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[General Principles of Syndrome Differentiation and Treatment] Abdominal distension and epigastric fullness (swelling of the heart region), if caused by Shanghan (Cold Damage disease), or chills and fever malarial fevers, or after a severe illness such as dysentery or diarrhea, occurring merely after eating with abdominal distension and epigastric swelling, poor appetite, belching with acid regurgitation, and feeling bloated even after consuming small amounts of food, must absolutely not be treated with digestive-promoting or purgative medications. If such medicines are used to induce defecation, the condition will worsen with increased heaviness and fatigue, moving further away from recovery. Instead, one may administer Zhengqi San (Regular Qi Powder), Jiahe San (Harvesting Grain Powder), Shenling Baizhu San (Ginseng, Atractylodes Macrocephala, and Poria Powder), or Sijunzi Tang (Four Gentlemen Decoction). Once the healthy Qi is strengthened, appetite will naturally double, and the distension will heal itself. (From *Heji Zhinan*)

If cold pathogen is contracted in winter, resulting in chest stuffiness and fullness with a deep and fine pulse, this is Cold Distension; treatment should focus on warming and resolving the cold pathogen. If heat pathogen is injured in summer, causing hardness and fullness of the chest and abdomen with a weak pulse, this is Summerheat Distension; treatment should focus on clearing heat and removing dampness. If the spleen is damaged by irregular eating habits, leading to Spleen Qi deficiency and sluggish digestion, any slight stagnation can result in distension. With a floating and slippery pulse, it is classified as Puffiness Distension; treatment should employ methods to resolve and guide out the stagnation, and the disease will heal spontaneously. If the ascending and descending mechanisms fail, causing obstruction and knotting in the chest, mixing of the Sanjiao (Triple Burner), and blockage of urination and defecation, sudden distension occurs with a deep and hidden pulse; this is Sanjiao Distension. There are also distinctions between deficiency and excess patterns. In deficiency patterns, the skin appears loose yet feels firm upon palpation, without pain but with Qi fullness; treatment involves regulating the ascending and descending of Qi and warming and tonifying the Spleen's primal Qi, leading to recovery. In excess patterns, there is internal retention of undigested food, with pathogenic excess inside, presenting as hardness and pain upon pressure; treatment should involve dispersing Qi and cleansing out the excess. As for distension resulting from chronic illness, where the Earth element of the Spleen has failed, it is a critical condition difficult to treat effectively. For all types of distension, one must investigate the root cause.