Lower Abdominal Pain

Lower Abdominal Pain

Gynecological pelvic inflammatory disease, uterine fibroids, dysmenorrhea, cystitis, bladder and urinary tract stones, bladder cancer, colitis (both non-specific and specific), appendicitis, and other conditions can all cause varying degrees and types of lower abdominal pain. First, modern medical physical and chemical examinations should be used to confirm the disease causing the lower abdominal pain, followed by TCM syndrome differentiation.

Pelvic inflammatory disease, whether it involves adnexal inflammation or more extensive pelvic inflammation, is generally considered a case of damp-heat descending in TCM. If the pain is severe, it may indicate blood stasis in the lower jiao, requiring selection from formulas such as Simiao San, Wandai Tang, Qingdai Tang, Guizhi Fuling Wan, Danggui Shaoyao Tang, and Taohong Siwu Tang, with possible additions of white snake tongue grass, banzhilian, dandelion, and houttuynia cordata for heat-clearing and detoxifying effects. Uterine fibroids are treated based on their size and location as indicated by ultrasound. Generally, fibroids less than 2 cm in diameter can be dissolved with herbal medicine; however, if the fibroid is too large and located near the cervical opening, early referral to Western gynecological surgery is advisable. Herbal treatment for uterine fibroids follows the principle outlined in "Jinkui Yaolue" regarding women with pre-existing masses: Guizhi Fuling Wan combined with Danggui Shaoyao Tang is the main prescription, with optional additions of sanleng, ezhushi, frankincense, and myrrh. This is a general rule of "treating the root cause," using blood-activating methods to address excessive uterine bleeding. Aside from menstrual cramps, the primary symptom of uterine fibroids is excessively heavy menstruation. Syndrome differentiation for dysmenorrhea still falls under the category of blood stasis in the lower jiao, with treatment focusing on blood-activating and stasis-resolving methods, choosing from formulas such as Xiaofu Zhuyu Tang, Xuefu Zhuyu Tang, Taohong Siwu Tang, and Guizhi Fuling Wan. Cystitis (including non-specific urinary tract infections) causes symptoms of bladder irritation such as frequent urination, urgency, and pain, with TCM believing that damp-heat accumulates in the bladder. Formulas such as Bajingsan, Longdan Xiexin Tang, Ganlu Xiaodu Yin, and Simiao San are available for selection, with additional options like Jinlingzi San and Shixiao San for those experiencing significant lower abdominal pain. Colitis includes dysentery and ulcerative colitis. Dysentery is traditionally treated as damp-heat accumulating in the large intestine, using heat-clearing and damp-draining methods, with options such as Xianglian Wan, Shaoyao Tang, Lianli Tang, Gegen Qinlian Tang, Zhi Shi Daozhi Wan, and Bai Touweng Tang. If diagnosed as amoebic dysentery, heavier use of yabandzi and kushen is recommended. Ulcerative colitis is often considered a case of Taiyin deficiency in TCM, requiring kidney-tonifying and spleen-strengthening, along with heat-clearing and damp-draining methods, with formulas such as Lizhong Tang, Fuzi Lizhong Tang, Lianli Tang, Wumei Wan, and Helile San being chosen. Appendicitis was historically known as intestinal abscess, with "Jinkui Yaolue" recording two highly effective prescriptions: Dahuang Mudan Tang and Yiyi Fuzi Baijiang San. Later generations have also proposed red vine, summer枯草, white snake tongue grass, banzhilian, bamboo leaf pepper, and other effective remedies for appendicitis, all of which can be selected and applied. Urinary tract stones (including bladder stones) generally fall under the categories of "stone urine" and "blood urine" in TCM, with mechanisms involving damp-heat accumulation in the liver and gallbladder. Treatment focuses on clearing heat and draining dampness, with formulas such as Shiwei San, Yulin San, Xiaoshi San, Bajingsan, and Xiaoji Yinzi San being chosen. Bladder cancer requires early diagnosis and early Western surgical treatment; patients who miss the opportunity for surgery can undergo Western chemotherapy (including systemic chemotherapy and local bladder irrigation) and radiation therapy, with TCM providing supportive treatment to reduce side effects of these therapies.

