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Additionally, use Biejia Jian Wan (Turtle Shell Decoction for Reducing Masses).

Original Note: The left side pertains to Blood and the Liver; Malaria pathogens stagnate within the Blood aspect. Treatment is primarily with Biejia Jian Wan (Turtle Shell Decoction for Reducing Masses). The right side pertains to Qi and the Stomach, involving either Phlegm or Food Stagnation. Treatment is primarily with Jijin Tuiqi Tang (Chicken Gizzard Lining Pushing Qi Decoction), added with Zhuyu (Bamboo Sap) and Baijiezi (White Mustard Seed).

Liu Yi's Comment: This is a method of treating both aspects simultaneously.

Deng's Comment: Biomasms (masses) forming on the left and right are most likely to prolong into Zhongman (Central Fullness/Bloating). Treating them head-on clears the logical path of treatment.

[Section on Swelling and Distension]

Ying Blood (Nutritive Blood) is originally deficient, and Liver Fire is originally vigorous; the responsibility lies in congenital endowment. Furthermore, acquired Spleen Qi is not robust, allowing Liver Wood to overact upon it. The ingested food generates Phlegm and Dampness, which store in the Stomach. If they can still be expelled through vomiting, peace prevails without incident; but after a long time, they infiltrate outside the membranes (Membrane Origin), the Qi mechanism becomes unclear, and distension arises. The Spleen is the source of Phlegm production; the Stomach is the vessel storing Phlegm. Unless the Middle Jiao (Spleen/Stomach) is transformed and transported, and the exterior of the membranes is penetrated, the disease trend will only increase, easily becoming Gu Disease (Abdominal Distension/Tympanites). The Spleen governs Blood, and the Liver stores Blood. After a long illness, Blood becomes even more depleted, necessitating assistance with harmonizing and nourishing methods. The ancients' use of drying and moistening agents together was precisely designed for such syndromes.

Guishao Liujunzi Tang (Angelica Sinensis and White Peony Root Six Gentlemen Decoction): Remove Renshen (Ginseng) and Gancao (Licorice); add Baijiezi (White Mustard Seed), Laifuzi (Radish Seed), Cheqianzi (Plantago Seed), Chuanpu (Atractylodes Lancea - *Note: Text says Chuan Pu, usually Houpo, assuming Houpo based on context of distension*), Suzi (Perilla Seed), Fupi (Areca Peel), Zhuyu (Bamboo Sap), Xiegeng (Snow Soup - Sea Cucumber and Water Chestnut).

Liu Yi's Comment: The medication addresses both deficiency and excess, being pertinent and not superficial.

Deng's Comment: After prolonged vomiting, Phlegm-Fluid infiltrates outside the membranes, leading to many cases of Gu Distension. This case discusses the pathology thoroughly and establishes precise treatment principles.

Chen's Comment: Houpo (Magnolia Bark), Baijiezi (White Mustard Seed), Laifuzi (Radish Seed), Dafupi (Areca Peel), etc., constitute Kuqing Yin (Clearing Decoction) from Zhang Jingyue, capable of treating distension caused by Damp-Heat and Phlegm-Fluid.

"The Classic" states: All abdominal fullness and enlargement belong to Heat; all damp swelling and fullness belong to the Spleen. Spleen Meridian Damp-Heat obstructs the Middle Jiao, first causing fullness, then manifesting as swelling, skin heat with slight sweating, thirst, and red face. Treatment is difficult.

Fangji (Stephania Root), Fuling (Poria), Shigao (Gypsum), Fupi (Areca Peel), Chenpi (Tangerine Peel).

Deng's Comment: This is a modification of Mugufangji Tang (Cinnamon Twig and Stepia Decoction) from "Jin Gui Yao Lue". The reason for removing Guizhi (Cinnamon Twig)'s warmth is due to excessive Heat. However, observing that symptoms persist after changing formulas, perhaps one must rely on Guizhi to warm and unblock Qi transformation to achieve efficacy? If one claims the disease is severe and the medicine light, adding fresh Dihuang (Rehmannia), Zhimu (Anemarrhena), and Maidong (Ophiopogon) might ultimately be unsuitable for distension diseases. Since it is stated as Damp-Fullness of the Three Jiaos, why not simply use Hezi's Guiling Ganlu Yin (Cassia Twig, Poria, and Melon Dew Decoction)?

