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Abdominal fullness, commonly known as abdominal distension, can belong to heat patterns or cold patterns. In Yang-heat patterns, there is abdominal fullness and dry throat, or constipation and difficult urination/defecation, tidal fever, and delirious speech. In Yin-cold patterns, there is abdominal fullness, vomiting of food that cannot be swallowed, spontaneous diarrhea worsening over time, and occasional spontaneous abdominal pain. Although abdominal fullness is a interior syndrome (Li Syndrome), it has degrees of depth. The classics state: If the exterior is resolved and there is no internal accumulation, but if it is not severe fullness, chills and fever will still occur, meaning the disease is not cured; this indicates the pathogen has not fully entered the fu organs, so the pathogen is shallow. If there is severe fullness, solidity, and hardness with dry feces, purgation can be used; even after four or five days, it will not cause harm, indicating the pathogen has entered the fu organs and the disease is deep. Abdominal fullness generally allows for purgation, but there are differences between excess and deficiency. The classics state: Abdominal fullness that does not decrease indicates an excess pattern, which can be treated with purgation; if abdominal fullness decreases intermittently, it indicates a deficiency pattern, and purgation should not be used. It also states: Abdominal fullness that does not decrease, even if slightly reduced, is insufficient to negate the need for purgation; it should be purged. *Jin Gui Yao Lue* states: Abdominal fullness that decreases intermittently and recurs is due to deficiency-cold qi rising from below; warm medicines should be used to harmonize it. Generally, stagnation of deficient qi also causes distension, but it is not as hard and painful as in excess patterns. All meridians can present with abdominal fullness, but Taiyin belongs to Spleen-Earth, located centrally, and specifically governs abdominal fullness. There are more than twenty clauses on abdominal fullness, with treatment methods including sweating, vomiting, purging, warming, and acupuncture. There are also cases where abdominal distension occurs after sweating, vomiting, or purging, with different treatments for each. Generally, the Stomach is the master of body fluids; sweating leading to loss of Yang causes Stomach Qi deficiency, preventing the frequent distribution of Qi, leading to Qi stagnation and distension. This should be treated with warming and dispersing methods; Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) is suitable. After vomiting, if the pathogen remains and abdominal distension occurs, it is because the pathogen in the chest has transmitted downward to the Stomach, causing obstruction and excess, resulting in distension. Purging is required; Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) is suitable. If the pathogen has not entered the fu organs and purgation is wrongly used, the exterior pathogen enters due to deficiency and becomes stagnant; there is empty irritability in the chest, and Qi cannot circulate freely up and down, causing abdominal fullness. Vomiting should be induced; Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is suitable. If physicians can examine the origin of the pathogen, truly understand the excess or deficiency of the pathogen's location, and appropriately use warming and tonifying methods or acupuncture when sweating, vomiting, and purging fail, perfect results can be achieved. Additionally, Chest Binding (Jie Xiong) starts from the epigastrium down to the lower abdomen, presenting with hardness, fullness, and pain, similar to abdominal fullness. However, pressing on Chest Binding causes pain and the hand cannot approach; abdominal pain presents with pain upon lifting or pressing, and the hand approaching is not very bothersome. Pi Syndrome (Stagnation Syndrome) also starts from the epigastrium down to the lower abdomen, similar to fullness. However, Pi Syndrome may only stay at the epigastrium, while abdominal fullness is mainly in the middle of the abdomen; these are differences, and clinical examination is necessary.

