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Erchen Tang (Cinnamon Twig and Dried Tangerina Peel Decoction) [Ref: He Yi] Heweiyin (Stomach-Harmonizing Drink) [Ref: Xin He Wu] Liu Junzi Tang (Six Gentlemen Decoction) [Ref: Bu Wu] Liyin Jian (Yin-Regulating Infusion) [Ref: Xin Re San] Hezhong Tang (Middle-Jiao-Harmonizing Decoction) [Ref: Han Wu Ba] Jinshui Liujun Jian (Metal-Water Six Gentlemen Infusion) [Ref: Xin He Yi] Wenweiyin (Stomach-Warming Drink) [Ref: Xin Re Wu] Sansheng Wan (Three Sages Pill) [Ref: Han Yi Qi Yi] Hewei Erchen Jian (Stomach-Harmonizing Erchen Infusion) [Ref: Xin He San] Quzhu Wan (Qu-Magnolia Pill) [Ref: He Bai Shi] Shulian Wan (Atractylodes-Coptis Pill) [Ref: Han Yi Qi Er] Eru Erchen Tang (Two Atractodises and Erchen Decoction) [Ref: He Si] Sanbu Wan (Three Tonics Pill) [Ref: Han Yi Liu Er] Ruan Shigao Wan (Soft Gypsum Pill) [Ref: Han Yi Qi San]

The *Abdominal Discussion* chapter of the *Huangdi Neijing* (Yellow Emperor's Inner Canon) records: The Yellow Emperor asked, "There is a disease characterized by fullness in the heart and abdomen; after eating in the morning, one cannot eat in the evening. What is this disease?" Qibo replied, "It is named Drum Distension (Gu Zhang, a condition characterized by abdominal distension resembling a drum). It can be treated with Jishi Li (Chicken Excrement Fermented Liquid); one dose brings improvement, two doses bring recovery." The Yellow Emperor asked, "Why does this disease recur?" Qibo said, "This is due to irregular diet, hence the occasional recurrence of illness. Although the disease may temporarily subside, the pathogenic Qi remains accumulated in the abdomen."

The *Meridian Chapter* states: Deficiency of the Foot-Taiyin Spleen Meridian leads to Drum Distension. Cold in the Stomach leads to distension and fullness.

The *Water Swelling Chapter* states: Skin Distension (Fu Zhang, a condition characterized by skin swelling that does not pit easily) occurs when cold pathogens lodge between the skin and muscles. Percussion yields a hollow sound, it is not firm, the abdomen enlarges, the whole body swells, the skin thickens, and pressing the abdomen leaves an indentation that does not immediately recover, while the abdominal color remains unchanged; these are its signs. The Yellow Emperor asked, "What about Drum Distension?" Qibo said, "The abdomen is distended, and the whole body is enlarged, to the same extent as Skin Distension; the complexion is dark yellow, and abdominal veins are prominent; these are its signs."

The *Discussion on Distension* chapter records: The Yellow Emperor asked, "How do pulse manifestations at the Cun Kou position indicate distension?" Qibo said, "A pulse that is large, firm, and choppy indicates distension." The Yellow Emperor asked, "How can one distinguish distension of the Zang and Fu organs?" Qibo said, "Yin meridians correspond to Zang organs, and Yang meridians correspond to Fu organs." The Yellow Emperor asked, "Does the Qi causing distension reside within the blood vessels, or inside the Zang and Fu organs?" Qibo said, "All three exist, but none is the primary seat of distension. Distension resides outside the Zang and Fu organs, pushing against them, expanding the chest and hypochondrium, and swelling the skin; thus it is named Distension. The five Zang and six Fu organs have their boundaries, and each has distinct pathological shapes. Ying (Nutritive) Qi circulates within the vessels; if Wei (Defensive) Qi reverses, it causes Vessel Distension. If Wei Qi merges with the vessels and circulates along the muscle intervals, it causes Skin Distension. Heart Distension manifests as mental restlessness, shortness of breath, and restless sleep. Lung Distension manifests as empty fullness in the chest, wheezing, and coughing. Liver Distension manifests as fullness and pain under the hypochondrium radiating to the lower abdomen. Spleen Distension manifests as frequent hiccups, heaviness and discomfort in the four limbs, inability to bear the weight of clothing, and restless sleep. Kidney Distension manifests as abdominal fullness radiating to the back, and persistent pain in the waist and thighs. Fu Organ Distension: Stomach Distension manifests as abdominal fullness, epigastric pain, smelling burnt odors from the nose, difficulty eating, and difficult defecation. Large Intestine Distension manifests as borborygmus and gurgling pain; if exposed to cold in winter, it leads to undigested diarrhea. Small Intestine Distension manifests as lower abdominal fullness radiating to the lower back with pain. Bladder Distension manifests as lower abdominal fullness and urinary retention. Sanjiao (Triple Burner) Distension manifests as Qi filling the skin, feeling light but not firm upon pressure. Gallbladder Distension manifests as pain and fullness under the hypochondrium, bitter taste in the mouth, and frequent sighing. Qibo said: "Wei Qi normally runs alongside the vessels, circulating through the muscle intervals, with smooth and reverse flows, Yin and Yang following each other, thereby achieving harmony with nature, allowing the five Zang organs to function cyclically, the four seasons to proceed in order, and grains to be digested. However, if Jue Qi (rebellious Qi) accumulates below, Ying and Wei Qi stagnate, cold Qi rebels upward, and true Qi conflicts with pathogenic Qi, the two energies clash, resulting in distension. (Detailed acupuncture treatments for this follow in the original text.)"