Sun's Comment: The interpretation of the text is indeed accurate.

Second Visit: Damp-Heat filling the Three Jiaos often leads to swelling. If the pathogenic factor leans towards the Lower Jiao, urination will surely be scant. The ancients' heavy, purgative methods were originally designed for such syndromes. However, this disease has been present for a long time, yet remains prevalent in the Middle and Upper Jiaos. Why not apply methods targeting the Middle and Upper Jiaos? Various symptoms remain unchanged, possibly due to the disease being severe and the medication too light. Increase the dosage of the previous formula.

Zhuye (Bamboo Leaf), Shigao (Gypsum), Xianshengdi (Fresh Rehmannia), Maidong (Ophiopogon), Zhimu (Anemarrhena), Banxia (Pinellia), combined with Wupi Yin (Five Peel Decoction).

Original Note: This patient is a twelve-year-old girl with sudden abdominal distension, facial and ankle edema, red face, thirst, and yellow urine. This syndrome belongs to Heat, which is rarely seen.

Liu Yi's Comment: Such prescriptions for treating distension require extraordinary insight to preserve; they serve to broaden the understanding of clinicians.

Epigastric and abdominal distension, dysfunction of bowel and bladder, meridian soreness and pain, limb weakness, wiry-thin pulse, white greasy and thick tongue coating. This is internal depression of Dampness. One should employ bitter-pungent venting and draining.

Cangzhu (Atractylodes Lancea), Chuanxiong (Sichuan Lovage Rhizome), Xiangfu (Cyperus Rhizome), Heizhi (Black Gardenia), Shenqu (Medicated Leaven), Fupi (Areca Peel), Chuanpu (Magnolia Bark), Chiling (Red Poria), Zexie (Alisma), Loupi (Trichosanthes Peel).

Liu Yi's Comment: This is also a case of Dampness depression transforming into Heat, hence the concurrent use of Zhizi (Gardenia) and Lou (Trichosanthes) for clearing and draining.

Deng's Comment: It purely presents signs of Dampness predominance. How do we know there is Heat within the Dampness? By adding Zhizi and Lou, while avoiding Jiang (Ginger) and Gui (Cinnamon). Reading the case note "dysfunction of bowel and bladder," the key lies in the yellow and scanty urine. Generally, such syndromes are easily misdiagnosed as Cold-Damp and treated with hot medicines.

Fine and wiry pulse indicates Spleen weakness combined with Liver depression; white and greasy coating indicates Dampness predominance with steaming Heat. Once Damp-Heat is resolved, Spleen health restored, and Liver Qi unblocked, various symptoms will tend toward peace.

Second Visit: Various symptoms tend toward peace, limb weakness persists; focus on strengthening the Spleen.

Xiangsha Liujunzi Tang (Aucklandia and Amomum Six Gentlemen Decoction).

Original Note: This is a modified Yueju Wan, incorporating half of Weiling San. This formula treats Dampness depression; its key indicator is the white, greasy, and thick tongue coating, ensuring efficacy. I often borrow it to treat Jaundice with good results, and for Head/Neck pain with Phlegm, it is also effective.

Sun's Comment: Yueju Wan treating Jaundice likely addresses syndromes formed by the interlocking obstruction of Qi, Dampness, and Heat. For head/neck pain with Phlegm, depression must be present for efficacy, and phlegm-resolving herbs must be added for safety.

The Spleen governs Dampness; Dampness depresses due to Spleen deficiency, steams into Heat, thus invading the Middle Jiao with hidden masses. Abdominal distension, poor appetite, loose stools, yellow complexion, red urine, cough, intermittent body heat, wiry-thin pulse. It easily develops into Gu Disease (Tympanites).

Yueju Wan (Xiangfu, Cangzhu, Chuanxiong, Shenqu, Zhizi) plus Jijin San (Chicken Gizzard Lining Powder), added with Chiling (Red Poria), Qinghao (Sweet Wormwood), Huangqin (Scutellaria), Chuanpu (Magnolia Bark).

Original Note: This is a Yueju Wan syndrome complicated by hidden masses. As Dampness transforms into Heat, Jijin San is combined to dissipate masses, and Huangqin/Qinghao to resolve Heat.

