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Cheng Wuji stated: "Yue" refers to constraint and aggregation. When Stomach Qi is strong but Spleen Qi is weak, Body Fluids (Jin Ye) are constrained and cannot distribute to the four directions, but only transport to the Bladder. Consequently, there is frequent urination and hard stools; thus it is called Pi Yue (Spleen Constraint). Administering this pill to purge the dryness and aggregation of the Spleen allows the intestines to become moist and the aggregation to resolve. Body Fluids then flow into the Stomach, bowel movements become smooth, urine volume decreases, and the disease resolves. However, I harbor doubts about this. Why? Since it is termed "Yue" (constraint), it implies that Spleen Qi is too weak to transform and transport. If Spleen Qi is weak, Earth Qi is deficient, inevitably leading to the dispersion of Spleen Qi and consumption of Spleen Blood. Tracing the origin, this condition often arises after prolonged illness, severe purging, or profuse sweating, where Yin Blood is withered, internal fire blazes and scorches, heat damages Yuan Qi (Original Qi), and further injures the Spleen. The damage to Yuan Qi occurs because Lung Metal is controlled by Fire, causing Qi to lose its grasping function. The injury to the Spleen occurs because the Lung is the child organ of the Spleen; when Lung Qi is depleted, fluids are exhausted, necessitating the borrowing of Mother Qi (from the Spleen) for self-rescue. When Metal is depleted, Wood lacks restraint; under such circumstances, it is impossible for Earth to remain uninjured. With the Spleen losing its transforming and transporting command, and the Lung losing its transmitting and descending function, one should expect constipation and difficult defecation, along with frequent urination without retention. Theoretically, one should nourish Yin and Blood to prevent the solitary Yang fire from blazing, thereby allowing Metal to perform clear transformation, restraining Wood pathogenic factors, and enabling Spleen Earth to be clear, healthy, and operational. Only then can essence and fluids enter the Stomach, moistening the intestines and ensuring patency. Currently, Rhubarb (Da Huang) is used as the Sovereign herb, Immature Bitter Orange (Zhi Shi) and Magnolia Bark (Hou Po) as Ministers. Although Peony (Shao Yao) nourishes blood, and Hemp Seed (Ma Ren) and Apricot Kernel (Xing Ren) provide warmth and moisture as Assistants and Envoys, this formula is suitable only for those with intense heat and substantial Zheng Qi (Upright Qi), bringing peace to them. I fear that in the Northwest regions, where the terrain is high and climate dense, and people have robust constitutions, it may be used. However, if applied to people in the Southeast, or those whose heat is intense but Qi and Blood are not substantial, although temporary relief of bowels may occur, the Spleen will become weaker and the intestines drier. Those who wish to use this prescription in the future must know that in the Northwest, the focus should be on resolving aggregation, while in the Southeast, the focus should be on moistening dryness. One must not be rigid and inflexible like tuning a zither without adjusting the pegs.

The Heart and Lungs are Yang, residing in the Upper Jiao; the Liver and Kidneys are Yin, residing in the Lower Jiao; the Spleen resides in the Middle and is also Yin, belonging to Earth. The Classics state: "When food enters the Stomach, its essence overflows and is transported upward to the Spleen. The Spleen scatters the essence, sending it upward to return to the Lung. The Lung regulates water passages, transporting downward to the Bladder. Water essences distribute to all four directions, and the five meridians run together." This indicates that the Spleen possesses the stillness of Kun (Earth) yet has the strength of Qian (Heaven). Thus, it enables the Yang of the Heart and Lung to descend and the Yin of the Liver and Kidney to ascend, achieving the harmony of Heaven and Earth interaction, which characterizes a healthy individual. Now, due to internal injury from the Seven Emotions, external invasion by the Six Excesses, irregular diet, or sexual exhaustion causing deficiency, the Yin of Spleen Earth is injured, and the official of transformation and transport fails. Although the Stomach receives grain, it cannot transform and transport it. Consequently, Yang rises spontaneously and Yin descends spontaneously, creating a state of non-interaction between Heaven and Earth (Pi Syndrome). At this time, clear and turbid qi mix, meridians and collaterals become obstructed, Qi transformation turns turbid, blood stasis stagnates and generates heat. Prolonged retention of heat leads to Qi transformation turning into dampness; dampness and heat generate each other, resulting in distension. This is what the Classics call Gu Zhang (Drum Distension). It is named so because although the abdomen is firm and full, the center is empty, resembling a drum. The disease is stubborn and difficult to treat, hence also called Gu (Poison/Parasite), implying something like insect erosion. Regarding treatment principles, one should tonify the Spleen, nourish Lung Metal to control Liver Wood, preventing the Spleen from suffering from hostile pathogens; nourish Kidney Water to control Heart Fire, allowing the Lung to receive commands for clear transformation. Avoid salty flavors to prevent aiding pathogens, and cut off delusions to protect Mother Qi (Spleen). There will be no unrest. Physicians who fail to recognize that the disease originates from deficiency, eager for quick effects, and showing off skills to seek rewards, are misguided. Patients suffer from distension and urgency, preferring purgatives for immediate relief, unaware that any comfort lasts only half a day, after which swelling worsens. Pathogens become excessive, True Qi is damaged, and death is near. Among ancient formulas, only Yu Yu Liang Wan (Hematit Pill), also known as Shi Zhong Huang Wan or Zi Jin Wan, appropriately controls the Liver and tonifies the Spleen. However, it must still be modified according to symptoms and seasons.

