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A person, after eating, feels fullness and discomfort in the chest. People assume it is due to overeating and indigestion, so they use pills such as Xiangsha Zhishi Wan (Fragrant Sand and Immature Bitter Orange Pill) to promote digestion. Although there seems to be slight relief, fullness returns shortly after. The same medication is used again. This cycle continues for a long time, eventually resulting in the syndrome of Middle Fullness (a disease characterized by abdominal distension). The abdomen gradually becomes high and swollen, the umbilicus protrudes, and the limbs and body become edematous. People then mistakenly diagnose it as Drum Distension (abdominal distension resembling a drum) and use harsh water-draining herbs like Qian Niu Zi (Pharbitis Seed) and Gan Sui (Kansui Root) to purge fluid retention. However, there was originally no pathogenic damp-fluid in the interior. Before any fluid is expelled, the healthy Qi becomes even more deficient, and the distension becomes more urgent. Suspecting that the previous medications were ineffective, doctors further administer purgatives such as Da Huang (Rhubarb Rhizome) and Ba Dou (Croton Seed). The condition remains unimproved. They then suspect that wind pathogens are firmly bound in the meridians and indiscriminately prescribe drugs like Long Dan Cao (Gentian Root), Yin Chen Hao (Artemisia Capillaris Herb), Fang Feng (Saposhnikovia Root), and Jing Jie (Schizonepeta Spike), continuing until the patient dies. These practitioners still claim to have employed methods such as "opening the ghost gate" (diaphoresis/sweating) and "purifying the clean mansion" (diuresis), arguing纷纭ly and sticking to their own views. They are all people who wield knives to stab those already down. Who knows that the syndrome of Middle Fullness actually stems from the decline of Spleen Earth, and the decline of Spleen Qi is caused by the coldness of Kidney Fire (Mingmen Fire). If warm-tonic medicines had been used early to strengthen Spleen Qi, how could it have reached such an extreme? The prescription used is Wendu Tang (Warm Earth Decoction): Ren Shen (Ginseng Radix et Rhizoma, 1 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 qian), Fu Ling (Poria, 3 qian), Luo Bo Zi (Radish Seed, 1 qian), Yi Yi Ren (Coicis Semen, 3 qian), Qian Shi (Euryales Semen, 5 qian), Shan Yao (Dioscoreae Rhizoma, 5 qian), Rou Gui (Cinnamon Twig, 3 fen), Gu Ya (Sprouted Grain, 3 qian). Decoct in water and take orally. After one dose, slight fullness is felt; after two doses, a sense of ease is experienced; after several doses, Middle Fullness naturally resolves.

This formula focuses solely on tonifying the Spleen and Stomach, absolutely avoiding digestive-promoting drugs that would consume Qi. The disease of Middle Fullness invariably arises from Qi deficiency. Without tonifying Spleen and Stomach Qi, how can distension dissipate? Moreover, adding Luo Bo Zi (Radish Seed) to the formula is exquisite; it assists Ren Shen and Bai Zhu in resolving distension without assisting them in generating pathogenic factors. Additionally, herbs such as Fu Ling, Yi Yi Ren, Qian Shi, and Shan Yao nourish Yin to facilitate fluid metabolism. As fluids flow, healthy Qi is not consumed, ensuring smooth drainage downstream without obstruction upstream. The only concern is that if water is cold and frozen, streams may dry up. Therefore, Rou Gui (Cinnamon Twig) is added to generate fire within the water, warming the Earth element. With melting snow and ice, there is no suffering from blockage. Alas, why do physicians insist on digestive purgation, leading to incurable conditions?

For this syndrome, Shuling Jiagui Tang (Atractylodes and Poria with Cinnamon Decoction) can also be used: Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 liang), Fu Ling (Poria, 5 qian), Rou Gui (Cinnamon Twig, 1 qian). Decoct in water and take orally.

