Acupuncture for Distention Disease: Diagnosis and Treatment Principles

The Yellow Emperor asked: “What pulse manifestation at the Cun Kou (寸口, cùn kǒu) point indicates Zhang Bing (胀病, zhàng bì), or distention disease?”

Qi Bo replied: “A pulse that is forceful, full, firm, and stagnant indicates the presence of Zhang Bing.”

The Yellow Emperor inquired: “What is the difference between distention in the five internal organs and the six fu organs?”

Qi Bo answered: “The distention of the Yin meridians affects the internal organs (Zang, 脏, zàng), while the distention of the Yang meridians affects the six fu organs (Fu, 腑, fǔ).”

The Yellow Emperor continued: “Can abnormal Qi flow lead to Zhang Bing? Is the distention within the blood vessels or the internal organs?”

Qi Bo explained: “Both the blood vessels and the internal organs can have abnormal Qi, but these are not the areas where Zhang Bing originates.”

The Yellow Emperor asked again: “I want to understand where Zhang Bing arises from.”

Qi Bo said: “Zhang Bing originates outside the internal organs, pressing inward upon them and expanding outward, causing swelling in the chest and ribs, which in turn causes the skin to swell. That is why it is called Zhang Bing.”

The Yellow Emperor replied: “The five internal organs and six fu organs are located deep within the chest and abdomen, like precious items stored safely in a cabinet, each maintaining its position in a specific order. Although they have different names, they share a common purpose within their domains. I would like to know the reasons for their functional differences.”

Qi Bo responded: “The chest and abdomen form the external boundaries of the internal organs. The Shan Zhong (膻中, shān zhōng) is the palace of the heart; the stomach is the storehouse for water and food; the throat and small intestine serve as the pathways for the digestion of food; the five openings of the digestive system—Yan Men (咽门, yān mén), Bi Men (贲门, bì mén), You Men (幽门, yōu mén), Lan Men (阑门, lán mén), and Po Men (魄门, pò mén)—are like the doors of a neighborhood; the Lian Quan (廉泉, lián quán) and Yu Ying (玉英, yù yīng) points are the pathways for the movement of fluids. Therefore, the five internal organs and six fu organs all have fixed locations, and the symptoms they exhibit vary accordingly.”

Qi Bo continued: “When the Ying Qi (营气, yíng qì) moves smoothly within the meridians but the Wei Qi (卫气, wèi qì) moves erratically, it can cause Zhang Bing in the blood vessels. If the Wei Qi merges with the meridian and flows through the muscles, it causes swelling of the skin. When needling to treat this, acupuncture should target the Zu Yangming Wei Jing (足阳明胃经, zú yáng míng wèi jīng) and needle the Zu San Li (足三里, zú sān lǐ) point using a draining technique. If the distention is near the point, one needle insertion will suffice; if it is further away, needle three times. Regardless of whether the condition is excess or deficiency, early treatment with draining techniques should be applied to address the primary symptom.”

The Yellow Emperor asked: “Can you describe the symptoms of Zhang Bing?”

Qi Bo answered: “When the heart is affected by Zhang Bing, the symptoms are restlessness, shortness of breath, and disturbed sleep. When the lungs are affected, the patient may feel fullness in the chest, difficulty breathing, and cough. When the liver is affected, there will be distention and pain in the sides, pulling toward the lower abdomen. When the spleen is affected, symptoms include belching, vomiting, fullness and discomfort in the limbs, a heavy feeling in the body, and difficulty moving, along with disturbed sleep. When the kidneys are affected, symptoms include abdominal distention, pulling pain in the back and hips, and discomfort in the lower back.”

“The six fu organs show their own forms of Zhang Bing,” Qi Bo continued. “The stomach shows distention in the abdomen, pain in the stomach, a foul odor in the nose, lack of appetite, and difficulty with bowel movements. The large intestine shows gurgling and painful sensations in the intestines, and in winter, exposure to cold can worsen symptoms, causing undigested food in the stools. The small intestine shows distention in the lower abdomen, with pulling pain in the waist. The bladder shows abdominal distention with difficulty urinating. The Sanjiao shows fullness in the skin, light and empty sensations, and looseness. The gallbladder shows pain and fullness in the sides, a bitter taste in the mouth, and frequent sighing.”

Qi Bo continued: “The symptoms of Zhang Bing in the internal organs and their treatment follow the same principles. Only by clearly understanding the directions of Ying and Wei Qi and the movement of Qi and blood, can the proper acupuncture techniques be applied for treatment. If draining techniques are used for deficient conditions or supplementary techniques for excessive conditions, it will cause the Qi to scatter, and the vital Qi cannot stabilize, which may lead to early death. However, when the correct method of draining and supplementing is used, the Qi and meridians are balanced, and the patient will be treated effectively.”

The Yellow Emperor asked: “What is the root cause of Zhang Bing?”

Qi Bo responded: “The Wei Qi in the body, under normal circumstances, flows along with the blood vessels and between the muscles. It moves with both order and irregularity, circulating in the Yang during the day and in the Yin at night, following the flow of the Ying Qi in the meridians and aligning with the natural rhythms of the seasons. If the Yin and Yang are not in balance, the Qi becomes stagnated and cold Qi rises, causing a conflict between the pathogenic Qi and the vital Qi. This results in Zhang Bing.”

The Yellow Emperor asked: “How can we explain this more clearly and simply?”

Qi Bo answered: “When the Wei Qi is disturbed and moves erratically, it mixes with the vital Qi and causes obstruction in the blood vessels, internal organs, or the six fu organs, leading to Zhang Bing.”

The Yellow Emperor said: “Very well explained!”

The Yellow Emperor then asked: “Earlier, we discussed that when Zhang Bing first appears, regardless of whether it’s a deficiency or excess, draining techniques should be used. For a condition close to the treatment point, one needle insertion will suffice, but for a condition further away, three insertions are needed. What if there is no improvement after three insertions?”

Qi Bo answered: “This means the needle has not reached the space between the muscles and did not target the correct acupoint. If the Qi cannot flow properly, the pathogenic Qi remains blocked. If the needle does not reach the right point and only stimulates the superficial layers, it worsens the imbalance between the Yin and Yang, causing Qi to resist and leading to further dysfunction. In this case, you must change to a different acupoint, and once the Qi begins to descend, the Zhang Bing will dissipate.”

For chronic Zhang Bing, Qi Bo concluded: “You must carefully observe the symptoms. For symptoms of excess, use draining techniques; for deficiency, use supplementation. Just like striking a drum—when you hit it, the sound follows. If you apply the right technique, the Zhang Bing will surely fade.”