Chronic Abdominal Pain - Middle Jiao Deficiency-Cold Pattern

Dr. Li Wei, DACM

Chronic Abdominal Pain · Middle Jiao Deficiency-Cold Pattern

Updated: June 23, 2026

Reviewed by: Dr. Li Wei, DACM

Reading Time: 7 min

Body Area: Abdomen

Pattern Overview

Middle Jiao Deficiency-Cold is a chronic pattern in abdominal pain, characterized by chronic functional pain with autonomic dysfunction, dull pain, fatigue, cold limbs, relief with warmth, and poor appetite. The core pathogenesis is Spleen-Stomach deficiency with Cold, leading to reduced GI motility, impaired tissue nourishment, and chronic pain.

Key Symptoms and Differentiation Points

| Differentiation Dimension | Manifestations |

| :— | :— |

| Primary Symptoms | Dull abdominal pain, fatigue, cold limbs, relief with warmth |

| Associated Symptoms | Poor appetite, loose stools, bloating, pale complexion |

| Tongue and Pulse | Pale and swollen tongue with thin white coating, deep and weak pulse |

| Pathogenesis | Spleen-Stomach deficiency with Cold |

| Etiology | Chronic illness, poor diet, overwork, constitutional Spleen deficiency |

Acupuncture Point Prescription

| Point | Location | Function |

| :— | :— | :— |

| Zhongwan (RN12) | 4 cun above the umbilicus | Front-Mu point of Stomach; harmonizes the Stomach |

| Qihai (RN6) | 1.5 cun below the umbilicus | Tonifies Qi and warms the lower abdomen |

| Pishu (BL20) | Lower back, 1.5 cun lateral to T11 | Back-Shu point of Spleen meridian; strengthens Spleen-Qi |

| Zusanli (ST36) | 3 cun below the patella, 1 finger-width lateral to the tibial crest | Strengthens Spleen and Stomach; tonifies Qi |

Clinical Recommendation: Filament needle, reinforcing method; heavy moxibustion is strongly recommended to warm the Middle Jiao and tonify Qi.

Herbal Formula

Base Formula: Xiao Jian Zhong Tang (小建中汤)

Composition:

Cinnamon Twig (Gui Zhi), White Peony (Bai Shao), Licorice (Gan Cao), Ginger (Sheng Jiang), Jujube (Da Zao), Malt Sugar (Yi Tang), Licorice (Gan Cao)

Action: Warms the Middle Jiao, supplements Qi, and relieves pain.

Modifications

| Associated Symptoms | Additions/Subtractions |

| :— | :— |

| Severe cold pain | Add Fu Zi, Gan Jiang to warm Yang and disperse Cold |

| Fatigue | Add Huang Qi to enhance Qi supplementation |

| Poor appetite | Add Sha Ren, Mu Xiang to harmonize the Stomach |

| Loose stools | Add Shan Yao, Yi Yi Ren to strengthen Spleen and stop diarrhea |

Western Mechanism Reference

Chronic functional pain with autonomic dysfunction, reduced GI motility, and impaired tissue nourishment. Middle Jiao Deficiency-Cold corresponds to chronic functional abdominal pain with autonomic dysfunction, where reduced GI motility and impaired tissue nourishment contribute to chronic pain and discomfort.

References

  1. Internal Medicine of TCM - Abdominal Pain with Middle Jiao Deficiency-Cold.

  2. Xiong Jibai: Middle Jiao Deficiency-Cold uses Xiao Jian Zhong Tang.

  3. WHO. (2023). Digestive health. World Health Organization.

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