Original Note: Above are Yueju Wan syndromes. Generally, Yueju Wan treats formless Damp-Heat biomasms, derived from Xiexin Tang; Jijin San treats tangible Food Stagnation masses, derived from Xiaoxiongan Tang. Furthermore, in the Epigastric Pain section, for pain due to depressed Phlegm with rapid pulse and thirst, use Qingzhong Juan Tong Tang. Zhizi stir-fried with Ginger Juice, Ganjiang (Dried Ginger) stir-fried with Child's Urine, Huanglian (Coptis) stir-fried with Ginger Juice, Cangzhu soaked in Child's Urine then sliced and stir-fried with Hemp Oil, Xiangfu stir-fried with Vinegar, Shenqu stir-fried with Ginger Juice, Tuohong (likely a typo or specific preparation), Ginger, Jujube. Treats epigastric Fire-depression pain with chills and fever. Using chills/fever as main indicators implies Yueju Wan plus Ginger, Coptis, Tangerine Peel, Jujube. Thus, this formula treats the depression of Qi, Fire, Dampness, Food, and Blood. It is truly exquisite. Some say Zhizi governs Fire, Cangzhu governs Dampness, Xiangfu governs Qi, Chuanxiong governs Blood, Shenqu governs Food, dividing them into Five Depressions. This seems unnecessary, just as five tones must play together to harmonize.

Deng's Comment: Large abdominal distension is a sign of Gu; cough and body heat are signs of Lao (Consumption). Here, Ying, Wei, Yin, and Yang are all injured. Medication should lean towards drying rather than moistening. Adding Guizhi (Angelica) and Shaoyao (Peony) to nourish Ying and subdue Wood is acceptable.

Sun's Note: Jijin San consists of Sharen (Amomum), Chenpi (Tangerine Peel), Chenxiang (Agarwood), Jineijin (Chicken Gizzard Lining), Xiangyuan (Citron).

Large abdominal distension for over forty days, recent急促 (rapid) breathing, ankle edema, yellow urine, dry mouth, wiry-rapid pulse. Damp-Heat pathogens, obstructed by Qi, exacerbated by Food. Treatment is difficult.

Kuqing Yin (Clearing Decoction: remove Baijiezi, Zhike): Add Heizhi (Black Gardenia), Zhuling (Polyporus), Sugeng (Perilla Stem), Chuanlian (Coptis), Xiangfu (Cyperus).

Original Note: The place where warm medicines are retained lies in the four characters: Dry Mouth, Yellow Urine.

Deng's Comment: Large abdominal distension is the disease; yellow urine and dry mouth are the manifestations; wiry-rapid pulse is the pulse. Inferring from manifestations and pulse, the nature of the pathogen will reveal itself without hiding.

Spleen deficiency causes internal Damp-Heat depression, forming Gu. Treat according to the principle of removing depression and eliminating stale accumulation.

Kuqing Yin (remove Baijiezi): Add Suye (Perilla Leaf), Xiangfu (Cyperus), Dongzhu (White Atractylodes).

Separately take Xiao Wenzhong Wan (Minor Warming Center Pill), morning and evening, each 1 qian.

Liu Yi's Comment: Abdominal fullness stems from the Spleen's failure to transport. The reasons for this failure are Phlegm, Dampness, Turbidity, Qi, and Blood Stasis. Hence, the formula uses many herbs to move Qi, resolve Phlegm, and clear/drain Damp-Heat.

Deng's Comment: This formula merely疏 (disperses) and resolves Damp-Heat. Why insist on harsh purgatives like Huarua (Kadoka), Ji (Euphorbia Kansui), and Sui (Euphorbia Esula)? Using Kuqing method without Baijiezi suggests the disease is not severe regarding Phlegm-Fluid.

The abdomen belongs to the Spleen. Abdominal enlargement reaching the umbilicus protrusion undoubtedly belongs to the Spleen. However, distension does not cease daily, pain recurs intermittently, thin white tongue coating, deep-wiry pulse, appearing in a constitution with delayed menstruation. Clearly, Blood deficiency fails to contain Qi, Qi depresses in the Middle, Cold adds externally, and Spleen Meridian Dampness consequently fails to dissipate.

Xiaoyao San (Free and Easy Wanderer Powder) combined with Jijin San, added with Xiangfu.

