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The *Zhen Jing* (Needle Classic) states: A pulse that is large, firm, and choppy indicates distension disease.

The *Mai Jing* (Pulse Classic) states: A deficient pulse at the Guan position indicates abdominal distension; a slow and slippery pulse indicates distension; a full and tight pulse also indicates distension.

Yan Shi states: For distension diseases, if the pulse is floating, it is easy to treat; if the pulse is deficient, it is difficult to treat.

Chen Wuze states: When the Qi of the Zang organs is not harmonious, they mutually overcome and attack each other, causing disease. For example, anger injures the Liver (Gan), Wood overcomes Earth, Spleen Qi becomes abnormal, and inevitably causes stomach distension; this is called "Sheng" (excessive overcoming). Anger injures the Liver, Liver Qi attacks the Lung, Lung Qi fails to transmit normally, and inevitably causes Large Intestine distension; this is called "Cheng" (over-acting). Worry and thought cause accumulation, and the Qi of the affected organ becomes stagnant; these are all internal causes. Alternatively, exposure to cold, heat, wind, or dampness transmits through the meridians to the Yangming channel, causing distension; this is an external cause. Irregular eating habits, consumption of raw, cold, sweet, or greasy foods that accumulate and do not disperse, or form masses, leading to bloating and fullness; this is neither purely internal nor purely external.

According to this discussion, Liver Wood overacting on Spleen and Lung causing distension is what Li Dongyuan referred to as insufficient Fire in the upper part of the Spleen and Stomach, with excessive Wood Qi causing distension. This text does not mention Fire, but since anger injures the Liver, could there not be Fire stirring? The Banxia Tang (Pinellia Decoction) mentioned adds Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root), along with Renshen (Ginseng Root) and Danggui (Angelica Sinensis Root) to regulate Blood and Qi. This suggests considering the string-tight and slow pulse, implying it may not be merely Liver Qi attacking the Spleen, but rather a condition of Fu organ closure and stagnation.

The *Nei Jing* (Inner Canon) states: When Taiyin arrives, there is accumulation and fullness. It also states: When Taiyin arrives, there is central fullness, Huoluan (cholera-like syndrome with vomiting and diarrhea), vomiting, and purging. It further states: All dampness, swelling, and fullness belong to Spleen Earth.

According to medical analysis: The Spleen is the Taiyin within Yin, and also the extreme Yin within Yin; it is the Earth of Kun Yuan, unchanging since antiquity. Heaven is Yang and Fire; Earth is Yin and Water. In humans, the Spleen corresponds to the transformation of Yin Water. If Spleen Qi is excessive, abdominal distension occurs, and food is not digested; thus, without Yang, one cannot transform the five grains. Excess Spleen manifests as severe cold, causing distension. Therefore, the *Mai Jing* states that cold in the Stomach causes distension. Generally, this disease is caused by Water Qi and Cold-Dampness. Treatment should employ strongly pungent and hot agents. Just as soil soaked in rainwater becomes mud and cannot generate all things, one must wait for gentle winds and warm suns to remove dampness and generate Yang, so that life can naturally flourish. With excess Spleen dampness and insufficient Yang, the five grains cannot be transformed; therefore, treatment with pungent and hot methods is suitable, and recovery will surely occur. However, there are degrees of severity.

Li Dongyuan states: The *Classic* says that most abdominal distensions and enlargements belong to Heat. This is a syndrome of excess from the Eight Benefits pathogenic factors, entering from outside heaven. Feeling Wind-Cold pathogens transmitting inward, Cold transforms into Heat, creating Stomach Excess, with afternoon tidal fever, intense thirst with desire to drink, and delirious speech. This is a concurrent disease of Taiyang and Yangming. For severe excess and fullness, Da Chengqi Tang (Major Order the Qi Decoction) is used to purge downward. For mild excess and fullness in Shaoyang-Yangming, Xiao Chengqi Tang (Minor Order the Qi Decoction) is used to purge downward. The *Wu Chang Zheng Da Lun* states: "Purging downward resolves the distension," which refers to this. Suppose malaria causes distension; there are Cold distension and Heat distension. This results from Heavenly pathogenic factors injuring Summerheat, not manifesting immediately, but occurring in autumn when Summerheat wanes. Knowing it is Cold, one might use Jiaojia Yinzi (Interlaced Drink) from the *Ju Fang*. Have we not heard that the *Su Wen* and *Ling Shu* state that internal deficiency and insufficiency, combined with Cold-Dampness invading, lead to central fullness, and that all Zang and Fu organs can have distension? Furthermore, compare the amount of Cold and Heat in distension patients. The *Yin Yang Ying Xiang Lun* states: "Turbid Qi residing above generates distension." The *Zhen Jing* states: For distension, treat the Three Yang channels. Among the Three Yang, Foot-Taiyang Bladder Cold Water causes distension. This aligns with the *Tong Ping Xu Shi Lun*, which states: Sudden abdominal fullness, unyielding to pressure, should be treated by taking the Foot-Taiyang meridian (the Front-Mu point of the Stomach). The *Wu Zang Sheng Cheng Lun* states: Abdominal fullness and distension (see previous text) are due to Stomach Cold-Dampness stagnation and obstruction. The *Mai Jing* states: Cold in the Stomach causes distension. Also, the *Jue Lun* states: Jue of Taiyin leads to abdominal fullness, difficulty in defecation, aversion to food, vomiting after eating, and inability to sleep. As described, Cold distension is mostly like this. The *Tang Ye Lao Li Lun* states that the treatment for central fullness should involve "opening the ghost gate" (inducing sweating) and "cleaning the pure residence" (promoting urination). It also states: For central fullness, "purge from within," referring to pathological conditions of the Spleen and Stomach where Qi is distributed upward and downward simultaneously. The Lower Jiao is like a drain, and Qi and Blood naturally differentiate; there is no need to purge waste matter like excrement. However, in cases of severe excess and fullness with dysfunction of bowel and bladder movements, one may resort to using Cold or Hot purgative agents as a temporary measure.