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The *Lung Meridian* states: A deficient pulse at the Guan position indicates internal distension; a slow and slippery pulse indicates distension; an excess of Lung Qi with a tight pulse also indicates distension. Yan Shi holds that distension with a floating pulse is easy to treat, whereas one with a deficient pulse is difficult to treat. The *Needle Classic* states: A pulse that is large, firm, and resembles roughness indicates distension.

The *Inner Canon* states: All cases of abdominal distension and enlargement belong to Heat. Furthermore, the *Needle Classic* states: Distension occurs outside the Zang-Fu organs, pushing against them and expanding the chest and hypochondrium, causing fullness in the skin; hence it is named "distension." It may arise from Jue Qi (rebellious Qi) below, where Ying and Wei Qi stagnate and stop, Cold Qi rebels upward, and True Pathogenic factors attack each other; the two Qi types clash and combine to form distension. Additionally, the *Tuning the Channels Chapter* states: Due to irregular diet and overexertion damaging the Spleen and Stomach, initially suffering from Heat in the Interior (*Re Zhong*), which has not yet transmitted to Cold in the Interior (*Han Zhong*), all result from the deficiency or excess of Spleen and Stomach Qi failing to transform and transport subtle essence, thereby controlling food and fluids. This leads to accumulation without dispersion, forming distension. This is distension caused by the depression of Cold-Dampness. Generally, children often suffer from distension due to irregular eating habits, consumption of raw/cold or sweet/greasy foods that accumulate and fail to disperse, or due to long-standing *Gan* syndrome (malnutrition syndrome) and unresolved masses after snow. These can all cause distension, characterized by an abdomen that feels like a drum when pressed. Thus, there are different names such as *Gan* distension, Qi distension, Diaphragm distension, Worm distension, Accumulation distension, Food distension, Deficiency distension, Cold distension, and Locked Belly distension. Treatment should be tailored to the severity and progression of each condition to avoid therapeutic errors.

Qian Yi stated: Treating distension is like engaging bandits in a forest battle. If the bandits have not yet left the forest, attacking them with troops will surely capture them. If they have already exited the forest, one must not attack hastily, as this will lead to mishandling; instead, one should gradually subdue them according to circumstances, which aligns with the natural flow. He further stated: Pediatric distension arises from Spleen-Stomach deficiency with rebellious Qi attacks. Excess patterns manifest as oppression, restlessness, wheezing, and fullness, and can be treated with purgation using *Zishuang Wan* (Purple Frost Pill) or *Baibing Zi* (White Cake). If there is no wheezing, it is a deficiency pattern, and purgation is contraindicated. Misusing purgation leads to Spleen deficiency, causing Qi to rebel upward and attach to the Lung. Since Lung and Spleen share a mother-son relationship, both become deficient. The Lung governs the eyelids and cheeks, while the Spleen governs the four limbs. Severe deficiency of the Mother Qi (Spleen Qi) results in swelling of the eyelids and cheeks. Yellow complexion indicates Spleen involvement; treatment involves *Taqi Wan* (Bed Qi Pill), administered gradually until resolved. If not fully cured, increase the dosage gradually. Do not use strongly warming and dispersing herbs like *Dingxiang* (Clove), *Muxiang* (Aucklandia Root), *Chenpi* (Aged Tangerine Peel), or *Doukou* (Cardamom), but rather allow the Qi to dissipate from above and below to achieve recovery. If the deficient Qi has already moved out and attached to the Lung, the Spleen and Stomach interior becomes weak, generating deficient Qi that enters the limbs and face. Children are prone to deficient heat; Spleen deficiency cannot tolerate extreme cold or warmth—cold induces raw/cold conditions, while warmth induces heat. One must recognize this to avoid error. Prolonged Stomach deficiency with heat often generates Jaundice disease or excessive thirst. Spleen deficiency fails to control Kidney Qi, which ascends with Lung Qi to the four limbs. If fluid-like, Kidney Qi floats into the Lung, causing severe wheezing. In such cases, *Taqi Wan* should be administered. After recovery, if the facial color remains pale, it indicates that the deficiency has not yet recovered. For pediatric deficiency-type distension, first administer *Taqi Wan*. If ineffective, and there is fecal impaction in the abdomen, yellow urine, occasional mild wheezing, a deep and solid pulse, and ability to drink/eat, purgation may be used. After recovery, if the Spleen was initially deficient and then accumulated pathogenic factors, the treatment strategy should be to tonify the Spleen first, then purge, and finally tonify the Spleen again to achieve cure. Do not tonify the Lung, as this may generate deficient Qi.