bubble_chart Concept

Umbilical abdominal pain refers to abdominal pain around the umbilical area.

This condition Neijing is referred to as "pain encircling the umbilicus." The "Cold-Damage Disease Treatise" and Jingui Yaolue both describe it as "pain around the umbilicus." Zhangshi Yitong and other texts refer to it as "pain at the umbilicus." In later generations, it is called umbilical abdominal pain.

Umbilical abdominal pain, along with lower abdominal pain and lateral lower abdominal pain, all fall within the category of abdominal pain. However, due to the specific location of the pain, the symptoms are named differently: pain around the umbilicus is called umbilical abdominal pain; pain below the umbilicus is called lower abdominal pain; pain on both sides below the umbilicus is called lateral lower abdominal pain. Clinically, these should be differentiated. For women, abdominal pain related to pregnancy, childbirth, menstruation, or vaginal discharge should be referred to the relevant gynecological entries.

bubble_chart Pattern Analysis

1. Cold Coagulation and Accumulation of Cold︰Sudden onset of severe pain in the umbilical and abdominal region, unrelenting and aggravated by cold but slightly alleviated by warmth, accompanied by poor appetite, borborygmus, cold abdomen, diarrhea or constipation, and in severe cases, reversal cold of hands and feet. The tongue texture is pale or bluish with a white and moist coating, and the pulse is deep, tight, and slow. This is an excess pattern, often caused by inherent weakness of the spleen and stomach, invasion of wind-cold pathogens in the umbilical and abdominal region, or improper diet with excessive consumption of raw and cold foods, leading to cold congelation and accumulation in the intestines and stomach, obstruction of middle yang, and stagnation of qi movement, resulting in pain due to obstruction. For sudden and severe umbilical and abdominal pain that persists without relief, the treatment should focus on warming the middle and dissipating cold, regulating qi, and relieving pain. The recommended formula is Heavenly Platform Lindera Powder with additions such as Dried Ginger and Cassia Bark. For severe constipation, Spleen-Warming Decoction with modifications can be used.
2. Spleen-kidney Yang Deficiency︰Cold pain in the umbilical and abdominal region, lingering in nature, sometimes mild and sometimes severe, preferring warmth and pressure, aggravated by cold, accompanied by mental fatigue, fear of cold, cold limbs, loose stools, pale tongue texture, thin white tongue coating, and deep, thin, weak pulse. This belongs to the deficiency pattern. It is often caused by prolonged decline of spleen yang affecting kidney yang, or kidney yang deficiency leading to fire failing to generate earth, resulting in dual deficiency of the spleen and kidney, with cold arising internally. The key points for differentiation are: the gradual onset of umbilical and abdominal pain, lingering and intermittent, often accompanied by signs of spleen-kidney yang deficiency such as mental fatigue, fear of cold, cold limbs, and loose stools. Treatment should focus on tonifying and replenishing the spleen and kidney, warming yang to relieve pain, and may include the use of Aconite Middle-Regulating Pill or Modified Yin-Regulating Decoction with Cassia Bark and Peony Root.
3. Yangming Heat Accumulation︰Abdominal pain around the navel, distended and hard with tenderness, late afternoon tidal fever, sweating of hands and feet, severe constipation, or watery diarrhea, scanty dark urine, red tongue texture, yellow, thick, and dry tongue coating, deep, slippery, and rapid pulse. This is due to tangible heat accumulation, caused by external cold invading the interior and transforming into heat, or warm-heat pathogens transmitting inward, scorching fluids and damaging them, leading to the binding of pathogenic heat with waste in the large intestine. The key diagnostic points are abdominal pain around the navel, even distended and hard with tenderness, severe constipation, or heat retention with watery discharge, which is foul and abnormal. These are signs of heat accumulation: abdominal pain around the navel, hard and distended with tenderness, late afternoon tidal fever, sweating of hands and feet, severe constipation, or heat retention with watery discharge, indicating the yangming fu-organ pattern. Treatment involves clearing heat and purgation, with appropriate selection of Stomach-Regulating Purgative Decoction, Major Purgative Decoction, or Minor Purgative Decoction.
4. Stomach and Intestine Qi Stagnation︰Pain around the umbilicus and abdomen, with distension and discomfort, the distending pain slightly relieved by flatus or accompanied by moving qi masses causing pain in the umbilical and abdominal region, aggravated by emotional distress, poor appetite, thin white tongue coating, and wiry-slippery pulse. This is due to the gathering of formless qi, often caused by dysfunction of the spleen and stomach in transportation and transformation, obstruction of qi movement in ascending and descending, and internal qi stagnation leading to stagnation and blockage, resulting in pain. The key diagnostic points are umbilical and abdominal pain accompanied by distension, or even moving qi masses, relieved by the downward passage of flatus, and often aggravated by emotional changes. Comparing the two syndromes, this is a manifestation of qi stagnation, with abdominal pain around the umbilicus, distension relieved by flatus, or even moving qi masses, and pain related to emotional changes. Treatment should focus on descending qi and dissipating masses, regulating the middle and relieving pain. Five Milled Ingredients Drink can be modified for use.
