ABDOMINAL DISTENTION/BLOATING
TCM Style

abdominal.jpg



SOURCES:


1. The Foundations of Chinese Medicine "A Comprehensive Texts for Acupuncturists and Herbalists," VOL 1 pages 192,242,243,276,279; Maciocia, Giovanni
2. The Practice of Chinese Medicine "The Treatment of Disease With Acupuncture and Chinese Herbs," VOL 2 pages 770,771,766; Maciocia, Giovanni





DESCRIPTION ON CONDITION:

The most common causes for Abdominal Distension/Bloating are caused by the consumption of too many cold and raw foods and emotional stress. Cold and raw foods cause dampness in the Spleen. This disrupts the Spleens function of Transformation and transportation resulting in Abdominal Bloating/Distension, due to Spleen Qi deficiency or Stagnation. Emotional Stress disrupts the flow of Liver Qi which then in turn causes the Liver to overact on the Spleen; Resulting in LIV and Spleen Qi Deficiency/Stagnation.




PATTERNS OF DISHARMONY/DIAGNOSIS:

Spleen Qi Deficiency
Spleen Yang Deficiency
Small Intestine Infestation of Worms
Large Intestine Heat Obstruction
Stagnation of Qi with Damp
Qi Stagnation, Damp. Qi Deficiency
Stagnation of Qi




PATTERN OF DISHARMONY/DIAGNOSIS:
CLINICAL MANIFESTATIONS:

Spleen Qi Deficiency: (TFOCM, pg 242-243;Maciocia)
The most common disharmony and the most common pattern in general. Diet plays a major role in SP Qi Def. The eating of too many raw, cold foods damage the Spleens ability to transform and transport, as well as eating too much or too little protein causing SP Qi Def.
S/S: lack of appetite, abdominal distension after eating, tiredness, lassitude, sallow complexion, weakness of the limbs, loose stools
If there is Dampness, then: nausea, stuffiness of the chest and epigastrium and a feeling of heaviness.

Spleen yang Deficiency: (TFOCM, pg 243-244; Maciocia)
Same manifestation as SP Qi Def. but with symptoms of cold such as chillness and cold limbs. Failure of Spleen Yang to warm the body will cause symptoms of cold.
S/S. lack of appetite, abdominal distension after eating, tiredness, sallow or bright white complexion, weakness of the four limbs, loose stools edema, chilliness, cold limbs.

Small Intestine Infestation of Worms: (TFOCM, pg276, Maciocia)
In Chinese medicine worms are caused by a cold condition in the Spleen and Intestines, allowing the worms to live and thrive. The worms obstruct the Small Intestines resulting in abdominal pain and malnourishment. Excessive eating of cold and raw foods is the cause of this pattern.
S/S: abdominal pain with distension, bad taste in mouth, sallow complexion, borborygmi, diarrhea (abdominal pain, diarrhea and borborygmi are key S/S).
Roundworms (ascarid): abdominal pain, vomiting of roundworms, cold limbs.
Hookworms: desire to eat strange objects, like wax, soil, uncooked rice or tea leaves.
Pinworms: itchy anus, worse in the evening.
Tapeworms: constant hunger.

Large Intestine Heat Obstruction: (TFOCM, pg 279-280, Maciocia):
Heat in Large Intestines causes constipation , in turn causes abdominal distension or bloating.
S/S:constipation, burning in anus, abdominal distension and pain that is worse with pressure, high fever or tidal fever, sweating especially on limbs, vomiting, thirst, delirium. Key Symptoms: constipation, abdominal pain, fever, thick-dry-yellow tongue coating, big pulse.

Stagnation Qi With Damp: (TPOCM, pg 770, Maciocia):

Emotional state is involved with abdominal pain and distension.
S/S: feeling bloated, constipation, irritability, moodiness, belching, borborygmi, a feeling of fullness and heaviness in the abdomen.


