bubble_chart Concept

Abdominal distension and fullness refers to a feeling of fullness and distension in the abdomen without external signs of distension.

This symptom was first mentioned in Suwen. Cire chapter and Liuyuan Zhengji Da Lun. Suwen. Daqi Lun. Yuji Zhencang Lun mentions "slight abdominal distension and fullness," Yinyang Yingxiang Da Lun mentions "middle fullness," Yifa Fangyi Lun mentions "fullness disease," and Lingshu. Xieqi Zangfu Bingxing chapter mentions "abdominal qi fullness," all of which fall under the category of abdominal distension and fullness. Jingui Yaolue also mentions this symptom. The

Cold-Damage Disease Treatise further categorizes mild abdominal distension and fullness as "slight abdominal fullness," abdominal distension and fullness with distension as "abdominal distension and fullness," with pain as "abdominal distension and fullness pain" or "abdominal distension and fullness with occasional pain," and with abdominal rigidity as "abdominal hard fullness."

This symptom often coexists with epigastric stuffiness and chest tightness, leading to confusion. Epigastric stuffiness mainly manifests as discomfort and fullness in the epigastric region, with the pathology located in the area below the heart and stomach; chest tightness mainly manifests as a suffocating discomfort in the chest, with the pathology located in the thoracic region, while abdominal distension and fullness is located in the large abdomen below the stomach. {|125|} Conditions such as simple abdominal distension, abdominal mass, umbilical colicky pain, and lower abdominal pain may also present with abdominal distension and fullness in clinical manifestations, but simple abdominal distension and abdominal mass can be palpated as tangible masses; umbilical colicky pain and lower abdominal pain are primarily characterized by pain. Additionally, abdominal distension and fullness symptoms may also be present in women's menstrual, leucorrhea, pregnancy, and postpartum conditions. However, these are not within the scope of this discussion, and relevant entries should be consulted.