Taiyang Stage After sweating leads to abdominal fullness, treat with Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction). Cheng Wuji notes: Abdominal distension after vomiting or purging is described as excess, indicating the pathogen entering the interior due to deficiency becoming excess. After sweating, the exterior is resolved; abdominal fullness is known not to be interior excess, but rather caused by insufficiency of Stomach and Spleen body fluids, Qi涩 (stagnation/blockage), and obstruction leading to fullness. This decoction harmonizes the Stomach and Spleen and descends Qi. Zhang Yuansu asks: In the Taiyang chapter, various post-sweating syndromes do not mention "Taiyang Disease," which is natural, but why list them under Shanghan? Why only mention abdominal fullness after sweating, treated with Houpo Banxia Shengjiang Renshen Tang? I say: Whenever "after sweating" is mentioned, it is because there is no exterior syndrome, no other interior syndromes, only abdominal fullness. Apart from this, health is restored. Can "Shanghan" be spoken lightly? Its transmission and prognosis change like flipping a palm. How can it be grouped with just one other syndrome? Other post-sweating entries follow this logic.

Houpo Shengjiang Renshen Gancao Banxia Tang Formula
Houpo (Bark of Magnolia officinalis, roasted, peeled) - Half jin (approx. 250g)
Shengjiang (Fresh Ginger Root) - Half jin (approx. 250g)
Renshen (Radix Ginseng) - One liang (approx. 37.5g)
Banxia (Rhizoma Pinelliae, washed) - Half sheng (approx. 150ml volume)
Gancao (Radix Glycyrrhizae) - Two liang (approx. 75g)
Take the above five herbs, boil in ten dou (approx. 20 liters) of water, reduce to three sheng (approx. 600 ml), remove dregs, take one sheng (approx. 200 ml) warm, three times daily.

After purgation in Shanghan, if there is irritability, abdominal fullness, and restlessness (unable to lie or sit comfortably), treat with Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction). Cheng Wuji notes: After purgation, only abdominal fullness without irritability indicates pathogen entering the interior as excess; only irritability without abdominal fullness indicates pathogen in the chest as empty irritability. Both irritability and fullness indicate pathogen obstructing the chest and abdomen. Fullness prevents sitting; irritability prevents lying, causing restlessness. Zhizi Houpo Tang clears irritability and relieves fullness. In Taiyang disease, after passing the meridian stage for over ten days, if there is a sensation of nausea in the epigastrium, chest pain, loose stools, mild abdominal fullness, and slight depression/irritability, following previous extreme vomiting or purging, treat with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction). If not cured, do not give it. Only wanting to vomit, chest pain, and loose stools indicate this is not Chaihu Syndrome, but result from extreme vomiting/purging. (See Wuzhuyu Tang and Banxia Xiexin Tang for vomiting details). In Taiyang Wind Strike, if fire therapy is used to induce sweating, wind pathogen combined with fire causes blood and Qi to overflow abnormally. Two Yangs scorching each other causes jaundice. Excess Yang leads to epistaxis; Yin deficiency leads to difficult urination. Both Yin and Yang are depleted, body becomes dry, only head sweats up to the neck, abdominal fullness, slight wheezing, dry mouth, rotten throat, or constipation. Long-term leads to delirium, severe cases include hiccups, restless limbs, picking at clothes/bed sheets. If urine is clear/profuse, it is treatable. In Shanghan, abdominal fullness and delirium with floating-tight pulse at Cun position indicate Liver attacking Spleen, named Zong (Vertical); puncture Qimen (LR14). (Abdominal fullness and delirium are Spleen/Stomach diseases; floating-tight is Liver pulse; Spleen disease showing Liver pulse is Wood overcoming Earth. Classics state: Water overcoming Fire, Wood overcoming Earth is called Zong. Qimen is the Front-Mu point of the Liver, used to drain excess Liver Qi). In Shanghan, fever, aversion to cold, intense thirst with desire to drink, abdominal fullness, spontaneous sweating, and clear urination indicate the disease is resolving; this is Liver attacking Lung, named Heng (Horizontal); puncture Qimen (LR14). (Note: Fever and aversion to cold are exterior; spontaneous sweating means exterior is resolved. Intense thirst and abdominal fullness are interior; clear urination means interior is harmonized. Thus, disease resolves spontaneously. The words "puncture Qimen" are suspected to be interpolations).

