Rethinking chronic abdominal wall pain: A new approach to integrating Western medicine and traditional Chinese medicine

Chronic abdominal wall pain is common but often misdiagnosed, frequently mistaken for visceral disease. Abdominal cutaneous nerve entrapment syndrome (ACNES) is increasingly recognized in Western medicine as a major cause, typically managed with diagnostic nerve blocks and, in refractory cases, surgical neurectomy. In traditional Chinese medicine (TCM), this condition aligns with “collateral disorder” (Luo Bing), in which pathogenic obstruction of superficial collaterals produces localized pain that is neither strictly external nor internal. This review examines conceptual parallels between ACNES and TCM, emphasizing theoretical foundations, modern innovations in minimally invasive acupuncture, and the potential for interdisciplinary integration. Western research on ACNES pathogenesis, diagnosis, and treatment is discussed alongside TCM classical sources and contemporary studies on Pizhen (a flat-head acupuncture needle) therapy. Western medicine provides diagnostic precision through imaging and nerve blocks but offers limited long-term solutions beyond invasive surgery. By contrast, TCM acupuncture, particularly Pizhen therapy, delivers a micro-invasive, precise, and systemic approach to fascial decompression and nerve release. Biomechanical studies indicate that it can relieve high-tension points, restore microcirculation, and regulate neuromuscular activity. Clinical practice highlights the importance of accurate localization of entrapment sites, pattern differentiation, and holistic regulation. Interdisciplinary integration combines the diagnostic strengths of Western medicine with the therapeutic versatility of TCM, reducing misdiagnosis, improving outcomes, and minimizing invasiveness. ACNES remains a treatable but under-recognized source of abdominal pain. Integrating minimally invasive TCM needle techniques with Western diagnostic methods offers a promising pathway toward precision and holistic care. Future priorities include standardizing protocols, conducting rigorous clinical trials, strengthening multidisciplinary collaboration, and enhancing public awareness. Such approaches hold strong potential to improve outcomes and quality of life for patients with chronic abdominal wall pain.