Qi Stagnation, Damp, Qi Deficiency (TPOCM, pg 771 Maciocia):

In Western patients with chronic abdominal pain and distention these are the most common patterns. With irritable Bowel Syndrome these three patterns are almost always present with combinations varying.
S/S: abdominal pain and distensu=ion that comes and goes, worse when tired or emotionally stressed, feeling bloated, constipation or loose stools, irritability, moodiness, belching, botborygmi, a feeling of fullness and heaviness in the abdomen, tiredness, poor appetite.

Stagnation of Qi (TPOCM, pg 766; Maciocia):
Due to Liver Qi Stagnation in the abdomen. There will be tiredness and alternation of constipation and diarrhea if the Liver invades the Spleen. Probably the most common cause of abdominal pain.
S/S: abdominal pain and distension that are clearly related to emotional state, bloated feeling, constipation, irritability, moodiness, belching, borborygmi.




PULSE/TONGUE:

Spleen Qi Deficiency: (TFOCM, pg 242-243;Maciocia)
P: Empty
T: Pale or normal colored, in chronic conditions swollen sides and a transverse cracks

Spleen yang Deficiency: (TFOCM, pg 243-244; Maciocia)

P: Weak, Slow, Deep
T: Pale, Swollen, Wet

Small Intestine Infestation of Worms: (TFOCM, pg276, Maciocia)
P: Deep, Weak, Slow
T: Pale, White Coat

Large Intestine Heat Obstruction: (TFOCM, pg 279-280, Maciocia):
P: Deep, Full, Big
T: Thick-Dry-Yellow (or Brown-Black) Coating, Red Body


Stagnation Qi With Damp: (TPOCM, pg 770, Maciocia):

P: Slippery and Wiry
T: Possibly No Changes, but in severe cases the sides of the tongue may be red with a sticky coat.

Qi Stagnation, Damp, Qi Deficiency (TPOCM, pg 771 Maciocia):

P: Soggy and Slightly Wiry
T: Possibly No Changes, but in severe cases the sides of the tongue may be red with a sticky coat.

Stagnation of Qi (TPOCM, pg 776; Maciocia):

P: Wiry or Tight Pulse (TFOCM, pg 192; Maciocia)
T: Possibly no change in color of the body. In severe cases the sides may be Red.




TREATMENT PRINCIPLES:

Spleen Qi Deficiency: (TFOCM, pg 242-243;Maciocia): Tonify Spleen Qi
Spleen yang Deficiency: (TFOCM, pg 243-244; Maciocia); Tonify and Warm Spleen Yang
Small Intestine Infestation of Worms: (TFOCM, pg276, Maciocia); No Acupuncture, but Herbs instead
Large Intestine Heat Obstruction: (TFOCM, pg 279-280, Maciocia): Clear Heat in the STomach and large Intestines, Promote Bowel Movement
Stagnation Qi With Damp: (TPOCM, pg 770, Maciocia): Sooth the Liver, Move Qi, Resolve Damp
Qi Stagnation, Damp, Qi Deficiency (TPOCM, pg 771, Maciocia):
Sooth the Liver, Move Qi, Resolve Dampness, Tonify Spleen Qi
Stagnation of Qi (TPOCM, pg 766, Maciocia):




TREATMENT STRATEGIES:

Spleen Qi Deficiency: (TFOCM, pg 242-243;Maciocia)

CV-12 Tonifies Spleen Qi
ST-36 Tonifies Spleen Qi
SP-3 SP Source Point and Tonifies SP Qi
SP-6 Tonifies SP Qi
BL-20 Tonifies SP Qi (W/ BL-21 is important for chronic conditions of SP and ST)
BL-21 Tonifies SP Qi

Spleen yang Deficiency: (TFOCM, pg 243-244; Maciocia)
CV-12 Tonifies Spleen Qi
ST-36 Tonifies Spleen Qi
SP-3 SP Source Point and Tonifies SP Qi
SP-6 Tonifies SP Qi
BL-20 Tonifies SP Qi (W/ BL-21 is important for chronic conditions of SP and ST)
BL-21 Tonifies SP Qi
SP-9 Damp
CV-9 Stimulate Spleen to Transform and Transport Fluids, Resolve Edema
ST-28 Stimulate Spleen to Transform and Transport Fluids, Resolve Edema
BL-22 Stimulate Spleen to Transform and Transport Fluids, Resolve Edema

Small Intestine Infestation of Worms: (TFOCM, pg276, Maciocia)
Acupuncture is not used in this case but rather Herbs.

