bubble_chart Concept

Single abdominal distension and fullness, also known as tympanites or single drum, refers to the condition where only the abdomen is swollen while the body and limbs remain emaciated.

This condition, Suwen. Fuzhong Lun refers to it as "tympanites". Lingshu. The chapter on water swelling calls it "anasarca". Zhubing Yuanhou Lun refers to it as "water tympanites". The "Zhizhi Fang" further distinguishes it into "grain swelling", "water swelling", "qi swelling", and "blood swelling".

Single abdominal distension and fullness is different from general swelling. General swelling refers to edema, which usually starts from the limbs and eye sockets, then spreads to the whole body. In single abdominal distension and fullness, the swelling is confined to the abdomen, and the limbs do not swell unless the condition is severe. Therefore, Yixue Xinwu. The discussion on swelling states: "How to distinguish between edema and tympanites? The answer is: if the eye sockets and feet swell first, followed by the abdomen, it is water swelling; if the abdomen swells first, followed by the limbs, it is distension.

Single abdominal distension and fullness should also be distinguished from abdominal masses. Abdominal masses refer to lumps in the abdomen, which may cause distension or pain. Although abdominal masses may also be seen in single abdominal distension and fullness, they are persistent and accompanied by prominent veins, indicating a more severe condition than simple abdominal masses. However, the appearance of abdominal masses is often a precursor to single abdominal distension and fullness. Yimen Falu states: "Any abdominal mass is the root of distension disease. Over time, the abdomen may become as large as a basket or a jar, which is single abdominal distension and fullness."

bubble_chart Pattern Analysis

1. Qi Stagnation with Dampness Obstruction︰The abdomen is distended like a drum, with a pale yellow skin color, fullness or pain under the ribs, reduced appetite, aggravated distension after eating, belching discomfort, scanty urine, white and greasy tongue coating, and a deep wiry or wiry slow pulse. This is due to dampness obstructing the qi aspect, primarily dominated by dampness. Dampness is heavy, turbid, and sticky, so it is often accompanied by anorexia, aggravated distension after eating, white and greasy tongue coating, and a wiry slow pulse. The treatment involves soothing the liver and regulating the spleen, promoting dampness elimination, and relieving fullness. The prescription selected is Bupleurum Liver-Soothing Powder combined with Stomach-Calming Powder.
2. Dampness-heat︰Abdominal distension and fullness is large and full, with tense abdominal skin resisting pressure, scorching skin, vexing heat, bitter taste in mouth, fetid mouth odor, dry stool, yellow urine, yellow and dull complexion, yellow-greasy or gray-greasy tongue coating, red tongue texture, and wiry-rapid pulse. It is due to the binding of dampness-heat, which easily consumes qi and damages yin. Therefore, it must be accompanied by symptoms such as vexing heat, bitter taste in mouth, fetid mouth odor, yellow and dull complexion, yellow urine, yellow-greasy or gray-greasy tongue coating, red tongue texture, and wiry-rapid pulse. In severe cases, seasonal pathogens transform into fire, disturbing the nutrient-blood and forcing blood to recklessly move, leading to symptoms such as vomiting, nosebleeds, and bloody stool. Treatment involves clearing and draining damp-heat, fortifying the spleen, and regulating qi. The formula selected is Middle Fullness Separatively Eliminating Pill. If pathogens transform into fire and disturb the nutrient-blood, it is advisable to clear the nutrient aspect and cool the blood. The formula selected is Rhinoceros Horn and Rehmannia Decoction with modifications.
3. Qi Stagnation and Blood Stasis︰The abdomen is enlarged and firm to the touch, with visible blue veins on the abdominal wall. Red patches or streaks may appear on the chest, back, neck, or face. The {|###|}complexion{|###|} is bluish-purple, and there is {|###|}hypochondriac region stabbing pain{|###|}. The body is emaciated, with {|###|}thirst{|###|} and a desire to drink. The lips and tongue are dark red or purple and lack luster. The pulse is wiry and thin or wiry and rough. This is a {|###|}pattern of deficiency and excess complex{|###|}, where deficiency is the root and excess is the manifestation. The symptoms arise from prolonged {|###|}liver depression qi stagnation{|###|}, which leads to qi stagnation and subsequently {|###|}blood stasis{|###|}. This manifests as {|###|}hypochondriac region stabbing pain{|###|}, a purple tongue, and a rough pulse. Yixue Rumen states: "At the onset, distension is due to qi. If qi does not flow, it obstructs blood circulation. If blood does not circulate, over time it leads to water retention." Qi stagnation, static blood, and water pathogens accumulate in the {|###|}middle energizer{|###|}, causing severe {|###|}abdominal distension and fullness{|###|}. Treatment should focus on {|###|}soothing liver and regulating qi{|###|}, as well as {|###|}invigorating blood and resolving stasis{|###|}. The recommended formula is Blood House Stasis-Expelling Decoction with modifications.
4. Spleen-kidney Yang Deficiency︰Abdominal distension, worse in the evening, not firm on palpation, accompanied by dull complexion, fear of cold and cold limbs, or lower limb edema, physical fatigue and mental fatigue, scanty urine, loose stool, pale and swollen tongue texture, thin white and slippery tongue coating, deep and thready weak pulse. It mostly arises from the failure of spleen yang to transport, leading to water-dampness accumulation, and subsequently affecting the kidneys. Yuyicao said: "Simple abdominal swelling is due to prolonged obstruction of the central region's axis of movement, where the clear fails to ascend and the turbid fails to descend, mutually binding and becoming firmly entrenched, truly caused by the decline of spleen qi." Therefore, clinically it must also present with fear of cold and cold limbs, mental fatigue and physical lassitude, scanty urine, loose stool, pale and swollen tongue texture, white and slippery tongue coating, deep and thready weak pulse, and other symptoms. Treatment involves strengthening the spleen and warming the kidneys, warming yang qi to promote diuresis, with the prescription selected from Aconite Middle-Regulating Decoction combined with Five Ingredients with Poria Powder with modifications.
5. Liver-kidney Yin Deficiency︰The abdomen is distended, with prominent veins in severe cases, and the body is emaciated, accompanied by a sallow complexion, or a dark face with purple lips, dry mouth and irritability, feverish sensation in the palms and soles, scanty and dark yellow urine, dry stools, a red and dry tongue without coating, and a wiry, thin, and rapid pulse. This condition often arises from prolonged illness leading to insufficient liver and kidney yin fluids, resulting in yin deficiency with effulgent fire. Therefore, symptoms such as dry mouth, irritability, epistaxis, gingival hemorrhage, bloody stools, a red and dry tongue, and a wiry, thin, and rapid pulse are commonly present. The treatment should focus on nourishing the liver and kidneys, cooling blood, and resolving stasis. The recommended formula is Six-Ingredient Rehmannia Decoction supplemented with Fleeceflower, Salvia, Suberect Spatholobus Stem, Scrophularia Root, and Dendrobium. For reckless blood movement due to heat, add thatch grass root and Hairyvein Agrimonia Herb.

