Running piglet refers to a subjective sensation of upsurge from the lower abdomen to the chest and possibly even the throat. This is typically accompanied by gripping abdominal pain, chest oppression, rapid breathing, dizziness, heart palpitations, and heart vexation. The term is first found in the Ling Shu where it is considered a minor form of bone withdrawal or bone epileptiform disease

Relevant Western Diseases:
Can be found in phobia, hysteria, anxiety, depression, psychoneurosis and schizophrenia, and possibly some western medical conditions

Differential Diagnosis:
Medical Disorders:
  1. Disorders of the heart, including arrhythmias
  2. Disorders of the stomach and upper gastrointestinal tract
  3. Disorders of the autonomic nervous system
  4. Hyperthyroidism
  5. Other endocrinological disorders
  6. Metabolic derangements
  7. Neurologic disorders including multiple sclerosis
  8. Chronic pain syndromes
  9. Disorders causing sexual dysfunctions
  10. Systemic Lupus Erythematosus (SLE)
  11. Acute intermittent porphyria
Effects of Substances:
  1. Alcohol or illicit substance intoxication or withdrawal
  2. Side effects of medications
Psychiatric Disorders:
  1. Panic Disorder
  2. Post-traumatic Stress Disorder (PTSD)
  3. Somatoform Disorder
  4. Major depressive episode with somatization
  5. Schizophrenia or other psychotic disorders
  6. Generalized Anxiety Disorder (GAD)
  7. Malingering
  8. Factitious Disorder

TCM Etiology & Pathogenesis:
There are three major mechanisms of this condition, all of which involve upward counterflow.
Heart Yang deficiency: with external assailing of cold evils resulting in the thoroughfare Qi counterflowing upward. In the Shan Han Lun, heart Yang vacuity is seen mainly due to iatrogenesis… However, heart Yang vacuity may also be due to overtaxation, enduring disease, and debility due to aging. In that case, running piglet disease may be provoked by sudden or intense fear and fright.
Spleen Yang deficiency: with water Qi ascending and intimidating. may be due to aging, enduring disease, unregulated eating and drinking, and iatrogenesis.
Liver Qi surging and counterflowing: may be due to unfulfilled desires, anger, and frustration causing Qi stagnation. Because the Qi is Yang, when it become stagnant and accumulates, it may counterflow upward. It may also be due to Liver Yin insufficiency failing to control Yang which then counterflows upward 1

“Emotional disharmony, especially frightening stimulation is the most common etiological factor especially the fear and frightening. Prolonged stress and depression and Zang Fu dysfunction can also lead to the disease
Disharmony of emotional activity can cause confusion of the Qi mechanism and rebellion upwards; fright, depression, and some emotional stimulants are the common pathological factors. In general, this pattern seems to occur more easily in middle-aged females. ”2

Prognosis:
This disease will be resolved in a short time after proper treatment; some cases may last longer depending on the pathological situation. Shen treatment and ongoing Shen care are more important to the outcome2

Diagnosis:
  1. Feeling of Qi moving from lower abdomen to the throat and chest
  2. Extremely fearful, anxious, nervous and moody at the same time
  3. Recurrent onset, but feel totally normal after occurrence
  4. No clear physical evidence in western medicine examinations
Should have A, then refer others

TCM Pattern Differentiation:
Qi Rebellious from Lower Abdomen Attacks Chest, Shen Irritable
Feeling of Qi moving from lower abdomen towards the chest and throat, extremely fearful, anxious, nervousness and depression, pattern occurs rarely or frequently during a day or year, feeling totally relieved after the attacks. Frightened and started easily, palpitations, insomnia, dreamy, Shen irritable
Tongue: pink tongue, white coat
Pulse: wiry, or irregular and uneven during attacks
Acupuncture Treatment: HT-7, LI-4, SP-6, CV-4, CV-6, CV-17, LR-3, PC-6, ST-36
Herbal Treatment: Ben Tun Qi Tang Modification2
[Dang Gui, Ban Xia, Huang Qin, Ge Gen, Bai Shao, Sheng Jiang]
Modifications:
Hypochondraic pain: + Yan Hu Suo, Chuan Lian Zi
Nausea, vomiting: + Zhu Ru, Xuang Fu Hua
Palpitations: + Sheng Long Gu, Sheng Mu Li
Abdominal fullness and distention: Mu Xiang, Zhi Ke
Swollen: Fu Ling, Yi Yi Ren
Insomnia: + Bai Zi Ren, Suan Zao Ren
Cold sensation: + Rou Gui, Gan Jiang

