Fullness and Distension Accumulation and Mass

Fullness and Distension (Accumulation and Mass)

The area below the heart belongs to the Yangming meridian, serving as the place where heart fire manifests its transformative power. The energy of the emperor fire transforms blood downward, traveling through the Chong meridian to be stored in the liver, thus originating from the area below the heart. Meanwhile, the yang energy of the kidney water ascends upward, traveling through the Chong meridian to connect with the lungs, spreading throughout the body via the lungs, and also emerging from the area below the heart. Since this region is the central soil of the Yangming meridian, it serves as a hub where water, fire, and blood qi circulate up and down. When fire descends and blood flows downward, and qi ascends and water spreads, the area becomes spacious and open. If fire does not descend, blood cannot flow downward, leading to stagnation; if qi does not spread, water cannot disperse, resulting in accumulation. According to the "Shanghan Lun," when treating fullness and distension below the heart, Xie Xin Tang is used to clear fire, Shi Zao Tang is used to drain water, and Gancao Xie Xin Tang and Shengjiang Xie Xin Tang both clear fire and water simultaneously. Wuling San resolves water accumulation, while Chaihu Tang resolves fire accumulation, indicating that this area requires both water to rise and fire to fall to achieve balance. If fire rises and water falls, blocking the central palace, it creates a state of imbalance, hence the term "fullness." In cases where fire floats above the water and fails to connect with it, fullness and distension often occur. If it is determined that fire cannot descend, Xie Xin Tang is used for treatment, possibly supplemented with raw Fuzi to open up the blockage. If it is determined that the yang energy of the bladder water cannot exit the area below the heart, Xiao Chaihu Tang is used to reorient the mechanism, allowing both water and fire to flow freely. When water and fire combine, mild cases result in "chest tightness," treated with Xiao Xianxiong Tang; more severe cases result in "deep chest tightness," treated with Da Xianxiong Tang. If only water accumulates, Erchen Tang and Zhishu Wan are used for treatment. Currently, many physicians only recognize food-related fullness and distension, failing to understand the broader spectrum of fullness and distension. In addition, there are other conditions such as chest oppression, none of which have been discussed here. What is being discussed here is the condition experienced by patients with blood loss. Whenever any of these conditions arise, additional ingredients such as Danggui, Dihuang, Chuanxiong, Chishao, and Danpi can be added to provide comprehensive care for blood-related conditions, achieving a holistic approach.

There is also the condition of accumulation, either spanning across the area below the heart or residing in the abdominal cavity. This is not phlegm, but rather internal blood, which can be addressed using Huazhi Wan. Phlegm is cleared with plain tea, while internal blood is cleared with vinegar and wine, regardless of whether it is located above or below the navel, and treatment is applied to both sides. Moreover, most cases below the navel involve blood accumulation, which can be treated with Di Dang Wan.

There are also masses observed below the navel, sometimes visible and sometimes hidden, with the latter being more common. For masses, use Ge Xia Zhuyu Tang and Di Dang Wan; for cysts, use Ju He Wan.

Fullness and distension affect the chest and diaphragm, accumulation affects the abdomen, and masses affect the lower jiao. All of these conditions can be treated with Zhenren Huatie Tang combined with Wuyu, as well as Xiaoyao San. Further details can be found in the section on blood stasis.

[Commentary] The area below the heart is the domain of the Yangming meridian, connected up and down through the Chong meridian, serving as the central hub for the circulation of water, fire, and blood qi. Heart fire descends from the Yangming meridian, and kidney water ascends from the Yangming meridian as well. If heart fire cannot descend or kidney water cannot ascend, both can become stagnant in the Yangming meridian, leading to fullness and distension. Based on this, the "Shanghan Lun" treats fullness and distension below the heart by using Xie Xin Tang to clear fire and Shi Zao Tang to drain water. Other treatments such as Shengjiang Xie Xin Tang, Banxia Xie Xin Tang, Gancao Xie Xin Tang, and others also employ both cold and hot approaches, collectively achieving the effect of raising water and lowering fire. When water and fire combine in the Yangming meridian, they tend to accumulate in the area below the heart; mild cases are referred to as "chest tightness," with symptoms felt in the area below the heart and pain upon palpation, treated with Xiao Xianxiong Tang; more severe cases are referred to as "deep chest tightness," with pain extending from the area below the heart to the lower abdomen, making it difficult to approach, treated with Da Xianxiong Tang. This article uses the theory of the Chong meridian connecting the upper and lower parts of the Yangming meridian to explain the pathogenesis and treatment principles of fullness and distension below the heart, presenting a clear and logical argument that is more precise than previous explanations relying solely on the concepts of cold and hot to interpret the condition of fullness.