Urgent morning bowel movements, rumbling sounds in the abdomen, and waves of colicky pain—this scenario is not uncommon in clinical practice. Yet despite sharing the same abdominal pain and borborygmus, some people find relief after drinking hot ginger decoction, while others feel worse the more they drink. Behind this lies the hidden constitutional code of two entirely different patterns: cold-dampness encumbering the spleen versus damp-heat accumulating in the intestines. In TCM clinical pattern differentiation, the first priority is to distinguish the tendency toward "cold" or "heat."
Cold-Dampness Type Abdominal Pain and Borborygmus: Cold Pain in the Abdomen, Relieved by Warmth
In diarrhea caused by cold-dampness encumbering the spleen, the abdominal pain typically presents as cold pain or dull pain. Those affected often feel a sensation of coolness in the abdomen, and the pain may be alleviated by pressing with the hand or applying heat. The Huangdi Neijing · Suwen states: "All diseases involving water fluids that are clear, transparent, and cold belong to cold." The stool in such individuals is usually thin and watery, pale in color, with little odor, and although borborygmus is frequent, the sound is relatively low and deep in pitch.
In TCM theory, the pathogen of cold-dampness damages spleen yang, leading to failure of transportation and transformation, internal retention of water-dampness, and failure of clear qi to ascend, causing it to pour downward into the intestines. The Shanghan Lun mentions: "Spontaneous diarrhea without thirst belongs to taiyin, because the organ has cold." This is a classic description of cold-dampness encumbering the spleen type diarrhea. Individuals with this constitution often present with aversion to cold, cold hands and feet, poor appetite, and a white, greasy tongue coating.
In meridian theory, Yinlingquan (SP9) is closely related to the pathogenesis of cold-dampness encumbering the spleen. This acupoint is located on the medial aspect of the lower leg, in the depression between the lower border of the medial condyle of the tibia and the medial border of the tibia. It belongs to the Foot Taiyin Spleen Meridian and is the He-Sea point of the Spleen Meridian. TCM holds that "He-Sea points treat the internal organs," and the He-Sea point of the Spleen Meridian is an important representative acupoint for regulating the spleen's function of transforming and transporting water-dampness. The Lingshu states: "Yinlingquan governs dampness." The naming and function of this acupoint precisely correspond to the pathological state of water-dampness retention and failure to separate clear from turbid in cold-dampness encumbering the spleen.
Damp-Heat Type Abdominal Pain and Borborygmus: Burning Sensation at the Anus, Unsatisfactory Defecation
In sharp contrast to the cold-dampness type, diarrhea caused by damp-heat accumulating in the intestines presents with abdominal pain that is mostly distending or colicky, with a more acute intensity. Although the pain may temporarily subside after defecation, it quickly recurs. The most typical sensation is a burning feeling at the anus and urgency to defecate, with sticky, malodorous stool that may even contain purulent or bloody material. The Wenbing Tiaobian states: "Dampness accumulates and heat steams, brewing in the meridians... entering the internal organs, causing diarrhea or dysentery." This precisely explains this condition.
In the damp-heat type, borborygmus tends to be high-pitched and rapid, unlike the low and deep sound of the cold-dampness type. Clinically, such individuals often present with dry mouth, bitter taste, scanty dark urine, and a red tongue with yellow, greasy coating. Interestingly, despite sharing the same abdominal pain and borborygmus, pressing the abdomen in damp-heat type individuals actually aggravates the discomfort—a stark contrast to the "likes pressure" characteristic of the cold-dampness type.
In meridian theory, Shangjuxu (ST37) corresponds to the pathological changes of damp-heat accumulating in the intestines. This acupoint is located on the lateral aspect of the lower leg, 6 cun below Dubi (ST35), one finger-breadth from the anterior border of the tibia. It belongs to the Foot Yangming Stomach Meridian and is the Lower He-Sea point of the Large Intestine. According to the theory that "He-Sea points treat the internal organs," Lower He-Sea points are where the qi of the six fu organs infuses into the lower limbs, and Shangjuxu is often used to explain the pathogenesis related to abnormal large intestine transmission function. The Lingshu · Xieqi Zangfu Bingxing records: "When the large intestine is diseased, there is sharp pain in the intestine with gurgling sounds," which closely corresponds to the abdominal pain and borborygmus caused by damp-heat accumulating in the intestines.
