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Initially, facial edema occurred. Pathogenic factors invaded the Yang regions (upper body/head). Qi stagnation and obstruction ensued. Both urination and defecation decreased. Treatment with Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Prepared Aconite Root) was ineffective. Subsequently, a method to guide out stagnation was employed. Stagnation refers to tangible pathological products.
Damp-heat is an intangible pathogen. Entering the Lung causes wheezing. Invading the Spleen causes distension. The opening and closing functions of all six Fu organs were abolished. Defecation was unsmooth. Urination was short and turbid. Occasionally, only drops could be discharged.
Observing the crimson tongue and thirst. Fu organ diseases manifest as back distension. Zang organ diseases manifest as abdominal fullness. Additionally, the body leans to one side or the other, and swelling worsens depending on the position. The damp-heat is dispersed throughout the Sanjiao (Triple Burner). Even skilled physicians find it difficult to quickly determine the outcome. The Classic states: "When the disease progresses from above downwards, treat the upper part." It also states: "When the disease progresses from above downwards and worsens in the lower part, one must first treat the upper part, then the lower part." This case is chaotic and disordered, lacking any clear sequence. This is due to the error of failing to distinguish between tangible and intangible pathogens. For now, clearing and purifying the Upper Jiao is prioritized.
Fei Huashi (Calcined Talcum), Da Xingren (Large Apricot Seed), Sheng Yiyiren (Raw Coix Seed), Bai Tongcao (White Tetrapanax Pith), Xian Pipaye (Fresh Loquat Leaf), Fulingpi (Poria Peel), Dan Douchi (Light Fermented Soybean), Hei Shanzhike (Black Gardenia Husk).

The pulse on the right is large and slow. The left hand pulse is small, rapid, and hurried. In winter, alternating chills and fever with body pain occurred, resolving with sweating. Since labor, irregular diet, and anger, the condition has worsened daily. Facial and foot edema are present. Breathing is wheezy. Tears flow, and epistaxis occurs. Lying down causes Qi rushing upward. Food intake stagnates in the middle and fails to transform.
As the season transitions to summer, when the Spleen and Stomach are dominant. Observing the complexion and pulse situation, Zhongman Distension Disease (Middle Fullness Distension) is imminent. Generally, this case belongs to damage caused by fatigue and overwork. The initial pathology lies in the Spleen and Stomach. Li Dongyuan said: "The Stomach is the root of Wei Qi (Defensive Qi). The Spleen is the source of Ying Qi (Nutritive Qi)." When Zang and Fu organs are diseased, Ying and Wei Qi lose their normal circadian rhythm, manifesting as cold and heat. This was originally not a Shaoyang syndrome (half-exterior, half-interior) of Malaria. At that time, if a skilled physician had been present, Jianzhong Tang (Middle-Building Decoction) would have been prescribed for recovery. The Classics state: "For exhaustion, use warming methods. For deficiency, use tonification." Jianzhong Tang is sweet and warm, establishing the clear Yang of the Spleen and Stomach, stabilizing the Middle Jiao, avoiding further delay. Zhang Zhongjing also stated: "A large pulse in men indicates consumption/deficiency." Thus, the teachings of the Neijing, Li Dongyuan, and Zhang Zhongjing serve as true standards and rules. Moreover, sweating and accumulated fatigue both injure Yang. Medicines that are acrid and dispersing rob Yang; bitter and cold medicines damage the Stomach. The patient reported that drinking sugarcane juice caused discomfort in the Zhongwan region, followed shortly by acute pain in the lower abdomen and loose stools. The Stomach Yang was clearly severely damaged by acrid and bitter medicines. The patient also described frequent coughing and rebellious Chong Qi (Penetrating Vessel Qi) rising from below. The Chong Meridian belongs to the Yangming Stomach. When Stomach Yang is extremely injured, the Middle Jiao lacks the true Qi to anchor it. When the Chong vessel moves, all vessels move. Turbid Yin scatters and spreads upwards. This explains why lying down causes Qi rushing upward.
My analysis is not baseless but aligns with the Neijing: "Turbid Qi residing in the upper part generates distension." It also corresponds to Taiyin dampness causing abdominal distension. As the ancients said: "Do not treat phlegm just because you see phlegm; do not treat blood just because you see bleeding." One should deduce based on the transmission and transformation of the etiology. Hence this discussion.
Noupu (Magnolia Bark), Xingren (Apricot Seed), Renshen (Ginseng Root), Fuling (Poria), Mi Wei Jiang (Honey-fried Ginger), Nanzao (Southern Date/Jujube).

