The human abdomen is not a simple physical space. It possesses a system so intricate and sophisticated—housing countless neural networks, immune cells, and over 100 trillion microorganisms—that it is often called the second brain. How does modern medicine explain qi stagnation, dampness-phlegm, and food stagnation mentioned in the Donguibogam? The first concept that comes to mind is the gut-brain axis. Our gut constantly communicates with the brain, influencing and being influenced by emotions, stress, and sleep patterns. Have you ever experienced abdominal pain or worsened constipation under stress? This happens because neurotransmitters secreted by the brain directly regulate intestinal motility. In particular, chronic stress suppresses parasympathetic nerve activity, slowing intestinal motility and decreasing gastric acid secretion and digestive enzyme production, which can cause indigestion and constipation.
Abdominal distension and gas are closely tied to gut dysbiosis, also known as microbiome dysbiosis. In our gut, beneficial bacteria and harmful bacteria maintain a balance. When specific harmful bacteria proliferate excessively, they produce large amounts of gas, such as methane, hydrogen, and carbon dioxide, during the process of digesting food. In particular, small intestinal bacterial overgrowth, where bacteria overgrow in the small intestine, triggers various symptoms such as abdominal distension, gas, diarrhea, or constipation, and can cause the lower abdomen to bulge outward like a potbelly. Furthermore, consuming refined carbohydrates or artificial sweeteners instead of sufficient insoluble dietary fiber feeds harmful bacteria, worsening dysbiosis.
Constipation is mainly caused by hypomotility of the gastrointestinal tract, or slow colonic transit. This occurs due to various factors, including autonomic nervous system imbalance, muscle relaxation, particularly pelvic floor muscle weakness, insufficient fluid intake, and lack of dietary fiber. The sedentary lifestyle of modern individuals further slows intestinal motility, and chronic dehydration hardens stool, making defecation difficult. In women, hormonal balance shifts during the menstrual cycle or pregnancy, especially involving progesterone, can reduce intestinal motility and exacerbate constipation.
Furthermore, visceral hypersensitivity refers to a state in which one feels heightened pain or discomfort from minor stimuli, even without structural abnormalities in the gut. This can stem from stress or past enteritis, making one perceive abdominal distension or pain much more intensely.
In this way, modern medicine reveals that chronic constipation and abdominal distension are not issues of the gut alone, but multifaceted conditions encompassing brain-gut interactions, gut microbiota ecosystems, hormonal balance, lifestyle habits, and even mental health. The statement in the Donguibogam that the source of qi and blood is blocked can be seen as an astute insight into the diverse vital signs that emerge when the body's integrated balance is disrupted.