5. Dampness-heat︰Pain around the umbilicus and abdomen, with the pain leading to a desire to defecate, yet the stool is passed incompletely and with difficulty (tenesmus). The stool is sticky, foul-smelling, and mixed with pus and blood. There is a bitter taste in the mouth and dryness, but no desire to drink water. The tongue texture is dark red, with a thick, yellow, greasy coating, and the pulse is slippery and rapid. This is due to dampness-heat descending and pressing on the large intestine, resulting in colicky pain around the umbilicus and abdomen. Heat causes rectal urgency, while dampness stagnation leads to tenesmus, with incomplete and difficult bowel movements, foul-smelling, sticky stool mixed with pus and blood. Tenesmus often involves pus and blood, and the discharge is foul-smelling. The treatment focuses on clearing dampness-heat, regulating qi and blood to relieve pain. The recommended formula is Peony Root Decoction with modifications.
6. Food Retention and Stagnation︰Pain around the umbilicus and abdomen, belching, nausea, poor appetite, or diarrhea with mostly undigested food, sour and foul-smelling stools, pain relieved after diarrhea, thick and greasy tongue coating at the root, and slippery pulse. This is what the Suwen·"On Impediment" refers to as "overeating harms the stomach and intestines." Initially, the retention of food occurs in the stomach, then moves to the large intestine, hence the pain around the umbilicus and abdomen, diarrhea with mostly undigested food, sour and putrid-smelling stools. After diarrhea, the accumulated food is expelled, and the pain is slightly relieved. Both conditions share the common manifestations of pain around the umbilicus and abdomen and irregular bowel movements, but the pain is relieved after diarrhea, with mostly undigested grains and sour, foul-smelling stools. For treatment, it is essential to promote digestion and remove stagnation; once the retention of food is eliminated, the pain will naturally cease. The Aucklandia and Areca Pill or Immature Orange Fruit Stagnation-Removing Pill can be modified for use.
7. Ascaris Intestinal Disturbance︰Umbilical and abdominal pain occurs intermittently without a fixed pattern, with episodes of severe pain. There may be visible lumps protruding from the abdomen, which subside when the pain stops, leaving the person seemingly normal. Symptoms include a sallow complexion and emaciation, occasional vomiting of clear fluid, teeth grinding during sleep, pica (craving for non-food items), or the presence of worm spots on the face. There may also be a history of passing worms in the stool. During pain episodes, the pulse may feel wiry or deep and hidden. The condition arises from unhygienic dietary habits, leading to the accumulation of dampness-heat and the breeding of parasites in the abdomen. The pain occurs when the parasites are active and subsides when they are quiet, resulting in intermittent umbilical and abdominal pain. A characteristic feature is the appearance of abdominal lumps when parasites gather and their disappearance when the parasites disperse. The pain is unbearable during episodes but resolves completely afterward. Other distinctive manifestations include vomiting clear fluid, teeth grinding during sleep, pica, worm spots on the lips and face, and passing worms in the stool. For treatment: - During pain episodes, the focus should be on quieting ascaris to relieve pain, using modified Mume Pill. - After the pain subsides, the approach should shift to expelling ascaris and killing worms, using Parasite-Exterminating Pill.

In summary, umbilical abdominal pain is one of the common clinical symptoms. The method of pattern identification generally considers pain that is relieved by pressure as deficiency, and pain that is aggravated by pressure as excess; if accompanied by constipation and dry accumulation, it is heat, and if accompanied by loose stools and cold limbs, it is cold; in cases of food injury (dyspepsia), the stool is sour and foul-smelling, and undigested food is passed; in cases of parasitic accumulation, the abdominal pain is severe but stops abruptly, and the patient appears normal; pain accompanied by distension indicates qi stagnation, and the presence of pus and blood in the stool often suggests dampness-heat. By grasping the nature of the pain and correlating it with the tongue, pulse, and accompanying symptoms, differentiation can be achieved.

bubble_chart Documentation

1. Leizheng Zhicai．abdominal pain: "When there is pain around the navel, and it is determined to be due to blood stasis in the liver and spleen collaterals, Sudden Smile Powder should be added with Chinese Angelica Root, Peach Kernel, and Leek Juice. If it is due to kidney deficiency causing disease in the Conception Vessel, Six-Ingredient Pill should be added with Tortoise Carapace."