Bloated Belly and Unable to Eat for Over Twenty Days? Doctor Zhang Jingyue’s Case of Severe Abdominal Distension — Shenxiang San (Clove & Cardamom Powder) With Moxibustion Resolves It in Three Days
Patient search terms: bloated belly / distending abdominal pain / gas and bloating / distending pain in both flanks / can’t eat / much worse at night
Medical terms for this condition: qi distension (qi zhang) · stagnation of qi movement · spleen-stomach qi deficiency · liver-spleen disharmony
Opening: the patient was nearly dying of bloating — and the famous doctor first confessed his own wrong turns
The physician in today’s story is the great Ming-dynasty doctor Zhang Jingyue. Doctor Luo opened with a plain truth: Doctor Zhang Jingyue was an honest man — he wrote down the whole process of his own wrong turns in treating illness, in his own book. That is extremely rare in classical case records.
💬 Note from Doctor Luo: Some doctors, when they write a book, only write about the cases they cured and the methods that worked; the wrong turns, they leave out. Not Doctor Zhang Jingyue — he even wrote about his own diarrhea. He had loose bowels for over a year; he tried every method and nothing worked, and in the end he only recovered by tonifying slowly — and he gave up alcohol because of it. Since drinking had injured his spleen and stomach, he wrote up the whole experience and the lesson together. So when you read Doctor Zhang Jingyue’s cases, you can see his real thought process — including the times he got it wrong. Today’s case is a famous formula he worked out while wandering down exactly such a wrong path — Shenxiang San (Divine Fragrance Powder).
Who was the patient? A wine-loving young man who ate feast-or-famine
The patient was a young man from Doctor Zhang Jingyue’s in-law family — the child of relatives, in the prime of youth and vigor. But the young man’s body already carried hidden problems, and Doctor Zhang Jingyue put his finger on the root in a few sentences:
💬 Note from Doctor Luo: He drank wine for days at a time — that was the first root of the disease. On top of that, his diet was feast-or-famine — either he starved, or he stuffed himself. Wine injures the spleen and stomach; irregular eating injures them too, and the liver meridian follows along. So the young man’s foundation was "spleen-stomach qi deficiency with liver-spleen disharmony" — it just hadn’t erupted yet.
The first wrong turn: he made himself vomit, and "vomited" the illness up into his chest
One day, right after a meal, both flanks suddenly began to hurt — the ribs ached fiercely on both sides. He thought: it must be something I ate. So he dug out some qi-moving, stagnation-dissolving medicine and took it — and then made himself vomit, throwing up everything he had eaten.
💬 Note from Doctor Luo: And what happened? After vomiting, rebellious qi rose — the qi went upward. The flank pain was less obvious now, but that breath of qi pushed upward and lodged in the chest and diaphragm — the distension and pain were worse than before! Worse still, the vomiting would not stop — he kept throwing up. The family saw the situation was bad and hurriedly called Doctor Zhang Jingyue.
Round one: stagnation-breaking medicine stopped the vomiting — but a lump formed under the left breast
Doctor Zhang Jingyue came and first gave qi-moving, stagnation-breaking herbs to push the qi downward. The medicine worked — the vomiting gradually stopped and the pain eased. But before anyone could breathe easy, a new problem arrived:
💬 Note from Doctor Luo: Between the left breast and the ribs, a lump gathered — swollen and full, as if something was stuck in there that wouldn’t go down. And the swelling had a pattern: every day at the hours of xu, hai, zi and chou — from seven in the evening to three in the morning, the hours when yin and yang hand over to each other — the distension became unbearable. The patient was miserable. These are precisely the hours when yin is at its fullest and yang is just beginning to be born — the turning point of the day.
Round two: rhubarb and croton seeds together — the more they attacked, the more it swelled
By now the vomiting had stopped, and Doctor Zhang Jingyue reasoned: is there stagnant accumulation stuck in there? Then attack it with the purging method. So he used rhubarb (da huang) and mirabilite (mang xiao), together with the fierce herbs san leng (bur-reed rhizome), e zhu (zedoary) and croton seeds (ba dou) — and on top of that, he had radish seed, mirabilite, garlic and chrysanthemum leaves pounded and applied externally to the swollen area. This was the classical "external application to guide the qi out" method.
💬 Note from Doctor Luo: And the result? "Hao bu neng xiao" — not the slightest effect. And the more he used these attacking, qi-regulating herbs, the more it swelled. Doctor Zhang Jingyue immediately grew alert: no, the direction must be wrong. At this point he wondered — could it be that the spleen qi was injured? He wanted to use tonics, but tonics couldn’t even get in — the patient could take neither food nor water, and it had already been over twenty days. Twenty-odd days without properly eating — the man was nearly at the end of his rope. At this point, even the famous doctor was "at his wit’s end."