In the prime of life, yet emaciated and sallow-complexioned. The pulse on the right is small and hurried; the left is small, wiry, and forceful. The illness began last autumn with sudden epigastric pain and a tangible lump. After the illness, a sudden fright occurred, leading to gradual loss of appetite and discomfort. Food enters but fails to transform, stagnating in the upper epigastrium. The abdomen becomes distended, extending to the hypochondriac region. Limbs are cold. Warmth returns gradually at night. Defecation occurs only after ten days, accompanied by blood. Pressing the Qihai point above the navel on an empty stomach reveals a small mass with slight tenderness. Movement and drinking water make it disappear. In colder weather, nail beds turn purple. Careful analysis suggests Liver and Spleen pathology. Qi and Blood obstruction leads to stagnation. Over time, Yang becomes weak and bi-blocked, preventing circulation up and down. This resembles the hexagram Pi (Stagnation). Previous treatments using draining or tonifying methods failed because the profound principle of promoting Yang circulation was unknown.
Xiebai (Macrostemon Bulb), Guizhi (Cinnamon Twig), Gualouren (Trichosanthes Seed), Shengjiang (Fresh Ginger), Banxia (Pinellia Rhizome), Fuling (Poria).

Normally, damp-phlegm obstructing Qi causes wheezing. This time, excessive eating led to stagnation. The Yang of the Yin organs fails to transport; the Qi of the Yang organs fails to circulate. Defecation and urination are unsmooth. Ankle edema and abdominal distension are present. The pulse is deep and wiry, indicating Cold-Damp and Phlegm-Stagnation obstructing the Qi level. Up and down are blocked. Treatment should differentiate according to the Three Jiao. I saw a prescription using Tusizi (Dodder Seed) to ascend Shaoyin and Wuzhuyu (Evodia Fruit) to drain Jueyin. I do not understand the rationale and dare not agree. Instead, I adopt Liu Hejian's method of separating and eliminating.
Da Xingren (Large Apricot Seed), Laifuzi (Radish Seed), Zhuling (Polyporus), Zexie (Alisma Rhizome), Tinglizi (Lepidium Seed), Noupu (Magnolia Bark), Sangbaipi (Mulberry Root Bark), Guangpi (Tangerine Peel), Xi Mutong (Akebia Stem).

Two years ago, early autumn, sores erupted. Collaterals and Qi-Blood failed to circulate smoothly, resulting in abdominal fullness and heaviness. Lying down provided relief. Pulsation to the left of the umbilicus worsened when lying down. Vomiting cold saliva, feeling cold internally, numbness, and speech impediment. Liver Wind intensified, and dredging function failed. The Classics state: "Liver disease causes vomiting of saliva. Wood insults Earth, naturally leading to distension." Zhu Danxi said: "Self-perceived cold is not true cold." After two ulcerations, harsh and drying hot medicines are unsuitable. I propose treating by promoting the circulation of Liver and Stomach Qi. For chronic illness in the elderly, blandness is preferred.
Yun Fuling (Cloud Poria), Sanjiao Huma (Triangular Sesame), Nong Juhong (Strong Tangerine Red Peel), Nen Gouteng (Young Uncaria Vine), Shu Banxia (Prepared Pinellia), Baixuanfuhua (White Inula Flower).

The pulse is faint and slow. Complexion is withered and yellow. Crabs are shellfish, salty and cold, sinking in nature. For those with insufficient Yang, consuming them damages Yang. The cause of illness has been tested twice by the patient. Chronic diarrhea and dysentery always damage the Kidney. Now, edema begins from below. This is Water failing Fire and deteriorating. If not warming the Lower Jiao, merely seeing red in stool and attributing it to Spleen-Stomach Damp-Heat will lead to catastrophic Middle Fullness.
Sheng Maotzu (Raw Atractylodes Macrocephala Rhizome), Shudi Tan (Charred Rehmannia Root), Shu Fuzi (Prepared Aconite Root), Dan Ganjiang (Mild Dried Ginger), Fuling (Poria), Cheqianzi (Plantago Seed).

Pulse is wiry on the left and floating-choppy on the right. Initially, epigastric pain radiated to the hypochondrium. Then, the abdomen became large and convex. Appetite decreased significantly. Defecation and urination were difficult and unsmooth. This resulted from the elderly man's hard work and excessive worry. Liver Wood became depressed, trapping Spleen Earth. Clear and Turbid Qi mixed, forming distension. The Zhen Qi of the Zang organs is consumed daily, while Fu Yang fails to transport. Ancient masters treating distension prioritized promoting Yang. Using Yin-nourishing softening medicines with slight additions of Guizhi and Fuzi would congeal Yin and Turbid Qi, which is not a good method. I propose using Ju Fang Yuliang Wan (Bureau Formula Yu Liang Pill) to warm the Water Organ (Kidney) and attack filth. Once there is slight improvement, combine with promoting Yang and firm tonification. This is the treatment method for deficiency-type internal injury distension. Draining and purging are set for tangible pathogens, different from intangible Qi-injury cases.
Yuyuliang Wan (Yu Yu Liang Pill).

