ABDOMINAL PAIN

Abdominal pain is usually defined in Traditional Chinese Medicine as a symptom manifesting as pain in the abdominal region. Causes are usually explained by both exterior infection and interior disorder of the organs. The etiological factors contributing to abdominal pain in terms of Chinese medicine are Cold, Heat, Deficiency and Excess. This section will discuss abdominal pain pattern differentiation both internal and external, excluding abdominal pain caused by OB-GYN and surgical problems.

 

ETIOLOGY

External Pathogenic Infection

In TCM it is believed that Cold, Dampness, Heat, and Summer-Heat can invade the abdomen, leading to dysfunction of the Spleen and Stomach. These elements may obstruct the normal movement of the Qi and metabolism causing irregular functions of the lower digestive tract.

Improper food intake

Most abdominal pain is usually caused by improper food intake, which results in the abnormal movement of Qi. Improper food intake can also severely impact the Spleen Yang Qi and its functions in digestive activities.

Abnormal emotional stress

Although certain levels of stress to the body can be maintained without symptoms, excessive emotional activity may result in abdominal pain. According to TCM the Liver controls the flowing of the Qi, and there is a belief that any kind of abnormal or excessive emotional activity will affect the Liver. For instance, anger may trigger the Liver to attack the Spleen or Stomach. The Stomach may respond by failing to descend the Qi, while the Spleen may fail in ascending, both resulting in Abdominal Pain.

Yang QiDeficiency

The digested material will not be transported or transformed due to a deficiency of Spleen Yang. Under such circumstances, water retention can occur, as well as a deficiency of Qi and Blood. This makes it difficult to warm and nourish interior organs in balance and the symptom of pain will manifest.

 

DIAGNOSIS

According to TCM pathological theory, the diagnosis of abdominal pain should focus on the quality of the pain. Is the pain accompanied by cold, hot, excess, or deficient symptoms? Pain could be caused by Qi, Blood, and Zang Fu problems. To further explain, the different qualities of pain can be diagnosed with simple definitions. For instance, Excess abdominal pain worsens with pressure to the region, whereas pressure soothes pain in Deficient abdominal pains. Pain that starts acts up when the stomach is full is excess in nature, while deficient pain usually begins with hunger. Pain that is reduced by heat is of the Cold nature, and pain reduced by cold is due to Heat.

The location of the pain is also important in explaining the causes and reasons of pain. For example, if the pain appears in the lower abdomen and is related to both sides of the hypochondriac region, it is a Liver and Gallbladder problem. If the pain is mostly located around the umbilicus and lower abdomen, the Spleen, Stomach, Intestines, Kidney, or Bladder usually is the cause. The following is a list of common causes of abdominal pain with symptoms to better help identify and diagnose abdominal pain.

 


 

Abdominal Pain due to Cold Pathogenic Influence

The patient will experience acute abdominal pain, which is relieved by warmth and pressure. The pain is usually associated with loose stools, diarrhea, borborygmus, clear urine, cold limbs, fever as well as an aversion to cold that may be seen in some cases. The tongue is usually pale with a white greasy coating, and pulse is deep and tight.

 

Abdominal paindue to Food Stagnation

There are usually sensations of distending pain in the abdominal region, which are relieved by bowel movements. Usually the pain is worse with pressure and associated with vomiting.  Irregular, hot, and sticky stools will be seen if Food Stagnation turns to Heat. The tongue will be red with a yellowish greasy coating, and the pulse will be fast and slippery.

 

Abdominal paindue to Yang Qi Deficiency

The patient will have chronic intermittent abdominal pain that is relieved by pressure and warmth. The symptoms are usually associated with loose stools, a pale complexion, fatigue and a sore and weak sensation in the lower back and knees that may be accompanied with Cold. The tongue will be swollen with teeth marks and a white coating, and the pulse is thin, deep, and slow.

 

Blood Stagnation

The patient will experience a bloated sensation accompanied with moving or fixed pain in the abdominal region. The pain will usually be relieved by belching and aggravated by anger or other sudden and drastic emotional changes. The patient will have a dark tongue with a white coating and a wiry or choppy pulse.

