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Abdominal stuffiness mass refers to a mass within the abdomen.

Abdominal stuffiness mass falls under the category of abdominal mass syndrome. Depending on the location of the mass and whether it is movable, it is referred to differently in the Neijing. If it occurs in the upper abdomen (above the stomach), around the navel, or in the lower abdomen, it is called "disease due to latent stagnation of qi and blood" (Fuzhong Lun, 《pathogenic qi zang-fu organs disease patterns》). If it occurs below the ribs, it is called "accumulation of breath" or "lump at the left hypochondrium" (Qibing Lun, 《pathogenic qi zang-fu organs disease patterns》). These masses are often clearly defined, with roots extending in all directions, or resembling an overturned cup, and are immovable upon palpation, hence termed "accumulation" or "concretion." If it occurs in the lower abdomen, it is called "hidden accumulation" or "lower abdominal mass in women (ovarian cyst)" (Qijue Lun, 《Edema》). For masses in the lower abdomen of women, it is referred to as "gathering of masses" or "stony uterine mass." These masses are often less clinically apparent and may be movable upon palpation, occasionally enlarging abnormally, hence termed "gathering" or "accumulation." Abdominal stuffiness masses can be divided into two categories: one is the clearly defined and immovable "accumulation" or "concretion," and the other is the less apparent and movable "gathering" or "accumulation." However, some accumulations or concretions may be movable initially but become hard and immovable over time (《defense qi》). Zhubing Yuanhou Lun．"Abdominal Mass Syndromes" states: "Abdominal mass... if the disease does not move, it is directly called concretion... gathering is false, as it is movable and illusory." Generally, gathering and abdominal accumulation diseases have a short course and are easier to treat, while accumulation and concretion have a long course and are harder to treat. Therefore, Jingui Yaolue．"Five zang-organs wind-cold abdominal mass pulse patterns and treatments" says: "Diseases include accumulation and gathering... accumulation is a disease of the zang organs, which does not move; gathering is a disease of the fu organs, which occurs intermittently, with shifting pain, and is treatable."

Throughout history, medical practitioners have used various terms for abdominal masses, such as Zhubing Yuanhou Lun calling it "addiction," Qianjin Fang calling it "hard abdominal mass disease gathering," Waitai Miyao calling it "abdominal mass," and Danxi Xinfa and 《Shicai Sanshu》 calling it "abdominal mass stuffiness mass." Stuffiness mass is different from stuffiness and fullness; stuffiness and fullness refer to a subjective sensation of stuffiness and fullness in the abdomen, which feels soft and lacks a defined mass upon palpation.

For women's abdominal masses, please refer to the dedicated section for discussion, which will not be elaborated here. As for children's stuffiness masses, due to their unique characteristics, they are also discussed in a separate section.