This year, long summer heat prevailed. Heat excess caused Yang Qi to leak outward. Digestion of food and water slowed. Dampness arose internally. Gradually, edema appeared, spreading from below upwards. Wheezing and coughing prevented lying flat. All these are due to turbid water condensing into phlegm, obstructing the Lung's descending function. However, urination is unfavorable, and the Taiyang channel is also unregulated. Although this is a Yang-deficiency case, the sour and cloying properties of Shan Zhu Yu (Cornus Fruit) and Shu Di Huang (Prepared Rehmannia Root) in Shenqi Tang (Kidney Qi Decoction) make it difficult for the medicine to descend.
Fuling (Poria), Guizhimu (Cinnamon Twig Wood), Xingren (Apricot Seed), Sheng Baishao (Raw White Peony Root), Ganjiang (Dried Ginger), Wuwei Zi (Schisandra Berry), Sheng Muli (Raw Oyster Shell), Zexie (Alisma Rhizome).

Previously suffering from fixed masses. At the Summer Solstice, when Yin begins to regenerate, repeated nocturnal emissions occurred. Consequently, the abdomen became firm and large. Urination and defecation alternated between patent and obstructed. At that time, a carbuncle ulcerated on the right knee, likely caused by Damp-Heat lingering in the collaterals. The pulse is small and weak on the left, slow and large on the right. Complexion is pale. The nose tip is bright. Eating exacerbates abdominal distension. Limbs fear cold. Heat rises from within. Severe cases involve epistaxis and bleeding gums. This is entirely due to Qi and Blood knotting within the body. It is certainly not distension due to accumulation or stagnant water. Ancients treated distension by clarifying Qi and Blood. Pain relief requires promotion of circulation. Know that purgatives promote bowel movement, while warming tonics protect Yang to promote circulation. Currently, isolated abdominal distension points to the Spleen and Stomach as the source of disease. Taiyin fails to transport, making Yangming dull. I propose a mild attacking method.
Chuan Guizhi (Sichuan Cinnamon Twig), Shu Dahuang (Prepared Rhubarb), Sheng Baishao (Raw White Peony Root), Nongpu (Magnolia Bark), Zhishi (Immature Bitter Orange), Dansheng Ganjiang (Mild Raw Dried Ginger).

Suffering from Wind for three months. Swelling moved around the whole body. Hands could not grasp, feet could not walk. The pulse was floating, large, and rapid. Fever and dry mouth. This is Yin deficiency generating internal heat. Excess heat generates Wind. Moreover, Wind moves easily. Fire and Heat intensify its momentum. Injury to sinews and collaterals causes flaccidity and inability to contract. Reversal into muscle tissue causes painful swelling.
Shengdi (Rehmannia Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Honghua (Safflower), Qianghuo (Notopterygium Rhizome).

A tangible mass in the left hypochondrium gradually enlarged the abdomen. Each time purgatives were used, defecation occurred, and distension slightly decreased. Subsequently, obstruction returned. Frequent purging was attempted to temporarily relieve symptoms. During the illness, distension floated in the lower part. Acupuncture was added to facilitate fluid discharge. Swelling subsided, but the disease remained. The patient has suffered for six years and has long given up hope of cure. Know that this illness initially stemmed from Liver Qi disharmony. Qi gathered to form a mass. Repeated purging injured the Spleen and Stomach. The ancients said: "Umbilical protrusion injures the Spleen." The current suffering involves difficulty in expelling urine and feces, with pain like knife stabbing. This is Qi distension. Long-term purging depletes Blood. When Blood is exhausted, Qi knots further. Promotion of circulation should utilize moistening agents that open orifices.
Hupo Xie (Amber Powder), Shexiang (Musk), Daheidoupi (Large Black Bean Skin), Du Niuxi (Cyathula Root).

From summer jaundice and mental fatigue, gradually progressing to Middle Jiao distension. Extending to Frost Descent, vomiting of stagnant blood occurred above, and foul stool below. The pulse is weak, fine, and irregular. The complexion lacks luster. Breathing includes wheezing. Historically suffering from Cold Disorder with rebellious Qi. The retention of old fluid has existed for some time. During the three summer months, when Spleen and Stomach are dominant, heaven is hot, earth qi rises, and human Qi leaks. Added to irregular diet and labor, appetite decreased and distension increased. The disease originated in the Middle, spreading up and down. The Six Fu organs function through unobstructed flow. Not only do the Fu organs fail to perform their duties, but Qi and Blood in the meridians and collaterals also cease to flow. Qi stagnation and Blood stasis worsen distension. Ancients treated distension specifically by promoting circulation, distinguishing between Yin and Yang. Later aggressive circulating methods, such as Shenyou, Zhouche, and Yugong formulas, are too harsh to try lightly in this chronic, debilitated state. I propose specifically promoting the Yang Qi of the Three Jiao to drive out entrenched Turbid Yin. Warming and tonifying are combined. If Yang Qi does not gradually revive, it is difficult to prescribe further. Borrowing Zhang Zhongjing's Baitong Tang (White Connecting Decoction): Qu Congbai (Remove Scallion White), Ganjiang (Dried Ginger), Zhuyedan (Pig Gallbladder Juice), Dan Fuzi (Mild Prepared Aconite).