Yesterday I received my newest edition of my favorite journal, The Lantern. Not only is this edition full of excellent and inspiring articles, it also features an article by Nigel Dawes!  The article is entitled “Evidence is More Valuable than Logic”. In addition, Nigel is going to be teaching in Australia, for our Australian readers.   His class is called “Fukushin in Modern Practice”. For other information about Nigel’s teaching and practice, check out his web-site as well as Michael Max’s informative 2-part interview with Nigel.

On to our final installment of my questions for Nigel:

Not wanting to take Nigel’s generosity too far….I finish my questions (for now!)

Okay, one more and I’ll leave you alone….at least for a little while..

On the  handouts you gave us at the start of class – the ones with the pictures of Osaka’s 13 abdomens – the ‘Inside Emergency’ # 9 says that the ‘Li Ji’ is a result of overstrained rectus abdominus compensating for low abdominal pressure.  I don’t get what this means. Could you explain it to me a bit more?  How do the muscles strain in response to low abdominal pressure?

So Dr. Otsuka, being a physician, is using standard western medical language here. Intra-abdominal pressure is of course the normal pressure maintained within the abdominal cavity which, when elevated, is often associated with vascular compression (itself a result of varying pathomechanisms though most commonly to fluid eg: ascites)causing cardiac problems such as Congestive Heart Failure and hypertension amongst other things. Lowered abdominal pressure occurs when there is hyper-flaccidity of the of both the voluntary and smooth muscles.  This occurs both on the surface of the abdomen and within the abdominal core. It is often associated with orthopedic problems leading to insufficient muscular support of the spine. The cuases may be poor tonus in weak individuals who do not exercise enough or possible internal associations with poor metabolic functions (including hypothyroidism, obesity etc.).

In the Ri Kyu abdomen which you ask about, there are actually 2 possible presentations. One would be a generally flaccid and chilly abdominal wall which is lax and powerless (Fuku Fu). In Kampo this is always associated with cold conformations and requires warming, nourishing formulas either containing Fu Zi, Gui Zhi or the ginger family. Si Ni Tang, Zhen Wu Tang, Li Zhong Tang even Si /Liu Jun Zi Tang are example formulas in this category.

However, when D. Otsuka talks of “compensation” in these cases, he means that the body, in order to try and maintain structural integrity (ie: for the spine to be protected and properly supported), will tighten in a reactive and somewhat unnatural way. In such cases the voluntary surface muscles of the abdomen (particularly the rectus abdominis m.) or even the entire layer of connective tissue covering the abdomen, will involuntarily tighten and eventually become spastic. This will give rise to the abdominal conformation of which you speak – the Ri Kyu abdomen. This presentation is then typically treated with the Jian Zhong family of formulas or various other formulas depending on the other co-existing abdomen findings. The so-called “jumping fishes” of the Da Jian Zhong SHO are simply another, different manifestation of the same kind of reactive, involuntary spasm occuring in response to lowered abdominal pressure and attempting to compensate for it. It’s almost like compensating for a particular emotional vulnerability by automatically becoming angry – a response in such cases that is usually an involuntary and spontaneous defense mechanism.

This lowered abdominal pressure will also by the way give rise to the “butterfly” or “bowtie” abdomen which is a lower, rather than a middle abdomen finding. As you know Otsuka interprets this lower abdominal finding as a Jin Gui Shen Qi Wan Sho. Again, the use of an aconite formula to warm and nourish and thereby relax the tension by restoring proper circulation.

So in summary the Ri Kyu (spastic) abdomen should be seen as a different manifestation of the same etiology (cold and deficiency) as the Fuku Fu Nan Jyaku Mu Ryoku (lax and powerless). It’s just the body reacting differently in each case. It could be argued perhaps that the latter is a more advanced stage as there is no longer energy and warmth left even to produce a last-ditch defense at the surface. It could also be argued in Kampo constitutional analysis that the spastic response occurs more readily in cold deficient types who are DRY whilst the flaccid response occurs more readily in cold and WET types.

Those constitutional distinctions are perhaps for another discussion!

Thank You Nigel!  Happy Dragon Water Year!