Lower Abdominal Masses

Diagnosis

Mass in abdomen that may be accompanied with pain in the abdomen or low back, distension, bloating, infertility, irregular vaginal bleeding, irregular menses, leukorrhea, miscarriage.  May be fibroids, tumor, or cancer.  Refer patient to gynecologist for full examination.

Etiology

Generally stagnation

1. LR Qi stagnation – emotional stresses, diet, anything that may cause the Zang to stagnate → Stasis → mass
2. Blood Stasis – stagnation → stasis, during menstruation or sex during menses or postpartum the body is ↓ & the cervix is open → attack by external pathogens → Blood Stasis block Jing Luo → mass
3. Phlegm – SP ↓, KI ↓, &/or LR Qi stagnation can cause Phlegm & Damp → stagnation → block Qi & blood circulation → mass

Western Medicine

Uterine fibroids – heavy menses that last a long time, mass felt in center of low abdomen, the patient may also be anemic.

Ovarian cysts or tumor – one sided mass &/or pain, doesn’t effect menses, may be small or large, do not necessarily show signs.

Pathogenesis Differentiation & Treatment

Main points:

Blood Stasis → very hard mass

Qi stagnation → mass that moves from time to time

Phlegm-Damp → soft, fluid filled

Phlegm stagnation → hard & soft (boiled egg)

* The situation is progressing badly if the mass is growing, getting harder, 5 colour leukorrhea is present, emaciation, irregular uterine bleeding

Qi stagnation

            not solid or hard mass, moveable, pain wanders

                        Plus – LR Qi stagnation symptoms (see Appendix 1)

                        P/T – regulate Qi, dissolve mass

                        Rx – Xiang Leng Wan

Blood Stasis

            hard mass, fixed, more painful, dark clotted delayed heavy menses

                        Plus – Blood Stasis symptoms (see Appendix 1)

                        P/T – promote circulation, remove Stasis, break up hardness

                        Rx – Gui Zhi Fu Ling Wan or Da Huang Zhe Chong Wan

Phlegm-Damp stagnation

mass is soft & hard similar to a boiled egg, large amounts of leukorrhea that is sticky white, cold body, poor appetite

            Plus – Phlegm-Damp symptoms (see Appendix 1)

            P/T – regulate Qi, eliminate Phlegm, dissolve hardness

            Rx – Kai Yu Er Chen Tang (with blood movers)

                        or Da Huang Mu Dan Tang (with clear Heat herbs)

Must Read: Zuo Jin Wan – clears Liver Heat, redirects rebel Qi, stops nausea & vomiting

IMPORTANT NOTE:  avoid the use of estrogen producing herbs when a mass is present