Lingering Dull Pain That Never Ceases: Why Does the Same Stomachache Respond to Warming Tonification in Some, Yet Worsen with Treatment in Others?

Many friends who come to the clinic often ask me one question: "My stomach aches with a dull pain—not severe, yet it clings to me like a shadow that I cannot shake off. What on earth is going on?" Their tone carries both exhaustion and confusion. In TCM clinical practice, between this "dull pain" and "severe pain" lies the code to constitutional differences. With the same stomachache, some feel much better after using warming foods, while others actually get worse. Today, let us talk about the pattern-differentiation logic behind this.

Constitution A: Dull Pain from Spleen Yang Insufficiency—Cold Pain with Empty-Stomach Pain

In clinical practice, when stomach pain is dull rather than severe but persists continuously, it is mostly seen in people with "spleen yang insufficiency." This kind of pain is often described as "a piece of ice stuffed inside the belly." Pressing on it feels somewhat comfortable, and drinking warm soup or eating warm foods can relieve the pain. These friends often also have poor appetite, loose stools, and cold hands and feet. The TCM classic Huangdi Neijing says: "Yang qi is like the sky and the sun; when it loses its place, lifespan is cut short and brilliance is lost." Spleen yang is like the sun of the body. Once it is insufficient, the stomach loses its warming nourishment, and this unceasing dull pain arises. For people of this constitution, if they chronically indulge in cold drinks and raw-cold foods in daily life, or live long-term in cold, damp environments, such problems are more easily triggered. Zusanli, also known as Xialing or Sanli, is an important acupoint on the lower leg. It is located on the anterior-lateral aspect of the lower leg, 3 cun below Dubi, one transverse finger-breadth from the anterior crest of the tibia. It belongs to the Foot Yangming Stomach Meridian and is the He-Sea point of the Stomach Meridian and the lower He-Sea point of the stomach. The Lingshu says: "When evil is in the spleen and stomach, then disease causes muscle pain... all are regulated at Zusanli." Zusanli is closely related to spleen-stomach function and holds significance in the warming and transforming functions of the stomach.

Constitution B: Dull Pain from Stomach Yin Depletion—Burning Pain with Dry Mouth and Tongue

But there is another situation in which the stomach pain is also dull, yet its nature is entirely different. In people with stomach yin depletion, the dull pain often carries a burning sensation, like a small flame gently licking inside the stomach. It is actually more obvious on an empty stomach and slightly relieved after eating. These friends often feel dry mouth and tongue, want to drink cold water, and tend to have dry stools. The tongue body is often reddish with little coating. As the Qing dynasty physician Ye Tianshi said in Wenre Lun: "To rescue yin, one does not focus on blood, but on fluids and sweat." When stomach yin is insufficient, the stomach loses its moistening nourishment, and this dull pain—seemingly similar but actually quite different—arises. In clinical practice, this constitution is mostly seen in people who stay up late long-term, overthink, or crave pungent foods. Sanyinjiao, also called Taiyin Jiao, is located on the medial side of the lower leg, 3 cun above the tip of the medial malleolus, posterior to the medial border of the tibia. It belongs to the Foot Taiyin Spleen Meridian and is the meeting point of the three meridians of Foot Taiyin, Jueyin, and Shaoyin. This acupoint is located on the spleen meridian and also communicates with the liver and kidney meridians. It is closely related to the nourishment and moistening of stomach yin and is often used as a reference in pattern differentiation of spleen-stomach yin-fluid depletion.

