Library

The *Yellow Emperor's Inner Canon* states: When the Foot-Taiyin Spleen Meridian is deficient, drum-like distension occurs. It also states: Cold in the Stomach leads to fullness and distension. Furthermore: When turbid Qi stagnates in the upper jiao, distension arises. Chen Feixia stated: "Distension and fullness refer to abdominal enlargement and Qi stagnation. This occurs because the Spleen and Lungs fail to transport and transform effectively." Distension is categorized into deficiency distension, cold distension, excess distension, and heat distension. Generally, deficiency and cold distensions account for eight or nine-tenths of cases, while excess and heat distensions 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 weakened Middle Qi and the Spleen's inability to transform dampness, making them difficult to detect and treat. If deficiency-cold distension is mistakenly treated as excess-heat distension, the resulting complications will be countless.

Deficiency distension may arise after vomiting or diarrhea, or due to excessive purgative medication, leading to abdominal distension. The appropriate treatment is to warm the middle and regulate Qi using Nongpo Wenzhong Tang (Magnolia Bark Decoction to Warm the Middle); if deficiency is accompanied by cold, add Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root). Excess distension occurs when there is pre-existing food accumulation in the abdomen, or due to overeating causing food to consolidate in the middle jiao. External signs include high swelling at the epigastrium and chest, fever, thirst, lethargy with a desire to lie down and silence, abdominal pain with slight wheezing, eyes closed and unopen, resembling an extreme state of deficiency. This condition is most common in children and difficult to identify. Unskilled physicians, failing to examine carefully, may mistake the inability to move limbs and closed mouth for Man Feng (Slow Wind/Chronic Convulsion), and administer calming and phlegm-resolving drugs. In ten cases, all ten die, with none surviving. They fail to understand the principle that "great excess can manifest as weakness," which refers precisely to this situation. Urgent purgation is required, administering Jicheng Hangxie Dan (Jicheng Cang Lake Pill) and Jicheng Sanxian Dan (Jicheng Three Immortals Pill).

Heat distension may result from heat pathogens of Shanghan (Cold Damage) entering the interior, causing constipation, scanty dark urine, high fever, red face, and irritability; Jicheng Hangxie Dan is indicated. Cold distension results from inherent Middle Qi coldness, with cold stagnation and knotting internally. There is no fever or thirst; instead, there is cyanosis of the face and lips, cold extremities, wheezing, and abdominal distension. First, use Taqi Wan (Collapse Qi Pill) to resolve cold stagnation, followed by Yigong San (Benefit Labor Powder) to regulate the Spleen and Stomach.

For generalized sores and scabies, where bathing and topical applications force toxins inward, causing abdominal distension: for mild cases, use Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Defeat Toxins) to raise and disperse; for severe cases, use Jicheng Hangxie Dan to mildly purge. If distension resolves after sores erupt, the prognosis is auspicious; if sores do not erupt, it is ominous. The Classic states "Cold in the Zang organs generates distension," implying that the Spleen is the ultimate Yin within the Yin. If Spleen dampness is excessive and Yang fire cannot transform it, it is like soil soaked in rain turning to mud, unable to nourish all things. One must wait for gentle winds and warm sun to remove dampness and generate Yang for natural growth. Such cases are suitable for treatment with acrid-hot herbs. The statement "Purgation resolves distension" applies only to those with excess damp-heat and food retention, robust Spleen-Stomach constitution, and strong physical temperament. For those with Spleen deficiency and internal cold, where Qi fails to transport fine essences, causing distension, one should primarily use sweet-warm herbs to tonify the Spleen, slightly assisting with acrid-hot herbs to move stagnant Qi. This allows the Spleen Earth to become robust and distension to circulate, leading to recovery. This is what the Classic calls "treating obstruction with obstruction" (using tonification for blockage symptoms), a method of following the disease's false presentation. Physicians who fail to investigate and cling to "purgation resolves distension," seeking quick results, and patients who prefer purgatives for immediate relief, do not realize that temporary relief injures True Qi further and worsens distension, bringing death near.

