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Abdominal distension is often caused by Spleen deficiency, usually resulting from prolonged illness; Stomach excess is mostly due to food stagnation. Treatment should involve tonifying deficiency, strengthening the Spleen, and regulating Qi. By purging food accumulation and promoting digestion, the body will naturally become tranquil.

[Note] Abdominal distension is primarily governed by the Spleen and Stomach meridians. The condition can be either Deficiency or Excess, which must be carefully differentiated. Deficiency arises from internal injury to the Spleen due to prolonged illness, while Excess results from food stagnation in the Stomach. For Deficiency, tonify the Spleen; for Excess, promote digestion and eliminate stagnation. If treatment is appropriate, the distension will gradually resolve.

Prolonged illness leads to Spleen deficiency and loss of normal transport and transformation functions, or sudden injury to Spleen Qi due to severe vomiting and diarrhea. Symptoms include abdominal distension after eating little, mental fatigue, sallow complexion, and emaciation. Xiangpo Sijunzi Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction with Cyperus and Magnolia Bark) is suitable.

[Note] Whenever a child suffers from Spleen deficiency due to prolonged illness, or sudden injury to Spleen Qi from vomiting and diarrhea, the healthy transport and transformation functions are impaired. Consequently, food cannot be digested, leading to abdominal distension even with small intake. Presenting symptoms such as mental fatigue, sallow complexion, and emaciation indicate Deficiency-type Distension. It is appropriate to treat this with Xiangpo Sijunzi Tang.

Xiangpo Sijunzi Tang
Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Fu Ling (Poria), Gan Cao (Licorice Root, honey-fried), Xiang Fu (Cyperus Rhizome, processed), Hou Po (Magnoliae Officinalis Cortex, stir-fried with ginger juice).
Use fresh ginger as a guide drug, decoct in water, and take orally.

[Formula Song] Xiangpo Sijunzi treats deficiency distension, Ginseng, Atractylodes, Licorice, and Poria combined together, add Cyperus and Magnolia Bark, decoct with ginger to calm the distension.

Excessive diet injures the Stomach internally, causing food stagnation, abdominal distension, and constipation. Accompanied by tidal fever, irritability, thirst, and robust physical constitution, Pingwei San (Pingwei Powder) or Xiaochengqi Tang (Minor Order the Yang Decoction) should be applied for effective treatment.

[Note] Excessive diet in children causes food stagnation in the Stomach, leading to abdominal distension, difficult defecation, tidal fever, irritability, thirst, and a robust physical constitution. This constitutes Excess-type Distension. For mild cases, Pingwei San is the primary formula; for severe cases, Xiaochengqi Tang is the primary formula.

Modified Pingwei San
Cang Zhu (Atractylodis Rhizoma, stir-fried), Hou Po (Magnoliae Officinalis Cortex, stir-fried with ginger juice), Da Fu Pi (Arecae Pericarpium, processed), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Licorice Root, raw), Lai Fu Zi (Radish Seed, baked), Shan Zha (Crataegi Fructus), Mai Ya (Hordei Fructus Germinatus, stir-fried), Shen Qu (Medicated Leaven, stir-fried).
Use fresh ginger as a guide drug, decoct in water, and take orally.

[Formula Song] Modified Pingwei treats excess distension, Atractylodes, Magnolia Bark, and Areca Peel combined, with Licorice, Citrus Peel, and Radish Seed, along with stir-fried Hawthorn, Barley Sprout, and Medicated Leaven.

Xiaochengqi Tang (See "Food Pain" chapter for formula details)