Library

*Suwen Jingzhu Jiejie* (Annotated and Annotated Excerpts of the Suwen), Chapter "Fu Zhong Lun" (Discourse on Diseases in the Abdomen) discusses diseases occurring within the abdomen. Originally containing eight clinical cases, one has been deleted here. Diseases of the abdomen indeed extend beyond these examples, but these represent the general and typical cases.

The Yellow Emperor asked: There is a patient suffering from fullness and distension in the heart and abdomen, who cannot eat dinner if they ate breakfast. What disease is this? Qibo replied: This disease is named *Guzhang* (Drum Distension). (Heart and abdominal fullness, inability to continue eating, with the abdomen shaped like a drum, hence the name Drum Distension. Commentary: *Guzhang* is a severe condition, seemingly not limited to just abdominal fullness and anorexia. *Tai Su* writes it as *Gu Zhang* (Grain Distension), which is reasonable. Qi stagnation preventing food digestion is not true *Guzhang*; Wang Bing's note stating "shaped like" is correct.) The Yellow Emperor asked: How should it be treated? Qibo replied: Treat it with *Ji Shi Li* (Chicken Dropping Fermented Liquid). One dose brings improvement; two doses bring recovery. (Ancient Materia Medica states that chicken droppings do not treat *Guzhang*, but primarily promote urination and are slightly cold. Current prescription methods involve decocting and drinking it. Commentary: *Guzhang* is inherently not treatable by chicken droppings, nor likely *Gu Zhang*. Generally, some prescriptions usable by ancients are unusable by later generations; this is such a case.) The Yellow Emperor asked: Why does it sometimes recur? (Recurrence refers to the return of symptoms similar to the original illness.) Qibo replied: This is due to unregulated diet, causing frequent relapses. (Commentary: For those with abdominal fullness and anorexia, the origin lies in diet, and subsequent failure to self-regulate leads to recurrence.)

The Yellow Emperor asked: There is a patient with support-like fullness in the chest and hypochondrium, interfering with eating. Upon onset, they first smell a fishy or foul odor, discharge clear fluid, expectorate blood streaks, experience cold limbs, dizziness, and frequent bleeding from both anterior and posterior orifices. What is this disease? How is it contracted? (Clear fluid refers to clear water, also called clear nasal mucus. Dizziness refers to vertigo. Anterior and posterior bleeding refers to bleeding from the genitalia and anus.) Qibo replied: This disease is named *Xueku* (Blood Dryness/Withering). It results from significant blood loss in youth, or sexual intercourse while intoxicated, leading to exhaustion of Middle Qi and liver injury, resulting in scanty menstruation or amenorrhea. (Significant blood loss is termed *Tuoxue* (Blood Collapse); metrorrhagia, epistaxis, and hematemesis fall under this category. Intoxication causes vigorous blood and Qi, generating internal heat; engaging in intercourse then depletes marrow fluids, exhausting Kidney Qi. The Liver stores Blood; significant blood loss injures the Liver. In men, this manifests as seminal deficiency; in women, as scanty or absent menstruation.) The Yellow Emperor asked: How should it be treated? What method should be used? Qibo replied: Use four parts *Wu Mei Gu* (Cuttlebone) and one part *Ru* (likely referring to *Euphorbia* or similar herb, textually debated), combined into pills using quail eggs, sized like small beans. Take five pills after meals, washed down with *Bao Yu Zhi* (Abalone Juice), to benefit the intestines. (Commentary: Taking medicine after meals is "Hou Fan". Ancient texts state Cuttlebone and *Ru* do not treat *Blood Dryness*. However, the Classic uses them to attack the root cause. Intoxication and labor during intercourse deplete Kidney Essence; amenorrhea indicates stagnant evil blood. Depleted essence causes impotence; stagnant blood causes Bi syndrome. Thus, these four herbs are used. Cuttlebone treats female blood closure; *Ru* disperses evil blood; Quail egg treats male impotence and boosts fertility; Abalone juice treats stagnant blood in limbs. The prescription logic follows this interpretation. New Corrections note textual variations regarding the herb names and properties compared to Wang Bing's notes.)

The Yellow Emperor asked: There is a patient with hardness and fullness in the lower abdomen, with roots extending up, down, left, and right. What disease is this? Is it treatable? Qibo replied: This disease is named *Fuliang* (Hidden Beam). (Commentary: *Fuliang* originally refers to the accumulation of the Heart. The presence of other *Fuliang* descriptions in this chapter indicates that any pathological mass forming in the chest or abdomen can be called *Fuliang*, meaning same name but different substance.) The Yellow Emperor asked: What causes *Fuliang*? Qibo replied: It wraps large amounts of pus and blood, residing outside the stomach and intestines. It is untreatable; cutting or pressing it can cause death. The Yellow Emperor asked: Why? Qibo replied: If located lower, it involves the Yin organs, causing pus and blood to pass downward; if located upper, it presses on the stomach, causing Diaphragm syndrome and internal abscesses near the stomach. (It occupies the regions of the Chong Mai (Penetrating Vessel) and Dai Mai (Girdle Vessel). The Dai Mai originates at the costal region, encircles the body, and crosses below the navel. The Chong Mai originates below the kidney, emerges at Qichong, descends along the thigh, and ascends from Guanyuan, running alongside the navel to the throat. Pathology here causes lower abdominal hardness. Due to its firmness resembling a hidden beam, it is named *Fuliang* and is difficult to treat. Pressing it causes unbearable pain and death because it contains pus/blood outside the gut. The Chong Mai connects to the Yin organs below and runs along the abdomen above. Lower involvement causes bloody/purulent stools; upper involvement causes diaphragmatic issues and gastric abscesses. Note: "Sheng" (generate) should be "Chu" (exit). Commentary: "Qie" means cutting pain. The note linking it to continuous pressing is wrong. *Tai Su* reads "Shi Wei" instead of "Xie Wei", both valid.) This is a chronic disease, difficult to treat. Located above the navel is "Ni" (Rebellious/Opposing); located below is "Cong" (Following/Favorable). Do not move it aggressively; instead, repeatedly drain it. (Above the navel approaches the Heart, hence Rebellious. Below is further from the Heart, allowing gradual treatment, hence Favorable. "Cong" means smooth/favorable. "Ji" means frequently. "Duo" means remove/draining. Meaning: Do not shift the location, but repeatedly drain the pathogen.)