 

TREATMENT AND PRESCRIPTIONS

As with all other pains that are caused by blockage of Qi flow, the main treatment method in TCM for abdominal pain is by moving the stagnation. The following basic methods apply to the most common manifestations of abdominal pain.

 

Abdominal Pain due to Cold Pathogenic Influence

Treatment Principle:  Expel the Cold and Regulate the Qi

Point Prescription:  CV-12, ST-36, SP-15, SP-4, and LI-4. Treat once every other day for 3 treatments as a course.

Technique: Insert 1cun # 32 needles into SP-4 and LI-4 with a twist reducing needle technique. Insert a 1.5 cun. # 32 needle into CV-12, ST-36 and SP-15 with a twisting even movement needle technique and apply moxa wool to the handle of the needles for 3-5 cones.

Additional points:

Diarrhea and cold extremities: moxibustion on CV-8 with salt.

 


 

Abdominal Pain due to Food Stagnation

Treatment Principle: Resolve the Food stagnation and Release the pain.

Point Prescription:  CV-10, ST-20, ST-25, and LI-11. Treat once every other day for 3 treatments as a course.

Technique: Insert 1.5 cun # 30 needles into CV-10 perpendicularly 1 cun deep with a twisting reducing needle technique. Insert 1.5 cun # 32 needles into ST-20, ST-25 and LI-11 with an even movement needle technique. Retain all needles for 20 minutes.

Additional points:

Thirst: ST-44

Sour regurgitation: GB-34.

 

Abdominal paindue to Yang Deficiency

Treatment Principle: Reinforcing the Spleen and Warming the Kidney thus releasing the pain.

Point Prescription:  BL-20, BL-23, LV-13, and CV-4. Treat once every other day, 5 treatments as a course.

Technique: Insert 1.5 cun # 32 needles into BL-20 and BL-23 perpendicularly, 1-1.2 cun deep with lifting and thrusting reinforcing needle technique, apply moxa wool on the handle of needles for 3 cones. Insert 1 cun # 32 needles into LV-13 with twisting reinforcing needle technique. Apply indirect moxibustion with Fu Zi cake on CV-4 for 5 cones.

Additional points:

Loose stool: ST-35 and SP-6.

 

Abdominal pain due to BloodStagnation

Treatment Principle: Regulate the Qiand Move the Blood.

Point Prescription:  LI-4, SP-10, CV-6, ST-28, BL-17, and BL-24. Treat once every other day for 5 treatments as a course.

Technique: Insert 1.5 cun # 30 needles into BL-17 and BL-24 with a twisting even movement technique and apply moxa wool to the handles of the needles for 3 cones. Insert 1 cun # 30 needles into LI-4 and SP-6 with a twisting reducing needle technique. Retain the needles for 20 minutes.

Additional points:

Hypochondriac pain: LV-14.

Upper abdominal pain: CV-12, CV-6, and CV-10.

 


 

ADJUNCTIVE THERAPIES

It is important to note at this point of the text that often the use of adjunctive therapies is very helpful in treatment of the patient. Many other types of therapies can be used in this case for the treatment of abdominal pains. Most commonly used ones are described in detail below to ensure correct applications and future reference.

 

Ear Acupuncture

Points: Large intestine, Small intestine, Stomach, Spleen, Shen Men, and Sympathetic.

Select 2 to 3 points for each treatment and insert 0.5 cun # 34 acupuncture needles with a medium-level stimulation technique. Retain the needles for 30 minutes.

Treat once daily, for 5 treatments as a course. Another method is to apply press-balls or inter-dermal needles in these points in the ear in the same fashion regularly after body acupuncture treatment.

 

Moxibustion

Points: CV-4, CV-8 and ST-25.

Apply indirect moxibustion with salt or ginger on CV-8 and a Fu Zi cake on CV-4 for 3 to 5 cones for Yang deficiency abdominal pain. Apply direct non-scarring moxibustion on ST-25 for 6 cones to treat abdominal pain due to Cold Pathogenic Invasion.

Treat once daily with 3 treatments as course.

 

Gua Sha

Treatment area: Along the Stomach meridian parallel to the navel. Apply medium stimulation Gua Sha until the skin turns a purple color or the pain is reduced. This is especially good for treating abdominal pain with fever.

