Liver-Qi invading the Stomach is probably the commonest cause of epigastric pain.

Hypochondrial pain

Interrogation, Chapter 38

These are the two lateral areas of the upper abdomen below the rib cage.

Liver-Qi stagnation

Hypochondrial pain and distension without a fixed location and coming and going according to the emotional state, irritability, moodiness, a feeling of a lump in the throat, premenstrual tension, Wiry pulse.

Liver-Blood stasis

Stabbing hypochondrial pain with fixed location which is worse at night, painful periods, dark and clotted menstrual blood, masses in the abdomen, purple nails and lips, purple or dark complexion, Purple tongue, Wiry or Firm pulse.

Damp-Heat in Liver and Gall-Bladder

Hypochondrial pain distension and fullness, bitter taste, poor appetite, nausea, a feeling of heaviness of the body, yellow vaginal discharge, vaginal itching, mid-cycle bleeding/pain, burning on urination, dark urine, yellow complexion and eyes, vomiting, Red tongue with redder sides and unilateral or bilateral sticky yellow coating, Wiry-Slippery-Rapid pulse.

Liver-Yin deficiency

Dull hypochondrial pain that is alleviated by rest, dizziness, numbness/tingling of the limbs, insomnia, blurred vision, floaters in the eyes, dry eyes, diminished night vision, scanty menstruation or amenorrhoea, dull-pale complexion without lustre but with red cheekbones, muscular weakness, cramps, withered and brittle nails, very dry skin and hair, night sweating, depression, a feeling of aimlessness, normal-coloured tongue without coating, Fine or Floating-Empty pulse.

Lesser-Yang syndrome

Hypochondrial pain and distension, alternation of chills and a feeling of heat, bitter taste, dry throat, blurred vision, irritability, nausea, unilateral sticky tongue coating, Wiry pulse.

Phlegm-Fluids in the hypochondrium

Hypochondrial pain that is worse on coughing and breathing, a feeling of distension and pulling of the hypochondrium, shortness of breath, Swollen tongue with sticky coating, Deep-Slippery-Wiry pulse.

Clinical note

• Never ask a patient about pain in the ‘hypochondrium’ but instead point to the area you mean.

Umbilical pain

Interrogation, Chapter 38

Pain in the area around the umbilicus is common in children.

Stagnation of Qi in the Stomach and Intestines

Umbilical pain and distension, epigastric pain and distention, belching, nausea, vomiting, hiccup, irritability, pulse Wiry on the right Middle position.

Cold in the Intestines

Spastic umbilical pain that is aggravated by cold liquids and alleviated by hot liquids, diarrhoea with pain, feeling of cold, a cold sensation in abdomen, thick white tongue coating, Deep-Wiry pulse.

Damp-Heat in the Intestines

Umbilical pain that is not relieved by a bowel movement, diarrhoea, mucus and blood in stools, offensive odour of stools, burning in the anus, scanty dark urine, fever, sweating which does not decrease the fever, a feeling of heat, thirst without a desire to drink, a feeling of heaviness of the body and limbs, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Spleen- and Kidney-Yang deficiency

Dull umbilical pain that comes and goes, lower backache, cold and weak knees, a feeling of cold, bright-white complexion, impotence, decreased libido, tiredness, lassitude, abundant clear urination, urination at night, loose stools, poor appetite, a desire to lie down, early-morning diarrhoea, Pale and wet tongue, Deep-Weak pulse.

Food poisoning

Severe umbilical pain, belching, nausea, vomiting, loose stools, thick tongue coating, Slippery pulse.

Heat in Bright Yang

Burning umbilical pain, intense thirst with a desire to drink cold liquids, mental restlessness, dry mouth, mouth ulcers, bleeding gums, dry stools, sour regurgitation, foul breath, nausea, vomiting soon after eating, a feeling of heat, sour regurgitation, tongue Red with a thick, dry dark-yellow coating, Deep-Full-Rapid pulse.

This corresponds to either the organ pattern of the Bright-Yang Heat within the identification of patterns according to the Six Stages or to the pattern of Dry-Heat in the Intestines within the identification of patterns according to the Four Levels.

Clinical note

• Umbilical pain is more common in children than in adults.

Central-lower abdominal pain

Interrogation, Chapter 38

In Chinese this area is called xiao fu which means ‘small abdomen’. It is influenced by the channels of the Kidneys, Bladder, Small Intestine and Directing Vessel.