Liu Yi's Comment: Deep-wiry differs from deep-thin. Deep-thin with sallow complexion indicates Lizhong Syndrome. This case grasps the character "Depression," using Xiaoyao San to disperse.

Deng's Comment: Deep-wiry pulse does not compare to Blood deficiency failing to contain Qi.

The general nature of this disease does not exceed Middle Cold and Liver Depression. The main idea of the prescription is warming the Middle and unblocking Liver Wood. One might add Wuxian San (Evodia Powder).

Single Abdominal Distension: Spleen Qi is certainly deficient; over time, Kidney Qi also becomes deficient. Loose stools indicate Qi scattering and failing to gather. The medications used should be one step further than ordinary Spleen/Kidney warming tonics; however, it is already late. Pity.

Fugui Lizhong Tang (Aconite and Cinnamon Warming Center Decoction) added with Rougu (Nutmeg), Danggui (Angelica), Muli (Oyster Shell), Mugua (Chaenomeles), Fuling (Poria), separately taken with Shengmai San (Generate Pulse Powder).

Liu Yi's Comment: The case states "one step further than ordinary warming," and looking at the added Rougu and Danggui, this initiates a峻 (severe/powerful) method.

Deng's Comment: Deficient-Cold distension should indeed be attributed to Spleen and Kidney. Whether it leans towards Kidney deficiency or Spleen deficiency depends on whether the distension is worse in the lower abdomen or the epigastrium. Adding Shengmai San suggests a glossy tongue with slight coating.

Large abdominal distension, loose stools, cold-white tongue coating, dry mouth preferring hot drinks, skin heat, rapid pulse. Spleen Yang is greatly deficient, powerless to transform Damp-Turbidity, resulting in Gu Disease. Treatment is tricky.

Fugui Zhizhong Tang (Aconite and Cinnamon Regulating Center Decoction) added with Mugua (Chaenomeles), Caoguo (Black Cardamom), Danggui (Angelica).

Deng's Comment: This is a pattern of Yang deficiency with夹杂 (intermixed) Damp-Heat. Indeed, Lizhong Tang is urgent, followed by clearing Damp-Heat. The layers are not inconsistent. I would propose Dongyuan's Ascending Yang and Draining Dampness method, incorporated with Wuling San. However, many patients are untreatable.

Second Visit: After four doses of warming tonics, abdominal distension gradually harmonizes. Pathogens exit via the Lower Jiao, hence diarrhea. However, skin heat has not receded, urine volume has not increased, dry mouth desires hot drinks, stomach lacks appetite, white coating has thinned, tongue body turns red. Middle Yang slightly revives, Damp-Heat not cleared.

Liling Tang (Regulating Poria Decoction).

Original Note: Cold-white tongue coating is the handle for using Guifu (Aconite/Cinnamon). Four doses leading to bowel evacuation means pathogens exit downwards; Middle Yang is still okay, Spleen Qi not exhausted. Combined with tongue body turning red, knowing Damp-Heat stagnation is severe, hence changing formula to reduce Fu/Gui. Renshen/Atractylodes are sufficient to support Spleen; additionally, Siling San (Four Poria Powder) drives out Dampness.

Diarrhea occurs, urine volume increases. Even if Yin pathogens exist in Liver, Spleen, and Kidney meridians, they can dissipate from here. Why do hidden masses still occupy the Middle, and abdominal distension remain unharmonized? This is Yang deficiency.

Sijunzi Tang (Four Gentlemen Decoction) added with Huangqi (Astragalus), Danggui (Angelica), Guizhi (Cinnamon Twig), Fuzi (Aconite), Chenpi (Tangerine Peel), Rougu (Nutmeg), Chenxiang (Agarwood), Ganjiang (Dried Ginger), Muli (Oyster Shell), Biejia (Turtle Shell), Jineijin (Chicken Gizzard Lining).

Original Note: This is Qijun Tang (Initiating Severe Tonification Decoction). Fuzi Lizhong Tang added with Huangqi, Danggui, Rougu is one step further than Fuzi Lizhong Tang.

Deng's Comment: The reason Yin pathogens do not dissipate is that Yang deficiency lacks power to transform them.

Within severe tonification, preserving the intent of dispersing and initiating is why it is called Qijun.

