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The treatment of distension and edema, for cases of Spleen and Kidney deficiency as listed in the previous discussion such as Xue's Shenqi Decoction (Kidney Qi Decoction), is indeed excellent; however, the method of its application should be expanded upon accordingly, rather than being applied rigidly.

Previously, I treated a friend surnamed Tao, who was over forty years old. Having contracted Cold Damage (Shanghan) and been mismanaged by other physicians, his life hung in the balance. I used large doses of Ginseng (Renshen), Aconite (Fuzi), and Prepared Rehmannia Root (Shudihuang), among others, and fortunately he was rescued. After recovery, he developed a preference for drinking alcohol. Within two months, he suddenly presented with complete swelling of the legs and thighs, with distension extending to the abdomen. The area felt drum-like upon palpation, hard and firm. Given that his previous illness had already damaged his Middle Qi (Zhong Qi), and his recent condition was exacerbated by dampness from alcohol, I judged that a modified Shenqi Decoction was necessary. I administered several doses consecutively. Although there were no adverse reactions, there was ultimately no effect. Others predicted he would certainly not survive. Upon careful consideration of the antecedents, the root cause was severe Spleen and Kidney deficiency. By adding diuretic and leaching agents (Shenli), I inadvertently diminished the tonifying power, which is akin to pouring water into a leaky vessel. Without the restoration of Yuan Qi (Primordial Qi), the disease could not recede. Therefore, I completely removed the diuretic herbs and exclusively prescribed Shenfu Liyin Decoction (Ginseng and Aconite Decoction to Nourish Yin), adding Atractylodes Macrocephala Rhizome (Baizhu). Administered in large doses, after three doses, the swelling of the lower legs gradually subsided; after more than twenty doses, the abdominal distension completely resolved. Upon recovery, everyone marveled and said, "This case seemed hopeless; treating this type of distension with this method—how miraculous your insight is!" Since then, for all cases of total deficiency, I have employed this method without exception, achieving full efficacy. This demonstrates that within excellent methods, there are even subtler ones, depending entirely on the practitioner's skill. The principle of "treating obstruction with tonification" (Sai Yin Sai Yong) is the ultimate approach here; students must deeply understand this meaning.

1. Distension due to food stagnation and Qi pain: I once treated the son of a relative by marriage. He was in the prime of youth but frequently drank alcohol and suffered from irregular eating habits, often skipping meals or overeating. One day, following a meal, he experienced severe pain in the hypochondrium. He self-medicated with Qi-moving and stagnation-resolving herbs and underwent emesis, expelling all food. After vomiting, rebellious Qi rose upward. Although the hypochondriac pain ceased, the Qi obstructed the chest and diaphragm, causing severe distension and pain, accompanied by vomiting. I used Qi-moving and Qi-breaking herbs, which gradually stopped the vomiting and pain. However, a lump formed under the left breast and rib cage, feeling distended, solid, and tender to pressure. There was obstruction in the umbilical and abdominal regions, preventing downward movement. During the Xu, Hai, Zi, and Chou hours (9 PM to 3 AM), the distension became unbearable. Since vomiting had ceased, purgative therapy was indicated. I exhausted all methods using Cathartic Rhizome (Dahuang), Mirabilite (Mangxiao), Burreed Tuber (Sanleng), Curcuma Rhizome (Ezhu), Croton Seed (Badou), Radish Seed (Luobozhi), Mirabilite, Garlic, and crushed Tangerine Peel poultices, yet achieved no effect. The more I attacked, the more the distension increased. Suspecting damage to Spleen Qi, I found tonification difficult as he could not tolerate any liquid intake for over twenty days. In desperation, awaiting death, I manually palpated the affected area. He pointed out a specific spot under the rib where pressing caused pain radiating to the chest and abdomen. Upon careful examination, this point corresponded exactly to Zhangmen (LR13). Zhangmen is the Front-Mu point of the Spleen and the Hui-Sea point of the Zang organs. Furthermore, the area below the breast and between the ribs corresponds to the Xuli collateral, the pathway through which Stomach Qi emerges, connecting strongly with Zhangmen. I realized that the symptom pattern of being milder during the day and heavier at night was not due to a tangible accumulation, but rather, the pain radiating upon pressure confirmed the pathology was in the Qi level. While decoctions for Qi disorders are generally appropriate, heat therapy disperses Qi, potentially lacking sufficient force. Therefore, I formulated Shenxiang San (Divine Fragrance Powder) for him to take three to four times daily, combined with moxibustion on Zhangmen (LR13) for fourteen moxa cones. This dispersed the stagnant Stomach Qi. Within three days, the distension gradually subsided, and appetite slowly returned, ensuring his survival. Both the presentation and treatment were unusual and difficult to predict. Earlier that spring, a neighbor suddenly suffered from painful distension and food blockage identical to this case. Despite various physicians employing aggressive attacking methods, he died. This was truly due to a lack of proper methodology. I record this case as a model for future practitioners.