The symptoms and signs discussed here are only the non-gynaecological ones. Pain in the central-lower abdominal area may of course also be due to various pathologies affecting the Uterus and the Directing Vessel. These are discussed in Chapters 84–89.

Damp-Heat in the Bladder

Central-lower abdominal pain and fullness, frequency and difficulty in urination, burning on urination, dark urine, thirst with no desire to drink, sticky yellow tongue coating on the root, Slippery-Rapid pulse.

Stagnation of Qi in the Bladder

Central-lower abdominal pain and distension, a pronounced feeling of distension in the area immediately over the symphysis pubis, frequent but scanty urination, Wiry pulse.

Intestines deficient and cold

Dull central-lower abdominal pain that comes and goes and is alleviated by warm liquids and the application of heat and aggravated by cold liquids, abdomen cold when touched, cold limbs, loose stools, pale urine, Pale tongue, Deep-Weak pulse.

Stasis of Blood in the Bladder

Stabbing central-lower abdominal pain, blood in the urine, pain on urination, Purple tongue, Deep-Wiry pulse.

Liver-Qi stagnation

Pain and distension of the central-lower abdominal area, urinary difficulty, a pronounced feeling of distension before urination, Wiry pulse.

Liver-Blood stasis

Severe pain of the central-lower abdominal area, urinary difficulty, blood in the urine, Purple tongue, Wiry pulse.

Liver-Fire

Pain of the central-lower abdominal area, urinary difficulty, burning on urination, headaches, dizziness, tinnitus, irritability, propensity to outbursts of anger, red face, thirst, bitter taste, constipation, dark urine, Red tongue with redder sides and dry yellow coating, Wiry-Rapid pulse.

Retention of food and Cold

Pain of the central-lower abdominal area, a pronounced feeling of distension which is worse after eating and with cold, a feeling of fullness, abdomen cold to the touch, Deep-Slippery pulse, tongue with thick sticky coating.

Spleen-Qi deficiency

Pain of the central-lower abdominal area, poor appetite, tiredness, slight abdominal distension, pale complexion, loose stools, Pale tongue, Empty pulse.

Kidney-Yin deficiency

Pain of the central-lower abdominal area, dizziness, tinnitus, night sweating, dry mouth with a desire to sip water, backache, poor memory, dark-scanty urine, tongue without coating, Floating-Empty pulse.

Kidney-Yang deficiency

Pain of the central-lower abdominal area, backache, dizziness, tinnitus, feeling cold, weak knees, bright-white complexion, tiredness, abundant clear urination, Pale and wet tongue, Deep-Weak pulse.

Lateral-lower abdominal pain

Interrogation, Chapter 38

In Chinese the lateral-lower abdominal areas are called shao fu which means ‘lesser abdomen’. They are under the influence of the channels of the Liver, Large Intestine and Penetrating Vessel. As a rule of thumb, when a problem occurs in the right lateral-lower abdominal area, it is likely to be caused by the gynaecological system; when it occurs in the left lateral-lower abdominal area, it is more likely to be the result of a Large Intestine pathology. However, this is only a broad rule and subject to exceptions.

Liver-Qi stagnation

Lateral-lower abdominal pain and distension, pain coming and going according to emotional mood, irritability, moodiness, constipation with small stools, Wiry pulse.

Damp-Heat in the Large Intestine

Lateral-lower abdominal pain, loose stools with mucus and blood, a feeling of heaviness, thirst with no desire to drink, burning in the anus, tongue with sticky yellow coating, Slippery-Rapid pulse.

Cold-Dampness in the Large Intestine

Lateral-lower abdominal pain, loose stools with mucus, a feeling of heaviness, sticky white tongue coating, Slippery-Slow pulse.

Liver-Blood stasis

Stabbing lateral-lower abdominal pain, a feeling of abdominal mass, hypochondrial pain, painful periods, dark complexion, Purple tongue, Wiry pulse.

Large Intestine deficient and cold

Dull lateral-lower abdominal pain that comes and goes and is better with rest, loose stools, a feeling of cold, cold limbs, pale complexion, tiredness, abdomen cold to the touch, Pale tongue, Deep-Weak pulse.

Girdle Vessel pain

Lateral-lower abdominal pain radiating to the back, or backache radiating to the lateral-lower abdominal area, Wiry pulse.