Taiyin abdominal fullness, excess Cold-Damp, insufficiency of True Yang. Pulse wiry, lower body not warm, dry mouth not desiring drink, difficulty eating, shortness of breath. The situation is quite dangerous. Propose warming-unblocking and resolving Dampness method.

Fuzi Maozhu Zhizhong Tang (Aconite and Atractylodes Regulating Center Decoction) added with Chuanpu (Magnolia Bark), Banxia (Pinellia).

Liu Yi's Comment: This is also a method of unblocking and tonifying combined.

Deng's Comment: Wiry pulse, difficulty eating, shortness of breath seem to indicate Cold-Fluid internally, further mixed with Liver Qi depression.

Warming and tonifying Yuan Yang, floating swelling and fullness increase without decrease; Yang decline is extreme. Umbilical flattening and slow pulse indicate necessity for warming and tonifying; however, warming/tonifying shows no gain, likely because downward leakage injures the Kidney further.

Fuzi Lizhong Tang combined with Sishen Wan (Four Spirit Pill), separately take Laifu Dan (Returning Life Pellet).

Liu Yi's Comment: This method is one step further than Shenqi Wan (Kidney Qi Pill).

Deng's Comment: Floating swelling and fullness often involve Damp-Heat and Wind pathogens; incompatibility with warming tonification is common.

Why not use Shang Yu Yuliang Wan (Shang's Hematite Pellet) for this disease?

Taiyin abdominal fullness, caused by Cold-Damp. If Yang is not vigorous, it will inevitably become Gu Disease.

Fuzi Lizhong Tang added with Chuanpu (Magnolia Bark), Dafupi (Areca Peel), Zexie (Alisma), Zhuling (Polyporus).

Liu Yi's Comment: This is a syndrome of Spleen Yang不振 (failure to rise) and Cold-Damp stagnation, hence using warming-resolution method.

Deng's Comment: Unresolved Cold-Damp requires warming-hot and unblocking-Yang, like the sun shining brightly, dispelling haze.

Middle fullness: Drain it internally. Initially, it may disappear rapidly, but later attacks fail to resolve it, and subsequent attacks meet resistance like iron or stone. This disease, though not like iron/stone, involves long-term injury to Righteous Qi, making it not an easy matter.

Zhizhong Tang combined with Wuling San (Five Poria Powder).

Original Note: Above are all modifications of Lizhong Tang. Remembering asking my master about Lizhong variations when attending him: "Lizhong is an excellent formula for Foot Taiyin." If Middle Jiao Yang Qi is uncomfortable, use Ganjiang (Dried Ginger) for its dispersing property; if Lower Abdomen Yang Qi sinks, use Paojiang (Roasted Ginger) for its retaining property. Variation depends on loose vs. normal stool. Heavy Dampness with no sweat uses Maozhu (Atractylodes Lancea); Light Dampness with Middle deficiency uses Dongzhu (White Atractylodes). Variation depends on turbid vs. clean tongue coating. This is the variation of this formula. If Spleen needs Lizhong but Stomach has Fire, ancients established Lianli Tang. If Qi mechanism is blocked, ancients established Zhizhong Tang. If Spleen needs Lizhong but person has True Yin deficiency, Jingyue established Liyin Jian. If Kidney True Yang declines, adding Fuzi is natural; for severe decline, ancients had Qijun Tang. Additionally, adding Mugua makes Hezhong Tang (for Liver disease); adding Zhishi/Fuling treats Stomach deficiency with Excess. If ancient formulas are used this way, how could one fail to become a famous doctor? Therefore appended as a method for using Lizhong.

Deng's Comment: Single abdominal distension inevitably injures Spleen Yang. Even with Excess pathogens, beware of hasty purging.

Sun's Comment: Thoroughly explained and worthy of emulation.

"All damp swelling and fullness belong to the Spleen." Injured by fatigue, Internal Dampness combines with External Dampness, depressing in Earth, causing Taiyin Qi transformation to fail. Treating disease must seek its root; first use Shi Pi (Solidify Spleen) method.

Chuanfu (Aconite), Yuzhu (White Atractylodes), Fuling (Poria), Chenpi (Tangerine Peel), Caoguo (Black Cardamom), Dafupi (Areca Peel), Wuyao (Lindera), Mugua (Chaenomeles), Zexie (Alisma).

