Case Question/Study: How Much Does the Warmth of the Lower Abdomen Play a Role When Prescribing FZ Formulas?

[Kevin]

How much does the warmth of the lower abdomen come into play when prescribing FZ formulas? I have a patient, CC of digestive issues (gas, bloating, alternating constipation/diarrhea). Her pulses :: quite weak L side pulses, not quite as weak R pulses (tight cun, wiry guan mid depth, deep wiry chi). Her abdomen shows a fair amount of hardness, but the lower abdomen is quite warm, which I believe to be a byproduct of blood stasis. She is on a contraceptive where she rarely has menses for 1.5 years now, which she was put on due to extremely heavy menstrual flow. She is very affected by cold/damp weather, where she feels it in her bones.I was originally thinking ZWT, perhaps combined with SNS or maybe GZFLW? Then I got threw off by how warm her abdomen was. Then, rookie mistake, I didn’t follow through to see if she had other lower abdomen signs like SQW bowtie or whether there was more hardness on L or R. D’oh!Thoughts?

[Christoph Ludwig Beer]

SQW pattern can totally have a warm abdomen, since it’s water stagnation that over time turns warm. However, with the digestive complaints you want to start with a different prescription like the ones you mentioned.

[laurieayres]

As standard FZ prescriptions should have a lower abdomen that is lax and cold to the touch, though some with floating yang can have an abdomen that is warm and clammy but if you hold your hand there it gets cold. But there are also a lot of patients that don’t show this for various reasons, for example I have lots of patients come in wrapped up really warm having just got off the boiling tube and as a result they just feel warm to the touch. So I wouldn’t focus too much on these things, Dr Tian and Dr Zeng didn’t use these for confirmation when they saw a FZ pulse, so once you’ve seen the clear FZ pulse I wouldn’t let these things deter you too much, unless it’s a clear finding that Dr T n’ Zee or ZZJ talks about. If you suspect there’s stasis then look at the chi positions, if they show stasis then investigate for lower abdominal fullness and hardness that is painful or uncomfortable to the touch and confirm with stasis symptoms, otherwise just warm if the pulse warrants it.

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