The following are assessment areas, their meanings and the indicated formulas as used in Japanese Abdominal Diagnosis:

1. Thickness of the abdominal wall: indicates subcutaneous fat; generally an excess or firmness conformation.
   • Excess with chest distress – Da Chai Hu Tang (Major Bupleurum Formula)
   • Deficiency or weakness has a thin abdominal wall with lack offlexibility – Zhen Wu Tang (Vitality Combination)

 

2. Abdominal distension: Usually part of an excess or firmness conformation.
   • An excess or firmness combination has a tight, distended abdomen and strong pulse – Da Chai HuTang (Major Bupleurum Formula)
   • A deficiency or weakness conformation presents a distended abdomen and a feeble pulse – Si Ni Tang (Bupleurum and Chih Shih Formula, Frigid Extremities Decoction)

 

3. Chest distress and subcardiac tightness:

• A feeling of outward pressure in the substernum area or epigastric region below the heart with tightness and sensitivity to palpation is an excess conformation – Da Chai Hu Tang (Major Bupleurum Formula) or some other mildly purgative, cholagogue type of formula.
  • A distended abdomen which is soft upon palpation and not painful or resistant is part of a deficiency or weakness conformation and may occur on either the right or the left side near the ribs – Xiao Chai Hu Tang (minor Bupleurum formula) or some other tonic formula that also relieves liver stagnancy.
  • In general, select the appropriate bupleurum formula considering all the other indications.

 

4. Epigastric pain or subcardiac swelling (shin ka hi):

• A feeling of distension in the epigastric region below the heart – Ban Xia Xie Xin Tang (Pinellia Combination)
  • If there is asthmatic wheezing, gasping respirations, palpitations and edema, give Mu Fang Ji Tang (Stephania and Ginseng combination).
  • Other pinellia formulas to consider are:
    • Gan Cao Xie Xin Tang (Pinellia and Licorice Combination): for stomach pain (use for 3 or 4 days)
    • Ban Xia Ho Pu Tang (Pinellia and Magnolia Combination): for nervous stomach and pain
    • Sheng Jiang Xie Xin Tang (Pinellia and Ginger Combination): for cold stomach from cold foods
    • Pinellia Combination with aconite: this is the strongest formula as it works overnight.

 

• When diagnosing subcardiac swelling, it generally indicates fluid stagnancy in the stomach and abdomen. Consider the following:
  1. If the patient has a large amount of subcutaneous fat, the abdominal surface will be softer and without resistance. If upon deeper palpation there is resistance, then it is subcardiac swelling.
  2. Initial diagnosis may only seem to indicate subcardiac swelling, but if the muscles feel rigid like a board, then it is not.
  3. Swelling and tightness around the umbilicus is not subcardiac swelling.
• For deficiency types, use tonic formulas such as: Li Zhong Tang (Ginseng and Ginger Combination), Si Jun Zi Tang (Four Gentlemen Decoction) or Liu Jun Zi Tang (Six Gentlemen Decoction).

 

• Subcardiac hardness: This may indicate a weakness conformation.

If there is a feeling of distress beneath the heart but no resistance or pain with palpation but asuccusion or slight hollow sound: Li Zhong Tang (Ginseng and Ginger Combination) or Si Jun Zi Tang (Four Gentlemen Decoction). 

• Subcardiac swelling and hardness: The area beneath the heart is distended with a feeling of distress over the heart – Yin Chen Hao Tang(Capillaris Combination) or Wu Ling San (Hoelen Five Herb Combination).

 Lower abdominal stress or tension or lowerabdominal softness: Either type is generally regarded as a kidney deficiency conformation requiring the use of a Rehmannia type formula (There may be othersymptoms such as lower back pain, joint pains, urinary problems, low energy):

• If there is impotence, lack of libido and coldness – Ba Wei Di HuangTang (Rehmannia Eight Combination)
• If there is heat and yin deficiency – Liu Wi Di Huang Tang (Rehmannia SixCombination)

 

• Vertical muscle spasms: A bar-like rigidity on the side of the umbilicus below the ribs isusually a deficiency conformation (especially if the skin is thin).
• Both or one side may be contracted and tight – Xiiao Jian Zhong Tang (MinorCinnamon and Paeonia Combination)
• If there is only tenseness in the upper abdomen – Si Ni San (Bupleurum and Chih Shih Formula, FrigidExtremities)

 

• Aortic palpation: If palpitations are seen on the midline of the abdomen and above the navel,thisindicate a heart disturbance (worry); if below the navel it is from fear or insecurity; on the navel it indicates the spleen; on the right side of the navel is lungproblems; and on the left side it is an indication of a liver imbalance.
  • To calm the heart – Zhi Gan Cao Tang (Baked Licorice Combination) orGui Zhi Jia Long Gu My Li Tang (Cinnamon and Dragon Bone Combination)
• Below the navel: Ba Wei Di Huang Tang(Rehmannia Eight Combination) or Liu Wei Di Huang Tang (Rehmannia Six Combination)
  • Directly on the navel – Bu Zhong Yi Qi Tang(Ginseng and Astragalus Combinnation), Si Jun Zi Tang (Four Gentlemen Decoction), Liu Jun Zi Tang (Six Gentlemen Decoction), or Wu Ling San(Hoelen Five Herb Combination)

