Library

The syndrome of *Zhongman* (Middle Fullness) should be differentiated based on whether the pathology is located in the upper or lower jiao. Although termed "middle fullness," implying the disease is neither in the upper nor lower regions, this condition—characterized by distension in the middle jiao (spleen and stomach)—is not merely caused by deficiency of Lung Qi, nor solely by deficiency of Kidney Qi. If Lung Qi were vigorous, its descending and purifying function would proceed smoothly downward, and the Stomach and Spleen would strictly obey this directive; thus, how could food stagnation occur to cause middle fullness? Precisely because Lung Qi is衰弱 (declining), its purifying command fails to operate in the middle jiao. Consequently, Liver Wood, lacking restraint, overacts upon Spleen Earth. The middle jiao suffers disaster, akin to robbers cutting off the road and grain supply routes; qi mechanism becomes obstructed, giving rise to the disease of middle fullness.

Symptoms include a sensation of slight fullness in the chest, acid regurgitation, ability to eat but lack of hunger, and abdominal distension after eating. These are all manifestations of upper jiao pathology rather than lower jiao pathology. The treatment method should employ flavors that strengthen Earth to control Wood, and especially utilize herbs that tonify Lung and support Metal. This is the correct approach. The formula used is *Zhu Jin Zhi Man Tang* (Assist Metal Decoction to Control Fullness). This formula tonifies qi to assist Lung Metal, uses herbs like Coicis Semen (Yi Yi Ren) and Dioscoreae Rhizoma (Shan Yao) to cultivate Spleen Qi, and employs Fructus Aurantii (Zhi Ke) and Raphani Semen (Luo Bo Zi) to resolve food stagnation and relieve distension. This illustrates the mutual restriction and complementarity within the formula. Upon initial administration, one may feel slight chest stuffiness, which will naturally clear with prolonged use. If one does not understand this subtle method and recklessly employs harsh draining and digesting agents, although there may be temporary relief, the condition will subsequently worsen. This exemplifies the profound principle of "treating obstruction with obstruction" (using tonification to treat false excess/obstruction).

Regarding fullness caused by Kidney deficiency, half stems from Cold in the Spleen, which in turn arises from insufficiency of Mingmen Fire (Fire of the Gate of Life). Without fire under the cauldron, how can cooking take place? Once Kidney Qi is deficient, it cannot transform substances in the lower jiao, leading to counterflow upward; this is why middle fullness symptoms arise. Symptoms necessarily include cold abdomen with intermittent pain, clear and copious urination, and constipation. The opening and closing of the Large Intestine are governed by the Kidney. Now, if Kidney Water is dried up, the Large Intestine lacks moisture to lubricate it; subjected to daily simmering, the intestines become constricted. Since the Small Intestine is also constricted, water and food are difficult to transform, and waste materials cannot reach the anus directly, inevitably accumulating in the lower pathways. Once the lower pathways are blocked, counterflow upward occurs, causing middle fullness. Such diseases are precursors to Fanwei (Regurgitation/Vomiting). It is erroneous for people to regard Fanwei solely as a Spleen-Kidney disease. One must urgently tonify Kidney Water and further augment Mingmen Fire. This water is True Water; True Water cannot generate without True Fire. Tonifying Fire within Water is precisely tonifying Water within Fire. When Water is generated, the Large Intestine receives mutual assistance from water, allowing vessels to pass and grain routes to transport. With no obstruction in the lower jiao, there will naturally be no suffering from fullness in the middle. If one ignores this profound theory and merely employs drastic purgatives like Rheum Radix et Rhizoma (Da Huang) and Pharbitidis Semen (Qian Niu), seeking only temporary relief, one will instead cause chronic constipation. The more one purges, the more deficient one becomes, eventually resulting in an incurable condition. The formula used is *Kuan Zhong San* (Loosen Middle Powder). This formula purely tonifies the Kidney meridian, with slight adjuvants to tonify the Liver, ensuring Liver Wood is peaceful and does not attack Earth. Then, Kidney Water can better moisten the Large Intestine. If the Large Intestine is moist, how can there be blockage? This is precisely treating middle fullness by not directly addressing it. People must not fail to understand this.

**Zhu Jin Zhi Man Tang (Assist Metal Decoction to Control Fullness):**
Ren Shen (Ginseng Radix et Rhizoma) 1 qian, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1 qian, Fu Ling (Poria) 3 qian, Shen Qu (Massa Medicata Fermentata) 1 qian, Gan Cao (Licorice Root) 1 fen, Luo Bo Zi (Raphani Semen) 1 qian, Da Fu Pi (Arecae Pericarpium) 5 fen, Zhi Ke (Fructus Aurantii) 5 fen, Shan Yao (Dioscoreae Rhizoma) 5 qian, Yi Yi Ren (Coicis Semen) 5 qian, Shan Zha (Crataegi Fructus) 5 grains, Mai Ya (Hordei Fructus Germinatus) 1 qian, Gu Ya (Oryzae Fructus Germinatus) 1 qian. Decoct in water and take orally.

**Kuan Zhong San (Loosen Middle Powder):**
Shu Di Huang (Rehmanniae Radix Praeparata) 2 liang, Bai Shao (Paeoniae Radix Alba) 5 qian, Dang Gui (Angelicae Sinensis Radix) 5 qian, Mai Dong (Ophiopogonis Tuber) 5 qian, Niu Xi (Achyranthis Bidentatae Radix) 3 qian, Xuan Shen (Scrophulariae Radix) 3 qian, Wei Yu (Polygonati Odorati Rhizoma) 5 qian, Che Qian Zi (Plantaginis Semen) 1 qian, Bie Jia (Testudinis Carapax et Plastrum) 5 qian, Gui Jiao (Corii Corii Colla) 3 qian, Shan Zhu Yu (Corni Fructus) 3 qian, Shan Yao (Dioscoreae Rhizoma) 5 qian, Dan Pi (Moutan Cortex) 3 qian, Sha Shen (Glehniae Radix) 3 qian. Decoct in water and take orally.