ABDOMINAL MASSES

GENERAL

Clinical Manifestations	Masses generally result from deficiency of Qi and blood so that blood becomes static and Phlegm arises and gels. Masses are generally located in the Blood Level. In the early stage, genuine Qi has not been damaged; evil Qi is strong, but not extremely so. During this phase the mass is relatively small and is relatively soft, and the patient’s general condition is fair. In the middle stage, genuine Qi is declining and evil Qi gaining strength. The mass is now larger and firmer on palpation. Pain is now continual, and is accompanied by worsening appetite, weakness and wasting. In the late stage, genuine Qi is depleted and evil Qi very strong. The mass has increased further in size and is now very hard. Pain is severe, and is accompanied by marked anorexia, dusky or sallow complexion, and severe emaciation. Location of Mass: The specific visceral organ affected determines the location of the mass. A mass in the right subcostal abdomen, accompanied by subcostal stabbing pain, jaundice and abdominal distention is located in the liver. A mass in the epigastrium, accompanied by vomiting or hematemesis, is located in the stomach. A mass in the right abdomen, accompanied by diarrhea or constipation, emaciation and weakness, is located in the intestines. A mass in the left abdomen, accompanied by increased frequency of defecation and feces that contain pus and blood, is also located in the intestines.
Treatment Principle
Herb Formulas	Topical: Xiao Pi Gao
Points	PC-6, SP-4, KI-6, LU-7

WIND-COLD

Clinical Manifestations	Itching or tickling in the throat Cough with expectoration of thin, watery or frothy white sputum Chills with low grade fever Anhidrosis No thirst Headache Aversion to Wind Blocked and / or runny nose with clear, watery nasal discharge Sneezing General body aches Maybe asthma T: Pink C: Thin, white and moist P: Superficial and tight
Treatment Principle	Expel Wind Dispel Cold Resolve Phlegm
Herb Formulas	Ma Huang Tang
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WIND-COLD INVASION WITH DAMP ACCUMULATION

Clinical Manifestations	Itching or tickling in the throat Wheezing Sneezing Gasping Cough with expectoration of thin, watery or frothy white sputum General body aches No thirst Dyspnea Headache Body aches A sensation of heaviness Chills with low grade fever Maybe asthma Intolerance of Cold Anhidrosis Blocked and/or runny nose with watery nasal discharge Chest discomfort Neck stiffness Irritability T: Pink C: Thin, white and moist P: Superficial and tight
Treatment Principle	Disperse Wind-Cold Induce diaphoresis Dispel Dampness
Herb Formulas	Ma Huang Jia Zhu Tang
Points	DU-16, GB-20, UB-12, LI-4, SJ-5 (Sedating technique), UB-13, LU-7, REN-17, SP-6, SP-9, Moxa REN-4, REN-6, DU-4

YANG MING FU (LARGE INTESTINE EXCESS HEAT)

Clinical Manifestations	High fever (sometimes rises and falls) Great thirst Profuse perspiration Aversion to Heat Abdominal pain (worse with pressure) Abdominal distension Dryness Constipation (hard dry knots) Dislikes pressure Restlessness Irritability Mental disturbances: Mentally unclear Delirious speech T: Red and dry, or black and moist C: Thick yellow or dry yellow P: Deep, strong and forceful
Treatment Principle	Purge the Intestines
Herb Formulas	Da Cheng Qi Tang Xiao Cheng Qi Tang
Points	For Heat: DU-14, LI-4, LI-11, ST-44, SJ-5 For Stagnation: ST-34, ST-36, ST-37, ST-39, REN-12 For constipation: ST-25, SJ-6, UB-25

INTESTINAL ABSCESS (ACUTE APPENDICITIS)

Clinical Manifestations	This can also be called Blood Stagnation in the Large Intestine, Blood and Heat Stagnation in the Large Intestine or Toxic Heat in the Large Intestine Pain in the lower right abdomen; refuses pressure Pain may be severe, boring, and in a fixed position or without fixed location Constipation or Mild diarrhea Maybe fever Maybe nausea and vomiting Anorexia T: Red C:Thick, yellow and greasy or sticky P: Rapid
Treatment Principle	Clear Heat Transform Dampness Invigorate Blood circulation Conduct Stagnation.
Herb Formulas	Da Huang Mu Dan Pi Tang Da Cheng Qi Tang
Points	Lanweixue, ST-37, ST-36 For high fever: + LI-11, LI-4 For abdominal pain: + ST-25 For nausea and vomiting: PC-6, SP-4

