典藏书目

In the *Suwen: Fuzhong Lun* (Plain Questions: Discussion on Abdominal Distension), the Yellow Emperor asked, "There is a disease characterized by fullness in the heart and abdomen, where the patient can eat in the morning but cannot eat by evening. What is this disease?" Qibo replied, "It is named Guzhang (Drum Distension). It should be treated with Jishi Li (Chicken Dropping Wine Decoction); one dose brings improvement, and two doses bring recovery." The Emperor asked, "Why does it sometimes recur?" Qibo said, "This is due to irregular diet, hence the disease occurs from time to time. Although when the disease seems to have subsided, the pathogenic qi still gathers in the abdomen."

Guzhang (Drum Distension) presents with external abdominal distension that is hollow inside, resembling a drum. This is caused by Liver Qi hyperactivity and Spleen Qi deficiency, leading to obstruction in the meridians and collaterals, while the Fu-organ Qi remains relatively patent. In the morning, Yang Qi is vigorous, so the patient can eat; by evening, Yang Qi declines, so the patient cannot eat. Chicken droppings (Jishi Bai) are good at resolving accumulated food stagnation. Since the chicken corresponds to the Liver (as an animal associated with the Wood element), it can also soothe the Liver. By steeping it in boiling wine and drinking the clarified liquid, it is named Jishi Li. The wine's aroma helps move Qi in the exterior and assist Yang Qi. Because there is no solid accumulation in the Fu organs, purgative drugs are not used. The root of the disease lies in Spleen weakness; thus, irregular diet leads to inevitable recurrence. Even when the illness appears to resolve, upon recurrence, turbid Qi still gathers in the abdomen.

In the *Linghu: Zhang Lun* (Spiritual Pivot: Treatise on Distension), the Yellow Emperor asked, "How do pulse manifestations at the Cun Kou (radial artery) indicate distension?" Qibo replied, "When the pulse is large, firm, and choppy, it indicates distension." The Emperor asked, "How can one distinguish between Zang-distension and Fu-distension?" Qibo said, "Yin pulses correspond to the Zang organs, and Yang pulses correspond to the Fu organs." The Emperor asked, "Does the Qi causing distension reside within the blood vessels, or inside the Zang and Fu organs?" Qibo said, "All three exist, but they are not the abode (She) of distension." The Emperor said, "I wish to hear about the abode of distension." Qibo said, "Generally, distension resides outside the Zang and Fu organs, compressing them, expanding the chest and hypochondrium, and swelling the skin. Hence it is called 'Zhang' (Distension)." The Emperor asked, "The Zang and Fu organs reside within the chest, hypochondrium, and abdomen, like precious artifacts stored in boxes and cabinets. Each has its specific location and dwelling, different names but same region, with distinct Qi. I wish to understand the reason behind this." Qibo said, "The chest and abdomen are the outer boundaries of the Zang and Fu organs; Danzhong (CV 17) is the palace city of the Heart Protector; the Stomach is the Grand Granary; the pharynx and Small Intestine are responsible for transmission; the five openings of the Stomach are like gates and doors of neighborhoods; Lianquan (CV 23) and Yuying (EX-HN22) are the pathways for body fluids. Thus, the Five Zang and Six Fu organs each have their boundaries, and their diseases manifest in different shapes. Ying-Qi (Nutritive Qi) circulates within the vessels; if Wei-Qi (Defensive Qi) rebels, it causes Mai-Zhang (Vessel Distension). If Wei-Qi merges with the vessels and circulates along the muscle intervals, it causes Fu-Zhang (Skin Distension). One should needle Zusanli (ST 36) using the reducing method. For conditions close to the surface, reduce once; for those distant, reduce three times. Regardless of excess or deficiency, the skill lies in rapid reduction."

This clarifies the pulse of internal distension. A pulse that is large, firm, and choppy indicates pathogenic Qi congestion and disharmony of Qi and Blood, confirming distension. Pulse manifestations in the Yang portion indicate distension in the Fu organs; manifestations in the Yin portion indicate distension in the Zang organs. However, becoming distended always involves pathology of Qi, blood vessels, and Zang-Fu organs, though these are not the fixed abode of distension. The "five openings of the Stomach" refer to the lips, teeth, pharynx, the upper opening of the stomach (Bumen/Hiatus), and the lower opening (Youmen/Pylorus), totaling five. Lianquan and Yuying are acupoints of the Ren Mai (Conception Vessel), located under the tongue, through which body fluids ascend. Ying-Qi moves within the vessels, while Wei-Qi moves outside. If Wei-Qi rebels, Ying-Qi becomes blocked and cannot communicate with Wei-Qi, resulting in Mai-Zhang (Vessel Distension). Wei-Qi runs parallel to the vessels outside the flesh layers. If vessel Qi is unobstructed but only Wei-Qi is disharmonious, it results in Fu-Zhang (Skin Distension), where distension is confined within the skin, and the pulse must be smooth and not choppy. Both syndromes should be treated by needling Zusanli (ST 36) of the Stomach Channel with the reducing method, regardless of excess or deficiency, because the Stomach is the Sea of the Zang and Fu organs and commands Ying and Wei Qi. This section clarifies that distension of Qi and blood vessels belongs to Ying-Wei disharmony; the following text will clarify distension of the Zang and Fu organs.