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The *Classic of Internal Medicine* (*Huangdi Neijing*) states: Deficiency of the Foot-Taiyin Spleen meridian leads to distension and swelling (Gu Zhang). It also states: Cold in the Stomach leads to fullness and distension. Furthermore, it states: When turbid Qi remains in the upper jiao, distension arises. Abdominal distension is caused by deficiency of Lung and Spleen Qi, which fails to perform normal transportation and transformation, resulting in abdominal bloating. It is categorized into deficiency distension, excess distension, cold distension, and heat distension. Generally speaking, deficiency and cold distensions account for eight or nine out of ten cases, while excess and heat distensions account for only two or three out of ten. Why is this? Excess-heat patterns are easily observed by people; they may arise from food stagnation or from Taiyang cold pathogen penetrating inward and transforming into heat. Therefore, they are easy to diagnose and treat. In contrast, deficiency-cold patterns result from the decline and deficiency of Middle Qi, where Spleen Qi fails to transform and transport, leading to distension. Thus, they are difficult to detect and treat. If deficiency-cold is mistaken for excess-heat, the diagnosis will be completely off the mark, and the resulting complications will be countless. Hence, this analysis on abdominal distension is presented.

In children, prolonged illness can weaken Spleen Qi, or acute vomiting and diarrhea can suddenly injure Spleen Qi, disrupting normal transportation and transformation. Consequently, food is not digested; even with little intake, the abdomen becomes full and distended. The presenting symptoms include mental fatigue, sallow complexion, and emaciation. This is deficiency distension. Ancient methods primarily prescribe Xiangpo Sijunzi Tang (Cinnamon Twig and Magnolia Bark Four Gentlemen Decoction), containing Renshen (Ginseng Radix), Tu Chao Baizhu (Earth-fried Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Zhi Gancao (Honey-fried Licorice Root), Zhi Xiangfu (Prepared Cyperi Rhizoma), Jiang Chao Houpo (Ginger-fried Magnolia Bark), with Shengjiang (Fresh Ginger) as a guiding herb.
[Chen Shouzhen’s Note] Children’s deficiency distension often results from prolonged illness injuring the Spleen internally, or from excessive use of purgative medicines, both leading to abdominal distension. The formula uses Jilin Renshen Xu (Jilin Ginseng Tendril) 5 fen, Zi Houpo (Purple Magnolia Bark) 1 qian, Zhen Guangpi (Authentic Tangerine Peel) 1.5 qian, Zhi Jinshu (Prepared Atractylodis Macrocephalae Rhizoma) 1.5 qian, Bai Yunling (White Poria) 1.5 qian, Cao Kou Ren (Grass Cardamom Seed) 5 fen, Nan Muxiang (Southern Costus Root) 5 fen, Zhi Gancao (Honey-fried Licorice Root) 5 fen. If accompanied by cold signs, add Shu Fuzi (Prepared Aconite Lateralis Radix) 5 fen.

When children overeat, food stagnates in the Stomach, causing abdominal distension and difficulty in defecation. Symptoms include tidal fever, irritability, thirst, robust physical constitution, and strong Qi. This is excess distension. For mild cases, ancient methods primarily prescribe Jiawei Pingwei Tang (Modified Earth Regulating Decoction), containing Chao Cangzhu (Fried Atractylodis Lanceae Rhizoma), Chao Houpo (Fried Magnolia Bark), Dafupi (Areca Peel), Sheng Gancao (Raw Licorice Root), Chenpi (Tangerine Peel), Laifuzi (Radish Seed), Bei Shanzha (Roasted Hawthorn Fruit), Chao Maiya (Fried Hordeum Sprout), Chao Shenqu (Fried Mass Medicamentii Fermentati), with Shengjiang (Fresh Ginger) as a guiding herb. For severe cases, ancient methods primarily prescribe Xiao Chengqi Tang (Minor Order the Qi Decoction) (see previous text).
[Chen Shouzhen’s Note] Children’s excess distension often stems from pre-existing food accumulation in the abdomen or overeating, causing pathogens to knot in the Middle Jiao. The presentation includes high distension at the epigastrium and chest, body heat, thirst, lethargy with unwillingness to speak, abdominal pain with slight panting, and eyes closed tightly. These appear to be obvious signs of extreme deficiency. This pattern is very common in children. If one does not examine carefully and mistakes the immobility of limbs and closed mouth for Slow Convulsion (Man Jing Feng), thereby using sedating and phlegm-resolving formulas, the harm to the child will be profound. Who would bear the responsibility? The formula uses Xiao Zhishi (Small Immature Bitter Orange) 1 qian, Bai Kou Ren (White Cardamom Seed) 1 qian, Nan Shanzha (Southern Hawthorn Fruit) 1.5 qian, Chao Maiya (Fried Hordeum Sprout) 1 qian, Fan Zhi Qu (Fan-style Mass Medicamentii Fermentati) 1 qian, Sheng Jinwen (Raw Rheum Palmatum Rhizoma) 5 fen. Xuanmingfen (Mirabilite) 1.5 qian, Sheng Gancao (Raw Licorice Root) 5 fen, Sheng Tiaohuang Qin (Raw Scutellaria Baicalensis Root) 1 qian, with Laifuzi (Radish Seed) 8 fen and Dafuzi (Areca Seed) 5 fen as guiding herbs.