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Distension disease has two types. Deficiency patterns are more common, while excess patterns are less frequent. Li Dongyuan and Qian Yi, among others, advocated treating from the perspective of deficiency. The *Neijing* states: "Taiyin is prone to dampness," referring here to cold-dampness. Treating it as a heat pattern would be an error. One must distinguish based on pulse and symptoms. In excess distension, it may be due to food stagnation or masses (abdominal lumps). There is first a physical object in the intestines and stomach, followed by distension manifesting externally. Palpation reveals hardness. It is appropriate to use methods to resolve and guide out stagnation; one must not use purgatives. Using purgatives will further deplete healthy qi, making it incurable. Wei Ling Wan (Stomach-Calm Pill) is indicated.

In deficiency distension, it may occur after prolonged vomiting, diarrhea, malaria, or dysentery, where the Spleen and Stomach have been damaged over time. This deficient qi resides outside the membrane source (a region between the interior and exterior). Although the exterior appears distended, the interior is empty. Palpation feels soft, and percussion yields a hollow sound. Purgatives must not be used; using them can lead to death. Warm tonification is appropriate. Qian's Modified Yigong San (Modified Benefit-Working Powder), prepared as pills, should be taken. Ingredients include: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Licorice Root, honey-fried, 1 qian each), Chenpi (Citrus Reticulata Pericarpium), Qingpi (Citrus Aurantium Pericarpium), Zhishi (Immature Bitter Orange, stir-baked), Nongpu (Magnolia Bark, stir-baked), Banxiaqu (Pinellia Fermented Paste), Huanglian (Coptis Rhizome, stir-fried with ginger juice). If dry mouth with desire to drink, unclear consciousness, and occasional delirious speech occur, Sanhuang Wan (Three-Yellow Pill) and Hejian Liangge San (He Jian's Cooling Chest Powder) are indicated, along with the Dan Dao method (a bowel-cleansing technique).

Liangge San (Cooling Chest Powder) formula: Lianqiao (Forsythiae Fructum, 1 qian), Huangqin (Scutellariae Radix, 2.5 fen), Boheye (Menthae Haplocalycis Folium, 2 fen), Zhiziren (Gardeniae Semen, 3 fen), Gancao (Licorice Root), Dahuang (Rhei Radix et Rhizoma), Puxiao (Natrii Sulfas, 5 fen each). Take one zhong of water and five leaves of Zhu Ye (Bambusae Folium), decoct until nearly ready, add one spoonful of honey, remove dregs, and take warm.

If caused by retained food, there will necessarily be aversion to food, acid regurgitation, and intermittent abdominal pain. Sanhuang Zhizhu Wan (Three-Yellow Immature Orange-Atractylodes Pill) is indicated (formula see below), or Muxiang Binglang Wan (Costus and Areca Nut Pill) may be used.

If caused by accumulations, there is paroxysmal abdominal pain. Dingxiang Pi Ji Wan (Clove Spleen-Accumulation Pill) is indicated.

Pediatric abdominal distension differs from adults; it is mostly due to food injury. Weiling Wan combined with Baohe Wan (Preserve Harmony Pill) from Danxi is indicated.

If indeed food-injured, with abdominal distension or pain, acid regurgitation, aversion to food, and difficult defecation, Muxiang Chengqi Wan (Costus Bowel-Regulating Pill) is indicated.

Muxiang Chengqi Wan formula: Zhishi (Immature Bitter Orange, stir-baked), Nongpu (Magnolia Bark, stir-fried with ginger juice), Binglang (Areca Seed, wine-soaked, equal parts), Muxiang (Costus Root, half dose), Dahuang (Rhei Radix et Rhizoma, wine-soaked, same dosage as the above three ingredients). Grind into powder, make pills with wine paste, size of hemp seeds, take with clear water.

Muxiang Binglang Wan: Treats all heat accumulations from injury, and also dysentery with abdominal pain. Ingredients: Muxiang (Costus Root), Binglang (Areca Seed), Qingpi (Citrus Aurantium Pericarpium, white pith removed), Chenpi (Citrus Reticulata Pericarpium, white pith removed), Ezhu (Curcumae Rhizoma, baked), Huanglian (Coptis Rhizoma), Huangbai (Phellodendri Cortex), Xiangfuzi (Cyperi Rhizoma), Zhike (Aurantii Fructus, bran-stir-fried, 1 qian each). Grind into powder, pound with water to make pills, size of hemp seeds, take with ginger soup.

Jiajian Taqi Tang (Modified Collapse-Qi Decoction): Treats abdominal distension. Ingredients: Bibai (Piperis Longi Fructus), Sharen (Amomi Fructus Rotundus), Qingpi (Citrus Aurantium Pericarpium), Chenpi (Citrus Reticulata Pericarpium), Dingxiang (Eugeniae Flos), Quanxie (Scorpio, stir-fried), Laifuzi (Raphani Semen, stir-fried, equal parts). Grind into powder, make pills with Shenqu (Medicated Leaven) paste, size of hemp seeds, take with Nongpu Tang (Magnolia Bark Decoction).