Nongpo Wenzhong Tang (Magnolia Bark Decoction to Warm the Middle): Treats epigastric and abdominal distension due to Stomach cold.
Chuan Po (Magnoliae Officinalis Cortex, 0.7 qian) Chenpi (Citri Reticulatae Pericarpium, 1 qian) Heijiangtan (Zingiberis Rhizoma Carbonized, 1 qian) Fuling (Poria, 1 qian) Cao Kouren (Amomi Fructus Rotundus Seed, 0.6 qian) Muxiang (Aucklandiae Radix, 0.5 qian) Zhigancao (Glycyrrhizae Radix et Rhizoma Prepared with Honey, 1 qian).
For deficiency with cold, add Shu Fuzi (Aconiti Lateralis Radix Praeparata), Rougui (Cinnamomi Cortex), and fresh Ginger in small amounts.

Jicheng Taqi Wan (Jicheng Collapse Qi Pill): Treats cold stagnation and knotting, abdominal deficiency distension.
Hujiaoren (Piperis Longi Fructus) Quanxieweii (Scorpio Tail, hooks removed, washed and stir-fried dry).
Take approximately 1 liang of Hujiaoren with skin removed, stir-fry, mix with powdered Scorpion tails, form pills with wheat paste, very small. Take 1-2 qian per dose, delivered with Chenpi decoction.

Hangxie Dan (See previous formula for Dampness Injury).

Jicheng Sanxian Dan (Jicheng Three Immortals Pill)
Wulingzhi (Trogopterori Faeces, 2 liang) Guangmuxiang (Aucklandiae Radix, 5 qian) Badouren (Crotonis Fructus Kernel, 40 grains, oil completely removed). Form pills with vinegar-treated Qu paste, size of mung beans, coated with Cinnabar. Dosage according to child's age.

Yigong San (Benefit Labor Powder)
Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian) Fuling (Poria, 1 qian) Dangshen (Codonopsis Radix, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian) Chenpi (Citri Reticulatae Pericarpium, 1 qian).

Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Defeat Toxins)
Jiesui (Schizonepetae Spica, 1 qian) Fangfeng (Saposhnikoviae Radix, 1 qian) Lianqiao (Forsythiae Fructum, 1 qian) Zhiqiao (Aurantii Fructus Immaturus, 0.7 qian) Shengma (Cimicifugae Rhizoma, 0.5 qian) Bohe (Menthae Haplocalycis Herba, 1 qian) Qianghuo (Notopterygii Rhizoma et Radix, 0.7 qian) Duohuo (Angelicae Pubescentis Radix, 0.5 qian) Fengegen (Puerariae Lobatae Radix, 1 qian) Chuantong (Lini Semen, 1 qian) Jinyinhua (Lonicerae Japonicae Flos, 1 qian) Huangqin (Scutellariae Radix, 1 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma, 0.5 qian) Zhiziren (Gardeniae Fructus Seed, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian).
For upper body edema, add 3 stalks of Congbai (Allii Fistulosi Bulbus); for lower body edema, add 10 stalks of Dengcao (Junci Medulla). Decoct in clear water.

Tu Weisheng commented: Chen Feixia stated that deficiency distension may arise after vomiting/diarrhea or excessive purging. However, vomiting injures Yang, and diarrhea injures Yin; purging also injures both Yang and Yin, similar to vomiting and diarrhea. Once Yin and Yang are damaged, tonifying Yin and Yang is imperative; how can one continue to use resolving and draining methods? Examining the original Nongpo Wenzhong Tang, it consists mainly of Qi-breaking herbs, which is inappropriate for this condition. I believe Liu Junzi Tang (Six Gentlemen Decoction) should be used, with slight addition of Muxiang as an assistant. This avoids worsening deficiency or exacerbating excess. Temporarily, based on cold or heat, one can add Guizhi, Fuzi, Danggui, Baishao, Zhishi, Chaihu, Huangqin, Huanglian, etc., making the treatment suitable for both deficiency-cold and excess-heat distensions.