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Drum distension
鼓 〔鼓〕gǔ
1. Severe abdominal distension. Drum distension is also called simple drum and spider drum (the spider having a rotund body and thin limbs) when swelling of the limbs is absent, as is usually the case. Drum distension is associated with a somber yellow coloration of the skin, and prominent green-blue veins (caput medusae).
Biomedical correspondence: ascites due to cirrhosis, abdominal tumors, or tubercular peritonitis.
Causes
- emotional frustration (anger damaging the liver);
- fondness of liquor and sweet fatty food;
- glomus lump;
- enduring illness;
- water toxin qì bind (mentioned in
The Origin and Indicators of Disease (诸病源候论 zhū bìng yuán hòu lùn) , now understood as blood fluke infestation).
Pathomechanisms
Two major pathomechanisms operate.
Spleen disease affecting the liver: Fondness of liquor and sweet fatty food causes damage to the spleen and prevents it from transforming damp turbidity so that damp-heat brews. The damp-heat then obstructs qì dynamic, causing liver depression. On the one hand, prolonged liver depression can cause blood stasis; on the other, it can cause liver qì to invade the spleen and the stomach, impairing movement and transformation of water-damp. Spleen vacuity and water-damp exacerbate each other, spleen qì vacuity gives way to spleen yáng vacuity, which finally leads to dual vacuity of the spleen and kidney with inhibited urination that prevents the discharge of fluids. Drum distension thus arises as a result of qì stagnation, blood stasis, and water collecting in the abdomen.
Liver and spleen disease affecting the kidney: Spleen vacuity deprives the kidney of nourishment, causing insufficiency of kidney yáng and inhibited bladder qì transformation. Debilitation of the life gate fire (kidney yáng) exacerbates spleen yáng vacuity. Liver depression transforms into heat to damage yīn causing liver-kidney yīn vacuity. Damp-heat can similarly damage yīn.
Patterns
In former times, distinction was made between
Qi stagnation and damp obstruction (气滞湿阻 qì zhì shī zǔ) causing distension that is not hard to the touch, associated with reduced eating with a tendency to bloating, belching, short voidings of scant urine, a white slimy tongue fur, and a stringlike pulse.
Medicinal therapy: Course the liver and rectify qì; move dampness and disperse the fullness. Use
Acumoxatherapy: Base treatment for drum distension mainly on ST, CV, and PC. Main points (applicable to all patterns):
Water-damp encumbering the spleen (水湿困脾 shuǐ shī kùn pí) drum distension is marked by enlargement, fullness, and distension. To the touch, it feels like a bag of water, which reflects the amassment of water due to devitalized spleen yáng. Stomach duct glomus and abdominal fullness is relieved slightly by heat, which indicates cold contending with the water. Scant urine, sloppy stool, swelling of the face and lower limbs reflects water evil encumbering the spleen and damage to kidney yáng. A white slimy tongue fur and a moderate pulse reflect exuberant dampness and debilitation of yáng. If the abdomen is large as an urn and the limbs are thin as brushwood from shedding of the major masses of the flesh, this is a sign of debilitation of spleen yáng, which indicates a poor prognosis.
Medicinal therapy: Warm the center and rectify the spleen; move qì and disinhibit water. Use
Acumoxatherapy: Use the main points given above, and add
Damp-heat (湿热 shī rè) drum distension is marked by fullness and hardness with a tensed sense of propping in the stomach duct and abdomen. The abdomen feels scorching hot. Other signs include vexation and thirst, bitter taste in the mouth, thirst without desire to drink, constipation or sloppy stool, rough voidings of reddish urine, yellowing of the skin, red tongue with grayish or blackish yellow slimy tongue fur, and a rapid stringlike pulse.
Medicinal therapy: Treat by clearing heat and disinhibiting dampness and by offensive precipitation to expel water. Use
Acumoxatherapy: Use the main points given above and add
Liver-spleen blood stasis (肝脾血瘀 gān pí xuè yū) drum distension is characterized by enlargement, hardness and fullness, prominent green-blue veins on the abdomen, stabbing pain in the rib-side and abdomen, dull blackish complexion, blood moles on the head, neck, chest, and arms, and red marks on the hands, purple-brown lips, thirst without desire to swallow fluids, black stool, purple-red tongue possibly with purple macules, and a fine rough or scallion-stalk pulse.
Medicinal therapy: Quicken the blood and transform stasis; move qì and disinhibit water. Use
Acumoxatherapy: Use the main points given above and add
Medicinal therapy: Warm and supplement the spleen and kidney; promote qì transformation and move water. Use
Acumoxatherapy: Use the main points given above, and add
Liver-kidney yīn vacuity (脾肾阴虚 pí shèn yīn xū) causes enlargement, distension, fullness and discomfort, in severe cases with prominent green-blue vessels. Other signs include short voidings of scant urine, vexation and insomnia, periodic bleeding gums or nosebleed in some cases, dry mouth, red-crimson tongue with little liquid, and a thin rapid stringlike pulse.
Medicinal therapy: Enrich the liver and kidney; cool the blood and transform stasis. Use
Acumoxatherapy: Use the main points given above and add
See entries listed below. Compare gǔ distension.
2.
Drum Distension
- Vacuity distension
- Repletion distension
- Cold distension
- Heat distension
- Food distension
Qì distension - Worm drum
- Blood drum
Qì drum - Water drum
- Gǔ distension
- Simple abdominal distension