Stagnation of Qi and stasis of Blood in the Penetrating Vessel

Lateral-lower abdominal pain, a feeling of fullness in the abdomen and umbilical region, a feeling of tightness of the chest, palpitations, anxiety, painful periods, a feeling of lump in the throat, a feeling of heat in the face, Purple tongue, Firm pulse.

Stagnation of Cold in the Liver channel

Lateral-lower abdominal pain radiating to the testis or vagina, contraction of the scrotum or vagina, pain alleviated by the application of heat, pale complexion, cold hands and feet, white tongue coating, Deep-Wiry-Slow pulse.

DISTENSION AND FULLNESS

Abdominal distension

Observation, Chapter 16; Interrogation, Chapter 38

‘Distension’ (in Chinese called zhang) is a word frequently used by Chinese patients; Western patients will seldom use this word and in Anglo-Saxon countries they might say ‘bloating’ or ‘bursting’ to express this symptom. Distension is a subjective feeling of the patient but also an objective sign, that is, the abdomen feels distended and hard like a drum on palpation.

Distension is the classic symptom of Qi stagnation; indeed, if there is a feeling of distension there is Qi stagnation. However, a feeling of distension may also be associated with Damp-Phlegm and, in a few cases, with a deficiency of Qi.

Liver-Qi stagnation

Abdominal distension that comes and goes according to emotional moods, hypochondrial or epigastric distension, irritability, moodiness, Wiry pulse.

Spleen-Qi deficiency

Slight abdominal distension after eating, poor appetite, tiredness, pale complexion, loose stools, Pale tongue, Empty pulse.

Damp-Phlegm obstructing the Spleen

Abdominal distension, a pronounced feeling of distension and oppression of the chest and epigastrium, sputum in the throat, a feeling of heaviness, Swollen tongue with sticky coating, Slippery pulse.

Liver-Yin deficiency

Slight abdominal and hypochondrial distension, dizziness, blurred vision, floaters, dry eyes, dry hair, dry nails, insomnia, tongue without coating, Floating-Empty pulse.

Clinical note

• Abdominal distension is one of the most common symptoms of all. Remember that no patient will use the word ‘distension’ but usually ‘bloating’.

Abdominal fullness

Interrogation, Chapter 38

‘Fullness’ (called man in Chinese) indicates a feeling of fullness in the abdomen or epigastrium; this is different from the feeling of distension, from both a subjective and an objective point of view. ‘Distension’ indicates a subjective feeling of bloating, while the abdomen feels distended and hard like a drum on palpation; ‘fullness’ indicates a subjective feeling of fullness and obstruction similar to what one feels after eating too much. With ‘fullness’, the abdomen feels hard on palpation but not distended like a drum.

A feeling of fullness generally indicates Dampness or retention of food.

Cold-Dampness in the Intestines

Abdominal fullness, hardness and coldness of the abdomen on palpation, cold limbs, nausea, vomiting, loose stools, sticky white tongue coating, Soft-Slow or Slippery-Slow pulse.

Damp-Heat in the Intestines

Abdominal fullness, hardness of the abdomen on palpation, nausea, vomiting, irritability, thirst with no desire to drink, foul-smelling stools, mucus in stools, dark urine, sticky yellow tongue coating, Slippery-Rapid pulse.

Retention of food

Epigastric fullness, epigastrium feels hard on palpation, nausea, sour regurgitation, belching, thick sticky tongue coating, Slippery pulse.

Stomach and Spleen deficient and cold

Slight abdominal fullness that comes and goes, abdomen not too hard on palpation, tiredness, poor appetite, loose stools, Pale tongue, Weak pulse.

Heat in Bright Yang (Organ pattern)

Umbilical fullness and pain, fever, sweating, intense thirst, constipation, dry stools, Red tongue with dry yellow or brown coating, Deep-Full-Rapid pulse. This corresponds to either the Organ pattern of the Bright-Yang Heat within the identification of patterns according to the Six Stages or to the pattern of Dry-Heat in the Intestines within the identification of patterns according to the Four Levels.

Clinical note

• It is important to explain to patients what we mean by ‘fullness’ and how it differs from ‘distension’.

ABNORMAL FEELINGS IN THE ABDOMEN

Feeling of cold in the abdomen

Interrogation, Chapter 38

This indicates both a subjective feeling of cold and an objective feeling of cold of the abdomen on palpation.

