Library

See the section on "Qi Disorders."

Chen Wuyue stated: When the Five Accumulations (accumulation of five pathogenic factors: cold, heat, wind, dampness, and food) persist for a long time, they inevitably lead to abdominal distension and fullness. However, internal pathogens can cause disease without necessarily forming distinct accumulations. Treatment should be adjusted according to the Qi characteristics of the respective Zang organs.

It is noted that abdominal distension and fullness often stem from cold patterns, internal injury, various Qi disorders, or excessive use of purgative/laxative medications leading to Spleen and Stomach deficiency. Such cases are very common, whereas those caused by Damp-Heat are fewer. Cases resulting from formed accumulations do exist but are less frequent. Ancient formulas often failed to distinguish between these causes. For instance, formulas like Yuyuliang Wan (Hematite Pill), which are drying and heating agents affecting Qi and Blood, might inadvertently exacerbate internal郁 Fire (stagnant Heat). In treating such diseases, when encountering severe excess, fullness, dryness, stagnation, obstruction, or Qi stagnation—especially if initially caused by internal injury with a surging and solid pulse—the purgative method is indispensable. However, cases arising from overuse of purgatives, post-dysentery/diarrhea states, or inherent Spleen and Stomach weakness failing to transform and transport nutrients require tonification of the Spleen and dispersion of Dampness. This is because Zheng Qi (Upright Qi) has already declined, let alone distension due to accumulation. Hence, it is said to treat with "Ping Zhi" (harmonizing regulation). For cases caused by Blood stasis or Blood accumulation, treatment should focus on blood-invigorating herbs. Cold patterns are treated with Heat methods; Heat patterns with Cold methods; stagnation is dispersed; mixed Clear and Turbid Qi is separated; Qi dynamics are regulated via ascending and descending mechanisms; or digestion is promoted. All treatments should be tailored to the specific condition.

The *Neijing* (Inner Canon) states: "When Clear Qi sinks below, it generates undigested stool diarrhea (Sun Xie); when Turbid Qi rises above, it generates abdominal distension (Peng Zhang)." This represents the reversal of Yin and Yang, indicating a reverse pathological progression. Wang Lü (courtesy name Faming) explained: Regarding Peng Zhang (abdominal distension), if analyzed through the lens of Cold, Heat, Warmth, and Coolness, what kind of distension is this? The answer is: This is distension caused by irregular diet, marking the onset of disease. Damp-Heat can also cause distension. A surging, slow, and deep pulse at the Right Guan position (reflecting Spleen/Stomach), combined with a wiry pulse floating above, indicates a combination of Wind, Dampness, and Heat pathogens. This signifies the failure of Spleen and Stomach functions, allowing Yin Fire to hyperactivity and attack the Spleen and Stomach. When excessive, it shifts leftward, obstructing the Yang pathways, leading to the severance of Fu Organ Qi at the exterior. Excessive Wind Qi causes the Mother organ (Liver Wood generating Heart Fire, implying generative cycle influence) to become replete. Severance of Wind Qi at the exterior implies that Grain Qi entering the Stomach fails to generate Clear Qi and Ying Qi (Nutritive Qi), manifesting as Wind Qi. "Yi Hu Tong Lei" (different sounds sharing similar categories) refers to Stomach Qi. The Classics state: "In deficiency, the affected organ incorporates the pathogen of its conquering element." Here, Earth (Spleen) is insufficient to control Liver Wood (Xie Qi). This reflects insufficient Spleen-Stomach Earth and excessive Fire and Wood. The Classics state: "Turbid Yin exits via the lower orifices, moves to the Zang organs, returns to the Fu organs, and settles in the earth." This is the normal state of health. Deviation from this leads to distension. The Classics state: "Irregular diet and improper daily routine affect Yin. When Yin is affected, pathogens enter the Zang organs. Entering the Zang organs leads to distension and obstruction." The *Tiao Jing Lun* (Treatise on Regulating Channels) states: "Obstruction in the Lower Wan leads to Heat in Stomach Qi, which steams upward into the chest, causing internal heat." The Lower Wan refers to You Men (Pylorus). The human body has seven Chong Gates (passages) from top to bottom, all flowing downward but influenced by upward movement. You Men connects upward to Xi Men (Aditus Laryngis/Epiglottis). If inhaled Qi cannot descend to Kidney and Liver, Yin Fire becomes active and resists, causing obstruction in the pharynx and diaphragm. Consequently, Turbid Yin Qi cannot descend, leading to dry and unpassed stool. Dampness in the Stomach combined with invading Yin Fire causes abdominal distension. Treatment focuses on You Men, ensuring its patency to drain Yin Fire, moisten dry Blood, and nourish new Blood. Once You Men is patent, stool passes freely, Xi Men is protected from pathogens, the diaphragm and pharynx open, and distension/fullness resolve. Thus, Turbid Yin returns to the earth. Therefore, the Classics say: "For fullness in the center, purge from within." This is the correct method.