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 conducted to confirm the disease causing the lower abdominal pain, followed by TCM syndrome differentiation.

Gynecological pelvic inflammatory disease, whether adnexitis or more extensive pelvic inflammation, is mostly attributed to damp-heat descending in TCM. If the pain is severe, it indicates blood stasis in the lower jiao, with options such as Simiao San, Wanda Tang, Qingdai Tang, Guizhi Fuling Wan, Danggui Shaoyao Tang, and Taohong Siwu Tang; when necessary, add white snake tongue grass, banzhilian, dandelion, and houttuynia cordata for their heat-clearing and detoxifying effects. Uterine fibroids are treated according to size and location 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 at the cervical opening, early referral to Western gynecological surgery is recommended. Herbal treatment for uterine fibroids generally follows the principle in "Jingui Yaolüe" that "women with pre-existing masses" should be treated with Guizhi Fuling Wan combined with Danggui Shaoyao Tang as the main formula, supplemented as needed with sanleng, ezhushi, frankincense, and myrrh. This is a general approach of using blood-activating methods to address excessive uterine bleeding. Besides menstrual abdominal pain, the main symptom of uterine fibroids is excessive menstruation. Syndrome differentiation for dysmenorrhea still involves 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 attributing it to damp-heat accumulating in the bladder. Options include Bazheng San, Longdan Xiexin Tang, Ganlu Xiaodu Yin, and Simiao San; for those with obvious lower abdominal pain, Jinlingzi San and Shixiao San can be added. Colitis includes dysentery and ulcerative colitis. Dysentery has traditionally been treated as damp-heat accumulating in the large intestine, using heat-clearing and dampness-draining methods, with options such as Xianglian Wan, Shaoyao Tang, Lianli Tang, Gegen Qinlian Tang, Zhishi Daozhi Wan, and Baitouweng Tang. If diagnosed as amoebic dysentery, heavy use of yabandzi and kushen is recommended in the aforementioned formulas. Ulcerative colitis is mostly considered a Taiyin deficiency in TCM, requiring kidney-tonifying and spleen-strengthening, along with heat-clearing and dampness-draining methods, with options such as Lizhong Tang, Fuzi Lizhong Tang, Lianli Tang, Wumei Wan, and Helile San. Appendicitis was historically called "intestinal abscess," with "Jingui Yaolüe" leaving behind two highly effective formulas—Dahuang Mudan Tang and Yiyi Fuzi Baijiang San. Later generations also proposed red vine, summer枯草, white snake tongue grass, banzhilian, bamboo leaf pepper, and other effective medicines for treating appendicitis, all of which can be chosen. Urinary tract stones (including bladder stones) generally fall under the TCM categories of "stone urine" and "blood urine," with mechanisms also involving damp-heat descending, requiring heat-clearing and dampness-draining methods. Options include Shiwei San, Yulin San, Xiaoshi San, Bazheng San, and Xiaoji Yinzi. 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. After confirming the above diagnoses, TCM syndrome differentiation should be performed. As previously mentioned, hepatitis is treated in TCM as liver qi stagnation and liver wood overcoming earth, which is generally effective; for severe pain, add Jinlingzi San, frankincense, myrrh, and green tangerine peel. Hepatic hemangioma is also related to liver qi stagnation and blood stasis, with options such as Xiaoyao San, Xiao Chaihu Tang, and Chaihu Shugan San, along with heavy use of blood-activating and stasis-resolving drugs like frankincense, myrrh, leeches, earthworms, panax notoginseng, sanleng, and ezhushi. Long-term use of these drugs can shrink the hemangioma and eliminate pain in the liver area. Fatty liver is mostly related to liver qi stagnation, with relatively few cases of concurrent 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 accumulating in the liver and gallbladder. In acute cases, it's Shaoyang; in chronic cases, it's Jueyin. For Shaoyang cases, adjust formulas such as Xiao Chaihu Tang, Da Chaihu Tang, Sanhuang Xiexin Tang, and Danshen Yin; for damp-heat-heavy cases, add tiger stick, money grass, banzhilian, white snake tongue grass, and flea herb; for severe pain, add yuanhusuo, chuanlianzǐ, frankincense, and myrrh. For Jueyin cases, adjust formulas such as Nuan Gan Jian, Si Ni San, and Shugan San; for jaundice, add nitrate alum stone powder; for severe pain, add zhishi and musk, and also add Jinlingzi and yuanhusuo; for damp-heat-combined cases, add money grass and tiger stick. Liver abscess was historically called "liver boil," with the condition being heat toxin trapped inside the liver. Treatment focuses on clearing heat, draining fire, and detoxifying, with formulas such as Da Chaihu 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, early consultation with Western specialists is required to strive for early surgery; if the opportunity for surgery is lost, try herbal treatment. Most cases involve damp-heat accumulating in the liver and gallbladder, with treatment focusing on clearing heat, relieving pain, and draining dampness, with formulas such as Da Chaihu Tang, Chaihu Shugan San, and Baidao Paishi Tang being adjusted accordingly, with heavy use of white snake tongue grass, banzhilian, tiger stick, flea herb, dandelion, and houttuynia cordata for heat-clearing and detoxifying purposes. Syndrome differentiation for chronic pancreatitis is as described above; in the acute phase, besides severe flank and epigastric pain, there is also a feeling of fullness and pain extending from the lower abdomen to the small intestine, mostly falling under the TCM category of "large chest constriction." Treatment focuses on addressing the root cause, with formulas such as Da Chaihu Tang, Da Xianxiong Tang, Da Chengqi Tang, and Baidao Paishi Tang being preferred.

