Library

Li Dongyuan stated: Some individuals suffer from alcohol consumption, ingestion of damp-producing wheat noodles, and rich, strong-flavored foods. Or, those accustomed to rich diets lie down immediately after eating, causing damp-heat qi to fail in transformation and dissemination, resulting in abdominal fullness. This is also a type of Heat Distension (Re Zhang). The *Tiao Jing Pian* (Chapter on Regulating Qi and Blood) states: Due to irregular diet and overexertion damaging the Spleen and Stomach, initially one may experience Re Zhong (Heat Syndrome in the Interior), which later transmits to Han Zhong (Cold Syndrome in the Interior). All arise from the deficiency of Spleen-Stomach Qi, which fails to transform and transport essence and grains, leading to the accumulation and failure to disperse of food and fluids, thus forming distension. This is distension caused by the stagnation and suppression of Cold-Dampness. The *Lao Li Lun* (Chapter on Fermented Drinks) prescribes treatment methods: first, bleed the collateral vessels to drain pathogenic factors, then regulate the True Meridian Qi and Blood, so that Qi and Blood become balanced, Yang Qi spreads, and Spirit becomes clear. This is the correct method of treatment. One might ask: Why does it say "all abdominal distensions and enlargements belong to Heat"? This is a general statement regarding pathogenesis. For instance, if external pathogens such as Wind-Cold, being excess pathogens, transmit from the exterior to the interior, cold transforms into heat, causing Stomach Excess and abdominal fullness; Zhang Zhongjing treats this with Chengqi Tang (Gut-Purging Decoction). There are also cases where those accustomed to rich diets have damp-heat stagnant within, forming distension; this is referred to as Heat Distension. Generally, Cold Distension is more common than Heat Distension, so practitioners must distinguish carefully.

Zhu Danxi stated: Heart and Lung belong to Yang and reside in the Upper Jiao; Kidney and Liver belong to Yin and reside in the Lower Jiao; Spleen resides in the Middle Jiao, also belongs to Yin, and corresponds to Earth. Classics state: When food enters the Stomach, its essence floats up and is transported to the Spleen; the Spleen scatters the essence upwards to the Lung; the Lung regulates water passages and transports downwards to the Bladder; water and essence distribute throughout the body, circulating through the five meridians. This is because the Spleen possesses the stillness of Kun (Earth) and the vigorous movement of Qian (Heaven), enabling it to descend the Yang of Heart and Lung and ascend the Yin of Kidney and Liver, achieving the harmony of Heaven and Earth interaction, which constitutes a healthy individual. Now, due to internal injury from Seven Emotions, external invasion of Six Evils, irregular diet, and sexual exhaustion leading to deficiency, the Yin of Spleen Earth is damaged, and the official responsible for transportation fails in duty. Although the Stomach receives grain, it cannot transform it, causing Yang to rise and Yin to fall, resulting in the obstruction of Heaven and Earth interaction (Pi Hexagram). Clear and turbid Qi mix, meridians and collaterals become blocked, stagnating to generate Heat; Heat lingering generates Dampness; Damp-heat mutually produce each other, eventually forming distension, known as Drum Distension (Gu Zhang). Although the exterior appears hard and full, the interior is hollow like a drum, making it stubborn and difficult to treat. It is also called Gu (Poison/Parasite), implying meaning similar to erosion by insects. Theoretically, one should tonify the Spleen, nourish Lung Metal to control Liver Wood, preventing the Spleen from suffering from attacking pathogens; nourish Kidney Water to control Heart Fire, allowing Lung Qi to be clear. One must also avoid rich flavors, abandon delusions, and stay away from music and entertainment, ensuring no discomfort. If physicians do not examine properly but seek quick effects, and patients, suffering from distension urgency, prefer purgatives to feel relief, they may temporarily feel better, but within a day or half-day, swelling worsens, pathogenic factors deepen, and True Qi is damaged. Among ancient formulas, only Yuyuliang Wan (Hematite Pill), also known as Shizhonghuang Wan (Yellow Pill from Stone) or Zijin Wan (Purple Gold Pill), which controls Liver and tonifies Spleen, is quite appropriate, but must be modified according to syndrome. My friend Yu Renshu suffered family tragedies consecutively, was nearly fifty years old, contracted this disease, and self-administered Yuyuliang Wan. His pulse was wiry, choppy, and rapid. I said: This pill is newly prepared; fire toxicity from processing remains, and there are too many warm-hot herbs. You should modify it yourself and not stick rigidly to the formula. Yu smiled and said: This formula cannot be modified. After taking it for one month, black blood appeared from his mouth and nose, and he wasted away until only bones remained, then died. Another case: Brother Yang, nearly fifty, loved alcohol, had malaria for half a year, and developed distension. His pulse was wiry and choppy, large when pressed heavily. Malaria was unresolved, limbs were emaciated, but abdomen was large like a spider. I instructed him to use Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) as Sovereign herbs, Dang Gui (Angelica Sinensis Root), Chuan Xiong (Sichuan Lovage Rhizome), and Bai Shao (White Peony Root) as Ministers, Huang Lian (Coptis Rhizome), Chen Pi (Citrus Peel), Fu Ling (Poria), and Hou Po (Magnolia Bark) as Assistants, and raw Gan Cao (Licorice Root) in small amounts, decocted into a thick liquid, taken three times daily. He strictly observed dietary restrictions. After one month, malaria resolved; after another half-year, urination became normal and distension healed. Modifications were minor, mainly focusing on tonifying Qi and moving Dampness. Another case: Mr. Chen, over forty, loved alcohol, often had blood in stool, contracted distension in spring, face was dark, abdomen large like a ghost, pulse rapid and choppy, weak when pressed heavily. I used Si Wu Tang (Four Substances Decoction) plus Huang Lian, Huang Qin (Scutellaria Root), Mu Tong (Akebia Stem), Bai Zhu, Chen Pi, Hou Po, and raw Gan Cao, decocted and administered. After one month, he stabilized. One case focused on tonifying Qi, the other on tonifying Blood; other herbs were largely similar, both achieved stability. Someone asked: Qi has no tonification method; why did tonifying Qi bring stability? I replied: "Qi has no tonification method" is a vulgar theory. Fullness and obstruction seem difficult to tonify, but consider that those with deficient Righteous Qi cannot move themselves. Classics state: The robust move Qi and recover; the weak stagnate and become diseased. If one does not tonify Qi, how can pathogens exit? Someone else asked: Your prescription is precise, why is efficacy slow? Patients will grow tired of your slowness and seek quick results. I said: The origin of this disease may be three to five years or ten-plus years; roots are deep and condition is severe, difficult to seek quick results. Only those who understand the King's Way (gentle, fundamental treatment) can cure this. Someone asked: Is Drum Distension terminal and untreatable by purgation? I said: If clearly determined as not deficiency, superficial pathology, strong Stomach Qi, non-adherent stagnation, and indications for purgation exist, it can be used.

Note: This discussion on distension caused by internal injury from Seven Emotions and external invasion of Six Evils aligns with Li Dongyuan’s concept of eight beneficial pathogens (external excess pathogens entering from outside). Internal injuries from fatigue, weakness, and Spleen-Stomach damage constitute deficiency pathogens arising from inside. Thus, differences between deficiency and excess, and interplay of Cold and Heat pathogenesis, require evidence-based medication.