Sweating does not resolve, abdominal distension and fullness with pain, drastic purgation is required, appropriate Major Purgative Decoction. If abdominal distension and fullness do not decrease, and the decrease is insignificant, purgation should be applied, appropriate Major Purgative Decoction.

bubble_chart Note

• This elaborates on the previous section, mutually explaining its meaning to differentiate the treatment.
• After sweating, if the exterior has resolved, and there is abdominal distension and fullness without pain, it is a case of abdominal distension and fullness that decreases at times and then returns to its original state of empty fullness, which should be warmed, as in the case of Magnolia Bark, Fresh Ginger, Pinellia, Liquorice and Ginseng Decoction.
• Now, after sweating, if the exterior is not resolved, and there is severe abdominal distension and fullness with pain, it is a case of abdominal distension and fullness that does not decrease, and the decrease is insignificant, indicating substantial fullness, which should be treated with purgation, appropriate Major Purgative Decoction, as there is rectal urgency, thus after attacking the interior, harmonize the exterior.

bubble_chart Collected Annotations

• Yu Chang said: "The phrase 'decrease is insignificant' vividly describes abdominal distension and fullness. It shows that even if the fullness is at ten, reducing one or two does not significantly reduce its intensity. Therefore, even if there are external pathogens not resolved, purgation should be applied without doubt!"
• Cheng Yingmao said: "If after purgation, abdominal distension and fullness remain as before, even if reduced by one or two, it cannot be considered reduced. Purgation can be applied again, and it must be continued until the fullness is completely reduced."
• Liu Hongbi said: "There is no method of purgation for Taiyin. If it is in the meridians, each meridian already has no reason for purgation, and if it is in the organs, Taiyin especially has no place to receive purgation, Cinnamon Twig plus Rhubarb Decoctionhow can there be no doubt? It is not known that the spleen and stomach are exterior and interior to each other. If Taiyang is mistakenly purged, Taiyin is affected by pathogens, and if the stomach has retained food, then the spleen becomes substantial due to the stomach's excess and also painful due to the Taiyang's pathogens. Since there is great fullness and pain, forming stomach excess, and this decoction cannot treat it, Major Purgative Decoction is appropriate."