Liu Yi's Comment: Case says "Solidify Spleen," but formula contains warming-unblocking herbs; this is not the orthodox method of Solidifying Spleen.

Deng's Comment: This intends for Spleen Yang to transport and sufficiently resolve Dampness; suitable for Dampness combined with Cold.

Sun's Comment: Most swellings/fullness arise from this.

Initial bloating, subsequently increasing distension, umbilical protrusion, visible veins, ankle edema, loose stools. This is internal Damp-Heat congestion, Middle deficiency failing to transform, trend moving downwards. Medication is most tricky. Prescribe based on bitter taste, red tongue, short red urine.

Guixin (Cinnamon Heart), Fuling (Poria), Zhuling (Polyporus), Baizhu (Atractylodes Macrocephala), Zexie (Alisma), Shigao (Gypsum), Hanshuishi (Calcitum), Huashi (Halloysite).

Liu Yi's Comment: This is Hejian's Ganlu Yin (Sweet Dew Decoction). Uses Wuling San to descend Dampness, Three Stones (Shigao, Hanshuishi, Huashi) to clear Heat.

Deng's Comment: Such methods cannot be used rashly by those who do not thoroughly understand the condition. Only when pulse is洪数 (Surging-Rapid) can one boldly use them, fearing Damp-Heat remains while Middle Yang exhausts.

Sun's Comment: Bitter taste, red tongue, short urine indicate Yin is greatly injured, Source of Transformation nearly extinct. How can one use the three stones' heavy/cold violent nature to drain Real Fire? In short, such dangerous signs are hard to reverse; despite good methods, ultimately futile.

Cough with abdominal fullness, known as Sanjiao Cough in Classics. Yellow, dry, bitter tongue coating, difficulty lying down, cold limbs, retracted genitals, thigh pain, scrotal swelling, loose stools, short urine. Various signs all belong to Wind-Pathogen and Damp-Heat, filling the Three Jiaos with no exit. This is Excess Syndrome, incomparable to Deficiency Fullness.

Sangpi (Mulberry Bark), Gupi (Dogwood Bark), Lingpi (Poria Peel), Loupi (Trichosanthes Peel), Dafupi (Areca Peel), Jiangpi (Ginger Peel), Fangji (Stephania), Xingren (Apricot Seed), Suzi (Perilla Seed), Tinglizi (Descurainia Seed), Cheqianzi (Plantago Seed).

Liu Yi's Comment: Damp-Heat congestion, Spleen fails to transport, Lung fails to descend. Hence formula specializes in dispersing/resolving, imitating Wupi (Five Peel) and Wuzi (Five Seed) methods.

Deng's Comment: Cold limbs and retracted genitals are due to Damp-Heat blocking Yang Qi. Diagnosing it as Damp-Heat Excess relies entirely on the yellow, dry, bitter tongue coating. Every disease has its key, immutable principle. This formula selects herbs well.

Middle Yang insufficient, excess Cold-Damp, epigastric blockage, poor appetite, white tongue, loose stools, fine-small pulse. Method should be warming-resolution, aiming for peace.

Maozhu Liling Tang (Atractylodes Regulating Poria Decoction) added with Dafupi (Areca Peel), Jineijin (Chicken Gizzard Lining), Gegua (Kudzu Flower), Chuanpu (Magnolia Bark).

Deng's Comment: Signs purely Cold-Damp, suitable for warming-resolution undoubtedly. Formula uses Gegua, implying the patient is a drinker.

Second Visit: Warming-resolution insufficient to eliminate distension; Yang deficiency is severe. Increase dosage to assist.

Maozhu 1.5 qian, Chuanfu 1.5 qian, Ganjiang 1.5 qian, Dangshen 3 qian, Rougui 0.7 qian, Fangfeng 2 qian, Fuling 3 qian, Wujiapi 3 qian, Chenpi 1 qian.

Deng's Comment: Efficacy upon taking this formula proves the first formula was disease-severe/medicine-light. For distension due to Yang deficiency with Cold, non-warming-hot large doses are ineffective.

Third Visit: Various symptoms tend toward peace, maintain previous method to dispel lingering Dampness.

