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Heat accumulates in the interior, leading to dry mouth and constipation. The *Classic of Acupuncture and Moxibustion* (*Huangdi Neijing*) states: "All abdominal distensions and enlargements belong to heat," which refers to this condition.

Zhike Cuan San (Bitter Orange Powder): Treats abdominal distension and fullness caused by heat syndromes.
Ingredients: Houpo (Magnoliae Officinalis Cortex), Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix) (each 1.5 liang); Zhi Cao (Prepared Licorice Root) (1 qian); Dahuang (Rhubarb Root and Rhizome) (steamed, 3 qian).
Usage: Crush into a powder. Take 3 qian per dose, with 5 slices of Shengjiang (Fresh Ginger Rhizome), 2 dates, and 1 Wumei (Mume Fruit), decocted in water for oral administration.

Commentary: There are two types of heat distension. Suppose external pathogenic factors such as wind-cold, characterized by excess, enter from the exterior into the interior; cold transforms into heat, resulting in stomach excess and abdominal fullness. Zhang Zhongjing treats this with Dachengqi Tang (Major Order the Qi Decoction) to purge downward. Alternatively, individuals who consume rich and greasy foods may have damp-heat stagnating in the middle jiao, leading to distension and fullness. For these cases, clearing heat and guiding out dampness is appropriate, primarily using Dongyuan's Zhongman Fenxiao Wan (Middle Fullness Dispersing Pill).

Zhongman Fenxiao Wan (Middle Fullness Dispersing Pill): Treats middle-jiao distension and heat distension. Do not use if there is cold syndrome.
Ingredients: Huangqin (Scutellariae Radix) (1 liang 2 qian); Huanglian (Coptidis Rhizoma) (stir-fried, 5 qian); Jianghuang (Curcumae Longae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Renshen (Ginseng Radix et Rhizoma), Zhi Cao (Prepared Licorice Root), Zhuling (Polyporus) (each 1 qian); Fuling (Poria), Ganjiang (Zingiberis Rhizoma), Sharen (Amomi Fructus Rotundus) (each 2 qian); Zhishi (Aurantii Fructus Immaturus), Banxia (Pinelliae Rhizoma) (each 5 qian); Houpo (Magnoliae Officinalis Cortex) (processed with ginger juice, 1 liang); Zhimu (Anemarrhenae Rhizoma) (stir-fried, 4 qian); Zexie (Alismatis Rhizoma), Chenpi (Citri Reticulatae Pericarpium) (each 1 qian).
Usage: Grind into fine powder, mix with steamed cake paste to make pills the size of tung tree seeds. Take 100 pills per dose, administered with hot plain boiled water after meals. Adjust dosage according to the patient's deficiency or excess.

There are also two types of cold distension symptoms: One is where cold qi attacks the exterior, causing distension on the outside. The *Classic* states: "Skin distension occurs when cold qi lodges in the skin; it is bulging but not hard, the abdomen is large, the whole body swells, the skin is thick, and when pressed with hand, the depression does not rise immediately, while the abdominal color remains unchanged. This is its presentation." The other is where cold qi enters the interior, causing distension on the inside. This is due to the condensation of yin qi, which lingers and does not dissipate, attacking the stomach and intestines internally, leading to symptoms of cold-center distension, fullness, and diarrhea. The *Classic* states: "Cold of the zang organs generates distension diseases." For those at the exterior, warm and disperse them; for those in the interior, warm and promote circulation.

Weiwetang (Stomach-Warming Decoction): Treats qi accumulation due to cold, resulting in abdominal distension, fullness, and inability to eat.
Ingredients: Shufuzi (Prepared Aconiti Lateralis Radix), Danggui (Angelicae Sinensis Radix), Houpo (Magnoliae Officinalis Cortex), Renshen (Ginseng Radix et Rhizoma), Banxiaqu (Pinelliae Fermented Rhizoma), Juhong (Citri Reticulatae Pericarpium Rubrum), Shengjiang (Fresh Ginger Rhizoma) (each 1 liang); Zhi Cao (Prepared Licorice Root) (1 liang); Chuanjiao (Sichuan Pepper) (remove eyes and closed ones, crush into powder).
Usage: Take 3 qian per dose.

Muxiang Taqi Wan (Costus Settling Qi Pill) (from *Yuanrong*):
Ingredients: Dingxiang (Caryophylli Flos), Hujiao (Piperis Longi Fructus) (each 3 qian); Yuliren (Prunus Armeniacae Semen Amarum) (4 qian); BaiChou (Brayerae Semen), Zhishi (Aurantii Fructus Immaturus) (each 1 liang); Binglang (Arecae Semen), Muxiang (Aucklandiae Radix), Xiewei (Scorpion Tail) (each 0.5 liang).
Usage: Grind into fine powder, form pills with rice paste the size of mung beans. Take 10 pills per dose, increasing gradually to 15 pills, taken with ginger soup.
This is a warming and promoting formula, most excellent for treating isolated abdominal distension (monostasis). If there is chest and hypochondriac distension, complete swelling of the whole body including face and eyes, nasal congestion, coughing and reverse flow of qi, and discharge of clear nasal mucus, one should first administer Xia Qinglong Tang (Minor Green Dragon Decoction) two or three doses to differentiate and benefit the meridians, and then proceed with anti-distension medications.