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Borborygmus, also known as abdominal rumbling, refers to the audible sounds produced by intestinal movements.

This condition was first mentioned in Suwen·Zangqi Fa Shi Lun. It is also referred to as "thunder in the intestines" or "the intestines making bitter sounds." Zhengzhi Zhunsheng, Zhangshi Yitong, Bianzheng Lu, and Zabing Yuanliu Xizhu all discuss this condition.

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1. Spleen-kidney Yang Deficiency︰borborygmus diarrhea, abdominal pain lingering, preference for warmth and pressure, cold limbs, soreness and weakness of the lower back and knees, tongue texture pale red, tongue coating white and slippery, pulse deep weak and forceless. The disease is located in the spleen and kidney, belonging to yang deficiency, with cold manifestations; it is caused by prolonged illness, excessive sexual activity damaging the kidney, or overuse of cold and cool medications, injuring yang qi, leading to gradual depletion of spleen and kidney yang qi, yang qi failing to warm, and dysfunction of the large intestine's transmission, resulting in borborygmus. Accompanied by cold limbs, diarrhea often worse at dawn, and symptoms such as soreness and weakness of the lower back and knees; treatment should focus on warming and tonifying the yang of the spleen and kidney, and the prescription selected is Aconite Middle-Regulating Pill.
2. Spleen Qi Deficiency︰borborygmus diarrhea, lower abdominal distension and bearing-down sensation, reduced food intake, shortage of qi with reluctance to speak, bodily fatigue and weakness, or accompanied by prolapse of rectum, and in women prolapse of uterus, pale tongue with white coating, slow and weak pulse. The disease is located in the spleen and stomach; it is qi deficiency without prominent cold manifestations. It is caused by overexertion or improper diet, which injures the qi of the spleen and stomach, leading to spleen deficiency and impaired transportation and transformation, hence borborygmus. There are also cases resulting from "after sweating to resolve cold-damage disease, disharmony in the stomach," as mentioned in Lingshu, the "Kou Jian" chapter: "When middle qi is insufficient,... the intestines suffer from rumbling." The key points for differentiation between the two are: accompanied by lower abdominal distension and bearing-down sensation, along with symptoms of middle qi deficiency such as shortage of qi with reluctance to speak, bodily fatigue and weakness, or prolapse of rectum, or uterine prolapse. Treatment should focus on tonifying the middle and replenishing qi, with the formula selection of Middle-Tonifying Qi-Replenishing Decoction. For cases of borborygmus diarrhea due to disharmony in the stomach after sweating in cold-damage disease, often accompanied by epigastric stuffiness, retching with foul-smelling food, treatment should aim to pungent dispersing and bitter descending, sweet and warm to tonify qi, with the formula selection of Fresh Ginger Heart-Draining Decoction.
3. Middle Jiao Cold-dampness︰Borborygmus in the abdomen, abdominal cold with a preference for warmth, cold body and limbs, vomiting clear water, loose stools mixed with sticky and frozen matter, pale and dark tongue texture, white and greasy tongue coating that is slippery, deep and slow or deep and wiry pulse. $Middle energizer cold-dampness borborygmus and phlegm-dampness obstructing the middle energizer borborygmus! Both conditions involve the middle energizer and are related to spleen deficiency and dampness accumulation. Their causes are both due to consuming raw or cold foods or overeating rich and sweet foods, which injure spleen qi. Spleen deficiency leads to dampness accumulation; those with innate constitutional insufficiency tend to transform into cold-dampness, while those with innate dampness excess tend to accumulate into phlegm-dampness. The key points of clinical differentiation are cold and phlegm. For cold-dampness, externally there is cold body and limbs, internally there is abdominal cold with a preference for warmth, above there is vomiting clear water, and below there is loose stools. Treatment should focus on invigorating the spleen and resolving dampness, warming the middle, using the Zhizhu Decoction. For phlegm-dampness, there is gurgling borborygmus, counterflow fullness in the epigastrium, dizziness upon rising, along with retching and nausea, greasy tongue coating, slippery pulse, etc., all of which differ from cold-dampness. Treatment should focus on invigorating the spleen and resolving dampness, unblocking yang, using the Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction.
4. Damp Phlegm︰borborygmus gurgling, counterflow fullness in epigastrium, dizziness upon rising, retching with desire to vomit, sticky mouth with bland taste, heavy limbs, tongue texture pale and dull, greasy coating, wiry-slippery or deep-moderate pulse. $Middle energizer cold-dampness borborygmus and phlegm-dampness obstructing the middle energizer borborygmus! Both conditions involve the middle energizer and are related to spleen deficiency with dampness accumulation. Their causes stem from consuming raw-cold foods or overindulging in rich, sweet foods, which injure spleen qi. Spleen deficiency leads to dampness accumulation: those with constitutional insufficiency tend toward cold transformation, resulting in cold-dampness; those with inherent dampness excess tend toward phlegm accumulation, forming phlegm-dampness. The key clinical differentiation lies in cold versus phlegm. Cold-dampness manifests externally as aversion to cold and cold limbs, internally as cold abdomen with preference for warmth, upward as vomiting clear fluid, and downward as loose stools. Treatment should focus on invigorating the spleen and resolving dampness while warming the middle, using Zhizhu Decoction. Phlegm-dampness presents with gurgling borborygmus, splashing sounds, counterflow fullness in epigastrium, dizziness upon rising, along with retching and desire to vomit, greasy tongue coating, and slippery pulse—all distinguishing it from cold-dampness. Treatment should emphasize invigorating the spleen and resolving dampness to unblock yang, using Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction.
5. Liver and Spleen Disharmony︰Borborygmus occurs intermittently, accompanied by abdominal pain, occasional diarrhea but the abdominal pain persists, discomfort in the chest and hypochondrium, belching, reduced food intake, a pale red tongue with thin white coating, and a wiry and moderate pulse. This is caused by injury from the seven emotions, liver failing to act freely, dysfunction of the spleen in transportation, leading to disorder of qi movement in the large intestine. Its characteristics include borborygmus that is always accompanied by abdominal pain, severe pain leading to diarrhea, yet the pain does not alleviate after diarrhea, and the borborygmus worsens with emotional fluctuations, along with discomfort in the chest and hypochondrium, belching, poor appetite, and a wiry and moderate pulse. Treatment should focus on soothing the liver, strengthening the spleen, and harmonizing the middle, with the prescription selected being Pain and Diarrhea Vital Formula.
6. Dampness-heat of Spleen and Stomach︰Borborygmus diarrhea, diarrhea with sensation of incomplete defecation, anal burning, foul-smelling stool, accompanied by bitter taste in the mouth, sticky mouth, scanty dark urine, red tongue with yellow greasy coating, slippery and rapid pulse. It is commonly seen during the prevalence of summerheat-dampness in late summer. Summerheat-dampness damages the spleen and stomach, leading to internal accumulation of dampness-heat, which affects the conduction of large intestine qi movement, hence resulting in borborygmus. Its characteristics include borborygmus diarrhea, diarrhea with sensation of incomplete defecation, anal burning, bitter taste in the mouth, sticky mouth, yellow greasy tongue coating, and slippery rapid pulse. The treatment should focus on clearing heat and regulating the intestines, using Pueraria, Skullcap and Coptis Decoction.