Yang deficiency of the Stomach and Spleen

A feeling of cold of the epigastrium and abdomen, dull epigastric pain, poor appetite, loose stools, tiredness, cold limbs, Pale tongue, Deep-Weak pulse.

Kidney-Yang deficiency

A feeling of cold generally or in the lower abdomen, backache, dizziness, tinnitus, weak knees, bright-white complexion, tiredness, abundant clear urination, Pale and wet tongue, Deep-Weak pulse.

Directing and Penetrating Vessels deficient and cold

A feeling of cold in the lower abdomen (centrally in the case of the Directing Vessel and laterally in the case of the Penetrating Vessel), irregular periods, painful periods, infertility, excessive white vaginal discharge, dark rings under the eyes, Pale tongue, Weak pulse.

Stagnation of Cold in the Liver channel

A feeling of cold in the central-lower abdomen extending to the scrotum, contraction of the scrotum or vagina, cold hands and feet, white tongue coating, Deep-Wiry pulse.

Feeling of pulsation under the umbilicus

Rebellious Qi in the Penetrating Vessel

A feeling of pulsation under the umbilicus, abdominal distension, epigastric fullness and discomfort, a feeling of tightness of the chest, palpitations, anxiety, a feeling of a lump in the throat, a feeling of heat in the face, Firm pulse.

Kidneys not receiving Qi

A feeling of pulsation under the umbilicus, breathlessness, wheezing, sighing, sweating, Pale tongue, Weak pulse.

Phlegm-Fluids in the abdomen

A feeling of pulsation under the umbilicus, abdominal fullness and distension, vomiting of watery fluids, a feeling of oppression of the chest, loose stools, Swollen tongue with sticky coating, Deep-Wiry pulse.

Feeling of energy rising in the abdomen

Western patients will seldom report this symptom as such, but it does occur frequently and must be elicited on interrogation. In Chinese medicine this symptom occurs in the so-called ‘Running Piglet’ pattern: the patient feels a sensation of energy rising all the way from the lower abdomen to the throat as if there were a running piglet in the abdomen. The most common pathology causing this symptom is rebellious Qi in the Penetrating Vessel.

Rebellious Qi in the Penetrating Vessel

A feeling of energy rising in the abdomen, abdominal distension or fullness, epigastric fullness and discomfort, ‘butterflies in the stomach’, a feeling of tightness of the chest, palpitations, anxiety, a feeling of a lump in the throat, a feeling of heat in the face, Firm pulse.

Stagnant Liver-Qi turned into Heat rebelling upwards

A feeling of energy rushing up from the abdomen to the throat and face from the lower abdomen, a feeling of heat in the face, anxiety, a tendency to be easily startled, a feeling as if one were going to die, palpitations, abdominal pain, a bitter taste, vomiting, mental restlessness, a feeling of hot and cold, tongue with red sides and yellow coating, Wiry-Rapid pulse.

Yin-Cold in the abdomen

A feeling of energy rising in the abdomen, abdominal fullness, distension and pain, vomiting of watery fluids, a feeling of oppression of the chest, loose stools, a feeling of cold, cold limbs, lower backache, Pale and Swollen tongue with sticky coating, Deep-Tight pulse.

BORBORYGMI

‘Borborygmi’ indicates a gurgling sound in the intestines.

Liver-Qi invading the Spleen

Borborygmi that come and go according to emotional moods and are not relieved after diarrhoea, abdominal distension, alternation of constipation and diarrhoea, irritability, sighing, pulse Wiry on the left and Weak on the right.

Damp-Heat in the Intestines

Borborygmi, loose stools with foul smell and mucus, burning sensation in the anus, thirst with no desire to drink, sticky taste, sticky yellow tongue coating, Slippery-Rapid pulse.

Damp-Phlegm in the Intestines

Borborygmi, loose stools, a feeling of abdominal fullness, a feeling of oppression of the chest, nausea, vomiting, mucus in the stools, Swollen tongue with sticky coating, Slippery pulse.

Spleen- and Kidney-Yang deficiency

Slight borborygmi, loose stools, backache, dizziness, cold limbs, tiredness, abundant pale urination, Pale and wet tongue, Deep-Weak pulse.

Stomach and Spleen deficient and cold

Slight borborygmi, a feeling of cold in abdomen and epigastrium, loose stools, cold limbs, tiredness, Pale and wet tongue, Deep-Weak pulse.