Yangming Stage Mouth bitterness, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, floating-tight pulse. If purged, abdominal fullness and difficult urination occur. (Mahuang Tang). Three Yang Combined Disease: Abdominal fullness, heaviness making turning difficult, insensitivity of mouth, greasy face, delirium, urinary incontinence. Sweating worsens delirium; purging causes sweat on forehead and cold extremities. If spontaneous sweating, use Baihu Tang (White Tiger Decoction). Yangming Disease with slow pulse: difficulty eating until full, slight irritability and vertigo after eating,必定 (must) difficult urination. This is about to become Grain Jaundice. Even if purged, abdominal fullness remains because of the slow pulse. (Zhi Bo Tang). After vomiting in Shanghan, if abdominal fullness occurs, give Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction). Cheng Wuji notes: *Nei Jing* states: All abdominal distensions and enlargements belong to Heat. Heat in Upper Jiao causes vomiting. If vomiting fails to resolve and abdominal fullness recurs, heat pathogen has entered the Stomach; use Tiaowei Chengqi Tang to purge Stomach heat. If sweating fails to resolve the disease and abdominal fullness/pain occur, urgently purge with Dachengqi Tang (Major Order the Qi Decoction). If abdominal fullness decreases intermittently but the reduction is negligible, purge with Dachengqi Tang. (Fullness and pain indicate excess; intermittent decrease suggests non-excess. The next clause explains the previous text: if only fullness without pain, it may not be excess; if fullness without decrease, it can be purged. Zhang Yuansu argues: The phrase "decrease is negligible" implies fullness does not decrease, warranting Dachengqi Tang. If it fluctuates, it is not indicated. The reference to "decrease is negligible" should be linked to the "fullness does not decrease" clause, not appended loosely. Similar textual issues exist in Taiyang chapter regarding Guizhi Tang vs Mahuang Tang for nosebleeds). After purging Yangming Disease, if there is profound irritability (Ao Nao) and烦 (restlessness), and dry feces in the Stomach, use Dachengqi Tang. If abdominal fullness is mild, stool is likely hard initially then loose, do not purge. (Post-purge Ao Nao and irritability is empty irritability, treat with Zhizi Chi Tang. If dry feces exist, it is not empty irritability, use Dachengqi Tang. Mild fullness with hard-then-loose stool indicates no dry feces; heat is not in Stomach but above, so do not purge). In Shanghan, after seven to eight days, yellow skin like orange peel, difficult urination, mild abdominal fullness, use Yinchen Hao Tang (Artemisia Capillaris Decoction). Yangming Disease with slow pulse, sweating without aversion to cold, body heaviness, shortness of breath, abdominal fullness, wheezing, and tidal fever indicate exterior is resolving and interior can be attacked. Continuous sweating on hands and feet indicates hardened stool; use Dachengqi Tang. If profuse sweating, slight fever/aversion to cold, exterior is unresolved; if no tidal fever, do not use Chengqi Tang. If severe abdominal fullness and blockage, use Xiaochengqi Tang (Minor Order the Qi Decoction) to mildly harmonize Stomach Qi, avoiding severe purgation. Yangming Disease with floating-tight pulse, mouth bitterness, dry throat, abdominal fullness, wheezing, fever, sweating, aversion to heat, body heaviness. (Wuling San, Baihu Tang). Yangming Disease with tidal fever and slightly hard stool: Dachengqi Tang. If no bowel movement for six-seven days, suspect dry feces; give small amount of Chengqi Tang. If no passage of gas after ingestion, stool is hard initially then loose, do not purge; purging causes fullness and anorexia. Thirst for water leads to hiccups. Subsequent fever indicates recurrent hard stool; use Xiaochengqi Tang. Yangming Wind Strike with wiry-floating-large pulse, shortness of breath, generalized abdominal fullness, hypochondriac and heart pain, Qi obstruction upon pressure, dry nose, inability to sweat, lethargy, whole-body and facial jaundice, difficult urination, tidal fever, occasional hiccups: give Xiao Chaihu Tang. If pulse is only floating with no other symptoms: Mahuang Tang.

