Library

To treat distension (鼓胀) caused by Qi stagnation, and simultaneously to treat deficiency with stagnation of the Spleen and Stomach, where food cannot be transformed and transported.

Raw Jineijin (Galli Gigerii Endothelium Corneum) (4 qian, cleaned of gravel and dregs, then crushed) Baizhu (Atractylodis Macrocephalae Rhizoma) (3 qian) Sheng Hangshao (Paeoniae Radix Alba) (4 qian) Chaihu (Bupleuri Radix) (2 qian) Guang Chenpi (Citri Reticulatae Pericarpium) (2 qian) Shengjiang (Zingiberis Rhizoma Recens) (3 qian)

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "All dampness-induced swelling and fullness belong to the Spleen." Indeed, the Spleen is connected to the Stomach via membranes and can assist the Stomach in distributing body fluids. Furthermore, residing in the Middle Jiao (enclosed by the oily membranes of the Middle Jiao), it can disseminate Qi transformation to the surrounding areas. If the Spleen loses its governing function, body fluids and Qi transformation will become stagnant, leading to swelling and fullness. Therefore, treating distension should primarily focus on regulating the Spleen and Stomach. Western medicine posits that the spleen has a hollow interior containing many veins. If blood in these veins fails to circulate due to spleen disease, becoming stagnant into threads or clumps, this is originally indigestible by herbal roots. Jineijin is the gizzard lining of the chicken; since it can digest gravel, copper, and iron, it is evident that it excels at resolving有形 (solid/physical) accumulations. Thus, it can directly enter the Spleen to eliminate venous stasis. Coupled with Baizhu to strengthen and tonify the Spleen and Stomach to control the action, the digestive power becomes even greater. Chaihu, as recorded in the *Shennong Bencao Jing* (Divine Farmer's Materia Medica), "mainly treats dietary accumulation in the intestines and stomach, promoting the elimination of the old and generation of the new," indicating its ability to assist Jineijin in resolving stasis. Moreover, used together with Chenpi, one ascending and one descending, allowing Qi to flow freely. Shaoyao (Paeoniae Radix) is used because although the condition is Qi distension, it must also involve water retention; Shaoyao effectively promotes urination, i.e., moves water. When used with Shengjiang, it also harmonizes Ying and Wei (Nutritive and Defensive Qi), ensuring the free flow of Qi transformation throughout the body. Qi distension is inherently difficult to treat. Since prescribing this formula, several cases have been treated successfully.

For example, an elderly man in his sixties suffered from severe abdominal distension. After administering this decoction for several doses, the effect was not rapid. One qian of Heiqiu (Semen Mezerei Preparatum), stir-fried and finely ground, was added and taken with the decoction. After two doses, significant improvement was observed. Heiqiu was then removed, and after several more doses, he was completely cured. If there is a sensation of heat during urination and the urine is yellow and red, Huashi (Talcum) should be酌情 (discretionarily) added in amounts of several qian.

Although Jinejin possesses strong digestive properties, various materia medica texts claim it can reduce urine volume, which may be unsuitable for conditions involving water retention. The use of Baishao (White Peony Root) in this formula to promote urination serves to compensate for the shortcomings of Jinejin.

The *Huangdi Neijing* states: "Pressing the abdomen leaving an indentation that does not immediately rise indicates Fengshui (Wind-Water edema)." From my clinical experience, I know that for all cases of Shui Gu (Water Distension), pressing leaves an indentation that does not immediately rebound. In contrast, for Qi Gu (Qi Distension), the indentation rebounds immediately upon lifting the hand. Some may doubt that if water accumulates in the abdomen without flowing to the limbs, resembling the "single abdominal distension" described in medical texts, it would be difficult to distinguish between Qi and Water. However, if it is indeed a Water condition, deep pressure followed by a pause will leave a slight indentation when the hand is lifted, whereas no such mark remains in Qi conditions. Furthermore, in Qi distension, urination is normal; in Water distension, urination is often obstructed. This is another clear sign.