bubble_chart Concept

Pain in the central lower abdomen is referred to as small abdominal pain. Small abdominal pain is a relatively common internal medicine symptom, often associated with pathologies of the kidney, bladder, small intestine, etc.

In classical medical texts, this condition is rarely listed as a separate entry but is more commonly found under sections such as "abdominal pain" (e.g., Yixue Zhengzhuan), "heart abdominal pain" (e.g., Jingyue Quanshu), or scattered among diseases like ischuria and stranguria.

The "spasmatic pain in lower abdomen" and "rectal urgency in the lower abdomen" mentioned in the "Cold-Damage Disease Treatise," as well as the "tense urgency in the lower abdomen" mentioned in Jingui Yaolue, actually refer to spasmodic pain in the lower abdomen, which falls within the scope of this condition. However, the pattern of bladder amassment of water caused by external contraction of wind-cold, characterized by difficulty in urination and distension and fullness in the lower abdomen, usually lacks significant pain and does not belong to this condition.

Pathologies of the uterus with appendages and the Chong and Ren meridians often manifest as lower abdominal pain, accompanied by symptoms such as menstrual irregularities, dysmenorrhea, amenorrhea, and leukorrhea, which fall under the scope of gynecology. The "rushing carbuncle" mentioned in Zabing Yuanliu Xizhu, which "occurs in the lower abdomen," "causes pain and fever," "feels hot like a palm," and "may also show slight redness and swelling," belongs to the scope of surgery. These will not be discussed in this section.

bubble_chart Pattern Analysis

1. Bladder Dampness-heat︰Slight abdominal distension and fullness with phlegm pain, scanty and dark urine, or hematuria, burning pain during urination, or even dribbling and blockage, lower abdominal tension, thirst, constipation, red tongue with yellow coating, rapid or thin and rapid pulse. This is a heat excess pattern, and once dampness-heat is resolved, the lower abdominal pain will also subside. The prescription used is Eight-Ingredient Rectification Powder with modifications. For cases of lower energizer deficiency-cold, the disease cause is lower energizer yang deficiency, where yang deficiency leads to cold. The condition does not develop overnight, and its manifestations include dull pain in the lower abdomen, cold lower abdomen as if frozen, aversion to cold with preference for warmth, clear and copious urine or dribbling after urination, pale tongue, thin pulse, and other signs of deficiency-cold. Treatment should focus on warming and tonifying the lower energizer to restore sufficient primordial yang, thereby eliminating deficiency-cold and relieving abdominal pain. The prescription used is Right-Restoring Pill with modifications.
2. Bladder Obstruction︰The so-called bladder obstruction may be caused by dampness-heat (bladder dampness-heat with lower abdominal pain), qi stagnation, static blood, or calculi, among others. In cases of qi stagnation, there is lower abdominal distension, fullness, and pain, chest and hypochondriac distension and pain, and lower abdominal pain after urination, with a wiry pulse. In cases of static blood, there is severe lower abdominal pain, or cramping, and hematuria. In cases of calculi obstruction, there is lower abdominal pain that radiates to the genital region, severe pain, and hematuria. If the calculi are expelled with urine, the symptoms suddenly resolve. There are distinctions among dampness-heat, qi stagnation, static blood, and calculi. Dampness-heat has been discussed previously. For lower abdominal pain due to qi stagnation, distension is more prominent than pain, with distension being the main symptom, accompanied by hypochondriac pain. Lower abdominal pain often occurs after urination, with difficulty in urination but no obvious signs of excessive heat or cold. This is caused by impaired qi movement, and treatment should focus on unblocking qi and dispersing stagnation, using modified Chen San (Sinking Powder). For lower abdominal pain due to static blood, there is lower abdominal distension, fullness, and pain, with pain being more severe than distension. In severe cases, the pain may feel like stabbing, with lower abdominal cramping or hematuria. Treatment should aim to promote free flow and activate blood circulation, using modified Peach Kernel Purgative Decoction or Resistant and Withstanding Decoction (pill form). For lower abdominal pain due to calculi obstruction, the pain is sharp as if cut by a knife, possibly radiating to the lower back or perineum, with obvious hematuria. Treatment should focus on promoting urination and expelling stones, using modified Pai Shi Tang (Stone-Expelling Decoction).
3. Deficiency-Cold of the Lower Jiao︰Dull pain in the lower abdomen, sometimes mild and sometimes severe, cold abdomen, or even as cold as ice, not warm even in midsummer, worsens with cold and improves with warmth, cold body and limbs, pale lips and red mouth, clear and abundant urine, or dribbling after urination, pale tongue with white coating, deep and thin pulse. This is a pattern of deficiency-cold. For those with dampness-heat in the bladder, where dampness-heat accumulates in the bladder, the onset is acute, with symptoms such as distension and fullness in the lower abdomen, severe pain or spasms, dark urine, burning pain during urination, thirst, constipation, yellow tongue coating, rapid pulse, and other signs of heat. Treatment should focus on clearing and draining damp-heat in the lower energizer.

The clinical distinction between minor abdominal pain and lesser abdominal pain is often not clear. Minor abdominal pain is generally more related to the bladder and uterus. Although there is a differentiation between deficiency and excess, cold and heat in clinical practice, heat pattern and excess pattern are more common, while deficiency pattern and cold pattern are less so. Zhangshi Yitong states: "There are three types of minor abdominal fullness, all of which are due to internal retention, not deficiency of qi."

bubble_chart Documentation

1. Jingyue Quanshu．Miscellaneous Syndrome Discussion: "Lower energizer small abdominal pain may be caused by cold, heat, food, worms, blood, or qi counterflow, all of which are possible. For cases of blockage, use diuretics or purgatives. Each case should be treated according to its specific type."