Abdominal Distention

Abdominal distention is a disorder marked by the enlargement of abdomen and accompanied by dark, yellow coloration of the skin or visible superficial veins on its surface. In the ancient medical literatures, various types are included in this category, such as "abdominal distention due to qi stagnation," "abdominal distention due to blood stasis," "ascites," "abdominal distention due to parasitic infection," etc.

Etiology and Pathogenesis

Emotional upsets, immoderate eating and drinking and exogenous pathogenic agents impair the function of liver and spleen, leading to the stagnation of qi and blood, retention of body fluids and obstruction of the meridians, and abdominal distention ensues. The deficiency of liver and spleen involves the kidneys, resulting in the deficiency of kidney-yin and kidney-yang, which further impairs the liver and spleen and impedes the qi activity of the bladder causing oliguria and an aggravation of the distention of the abdomen. Moreover, in cases of jaundice, malaria and schistosomiasis, abdominal distention may also develop.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between abdominal distention and edema: Edema is a disorder with retention of fluid resulting from the effects of wind and dampness, improper diet and overstrain involving the lungs, spleen and kidneys. Edema usually begins from the eyelids and then affects the head, face and limbs, or starts from the lower limbs and subsequently involves the whole body. Ascites only appears in the late stage.

(b) Differentiation between asthenia and sthenia syndromes: In the early stage, abdominal distention is attributed to dysfunction of the liver and spleen, which leads to retention of dampness and stagnation of qi and usually manifests itself as a sthenia-syndrome such as qi stagnation, blood stasis, dampness-heat, cold-dampness, etc. As the disease progresses over a long period of time, asthenia-syndrome, such as deficiency of spleen-yang and kidney-yang and deficiency of the liver-yin and kidney-yin, may develop. However, the coexistence of both syndromes may also be seen, which is mostly attributed to a primary asthenia-syndrome with a secondary sthenia-syndrome.

B. Therapeutic principles

The theory which aims at both the elimination of evils and the restoration of healthy qi is the general principle. Those of regulating qi circulation and eliminating dampness, activating qi and blood circulation, invigorating the spleen and promoting diuresis as well as warming the kidneys and nourishing the liver are the principles commonly used.

Classification and Treatment

A. Stagnation of qi and retention of dampness

Manifestations: Enlargement of the abdomen with tense skin, distention or pain over the hypochondria, abdominal distention occurring after food intake, poor appetite, emaciation, thick and greasy tongue coating and wiry and smooth pulse.

Therapeutic principles: Disperse the stagnated liver-qi, and expel dampness.

Prescription: Bupleuri Powder for Dispersing the Depressed Liver-Qi with Powder for Regulating the Function of the Stomach

Radix Bupleuri 10 g
Radix Paeoniae Rubra 15 g
Fructus Aurantii 10 g
Rhizoma Cyperi Praeparata 10 g
Rhizoma Atractylodis 10 g
Cortex Magnoliae Officinalis 6 g
Pericarpium Citri Reticulatae 10 g
Poria 10 g
Pericarpium Arecae 10 g
Rhizoma Chuanxiong 10 g

Remarks: Add Semen Plantaginis and Rhizoma Alismatis for cases with oliguria. Add Radix Aucklandiae and Fructus Amomi for those with marked abdominal fullness and eructation. Add Radix et Rhizoma Rhei and Semen Persicae for those with constipation.

B. Accumulation of dampness-heat

Manifestations: Marked abdominal distention, bitter taste in the mouth, restlessness, feverish sensation, oliguria, constipation or loose stool, red tip and margin of the tongue with yellow and greasy coating and wiry and rapid pulse.

Therapeutic principles: Clear away heat and dampness, and dispel water by promoting diuresis.

Prescription: Zongman Fenxiao Bolus

Rhizoma Coptidis 5 g
Cortex Magnoliae Officinalis 10 g
Fructus Aurantii Immaturus 10 g
Radix Scutellariae 10 g
Rhizoma Pinelliae 10 g
Pericarpium Citri Reticulatae 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Poria 15 g
Polyporus Umbellatus 10 g
Rhizoma Alismatis 10 g
Semen Plantaginis 10 g
Exocarpium Benincasae 30 g

Remarks: Increase the dosage of diuretics for cases with ascites. Add Radix Codonopsis Pilosulae and Rhizoma Polygonati for those with impairment of qi and yin.

