Lesser abdominal pain

1. Smaller abdominal pain.

2. Pain in the abdomen below the umbilicus on either the left, right or both sides. It is due to cold stagnating in the liver channel, depressed liver qì, large intestine damp-heat or lower burner vacuity cold.

Patterns

Cold stagnating in the liver channel (肝滞肝脉 gān zhì gān mài) causes lesser abdominal pain stretching into the testicles. The pain is acute with sagging distension. In some cases, the scrotum retracts. The pain is exacerbated by cold and slightly relieved by heat. Other signs include bright-white facial complexion, physical cold and cold limbs, a white glossy tongue fur, and a sunken slippery stringlike pulse.

Medicinal therapy: Warm and disperse liver channel cold. Use Chinese Angelica Counterflow Cold Decoction (当归四逆汤 dāng guī sì nì tāng) plus evodia (Evodiae Fructus, 吴茱萸 wú zhū yú) and fresh ginger (Zingiberis Rhizoma Recens, 生姜 shēng jiāng).

Depressed liver qì (肝气郁 gān qì yù) causes qì stagnation in the lesser abdomen with pain stretching into the testicles. The pain is fluctuating and intermittentand is brought on by emotional stimulus or excessive exertion. Alternatively, in the lesser abdomen or to the side of the umbilicus there is a lump that gathers and disperses at irregular intervals and that is associated with periodic acute, even unbearable, distending pain exacerbated by pressure.

Medicinal therapy: Course the liver and rectify qì. Use Bupleurum Liver-Coursing Powder (柴胡疏肝散 chái hú shū gān sǎn) plus toosendan (Toosendan Fructus, 川楝子 chuān liàn zǐ), fennel (Foeniculi Fructus, 茴香 huí xiāng), psoralea (Psoraleae Fructus, 补骨脂 bǔ gǔ zhī), and fenugreek (Trigonellae Semen, 胡芦巴 hú lú bā).

Large intestine damp-heat (大肠湿热 dà cháng shī rè) causing lesser abdominal pain occurs in dysentery with stool containing pus and blood, tenesmus, and thirst with desire to drink.

Medicinal therapy: Clear heat, disinhibit dampness; quicken the blood and relieve pain. Pulsatilla Decoction (白头翁汤 bái tóu wēng tāng).

Lower burner vacuity cold (下焦虚热 xià jiāo xū rè) causes continuous lesser abdominal pain, usually more severe on the left side, together with a bright-white facial complexion, fatigue and lack of strength, physical cold and fear of cold, and lack of warmth in the extremities. Other signs include vomiting or diarrhea. The tongue is pale with white fur, and the pulse is stringlike and slow. Lower burner vacuity cold, like liver channel qì stagnation, causes cold pain. However, in lower burner qì vacuity, the liver viscus is affected rather than the liver channel, and instead of pain stretching into the testicles, there is vomiting or diarrhea.

Medicinal therapy: Warm and disperse cold in the liver viscus. Use Evodia Decoction (吴茱萸汤 wú zhū yú tāng).