My friend Yu Renshu, a scholar and physician, suffered consecutive family tragedies. At fifty, he contracted this disease and prepared Yu Yu Liang Wan himself to take. Upon examining his pulse, I found it wiry, choppy, and rapid. I said, "This pill is newly prepared; the fire toxicity from calcination remains, and there are too many warm-hot herbs. You should modify it yourself; do not stick rigidly to the formula." Yu smiled and said, "Modern people are inferior to ancients; this formula cannot be modified." After taking it for one month, he bled from the mouth and nose and died emaciated.

Another patient, Brother Yang, nearly fifty years old, addicted to alcohol, had suffered malaria for half a year and developed distension. Believing he would surely die, he sought treatment. His pulse was wiry and choppy, large upon heavy pressure. The malaria had not resolved; his limbs were emaciated while his abdomen was massive, resembling a spider. I instructed him to use Ginseng (Ren Shen) and Atractylodes Macrocephala (Bai Zhu) as Sovereign herbs, Angelica Sinensis (Dang Gui), Ligusticum Chuanxiong (Chuan Xiong), and Peony (Shao Yao) as Ministers, Coptis (Huang Lian), Tangerine Peel (Chen Pi), Poria (Fu Ling), and Magnolia Bark (Hou Po) as Assistants, with a small amount of Licorice Root (Gan Cao) decocted into a thick tea. He took it three times daily and strictly observed dietary restrictions. After one month, the malaria resolved through sweating. Half a year later, urine output increased, and the distension healed. There were slight modifications during the process, but the main principle was tonifying Qi and promoting dampness removal.

Another case involved Mr. Chen, in his forties, addicted to alcohol, with occasional blood in stool. He developed distension in spring, with a dark complexion and a massive abdomen, looking ghost-like. His pulse was rapid and choppy, weak upon heavy pressure. I prescribed Si Wu Tang (Four Substances Decoction) added with Coptis (Huang Lian), Scutellaria (Huang Qin), Akebia Stem (Mu Tong), Atractylodes Macrocephala (Bai Zhu), Tangerine Peel (Chen Pi), Magnolia Bark (Hou Po), and Licorice Root (Gan Cao), decocted as a soup. He remained stable for nearly a year.

One case focused on tonifying Qi, the other on nourishing Blood; the remaining herbs varied slightly, yet both achieved stability and longevity. Someone asked: "It is said that Qi does not require tonification. Why did your Qi tonification succeed? Is there a theory to explain this?" I replied: "'Qi does not require tonification' is a secular saying. They argue that Qi disorders manifest as fullness, oppression, and blockage, seemingly difficult to tonify for fear of exacerbating the condition. But they fail to consider that when Zheng Qi (Upright Qi) is deficient, it cannot circulate; pathogenic stagnation adheres and cannot exit, causing disease. The Classics state: 'Those who are vigorous recover as Qi moves; those who are timid develop disease as pathogens adhere.' If timid Qi is not tonified, how can it move?" Another asked: "Your medication is indeed prudent, but why is the effect slow? Patients bedridden for long periods will likely find your approach tedious and seek speed." I replied: "The onset of this disease may span three to five years, or even ten-plus years. The root is deep, and the condition is severe. Seeking quick results invites disaster! Only those who understand the 'Kingly Way' (gradual, holistic healing) can cure this disease." Someone asked: "Is it absolutely forbidden to give purgatives for distension at the terminal stage?" I replied: "If it is certain that the disease is not due to deficiency, the pathology is shallow, the Spleen and Stomach are still strong, the accumulation is not entrenched, and there are signs indicating purgation is indicated, then mild guidance and drainage may be appropriate. However, adopting Zhang Hezi's Xun Chuan San or Yu Gong Wan as standard protocols for rapid aggressive purging is something I dare not endorse."