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**Gu Zhang (Drum Distension)** refers to swelling and fullness. Regardless of whether the pathology involves the five zang organs or six fu organs, whether it is a new or chronic condition, and whether it presents as deficiency or excess, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be used exclusively. However, if the distension arises from qi stagnation, He Zhong Wan (Harmonize the Middle Pill) is efficacious. (Its efficacy lies in the combination of Chen Pi [Tangerine Peel] and Mu Gua [Chaenomeles Fruit].) It can also be used at the initial stage of various types of Gu Zhang. I do not believe in any other methods outside of this.

There is another type where cold water insults the spleen earth (kidney water coldness overacting on spleen earth). In such cases, swelling necessarily begins in the head, face, and four limbs, before spreading to the abdomen. Only for this specific presentation is Bu Zhong Yi Qi Tang suitable, taken together with Jin Gui Jia Jian Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet). (For this condition, taking Bu Zhong Yi Qi Tang alone is ineffective, and taking Jin Gui Jia Jian Shen Qi Wan alone is also ineffective.) However, treatment must begin early; otherwise, the pathogenic water will flood the middle jiao, leading to a collapse like a breached dam, rendering treatment futile.

There is also a case of middle-jiao deficiency complicated by dryness and distension. In such instances, use Bu Zhong Yi Qi Tang to administer Xuan Ming Fen (Mirabilite), three qian, which yields immediate results.

Another type is food-induced Gu Zhang, caused by dietary injury. At its onset, it invariably presents with Que Mu (Night Blindness/Aleukia, colloquially known as "chicken blindness entering the belly"). Physicians who disbelieve this and treat only the eyes fail to realize that this is the root of the distension. At this stage, one must urgently employ clearing agents. As stated in the Classics: "Open the ghost gate (induce sweating), cleanse the net house (promote urination)," thereby removing stagnation and eliminating stale pathogens. However, ancient methods are too harsh. The current prescription, Bao Zhong Wan (Protect the Middle Pill), is recommended; long-term consumption leads to self-healing. (Note: Bao Zhong Wan is not without its harshness; long-term use may damage middle qi, so dosage should be carefully considered. Zhang Xujiang stated: All distensions belong to spleen deficiency with inadequate transformation and transportation, resulting in turbid qi filling the spaces. In the early stages, slightly assist with digestive and qi-regulating herbs first. If the condition is severe with obstructed urination and defecation, mildly promote drainage. For weak individuals or those with prolonged illness, as well as post-dysentery, post-ulcer, or postpartum states, prioritize tonifying spleen qi with Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala Rhizome), and Bai Shao (White Peony Root), assisted by digestive herbs such as Hou Po (Magnolia Bark), Mu Xiang (Vladimiria Root), and Huang Lian (Coptis Rhizome). However, the kingly way of medicine yields no quick results; dozens of doses are required for gradual efficacy. It is common to see the use of Shang Lu (Phytolacca Root) and Qian Niu (Morning Glory Seed) to drain water, causing immediate reduction of swelling. Yet, relapse and death within three days are frequent. This is largely due to patients seeking quick fixes and physicians lacking theoretical understanding, thereby shortening natural lifespans. How tragic! Looking back at famous physicians of past and present, none surpass Li Dongyuan, Zhu Danxi, Xue Xinpu (Xue Ji), and Wang Sun'an (Wang Kentang). Would they have endured prolonged treatments if they did not know that attacking/purgative methods yield faster results? But what about the middle qi? These words can be spoken to the enlightened, but are difficult to explain to the vulgar.)

Dongzhuang stated: When treating swelling, regardless of the outcome, one should take the aforementioned methods as the pivot. Formulas such as Shu Zuo Yin (Discharge Irrigation Decoction), Jun Chuan San (Unclog River Powder), and Shen You Wan (Divine Protection Pill) should not be used recklessly unless the patient has robust constitution, strong physique, and abundant qi. Zhu Danxi’s principles of tonifying the spleen, protecting the lungs, and clearing fire are indeed unchangeable standards.

**He Zhong Wan (Harmonize the Middle Pill)**
Chen Pi (Tangerine Peel, 1 liang), Mu Gua (Chaenomeles Fruit, 1 liang, remove core), Ren Shen (Ginseng, 3 liang), Bai Zhu (Atractylodes Macrocephala Rhizome, 3 liang), Gan Jiang (Dried Ginger, 1 liang), Gan Cao (Licorice Root, 1 liang).
Grind into powder, make pills with steamed wheat cake paste. Take 30-50 pills with warm water before meals.

**Jin Gui Jia Jian Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet)**
Indicated for spleen-kidney yang deficiency with cold, heavy sensation in the lower back, edema of the feet, retention of damp-fluids, difficulty in urination, abdominal swelling, limb edema, asthma with excessive phlegm, or established hydrothorax/ascites. Efficacy is miraculous.
Fu Ling (Poria, 3 liang), Ze Xie (Alisma Rhizome, 1 liang), Shan Yao (Chinese Yam Rhizome, 1 liang), Yu Rou (Cornus Fruit, 1 liang), Dan Pi (Moutan Cortex, 1 liang), Fu Zi (Aconite Lateral Root, 5 qian), Rou Gui (Cinnamon Bark, 1 liang), Niu Xi (Achyranthes Root, 1 liang), Che Qian (Plantago Seed, 1 liang), Shu Di (Prepared Rehmannia Root, 4 liang, crushed and mixed with wine, pounded into paste).
Grind into powder, mix with Rehmannia paste and refined honey to form pills the size of tung tree seeds. Take 70-80 pills on an empty stomach with rice gruel.

**Bao Zhong Wan (Protect the Middle Pill)**
Zhi Shi (Immature Bitter Orange, stir-fried), Hou Po (Magnolia Bark, stir-fried with ginger juice), Huang Qin (Scutellaria Root, washed with wine), Ban Xia (Pinellia Tuber, stir-fried with ginger juice), Cang Zhu (Atractylodes Lancea Rhizome, soaked in rice wash water and stir-fried), Chen Pi (Tangerine Peel), Lai Fu Zi (Radish Seed, stir-fried), San Leng (Sparganium Rhizome), Peng Zhu (Curcuma Zedoaria Rhizome, equal parts).
Make pills using Shen Qu (Medicated Leaven).