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(This condition is often associated with edema. It should be treated using methods for edema. However, if there is internal distension without external swelling, the treatment method differs slightly.)

For severe fullness and distension in the heart and abdomen, Pingwei San (Stomach-Pacifying Powder) should be used as the principal formula. If due to Qi stagnation, add two qian of Maiya (Hordei Fructus Germinatus) and Xiangfu (Cyperi Rhizoma). If due to food retention, add Laifuzi (Raphani Semen), Shanzha (Crataegi Fructus), and Ganjiang (Zingiberis Rhizoma). If due to alcohol injury, add three qian of Gange (Puerariae Radix) and one qian of Sharen (Amomi Fructus). If there is excessive phlegm, add three to four qian of Fuling (Poria). If there is frequent vomiting, add three qian of Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens). If there is distension in the upper chest that does not spread horizontally, add Mutong (Akebiae Caulis), Qiancao (Rubiae Radix et Rhizoma), Maimendong (Ophiopogonis Radix), Gualou (Trichosanthis Fructus), and Beimu (Fritillariae Bulbus). If turbid Qi remains in the upper part, add Chaihu (Bupleuri Radix), Banxia (Pinelliae Rhizoma), and Jiegeng (Platycodonis Radix). If there is epigastric stuffiness and fullness, add one qian each of Huanglian (Coptidis Rhizoma) and Huangqin (Scutellariae Radix), and eight fen of Ganjiang (Zingiberis Rhizoma).

If there is abdominal pain, add three qian of Sheng Baishao (Paeoniae Radix Alba). If the abdominal pain is caused by constipation, add an additional two qian of Dahuang (Rhei Radix et Rhizoma). If urination is obstructed, combine with Wuling San (Five-Ingredient Powder with Poria). If distension occurs around the navel, extending left, right, above, and below, the distension will necessarily be accompanied by pain. This indicates rebellious and unsmooth Qi of the Chong Mai (Penetrating Vessel). Remove Cangzhu (Atractylodis Rhizoma) and add Honghua (Carthami Flos), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Chaihu (Bupleuri Radix), and Guizhi (Cinnamomi Ramulus) to treat it. If distension and pain occur in the hypochondriac regions on both sides along with lower abdominal pain, this indicates that the Jueyin (Liver) channel fails to interact internally with the Shaoyin (Kidney) channel and externally harmonize with the Shaoyang (Gallbladder) channel. Add Chaihu (Bupleuri Radix), Renshen (Ginseng Radix), Banxia (Pinelliae Rhizoma), Guizhi (Cinnamomi Ramulus), and Danggui (Angelicae Sinensis Radix) to treat it. (Article 80)

For abdominal distension that prefers pressure, the following four formulas are suitable.

Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle) (Article 107) ○ (Indicated for deficiency-cold patterns.)

Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) (Article 5) ○ (Indicated for dysfunction of Spleen Earth and failure of Earth Qi to ascend.)

Liujunzi Tang (Six-Gentlemen Decoction), added with Ganjiang (Zingiberis Rhizoma) (Article 2) ○ (Indicated for spleen deficiency with excessive phlegm causing abdominal distension.)

Xiangsha Liujunzi Tang (Six-Gentlemen Decoction with Cyperi and Amomi) (Article 3)

My Commentary: For the aforementioned methods, if they fail to produce results, the treatment must focus primarily on the Bladder. Yu Jiayan stated: The chest in the human body is empty and vast like the Great Void. When Earth Qi rises to form clouds, it must be met by Heaven Qi descending to form rain, so that Earth Qi can settle and remain still. This truly embodies the meaning of "the Upper Jiao is like mist, the Middle Jiao is like a fermenting vat, and the Lower Jiao is like a ditch." Only when clouds move and rain falls will the ditches and channels fill up, water passages become smooth and clear, and a new scene emerge in the universe. This theory places primary importance on the Bladder channel. The Classic states: "The Bladder is the official of the metropolitan area, storing fluids; through Qi transformation, it can discharge them." Just as some people drink unlimited amounts of alcohol without getting drunk, it is all due to the Qi transformation of the Bladder metabolizing the liquid. Danzhong (Conception Vessel point located at the center of the chest) is located within the diaphragm, while the Bladder is located in the abdomen. When the Bladder's Qi transformation functions normally, the abdomen remains hollow and accommodating, allowing Qi from Danzhong to descend. If the Bladder fails to transform Qi, the abdomen will distend first, and how could the Qi of Danzhong reach the lower part? However, to restore the Qi transformation of the Bladder, the key lies in preserving Kidney Qi. The Kidney and Bladder are interior-exteriorly related (Kidney is the Zang organ, Bladder is the Fu organ). When Kidney Qi moves, it must first pour into the Bladder. Repeated movement leads to Bladder distension, which inevitably affects the chest and diaphragm, creating a state of obstruction indescribable by words. If Kidney Qi does not move recklessly, storage becomes more secure, and the Bladder remains pure and tranquil. Consequently, Qi from Danzhong enters without becoming excessive. Since Qi from Danzhong descends swiftly, it is not disturbed by traction, leaving the chest empty and vast like the sky. This discussion serves as the golden needle (key principle) for treating chest and abdominal fullness as well as fluid-retention conditions.