Blood Distention 1 with hematoma

Blood Distention (1) (with hematoma)

The symptoms of blood distention include fullness in the flanks and lower abdomen, visible blood streaks across the body, restlessness and frequent sipping of water, reddish urine, black stools, and prominent blue veins on the abdomen. Medical texts all describe this as a female-specific condition, but Yu Jia Yan argues that men are also frequently affected. The complexion is pale and yellowish, with crab-claw-like wrinkles, and although the pulse is extremely weak, the gait remains unchanged. People are often angry and forgetful, with dry mouth and constipation, flank and abdominal pain, and once the distention reaches a certain level, the abdomen becomes as big as a basket, making it impossible to save. Southeast China has the highest incidence, likely because the East Sea is rich in fish and salt, and fish have a delicious flavor that easily causes heat. Salt, on the other hand, has a salty and bitter taste, which tends to promote blood flow. Blood is a yin entity; initially, it mixes with heat without causing any noticeable illness. Over time, however, the central heating system gradually heats up, and the qi becomes increasingly hot. When qi gets hot, it binds with blood, preventing it from flowing. As a result, qi resides within the blood, while blood wraps around the qi, much like a pregnant woman carrying a child. By the time the pregnancy reaches nine months (2), the abdomen looks as if it is holding something. In general, all foods that are rich and greasy, including chili, ginger, and cinnamon (3), can cause heat. The treatment involves adding six君子汤 with dried ginger, chuan xiong, and fang ji to the mixture, boiling rice and lotus leaves to make pills, and drinking the broth while focusing on centralization to distribute the effects to the periphery.

According to Yu's theory, his explanation of the origin of blood distention is the most detailed and accurate. However, the prescription he recommends does not align with the idea that heat causes blood to bind while preventing it from flowing. Six君子汤 and the additional ingredients are more suitable for treating phlegm-related distention, and they require cold drinks to be effective. For example, the theory suggests using cooling and qi-regulating products, with Di Dang Wan as the main remedy and Dan Zhi Xiao Yao San combined with ginger and xiang fu as the supporting treatment. Many books recommend using Tao Nu San or Amber San for treatment, but both of these formulas use warm medicines, which can also cause blood to congeal due to cold, differing from Yu's theory. Physicians should carefully assess the situation and choose the appropriate treatment.

There are also stone masses (4) and intestinal growths (5), which look like a pregnancy, with the abdomen growing larger day by day and menstruation occurring on schedule for intestinal growths, while cold invades the intestines, causing qi disorders but not blood disorders. For intestinal growths, Ju He Wan is recommended. For stone masses, where menstruation does not occur on schedule, it is due to cold invading the uterine opening, causing the opening to close and preventing blood from flowing out, leading to hematemesis and other symptoms. In such cases, Amber San and Tao Nu San are recommended, followed by Wen Jing Tang.

Single abdominal distention is considered blood distention, while if all four limbs are swollen, or if the swelling starts from the limbs and spreads to the abdomen, and the color is red, it is called a hematoma. There are also non-red cases, where blood transforms into water and thus does not appear red. This can happen after hematemesis, when blood stasis turns into water and causes swelling. It can also occur when a woman's menstrual cycle does not function properly, causing blood to turn into water and swell. Once it has turned into water, it needs to be treated as water as well, with Wu Pi Yin combined with Dang Gui, Bai Shao, Pu Huang, Dan Pi, and Peach Kernel. Alternatively, one can use dried lacquer or realgar vinegar pills, or brew malt soup to treat it.

Furthermore, all cases of distention and swelling must be classified as yin or yang. Yin conditions are characterized by deep, slow, and tense pulses, often accompanied by cold phlegm symptoms, and require Zhong Fen Xiao Xiao Tang combined with peach kernel. Yang conditions are characterized by rapid pulses, thirst, and shortness of breath, and require Xiao Chai Hu Tang combined with zhi mu, gypsum, fang ji, dan pi, peach kernel, zhu ling, fu ling, and che qian zi for treatment. More details can be found in the six-volume section on swelling.

[Note]

(1) Blood distention: A type of distention, also known as "blood accumulation distention." Symptoms include bruising on the body, abdominal distention resembling a drum, rough skin, and multiple masses in the abdomen, possibly accompanied by hematemesis, epistaxis, and other blood-related symptoms. It corresponds to advanced stages of modern medical conditions such as cirrhosis and schistosomiasis.

(2) Mi Yue: Full term. Mi means "full."

(3) Jing: Fine grain.

(4) Stone mass: An ancient disease name, mentioned in "Ling Shu · Water Distention Chapter." It refers to a lump inside the uterus that grows day by day, resembling a pregnancy, accompanied by amenorrhea, and named for its hardness like a stone. Similar to uterine fibroids.

(5) Intestinal growth: An ancient disease name, mentioned in "Ling Shu · Water Distention Chapter." It refers to a lump inside the abdomen that can gradually grow, making the abdomen look like a pregnancy, and can be moved by pushing. Menstruation occurs on schedule. Similar to ovarian cysts.

[Commentary] This condition is also called "blood accumulation distention," referring to a disease where there is a lump in the abdomen that swells like a drum. Yu Jia Yan refuted the previous misconception that blood distention is exclusive to women, arguing that both men and women can suffer from it, with the highest incidence in the Jiangnan region, linked to high consumption of fish and salt. His argument closely resembles late-stage schistosomiasis-related cirrhosis—both men and women are affected, the Jiangnan region has the highest incidence, and high consumption of fish and salt is a contributing factor. The author strongly agrees with Yu's views, but disagrees with his use of Six君子汤 to treat blood distention, believing it does not match the symptoms. He proposes using Di Dang Wan to attack the root cause and Xiao Yao San combined with xiang fu and ginger to harmonize qi and blood as alternative treatments. Hematomas usually refer to cases where blood distention is accompanied by redness in all four limbs, but since blood can transform into water, there are also non-red cases, which may include ascites associated with liver cancer and other conditions with blood clots, requiring careful attention. Since blood can transform into water, treating hematomas requires addressing both blood and water simultaneously, typically using Wu Pi Yin combined with Dang Gui, Bai Shao, Pu Huang, Dan Pi, and Peach Kernel. This section also discusses two common conditions among women—intestinal growths and stone masses—which both present symptoms of "looking like a pregnancy, with the abdomen growing day by day," but intestinal growths occur during menstruation, while stone masses do not. Given this, these two conditions may be related to ovarian cysts and uterine fibroids.