3. Lower Abdominal Pain

3. Lower Abdominal Pain
   Gynecological pelvic inflammatory diseases, uterine fibroids, dysmenorrhea, cystitis, bladder and urinary tract stones, bladder tumors, colonic inflammation (both non-specific and specific), appendicitis, and other conditions can all cause varying degrees and different characteristics of lower abdominal pain. First, confirm the underlying disease causing lower abdominal pain through modern medical diagnostic methods such as physicochemical tests, then proceed with TCM syndrome differentiation. Whether it is adnexitis or more widespread pelvic inflammation, gynecological pelvic inflammatory diseases often fall under the category of “Damp-Heat Descending,” and if the pain is severe, it may indicate “blood stasis in the lower jiao.” Options include Si Miao San, Wan Dai Tang, Qing Dai Tang, Gui Zhi Fu Ling Wan, Dang Gui Shao Yao Tang, and Tao Hong Si Wu Tang; when necessary, add Bai Hua She She Cao, Ban Zhi Lian, Gong Ying, and Baishang to clear heat and detoxify. For uterine fibroids, treatment principles are determined based on their size and location as indicated by ultrasound; fibroids smaller than 2 cm can be treated with traditional Chinese medicine to dissolve them. If the fibroid is large or located near the cervical os, prompt referral to Western medicine for gynecological surgery is advisable. When treating uterine fibroids with TCM, follow the principle outlined in the Golden Cabinet’s “Women who have long-standing illnesses,” using Gui Zhi Fu Ling Wan in combination with Dang Gui Shao Yao Tang, with appropriate additions of San Ling, E’zhu, Roushi, and Momo—this is an example of “using the root to treat the symptom,” meaning that herbal remedies are used to treat excessive menstrual bleeding. In addition to abdominal pain during menstruation, the primary manifestation of uterine fibroids is menorrhagia. For dysmenorrhea, syndrome differentiation still focuses on “blood stasis in the lower jiao,” and treatment should emphasize blood circulation and stasis resolution; options include Shao Fu Zhu Tang, Xue Fu Zhu Tang, Tao Hong Si Wu Tang, and Gui Zhi Fu Ling Wan. Bladder inflammation (including non-specific urinary tract infections) often presents with bladder irritation symptoms such as frequent urination, urgency, and dysuria; TCM often describes “damp-heat accumulating in the bladder,” and options include Ba Zheng San, Long Dan Xie Gan Tang, Gan Lu Xiao Du Yin, and Si Miao San. For those with obvious lower abdominal pain, add Jin Ling Zi San or Shi Xiao San. Colonic inflammation includes dysentery and ulcerative colitis; traditionally, TCM views dysentery as “damp-heat” accumulating in the large intestine, and uses “clearing heat and draining dampness” approaches, selecting formulas like Xiang Lian Wan, Shao Yao Tang, Lian Li Tang, Ge Gen Qin Lian Tang, Zhi Shi Dao Zhi Wan, and Bai Tou Weng Tang. If amoebic dysentery is diagnosed, these formulas can be used extensively.

Practical Internal Medicine Integrating TCM and Western Medicine

Artemisia annua and Kuhlan. Ulcerative colitis often falls under the category of “Tai Yin Deficiency and Diarrhea,” and treatment should focus on tonifying the kidneys, strengthening the spleen, clearing heat and draining dampness; formulas like Li Zhong Tang, Fu Zi Li Zhong Tang, Lian Li Tang, Wu Mei Wan, and He Li Bo San are commonly used. Appendicitis was historically known as “Intestinal Carbuncle,” and the Golden Cabinet’s “Da Huang Mu Dan Pi Tang” and “Jie Yi Fu Zi Baishang Tang” were two well-established formulas with proven efficacy. Later, researchers discovered effective medicinal herbs for treating appendicitis, such as Hong Teng, Xia Ke Cao, Bai Hua She She Cao, Ban Zhi Lian, and Zhu Ye Jiao, all of which can be used as treatment options. Urinary tract stones (including bladder stones) generally fall under the category of “Shi Lin” and “Xue Lin” in TCM, with the underlying mechanism often being “damp-heat descending,” and treatment should focus on clearing heat and draining dampness; formulas like Shi Wei San, Yu Lin San, Xiao Shi San, Ba Zheng San, and Xiao Ji Yin Zi can be used. For bladder cancer, early diagnosis and early Western medical surgery are crucial; for patients who miss the opportunity for surgery, Western medicine can be used for chemotherapy (including systemic chemotherapy and local bladder irrigation) and radiation therapy. TCM can support treatment by tonifying the body’s fundamental forces, reducing the side effects of chemotherapy and radiation therapy.