The Yellow Emperor said: You often mention *Rezhong* (Heat Center) and *Xiaozhong* (Consumption Center). These patients must avoid rich foods (*Gaoliang*), fragrant herbs (*Fangcao*), and mineral drugs (*Shiyao*). Mineral drugs cause epilepsy; fragrant herbs cause mania. (Excessive thirst and urination is *Rezhong*. Excessive eating and urination is *Xiaozhong. Excessive joy is Dian (epilepsy/mania variant). Excessive anger is Kuang (mania). Fragrant refers to delicious/tasty.) *Rezhong* and *Xiaozhong* affect wealthy people. Banning rich food goes against their desires; banning herbs/minerals prevents cure. I wish to hear your explanation. *Rezhong/Xiaozhong* result from Spleen Qi overflowing due to sweet/greasy diets, hence the ban on rich foods. Wealthy people are arrogant and indulgent; banning food offends them, worsening the disease. The Emperor posed this question due to difficulty in refutation. *Gao* refers to fat/lard; *Liang* to fine grain. *Shiyao* are mineral drugs; *Fangcao* are aromatic herbs. These are hard for the wealthy to abstain from. Qibo replied: The Qi of fragrant herbs is beautiful/mild, but the Qi of mineral drugs is fierce/harsh. Both act rapidly and firmly. Therefore, they cannot be taken by people with slow, gentle dispositions. (Spleen overflow creates disease; mild Qi burdens the Spleen; harsh Qi fuels heat. A gentle person with calm spirit avoids internal injury. Commentary: The wealthy should learn restraint from this.) The Yellow Emperor asked: Why can they not take them? Qibo replied: Heat Qi is fierce, and drug Qi is similar. Their meeting may internally injure the Spleen. The Spleen is Earth and fears Wood. Patients taking these drugs will see changes on Jia/Yi days (Wood days). (Excess Heat leaves residual Wood Qi, causing irritability. Irritability allows Heat to use Wood to injure the Spleen. Jia/Yi correspond to Wood, so Spleen pathology is reassessed on these days.)

The Yellow Emperor asked: There is a patient with swelling of the chest (*Ying*), neck pain, chest fullness, and abdominal distension. What disease is this? How is it caused? (*Ying* is the side of the chest; Neck is front of the neck; Chest is between the *Ying*.) Qibo replied: It is named *Jueni* (Jue-Ni Reversal). (Caused by rebellious Qi, hence the name.) The Yellow Emperor asked: How to treat? Qibo replied: Moxibustion causes aphonia; stone needle therapy causes mania. One must wait for the Qi to merge and harmonize before treating. (Stone refers to stone needles for lancing.) The Yellow Emperor asked: Why? Qibo replied: Yang Qi is heavy and excessive in the upper body. Moxibustion drives Yang into Yin, causing aphonia; Stone therapy drains Yang, causing mania due to deficiency. (Moxa aids Yang; excess Yang enters Yin. Stone therapy expels Yang; deficiency leads to mania.) Treatment must wait for Qi to merge, ensuring recovery. (Commentary: "Bing" means merging. The explanation is subtle: Aggressive treatment of rebellious Qi spreading to chest/abdomen worsens rebellion. One must guide the Qi to merge, then tonify the Mother for fullness, nourish Yin for floating Yang, and clear/drain fire/stagnation. This lowers ascending Qi and consolidates scattered Qi.)

The Yellow Emperor said: Excellent! How do we know a pregnant woman is about to give birth? Qibo replied: The body shows signs of illness (amenorrhea) but the pulse lacks pathogenic characteristics. (Illness here refers to amenorrhea. Pulse texts state: "Chuni pulse stopping indicates amenorrhea." Here, amenorrhea with a normal pulse indicates pregnancy. Commentary: The Emperor's question had two parts; Qibo only answered the pregnancy part, missing the "about to give birth" aspect, suggesting a textual lacuna. "Qie Sheng" means impending delivery.)

The Yellow Emperor asked: In heat diseases accompanied by pain, what is the cause? Qibo replied: Heat diseases manifest in Yang pulses due to the movement of the Three Yang channels. Renying pulse 1x stronger indicates Shaoyang; 2x indicates Taiyang; 3x indicates Yangming. When Yang enters Yin, the disease affects the head and abdomen, causing distension and headache. The Yellow Emperor said: Excellent! (Commentary: Heat is Fire. Excess Fire causes heat. Disease belongs to Three Yang; when extreme, Qi enters Yin, all being Fire-related pathology.)