CHAPTER 60 Abdominal Masses
). Ji indicates actual abdominal masses which are immovable; if there is an associated pain, its location is fixed. These masses are due to stasis of Blood. I shall call them ‘Blood masses’. Ju indicates abdominal masses which come and go, do not have a fixed location and are movable; if there is an associated pain, it too comes and goes and changes location. Such masses are due to stagnation of Qi. I shall call them ‘Qi masses’. Actual abdominal lumps therefore pertain to the category of abdominal masses and specifically Ji masses, i.e. Blood masses.Another name for abdominal masses was Zheng Jia (
), Zheng being equivalent to Ji, i.e. actual, fixed masses, and Jia to Ju, i.e. non-substantial masses from stagnation of Qi. Zheng Jia is normally used in referring to abdominal masses that generally occur only in women; but they do occur in men as well, though rarely. Chapter 60 of the Simple Questions says: “Diseases of the Directing Vessel … in women are masses below the waist.”1 In this context, the Simple Questions uses the term Jia-Ju, i.e. non-substantial masses from Qi stagnation.
The term Ji Ju appears in the Classic of Difficulties which clearly distinguishes the two types:
Ji masses pertain to Yin and Ju masses to Yang … When Qi accumulates it gives rise to Ji masses, when it gathers it gives rise to Ju masses. Ji masses arise from the Yin organs and Ju masses from the Fu organs. Ji masses have a fixed location and pain, and have boundaries above and below, and edges to the right and left [i.e. they have clearly defined borders]. Ju masses seem to start from nowhere, without a boundary above and below and with a moving pain.2
The Essential Prescriptions of the Golden Cabinet by Zhang Zhong Jing says:
Ji masses arise from the Yin organs and they cannot be moved; Ju masses arise from the Yang organs, they come and go, the pain has no fixed location, and they are easier to treat.3
The General Treatise on the Aetiology and Symptoms of Diseases (AD 610) says:
Abdominal masses are due to cold and heat not being regulated [i.e. exposure to extremes of weather], irregular diet and stagnation of the Qi of the Yin organs. If they do not move they are called Zheng; if they are movable they are called Jia. ‘Jia’ implies the meaning of ‘false’: this is because these masses can come and go and are not actual masses.4
Aetiology
Emotional strain
Emotional strain is the most common cause of the formation of abdominal masses. Anger, especially when repressed, frustration, resentment, hatred, worry and guilt can all lead to stagnation of Liver-Qi and, in the long run, to stasis of Liver-Blood. The Liver channel plays an important role in the movement of Qi in the lower abdomen and, in women, Liver-Blood plays a paramount role in the circulation of Blood in this area.
Irregular diet
Diet is another important aetiological factor in the formation of abdominal masses. Irregular eating or the excessive consumption of cold and raw foods may lead to the formation of Cold in the lower abdomen. Cold contracts and naturally interferes with the circulation of Qi and, especially, Blood; it may lead to stasis of Blood.
Excessive consumption of greasy foods, on the other hand, impairs the Spleen and may lead to the formation of Dampness and Phlegm, which can settle in the lower abdomen and bring about abdominal masses. There is also a close interaction between Phlegm and stasis of Blood so that one may lead to or aggravate the other.
External pathogenic factors
External pathogenic factors are less important in the aetiology of abdominal masses. The most important pathogenic factor is external Cold which can invade the lower abdomen and impair the circulation of Blood eventually leading to stasis of Blood. Chapter 66 of the Spiritual Axis says: “Ji masses are due to Cold.”5
Pathology
As for pathology, abdominal masses are always characterized by either stagnation of Qi or stasis of Blood, the former being non-substantial and the latter substantial masses. In addition to stagnation, there may also be Phlegm. However, in all cases of abdominal masses there is always an underlying deficiency of Qi. Deficient Qi fails to transport and transform and, leading to stagnation of Qi and Blood, it allows masses to form.
Masses from stagnation of Qi come and go, are movable on palpation and change location. If there is pain, the pain has no fixed location and is accompanied by a pronounced feeling of distension.
Masses from stasis of Blood are fixed in location, they are not movable on palpation and feel quite hard. If there is pain, it is fixed and stabbing in character.
Masses from Phlegm feel soft on palpation and have a fixed location. There is usually no pain.
Identification of patterns and treatment
The treatment of abdominal masses is always based on moving Qi and Blood. However, there are other factors to take into account depending on the stage of the disease. In the beginning stages of the condition, the pathogenic factor (stagnation of Qi or stasis of Blood) is relatively weak and the body’s Qi relatively strong. In the middle stages, the body’s Qi is weakening and the pathogenic factor becoming more prominent. In the late stages, the pathogenic factor is very prominent and the masses very developed while the body’s Qi is very weak.