There are individuals who crave food before seeing it but feel aversion upon seeing it. Forcing themselves to eat results in fullness lodged in the Upper Jiao (Upper Burner), accompanied by slight distension and oppression. This indicates not only Stomach Qi deficiency but also the decline of Pericardium Fire. The Pericardium is the mother organ of Stomach Earth. If the mother's Qi declines, how can it generate the child? If Pericardium Fire is insufficient, how can it generate Stomach Earth? Thus, to enable the Stomach to digest food, one must tonify Stomach Earth while simultaneously supplementing Pericardium Fire. The prescription used is Shengwei Jinshi Tang (Generate Stomach and Promote Appetite Decoction): Ren Shen (Ginseng Radix et Rhizoma, 3 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 qian), Chao Zao Ren (Fried Ziziphus Seed, 5 qian), Yuan Zhi (Polygalae Radix, 8 fen), Shan Yao (Dioscoreae Rhizoma, 3 qian), Fu Ling (Poria, 3 qian), Shen Qu (Medicated Leaven, 5 fen), Liang Jiang (Galangal Rhizome, 5 fen), Luo Bo Zi (Radish Seed, 1 qian), Zhi Ke (Aurantii Fructus, 5 fen), Gan Jiang (Zingiberis Rhizoma, fried black, 1 qian). Decoct in water and take orally.

Treating the Stomach in this formula is essentially treating the Pericardium. The Pericardium and Stomach share a mother-child relationship; why treat them separately? By not directly treating Middle Fullness, it resolves spontaneously. This demonstrates that tonifying Fire is superior to tonifying Earth.

For this syndrome, Tiaoji San (Regulate Hunger Powder) is also excellent: Ren Shen (Ginseng Radix et Rhizoma, 5 fen), Shan Yao (Dioscoreae Rhizoma, 1 liang), Bai Shao (Paeoniae Radix Alba, 3 qian), Gan Cao (Licorice Root, 5 fen), Rou Gui (Cinnamon Twig, 1 qian), Chang Pu (Acori Tatarinowii Rhizoma, 5 fen), Rou Dou Kou (Myristica Seed, 1 piece), Chao Zao Ren (Fried Ziziphus Seed, 3 qian). Decoct in water and take orally. Ten doses result in cure.

Some individuals feel depressed and stifled in the heart. Over time, this leads to fullness in both hypochondriac regions. When food enters the throat, immediate bloating occurs, preventing digestion. People mistake this for the onset of Drum Distension, unaware that it is caused by Qi stagnation. Using water-draining drugs will worsen the condition; using digestive-promoting drugs only provides temporary relief and cannot eliminate chronic distension. The treatment method should primarily focus on relieving depression (stagnation). However, prolonged Qi stagnation inevitably leads to Qi deficiency. If one only resolves stagnation without tonifying Qi, Qi will fail to transform food, and distension will not resolve. The prescription used is Kuai Ge Tang (Quick Diaphragm Decoction): Ren Shen (Ginseng Radix et Rhizoma, 1 qian), Fu Shen (Poria with Hostwood, 5 qian), Bai Shao (Paeoniae Radix Alba, 3 qian), Bai Jie Zi (Mustard Seed, 2 qian), Luo Bo Zi (Radish Seed, 5 fen), Bing Lang (Areca Seed, 3 fen), Shen Qu (Medicated Leaven, 5 fen), Zhi Ke (Aurantii Frizctus, 3 fen), Chai Hu (Bupleuri Radix, 5 fen), Yi Yi Ren (Coicis Semen, 3 qian), Hou Po (Magnolia Bark, 3 fen). Decoct in water and take orally. Symptoms lighten after one or two doses; complete recovery occurs after four doses.

This formula relieves stagnation without damaging righteous Qi and reduces distension without causing blockage. Combining attacking and tonifying methods facilitates success.