Large Intestine Heat Obstruction: (TFOCM, pg 279-280, Maciocia):
LI-11 Clears Heat in L.I.
LI-4 Clears Heat in LI and Promotes Bowel Movement
SP-15 Promotes Bowel Movement
TB-6 Clears heat in LI and Promotes Bowel Movement
LI-2 Clears Heat in L.I.
ST-44 Clears Heat in ST
ST-25 Clears Heat in LI

Stagnation Qi With Damp: (TPOCM, pg 770, Maciocia):
CV-6 Moves Qi in the abdomen; Especially when combined with GB-34
PC-6 moves Liver Qi indirectly (due to PC relationship with Liver Yin Channels), Calms the Mind and Settles the Ethereal soul. This a very important and effective point for this condition.
PC-7 Instead of PC-6 if the Emotional Stress is More severe, especially to a relationship breakup.
TB-6 Moves Qi in Abdomen
GB-34 Moves Liver Qi in combination with CV-6, it Moves Liver Qi in the Lower abdomen.
LIV-3 and BL-18 Move Liver Qi, Stop pain, Calm the Mind and Settles the Ethereal Soul.
SP-6 Soothes the Liver, Stops Abdominal pain and Calms the Mind.
CV-9, SP-9,ST-28 and BL-22 Resolver Lower Burner Dampness
ST-39 Lower Abdominal Pain.


Qi Stagnation, Damp, Qi Deficiency (TPOCM, pg 771, Maciocia):
CV-6 Moves Qi in the Abdomen, Especially with GB-34
PC-6 moves Liver Qi indirectly (due to PC relationship with Liver Yin Channels), Calms the Mind and Settles the Ethereal soul. This a very important and effective point for this condition.
TB-6 Moves Qi in Abdomen
GB-34 Moves Liver Qi in combination with CV-6, it Moves Liver Qi in the Lower abdomen.
LIV-3 and BL-18 Move Liver Qi, Stop pain, Calm the Mind and Settles the Ethereal Soul.
SP-6 Soothes the Liver, Stops Abdominal pain and Calms the Mind.
CV-9, SP-9,ST-28 and BL-22 Resolve Lower Burner Dampness
ST-39 Lower Abdominal Pain.

CV-12, ST-36 and BL-20 Tonify the Spleen

Stagnation of Qi (TPOCM, pg 776; Maciocia):
CV-6 Moves Qi in the Abdomen, Especially with GB-34
PC-6 moves Liver Qi indirectly (due to PC relationship with Liver Yin Channels), Calms the Mind and Settles the Ethereal soul. This a very important and effective point for this condition.
PC-7 Instead of PC-6 if the Emotional Stress is More severe, especially to a relationship breakup.
TB-6 Moves Qi in Abdomen
GB-34 Moves Liver Qi in combination with CV-6, it Moves Liver Qi in the Lower abdomen.
LIV-3 and BL-18 Move Liver Qi, Stop pain, Calm the Mind and Settles the Ethereal Soul.
SP-6 Soothes the Liver, Stops Abdominal pain and Calms the Mind.
ST-39 Lower Abdominal Pain.




PATIENT EDUCATION/RECOMMENDATIONS:

Lifestyle changes are imperative to eliminate the patterns responsible for abdominal bloating and distension. Reduction or elimination of the consumption of too much raw and/or cold foods, as well as emotional stress reducion will prevent the Spleen and Liver Qi from deficiency and Stagnation.





PROGNOSIS:

Prognosis is usually good as long as patient has made lifestyle changes to incorporate better dietary and stress reduction methods. Dietary changes are imperative to reduce Sp Qi Deficiency and Stagnation. Reduction in the consumption of cold and raw foods will greatly reduce or eliminate the cold and dampness in the Spleen. Emotional Stress reduction will reduce the Liver Qi Stagnation which invades the Spleen causing moodiness, tiredness, and abdominal bloating/distension.