bubble_chart Pattern Analysis

1. Internal Accumulation of Cold-dampness︰Abdominal distension and fullness, which does not decrease upon pressure, poor appetite, nausea and vomiting, diarrhea, or epigastric and abdominal pain, thirst without desire to drink, white and greasy tongue coating, and wiry and moderate pulse. This is caused by cold pathogens directly attacking the interior, or prolonged residence in damp and low-lying areas, or consumption of cold, unclean food and drinks, leading to the combined internal and external factors. Cold-dampness invades the middle energizer, disrupting the ascending and descending functions of the spleen and stomach, resulting in abdominal distension and fullness. Since cold-dampness is a yin pathogen, its stagnation in the middle energizer causes abdominal distension and fullness; its obstruction of the spleen and stomach leads to turbid yin failing to descend, resulting in nausea and vomiting; clear yang failing to ascend causes diarrhea; impaired qi movement leads to epigastric and abdominal pain; and the spleen and stomach failing to function smoothly results in poor appetite. Thirst without desire to drink, white and greasy tongue coating, and wiry and moderate pulse are all signs of internal accumulation of cold-dampness. For those with internal accumulation of cold-dampness, it is appropriate to warm and resolve cold and dampness. The recommended formulas are Stomach Poria Decoction and Magnolia Bark Middle-Warming Decoction, modified as needed.
2. Spleen and Stomach Yang Deficiency︰Abdominal distension and fullness, occurring intermittently, sometimes mild and sometimes severe, relieved by warmth, pressure, or consuming warm drinks and food; mental fatigue and lack of strength, poor appetite, a pale and swollen tongue with possible tooth marks, thin white coating, and a slow pulse. Due to constitutional deficiency of the spleen and stomach, weakened middle yang, excessive consumption of raw, cold, or rich foods, overuse of cold-natured medications, or prolonged illness and inadequate recuperation, leading to deficiency-cold of the spleen and stomach, resulting in abdominal distension and fullness. Because internal cold due to middle deficiency cannot be resolved quickly, the abdominal distension and fullness occur intermittently, sometimes mild and sometimes severe, and are relieved by warmth, pressure, or consuming warm drinks and food. Middle deficiency leads to insufficient generation and transformation of qi and blood, hence mental fatigue and lack of strength. Insufficient transformation further weakens the lifting function of qi, resulting in prolapse of zang-fu organs. Spleen deficiency impairs transportation, while stomach deficiency impairs reception, leading to poor appetite. A pale and swollen tongue with possible tooth marks, thin white coating, and a slow pulse are all signs of deficiency-cold of the spleen and stomach. Treatment should focus on warming and tonifying the spleen and stomach, with prescriptions such as Middle-Regulating Decoction or Magnolia Bark Fresh Ginger Rhizome Liquorice Root Pinellia Ginseng Decoction.
3. Dampness-heat︰Abdominal distension and fullness with distension, gastric stuffiness with nausea and vomiting, restlessness in the heart, thirst without desire for excessive drinking, frequent sweating, large loose stools, scanty and dark urine, red tongue with yellow and greasy coating, soggy and rapid pulse. This is caused by exposure to external pathogens, or habitual indulgence in rich foods, dairy products, and pungent foods, leading to spleen and stomach injury and impaired transportation and transformation, resulting in internal dampness-heat that fails to disperse. Due to the obstruction of dampness-heat internally, the ascending and descending of qi movement is impaired, leading to abdominal distension and fullness with distension, gastric stuffiness with nausea and vomiting, and large loose stools. Heat stagnation internally causes restlessness in the heart; the combination of dampness-heat results in thirst without desire for excessive drinking; the binding of dampness-heat, being sticky and stagnant, makes it difficult to resolve the pathogens despite frequent sweating; dampness-heat pouring downward causes scanty and dark urine; a red tongue with yellow and greasy coating and a soggy and rapid pulse are all signs of dampness-heat. Treatment should focus on resolving dampness and clearing heat, and the prescription of choice is Wang's Coptis and Magnolia Bark Decoction.
4. Food Retention︰Abdominal distension and fullness with distending pain, belching of foul odor or acid regurgitation, aversion to the smell of food, or foul-smelling diarrhea like rotten eggs, thick and greasy tongue coating, and deep slippery pulse. This is caused by overeating or irregular eating habits, which damage the stomach and intestines, impairing the digestion of food and leading to food retention. Due to retained food stagnation and obstructed qi movement, there is abdominal distension and fullness with pain; food stagnating in the stomach disrupts its descending function, resulting in belching of foul odor or acid regurgitation, or aversion to the smell of food; impaired spleen function leads to foul-smelling diarrhea like rotten eggs; a thick and greasy tongue coating and deep slippery pulse are signs of retained food stagnation. Treatment should focus on promoting digestion and removing food stagnation, and the recommended formula is Harmony-Preserving Pill.
5. Excess Heat with Internal Constipation︰Abdominal distension and fullness persist without relief, or if there is slight relief, it is negligible. There may be hardness and pain, or pain around the navel, severe constipation, sweating on the hands and feet, tidal fever with delirious speech, a deep and replete pulse, or a slow but forceful pulse, and a yellow, dry tongue coating or a scorched and fissured coating with prickly projections. This condition is commonly observed during the progression of externally contracted febrile diseases. It arises when pathogenic heat enters the interior, stagnates in the stomach and intestines, and combines with fecal matter in the intestines, obstructing the intestinal tract and impairing the large intestine's transporting function. When the large intestine's transporting function is obstructed, the qi movement of the stomach and intestines cannot descend smoothly, hence the persistent abdominal distension and fullness with negligible relief. The combination of intangible pathogenic heat and tangible dry feces internally leads to abdominal distension and distending pain. The obstruction of bowel qi results in severe constipation. Since the limbs receive qi from the stomach, excessive heat in the Yangming channel causes sweating on the hands and feet. The intense interior heat disturbs mental activity, leading to tidal fever and delirious speech. A yellow, dry tongue coating or a scorched and fissured coating with prickly projections are all signs of excessive pathogenic heat and fluid depletion. Clinically, this condition is characterized by distension and fullness throughout the entire abdomen, hardness and pain, or pain around the navel, and is invariably accompanied by severe constipation. The treatment principle is to purge heat accumulation, and the recommended formula is Major Purgative Decoction.

Cold-dampness accumulation abdominal distension and fullness and deficiency-cold of spleen and stomach abdominal distension and fullness: The main distinguishing points are that in the case of cold-dampness accumulation abdominal distension and fullness, the distension does not decrease upon pressure and is accompanied by nausea, diarrhea, epigastric pain, and a thick greasy tongue coating. In contrast, deficiency-cold of spleen and stomach abdominal distension and fullness prefers warmth and pressure, and is accompanied by mental fatigue, lack of strength, visceral prolapse, and a thin white tongue coating. Although both are related to cold, the former is considered excess, while the latter is deficiency.

The main distinguishing points are: dampness-heat accumulation abdominal distension and fullness with bloating, gastric stuffiness, nausea, thirst without desire to drink much, loose stools, and a yellow greasy tongue coating; whereas retained food stagnation abdominal distension and fullness is characterized by bloating and pain, belching, acid regurgitation, fetid mouth odor, anorexia, foul-smelling stools like rotten eggs, and a thick greasy tongue coating.

The symptom of abdominal distension and fullness can be categorized into cold, heat, deficiency, excess, and food-related types. Clinically, it can be differentiated by combining the characteristics of the syndrome, cause, pulse, and treatment.

bubble_chart Documentation

1. Lingshu-Xieqi Zangfu Bingxing: "In cases of Sanjiao disorders, there is abdominal qi distension."
2. Zhengzhi Huibu："Qi distension results from depression of the seven emotions, with chest and abdominal fullness and discomfort, often accompanied by emaciation of the limbs."