Taiyin Stage Disease presents with abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purged, chest/epigastric binding/hardness occurs. (Lizhong Wan/Tang; if no thirst, Sini Tang). Zhang Yuansu notes: Initial Shanghan affects Taiyang, then transmits to Yangming/Shaoyang. Pathogens entering via Yin meridians: Taiyang is first affected by external Wind-Cold from exterior. Diseases starting in Yin meridians are internal injuries from excessive raw/cold food, entering via Taiyin. Taiyin is Spleen; raw/cold food damages Spleen, causing abdominal fullness, vomiting, inability to eat, spontaneous diarrhea without thirst, and warm extremities. Guizhi Jia Shaoyao Tang and Guizhi Jia Dahuang Tang (see previous clauses).

Shaoyin Stage Disease, after six-seven days, abdominal fullness and constipation: urgently purge with Dachengqi Tang. Cheng Wuji notes: This is Shaoyin transmitting to Fu organs. At six-seven days, Shaoyin pathogen enters Fu; Yangming internal heat is severe, causing fullness and constipation. Yangming Earth overcoming Kidney Water causes dryness; urgently use Dachengqi Tang to save Kidney Water.

Jueyin Stage Diarrhea with undigested food: do not sweat; sweating causes abdominal fullness. (Sini Tang). Diarrhea, abdominal fullness, body pain: first warm the interior with Sini Tang, then attack the exterior with Guizhi Tang. (Diarrhea and fullness indicate interior deficiency-cold; warm interior first. Body pain indicates unresolved exterior. After diarrhea stops and interior harmonizes, use Guizhi Tang for exterior). Shanghan with hiccups and abdominal fullness: check anterior (urine) and posterior (stool) obstructions; relieve obstruction to cure. Cheng Wuji notes: Hiccups and fullness indicate Qi rising without descending. Check anterior/posterior obstructions and relieve them to descend Qi. Anterior is urine, posterior is stool. Use Wuling San or Xiaochengqi Tang.

Contraindications Constipation for six-seven days: give small dose of Xiaochengqi Tang. If no gas passes, do not purge; purging causes fullness and anorexia. (See Constipation section). Abdominal fullness with vomiting/diarrhea: contraindicated for purging. (See Taiyin section). Abdominal fullness with floating-tight pulse, mouth bitterness, dry throat: contraindicated for sweating/purging/acupuncture. (See Spontaneous Sweating section). Abdominal fullness with slow pulse: contraindicated for purging. (See Slow Pulse section). Abdominal fullness with weak pulse and spontaneous diarrhea: if using Dahuang (Rhubarb) and Shaoyao (Peony), reduce dosage. (See Taiyin Disease section).

Appendix
Huoren Shu: If irregular diet causes Cold in Yin meridians, chest/diaphragm discomfort, abdominal fullness/blockage, blue lips, cold extremities, deep-thin pulse, low mood, or acute abdominal pain, use Lizhong Tang plus Qingpi (Aurantii Fructus Percarpus). One to two doses bring relief. Zhishi Lizhong Wan and Wuji San are excellent. For abdominal distension/fullness, Jiegeng Banxia Tang is suitable.

Jiegeng Banxia Tang Treats Shanghan with epigastric/abdominal stagnation and fullness, intermittent pain.
Jiegeng (Platycodon Root, lightly fried) - One liang
Banxia (Pinellia Rhizome, ginger-processed) - One liang
Juhong (Citrus Reticulata Pericarpium) - One liang
Grind into powder. Take four qian (approx. 15g) per dose, with three slices of fresh ginger, decoct in water.

Haizang: Shaoyin Syndrome with dribbling urination, fecal incontinence. Patient ill for six-seven days, heavy body, unable to open eyes, body cold as ice, abdominal fullness. Will swallow if offered food, otherwise shows no desire. Pulse is deep-thin, rapid, forceful upon pressure. Urgently purge with Dachengqi Tang.