FLATULENCE

Spleen-Qi deficiency

Flatulence, slight abdominal distension, loose stools, poor appetite, tiredness, pale complexion, Pale tongue, Empty pulse.

Liver-Qi invading the Spleen

Flatulence, hypochondrial and abdominal distension, alternation of constipation and diarrhoea, irritability, tiredness, poor appetite, Pale tongue, pulse Wiry on the left and Weak on the right.

Liver-Qi stagnation

Flatulence, hypochondrial or epigastric distension, irritability, moodiness, Wiry pulse.

SKIN SIGNS

Distended abdominal veins

Observation, Chapter 16

Stasis of Blood in the Liver and Spleen

Blue veins on abdomen, abdominal pain, hypochondrial pain, blood in stools, dark complexion, spider naevi on the throat and chest, Purple tongue, Wiry pulse.

Qi stagnation with Dampness

Blue veins on abdomen, abdominal distension and fullness, a feeling of heaviness, sticky tongue coating, Wiry-Slippery pulse.

Spleen- and Kidney-Yang deficiency

Pale-blue veins on abdomen, abdominal distension, oedema, cold limbs, frequent pale urination, tiredness, weak knees, loose stools, darkish complexion, Pale and wet tongue, Deep-Weak pulse.

Liver- and Kidney-Yin deficiency

Blue veins on abdomen, dizziness, tinnitus, dry eyes, backache, night sweating, tongue without coating, Floating-Empty pulse.

Blood-Heat

Red veins on the abdomen, abdomen hot to the touch, a feeling of heat, skin diseases with red eruptions, dry mouth, bleeding, Red tongue, Rapid pulse.

Stagnation of Cold

Dark blue veins on the abdomen, abdominal pain and distension worse for cold liquids and better for warmth, tongue with white coating, Deep-Slow pulse.

Lines

Observation, Chapter 16

Blood stasis deriving from Cold

Blue lines on the abdomen, abdominal pain, blood in the stools worse with cold liquids and better for warmth, Pale-Purple tongue, Wiry-Slow pulse.

Blood stasis with Blood-Heat

Purple lines on the abdomen, abdominal pain aggravated by exposure to heat, blood in the stools, Reddish-purple tongue, Wiry-Rapid pulse.

Maculae

Observation, Chapter 16

Blood-Heat

Red maculae on the abdomen aggravated by exposure to heat, blood in the stools, skin eruptions, Red tongue, Rapid pulse.

Blood stasis

Purple maculae on the abdomen, abdominal pain, abdomen hard on palpation, Purple tongue, Wiry or Choppy pulse.

ABDOMINAL MASSES

Observation, Chapter 16

Abdominal masses are called Ji Ju. Ji indicates actual abdominal masses which are fixed and immovable; if there is an associated pain, its location is fixed. These masses are due to stasis of Blood and I call them ‘Blood masses’. Ju indicates abdominal masses which come and go, do not have a fixed location and are movable. If there is an associated pain, it too comes and goes and changes location. Such masses are due to stagnation of Qi and I call them ‘Qi masses’.

Actual abdominal lumps therefore pertain to the category of abdominal masses and specifically Ji masses (i.e. Blood masses).

Another name for abdominal masses was Zheng Jia, Zheng being equivalent to Ji (i.e. fixed masses) and Jia being equivalent to Ju (i.e. non-substantial masses from stagnation of Qi). The two terms Zheng Jia normally referred to abdominal masses occurring only in women, but although these masses are more frequent in women they do occur in men as well.

Liver-Qi stagnation

Movable abdominal masses which come and go, abdominal distension and pain which come and go with the masses, irritability, depression, hypochondrial or epigastric distension, irritability, moodiness, Wiry pulse.

Liver-Blood stasis

Hard and immovable abdominal masses, abdominal distension and pain, irritability, painful periods, dark complexion, Purple tongue, Wiry pulse.

Phlegm and retention of food

Masses in the epigastrium or umbilical area, a feeling of fullness, oppression and pain of the epigastrium, Swollen tongue with thick coating, Slippery pulse.

Stomach- and Spleen-Qi deficiency

Soft masses in the epigastrium or umbilical area, slight abdominal distension, poor appetite, tiredness, pale complexion, loose stools, Pale tongue, Empty pulse.

