Abdominal diagnosis (fù zhěn) is a method of differential diagnosis based on symptom responses, which can be divided into four components: observation (wàng zhěn), auscultation (wén zhěn), inquiry (wèn zhěn), and palpation (qiè zhěn): Observation: This involves examining the shape and color of the abdomen;Auscultation: This involves listening to the sounds and odors from the abdomen, such as the splashing sound in the epigastric region and bowel sounds;Inquiry: This involves assessing the patient’s self-reported abdominal symptoms and any systemic symptoms;Palpation: This involves examining the sweating of the abdominal wall, skin temperature, overall and local tension, abdominal aortic pulsation, local resistance and tenderness, and the splashing sound in the epigastric region (gastric splashing sound). It is advisable to perform tenderness checks last when anticipating tenderness, and to check for the splashing sound in the epigastric region last as well.
Abdominal Diagnosis Procedure
The abdomen is generally divided into regions: the subxiphoid area, the chest and hypochondrium, the area below the ribs, the periumbilical region, and the lower abdomen. During abdominal diagnosis, the patient lies supine, with legs extended, hands resting at the sides of the thighs, relaxing the abdominal muscles, and maintaining a calm state of mind. The practitioner sits or stands on the patient’s right side to perform the examination. First, observe for any abnormalities in the abdominal wall, then use the fingertips or palm to palpate from top to bottom, starting from the left side to the right, to understand the conditions of each area. The technique should be gentle and gradual, starting lightly and progressing to deeper pressure.
Typical Abdominal Diagnosis Manifestations
1. A sunken abdomen with a relaxed abdominal wall is often indicative of a deficiency syndrome. For example, localized sunken areas in the upper abdomen and right hypochondrium may indicate early signs of gastric or duodenal perforation. If the entire abdominal wall is thin and the skin is taut, with the abdomen sinking inward around the umbilicus, this is referred to as a scaphoid abdomen, which is severe in cases of significant emaciation, fluid loss, and extreme depletion of organ essence, as seen in cholera, diarrhea, and dysentery.
2. A distended and protruding abdomen with a tense abdominal wall is often indicative of a repletion syndrome. If the abdominal skin is tense and shiny, and feels too hot to the touch, this may indicate severe internal abscesses; if the abdomen is distended without any skin markings due to ascites, this indicates a critical condition; abdominal distension without fullness in the epigastric region suggests a milder condition, while fullness in the epigastric region indicates a more severe condition. In cases of measles, abdominal distension may indicate a counterflow condition.
3. Abdominal distension, also known as simple abdominal distension, is characterized by an enlarged abdomen with a pale yellow skin tone, and in severe cases, visible abdominal veins, with limbs not swollen or slightly swollen. This is caused by the accumulation of qi, water, and blood in the abdomen. If the abdomen is higher than the chest when lying flat, and protrudes when sitting or standing, with soft pressure leaving no indentations, and a drum-like sound upon percussion without a wave-like sensation, this indicates qi distension, often due to qi stagnation. If the abdomen is firm and shiny, resembling a frog’s belly when lying flat, with a water-like feel upon palpation, leaving indentations, and a dull sound upon percussion with a wave-like sensation, this indicates water distension, often due to water accumulation. If visible veins appear on the abdomen, and red streaks are seen on the cheeks and neck, this indicates blood stasis. If the abdomen does not show visible veins, it is easier to treat; however, if veins are prominent and the abdomen is distended, it is more difficult to treat.
4. Malnutrition (gān jī) in children is characterized by thinness, a distended abdomen, visible veins, and symptoms such as anorexia and loose stools, caused by prolonged deficiency of the spleen and stomach leading to internal stagnation.
5. Hernia is characterized by a hemispherical bulge in the abdominal wall when standing or straining, which can be reduced when lying down. This is often due to cold stagnation in the liver meridian or weakness in qi leading to insufficient lifting power, or qi stagnation causing obstruction. If it occurs at the umbilicus, it is called umbilical hernia, commonly seen in children, especially when crying; if it occurs along the midline of the abdomen, it is called abdominal wall hernia; if it occurs in the middle of the groin, it is called inguinal hernia, more common in females; if it occurs in the iliac fossa, it is called iliac hernia. Generally, there is mild pain, but if it cannot be reduced when lying down, it may lead to severe colicky pain.
6. Scars on the abdomen are often remnants of trauma, surgery, or skin ulcers, particularly surgical scars, which are very helpful for diagnosis and should be carefully inquired about to understand past diseases.
7. Abdominal striae, which often appear in women after pregnancy, are longitudinal stripes on the lower abdominal wall that are light blue or pink, turning silver-white after childbirth and persisting long-term, known as striae gravidarum. This is due to blood nourishing the fetus and the loss of nourishment in the Chong and Ren meridians. Additionally, patients with distension, ascites, or chronic accumulation may also develop purple abdominal striae, often accompanied by purple striae on the upper thighs and buttocks and other signs. Abdominal striae can also be seen in patients who have taken large amounts of hormones for a long time.
8. Abdominal veins that are engorged and appear purple are often seen in patients with chronic illness, blood stasis, and qi stagnation. If the veins radiate from the umbilicus upwards and downwards, with normal blood flow direction, this indicates mild qi stagnation and blood stasis; if the veins radiate in all directions from the umbilicus, often accompanied by crab-claw patterns and blood streaks, this indicates severe obstruction of the meridians and blood flow, often seen in patients with distension.
9. A thick abdominal wall indicates a thick intestine, while a thin abdominal wall indicates a thin intestine. A thick and large abdominal wall that is soft yet firm upon palpation, or feels like a floating board on water, indicates a vital sign of longevity; conversely, a thin and small abdominal wall that is hard and lacks elasticity, or feels soft like paper floating on water, indicates a lack of vitality and a sign of premature death.
10. A sunken upper abdomen with a protruding lower abdomen often indicates organ prolapse (such as gastric prolapse), commonly due to insufficient middle qi; a large and evenly protruding abdomen with thick skin folds and a deep umbilicus is characteristic of obesity.
11. High abdominal movement indicates deficiency or heat; if the movement is scattered and not gathered, it suggests severe deficiency of the viscera. If there are lumps in the abdomen that appear and disappear, this indicates parasitic accumulation. If there is a lump that rises with a head and feet, this indicates cold pain.
12. Dry and lusterless abdominal skin, or skin that is tense or board-like, indicates internal blood stasis; if there is movement in the abdomen, it signals the presence of pathological blood; if there is a mass on the right side of the lower abdomen, it indicates the presence of accumulated blood; if the umbilicus is taut, it indicates the presence of blood stasis in the lower abdomen; if there is pain in the lower abdomen with taut skin, it indicates intestinal abscess.
13. Visible peristalsis in the abdomen often indicates dysfunction of the viscera and is pathological. If peristalsis is seen in the epigastric region, starting from the left hypochondrium and moving slowly towards the upper right of the umbilicus, forming a wide wave-like motion, this indicates a gastric condition, often due to narrowing or obstruction at the gastric outlet, making it difficult for food to pass, leading to vomiting and dry stools resembling sheep droppings, with a gaunt appearance. If peristalsis is seen around the umbilicus, appearing in a parallel arrangement, this indicates an intestinal condition, often due to obstruction in the intestines, commonly accompanied by persistent vomiting, complete loss of bowel movements, and severe abdominal pain.
14. The appearance of rashes on the abdominal skin is often seen in patients with acute febrile diseases or due to invasion of wind, dampness, and heat toxins into the skin.
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