Dizziness Hypertension, cerebral arteriosclerosis, hypotension, anemia, ear-originated vertigo, neurasthenia, menopausal syndrome, intracranial tumors, and other conditions can all cause dizziness. Conducting a Western 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 blood-activating and stasis-resolving treatment, as the saying goes: "Treat the wind first, then treat the blood; once the blood flows, the wind will naturally dissipate." Options include Xuefu Zhuyu Tang, Guanxin II, and Taohong Siwu Tang. Hypotension is mostly related to deficiency of both heart and spleen or sinking of middle qi, requiring nourishing blood and strengthening the heart, supplementing the middle qi, with formulas such as Guipi Tang, Bu Zhong Yi Qi Tang, and Shengmai San being preferred. Most cases of anemia are related to deficiency of both heart and spleen, disharmony between heart and kidney, or lack of unified blood flow. In recent years, many formulas have been developed to treat anemia, but most follow the same principles. The most commonly used formulas include Guipi Tang, Bu Zhong Yi Qi Tang, Liuwei Dihuang Tang, and Xiangsha Liujunzi Tang. Depending on the specific condition, adding tu si zi, nu zhen zi, gou qi zi, he shou wu, and xianhe cao can lead to more satisfactory results. Ear-originated vertigo is mostly related to water qi overwhelming the heart, dampness hindering yang, phlegm confusing the heart's pathways, and blood deficiency generating wind. Treatment focuses on clearing the heart, removing phlegm, calming the mind, and warming the yang, with formulas such as Linggui Zhugan Tang, Zhenwu Tang, Wuling San, and Xuanfu Dai Zhe Tang being preferred. 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 "xianghuo," water not containing wood, yin deficiency and yang excess, blood deficiency generating wind, internal movement of liver wind, and floating yang. Formulas such as Guipi Tang, Tianwang Buxin Dan, Baizi Yangxin Tang, Xuefu Zhuyu Tang, Ganmai Dazao Tang, Chaihu Jia Longgu Muli Tang, and Yi Gan Tang are recommended.

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 course for studying TCM. Modern research on the concept of Zang-Xiang is also an important pathway for integrating 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 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 eventually merge further, at which point TCM will embark on a path of comprehensive modernization.