bubble_chart Pattern Analysis

1. Qi Stagnation and Blood Stasis︰Stuffiness masses frequently occur in the hypochondrium, initially soft and not firm, with distending pain or tenderness, and fixed pain locations. Over time, the stuffiness masses harden, the pain intensifies, often presenting as stabbing pain, accompanied by emaciation, fatigue, dull complexion, reduced appetite, or even scaly skin. The tongue may appear purplish-blue or with ecchymosis, and the pulse is wiry or wiry-thin. Some cases are primarily due to qi stagnation, while others are mainly caused by blood stasis. In cases dominated by qi stagnation, the stuffiness masses are less pronounced or merely palpable, with hypochondriac distending pain or tenderness, epigastric stuffiness, anorexia, belching, nausea, bitter taste in the mouth, vertigo, or loose stools. The tongue coating is thin and yellow, and the pulse is wiry-thin. This condition often arises from emotional distress, with depression and anger damaging the liver, leading to liver qi stagnation. Thus, the clinical manifestations predominantly feature qi stagnation symptoms. Liver qi dysfunction may either invade the stomach, resulting in liver-stomach disharmony (epigastric stuffiness, anorexia, accompanied by nausea and belching), or overact on the spleen, causing liver-spleen disharmony (epigastric stuffiness, anorexia, accompanied by loose stools or diarrhea). However, chest discomfort, hypochondriac distending pain, and a wiry pulse are common qi stagnation symptoms in both scenarios. Treatment should focus on soothing the liver and relieving depression, moving qi to alleviate pain, supplemented with blood-activating herbs. The recommended formula is Peripatetic Powder combined with Toosendan Fruit Powder with modifications. If the condition persists and unresolved qi stagnation leads to blood stasis accumulation, the stuffiness masses become noticeably enlarged, hard, and immobile, with severe pain often presenting as stabbing pain. The complexion may turn dark, or the skin may become scaly. The tongue appears bluish-purple or with ecchymosis, and the pulse is wiry or choppy. This represents a stuffiness mass syndrome primarily characterized by blood stasis. Treatment should prioritize activating blood and dispelling stasis, supplemented with qi-moving herbs. The formula Infradiaphragmatic Stasis-Expelling Decoction combined with Sudden Smile Powder with modifications may be used, or alternatively, Turtle Carapace Decocted Pill with modifications. In clinical presentations of qi stagnation and blood stasis stuffiness masses, cases dominated by qi stagnation often occur in the early stages, with a short course, mild symptoms, and better prognosis. In contrast, cases dominated by blood stasis result from prolonged accumulation, with a longer course, severe symptoms, and poorer treatment outcomes. The pathogenesis involves qi stagnation leading to blood stasis, and the aggregation of static blood forms stuffiness masses in the hypochondrium.
2. Phlegm-Food Coagulation︰Stuffiness masses often occur in the epigastric or umbilical-abdominal regions, presenting as epigastric distension and stuffy pain, tenderness with guarding, poor appetite, or emaciation with fatigue, complexion shallow yellow, shortness of breath, pale tongue, and thin pulse. The cause is often attributed to injury from cold food or drink. The Neijing and the Baibing Shisheng chapter state: "The initial formation of accumulation arises from cold." Due to consuming raw or cold food, "it enters the stomach and intestines, causing distension. Distension then compels the phlegm-fluid retention outside the intestines to accumulate and fail to disperse, gradually forming accumulations over time." This refers to the mutual binding of food and phlegm, resulting in abdominal stuffiness masses. When occurring in the epigastric region, there may be pain or guarding upon palpation. Treatment should focus on purging phlegm and food accumulation, using formulas such as Major Purgative Decoction or modified Taiping Wan. In some cases, stuffiness masses arise from the mutual binding of phlegm, food, and static blood, as described in the Neijing and the Baibing Shisheng chapter: "When phlegm-fluid retention and blood contend with each other, they combine, congeal, and fail to disperse, forming accumulations." Treatment should expel phlegm and food while dispelling static blood, addressing both phlegm and stasis simultaneously. The Yixue Zhengzhuan states: "For masses formed by phlegm binding with blood to create nests, use Peach Kernel, Carthamus, Cyperus, Rhubarb Rhizome, and similar herbs to treat them." **Middle qi deficiency-induced abdominal stuffiness masses vs. phlegm-food congealed abdominal stuffiness masses!** The former results from insufficient spleen qi, impaired transportation and transformation, or cold congealing and water-dampness failing to transform, leading to phlegm-fluid retention accumulating in the epigastrium, or food stagnation failing to disperse, with food accumulation lodging in the abdomen. Over time, middle qi becomes deficient and sinks, resulting in epigastric or abdominal stuffiness masses that may vary in size but feel soft upon palpation, often presenting as dull pain. Symptoms such as epigastric distension, anorexia, emaciation, fatigue, loose stools, pale tongue, and thin pulse are all clinical signs of spleen deficiency, typically with a prolonged course. Treatment should prioritize tonifying the middle and replenishing qi, using formulas like Middle-Tonifying Qi-Replenishing Decoction with modifications or a single-herb preparation of Atractylodes Rhizome powder for oral administration (Puji Benshi Fang).
3. Spleen Qi Deficiency︰Stuffiness masses are located in the periumbilical or lower abdomen, soft to the touch, and vary in size with changes in body position. They may not be noticeable when lying flat but become evident when standing. Mostly presenting as dull pain, accompanied by abdominal distension and fullness, reduced appetite, and loose stools. There may also be emaciation, fatigue of the limbs, a shallow yellow complexion, a pale tongue texture, and a thin pulse. This condition arises from insufficient spleen qi, leading to impaired transportation and transformation, or from congealing cold and failure to transform water-dampness, resulting in phlegm-fluid retention accumulating in the stomach and epigastrium. Alternatively, it may be due to food stagnation failing to transform, leading to food accumulation lingering in the abdomen. Over time, middle qi becomes deficient and sinks, causing stuffiness masses in the epigastrium and abdomen that vary in size but remain soft to the touch, often presenting as dull pain. Symptoms such as epigastric distension, anorexia, emaciation, fatigue, loose stools, a pale tongue, and a thin pulse are all clinical manifestations of spleen deficiency. Generally, the disease course is prolonged. Treatment should focus on tonifying the middle and replenishing qi, using Middle-Tonifying Qi-Replenishing Decoction with modifications, or alternatively, powdered Atractylodes Rhizome taken orally (Puji Benshi Fang).

The symptom of abdominal stuffiness and masses has been recorded in various medical texts throughout history, not only with numerous names, such as the "five accumulations" mentioned in the Nan Jing (including lump at the left hypochondrium, disease due to latent stagnation of qi and blood, mass due to qi stagnation, abdominal mass due to lung disorder, and running-piglet), but also with clinical manifestations that are often confused with each other. However, they can generally be referred to as abdominal stuffiness and masses. The Danxi Xinfa states: "Qi cannot form lumps or accumulations; lumps are tangible entities formed by phlegm, food accumulation, and dead blood." Initially, it may present as an excess pattern, such as when phlegm and food congeal to form abdominal stuffiness and masses at the onset. However, once the stuffiness and masses have formed and can be palpated, the condition has persisted for a long time, and thus it often manifests as a deficiency pattern or a pattern of deficiency and excess complex. Treatment should not focus solely on attacking the pathogen but should also consider supporting healthy qi. Prescriptions often include formulas like Xiangsha Liujun, which support the righteous and tonify the spleen. Therefore, the Jingyue Quanshu states in the section on miscellaneous diseases: "The key to treating accumulations lies in understanding the appropriateness of attacking and supplementing, and the appropriateness of attacking and supplementing should be discerned based on which is more urgent. For abdominal masses that have not persisted long and where the original qi is not damaged... rapid attack is permissible; if the abdominal mass has persisted for a while and the original qi is increasingly deficient... treatment should be gradual, focusing solely on strengthening the spleen and stomach to secure the root."

bubble_chart Documentation

1. "Jingui Yuhan Yaolue Jiyi. Five zang-organs wind-cold abdominal mass": "Shao's 'Mingyi Zhizhang Canbu' states: Stuffiness masses are mostly located between the skin and the membrane, not connected to the intestines and stomach, yet doctors often use drastic formula purgation. How can this mass enter the intestines and stomach and be expelled through the stool? I have seen cases where the disease is not necessarily cured, but the original qi is already depleted, and over the years, many have reached an incurable state" (cited from "Internal Medicine").
2. Zhengzhi Huibu . Abdominal mass: "The general method is to soften with salty substances and to reduce hardness by cutting, focusing mainly on regulating qi and relieving depression. Either attack with what is disliked or lure with what is liked, then it is easy to cure."