Fukushin: Japanese Abdominal Diagnosis
Compiled by Dr. Michael Tierra L.AC., O.M.D.
- Thickness of the abdominal wall -- indicates subcutaneous fat, an excess or firmness conformation.
- Excess with chest distress --- Ta chai hu tang (Major Bupleurum formula)
- Deficiency or weakness conformation presents a thin abdominal wall with lack of flexibility --- Chen Wu Tang (Vitality combination)
- Abdominal distension --- Usually part of an excess or firmness conformation.
- An excess or firmness combination is with tight, distended abdomen and a strong pulse --- Ta chai hu tang (Major Bupleurum formula)
- A deficiency or weakness conformation presents a distended abdomen and a feeble pulse --- Szu ni Tang (Ginger, licorice Combination)
- Chest distress and subcardiac tightness --- a feeling of outward pressure in the substernum area or epigastric region below the heart with tightness and sensitivity to palpation is part of an excess conformation --- Ta chai hu tang (Major Bupleurum formula) or some other mildly purgative, cholagogue type of formula.
- A distended abdomen which is soft upon palpation and is not painful or resistant is part of a deficiency or weakness conformation and may occur on either the right or the left side near the ribs --- possibly Hsiao chai hu tang (minor Bupleurum formula) or some other tonic formula that also relieves liver stagnancy.
- Select the appropriate bupleurum formula considering all the other indications.
- Epigastric pain or subcardiac swelling (shin ka hi) --- a feeling of distension in the epigastric region below the heart is a general indication of Pan hsia hsieh hsin-tang (Pinellia combination).
- If there is asthmatic wheezing, gasping respirations, palpitations and edema, give Mu fang chi tang (Stephania and Ginseng combination).
- Other pinellia formulas to consider are:
- Kan tsao hsieh hsin tang (Pinellia and licorice combination) -- use for 3 or 4 days for stomach pain.
- Pan hsia ho pu tang (Pinellia and magnolia combination) -- for nervous stomach and pain.
- Sheng chiang hsieh hsin tang (Pinellia and ginger combination) -- for cold stomach from cold foods.
- Pinellia combination with aconite -- the strongest, with double aconite, it works overnight.
- When diagnosing subcardiac swelling, it is generally an indication of fluid stagnancy in the stomach and abdomen and one should consider the following:
- If the patient has a large amount of subcutaneous fat there will be a somewhat soft abdominal surface without resistance. If upon deeper palpation there is resistance then it is subcardiac swelling.
- Initial diagnosis may only seem to be subcardiac swelling. If the muscles feel rigid, like a board then it is not.
- Swelling and tightness around the umbilicus is not subcardiac swelling.
- For deficiency type use tonics such as Ginseng and ginger combination, Four major herbs combination or Six major herbs combination.
- Subcardiac hardness --- may indicate a weakness conformation. there is a feeling of distress beneath the heart but no resistance or pain with palpation but a succusion or slight hollow sound -- Jen sheng tang (Ginseng and Ginger combination), Szu chun tzu tang (Four major herb combination).
- Subcardiac swelling and hardness -- the area beneath the heart is distended with a feeling of distress over the heart -- Yin chen hao tang (Capillaris combination) or Wu ling san (Hoelen five Herb combination).
- Lower abdominal stress or tension or lower abdominal softness -- Either type is generally regarded as a kidney deficiency conformation requiring the use of a Rehmannia type formula either Pa wei ti huang wan (Rehmannia eight) if there is impotence, lack of libido and coldness or Liu wei ti huang (Rehmannia six) is there is heat and yin deficiency. Other symptoms that may also be present are lower back pain, joint pains, urinary problems, low energy.
- Vertical muscle spasms --- A bar-like rigidity on the side of the umbilicus below the ribs -- it is usually a deficiency conformation (especially if the skin is thin). Both or one side may be contracted and tight -- Hsiao chien chung tang (Minor cinnamon and paeonia combination) is prescribed. It there is only tenseness in the upper abdomen the Szu ni san (Bupleurum and chih-shih formula) is used.
- Aortic palpation --- on the midline of the abdomen and above the navel it indicate a heart disturbance (worry); below the navel it is an indication of fear or insecurity; on the navel it is an indication of spleen; on the right side of the navel is an indication of lung problems; on the left side it is an indication of liver imbalance.
- Use a formula to calm the heart such as Baked licorice combination or Cinnamon and dragon bone;
- For below the navel select either Rehmannia six or Eight combination;
- Directly on the navel use Bu zhong yi chi tang (Ginseng and astragalus), Astragalus and ginger, Szu junza tang (Major Four herbs combination) or Liu junza tang (Six herbs combination), or Wu ling san (Hoelen formula).