BLOOD STAGNATION IN THE STOMACH

Clinical Manifestations	Immovable lumps around the umbilicus-worse with pressure Acute pain and pressure Sharp, stabbing epigastric pain with a fixed location Abdominal and flank distention worse with pressure Dislike of pressure and Heat on epigastrium Pain predominates over distention or Pain but no distention Worse after eating Epigastric rumbling Vomiting purple / black blood Stools with blood like tar (melaena) May be abdominal or epigastric lumps or masses Sweating of head Heartburn Afternoon mental depression and anxiety Fright Frequent low grade fever or afternoon Fever with cold limbs Withered, sallow complexion Emaciation Protracted course of development T: Dark purple with purple spots or dots C: Normal P: Choppy or Full and rapid in the QI position or Wiry and choppy
Treatment Principle	Adjust Qi Transform Stagnation Stop pain
Herb Formulas	With profuse lochia and echymotic Blood: Shi Xiao San With amenorrhea: Tao Nu San For fatigue, emaciation and anorexia due to Qi Deficiency: Liu Jun Zi Tangmodified With fatigue due to fast rooted mass: Xue Jie San With convulsions and mental disturbance with a full, rapid pulse: Da Quan Tang For Blood Stagnation due to Cold: Wen Jing Tang Topical: Xiao Pi Gao
Points	SP-6, SP-10, SP-15, ST-25, REN-4, REN-6 REN-12, LIV-13, SP-6, PC-6, UB-17, UB-18, UB-20 ST-21, ST-34 To Transform Blood Stagnation and Invigorate Blood circulation: + UB-17, SP-6, SP-4, SP-10 For epigastric pain due to Blood Stagnation: PC-6, ST-36, UB-17, SP-6 SP-4

LIVER BLOOD STAGNATION DUE TO LIVER BLOOD DEFICIENCY

Clinical Manifestations	Pale complexion or Facial color dark and dull Pale lips Blurred or failing vision Spots before eyes Dizziness Dry eyes Pale nail beds Irritability Frightens easily Insomnia with much dreaming Tinnitus Numbness of limbs Light menses or amenorrhea Late menses Irregular menses Dysmenorrhea Emaciation Sides and ribs distended on both sides (maybe with sharp pain) Enlargement of the Liver and Spleen Suffocating sensation in chest Melancholy Depression Inappropriate anger Breast distention and pain before and during menses T: Pale or Dark purple (maybe purple spots on edge of tongue) C: Little P: Thready or Wiry, choppy and slow
Treatment Principle	Nourish the Liver Reinforce Blood. Activate Blood circulation Soften hardness.
Herb Formulas	Si Wu Tang Topical: Xiao Pi Gao
Points	UB-17, UB-18, UB-20, LIV-3, LIV-13, LIV-14, SP-6, REN-4, ST-36

LIVER AND SPLEEN DEFICIENCY WITH BLOOD STAGNATION DUE TO DAMPNESS

Clinical Manifestations	Abdominal mass which is localized and hard Continuous cramping pain in the abdomen Pain is not severe Pain is relieved by pressure Edema of the feet Urinary difficulty Slight edema (primarily of the lower limbs) Symptoms generally occur during pregnancy Pale face Fatigue Heaviness of head Lassitude Lower abdominal pain Dizziness Tinnitus Lumbago Edema Abdominal pain with edema during pregnancy due to Blood Deficiency and abnormal water circulation	Oliguria Palpitations Cold feet Extreme coldness of the hands and feet Vertigo Weakness and numbness of lower back and legs during pregnancy or postpartum Mal position of the fetus Dysmenorrhea Irregular menstruation Right upper quadrant pain Hepatomegaly Anemia Lack of energy Sore back Thirst with no desire to drink T: Pale or pink maybe petechiae on margin C: Thin or Greasy white P: Deep and weak or Soft, floating, small and slow or Wiry and small or Wiry and rough
Treatment Principle	Nourish Liver Blood Soften the Liver Spread Liver Qi Strengthen the Spleen Resolve Dampness
Herb Formulas	Dang Gui Shao Yao San Topical: Xiao Pi Gao
Points

