Lower Abdominal Pain That Pulls Down and Reaches the Waist, With a Lump Below the Belly Button? Doctor Zhang Xichun’s Case of Sinking of the Great Qi With Liver Qi Stagnation

What people search for: lower abdominal pain / lump below the left side of the belly button / pain in the lower abdomen that reaches the waist / bearing-down sensation / difficulty urinating Corresponding medical terms: sinking of the great qi · liver qi stagnation · stagnation of the qi aspect · blockage of the channels

Opening scene: a 15-year-old girl with a “something” growing below her belly button

Today’s patient is a very special one — a 15-year-old girl. Just to the lower left of her navel, a lump had grown, and it kept pulling downward, layer after layer, as if there were something hanging inside her belly.

💬 Note from Doctor Luo: Everyone, today we continue with how Doctor Zhang Xichun treated sinking of the great qi (da qi xia xian). Earlier we discussed the Shengxian Decoction (Decoction to Raise the Sinking) and the Huiyang Shengxian Decoction (Decoction to Return the Yang and Raise the Sinking) — warming the yang while lifting the qi upward. Today’s case turns in yet another direction. Watch carefully.

What did the pain feel like? Pulling downward and shooting into the waist

This girl’s pain had a very distinctive character: it pulled downward, and it spread in all directions — when it spread, it shot straight into the waist, so the waist hurt along with it. The pain was unbearable; she would often moan out loud, in real misery.

💬 Note from Doctor Luo: Whenever I have met a case like this — pain on one side of the lower abdomen — it very often connects to the waist. The patient usually feels the waist also sinking, and the pain is severe, so they make sounds and suffer terribly. Remember this pattern.

Where did the trouble begin? Straining to urinate — that’s when things got big

How did the illness start? At first it was difficulty urinating (xiao bian bu li) — the urine just wouldn’t flow freely. While urinating, she had to strain hard; and when she strained, the waist began to hurt first, and that was the worst pain of all. Later the pain gradually appeared in the front, to the lower left of the navel, and right there a lump slowly formed.

💬 Note from Doctor Luo: “Difficulty urinating” is a Chinese medicine term — it simply means the urine doesn’t come out easily. Trace this girl’s illness back to its root, and it was caused by straining too hard while urinating. Strain wounds the qi, the qi sinks downward, and that set off a whole chain of problems.

Five months on: the lump went from soft to hard, and the pain kept its own schedule

When the lump first formed, if you rubbed it with your hand it was still soft. But by now five months had passed, and the place had become harder and harder. And the pain kept its own fixed schedule: it grew worse from four in the afternoon, and slowly eased from four the next morning — during the day it was much lighter.

💬 Note from Doctor Luo: This time pattern of the pain is very interesting — worsening at four in the afternoon points to stagnation of the qi and blockage of the channels in there. When Doctor Zhang Xichun took her pulse, what he felt was a thin and deep pulse — the qi was insufficient, and it was also sunk deep inside. Those two things had come together.

Doctor Zhang Xichun takes the pulse: thin and deep — the problem was in the “qi”

Doctor Zhang Xichun’s analysis: the illness began with straining during urination, which wounded the qi of the upper burner — in other words, sinking of the great qi. But it wasn’t just sinking — on top of that came stagnation of the qi aspect, which in plain terms is liver qi stagnation (gan qi yu jie). The qi had sunk, and then it had gotten blocked, leading to blockage of the channels (jing luo yu zu) — and that made the problem far more complicated.

💬 Note from Doctor Luo: See, this is the key point I want to stress today: when sinking of the great qi is combined with stagnation of the qi aspect, the situation becomes much more complicated. Liver qi stagnation and sinking of the great qi can sometimes join forces to harm our bodies — that is exactly what the title of this material is about.

Liyu Shengxian Decoction: clearing the stagnation and lifting the qi at the same time

Once the pattern was recognized, the formula followed — Liyu Shengxian Tang (Decoction to Regulate Stagnation and Raise the Sinking, 理郁升陷汤). Look at this: in Doctor Zhang Xichun’s Shengxian Decoction series, this is already the third formula: raw astragalus (sheng huang qi), six qian (about 18 g) — the chief herb; matched with zhi mu (anemarrhena), three qian (about 9 g), to clear the heat of the astragalus; dang gui (Chinese angelica), three qian (about 9 g), to nourish the blood; cassia twig tips (gui zhi jian), one and a half qian (about 4.5 g), to lift upward; and chai hu (bupleurum), one and a half qian (about 4.5 g), also to lift upward.

💬 Note from Doctor Luo: What does the Liyu Shengxian Decoction treat? It treats the condition where the great qi of the chest has sunk, the qi aspect is also stagnant, and the channels have become blocked as a result. The thinking of this formula is to clear the stagnation on one hand while lifting the qi upward on the other — a different direction from the earlier Huiyang Shengxian Decoction, which warmed the yang while lifting the qi. Compare the two.