4. Flank Pain
   Hepatitis, liver cancer, liver abscess, hepatic hemangioma, fatty liver, cholecystitis, gallstones, gallbladder cancer, pancreatic disorders, and other conditions can all cause flank pain. Once these diagnoses are confirmed, TCM syndrome differentiation should be performed. Hepatitis can be treated with TCM syndrome differentiation as previously described, focusing on “liver qi stagnation” and “liver wood overcoming earth,” and most cases respond well. For those experiencing severe pain, add Jin Ling Zi San, Roushi, Momo, and Qing Chen Pi. Hepatic hemangiomas are often associated with liver qi stagnation and qi stagnation and blood stasis; they can be treated with formulas like Xiao Yao San, Xiao Chai Hu, Chai Hu Shu Gan San, and others, with long-term use of blood-moving and stasis-resolving herbs such as Roushi, Momo, Water Leech, To Bei Chong, San Qi, San Ling, and E’zhu. Fatty liver often involves liver qi stagnation, though blood stasis is less common; the condition lies in the qi division, and treatment should focus on regulating qi and dispersing liver qi; formulas like Chai Hu Shu Gan San, with additions of Muxiang, Fo Shou, Qing Chen Pi, Mu Gua, Huangqi, and Danshen, can be used to shrink hepatic hemangiomas and eliminate pain in the liver area. Fatty liver is often associated with liver qi stagnation, and in most cases, blood stasis is present; treatment should focus on regulating qi and dispersing liver qi, with formulas like Chai Hu Shu Gan San, with additions of Bai Hua She She Cao, Ban Zhi Lian, Hu Zhang, and others. Cholecystitis and gallstones often occur together; the underlying mechanisms of both conditions are often damp-heat accumulation in the liver and gallbladder, with acute cases involving Shaoyang and chronic cases involving Jueyin. For Shaoyang cases, adjustments can be made in formulas like Xiao Chai Hu, Da Chai Hu, San Huang Xie Xin, and Danshen Yin; for heavy damp-heat, add Hu Zhang, Tai Jiu, Roushi, and Momo; for severe pain, add Yuan Hu, Chuan Lian Zi, Roushi, and Momo. For Jueyin cases, adjustments can be made in formulas like Nuang Gan Jian, Si Ni San, and Shu Gan San; for jaundice, add Ni Shi Fan Shi Tang, and for severe pain, increase the amount of Zhi Shi and Muxiang, or add Jin Ling Zi and Yuan Hu; for damp-heat, add Qianjin Cao and Hu Zhang. Liver abscesses were historically known as “Liver Carbuncle,” and the condition is characterized by heat-toxins accumulating in the liver; treatment should focus on dispersing liver qi, clearing heat, and detoxifying; formulas like Da Chai Hu, Long Dan Xie Gan, Dang Gui Long Hui Wan, and others can be used with adjustments to include Er Hua, Lian Qiao, Gong Ying, Baishang, Bai Hua She She Cao, Ban Zhi Lian, and Xia Ke Cao. For liver cancer and gallbladder cancer, after diagnosis, seek early consultation with Western medicine specialists to strive for early surgery; if the opportunity for surgery is lost, TCM treatment can be attempted. In most cases, the condition involves damp-heat accumulation in the liver and gallbladder, and treatment should focus on dispersing liver qi, relieving pain, and clearing heat and draining dampness; formulas like Da Chai Hu, Da Lie Xin, Da Cheng Qi, and Ba Zheng San can be used with adjustments to include Bai Hua She She Cao, Ban Zhi Lian, Hu Zhang, and others for heat-clearing and detoxification. For pancreatic inflammation, chronic cases were discussed earlier; in the acute phase, in addition to severe flank and epigastric pain, there may also be fullness and pain in the lower abdomen, often falling under the category of “Great Chest Blockage” in TCM; treatment should focus on addressing the root cause, and formulas like Da Chai Hu, Da Lie Xin, Da Cheng Qi, and Ba Zheng San can be used.

