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5. Abdominal distension accompanied by fever and hemorrhage, cold extremities with signs of collapse (a critical state of Yang deficiency and Yin exhaustion), frequent and unceasing diarrhea; edema starting in the four limbs and then spreading to the abdomen, followed immediately by abdominal fullness after purging. Distended and prominent subcutaneous veins on the abdomen, blackened lips, protruding umbilicus, putrefaction of the scrotum, flattening of swelling in the supraclavicular fossa (Quepen), back, and soles of the feet, a pulse that is large but intermittent, or deficient, thready, and choppy. Encountering such swelling conditions is indeed alarming.

[Note] Abdominal distension with fever indicates distension due to excessive Yang heat; if accompanied by vomiting blood, epistaxis, or hematochezia, it signifies the loss of Yin fluids. Thin and cold extremities indicate distension due to excessive Yin cold; if accompanied by incessant frequent diarrhea, it signifies the sinking and loss of Middle Qi. If swelling starts in the abdomen and spreads to the limbs, it is treatable; if swelling starts in the limbs and then involves the abdomen, it is untreatable. Swelling diseases are mostly excess patterns. If symptoms temporarily resolve after taking purgatives but recur immediately, it indicates that righteous Qi cannot overcome pathogenic factors, which is also untreatable. Prominent and raised abdominal veins, skin swollen and dark cyanotic, protruding umbilicus, putrefying scrotum, flattened swelling in the supraclavicular fossa, back, and soles indicate damage to the Five Zang organs, all of which are untreatable. A pulse that is large yet intermittent, or deficient, thready, and choppy, indicates the deterioration of Qi and Blood, all of which are death pulses.

6. Skin distension (Fuzhang) and vessel distension (Maizhang) present as generalized body swelling. Single abdominal distension presents as a drum-like abdomen with normal limbs. For skin distension, Muxiang Liuqi Yin (Wood Fragrance Qi-Regulating Decoction) is indicated. For vessel distension, add Jianghuang (Turmeric Rhizome) and Fuxiong (Ligusticum Chuanxiong Rhizome) to this formula.

[Note] Skin distension refers to swelling of the skin; vessel distension refers to swelling of the meridians. Both of these involve generalized body swelling. Single abdominal distension refers to abdominal fullness without limb swelling. Drum distension refers to an abdomen swollen like a drum. Both of these involve abdominal distension without limb swelling. Skin distension is suitable for treatment with Muxiang Liuqi Yin. Vessel distension also uses this decoction, additionally adding Jianghuang and Fuxiong. The formula is recorded in the chapter on various types of distension.

Houpo San (Magnolia Bark Powder) and Xiayuxue Tang (Decoction for Expelling Stasis-Blood)

7. Single abdominal distension (drum distension) should be treated by distinguishing between Qi excess and Blood excess. Intestinal polyps (Changqin - accumulations in the abdomen belonging to Qi disorders) caused by Qi excess are treated similarly to Qi excess distension, using Houpo San, composed of Houpo (Magnolia Officinalis Bark), Binglang (Areca Seed), Muxiang (Vladimiria Root), Zhike (Aurantium Fructus Immaturus), Qingpi (Citrus Reticulata Pericarpium Viride), Chenpi (Citrus Reticulata Pericarpium), Gansui (Kansui Radix), and Daji (Euphorbia Pekinensis Root). Stone fibroids (Shijia - hard masses in the abdomen belonging to Blood disorders) caused by Blood excess are treated similarly to Blood excess distension, using Xiayuxue Tang, composed of Dahuang (Rhubarb Root), Taoren (Persicae Semen), E'chong (Mylabris), and Gansui (Kansui Radix).

Cold Distension and Heat Distension: Zhongman Fenxiao Tang (Decoction for Dispersing Fullness in the Center)

8. Distension caused by Qi deficiency should be distinguished into cold and heat types. There are two formulas for Zhongman Fenxiao Tang. For cold distension, use Ren Shen, Huang Qi, Dang Gui, Fu Ling, Houpo, etc., including Banxia (Pinellia Tuber), Wuyu (Evodia Fruit), Huanglian (Coptis Rhizome), Ganjiang (Zingiberis Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Chuanwu (Aconitum Carmichaelii Lateralis Radix Praeparata), Mahuang (Ephedrae Herba), Qingpi (Citrus Reticulata Pericarpium Viride), Huangbai (Phellodendri Cortex), Ze Xie (Alismatis Rhizoma), Bidengqie (Schizonepetae Fructus), Caodoukou (Amomi Fructus Rotundus), Yizhi (Alpiniae Oxyphyllae Fructus), and Muxiang (Vladimiria Root). For heat distension, use Suosha, Liujun Zi, Zhimu, Zhuling, Ze Xie, etc., including Zhike (Aurantium Fructus Immaturus), Houpo (Magnolia Officinalis Bark), Huangqin (Scutellariae Radix), Huanglian (Coptis Rhizome), Ganjiang (Zingiberis Rhizoma), and Jianghuang (Curcumae Longae Rhizoma).

[Note] Distension has distinctions of deficiency, excess, cold, and heat. If distension is accompanied by weak form and Qi with cold signs, Cold Distension Zhongman Fenxiao Tang is suitable, composed of Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Houpo (Magnolia Officinalis Bark), Banxia (Pinellia Tuber), Wuyu (Evodia Fruit), Huanglian (Coptis Rhizome), Ganjiang (Zingiberis Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Chuanwu (Aconitum Carmichaelii Lateralis Radix Praeparata), Mahuang (Ephedrae Herba), Qingpi (Citrus Reticulata Pericarpium Viride), Huangbai (Phellodendri Cortex), Ze Xie (Alismatis Rhizoma), Bidengqie (Schizonepetae Fructus), Caodoukou (Amomi Fructus Rotundus), Yizhi (Alpiniae Oxyphyllae Fructus), and Muxiang (Vladimiria Root). If distension is accompanied by weak form and Qi with heat signs, Heat Distension Zhongman Fenxiao Tang is suitable, composed of Suosha (Amomi Fructus), Ren Shen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata), Guangpi (Citrus Reticulata Pericarpium), Banxia (Pinellia Tuber), Zhimu (Anemarrhenae Rhizoma), Zhuling (Polyporus), Ze Xie (Alismatis Rhizoma), Zhike (Aurantium Fructus Immaturus), Houpo (Magnolia Officinalis Bark), Huanglian (Coptis Rhizome), Ganjiang (Zingiberis Rhizoma), and Jianghuang (Curcumae Longae Rhizoma).