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There are external causes, internal emotional stagnation, Qi deficiency, and Blood deficiency.

Generally speaking, diseases of swelling and distension arise from Spleen-Stomach weakness, combined with internal injury by the Seven Emotions (seven types of emotional responses), external invasion by the Six Excesses (six pathogenic factors), irregular diet, and sexual indiscretion leading to deficiency. The Yin of the Spleen Earth is injured, causing the organ responsible for transportation and transformation to lose its function. Although the Stomach receives food, it cannot transform and transport; clear and turbid Qi interfere with each other, meridians and collaterals become obstructed, stagnation generates heat, prolonged heat produces dampness, and the mutual generation of damp-heat eventually results in swelling and distension. Although the exterior appears hard and full, the interior is hollow like a drum. As stated in the classics, this is called "Drum Distension" (Gu Zhang). Treatment should tonify the Spleen Qi, and also nourish Lung Metal to control Liver Wood, ensuring the Spleen is free from the threat of "thief pathogens" (Liver overacting on Spleen); nourish Kidney Water to control Heart Fire, allowing Lung Qi to receive instructions for clear descent; avoid salty flavors to prevent aiding the pathogenic factor; and cut off delusions to preserve the maternal Qi (Kidney Essence). Only then can the body be at peace. People often use purgative or diuretic drugs to seek temporary relief, but the distension recurs, damaging True Qi and bringing death closer. How tragic! If the disease is superficial and Spleen Qi is still strong, using unblocking methods might seem appropriate, yet one must not use purgative/diuretic drugs. At the time of treating the patient, careful observation is required.

Zhu Danxi said: Distension that is better in the morning and worse in the evening indicates Blood deficiency; distension that is worse in the morning and better in the evening indicates Qi deficiency; constant urgency and distension throughout the day indicate both Qi and Blood deficiency. Abdominal distension in fat, pale individuals indicates Qi deficiency with Phlegm; abdominal distension in thin, dark-skinned individuals indicates Blood deficiency with Heat.

The Pulse Method states: Abdominal distension with a floating and large pulse indicates the pathogen is exiting, and the patient will escape danger; a deficient and small pulse indicates impending death, requiring urgent effort in treatment.

The Essentials state: For swelling and distension, a Wiry (Xian) pulse indicates the Spleen is controlled by the Liver; a Surging and Rapid pulse indicates Heat distension; a Slow and Weak pulse indicates Yin-Cold; a Floating pulse indicates Empty distension; a Tight pulse indicates Excess in the Middle Jiao; a Floating pulse indicates treatability; a Deficient pulse indicates critical danger.

1. Drum Distension, also known as Single Abdominal Distension, is caused by extreme Spleen deficiency. One must stay away from music and entertainment, avoid rich and greasy foods, and strongly tonify Middle Qi using Si Jun Zi Tang (Four Gentlemen Decoction) added with Cang Zhu (Atractylodis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Shen Qu (Massa Medicata Fermentata), and Hou Po (Magnoliae Officinalis Cortex), taken in large doses.

2. Abdominal distension due to Blood deficiency should be treated with Si Wu Tang (Four Substances Decoction) modified.

3. Abdominal distension in obese individuals should be treated with Ping Wei San (Powder to Pacify the Stomach) combined with Wu Ling San (Five-Ingredient Powder with Poria) modified.

4. Abdominal distension in thin, dark-skinned individuals, indicating Blood deficiency with Heat, should be treated with Si Wu Tang (Four Substances Decoction) added with Huang Lian (Coptidis Rhizoma) and Hou Po (Magnoliae Officinalis Cortex).

5. Individuals with an Excess pulse and robust physique may undergo purgation. Shi Zao Tang (Ten Date Decoction) or San Hua Wan (Three Flowers Pill) may be used; both formulas belong to the category of draining water edema.

6. Disturbance of the Liver due to anger, leading to disharmony between the Spleen and Stomach, should be treated with Ping Gan Yin Zi (Decoction to Calm the Liver) or Tiao Zhong Shun Qi Tang (Decoction to Regulate the Middle and Smooth Qi).

7. Abdominal distension due to Food Stagnation should be treated with Ping Wei San (Powder to Pacify the Stomach) added with Shen Qu (Massa Medicata Fermentata), Sha Ren (Amomi Fructus), Bing Lang (Arecae Semen), and Xiang Fu (Cyperii Rhizoma).

8. Abdominal distension due to Meat Stagnation should be treated with Ping Wei San (Powder to Pacify the Stomach) added with Cao Guo (Tsaoko Fructus), Sha Ren (Amomi Fructus), Bing Lang (Arecae Semen), or A Wei Wan (Asafoetida Pill).

9. Abdominal distension due to Blood Stasis should be treated with Di Dang Tang (Decoction to Pierce the Accumulation) or Can Xiong Tang (Decoction of Ginseng and Ligusticum) added with Hong Hua (Carthami Flos) and Tao Ren (Persicae Semen).

10. Abdominal distension caused by the Seven Emotions injuring the body, resulting in Turbid Qi remaining in the upper part, should be treated with Mu Xiang Shun Qi Tang (Decoction of Aucklandia to Smooth Qi).