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(Note: Swelling)
Guzhang (Drum Distension) refers to the condition where the abdomen is distended and large like a drum. The etiologies include Qi stagnation, Blood stasis, Water retention, Food accumulation, Pi masses (obstructive masses), and Parasite accumulation. Each has its own differentiation of Cold/Heat and Deficiency/Excess, as well as distinctions in swelling characteristics.

For cases caused by Qi stagnation, the patient is prone to anger, leading to Hyperactive Liver Qi and Spleen Qi Deficiency, resulting in the failure of Lung Qi to disperse. Patients presenting this syndrome will invariably have accompanying coughing. Treatment should initially employ light agents, such as Sangbai Pi (Morus Albae Cortex), Xingren (Armeniacae Semen Amarum), and Tongcao (Tetrapanacis Medulla). This corresponds to what Xu Zhicai described in his "Ten Categories of Formulas" (Shi Ji) as "Lightness can dispel Excess." Subsequently, herbs that drain the Liver and transform Qi should be used, such as Sang Ye (Mori Folium), Hei Zhi Zi (Gardeniae Fructus Preparatus), Xiakucao (Prunellae Spica), Guangpi (Citri Reticulatae Pericarpium), Sharen Qiao (Amomi Fructus Pericarpium), and Dasu Geng (Perillae Caulis). For abdominal fullness caused by Qi Deficiency, one should tonify the Middle and augment Qi, adding ingredients from Wupi Yin (Five-Peel Decoction) to transform Qi and promote diuresis.

For cases caused by Blood stasis, it implies that blood has left the vessels, causing stasis within the Zang-Fu organs. Alternatively, it may result from bloody dysentery with difficult defecation, preventing the expulsion of pathogens. Treatment should focus on expelling stasis using Tao Ren (Persicae Semen), Guiwei (Angelicae Sinensis Radix Caudex), Honghua (Carthami Flos), Zharu (Crataegi Fructus), Zhishi (Aurantii Fructus Immaturus), Jineijin (Galli Gigerii Endothelium Corneum), and Dahuang (Rhei Radix et Rhizoma), combined with Qi-moving herbs.

For cases caused by Water retention, the causes are either Spleen Earth Deficiency failing to control Water, or Kidney Yang Deficiency and Cold failing to transform Qi, leading to water flooding. Treatment requires tonifying Earth and warming the Kidney, along with herbs that promote urination and transform Qi. In cases of Excess-type edema, where pressing the ankles leaves an indentation like mud, the infraorbital area is puffy as if just awakened, accompanied by facial edema, one should first apply "Kai Guimen" (Opening the Ghost Gate, i.e., inducing sweating) using Wind-dispelling herbs. Subsequently, use Wupi Yin (Five-Peel Decoction) supplemented with Yiren (Coicis Semen), Sharen Qiao (Amomi Fructus Pericarpium), Zexie (Alismatis Rhizoma), and Cheqianzi (Plantaginis Semen) to promote urination, known as "Jing Jingfu" (Cleaning the Fu Organs). This type of case is the easiest to treat.

Among these Qi, Blood, and Water syndromes, if complicated by food accumulation, digestive-resolving herbs should be added. If distension is due to Pi masses, Xiaopi Wan (Mass-Resolving Pill) should be used, modified according to the specific cause. If Guzhang is caused by parasite accumulation, Binlang (Arecae Semen), Leiwuan (Oryzodendronis Rhizoma), Wuyi (Meliosmae Fructus), and Shijunzi (Quisqualis Fructus) should be used, possibly augmented with Dahuang (Rhei Radix et Rhizoma) and Zhishi (Aurantii Fructus Immaturus).

Generally, edema is easy to treat, while distension is difficult. Edema often stems from external pathogens, whereas distension originates from internal Zang-Fu dysfunction. If there is no swelling in the upper or lower body, but only prominent varicose veins on the abdomen, protruding umbilicus, and isolated abdominal distension, it is particularly difficult to treat.

After malaria resolves, one must strictly avoid sudden tonification, which often leads to unpredictable complications. Since the pathogen is half-inside, upon initial recovery, the pathogen is not yet fully expelled in 40-50% of cases. Those skilled in regulation should consume vegetarian and bland meat diets, waiting for the Stomach Qi to recover; once Zheng Qi (Upright Qi) is strong, the lingering pathogen will naturally depart. It is common to see individuals who, after recovering from malaria, take Ginseng Decoction and ultimately develop Wei Syndrome (Flaccidity Syndrome); others who eat baked Lablab Beans immediately after malaria develop Guzhang, both leading to death. How prudent one must be!