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The *Classic of Internal Medicine* states: Deficiency of the Foot-Taiyin (Spleen) meridian leads to drum-like distension. It also states: Cold in the Stomach leads to fullness and distension. Furthermore, it states: When turbid Qi remains in the upper part, distension arises.

Distension and fullness refer to abdominal enlargement and Qi stagnation. This occurs due to deficiency of Spleen and Lung Qi, which fails to perform normal transportation and transformation, thereby generating distension. Distension is categorized into deficiency distension, excess distension, heat distension, and cold distension. Generally, deficiency distension and cold distension account for seven or eight tenths, while excess distension and heat distension account for two or three tenths. Excess-heat patterns are easily observed by people, often caused by food retention or Shaoyang disease pathogens entering the interior; thus, they are easy to diagnose and treat. In contrast, deficiency-cold patterns result from decline of Middle Qi (Spleen-Stomach Qi) and failure of Spleen Qi to transform, leading to distension; therefore, they are difficult to detect and treat. If deficiency-cold distension is mistakenly treated as excess-heat distension, the resulting complications would be countless.

Deficiency distension may arise after vomiting and diarrhea, or due to excessive purgative medication, resulting in abdominal distension. The appropriate treatment is to warm the middle and regulate Qi using Nongpu Wenzhong Tang (Thick Magnolia Bark Decoction to Warm the Middle). If deficiency is accompanied by cold, add Fuzi (Aconite Lateral Root) and Guizhi (Cinnamon Twig).

Excess distension occurs when there is pre-existing food accumulation in the abdomen, or due to overeating, causing food to consolidate in the center. External manifestations include high swelling at the epigastrium and chest, fever, thirst, lethargy with unwillingness to speak, abdominal pain with slight panting, eyes closed and unopenable, presenting an appearance of extreme deficiency. This pattern is most common in children and difficult to recognize. Unskilled practitioners who fail to examine carefully may mistake the immobility of limbs and closed eyes for Slow Convulsion (a pediatric condition characterized by chronic convulsions), and administer calming spirit and resolving phlegm medications. Such treatments lead to death in nearly all cases, with no survivors. One must understand that "great excess presents with deficient signs," which refers precisely to this situation. Urgent purgation is required; Chengji Hangxie Dan (Chengji Hengxie Pill) should be administered together with Chengji Sanxian Dan (Chengji Three Immortals Pill).

Heat distension may result from heat pathogens of Wind-Cold disease entering the interior, causing constipation, scanty dark urine, high fever throughout the body, red face, and irritability. Chengji Hangxie Dan is indicated.

Cold distension results from inherent cold in the Middle Qi, with cold stagnation and consolidation. There is no fever or thirst; instead, there is a blueish complexion of the face and lips, cold hands and feet, panting, and abdominal distension. First, use Taqi Wan (Collapse Qi Pill) to eliminate the distension, followed by Yigong San (Yigong Powder) to regulate the Spleen and Stomach.

In cases where sores and scabies cover the whole body, distension arises because bathing and topical applications force toxins inward. For mild cases, Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Overcome Toxins) is used to raise and disperse; for severe cases, Chengji Hangxie Dan is used to mildly promote drainage. If sores erupt and distension subsides, it is auspicious; if sores do not erupt, it is ominous.

The *Classic* states that cold in the Zang organs generates distension. The Spleen is the ultimate Yin within Yin. Due to excess Spleen dampness, without Yang Qi, transformation cannot occur. Just as soil subjected to prolonged rain becomes mud and cannot nurture all things, it requires gentle winds and warm suns to remove dampness and generate Yang before natural growth can occur. For such cases, it is appropriate to employ acrid-hot herbs.

The *Classic* states that "purging will resolve distension." This statement applies to those with excess damp-heat and food retention, robust Spleen and Stomach constitution, and strong physical temperament. However, for those with Spleen deficiency and internal cold, where Qi fails to transport refined essences leading to distension, the primary treatment should be sweet-warm tonification of the Spleen, slightly assisted by acrid-hot herbs to move stagnant Qi. This allows the Spleen Earth to become vigorous and distension to resolve. This is what the *Classic* refers to as "treating obstruction with obstruction" (using tonification for blockage symptoms), a method of following the disease's apparent nature. Physicians who do not comprehend this, but cling to "purging resolves distension" and seek quick effects, often prescribe diuretics and purgatives to satisfy patients' desire for relief. They fail to realize that temporary relief injures True Qi further and exacerbates distension, bringing death near.

Various schools treating distension and edema only know how to move Qi and promote urination, combining attack and reduction, often resorting to harsh purgatives. This is a path to rapid death. They do not realize that when extreme Spleen Qi deficiency causes swelling and distension, further purging increases deficiency. Seeking only immediate relief damages Yin and True Yuan, with disaster ensuing immediately. Future physicians should pay close attention to this.