C. Retention of cold-dampness in the spleen
Manifestations: Abdominal distension with cold pain, fatigue, aversion to cold, loss of appetite, oliguria, loose stool, pale tongue with thing, white coating and deep and slow pulse.

Therapeutic principles: Warm the kidneys, benefit the spleen, and expel dampness by promoting diuresis.

Prescription: Decoction for Strengthening the Spleen

Radix Aconiti Lateralis Praeparata 10 g
Rhizoma Zingiberis (dried) 10 g
Semen Alpiniae Katsumadai 10 g
Radix Codonopsis Pilosulae 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Poria 15 g
Cortex Magnoliae Officinalis 10 g
Radix Aucklandiae 6 g
Pericarpium Arecae 10 g
Semen Plantaginis 10 g
Rhizoma Alismatis 10 g

Remarks: Add Radix Angelicae Sinensis, Radix Paeoniae Rubra and Rhizoma Corydalis for cases with blood-stasis syndrome.

D. Qi stagnation and blood stasis

Manifestations: Enlarged and indurated abdomen, stabbing pain or an indurated mass in the hypochondrium, engorged superficial veins over the abdominal wall, congested capillaries or spider nevus on the skin, purplish tongue with ecchymoses, oliguria and thready and unsmooth or wiry pulse.
Therapeutic principles: Activate blood and qi circulation, eliminate blood stasis, and promote diuresis.

Prescription: Decoction for Removing Blood Stasis Under the Diaphragm

Semen Persicae 10 g
Cortex Moutan Radicis 10 g
Radix Paeoniae Rubra 15 g
Radix Linderae 10 g
Rhizoma Corydalis 10 g
Radix Angelicae Sinensis 12 g
Radix Glycyrrhizae Praeparata 5 g
Semen Phaseoli 30 g
Radix Rehmanniae 15 g
Semen Plantaginis (wrapped in with cloth) 20 g
Carapax Trionycis Praeparata 30 g

Remarks: Add Radix et Rhizoma Rhei, Radix Sanguisorbae, Rhizoma Coptidis and Rhizoma Pinelliae for those hematemesis or hematochezia. Apply Powder for Restoring Pulse Beat or inject a solution made from the powder for cases with collapse-syndrome.

E. Deficiency of liver-yin and kidney-yin
Manifestations: Enlarged abdomen, dryness of mouth and lips, feverish sensation over palms, soles and the chest, bleeding from the gum, epistaxis, oliguria, crimson and dry tongue and wiry and thready pulse.

Therapeutic principles: Tonify yin, cool the blood, eliminate blood stasis, and promote diuresis.

Prescription: Polyporus Umbellatus Decoction with Bolus of Six Drugs Containing Rehmanniae Praeparata

Polyporus Umbellatus 30 g
Talcum 15 g
Rhizoma Alismatis 15 g
Colla Corii Asini 10 g
Radix Rehmanniae 15 g
Rhizoma Dioscoreae 20 g
Cortex Moutan Radicis 10 g
Poria 10 g
Radix Achyranthis Bidentatae 15 g

Experiential Prescriptions

A. A fish (about 250 g), Pericarpium Citri Reticulatae 910 g), Fructus Amomi (10 g), Pericarpium Zanthoxyli (15 g) and Rhizoma Zingiberis Recens (10 g); prepared as a decoction.

B. One piece of Pericarpium Lagenariae Sicerariae and Herba Scutellariae Barbata (30 g); prepared as decoction.

C. Endothelium Corneum Gigeriae Galli 915 g), Rhizoma Atractylodis Macrocephalae (10 g), Rhizoma Zingiberis Recens (10 g) and Rhizoma Imperatae (fresh, 60 g); prepared as a decoction.

Copyright 1995 Hopkins Technology