Introduction: Qi stagnation in the spleen and stomach refers to the pathological changes of the Qi mechanism in the middle jiao being disordered, leading to stagnation and obstruction. The treatment principle is to promote Qi movement and relieve stagnation, which is based on the pathogenesis of spleen and stomach Qi stagnation.
Indications: The main symptom is abdominal distension.
Pathological Analysis: Abdominal distension is a condition located in the middle jiao. The mechanism of this distension is related to the obstruction of the Wei Qi (Defensive Qi). Wei Qi circulates between the membranes and regulates the ascending and descending of Qi. If the flow of Wei Qi is obstructed, it can lead to distension. Therefore, the Ling Shu states: “When Wei Qi is retained in the abdomen, it causes accumulation and obstruction, leading to fullness in the chest and abdomen, and difficulty in breathing.”
The causes of Wei Qi dysfunction, as mentioned in the Nei Jing, state that “all abdominal distensions are due to heat.” However, in reality, cold conditions are more common than heat. Cold pathogens invade, causing the pores to close, which affects the ascending and descending of Wei Qi, leading to distension. Thus, the Ling Shu states: “When Ying and Wei are stagnant, cold Qi rises, true pathogens attack, and the two Qi clash, it results in distension.” In addition to wind-cold causing distension, internal food accumulation is also frequently observed. This mechanism is contrary to the above, as it first causes stagnation and dysfunction of the spleen and stomach, which subsequently leads to obstruction of the Qi mechanism.
Since Wei Qi originates from the kidneys, is nourished by the spleen, disseminated by the lungs, and regulated by the liver, any pathological changes will naturally be related to the dysfunction of these organs. Therefore, Qi stagnation and distension cannot be solely attributed to the spleen and stomach; the normal function of lung Qi and liver Qi must also be considered. Only by analyzing the interrelationship of the five organs can we reveal the internal connection between Qi stagnation and organ dysfunction, as well as the abnormal ascending and descending of Wei Qi.
Abdominal distension should not only focus on Qi but also consider the interrelationship and mutual influence between Qi, blood, and body fluids. Clinically, the accumulation of phlegm and dampness can affect the smooth flow of Wei Qi. The membranes and the three jiaos serve as a common passage for the rise and fall of body fluids and Qi. When body fluids accumulate, it inevitably obstructs the flow of Wei Qi; conversely, stagnation of Wei Qi will hinder the circulation of body fluids, and these two often influence each other. The Suwen states: “Cold Qi generates turbidity… when turbidity is above, it causes distension,” which elucidates the pathological process where cold leads to the accumulation of body fluids, and the stagnation of body fluids obstructs the flow of Wei Qi, resulting in distension. The Wen Bing Tiao Bian states: “Dampness in the three jiaos leads to loss of regulation, causing abdominal distension and unsmooth bowel movements,” which also refers to the mechanism of Qi obstruction.
Principles and Formulas: For Qi stagnation and distension, the principle should be to promote Qi movement and relieve obstruction, allowing the Qi mechanism to flow smoothly, thus alleviating distension. Commonly used herbs for this purpose include Hou Po (Magnolia Bark), Chen Pi (Dried Tangerine Peel), Ji Ke (Bitter Orange), Mu Xiang (Aucklandia), Dou Kou (Cardamom), Sha Ren (Amomum), Gao Liang Jiang (Galangal), Su Ye (Perilla Leaf), and Da Fu Pi (Areca Peel), which are selected based on the conditions of cold, heat, deficiency, and excess. Formulas such as Ban Xia Hou Po Tang, Hou Po Wen Zhong Tang, Kuan Zhong Ba Bao San, Zhuan Guan Yin Zi, Cao Dou Kou Yin, and San Wan Pi Qi Wan all embody the principle of promoting Qi and relieving distension.
