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In addition to Shuigu (Ascites with fluid accumulation) and Qigu (Abdominal distension due to Qi stagnation), there is another condition known as Xuegu (Abdominal distension due to blood stasis), which is even more difficult to treat than Shuigu or Qigu. However, this condition is very rare; a physician might practice for decades without encountering it once. Even if encountered, it is often mistaken for Shuigu or Qigu, and the practitioner may not realize it is Xuegu. Therefore, medical texts rarely discuss this condition, truly because the swelling morphology of this condition is almost indistinguishable from that of Shuigu and Qigu. The only distinguishable feature is the appearance of purple reticular patterns on the superficial veins throughout the body.

The etiology of Xuegu is mostly due to excessive physical exertion, which agitates Qi and Blood, or due to sudden anger causing Qi to rise upward, leading Blood to ascend with Qi. This results in Blood failing to return to its proper meridians. If this Blood is not immediately expelled through vomiting or diarrhea, it remains stagnant in the Zang-Fu organs, blocking the meridians. Consequently, the Qi transformation throughout the body becomes obstructed, and the water metabolism of the Sanjiao (Triple Burner) fails to function normally. Thus, at the onset of Xuegu, symptoms of Water retention and Qi stagnation are often present. As the blood stasis gradually accumulates and fills up, the blood vessels throughout the body become blocked by stasis. The superficial veins become visible and turn purple, with fine reticular patterns extending outward from these purple areas. Initially, there may be only two or three such areas, but eventually, purple reticles cover the entire body. If, when the purple color first appears in the superficial veins, the patient's constitution is still supportive, it is appropriate to first use Xia Yuxue Tang (Downward-Purging Decoction for Blood Stasis) from the *Jingui Yaolue* (*Essential Prescriptions of the Golden Cabinet*), added with Ye Taishen (Codonopsis Radix, Dangshen) for a few qian, to purge the stasis. After the abdominal stasis is purged, medication can be used again to resolve the stasis within the blood vessels, supplemented by herbs that promote diuresis and regulate Qi. Persisting in treatment for one month may yield results. If the condition progresses to the point where multiple superficial veins throughout the body show purple discoloration, the patient's body must have become extremely emaciated and weak. At this stage, even administering Xia Yuxue Tang might risk the patient's inability to withstand the purgation after the stasis is expelled. In such cases, one may use my formulated Huayu Tongjing San (Blood-Resolving and Meridian-Unblocking Powder), optionally mixed with Sanqi powder (Notoginseng Radix et Rhizoma), or taken with a decoction of herbs that promote diuresis and regulate Qi. Over time, this too can be effective. If the abdominal stasis has been purged but the purple reticles on the body have not yet disappeared, one can use Dan Shen powder (Salvia Miltiorrhiza Radix et Rhizoma) and Sanqi powder, each 1 qian, along with a decoction of Shan Zha (Crataegus Pinnatifida Fructus) 4 qian, taken with brown sugar water, twice daily. With prolonged use, they will naturally dissipate.

Xia Yuxue Tang (Downward-Purging Decoction for Blood Stasis) from *Jingui Yaolue*: Dahuang (Rhei Radix et Rhizoma) 3 liang (equivalent to 9 qian today), Taoren (Persicae Semen) 30 pieces, E chong (Eupolyphaga seu Steleophaga, ground beetle) 20 pieces (feet removed and roasted/fried). The above three ingredients are powdered, mixed with refined honey to form four pills. One pill is boiled in 1 sheng of wine (approximately 4+ liang), yielding 8 ge, taken in one dose. The discharged stasis resembles pig liver. Note: This formula must be prepared as pills and then administered as a decoction. This method involves consuming not only the liquid but also the dregs. Such administration ensures that the medicinal power is both gentle and potent, allowing long-standing abdominal stasis to be completely purged with a single dose. Those using this formula must adhere to this method for efficacy. Furthermore, the skin of Xingren (Armeniacae Semen Amarum, bitter apricot seed) is toxic, whereas the skin of Taoren is non-toxic. Its red skin possesses particularly strong blood-invigorating properties. Thus, the Taoren in this formula seems suitable for raw use with the skin intact. However, if raw Taoren with skin is indeed used, careful identification is required to ensure it is genuine Taoren and not mistakenly substituted with Xingren with skin.

Ultimately, patients with Xuegu whose constitutions are still relatively robust can be cured if treated according to the aforementioned methods. If the patient has become emaciated and weak, even if the stasis is thoroughly cleared, there remains a risk of danger. This is an important point to recognize. During clinical practice, this matter must be clearly explained to the patient. If the patient earnestly requests treatment, it is not too late to proceed.