Borborygmus is one of the disorders of qi movement, closely related to the spleen, stomach, liver, kidneys, and large intestine. The spleen governs transportation and transformation, the stomach governs harmony and descending, the liver governs the free flow of qi, the kidneys govern warming, and the large intestine is responsible for transportation. Dysfunction of the large intestine can lead to borborygmus, as can disharmony in the ascending and descending functions of the spleen and stomach, improper dispersion of liver qi, and deficiency of kidney qi leading to insufficient warmth, all of which can cause disorder in the qi movement of the large intestine and result in borborygmus. In individuals with weak stomach and intestinal deficiency, external cold invading the surface and impaired lung qi can also descend to the large intestine, causing borborygmus. When treating cases where the disorder originates from other organs and affects the large intestine, the other organs are considered the root, and the large intestine is the branch. Treatment should be based on this principle when prescribing medication.

bubble_chart Documentation

1. Zabing Yuanliu Xizhu．borborygmus Origin: "borborygmus is a disease caused by large intestine qi deficiency. Only when the qi of the large intestine is first deficient, all diseases gather together to form this symptom. ... The reason for its sound is, firstly, due to middle qi deficiency. If qi-breaking medicine is used, although it may temporarily stop, it will not cure. It is advisable to use Middle-Tonifying Qi-Replenishing Decoction with Blast-Fried Ginger. Secondly, it is due to cold in the viscera with water, it is advisable to use Middle-Regulating Decoction with Cassia Bark, Poria, and Plantain Seed. Thirdly, it is due to fire wanting to rise, stirring the water, it is advisable to use Two Old Ingredients Decoction with Coptis Rhizome, Skullcap Root, and Gardenia. Fourthly, it is due to diarrhea, it is advisable to raise yang and remove dampness, using Zhiban Decoction. Fifthly, it is due to lowering qi, temporarily stopping and then sounding again, it is advisable to use Yizhong Decoction. Sixthly, it is due to rapid movement, like the sound of water in a bag, it is advisable to use Hejian Pepperweed Seed Pill. Although the symptoms are different, the sound may be empty or solid, up or down, high or low, which can be known by pressing."