Kidney-Yang deficiency with Liver-Blood stasis

Abdominal masses, backache, dizziness, tinnitus, a feeling of cold, weak knees, bright-white complexion, tiredness, abundant clear urination, Pale and wet tongue, Deep-Weak pulse.

Damp-Phlegm

Abdominal masses which are relatively soft on palpation, a feeling of heaviness, a feeling of oppression of the chest, Swollen tongue with thick sticky coating, Slippery pulse.

Damp-Heat

Abdominal masses, pain, tenderness on palpation, thirst, a feeling of heat, a feeling of heaviness, tongue with sticky yellow coating, Slippery-Rapid pulse.

Small hypochondrial lumps

Observation, Chapter 16

Liver-Blood stasis

Small, hypochondrial lumps, hypochondrial pain, abdominal pain, painful periods, dark complexion, Purple tongue, Wiry pulse.

Lumps in the epigastrium

Observation, Chapter 16

Damp-Phlegm in the Middle Burner

Lumps in the epigastrium which are soft, epigastric distension, a feeling of heaviness, poor appetite, Swollen tongue, Slippery pulse.

Blood stasis

Lumps in the epigastrium which are hard and immovable, epigastric pain, vomiting of blood, dark complexion, Purple tongue, Wiry or Choppy pulse.

Phlegm and Blood stasis in the Middle Burner

Lumps in the epigastrium which are hard and immovable, epigastric distension and pain, vomiting of blood, dark complexion, Purple and Swollen tongue, Wiry-Slippery pulse.

OEDEMA OF THE ABDOMEN

Observation, Chapter 16

Spleen-Yang deficiency

Oedema of the abdomen, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, feeling cold, cold limbs, Pale and wet tongue, Deep-Weak pulse.

Kidney-Yang deficiency

Oedema of the abdomen and ankles, lower backache, cold knees, a feeling of cold generally or in the lower back, weak legs, bright-white complexion, weak knees, tiredness, lassitude, abundant clear or scanty clear urination, urination at night, apathy, loose stools, impotence, decreased libido, Pale and wet tongue, Deep-Weak pulse.

ABDOMINAL SIZE

Thin abdomen

Observation, Chapter 16

Qi and Blood deficiency

Thin abdomen, loose stools, tiredness, weak limbs, Pale tongue, Weak or Choppy pulse.

Yin deficiency

Thin abdomen, poor appetite, dizziness, tinnitus, night sweating, dry mouth with a desire to sip water, backache, poor memory, scanty dark urine, tongue without coating, Floating-Empty pulse.

Large abdomen

Observation, Chapter 16

Phlegm obstructing the Spleen

Large abdomen, abdominal distension, oppression of the chest, dizziness, poor appetite, Swollen and Pale tongue, Slippery pulse.

SAGGING LOWER ABDOMEN

Observation, Chapter 16

Damp-Phlegm in the Lower Burner

Sagging lower abdomen, swollen and soft abdomen, abdominal distension, a feeling of heaviness, Swollen tongue, Slippery pulse.

Severe Spleen- and Kidney-Yang deficiency

Sagging lower abdomen, tiredness, lethargy, feeling cold, frequent clear urination, lower backache, Pale and Wet tongue, Deep-Weak pulse.

UMBILICUS

Protruding umbilicus

Observation, Chapter 16

Empty-Cold with Qi stagnation

Protruding umbilicus worse with cold liquids, better for warmth, worse with emotional upsets, Pale tongue, Deep-Weak-Slow and slightly Wiry pulse.

Blood stasis with oedema

Protruding umbilicus, pain around the umbilicus, swollen abdomen, blood in the stools, Purple tongue, Wiry or Choppy pulse.

Spleen- and Kidney-Yang deficiency

Protruding umbilicus worse with cold, loose stools, tiredness, Pale and Wet tongue, Deep-Weak pulse.

Sunken umbilicus

Observation, Chapter 16

Blood stasis with Spleen-Qi sinking

Sunken umbilicus, pain around the umbilicus, a feeling of bearing down, tiredness, blood in the stools, Pale-Purple tongue, Wiry or Choppy pulse.

Damp-Heat in the abdomen

Sunken umbilicus, umbilical area tender on palpation, abdominal distension, swollen abdomen, tongue with sticky yellow coating, Slippery-Rapid pulse.

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ABDOMEN

ABDOMEN