The *Major Discussion on Yin-Yang Correspondence to Phenomena* states: When turbid Qi stays in the upper part, distension arises.

The *Discussion on Life-Giving Heaven* states: Due to Qi dysfunction, edema occurs; if the four extremities alternate abnormally, Yang Qi will be exhausted.

The *Chapter on Generation of the Five Zang Organs* states: Abdominal fullness and distension, support-like pain in the chest and hypochondrium, lower jiao coldness with upper jiao cloudiness, indicate pathology in the Foot-Taiyin and Foot-Yangming meridians.

The *Chapter on Original Spirit* states: Excess of Spleen Qi leads to abdominal distension. Excess of Kidney Qi leads to distension.

The *Major Discussion on the Six Yuan and Correct Chronicles* states: When Taiyin arrives, central fullness, cholera, vomiting, and diarrhea occur. When Taiyin arrives, there is heaviness and edema. When Earth Qi is depressed and erupts, people suffer from heart and abdominal distension, edema, and body heaviness.

The *Major Discussion on the Most Essential and True* states: All dampness-induced edema and fullness belong to the Spleen. All distensions with abdominal enlargement belong to Heat. (Note: The above distensions all discuss Qi as the pathogen.)

The *Chapter on Water and Acupoints* records: The Yellow Emperor asked, "Why does the Shaoyin meridian govern the Kidneys? Why do the Kidneys govern water?" Qibo said, "The Kidneys are Supreme Yin; Supreme Yin means storing abundant water. The Lungs are Taiyin; Shaoyin corresponds to Winter pulses. Thus, the root of water accumulation is in the Kidneys, and the branch is in the Lungs; both involve water accumulation." The Yellow Emperor asked, "Why can the Kidneys accumulate water and cause disease?" Qibo said, "The Kidneys are the gate of the Stomach. If the gate is not functional, water accumulates and spreads according to its nature. Therefore, water disease manifests downward as leg edema and abdominal distension, and upward as panting and inability to lie flat; this is simultaneous involvement of root and branch."

The *Water Swelling Chapter* states: At the onset of water disease, the eyelids swell slightly, resembling the appearance after waking up; the neck pulse beats visibly; there is occasional coughing; coldness is felt in the inner thighs; the calves swell; and the abdomen enlarges, indicating that water disease has formed. Pressing the abdomen causes it to rise immediately, like a bag wrapped around water; these are its signs.

The *Chapter on Differentiating Five Obstructions and Body Fluids* states: When Yin-Yang Qi pathways are blocked, the Four Seas are closed, the Sanjiao fails to drain, and body fluids fail to transform, remaining in the lower jiao and failing to渗 (seep) into the Bladder, leading to lower jiao distension. Overflowing water results in Water Distension.

The *Chapter on Evaluating Heat Diseases* states: In all cases of water qi, slight swelling first appears under the eyes. Water is Yin, and the area under the eyes is also Yin. The abdomen is the residence of Supreme Yin. Therefore, when water resides in the abdomen, swelling under the eyes must occur.

The *Meridian Chapter* states: Stomach disease leads to abdominal edema.

The *Chapter on Pathogenic Factors and Zang-Fu Disease Forms* states: Stomach disease manifests as abdominal distension, epigastric pain centered at the heart region, upward support to both hypochondria, obstruction in the throat, and inability to swallow food and drink. Sanjiao disease manifests as abdominal Qi fullness, especially hardness in the lower abdomen, inability to urinate, urgency, and overflow leading to water retention and distension. A slightly large Kidney pulse indicates Stone Water (Shi Shui), starting from below the navel to the lower abdomen, hard and rising, extending up to the stomach; this is incurable and fatal.

The *Chapter on Clarifying the Five Qi* states: Overflow from the lower jiao leads to water.

The *Chapter on Counter-Regulation* states: Inability to lie flat and panting upon lying down is caused by water qi invasion. Water flows along the channels of body fluids. The Kidneys are the Water Storehouse, governing body fluids, and also governing sleep and panting.

The *Chapter on Differentiating Yin-Yang* states: When Yin and Yang knot and skew, with much Yin and little Yang, it is called Stone Water, manifesting as lower abdominal swelling. Knotting of the Three Yin meridians is called Water disease.

The *Chapter on Liquids and Malt Wines* records: The Yellow Emperor asked, "There is a disease not arising from the hair pores, but where the Yang Qi of the five Zang organs is already exhausted, body fluids fill the torso, Po (Corporeal Soul) resides alone internally, isolated essence depletes internally, Qi dissipates externally, the form cannot maintain itself against clothing, causing urgency in the four extremities disturbing the interior. This is Qi rejecting internally and form suffering externally. How should it be treated?" Qibo said, "Balance and regulate using weighing measures, remove stagnant and old blood. Therefore, gently move the four extremities, wear warm clothes, apply Mu Ci (lateral needling) at corresponding sites to restore the form, open the ghost gates (induce sweating), purify the clean mansion (promote urination), let essence recover in time, allow the five Yang Qi to spread, dredge and cleanse the five Zang organs. Thus, essence generates spontaneously, form becomes robust, bone and flesh protect each other, and Great Qi becomes peaceful." (Note: The above distensions all discuss Water as the pathogen.)

The *Chapter on Taiyin and Yangming* states: Irregular diet and improper daily routine injure Yin; injury to Yin allows pathogens to enter the five Zang organs, leading to abdominal fullness and blockage.

The *Chapter on Different Methods and Suitable Areas* states: In the Northern region, people enjoy living outdoors and consuming dairy products; cold in the viscera generates fullness diseases. (Note: The above two passages discuss Diet as the cause of distension.)