Thus, irrespective of the pathogenic factor involved, the principle of treatment must be guided by the stage of the condition:
Also, when moving Qi in Qi masses, the treatment principle is to move Qi primarily and invigorate Blood secondarily. In Blood masses, the treatment principle is to invigorate Blood, eliminate stasis, ‘break’ Blood primarily and move Qi secondarily. Thus, the formulae given below are only a guideline. The approach adopted should be chosen according to the pattern of the disease, but the formulae must be modified in every case according to its stage.
Furthermore, all prescriptions indicated below should be modified with the addition of ‘softening’ herbs, i.e. herbs which soften masses: this is particularly necessary for masses from stasis of Blood or Phlegm. Softening herbs are:
As for the relative application of acupuncture and herbal medicine, especially for Blood masses, the herbal treatment is primary in relation to acupuncture.
Qi masses
Liver-Qi stagnation
Clinical manifestations
Movable abdominal masses which come and go, abdominal distension and pain which come and go with the masses, a feeling of discomfort in the hypochondrium, depression, moodiness, irritability, alternation of constipation and diarrhoea. Tongue: the body colour may be normal or slightly Red on the sides. Pulse: Wiry.
Acupuncture
G.B.-34 Yanglingquan, Ren-6 Qihai, LIV-3 Taichong, T.B.-6 Zhigou, P-6 Neiguan, SP-6 Sanyinjiao, LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), KI-14 Siman, Ren-6 Qihai. Reducing or even method.
Herbal treatment
a Prescription
b Prescription
Explanation
The present formula differs from the previous one in three respects: it is much stronger in its action and better at dissolving masses, it invigorates Blood and it scatters Cold. It is therefore especially indicated when Qi stagnation is associated with Cold and the tongue is Pale and the pulse is Tight.
Women’s Treasure remedy
This remedy pacifies the Liver, moves Qi, eliminates stagnation, tonifies Spleen-Qi, nourishes Liver-Blood and settles the Ethereal Soul. The tongue presentation appropriate to this remedy is a body with slightly Pale sides.
Liver-Qi stagnation
Movable abdominal masses which come and go, abdominal distension and pain which come and go with the masses, a feeling of discomfort in the hypochondrium, depression, moodiness, irritability, alternation of constipation and diarrhoea. Tongue: the body colour may be normal or slightly Red on the sides. Pulse: Wiry.
G.B.-34 Yanglingquan, Ren-6 Qihai, LIV-3 Taichong, T.B.-6 Zhigou, P-6 Neiguan, SP-6 Sanyinjiao, LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), KI-14 Siman, Ren-6 Qihai. Reducing or even method.
Retention of food and Phlegm
Clinical manifestations
Soft abdominal masses, which may be strip-like in shape, abdominal distension, constipation or diarrhoea, poor appetite, nausea and a feeling of fullness. Tongue: Swollen, with a sticky coating which is thicker on the root. Pulse: Slippery.
Acupuncture
Ren-12 Zhongwan, BL-20 Pishu, Ren-10 Xiawan, Ren-6 Qihai, L.I.-4 Hegu, ST-40 Fenglong, ST-36 Zusanli, BL-21 Weishu, ST-34 Liangqiu, SP-6 Sanyinjiao. Reducing or even method, except on Ren-12 and BL-20 which should be reinforced.
Herbal treatment
a Prescription
Explanation
This formula moves Qi and resolves food retention in the lower abdomen. It is particularly used if there is constipation.
Modifications
b Prescription
c Prescription
Explanation
Soft abdominal masses, which may be strip-like in shape, abdominal distension, constipation or diarrhoea, poor appetite, nausea and a feeling of fullness. Tongue: Swollen, with a sticky coating which is thicker on the root. Pulse: Slippery.
Ren-12 Zhongwan, BL-20 Pishu, Ren-10 Xiawan, Ren-6 Qihai, L.I.-4 Hegu, ST-40 Fenglong, ST-36 Zusanli, BL-21 Weishu, ST-34 Liangqiu, SP-6 Sanyinjiao. Reducing or even method, except on Ren-12 and BL-20 which should be reinforced.
Blood masses
Stagnation of Qi and Blood
Clinical manifestations
Hard and immovable abdominal masses, abdominal distension and pain, late periods. Tongue: Purple. Pulse: Wiry.
Treatment principle
Move Qi, invigorate Blood, remove obstructions from the Connecting channels and dissolve masses.
Acupuncture
G.B.-34 Yanglingquan, Ren-6 Qihai, LIV-3 Taichong, T.B.-6 Zhigou, P-6 Neiguan, SP-6 Sanyinjiao, LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), SP-10 Xuehai, BL-17 Geshu. Reducing or even method.
Herbal treatment
b Prescription
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