KIDNEY AND LIVER YIN DEFICIENCY WITH LIVER QI STAGNATION

Clinical Manifestations	Hypochondriac and chest pain Dry, parched mouth and throat Bitter taste in mouth Acid regurgitation Epigastric and abdominal distention T: Red and dry P: Thready and weak or Wiry and Deficient
Treatment Principle	Enrich Kidney and Liver Yin Spread Liver Qi
Herb Formulas	Yi Guan Jian
Points	UB-18, UB-23, KI-3, SP-6, LIV-2, LIV-3, LIV-4, LIV-5, LIV-14, LIV-13, GB-40, GB-41, PC-6

TRUE QI DEFICIENCY (LATE STAGE)

Clinical Manifestations	Hard mass progressively worsening pain sallow or dusky complexion Extreme emaciation Fatigue Loose stools Anorexia Dizziness Weak voice Reluctance to speak Sweating with little or no exertion T: Pale purple C: None P: Thready and rapid or Taut and thready
Treatment Principle	Tonify Qi Nourish the Blood Release Blood Stasis Dissipate masses
Herb Formulas	Ba Zhen Tang + Hua Ji Wan
Points	REN-6, REN-12, SP-6, ST-36, UB-17, UB-20 KI-3, LU-9, SP-6, ST-36

QI AND BLOOD STAGNATION

Clinical Manifestations	Abdominal masses which are visible when lying down Piercing hypochondriac pain Irritability Indigestion Constipation Dysmenorrhea Amenorrhea Chronic diarrhea Daybreak diarrhea Palpable abdominal masses Irregular menstruation Breast distention Abdominal tumors Hypochondriac distention T: Purple with purple spots on the side P: Wiry, choppy and tight
Treatment Principle	Invigorate the Blood Dispel Blood Stasis Move Qi Alleviate pain
Herb Formulas	Ge Xia Zhu Yu Tang Huo Luo Xiao Ling Dan Bie Jia Wan Jin Ling Zi San + Shi Xiao San With Qi and Blood Deficiency: Ba Zhen Tang + Hua Ji Wan modified For more severe Qi Stagnation and Blood Stasis and symptoms of Cold: Da Qi Qi Tang Topical: Xiao Pi Gao
Points	LIV-2, LIV-13, UB-17, UB-18 LIV-14, LIV-13, LIV-3, SP-6, UB-17

QI, BLOOD AND PHLEGM STAGNATION

Clinical Manifestations	Facial color dark and dull Emaciation Sides and ribs distended on both sides (maybe with sharp pain) Enlargement of the Liver and Spleen Suffocating sensation in chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses Anorexia Edema Abdominal distention Chest and hypochondriac distention Dizziness Nausea Vomiting Thirst with no desire to drink Maybe no thirst Palpitations Shortness of Breath T: Varies from Normal to Dark purple (maybe purple spots on edge of tongue) C: Thick and slippery P: Wiry, choppy and slow or Slippery, full and maybe wiry
Treatment Principle	Circulate Qi Invigorate the Blood Break up Stasis Eliminate Phlegm Warm Cold
Herb Formulas	Xiang Leng Wan Topical: Xiao Pi Gao
Points

BLOOD STAGNATION

Clinical Manifestations	Abdominal masses Irregular and painful periods or Delayed menstruation with decreased menses or Dysmenorrhea The menses may become dark purple in color and contain many clots May be abdominal pain with guarding Pain in the lower abdomen Irritability Manic behavior Frequent abdominal pain Mental restlessness T: Purple or Pale with purple dots C: Normal P: Wiry or Choppy or Thin and wiry or Taut and thready
Treatment Principle	Invigorate the Blood Promote Qi circulation Dispel Stasis Regulate menstruation Promote conception Pacify the Liver and the Chong channel Nourish the uterus
Herb Formulas	Ge Xia Zhu Yu Tang To nourish and strengthen the Spleen and the Stomach: alternate with Liu Jun Zi Tang Lower Jiao: Zhe Cong Yin Topical: Xiao Pi Gao
Points	LIV-3, UB-18, UB-20, UB-21 LIV-3, GB-34, UB-17, SP-10, SP-6, SP-4, PC-6, SJ-6, REN-6, REN-4, ST-29, KI-14, KI-6 on the right and LU-7 on the left REN-3, ST-29, SP-6, KI-13