5. Dizziness
   Hypertension, cerebral arteriosclerosis, hypotension, anemia, ear-related dizziness, neurasthenia, menopausal syndrome, intracranial tumors, and other conditions can all cause dizziness. First, confirm the Western medical diagnosis before proceeding with TCM syndrome differentiation, which greatly improves the accuracy of diagnosis. Hypertension is often associated with “Yin Deficiency and Yang Exuberance,” where Yang Exuberance leads to Wind; treatment should focus on nourishing yin, suppressing yang, and calming the liver to extinguish Wind; formulas like Qi Ju Di Huang Tang, Zhen Gan Xi Feng Tang, and Jian Li Tang can be used with adjustments. Some cases of hypertension exhibit only mild symptoms of Yang Exuberance, and formulas like Zhen Wu Tang and Ling Gui Shu Gan Tang can be used for treatment. Cerebral arteriosclerosis is often associated with blood stasis; treatment should focus on promoting blood circulation and resolving stasis—this is the principle of “treat Wind by activating blood circulation, and when blood is active, Wind naturally disappears.” Formulas like Xue Fu Zhu Tang, Guan Xin No. 2, and Tao Hong Si Wu Tang can be used for treatment. Hypotension is often associated with “heart-spleen deficiency” or “middle qi sinking”; treatment should focus on nourishing blood, replenishing the heart, and strengthening the middle qi; formulas like Gui Pi Tang, Bu Zhong Yi Qi Tang, and Sheng Mai San can be used. Most cases of anemia are related to heart-spleen deficiency, heart-kidney disharmony, or qi not governing blood. In recent years, many anemia treatment formulas have been developed, but most of them follow the same basic principles; the most commonly used formulas include Gui Pi Tang, Bu Zhong Yi Qi Tang, Liu Wei Di Huang Tang, and Xiang Sha Liu Jun Zi Tang. By carefully considering the specific condition and choosing formulas accordingly, adding ingredients like Tu Si Zi, Nu Zhen Zi, Gou Qi Zi, He Shou Wu, and Xian He Cao can lead to more satisfactory results. Ear-related dizziness is often associated with “Water Qi Ling Xin,” “Wetness Confusing Heart Yang,” “Phlegm Obstructing Heart Mind,” or “Blood Deficiency Leading to Wind,” and treatment should focus on clearing the heart, eliminating phlegm, calming the heart, promoting water metabolism, and warming yang to transform phlegm; formulas like Ling Gui Shu Gan Tang, Zhen Wu Tang, Wu Ling San, Xuan Fu Dai He Tang can be used for treatment. Neurasthenia and menopausal syndrome are treated with relatively flexible TCM syndrome differentiation, with several types of diagnosis: “Heart-Spleen Deficiency,” “Heart-Kidney Disharmony,” “Excessive Fire,” “Water Not Containing Wood,” “Yin Deficiency and Yang Exuberance,” “Blood Deficiency Leading to Wind,” “Liver Wind Internal Movement,” “Deficient Yang Rising,” and others; formulas like Gui Pi Tang, Tian Wang Bu Xin Dan, Bai Zi Yang Xin Tang, Xue Fu Zhu Tang, Gan Mai Da Zao Tang, Chai Hu Jia Long Gu Mu Li Tang, and Yi Gan Tang can be used for treatment.

(Pei Zheng Xue)

Chapter Three: Modern Research on the Concept of TCM Organs

The theory of organ systems is a fundamental component of the entire TCM academic framework. Understanding the organs is a mandatory course for learning TCM, and modern research on the concept of organs serves as an important avenue for integrating TCM and Western medicine. Over decades, TCM-Western medicine integration efforts have yielded substantial results in this field, initially establishing key points of convergence between the two medical systems in basic theory. These convergences have enabled TCM and Western medicine to develop a shared language academically. As these convergences continue to grow and research on each point of convergence deepens, TCM and Western medicine will eventually move toward further integration—and in the future, TCM will embark on a path toward comprehensive modernization.

