bubble_chart Concept

The term "exposed abdominal veins" refers to the visible protrusion of veins on the abdominal skin. Neijing refers to it as "abdominal tendons," as mentioned in Lingshu·Chapter on Water Swelling: "abdominal distension and fullness, the entire body becomes large, similar to anasarca, with a pale yellow complexion and prominent abdominal tendons, these are the signs."

Exposed abdominal veins often appear simultaneously with abdominal distension, both of which are clinical manifestations of tympanites.

In cases of infantile malnutrition with accumulation, abdominal distension and fullness may also present with exposed abdominal veins, which is not discussed in this entry.

bubble_chart Pattern Analysis

1. Qi Stagnation with Dampness Obstruction︰Abdominal distension and fullness with prominent veins, distending pain in both hypochondria, poor appetite, aggravated abdominal distension and fullness after eating, fatigue, scanty urine, loose stools, white and greasy tongue coating, and wiry pulse. This is caused by liver depression and qi stagnation, impaired dispersion, transverse invasion of the spleen, dysfunction of the spleen in transportation, internal retention of water-dampness, obstruction of dampness-turbidity, impeded flow of qi and blood, and blockage of collaterals. In addition to abdominal distension and fullness with prominent veins, the clinical manifestations also include distending pain in both hypochondria due to liver qi depression, as well as poor appetite, aggravated abdominal distension and fullness after eating, fatigue, scanty urine, and loose stools due to spleen deficiency with dampness retention. The same symptoms of abdominal distension and fullness with prominent veins, dysuria, and hypochondriac pain are primarily differentiated by the presence of stabbing pain in the hypochondriac mass, dry mouth with a desire to hold water but no urge to swallow, black stools, vascular nevi on the head, neck, chest, and arms, dark purple lips, a dark purple tongue texture with ecchymosis, and a thin and choppy pulse, which are signs of static blood. For abdominal distension with prominent veins due to qi stagnation and dampness obstruction, the treatment should focus on soothing the liver and fortifying the spleen, draining dampness, and relieving fullness. The recommended formula is Bupleurum Liver-Soothing Powder combined with Stomach Poria Decoction with modifications.
2. Liver-Spleen Blood Stasis︰The abdomen is distended, firm, and full, with prominent veins and a mass under the ribs causing stabbing pain. There is a dry mouth with a desire to hold water but no urge to swallow, black-colored stools, a dull and dark complexion, spider angiomas on the head, neck, chest, and arms, and purplish-dark lips. The tongue is dark purple with ecchymosis, and the pulse is thin and choppy. This condition is caused by static blood obstructing the liver and spleen, leading to blocked collaterals. This syndrome often develops from qi stagnation and dampness obstruction. Treatment should focus on invigorating blood and resolving stasis, as well as unblocking water and dispersing edema. The modified Tiaoying Decoction is recommended.
3. Spleen-kidney Yang Deficiency︰The symptoms include abdominal distension and fullness, exposed veins, fear of cold, cold limbs, epigastric stuffiness, anorexia, soreness and weakness of the waist and knees, dysuria, loose stools, edema of the lower limbs, pale yellow complexion, a swollen and pale purple tongue with white and slippery coating, and a deep and thin pulse. This syndrome is caused by spleen-kidney yang deficiency, failure to transform water-dampness, accumulation of cold water, and obstruction of the collaterals. Therefore, in addition to abdominal distension and fullness, exposed veins, and dysuria, there are also manifestations of spleen qi deficiency such as epigastric stuffiness, anorexia, and loose stools, as well as kidney yang deficiency symptoms like fear of cold, cold limbs, soreness and weakness of the waist and knees, and edema of the lower limbs. The treatment for this syndrome should focus on tonifying the spleen and kidneys, moving qi to promote urination, and the recommended prescription is Spleen-Strengthening Decoction with modifications.
4. Liver-kidney Yin Deficiency︰The main manifestations include abdominal distension and fullness, visible veins on the abdomen, dizziness and blurred vision, restlessness and insomnia, dry mouth and throat, gum bleeding or epistaxis, scanty urine, dull complexion, a red tongue with little moisture, and a wiry, thin, and rapid pulse. This syndrome often begins with symptoms of water-dampness obstruction, which then transforms into heat due to dampness stagnation, leading to liver and kidney yin damage. Therefore, in addition to abdominal distension and fullness, visible veins on the abdomen, and difficulty in urination, clinical manifestations also include liver-kidney yin deficiency, internal generation of deficient heat causing dizziness and blurred vision, restlessness and insomnia, dry mouth and throat, gum bleeding or epistaxis, and a wiry, thin, and rapid pulse. For treating abdominal distension with visible veins due to liver-kidney yin deficiency, the approach should focus on nourishing the liver and kidney, promoting diuresis, and reducing distension. The recommended formula is All-Along Decoction combined with Polyporus Decoction with modifications.

The appearance of greenish veins on the abdomen often occurs on the basis of tympanites. Various causes leading to the retention of water-dampness internally, poor circulation of qi and blood, and obstruction of the collaterals can all result in the appearance of greenish veins on the abdomen. Therefore, the pattern differentiation and treatment of greenish veins on the abdomen must be combined with the condition of the abdomen and the overall body.

bubble_chart Documentation

1. Jingyue Quanshu．Swelling: "If green veins appear on the belly and the abdomen swells after diarrhea, it is fatal."
2. Zabing Yuanliu Xizhu．The Origin and Development of Swelling: "This tympanites is also a qi aspect disease, hence it resembles anasarca, but the difference lies in the presence of raised veins on the abdomen. However, the root of anasarca lies in the lungs, while the root of tympanites lies in the spleen, caused by injury to spleen yin. Although the stomach can receive food, the spleen cannot transform it, or it may be caused by anger damaging the liver, gradually eroding the spleen. When spleen deficiency reaches its extreme, yin and yang do not interact, clear and turbid mix, the pathways become blocked, leading to stagnation and heat, which in turn generates dampness. Dampness and heat mutually generate each other, hence the abdominal distension and fullness are significant, hollow inside with nothing, the outer skin is tight and tense, and one cannot eat in the evening what was eaten in the morning. However, if umbilical hernia occurs, green veins appear on the belly, and the skin shines like oil, it is incurable."