Why Do Identical Symptoms Require Completely Different Approaches?
The Jingui Yaolüe emphasizes: "For all diseases in the organs, when wishing to attack them, one should attack according to what is obtained."—The fundamental principle of treatment lies in identifying the root cause. Although both cold-dampness encumbering the spleen and damp-heat accumulating in the intestines present with abdominal pain, borborygmus, and diarrhea, the core contradiction is diametrically opposite: the former is "insufficient yang qi with internal retention of cold-dampness," while the latter is "dampness and heat mutually binding, obstructing the movement of qi."
From a constitutional perspective, individuals who have long resided in damp environments and who indulge in cold and raw fruits and vegetables are more prone to developing the state of cold-dampness encumbering the spleen. Those with irregular eating habits, frequent consumption of spicy and greasy foods, or excessive alcohol intake are more likely to develop a damp-heat constitution. In clinical practice, licensed TCM practitioners will inquire about lifestyle habits and dietary preferences through consultation, then combine tongue and pulse findings for a comprehensive assessment. Behind the same symptom may lie completely different directions for regulation—this is precisely the essence of TCM's "treating the same disease with different methods."
In TCM understanding, Zusanli (ST36) also carries core information about spleen and stomach transportation and transformation. This acupoint is located on the anterior-lateral aspect of the lower leg, 3 cun below Dubi (ST35), one finger-breadth from the anterior border of the tibia. It belongs to the Foot Yangming Stomach Meridian and is the He-Sea point of the Stomach Meridian. The Lingshu states: "When pathogenic factors are in the spleen and stomach, there is muscle pain... all are regulated through Zusanli." As the site where qi and blood of the Stomach Meridian converge, Zusanli is often used to understand the balanced regulation of qi movement in the middle jiao, and it also provides a theoretical reference for "treating the same disease with different methods."
It is worth noting that if some individuals simultaneously present with fever, vomiting, or severe dehydration, this may indicate acute infectious enteritis, and relying solely on dietary therapy is not appropriate—prompt medical attention should be sought. For chronic, recurrent abdominal pain, borborygmus, and diarrhea, a licensed TCM practitioner should conduct detailed pattern differentiation to distinguish whether it is spleen-kidney yang deficiency, liver depression with spleen deficiency, or other possibilities.
An Open-Ended Reflection
The next time you experience abdominal pain and borborygmus, take a moment to observe: Does the abdomen prefer warmth and pressure, or does it reject pressure and fear heat? Is the stool sticky and malodorous? Is there a burning sensation at the anus? These details may be the very key to understanding your own constitution. The true path of regulation has never been about applying some "universal formula," but rather about respecting each individual's unique constitutional differences.
Related Knowledge Q&A
What causes cold-dampness type abdominal pain and borborygmus?
TCM holds that cold-dampness type abdominal pain and borborygmus requires holistic pattern differentiation, using the four diagnostic methods of inspection, auscultation and olfaction, inquiry, and palpation in combination, along with individual constitutional characteristics for comprehensive assessment—it cannot be generalized. The specific direction of regulation must be determined by a licensed TCM practitioner after face-to-face consultation.
How long does it take to improve damp-heat type abdominal pain and borborygmus?
The duration of improvement varies from person to person. Acute issues may improve within a few sessions, while chronic constitutional conditioning is recommended to continue for 1-3 months. TCM emphasizes gradual progress and discourages rushing; the specific timeframe should be assessed by a physician based on individual circumstances.
Why do identical symptoms require different approaches, and what should be noted in daily life?
For daily maintenance, it is recommended to maintain regular rest, a balanced diet, moderate exercise, and emotional stability. Specific precautions should be flexibly adjusted according to individual constitution and seasonal changes. A licensed TCM practitioner can be consulted for targeted advice.