Three herbs lead the lifting, frankincense and myrrh stop the pain

There was another fine point in the formula: ru xiang (frankincense) and mo yao (myrrh) regulate the qi and stop pain. And Doctor Zhang Xichun had a piece of hard-won experience — this kind of illness most often appears on the left side. When the left side goes wrong, either the blood is deficient and cannot rise, or the qi is deficient and cannot rise — so he would often add a little chai hu (bupleurum) to lift the liver qi of the left side.

💬 Note from Doctor Luo: The formula itself is simple, but the modifications carry the real craft: if the sinking is severe, Doctor Zhang Xichun would add raw dragon bone (sheng long gu) and raw oyster shell (sheng mu li), five qian each (about 15 g); if there is a bearing-down sensation in the lower abdomen, he would add sheng ma (cimicifuga). One direction presses downward, the other lifts upward — which one you use depends entirely on the disease mechanism.

Two doses and the bearing-down and the pain were both gone; dragon’s blood finished the job, and the lump dissolved

In the prescription he wrote for this girl, the frankincense and myrrh were both increased to four qian (about 12 g) — the amounts were raised; he also added dan shen (salvia root), three qian (about 9 g), to invigorate the blood and resolve stasis, and sheng ma (cimicifuga), one and a half qian (about 4.5 g). What happened? After only two doses, the bearing-down sensation and the pain were both cured! Then Doctor Zhang Xichun removed the sheng ma from the formula and had the girl take xue jie (dragon’s blood) powder with the prepared medicinal decoction — dragon’s blood is an herb that invigorates the blood and resolves stasis — and after several more doses, that lump also dispersed.

💬 Note from Doctor Luo: Dragon’s blood invigorates the blood and resolves stasis. In fact, the one I often have patients take with their decoction is san qi (notoginseng) powder — the principle is the same: invigorate the blood, resolve stasis, and slowly melt away the stagnant congestion. This case is a special one, and it tells us something: when sinking of the great qi is combined with stagnation of the qi aspect, the treatment must be more comprehensive — lifting alone won’t do; you also need to clear stagnation and resolve stasis, three approaches working together.

Bonus story: lower abdominal pain that even Peking Union Medical College Hospital couldn’t explain — the root cause was anger

Doctor Luo says that pain on both sides of the navel, lower down, in the lower abdomen, is something he encounters several times every year. He gave an example: the wife of a friend of his, during the Spring Festival, developed pain on both sides of the lower abdomen that also pulled at the waist — exactly the same symptoms as this girl. She went to the International Medical Center of Peking Union Medical College Hospital (PUMC) in Beijing and was examined top to bottom — they even found a gallbladder polyp — but still couldn’t figure out what the pain was. They suspected a problem with the adnexa (fallopian tubes and ovaries); test after test, nothing was found.

💬 Note from Doctor Luo: I judged that her illness was connected to her emotions — there had to be stagnation. When the emotions are stagnant, I free up the movement of qi (qi ji), have her take san qi (notoginseng) powder, and also prescribed a formula on the same line of thinking — and the result was that she recovered very quickly. Sometimes I meet several such patients in a row, all with qi stagnation in the two sides of the lower abdomen.

Doctor Luo’s closing note: the liver channel runs through the lower abdomen — don’t underestimate “getting angry”

Why does stagnation love to block up the two sides of the lower abdomen so much? Because the liver channel (gan jing) passes through both sides of the lower abdomen on its course. When the liver qi stagnates, it can lead to all kinds of problems; and if you also run into sinking of the great qi, the problem becomes even more complicated.

💬 Note from Doctor Luo: Getting angry, or holding on to something that weighs on your mind, often brings on this kind of condition. I’m telling you this case not to teach everyone to prescribe for themselves — if you have this kind of problem, go see a doctor, and let them judge, on the basis of this line of thinking, whether the herbs are appropriate for you. But you should all know this in your own hearts: when the qi is not flowing smoothly, it really can harm the body. That is one piece of Chinese medicine knowledge we can take away today.

What to take away

• Straining too hard can sink the qi: forcing the body — here, straining to urinate — can wound the qi and send it sinking, setting off pain, bearing-down, and even a lump in the lower abdomen.
• Sinking plus stagnation is a different animal: when sinking of the great qi is joined by liver qi stagnation, the channels get blocked, and the treatment has to clear stagnation and resolve stasis at the same time as lifting the qi — three approaches together.
• Left-side illness often points to qi or blood deficiency: Doctor Zhang Xichun’s experience was that this illness tends to strike the left side, where deficient blood or qi fails to rise; bupleurum lifts the liver qi there.
• Time patterns in pain matter: pain that worsens at four in the afternoon signals stagnation of the qi and blockage of the channels — a clue worth remembering.
• Emotion is real medicine: the liver channel passes through the lower abdomen, so anger and emotional congestion can show up there; freeing the qi movement resolved the modern case that hospital tests could not explain.

Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s case records; the original case comes from Yixue Zhongzhong Canxi Lu (《医学衷中参西录》, published in installments between 1918 and 1934).