Constitution C: Dull Pain from Liver Depression Overacting on the Spleen—Distending Pain with Emotional Fluctuations

There is also another situation that cannot be ignored: the stomach pain is dull, not severe, but persists continuously, yet worsens with emotional fluctuations. This kind of pain is often accompanied by a sensation of fullness and distension, as if cotton is stuffed in the stomach, and it is slightly relieved after belching. These friends often tend to be tense, under greater pressure, or have a more sensitive personality. Traditional TCM theory holds that the liver belongs to wood and the spleen belongs to earth; wood overacts on earth. Poor emotional regulation leads to liver qi stagnation, which in turn affects the normal function of the stomach. The Jingui Yaolue long ago clearly taught: "When seeing liver disease, know that the liver will transmit it to the spleen, so first fortify the spleen qi." For the dull pain of this constitution, simple warming tonification or nourishing methods often yield little effect. The key lies in soothing the liver and regulating qi, allowing the movement of qi to recover its free-flowing nature. Taichong, also known as Taichong point, is located on the dorsum of the foot, between the first and second metatarsal bones, in the depression anterior to the junction of the metatarsal bases. It belongs to the Foot Jueyin Liver Meridian and is the Yuan-Source point of the Liver Meridian. The Yuan-Source point of the Liver Meridian is closely related to the liver's function of coursing and discharging qi. In TCM classics, it is regarded as an important acupoint for regulating the movement of qi, and it has a certain theoretical connection with the pathological mechanism of stomach discomfort caused by "wood overacting on earth."

Why does the same dull pain require completely different treatment directions?

This question is precisely where the essence of TCM "treating the same disease with different methods" lies. For the same continuous dull stomach pain, those with spleen yang insufficiency are like land in winter and need sunlight to melt the ice; those with stomach yin depletion are like a dried-up riverbed and need rain to moisten it; those with liver depression overacting on the spleen are like a river channel blocked by a huge rock and need to be dredged before irrigation. The three have different causes and different pathomechanisms. If a generic approach is used indiscriminately, it is inevitable that one may "pour oil on the fire" or "add frost to snow." This is why some feel comfortable after drinking ginger brown sugar water, while others become drier the more they drink it, and still others feel even more bloated after drinking it.

When the dull pain persists without cease, how can we look for clues in the details of daily life?

In clinical practice, to judge one's constitutional tendency, one may observe from the following angles. First, the temporal pattern of the pain: Is it worse on an empty stomach or after meals? Is it more obvious at night or during the day? Second, accompanying symptoms: Is there aversion to cold and cold hands and feet, or dry mouth and a desire to drink water? Third, emotional state: Is the pain related to stress or anger? The Lingshu · Ben Zang points out: "Observe the external correspondences to know the internal organs, and then one knows the disease." These daily details are precisely the signals the body transmits to us. If accompanied by constipation and irritability, it may be related to stomach yin insufficiency; if accompanied by diarrhea and aversion to cold, spleen yang insufficiency is more likely; if accompanied by chest tightness and belching, the liver depression factor cannot be ignored.

In caring for the stomach, why can we not look only at symptoms?

Many friends are accustomed to looking for methods based on the names of symptoms, but TCM places greater emphasis on the "pattern" behind the symptoms. When stomach pain is dull, not severe, but persists continuously, the very word "dull" itself indicates that the problem is not temporary but rooted in the fundamental constitution. For those with spleen yang insufficiency, warming foods may be appropriately chosen in daily life, but care should be taken not to overdo the amount, lest heat be generated; for those with stomach yin depletion, cool and moistening items are suitable, but bitter-cold excess must be avoided, lest the spleen and stomach be damaged; for those with liver depression overacting on the spleen, attention should be paid to emotional guidance and appropriate exercise to help the movement of qi flow. These care approaches require a licensed TCM physician to determine a specific plan according to individual constitution and must not be blindly applied.

Have you ever thought that the dull pain in the stomach may not be only a stomach problem?

It may be the call of spleen yang, the thirst of stomach yin, or the sigh of liver qi. In the world of TCM, every persistent symptom is a whisper of the body, waiting for us to listen and identify. Next time that lingering dull pain strikes again, it may be helpful to calm the mind and feel its location, nature, and pattern. Have you ever noticed at what time and under what conditions the pain appears? Does it have hidden connections with your emotions, diet, and daily routine? These seemingly trivial details may be the key to unlocking the body's code.

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