However, as mentioned above, in women the two conditions may well overlap and it may be
very difficult to distinguish between them. Indeed, from a purely Chinese medical perspective, it
is not even that important to distinguish between the two conditions as some of their pathologies
coincide: Cold in the Lower Burner, Damp-Heat, stagnation of Qi or Blood. In other ways it is
of course important to distinguish whether the pain is of intestinal or gynaecological origin, in
order to advise the patient on life-style and diet and to have a better idea of prognosis.

The category of "abdominal pain" discussed here may also overlap with other conditions,
particularly constipation, diarrhoea and abdominal masses. Generally speaking, the present
chapter will discuss the condition when abdominal pain is the main presenting symptom, even
though it may be accompanied by constipation or diarrhoea. Although these two conditions may
also be accompanied by some abdominal pain, they are discussed under the categories of
"Diarrhoea" (Chapter 18) and "Constipation" (Chapter 19) if the change in bowel habit is the
main presenting manifestation. As for "abdominal masses", this condition may or may not
present with pain. Again, if pain is the main presenting symptom the reader should use the
differentiation and treatment given in this chapter. If an abdominal mass is the main sign, then
one should use the differentiation and treatment given in the chapter on "Abdominal Masses"
(Chapter 17).

Finally, the area of abdominal pain illustrated in Figure 16.1(386) includes the hypogastric
region, i.e. the small, rounded area immediately above the pubic bone (Figure 16.2(387)).

Although abdominal pain of intestinal origin may be centred only in this region, a purely
hypogastric pain is more often of urinary origin and the reader should refer to the chapters on
urinary diseases (Chapter 20, 21 ).

Aetiology and Pathology

External Pathogenic Factors

Cold and Dampness are the two pathogenic factors which most frequently cause abdominal pain.

External Cold may invade the Intestines directly without causing exterior symptoms first. This
happens when a person is exposed to cold, especially when the body is wet after swimming.
Invasion of the Intestines by Cold is also facilitated by excessive consumption of cold foods and
especially cold drinks. For these two reasons (excessive consumption of cold drinks and
exposure to cold after swimming), paradoxically, invasion of the Intestines by Cold is more
common in summertime.

Women are more prone to invasions of the Intestines by Cold during and immediately after the