Treat once daily for 2 treatments as a course.

 

Cupping technique

Points: CV-8.

Apply a fire cup on the CV-8 for three minutes to treat abdominal pain due to stagnation of Qi and Blood.

Treat once daily, 2 treatments as a course.

 

Scalp Acupuncture

Treatment zone: Middle line of the vertex, lateral line 2 and lateral line 3 of the forehead.

Insert 1.5 cun # 30 needles transversely 1 cun deep at a 30-degree angle with a fast twisting needle technique. Retain the needles for 30 minutes to one hour.

Treat once daily for 3 treatments as a course.

 


 

TRADITIONAL PRESCRIPTIONS AND TECHNIQUES

For the pain located above navel: CV-10 and ST-24 (Author’s Clinical Experience)

Insert 1.5 cun #30 needles into CV-10 and ST-24 with a twisting reducing needle technique and apply moxa wool on the handles of the needles 3 times.

Treat once every other day for 3-5 treatments as course.

For pain around the navel (Deficiency Cold in the Small Intestine): CV-8 (Zhen Jiu Jia Yi Jing)

Apply 3 cones of indirect moxibustion with salt and ginger, or use a moxa pole on CV-8 for 20 minutes.

Treat once or twice a day, 3 to 5 treatments as course.

For pain located on both sides of the navel: SP-15 and ST-25. (Author’s Clinical Experience)

Insert 1.5 cun #32 needles into SP-15 and ST-25 with a twisting even movement needle technique and apply moxa wool on the handles of the needles with 3 cones if the patient has Cold symptoms.

Treat once very other day, 3 to 5 treatments as a course.

For pain located on the lower abdomen: CV-6 and ST-27 (Author’s Clinical Experience)

Insert 1.5 cun #32 needles into CV-6 and ST-27 perpendicularly 1 to 1.2 cun deep with a twisting even movement needle technique. Retain all needles for 20 minutes. One can also choose to apply moxa wool on the handles of needles with 3 cones.

Treat once every other day, 3 treatments as a course.

For abdominal pain located around the navel: CV-9, ST-25, CV-7, and ST-36 (Lei Jing Tu Yi)

Apply direct non-scarring moxibustion on those points with 7 cones.

Treat once every other day, 3 treatments as a course.

For abdominal pain with borborygmus: ST-37 (Wei Shen Bao Jian)

Inset 1.5 cun #30 needles into ST-37 with the “Qing Long Bai Wei” (Green Dragon Waves the Tail), which is one type of technique to move the Qi .  Retain needles for 30 minutes and treat once daily for 3 treatments as a course.

For abdominal pain on the both sides of the navel that travels up to the epigastric region: ST-25 (Jiu Fa Mi Chuan)

Apply direct non-scarring moxibustion on ST-25 for 7 cones each treatment.

Treat once daily for 3 treatments as course.

For abdominal pain with Heat and yellowish urine: KI-11 (Shen  Jiu Jing Lun)

Insert 1.5 cun #30 needles into KI-11 with a lifting and thrusting reducing needle technique.

Treat once daily for 3 treatments as a course.

For lower abdominal pain with Interior Cold: CV-6, BL-27, and LV-8 (Shen Jiu Jing Lun)

Apply direct non-scarring moxibustion on CV-6, BL-27, and LV-8 with 7 cones.

Treat once every other day for 2 treatments as course.

For lower abdominal pain with Heat and yellowish urine: KI-11 (Shen Ying Jing)

Insert 1.5 cun #30 needles into Ki-11 with a lifting and thrusting reducing needle technique.

Treat once daily for 3 treatments as a course.

For lower abdominal pain with Cold: CV-6, BL-27, and LV-8 (Shen Jiu Jing Lun)

Apply direct non-scarring moxibustion on CV-6, BL-27, and LV-8 for 7 cones.

Treat once or twice daily for 3 treatments as a course.


 

For acute abdominal pain: LU-7, CV-17, LV-1, LU-1, SI-1, LU-9, and SP-6 (Zhen Jiu Da Cheng)

Insert 1 cun #30 needles into LV-1, SI-1, LU-9, LU-7, and SP-6 with a twisting reducing needle technique; then insert a 1.5 cun #30 needles into CV-17 with a twisting even movement needle technique. Retain all needles for 20 minutes.