Chuanfu 1 qian, Guizhi 1 qian, Dangshen 3 qian, Sheng Baizhu 1.5 qian, Ganjiang 0.4 qian, Fuling 1.5 qian.

Liu Yi's Comment: Changing Maozhu to Baizhu suggests heavy/turbid white coating has transformed. This case achieves efficacy purely through warming-resolution, as Yang movement naturally transforms Dampness.

Hidden masses for long duration, dispersing into Gu, hence left hypochondriac mass painful, large abdomen gradually full, passing red turbid feces. Plus epigastric pain after eating, chronic vomiting of Phlegm-Saliva with Blood Stasis. Yuan Qi increasingly deficient, showing inability to support. Difficult to gather or disperse, truly tricky.

Xiangyuanpi (Citron Peel), Renzhongbai (Human Midsection Ash), Taoren Ni (Peach Kernel Paste), Jineijin (Chicken Gizzard Lining), Zhi Biejia (Processed Turtle Shell), Shegan (Belamcanda), Muli (Oyster Shell), Chuanbeimu (Fritillaria), Chenpi (Tangerine Peel), Sharen (Amomum), Xiegeng (Snow Soup).

Liu Yi's Comment: "Ben Cao Jing Shu" states: Shegan treats old Blood pain.

Deng's Comment: This is Phlegm, Blood Stasis, and Food Stagnation mixed causing harm, plus increasingly deficient Yuan Qi. Treatment is difficult.

Second Visit: Red turbid feces removed, Stomach Phlegm-Saliva still overflowing, large abdominal distension so severe, unbearable endurance.

Previous formula removes Chenpi, Beimu; adds Walengzi (Arca Shell), Yanhu (Corydalis), Danshen (Salvia), Xianou (Fresh Lotus Root).

Original Note: Masses disperse into Gu, bleeding above and below clearly indicates Blood Stasis. Resolving Stasis and Masses is a fixed principle. Unfortunately, Yuan Qi is greatly deficient, unable to withstand attacking/resolving, yet cannot be tonified. Thus organizing this formula to resolve Stasis/Masses without severe depletion. Disease halved, yet ultimately difficult to cure.

Deng's Comment: Now red feces removed, Phlegm-Saliva still overflowing. Why change formula to remove Chenpi/Beimu (Phlegm-resolving) and add Yanhu/Danshen (Blood-moving)? This seems contradictory.

History of hidden masses indicates Liver/Spleen disharmony. Last year bloody dysentery below, masses in middle, long unresolved, large abdominal distension, red urine, yellow tongue, wiry-thin-rapid pulse. Internal Damp-Heat aggregation, Spleen deficiency powerless to resolve, easily becoming Gu. Do not neglect.

Guishao Yigong San (Angelica and White Peony Extraordinary Skill Powder) added with Chuanlian (Coptis), Chuanpu (Magnolia Bark), Muxiang (Aucklandia).

Separately take Zhishi Xiaopi Wan (Immature Bitter Orange Reducing Epigastrium Pill), Xiao Wenzhong Wan.

Liu Yi's Comment: Prescription is stable/solid. However, Guishao Yigong San seems to have too much tonification and too little resolution.

Deng's Comment: This syndrome definitely has Damp-Heat retention. Propose adding Taoren (Peach Kernel) and Zhata (Charred Hawthorn) to guide it in decoction; if severe, Jiuzhi Jun (Wine-processed Rhubarb) can be considered.

Master Liu's comments are like a blow to the head.

Distension is always outside the Zang-Fu. This disease's distension does not start in the abdomen, but swells from ankles first, then reaches abdomen, rising from below to above. Due to Spleen deficiency failing to transport Dampness, Dampness tends downward, remaining in its own meridian; swelling reaching the center violates the root. Swollen areas feel like stone. Yang Qi greatly injured, treatment tricky.

Fugui Zhizhong Tang added with Rougu (Nutmeg), Danggui (Angelica), Fangji (Stephania), Niuxi (Achyranthes).

Separately take Shenqi Wan (Kidney Qi Pill).

Liu Yi's Comment: Besides Fangji in the formula, no other Dampness-resolving herbs. Based on condition, should incorporate diuretic/draining herbs.

Deng's Comment: Swelling starting from ankles indicates injury to Kidney Yang. Hence prescription focuses on warming-assisting Kidney Qi.