My niece suffered from food stagnation and Spleen deficiency. After smallpox, she injured her food again, resulting in abdominal distension and loss of appetite. I used the Weiling Wan formula, adding stir-baked Zhishi (Immature Bitter Orange), stir-baked Shenqu (Medicated Leaven), Maiqu (Wheat Medicated Leaven), and Qingpi (Citrus Aurantium Pericarpium), made into pills for her to take.

My grandson, Bangzi, first suffered from malaria, then developed malnutrition (Gan syndrome) from food injury, and suffered another food injury. He was very thin, with a large, hard, distended abdomen, and cried when seeing people. I prescribed a formula containing: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Baifuling (Poria), Gancao (Licorice Root), Banxiaqu (Pinellia Fermented Paste), Zhishi (Immature Bitter Orange, stir-baked), Nongpu (Magnolia Bark), Huanglian (Coptis Rhizoma), Muxiang (Costus Root), Ezhu (Curcumae Rhizoma), Sharen (Amomi Fructus Rotundus), Shijunzi (Quisqualis Fructus), Shenqu (Medicated Leaven), Maiya (Hordei Fructus Germinatus), Biejia (Testudinis Carapax et Plastrum), Yemingsha (Chiropterae Os), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), etc.

A child had abdominal distension after diarrhea. I treated him with Jiajian Taqi Wan (Modified Collapse-Qi Pill), and he recovered.

A child had persistent malaria with a large, hard abdomen. I treated him with Huapi Wan (Resolve-Mass Pill), and he recovered.

A five-year-old child had a large abdomen but good appetite. Upon seeing him, I told his parents: "Excessive milk damages the Stomach; food accumulation injures the Spleen. Your son's abdomen is so enlarged, and without self-restraint, indulging his appetite, I fear his intestines and stomach will be injured. It will either become intestinal dysentery or develop into Gan syndrome." Indeed, he later developed Gan syndrome, with a large abdomen and visible blue veins. I treated him with Jisheng Wan (Collect-Sage Pill) for regulation, and he recovered.

A child who ate well had a large abdomen. I alternated between Baohe Wan (Preserve Harmony Pill) and Weiling Wan (Stomach-Calm Pill) for regulation, and he recovered.

A child had abdominal pain and distension due to food injury. A doctor treated him with purgatives, and he recovered. Later, he injured his food again, causing abdominal distension, and the doctor purged him again. I heard this and said, "This is not the correct treatment; it will mistakenly kill this child." When Spleen deficiency cannot digest food, fullness leads to distension. This situation requires tonifying the Spleen to assist transportation and transformation. How can purgatives be used? Initially, the distension was due to overeating injuring the Spleen. Not using resolving and guiding methods, but instead purging, was an error. Subsequent distension was due to Spleen deficiency. Purging repeatedly is a grave mistake. Repeated purging led to repeated distension, resulting in a huge abdomen without skin markings, protruding umbilicus, flat back, and death. Although it was the doctor's error, the parents' failure to listen to my advice was also at fault.

Masses in the abdomen are common after malaria. Children with masses often present with chills and fever resembling malaria; this should not be treated as malaria. Once the mass is resolved, the chills and fever will stop naturally. Our family's Xiaopi Wan (Resolve-Mass Pill) is very effective. Ingredients: Renshen (Ginseng Radix et Rhizoma), Chenpi (Citrus Reticulata Pericarpium), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Muxiang (Costus Root), Huanglian (Coptis Rhizoma), Sharen (Amomi Fructus Rotundus), Biejia (Testudinis Carapax et Plastrum), Zhishi (Immature Bitter Orange), Yemingsha (Chiropterae Os), Shijunzi (Quisqualis Fructus), Ganchan (Bufo Skin), Banxiaqu (Pinellia Fermented Paste), Maiya (Hordei Fructus Germinatus), Haikunbu (Sargassum). Grind into powder, make pills with wine paste, size of hemp seeds, take with rice drink.

My late father treated masses using only Xiangchan Wan (Costus-Bufo Pill). This is one of our thirteen family formulas. Ingredients: Muxiang (Costus Root), Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Jiegeng (Platycodonis Radix), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Biejia (Testudinis Carapax et Plastrum), Lvfan (Green Vitriol), Zhishi (Immature Bitter Orange), Shijunzi (Quisqualis Fructum), Lian Gen Pi (Meliae Radicis Cortex), Hezi (Terminaliae Chebulae Fructus), Ganchan (Bufo Skin, 7.5 qian), Huanglian (Coptis Rhizome, 1 liang). Grind into powder, make pills the size of mung beans. Take 30-40 pills per dose with rice drink.