The herbs that promote Qi movement and relieve obstruction, such as Su Ye, Huo Xiang, Sha Ren, Bai Dou Kou, Chen Pi, and Mu Xiang, all possess aromatic characteristics. They can not only promote the Qi mechanism but also awaken the spleen and transform dampness. Certain formulas that dry dampness, such as Cang Zhu (Atractylodes), Bai Zhu (White Atractylodes), Ban Xia (Pinellia), and Zao Jiao (Soapberry), target the coexistence and mutual influence of Qi and damp turbidity.
In cases of Qi stagnation, it is sometimes necessary to combine with blood-activating substances, as Qi is the commander of blood. When Qi moves, blood moves; when Qi stagnates, blood stagnates. Combining with blood-activating substances not only addresses the issues of Qi and blood circulation but also facilitates the smooth flow of Qi, as both are mutually influential.
Although spleen and stomach Qi stagnation is a condition in the middle jiao, the cooperative relationship between the organs should also be noted. These formulas often include Su Ye, Xing Ren (Apricot Kernel), and Jie Geng (Platycodon) to promote the descent of lung Qi; Chai Hu (Bupleurum), Xiang Fu (Cyperus), and Qing Pi (Green Tangerine Peel) to soothe the liver and relieve stagnation. These herbs may seem unrelated to the main symptoms, but upon closer examination, they are indeed essential, as the ascending and descending of Wei Qi relies on the coordination of the lungs, spleen, and liver.
Common combinations for this principle include:
Warming and Promoting Qi: Qi stagnation due to cold is more common and often combined with Gan Jiang (Dried Ginger) and Gao Liang Jiang to warm and promote the Yang in the middle jiao, allowing the cold to disperse and the Qi mechanism to flow smoothly, restoring the ascending and descending functions, as seen in Ban Xia Hou Po Tang and Hou Po Wen Zhong Tang. These formulas can also be combined with Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite) to warm and open the obstructions, disperse the cold, warm the Yang, and nourish the spleen, as seen in Qiang Zhong Tang and Ren Shen Tang.
Clearing Heat and Promoting Qi: Qi stagnation with a tendency towards heat is often seen in summer, usually accompanied by damp turbidity. When the three jiaos are damp and stagnant, the ascending and descending functions are impaired, leading to distension in the abdomen. For this type of presentation, heat-clearing herbs can be added to formulas that promote Qi and transform dampness, such as the modified Zheng Qi San.
Strengthening the Spleen and Promoting Qi: When Qi stagnation is due to deficiency, herbs that tonify Qi and strengthen the spleen, such as Ren Shen and Bai Zhu, are commonly used. Using tonifying herbs for Qi stagnation may seem inappropriate, but the purpose is to restore the function of the spleen and stomach, allowing the Qi mechanism to flow smoothly. This combination of promoting and tonifying is a structure that addresses both spleen deficiency and Qi stagnation simultaneously. This structure also embodies the principle of “using tonics to relieve obstruction,” as seen in Qiang Zhong Tang and Ren Shen Tang.
Eliminating Accumulation and Relieving Obstruction: In cases of Qi stagnation due to food accumulation, the righteous Qi is not deficient, and it is important to quickly eliminate the accumulation. Using herbs like Qian Niu Zi (Morning Glory Seed) and Bing Lang (Betel Nut) is not only harmless but can also lead to rapid recovery. If it is food accumulation, it is especially necessary to use digestive herbs like Shan Zha (Hawthorn), Shen Qu (Fermented Mass), and Mai Ya (Barley Sprout) or purgative herbs like Da Huang (Rhubarb) and Bing Lang to eliminate the cause of Qi stagnation, allowing normal gastrointestinal transmission, thus alleviating distension. Formulas like Bao He Wan and Mu Xiang Bing Lang Wan exemplify this.
Distension due to Qi stagnation should be differentiated from abdominal fluid accumulation. In cases of gas distension, tapping the abdomen will produce a hollow sound; in cases of fluid accumulation, tapping while lying on the side will produce a heavy, dull sound. If the distension is due to fluid retention, treatment should focus on methods for resolving fluid accumulation.
