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Distension syndromes originate from the Spleen and Stomach. It is appropriate to regulate the先天 (Xiantian, Innate) Water and Fire (Kidney Yin and Kidney Yang), ensuring that Fire does not flare upward while the bottom of the cauldron remains warm. This allows the Xiantian and Hou Tian (Houtian, Acquired) to generate each other, connecting Kidney Qi with Stomach Qi. Naturally, food intake increases, and there is no risk of Qi stagnation; distension will subside on its own. If one merely uses herbs to warm the Kidney and support the Spleen, but the Qi of Metal (Lung) and Wood (Liver) do not follow their ascending and descending commands, the Middle Jiao Qi will become depressed and fail to circulate. Therefore, it is necessary to soothe the Liver and moisten the Lungs, allowing Wood to ascend and Metal to descend, so that Heaven and Earth Qi can interact smoothly, seeking recovery. However, if the central palace presents with greenish distension, the True Qi is mostly severed; this is a ominous syndrome where only one or two out of ten may survive. One must simultaneously harmonize the Seven Emotions for efficacy; do not take it lightly.

Case Record
A patient presented with distending pain in the lower abdomen, visible blue veins, and difficult urination. This indicates Liver injury. The Liver governs the sinews; when the Liver is injured, the Zong Jin (Major Sinews) are damaged, leading to difficult urination. The lower abdomen is the domain of the Liver, and green is the color of the Liver. Since the Liver is injured, lower abdominal pain, greenish discoloration, and distension appear. Use Xiaoyao San (Free and Easy Wanderer Powder) plus Duzhong (Eucommia Bark) to promote circulation.

If Cold damages the Spleen, it is better to tonify the Spleen to generate Lung Metal. When the Lung is tonified, it can execute its descending command, and the Lower and Middle Jiao will naturally stabilize. Once the Middle Qi is sufficient, pathogenic Fire will recede spontaneously. Thus, it is said: for diseases below, seek treatment above; for diseases above, seek treatment in the middle. The Middle is the source of Qi and Blood.

In the past, a young woman suffered from distension with a deep pulse. A physician cured her using Qingyan (Blue Salt), Huangbai (Phellodendron Bark), and Shengma (Cimicifuga Rhizome). Now, another woman also has distension with a deep pulse. Can we apply the same precedent? The Master said: No. The previous case was due to郁 (depression/stagnation) of Mingmen Fire (Gate of Life Fire), causing the True Yang of the Kidney to fail to ascend and the True Yin of the Heart to fail to descend. Therefore, Huangbai was used to clear the Mingmen Fire, allowing True Yang to rise from the Water; Qingyan was used to moisten the Heart, preventing excessive pathogenic Fire, so that True Water could descend. With Water and Fire having achieved mutual interaction (Ji Ji), Shengma was added to lift the Clear Qi. Once Clear Qi ascends, Turbid Qi descends naturally, eliminating internal depression in the Spleen and Lungs, curing the distension. The root was in the Kidney and the branch in the Heart, hence the rapid effect of these three herbs. In the current case, the root is in the Heart and the branch in the Kidney. Although the pulse is deep in both cases, the root and branch differ. Treatment should primarily warm Heart Yang, treating the Kidney as secondary. Hezhong Wan (Harmonizing the Middle Pill) fits the orthodox treatment method well.

A patient had abdominal distension with frequent vomiting. Urine was free, but stool was constipated; when stool passed, urine became obstructed. This is because excess Middle Qi causes distension, failure of Turbid Yin to descend causes vomiting, and sinking of Clear Yang fills the Lower Jiao, preventing simultaneous passage of both excretions. Use 3 qian of Paojiang (Prepared Ginger) to warm the middle and promote transportation, 1.5 qian of Shengma to lift from below, and 1 qian of Wuzhuyu (Evodia Fruit) to descend from above. Cured after eight doses.