Heart Yang Vacuity w/ Upsurging of Yin Cold Qi of the Kidneys1
Palpitations below navel ascending below the heart, shortness of breath, chilled limbs, possible cyanosis of nails, chest pain
Tongue: dark, possibly purplish tongue
Pulse: possibly regularly intermittent
Treatment Principle: Warm and free the flow of heart Yang, level upsurge and downbear couterflow
Acupuncture Treatment: BL-15, BL-23, CV-4. Moxa in this order
Herbal Treatment: Gui Zhi Jia Gui Tang1
[Gui Zhi (15g.), Bai Shao (10g.), Gan Cao (10g.), Da Zao (12 pieces), Sheng Jiang (3 slices)]
Modifications:
If leveling kidney evils: use Rou Gui
If resolving Taiyang evils: Use Gui Zhi

Spleen Yang insufficiency w/ Water Qi Ascending and Intimidating1
Palpitations below the abdomen that may stretch to below the heart, fatigue, lack of strength, counterflow chilling of the four limbs, loose stools, edema, te sound of water sloshing about under the heart
Tongue: swollen pale tongue w/ teethmarks on edges, thin white slimy coat
Pulse: weak, faint, moderate, or slow
Treatment Principle: Warm and supplement spleen, seep water, level upsurging and downbear counterflow
Acupuncture Treatment: Moxa in order: BL-15, BL-20, BL-21, CV-9; Drain: PC-7
Herbal Treatment: Ling Gui Cao Zao Tang1
[Fu Ling (25g.), Gui Zhi (12g.), Gan Cao (6g.), Da Zao (15 pieces)]

Liver Qi Counterflowing Upwards1
Periumbilical palpitations followed by an upsurging of Qi from the abdomen to the sternum when the patient becomes upset, chilled limbs and body when nervous but restoration of the heat in the limbs when relaxed and at ease, heart palpitations
Tongue: white slimy coat
Pulse: bowstring, tends to be hooked (floating in the inch and deep in the cubit)
Treatment Principle: Level the liver and downbear upward counterflow
Acupuncture Treatment: LR-3, CV-17, PC-6, SP-4
Herbal Treatment: Ben Tun Tang Jia Jian1
[Dang Gui (10g.), Ban Xia (12g.), Chen Xiang (10g.), Chuan Xiong (10g.), Ge Gen (10g.), Bai Shao (18g.), Gan Cao (10g.), Sheng Jiang(7 pieces)]

Liver Yin Insufficiency w/ Liver Qi Surging & Counerflowing1
Feeling of Qi flowing upward from te lower abdomen, chest oppression, throat tightness, dizziness, vertigo, thin or emaciated body, dry rough eyes
Tongue: thin tongue, scanty fluids and scanty or even peeled coat
Pulse: bowstring, fine, rapid
Treatment Principle: Enrich Yin and nourish the blood, level surging and downbear counterflow
Acupuncture Treatment: Even Technique: KI-3, SP-6, LR-3, CV-4, CV-6; Drain: CV-17, PC-7
Herbal Treatment: Yi Guan Jian Jia Wei1
[Sha Shen (15-20g.), Sheng Di (15-20g.), Gou Qi Zi (12-15g.), Mai Dong (10-12g.), Dang Gui (10-12g.), Cuan Lian Zi (10g.), Dai Zhe Shi (10g.)]
Modifications:
Dry mouth w/ bitter taste: + Huang Lian
Constipation: + Bai Zi Ren, Zhi Ke