The condition of abdominal distension and fullness, known as "大一症," develops gradually due to qi stagnation, blood stasis, and water retention. It begins with the constraining of liver qi, followed by the dysfunction of the spleen in transportation, leading to the accumulation of dampness internally. Coupled with qi stagnation and blood stasis, the distension worsens over time. The condition typically progresses from excess to deficiency, or presents with a complex interplay of deficiency and excess. The treatment principle focuses on expelling pathogenic factors in cases of excess, while not neglecting to support the body's vital qi. In cases of deficiency, the emphasis is on supporting the vital qi, while incorporating agents to expel pathogenic factors. However, in the early stages, excessive purging should be avoided, as haste can lead to failure and even danger. In the late stage (third stage), excessive use of pungent and drying warming and tonifying agents should also be avoided, as it can exacerbate the distension. Gezhi Yulun states: "Physicians who fail to recognize that the illness arises from deficiency, rush to achieve quick results, flaunt their skills, and seek rewards. Patients, suffering from severe distension, are eager to take purgatives

for temporary relief, not realizing that alleviation for a day or half a day only worsens the distension, and the pathogenic factors become even more severe."

bubble_chart Documentation

1. Zhangshi Yitong-Drum Distension: "Distension generally arises from the deficiency and weakness of the spleen and stomach qi, which fails to transport and transform the essence, leading to the accumulation and non-dispersion of water and grains, thus resulting in distension and fullness. Improper diet and lack of proper nourishment cause the clear qi to descend and turbid qi to fill the chest and abdomen. The mutual steaming of dampness and heat then gives rise to this syndrome. Scanty and astringent urination indicates that the disease is stubborn and difficult to treat. A method of half-supplementation and half-purgation should be employed, focusing on fortifying the spleen, regulating qi, and relaxing the middle. Overuse of harsh methods should be avoided, as it may further damage the spleen and stomach, leading to recurrent distension that becomes incurable. Appropriate treatments include Separatively Eliminating Decoction and Fenxiao Pill, with modifications based on cold, heat, deficiency, or excess conditions. ... When blood stasis leads to distension, with visible green veins on the abdomen or red streaks and marks on the hands and feet, scanty urination, and black stools, use the Stasis-Precipitating Decoction from the Golden Cabinet. If ineffective, replace with Resistant and Withstanding Pill, removing leech and adding Ailanthus Cicada to form pills."
2. Bianzheng Lu-Drum Distension: "At the initial stage, how can one discern whether it is worm distension or blood distension? I differentiate it by observing the face: a pale yellow complexion with red dots or streaks indicates the condition. Further verification can be made by examining the abdomen: pain before eating that subsides after eating is another sign."