Flank Pain Hepatitis, liver cancer, liver abscess, hepatic hemangioma, fatty liver, cholecystitis, gallstones, gallbladder cancer, pancreatic diseases, and other conditions can all cause flank pain. Once these diagnoses are confirmed, TCM syndrome differentiation can proceed. As previously mentioned, hepatitis is treated in TCM based on liver qi stagnation and liver wood overcoming earth, which often yields good results; for severe pain, additional use of Jinlingzi San, frankincense, myrrh, and green tangerine peel is recommended. Hepatic hemangiomas are also related to liver qi stagnation and blood stasis, with options such as Xiaoyao San, Xiaochaihu Tang, and Chaihu Shugan San being chosen, along with long-term use of blood-activating and stasis-resolving herbs like frankincense, myrrh, leeches, earth beetles, Han Sanqi, sanleng, and ezhushi, which can shrink the hemangioma and eliminate pain in the liver area. Fatty liver is mostly related to liver qi stagnation, with relatively few cases involving blood stasis; the illness resides in the qi aspect, with treatment focusing on moving qi and soothing the liver, using formulas such as Chaihu Shugan San with musk, Buddha's hand, green tangerine peel, papaya, astragalus, and salvia miltiorrhiza. Cholecystitis and gallstones often cause each other, with both conditions stemming from damp-heat accumulation in the liver and gallbladder. In acute cases, the focus is on Shaoyang, while in chronic cases, it shifts to Jueyin. For Shaoyang cases, adjustments can be made to formulas such as Xiaochaihu Tang, Dachaihu Tang, Sanhuang Xiexin Tang, and Danshen Yin, adding tiger stick, money grass, banzhilian, white snake tongue grass, and flea herb for severe damp-heat, and adding yuanhusuo, chuanlianzǐ, frankincense, and myrrh for severe pain. For Jueyin cases, adjustments can be made to formulas such as Nuan Gan Jian, Si Ni San, and Shugan San, adding nitrate alum stone powder for jaundice, and increasing zhi shi and musk for severe pain, with additional options like Jinlingzi and yuanhusuo, and adding money grass and tiger stick for damp-heat. Liver abscess was historically called liver carbuncle, with the condition being caused by internal heat toxicity in the liver. Treatment focuses on clearing heat, draining fire, and detoxifying, with formulas such as Dachaihu Tang, Longdan Xiexin Tang, and Danggui Longhui Wan being adjusted accordingly, adding erhua, lianqiao, dandelion, houttuynia cordata, white snake tongue grass, banzhilian, and summer枯草. Once liver cancer and gallbladder cancer are confirmed, Western specialist consultation is required first to strive for early surgery; if the opportunity for surgery has been missed, herbal treatment can be attempted, with most cases falling under the category of damp-heat accumulation in the liver and gallbladder. Treatment focuses on relieving pain and clearing heat, with formulas such as Dachaihu Tang, Chaihu Shugan San, and Baidao Paishi Tang being adjusted accordingly, with additional use of white snake tongue grass, banzhilian, tiger stick, flea herb, dandelion, and houttuynia cordata for heat-clearing and detoxifying effects. Syndrome differentiation for chronic pancreatitis is as described earlier; in the acute phase, besides severe flank and epigastric pain, there is also a feeling of fullness and pain extending from the lower abdomen up to the small intestine, mostly falling under the category of "large chest constriction" in TCM, requiring treatment that addresses the root cause. Most formulas are chosen from Dachaihu Tang, Daxianxiong Tang, Dachengqi Tang, and Baidao Paishi Tang.

Dizziness Hypertension, cerebral arteriosclerosis, hypotension, anemia, ear-originated vertigo, neurasthenia, menopausal syndrome, intracranial tumors, and other conditions can all cause dizziness. Conducting a Western medical diagnosis first, followed by TCM syndrome differentiation, greatly enhances the accuracy of the diagnosis. Hypertension is usually associated with yin deficiency and yang excess, with yang excess generating wind; treatment focuses on nourishing yin and subduing yang, calming the liver and extinguishing wind, with formulas such as Qiju Dihuang Tang, Zhen Gan Xi Feng Tang, and Jianling Tang being adjusted accordingly. Some cases of hypertension with mild yang excess symptoms can be treated with Zhenwu Tang and Linggui Zhugan Tang. Cerebral arteriosclerosis is mostly related to blood stasis, requiring treatment that activates blood and resolves stasis, following the principle: "treat the wind first, then treat the blood; once the blood flows, the wind will naturally dissipate." Formulas such as Xuefu Zhuyu Tang, Guanxin II Hao, and Taohong Siwu Tang are chosen for this purpose. Hypotension is mostly related to deficiency of both heart and spleen or sinking of middle qi, requiring treatment that nourishes blood, strengthens the heart, and replenishes middle qi, with formulas such as Gui Pi Tang, Bu Zhong Yi Qi Tang, and Shengmai San being selected. Most cases of anemia are related to deficiency of both heart and spleen, disharmony between heart and kidney, or inability of qi to unify blood. In recent years, many formulas have been developed to treat anemia, but most adhere to the aforementioned principles, with the most commonly used formulas being Gui Pi Tang, Bu Zhong Yi Qi Tang, Liuwei Dihuang Tang, and Xiangsha Liujunzi Tang. By selecting formulas based on specific conditions, adding tu si zi, nu zhen zi, gou qi zi, he shou wu, and xianhe cao to the formulas, the therapeutic effect can be further improved. Ear-originated vertigo is mostly related to water qi overwhelming the heart, dampness hindering yang, phlegm confusing the heart, and blood deficiency generating wind, requiring treatment that clears the heart, eliminates phlegm, calms the spirit, and warms the yang. Formulas such as Linggui Zhugan Tang, Zhenwu Tang, Wuling San, and Xuanfu Dai Zhe Tang are chosen for this purpose. Neurasthenia and menopausal syndrome allow for more flexible TCM syndrome differentiation, mainly involving deficiency of both heart and spleen, disharmony between heart and kidney, excessive "fire" in the body, lack of water to nourish wood, yin deficiency and yang excess, blood deficiency generating wind, internal movement of liver wind, and floating yang. Formulas such as Gui Pi Tang, Tianwang Bu Xin Dan, Baizi Yangxin Tang, Xuefu Zhuyu Tang, Gan Mai Da Zao Tang, Chaihu Jia Longgu Mu Li Tang, and Yi Gan Tang are chosen for this purpose.

Section 4: Modern Research on the TCM Concept of Zang-Xiang

The theory of Zang-Xiang is a crucial component throughout the entire system of TCM, and understanding Zang-Xiang is an essential part of studying TCM. Modern research on the concept of Zang-Xiang is also an important pathway for the integration of Chinese and Western medicine. Over the decades, efforts in integrating Chinese and Western medicine in this area have yielded abundant results, initially forming significant points of convergence between the two systems in terms of basic theory. It is precisely these points of convergence that have enabled Chinese and Western medicine to develop a common language in academic discourse. As these points of convergence gradually increase and research on each point deepens, the two systems will ultimately merge further, at which point TCM will embark on a path toward comprehensive modernization.