TOXIC HEAT

Clinical Manifestations	Rapidly developing jaundice with a gold color High fever Restlessness Irritability Thirst Foul breath Vomiting Abdominal pain Constipation Scanty urine Skin rashes Epistaxis Bleeding gums Muscular spasms or Convulsions Hypochondriac and Stomach fullness and pain Unclear thinking Delirium Epistaxis Hematochezia Bleeding from the mouth Bruises easily T: Deep red C: Dry yellow P: Rapid
Treatment Principle	Clear Heat Resolves toxicity Cool the Blood Stop pain
Herb Formulas	Pai Nong San
Points

TOXIC HEAT WITH PHLEGM OR BLOOD STAGNATION

Clinical Manifestations	Local redness Swelling and pain Maybe fever and chills T: Normal C: Thin white or yellow P: Rapid and forceful
Treatment Principle	Clear Heat Eliminate toxins Reduce swelling Soften hardness Activate Blood circulation Stop pain
Herb Formulas	Xian Fang Huo Ming Yin Topical: Xiao Pi Gao
Points

FOOD STAGNATION

Clinical Manifestations	Fixed growing lumps in the epigastrium with pain - worse with pressure Nausea Emaciation Loss of facial luster Loss of luster of lips Fullness of epigastrium Acid regurgitation Eructation Loose stools Constipation T: Normal C: Thick, turbid P: Deep and choppy
Treatment Principle	Clear Food Conduct Stagnation
Herb Formulas	With normal Qi: Wu Yao San Da Cheng Qi San With poor constitution: Liu Jun Zi Tang With Spleen and Stomach Deficiency with nausea: External - anhidrosis
Points	REN-12, LIV-13, SP-4, ST-36, UB-20, UB-21 LI-10, ST-36

QI PI

Clinical Manifestations	Mass below and slightly to the right of the xiphoid process (xyphomegaly) Maybe with jaundice Maybe with muscular atrophy Maybe weak limbs Stuffy chest due to Qi Depression Formless accumulations in the hypochondrium with jerking pain Relapse of pain after eating cold food Discomfort in the epigastrium Anorexia T: Normal C: Thin white P: Wiry and choppy
Treatment Principle
Herb Formulas	With stuffy chest and Qi dysfunction: Zhu Qi Wan With Phlegm and Food Stagnation: Kai Yu Zheng Yuan San With poor constitution with Qi Deficiency: Xiang Sha Liu Jun Zi Tang
Points	SP-4, LIV-3, LIV-13, ST-36, REN-12

XUAN PI

Clinical Manifestations	Xuan =cord like swelling at the sides of the umbilicus Pi = mass in the hypochondrium which is palpable only during episodic pain Protrusion of a mass on both sides of the umbilicus with unbearable pain Size: from finger to fist Tight as a bowstring May manifest between ribs T: Normal C: Thin white P: Wiry and choppy
Treatment Principle
Herb Formulas	Cong Bai San For a stronger effect: Cong Bai San+ Wu Ji San
Points	ST-25, REN-6, LIV-3, GB-34, SJ-6

SHAN LUMP

Clinical Manifestations	Irritating pain which may radiate upward from the lower abdomen to the waist and flanks Severe pain during paroxysmal attack when obvious protrusion can be seen No protrusion, no pain Frequent impeded urination Abnormal leukorrhea T: Normal C: Thin P: Wiry and tight or Choppy
Treatment Principle	Eliminate Stasis Warm the Blood
Herb Formulas	Dang Gui San Pan Cong San
Points	SP-6, LIV-3, LIV-4, REN-4, REN-6

CHONG TAN SHI JIA

Clinical Manifestations	Shi Jia=amenorrhea Chong Tan=No interruption Associated with ovarian cyst Palpable lumps in the abdomen Size: from a chicken egg to a fetus Lumps are hard and movable May interrupt menstruation
Treatment Principle
Herb Formulas	With Intestinal blockage: Er Chen Tang modified To dissolve lumps: Shi Jin Mo Wei Hui Wan For Shi Jia: Jian Xian Dan
Points	SP-6, SP-10, LIV-3, ST-36, REN-4, UB-17, UB-20

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