- Fluidic sounds in the abdomen --- upon light percussion one hears fluidic sounds. It indicates a weakness conformation with weakness and atony of the stomach and stomach muscles, gastropsis, or gastrectasis --- Jen sheng tang (Ginseng and Ginger combination) if there is accompanying low energy with weak digestion or Wu ling san (Hoelen five herb combination) if there is mainly fluid accumulation and edema.
- Spasms and tightness of the lower intestines, either the right (ascending colon) or the left side (descending colon) -- a symptom of stagnation and excess, for left side give Tao ho cheng chi tang (Persica and rhubarb combination), for right side give Ta Huang mut tan Pi (rhubarb and Moutan Combination).
- Mass below the navel --- on either the right or left side there is one or two areas of resistance indicating stagnant blood or lumpy feeling indicating a fluid stagnation condition (often fibroids or cysts) --- it is very common in women after childbirth -- it can be caused by a lack of walking and many traditional develop exercises such as belly dancing or the Hawaiian hula to prevent it. It there are apparent blue veins then it indicates stagnant blood and liver chi, possibly with accompanying temper and/or parasites.
- Use blood and fluid dispersing formulas such as:
- Kuei chi fu ling tang (Cinnamon and hoelen combination) for fluid stagnation and especially for fibroid cysts.
- Huang lien chieh tu tang (Coptis and scutellaria combination)
- Tang kuei shao yao san (Tang kuei and peony formula) with blood deficiency
- Sheng hua tang (Tang kuei and ginger combination)
- Wen ching tang (Tang kuei and evodia combination)
- Ta huang mu tan pi tang (Rhubarb and Moutan) is the strongest.
- Szu wu tang (Tang kuei four) for blood deficiency
- Pa wei wan (Ba wei wan) or Pa chen tang (Tang kuei and ginseng eight) for blood and chi deficiency
- Tang kuei, ginger, evodia and aconite (very hot)
- Erratic peristalsis -- Chronic hyperactive bowel syndrome with irregular movement of the intestines, colitis and sometimes abdominal pain. If it is a deficiency conformation, purgatives cannot be given even if their is constipation otherwise Ta chien chung tang (Major zanthoxylum combination) is prescribed.
- Umbilical pain --- Upon relatively gentle palpation either directly on the umbilicus or immediately above it there is painful discomfort. The patient also exhibits a tense, tight pulse with strong abdominal muscles --- Ko ken tang or Gegen tang (Pueraria Combination) is indicated.
- A straight line of hardness or tightness which passes through the center of the umbilicus. It indicates deficiency and weakness of the spleen and kidneys. Above the umbilicus is the spleen while below is the kidneys. For spleen deficiency Chen wu tang ( Vitality combination) is used, for kidney deficiency Pa wei ti huang (Rehmannia eight) is given.
- Muscle spasm and tightness below the abdomen --- indicates kidney and liver wind --- Kuei chih chia ko ken tang (Cinnamon and dragon bone) is used.
- Yang pulses are Floating (superficial), Large, Fast, Stronger. Yin pulses are deeper, thin or thready, weak, slow, .
- Slippery pulse indicates damp stagnation.
- Bowstring or tense pulse indicates liver wind or liver stagnation
- Irregular pulses:
- Hasty= fast but misses a beat occasionally, stagnation with heat.
- Knotted=leisurely but misses a beat irregularly (stagnation of chi, blood or fluid.
- Intermittent=loses a beat at some regular interval, often seen in older or very weak people with exhausted yin organs.
- Scattered pulse=a yin pulse which feels indistinct, big but without strength when pressure is applied. (exhausted yang)
- Shape: large and flabby possibly with tooth prints indicates def. of chi, yang and phlegm dampness, def. spleen chi and yang.
- Thin and shrunken indicates def. chi, blood and yin.
- Rigid tongue indicates wind, heat, yin def.
- Deviated tongue indicates stroke, wind-phlegm obstruction.
- pale tongue lack of chi, blood or yang
- red tongue internal or external heat, deep red is internal heat. hyperactive, yin deficient type.
- purplish tongue is stagnation of chi and blood
- red tip is heart or lung heat, red sides is liver-gall bl. heat
- Cracked tongue can indicate damage to corresponding organs or normal.
- Coat: white coat is cold, if thin it is wind cold, if it is thick it is food stagnation, sticky or moist is damp, dry white coat is fever.
- Yellow coat is heat, if thin it is wind heat, if thick it is food stagnation in stomach and intestines, also liver stagnation, if yellow and sticky it is internal damp heat, if dry yellow it is stomach and intestinal heat with damage to yin.
- Greyish Black coat may be moist or dry, usually means internal cold and def. yang. If dry it means consumption of body fluids by excess or deficient heat. If moist it means def. yang.
- Peeled Coat: no tongue coat, mirror smooth usually means yin deficient type.
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