I. Research on the Kidneys

The kidneys are considered the root of innate vitality, the source of original yin and original yang, and the basis for the yin and yang of all five internal organs and six viscera. Throughout history, physicians have placed great importance on the changes and transformations of kidney yin and kidney yang, viewing them as critical factors influencing human health, development, growth, aging, disease, and death. In the 1950s, Shanghai First Medical College was the first to use tonifying kidney and yang therapies to treat six conditions—such as bronchial asthma and functional uterine bleeding—each of which appeared completely different from a Western medical perspective, yet all achieved satisfactory therapeutic outcomes. This discovery revealed the essence of traditional Chinese medicine’s “treating similar diseases with different approaches.” Starting from this insight, extensive work was conducted to explore the nature of the kidneys, revealing that patients with kidney yang deficiency often showed lower levels of 24-hour urinary 17-hydroxycorticosteroid compared to normal values. This finding suggested a connection between kidney yang deficiency and the functional status of the adrenal cortex in modern medicine. Subsequently, methods such as plasma cortisol diurnal rhythm measurements reflecting hypothalamic function, methyldopa SV-4885 tests reflecting pituitary function, and ACTH stimulation tests reflecting adrenal cortical function were adopted. These three levels of testing collectively provided a comprehensive understanding of the functional state of the hypothalamic-pituitary-adrenal axis. Through routine testing of healthy individuals with kidney yin deficiency and kidney yang deficiency, it was demonstrated that the hypothalamic-pituitary-adrenal axis was disrupted in those with kidney yang deficiency, thereby confirming that “kidney yang deficiency” has a material basis. After repeated studies and consistent findings both domestically and internationally, it became clear that TCM’s kidneys are closely related to the endocrine system in modern medicine. Since the 1980s, the Integrated TCM and Western Medicine Research Institute at Shanghai First Medical College has expanded its research on thyroid axis and gonadal axis functions [21]. It was found that in patients with chronic bronchitis, those with kidney yang deficiency had lower TSH levels, whereas those without kidney yang deficiency had normal TSH levels. After treatment with tonifying kidney herbs, TSH levels returned to normal. Additionally, a complete set of gonadal axis tests was conducted on male patients with kidney yang deficiency and male patients with sexual dysfunction [3], revealing that patients with kidney yang deficiency exhibited varying degrees of gonadal axis dysfunction, while those with sexual dysfunction (without kidney yang deficiency) had basically normal gonadal axis function. Furthermore, when measuring thyroid axis and gonadal axis functions in elderly individuals averaging 69 years old [4], it was found that the changes in these axes were remarkably similar to those seen in patients with kidney yang deficiency. Thus, the appearance of kidney yang deficiency was positively correlated with aging, and the key underlying mechanism lay in disruptions in hypothalamic regulatory function. This led to a more precise understanding of the nature of kidney yang deficiency. Guided by these theories, domestic scholars widely used tonifying kidney and yang herbs to treat aging, and experimental studies proved that these herbs could enhance T cell immune function in the elderly, while also exhibiting significant anti-aging effects on the gonadal axis. This supported the idea that “the clock of aging begins in the hypothalamus.”

The Integrated TCM and Western Medicine Research Institute at Shanghai First Medical College, following the traditional approach of “treat lungs when urgent, treat kidneys when slow,” developed warm-yang tablets to tonify the kidneys. A preventive treatment program was implemented for 7 batches totaling 419 asthma patients, with a prophylactic kidney-tonifying regimen during periods of no attacks [5], achieving an efficacy rate of 63.4%–75.5%. In contrast, the control group without kidney-tonifying treatment had an efficacy rate of only 14%–22.2%. Based on these therapeutic results, research in endocrinology revealed that even patients without clinical manifestations of kidney yang deficiency still harbored potential functional changes in the adrenal cortical axis similar to those seen in kidney yang deficiency. Warm-yang tablets could adjust adrenal cortical function at the microscopic level, and at the macroscopic level, they could improve asthma attacks. Moreover, warm-yang tablets also possessed immune-regulatory and neuroendocrine-regulatory functions, potentially contributing to the prevention of asthma attacks. Traditional Chinese medicine believes that “the kidneys store essence,” and “the kidneys govern reproduction”—in men, the kidneys “store essence,” while in women, they “store the egg cells,” highlighting the close relationship between the kidneys and reproductive functions in both men and women. The Obstetrics and Gynecology Hospital of Shanghai First Medical College studied ovarian dysfunction leading to ovulatory disorders.