For this syndrome, Shuzhang Tang (Relieve Distension Decoction) is also effective: Shen Qu (Medicated Leaven, 3 qian), Chai Hu (Bupleuri Radix, 5 fen), Bai Shao (Paeoniae Radix Alba, 3 qian), Fu Ling (Poria, 1 qian), Luo Bo Zi (Radish Seed, 1 qian), Hou Po (Magnolia Bark, 5 fen), Ren Shen (Ginseng Radix et Rhizoma, 5 fen), Bai Dou Kou (Cardamomi Fructus, 3 pieces), Su Ye (Perillae Leaf, 8 fen), Bai Jie Zi (Mustard Seed, 2 qian). Decoct in water and take orally. Ten doses result in cure.

Some patients suffer from Middle Fullness. They retain taste sensation for food, but overeating leads to bloating and indigestion. People attribute this to Spleen Qi deficiency, not realizing it is actually Kidney Qi deficiency. The abdominal fullness is false fullness (deficiency-type) rather than true fullness (excess-type). Treating it as edema would lead to imminent death. The Spleen belongs to Earth. Earth controls Water, but this control fundamentally relies on the Fire within the Kidneys. Earth becomes firm when warmed by Fire; once firm, it can contain objects, and thus contain water. When Kidney Fire is deficient, Earth loses its firmness and cannot contain objects, instead accumulating water. This disrupts normal physiological flow, leading to abdominal fullness and progressing to Water Drum Distension. Ignoring the need to tonify Kidney Fire to generate Spleen Earth, and instead using water-draining methods to injure the Spleen, is akin to breaching a dam to protect the soil—the soil will inevitably collapse. Therefore, treating Middle Fullness caused by Kidney deficiency requires urgently tonifying the Fire of the Gate of Vitality (Mingmen).

However, directly tonifying Fire is inadvisable because Kidney Fire does not arise independently; it is generated within Kidney Water. Tonifying Fire without tonifying Water results in solitary Yang failing to grow, lacking Yin to generate Yang, and thus lacking Water to generate Fire. Some may doubt: if Earth is deficient and cannot control Water, tonifying the Kidney to generate Water might increase waves and exacerbate distension. This is incorrect. The Water in the Kidneys is True Water. Pathogenic Water bullies Fire to insult Earth, whereas True Water aids Fire to generate Earth. There is a distinct difference. Therefore, for Middle Fullness due to Kidney deficiency, one must tonify Fire to generate Earth, and also tonify Water to generate Fire. The prescription used is Jin Kui Shen Qi Wan (Golden Cabinet Kidney Qi Pill): Fu Ling (Poria, 6 liang), Fu Zi (Aconiti Lateralis Radix Praeparata, 1 piece), Niu Xi (Achyranthis Bidentatae Radix, 1 liang), Rou Gui (Cinnamon Twig, 1 liang), Ze Xie (Alismatis Rhizoma, 2 liang), Che Qian Zi (Plantaginis Semen, 1.5 liang), Shan Zhu Yu (Corni Fructus, 2 liang), Shan Yao (Dioscoreae Rhizoma, 4 liang), Mu Dan Pi (Moutan Cortex, 1 liang), Shu Di Huang (Rehmanniae Radix Praeparata, 3 liang). Grind each into powder and form pills with honey. Take 1 liang daily morning and evening with plain boiled water. Initial intake may cause slight distension; long-term use eliminates distension and fullness completely.

This is the supreme medicine for tonifying Fire. Among these ingredients, those promoting diuresis and strengthening the Spleen outnumber those tonifying Yin and Fire. Although the intent leans toward tonifying Fire, the practical emphasis is on saving the Spleen; tonifying Fire is precisely tonifying the Spleen. Thus, tonifying Yin can be light, but tonifying the Spleen must be heavy.

For this syndrome, Xunpi Tang (Smoke-Spleen Decoction) is also good: Shu Di Huang (Rehmanniae Radix Praeparata, 5 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 5 qian), Shan Zhu Yu (Corni Fructus, 4 qian), Po Gu Zhi (Psoraleae Fructus, 1 qian), Du Zhong (Eucommiae Cortex, 3 qian), Fu Zi (Aconiti Lateralis Radix Praeparata, 5 fen). Decoct in water and take orally. Fullness and oppression resolve after two doses; complete recovery occurs after ten doses.