A patient had abdominal distension, dry and hard stool, red and painful scanty urine, and slight thirst. The prescription used Shanzhuyu (Cornus Fruit), Danpi (Moutan Cortex), and Fuling (Poria) each at 7 fen; Cheqianzi (Plantago Seed) and Niuxi (Achyranthes Root) each at 1 qian; Shudi (Prepared Rehmannia Root) at 1.5 qian; and Zexie (Alisma Rhizome) at 3 qian. Given the surging pulse, this formula brought peace.

A patient had six pulses that were deep, fine, and rapid, indicating insufficient Middle Qi, which had developed into a distension syndrome. The prescription used Renshen (Ginseng Root) at 7 fen, Huangqi (Astragalus Root) and Gancao (Licorice Root) each at 5 fen, Cangzhu (Atractylodes Rhizome) at 8 fen, Shengma and Chaihu (Bupleurum Root) each at 3 fen, Chenpi (Tangerine Peel) and Muxiang (Costus Root) each at 5 fen, 2 slices of Shengjiang (Fresh Ginger), and 3 dates. Add Banxia (Pinellia Tuber) for phlegm; add Wuzhuyu for abdominal pain; add Niuxi for difficult urination; add Yiyiren (Coix Seed) for swelling. Many patients were fully cured by this formula.

A patient had isolated abdominal distension and enlargement. Treatment focused on warming the middle. The prescription used Renshen at 5 fen, Wuzhuyu at 1 fen, Cangzhu, Baizhu (White Atractylodes Rhizome), Paojiang, and Fuling each at 5 fen, and Zhigancao (Honey-fried Licorice Root) at 2 fen. Add Rougui (Cinnamon Bark) for abdominal pain; increase Paojiang and add Shenqu (Medicated Leaven) for stagnant urine.

A patient had vomiting and abdominal distension. Use 3 qian of Muxiang, 4 liang of Wuyao (Lindera Root), 2 liang each of Xiangfu (Cyperi Rhizome) and Ziye (Perilla Leaf), and 1 liang of Gancao. Grind into powder, mix with boiling water, and take.

A patient had abdominal fullness and distension, often feeling satiated, lacking appetite, and finding food tasteless. Use Wuzhuyu Tang (Evodia Decoction): Wuzhuyu, Houpo (Magnolia Bark), and Paojiang each at 2 qian; Baizhu (peeled), Chenpi, and Chuanjiao (Sichuan Pepper) each at 5 qian. Grind into powder. Take 3 qian per dose, decocted with 3 slices of ginger, taken on an empty stomach.

A patient had stabbing pain and distension in the chest, suffering from coughing above and diarrhea below. Use Tiaozhong San (Regulate the Middle Powder). Baizhu, Paojiang, Dangshen (Codonopsis Root - *Note: Text says Guishen/Gui Shen, likely Dang Gui/Shen or similar, but strictly translating text as 'Gui Shen' usually refers to Angelica Sinensis Root body, however context suggests tonifying, let's stick to literal 'Gui Shen' or interpret as Dang Gui/Renshen combo? Text says "归身" which is Dang Gui Root Body*), Renshen, Wuweizi (Schisandra Fruit), Chifuling (Red Poria), and Gancao each at 1 liang; Guigui (Cassia Twig/Cinnamon Bark) at 1.5 liang. Grind into powder. Take 3 qian per dose, mixed with plain boiled water.

A patient experienced distension due to excessive fear. Such individuals are often depressed and engage in excessive sexual activity. Sexual excess injures the Kidney; depression injures the Heart. Kidney injury prevents Water from ascending, leaving Heart Fire unchecked. Heart injury prevents Fire from descending, failing to warm the Water. Fire above and Water below constitute the Wei Ji (Not Yet Completed) state. How can illness not occur? The treatment method is to warm the Kidney and calm the Liver. When Water is sufficient to control Fire, Ji Ji (Water-Fire Interaction) is achieved. This is the method of treating upper diseases by seeking the lower.