Treat once every other day, 2 treatments as a course.

 For abdominal pain around the navel: LI-8 (Shen Yin Jing)

Insert 1 cun #30 needles into LI-8 perpendicularly 0.5 to 0.8 cun deep with a lifting and thrusting reducing needle technique and “He Gu Ci” (one kind of moving Qi  and reducing pain technique). Retain the needles for 30 minutes.

Treat just for emergency cases.

For severe pain on the lower abdomen: CV-6, SP-6 (Zhen Jiu Zhai Ying Ji)

Insert 1.5 cun #30 needle into CV-6 perpendicularly 1 to 1.2 cun deep with a lifting and thrusting even movement technique; then insert a 1.5 cun #30 needles into SP-6 obliquely upwards 1 cun deep at a 45 degree angle with a twisting reducing needle technique. Retain all needles for 30 minutes.

Treat once daily, 3 treatments as a course.

For lower abdominal pain traveling to the genital region with a cold sensation: CV-4, and BL-43 (De Xiao Fang)

Apply indirect moxibustion with ginger on CV-4 and BL-43 for 5 cones.

Treat once every other day, 5 treatments as a course.

For bloating pain in the lower abdomen: LV-2, KI-2, ST-44, and LV-1 (Zhen Jiu Fen Yuan)

Insert 1 cun #30 needles into all these points with a twisting reducing needle technique. Retain all needles for 20 minutes.

Treat once every other day, 3 treatments as a course.

For acute abdominal pain: SP-1 and LV-1 with direct non-scarring moxibustion for 14 cones. (Yu Long Ge)

For acute bloating pain in abdominal region: CV-15, CV-13 and CV-5. (Yu Long Ge)

Insert 1.5 cun #30 needles into CV-15, CV-13 and CV-5 perpendicularly 1 cun deep with a twisting reducing needle technique.  Retain the needles for 30 minutes.

Treat once every other day, 3 treatments as a course.

 

CASE ANALYSIS

30 year-old female with a main complaint of acute abdominal pain for 2 days

Signs and Symptoms: pain worse with pressure, loss of appetite, associated Deficiency Cold sweating, and lassitude. The tongue is pale with a white coating; the pulse is weak, thin and wiry.

Diagnosis: Abdominal pain  due to stagnation of Qi.

Treatment Principle: Regulate Qi and Release Pain.

Point Prescription:  CV-6, ST-25, CV-8, CV-4, BL-23, BL-32, and CV-6.

Treat once or twice daily, 3 treatments as a course

 

Technique: Insert 1.5 cun #30 needles into CV-6 perpendicularly 1 to 1.2 cun deep with “Feng Huang Zhang Chi” (Red Phoenix spreads its Wings) technique and apply moxa pole on ST-25, CV-8 and CV-4 for 20 minutes until the pain is gone. Apply the moxa pole on BL-23, BL-32 and CV-6 to reinforce, move the Qi, and prevent the pain from coming back.

Result: The pain was relieved after 1 treatment, and moxa pole was continued on the second day only to help the Qi circulation.

 

EVALUATION

Abdominal pain is a common and complicated symptom seen in the clinic. TCM allows for many possible causes, such as Cold invading the intestines, deficiency of Spleen Yang, or stagnation of improper food intake. Acupuncture treatments are very effective to reduce the pain. Point selection is the key to treating abdominal pain. For example, points selected from the Conception vessel and the Foot Tai Yang and Foot Yang Ming meridians with reducing needle techniques usually treat abdominal pain due to a Cold invasion. Points selected from the Conception vessel, the Foot Tai Yin, the Foot Yang Ming meridians and the Back-Shu points with reinforcing needle techniques are used for deficiency of the Spleen and Kidney. Points from the Foot Tai Yin and the Foot Yang Ming meridians with reducing needle techniques and moxibustion usually treat abdominal pain due to stagnation of food. Long term and chronic abdominal pain combined with other diseases should be referred out for further examinations.

 

 

 

please read original book for details,.........................