 

• Fluidic sounds in the abdomen: If upon light percussionone hears fluidic sounds. It indicates a weakness conformation with weakness and atony of the stomach and stomach muscles, gastropsis, or gastrectasis
• Ifthere is accompanying low energy with weak digestion – Li Zhong Tang (Ginseng and Ginger Combination)
• If there is mainly fluid accumulation andedema – Wu Ling San (Hoelen Five Herb Combination)

 

• Spasms and tightness of the lower intestines, either theright (ascending colon) or the left side (descending colon): This is a symptom of stagnation and excess
• For left side – Tao He Cheng Qi Tang(Persica and Rhubarb Combination)
• For right side – Da Huang Mu Dan Pi Tang (Rhubarb and MoutanCombination)

 

• Mass below the navel: This can be either on the right or left side where one feels one or moreareas of resistance. If there are apparent blue veins this indicates blood and stagnantion, or if there’s a lumpy feeling it indicates fluid stagnation (often fibroidsorcysts). This can be very common in women after childbirth but can also be caused by a lack of walking (many traditional develop exercises such as belly dancing or theHawaiian hula prevent this). Use blood and fluid dispersing formulas such as:
  • For fluid stagnation, especially for fibroid cysts – Gui Zhi Fu LingTang (Cinnamon and Hoelen Combination)
  • For heat – Huang Lian Jie Du Tang (Coptis and Scutellaria Combination)
  • For BloodDeficiency – Dang Gui Xiao Yao San (Dang Gui and Peony Combination) or Si Wu Tang (Dang Gui Four Combination)
  • For blood and qideficiency–Ba Zhen Tang (Dang Gui and Ginseng Eight Combination) or Ba Wei Di Huang Tang (Rehmannia Eight Combination)
  • For coldness with blooddeficiency and/or stagnation – Wen Jing Tang (Dang Gui and Evodia Combination)
  • The strongest formula – Da Huang Mu Dan Pi Tang (Rhubarband Moutan Combination)
  • The hottest formula – Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Dang Gui and GingerCombination)

 

• Erratic peristalsis: Chronic hyperactive bowel syndrome with irregular movementof the intestines, colitis and sometimes abdominal pain. If a deficiency conformation, do not give purgatives – Da Jian Zhong Tang (Major ZanthoxylumCombination).

 

• Umbilical pain: Upon relatively gentle palpation, either directly on the umbilicus orimmediatelyabove, it there is painful discomfort along with a tense, tight pulse with strong abdominal muscles – Ge Gen Tang (PuerariaCombination).

 

• Astraight line of hardness or tightness which passes through the center of the umbilicus: Thisindicates deficiency and weakness of the spleen and kidneys (above the umbilicus is the spleen while below is the kidneys).
• For spleen deficiency –Zhen Wu Tang ( Vitality combination)
• For kidney deficiency – Ba Wei Di Huang Tang (Rehmannia EightCombination)

 

• Muscle spasm and tightness below the abdomen: This indicates kidney deficiency and liver wind –Gui Zhi Jin Long Gu Mu Li Tang (Cinnamon and Dragon Bone Combination).

PULSE OVERVIEW FOR ABDOMINAL DIAGNOSIS:

• Yang pulses: floating (superficial), large, fast, strong; indicates heat, excess
• Yin pulses: deeper, thin or thready, weak, slow –Iindicates coldness or blood or yin deficiency
• Slippery pulse: indicates dampness
• Bowstring or tense pulse: indicatesliver wind or liver stagnation
• Scattered pulse: a yin pulse which feels indistinct and big but without strength when pressure is applied –indicates exhausted yang
• Irregular pulses:
• Hasty: fast but misses a beat occasionally is stagnation with heat.
• Knotted: leisurely but misses a beat irregularly is stagnation of qi, blood or fluids
• Intermittent: looses a beat at some regular interval (often seen in older orvery weak people with exhausted yin organs) indicates a deeper deficiency

TONGUE OVERVIEW FOR ABDOMINALDIAGNOSIS: Shape

• Large and flabby possibly with tooth indentation: Indicates deficient qi or yang(especially of the spleen) plus phlegm dampness
• Thin and shrunken: deficient blood and/or yin.
• Rigid tongue: wind orextreme heat or yin deficiency
• Deviated tongue: indicates wind, wind-phlegm obstruction or potentialstroke

Color

• Pale: deficient qi, blood or yang
• Red: internal or externalheat
• Deep red: internal heat or deficient yin
• Purplish: stagnation of blood
• Red tip: heart orlung heat
• Red sides: liver heat

 Coat

• White: coldness
• White and thin: wind cold
• White and thick: food stagnation
• White and sticky or moist: dampness
• Yellow: heat
• Yellow and thin: wind heat
• Yellow and thick: food stagnation in stomach and intestines
• Yellow and sticky: internal damp heat
• Yellow and dry: stomach and intestinal heat with damage to yin.
• Greyishblack: extreme heat or coldness

 Tongue Body

• Cracked tongue: damage to corresponding organs orelsea normal tongue
• Peeled Coat (no tongue coat, mirror smooth): yin deficiency

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