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**All cases of abdominal distension and enlargement belong to Heat:** This is a syndrome of excess pathogenic factors among the "Eight Benefits" (referring to pathological excesses), where the pathogen enters from outside (heaven). It results from contracting wind-cold pathogens, which transmit inward, transforming from cold into heat, leading to a stomach excess syndrome.

Manifestations include: tidal fever in the late afternoon, extreme thirst with a desire to drink, and delirious speech. If there are simultaneous Taiyang and Yangming syndromes presenting with severe excess and fullness, Da Cheng Qi Tang (Major Order the Qi Decoction) should be used for purgation. If Shaoyang and Yangming syndromes present with mild fullness and excess, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be used for purgation. By employing purgation, the distension will resolve; this is what is meant.

Suppose malaria causes distension and fullness; there are also cold distension and heat distension types. These arise from heavenly pathogenic factors injuring the summer-heat, resulting in disease. If not treated promptly, when autumn arrives and the summer-heat qi declines and perishes, the malaria illness manifests. Recognizing it as a cold syndrome, using Jiao Xie Yin Zi (Intersecting Resolution Drink) from the *Ju Fang* (Standard Formulary) is correct.

Internal deficiency and insufficiency, along with cold-dampness causing middle-jiao fullness, as well as distension in all five zang and six fu organs, require comparison based on the pulse diagnosis regarding the degree of cold and heat. Cold in the stomach leads to distension; turbid qi stagnating in the upper jiao generates distension. Treatment for distension should target the Foot Three Yang meridians. Among them, the Foot Taiyang Bladder Meridian governs cold water; if cold water pathology occurs, distension arises. Sudden abdominal fullness that does not subside upon pressure indicates taking the Foot Taiyang meridian, as it is the front-mu point of the stomach. This aligns with conditions of abdominal fullness, distension, and rebellious qi rising from the limbs, diaphragm, and hypochondrium to the head, caused by the obstruction of cold-dampness in the Taiyin and Yangming meridians within the stomach. Distension due to Taiyin pathology involves constipation, anorexia, vomiting after eating, and inability to lie down. As described above, there are many such cases of cold distension.

The treatment method for middle-jiao fullness should be "opening the ghost gate and cleansing the clean mansion." "Opening the ghost gate" refers to inducing sweating; "cleansing the clean mansion" refers to promoting urination. For middle-jiao fullness, one should drain from within, meaning that when the spleen and stomach are diseased, the pathogen should be dispersed upward and downward. Warming the lower jiao is like dredging channels; qi and blood will naturally differentiate without needing to purge fecal matter forcefully. However, if there is true excess and fullness with difficulty in urination and defecation, one may resort to purgatives using cold or hot herbs as a temporary measure.

Alternatively, individuals who consume alcohol, damp-wheat noodles, rich flavors, or fatty and sweet foods, or those who lie down immediately after eating, cause damp-heat qi to fail in proper transformation and distribution, resulting in abdominal distension. This type of distension is also heat distension, treated primarily with Fen Xiao Wan (Separate and Disperse Pill).

If one consumes excessive cold-cooled foods, or if the spleen and stomach have been deficient for a long time, cold in the stomach leads to distension, or internal cold generates fullness diseases. For treating cold distension, Zhong Man Fen Xiao Tang (Middle Fullness Separation and Disperse Decoction) is the primary formula.

Treating middle-jiao fullness, heat distension, drum distension, qi distension, and water distension does not fall under the category of cold distension.

Bai Zhu (Atractylodis Rhizoma), Ren Shen (Ginseng Radix), Zhi Gan Cao (Prepared Licorice Radix et Rhizoma), Zhu Ling (Polyporus), Jiang Huang (Curcumae Longae Rhizoma) (each 1 qian); Bai Fu Ling (Poria with Hostwood Removed), Gan Sheng Jiang (Dried Ginger), Sha Ren (Amomi Fructus) (each 2 qian); Ze Xie (Alismatis Rhizoma), Ju Pi (Citri Reticulatae Pericarpium) (each 3 qian); Zhi Mu (Anemarrhenae Rhizoma) (stir-fried, 4 qian); Huang Qin (Scutellariae Radix) (removed rot, stir-fried; use 1 liang 2 qian in summer); Huang Lian (Coptidis Rhizoma) (cleaned and stir-fried); Ban Xia (Pinelliae Tuber) (washed seven times in decoction); Zhi Shi (Aurantii Fructus Immaturus) (stir-fried, each 5 qian); Hou Po (Magnoliae Officinalis Cortex) (processed with ginger juice, 1 liang).

Except for Fu Ling, Ze Xie, and Sheng Jiang, grind the remaining ingredients into an extremely fine powder. Mix evenly with the aforementioned three flavors (Note: The text implies mixing specific components, but traditionally all listed herbs are processed together). Steamed dough pills made from rice soup, sized like paulownia seeds. Take 100 pills each time, warmed, swallowed with plain warm water, taken at a distance from meals. Adjust dosage according to the patient's age and constitution.