The famous doctor’s honest confession: deficiency or excess, true or false — nobody should brag
You may ask: a physician as great as Doctor Zhang Jingyue — couldn’t he tell deficiency from excess? Doctor Luo took a moment here to speak from the heart:
💬 Note from Doctor Luo: Nobody should brag. I’ve followed senior physicians, and in my own practice patients often come in and the formula doesn’t work — so you think again, ask again, study again, change your approach and your formula. Who can hit the bull’s-eye on the first try? When deficiency and excess are truly mixed, with true and false tangled together, the judgment is terribly hard. Deficiency sometimes looks exactly like excess, and excess sometimes looks exactly like deficiency — there are always false appearances. Look at this patient: swollen and in pain — he looks like a textbook case of excess. Yet every qi-regulating and purging treatment failed. Doctor Zhang Jingyue wrote down this wrong path precisely to tell later generations: famous doctors are not people who never err — they are people who, when they err, wake up and turn back.
The turning point: one press on Zhangmen point, and Doctor Zhang Jingyue suddenly understood
With medicine no longer safe to use casually, Doctor Zhang Jingyue could only press and massage with his hands. As he pressed, the patient said: there is a spot under the left ribs — pressing it hurts, and the whole chest and belly ache with it. Doctor Zhang Jingyue examined carefully and found that the tender spot was exactly Zhangmen point!
💬 Note from Doctor Luo: Zhangmen (LR13) lies on the Liver meridian (the foot jueyin liver channel) — and it is simultaneously the front-alert (mu) point of the Spleen. A mu point is where the qi of an organ gathers; it is intimately connected with the internal organ. How do you find it? Simply: bend your arm and press your elbow tip against the ribs — roughly that position. For stagnant liver qi and for soothing the liver and strengthening the spleen, Zhangmen is always a key point. And according to the Huangdi Neijing (Yellow Emperor’s Inner Canon), this is precisely the region of "xu li" — the road where stomach qi comes in and goes out; stomach qi communicates through Zhangmen. Doctor Zhang Jingyue suddenly saw it: "worse by day’s end, easier by day — this was never a tangible accumulation; the disease lies in the qi aspect, no doubt about it!"*
Why didn’t the decoctions work? — aromatic herbs lose their qi the moment they’re boiled
Since the disease lay in the qi aspect, using a decoction to regulate qi was not wrong in principle — so why had nothing worked before? Doctor Zhang Jingyue figured out the crucial issue: "jing huo ze qi san" — pass aromatic qi-regulating herbs over fire and the qi disperses.
💬 Note from Doctor Luo: This is a great principle of herbal use, and everyone should remember it: herbs like white cardamom (bai dou kou), apricot kernel (xing ren) and nutmeg (rou dou kou) — these aromatic qi-moving herbs — if you boil them in the pot together with the other ingredients, after half an hour over the flame their aromatic volatile compounds are long gone. The medicinal qi has dispersed, so naturally there’s no strength left. That’s why in Sanren Tang (Three-Seed Decoction — apricot kernel, white cardamom, coix seed and magnolia bark), the apricot kernel must be pounded and wrapped separately, and the white cardamom too — you boil the other herbs first, and only when there are ten minutes left and you’re about to turn off the fire do you add them, boiling for ten more minutes before closing. That’s exactly how Tongrentang pharmacy wraps its prescriptions. The same goes for aromatic herbs like huoxiang (patchouli) and peilan (eupatorium) — the late master Zhao Shaoqin used huoxiang and peilan always wrapped separately and added near the end, dropped in ten minutes before the pot comes off the fire, purely to capture that aromatic qi-moving action. Boil them past their prime and the medicine has no power.
Shenxiang San: clove matched with white cardamom, ground to powder and taken with hot water
Having solved the problem of medicinal strength, Doctor Zhang Jingyue created a formula — Shenxiang San (Divine Fragrance Powder). Extremely simple — just two herbs:
💬 Note from Doctor Luo: Clove (ding xiang) is a warming herb that moves qi; white cardamom (bai dou kou) is also aromatic and qi-moving, reviving the yang qi of the spleen and stomach — both are on the warm side. Grind equal parts into powder, stir it into hot water and drink five to seven fen — that’s about one to two grams; for severe cases use one qian (about three grams). If the pain is caused by cold, send it down with ginger decoction. The white cardamom can also be replaced with sha ren (amomum fruit) — amomum has the action of guiding qi downward. Take it three or four times a day. The formula’s indications are written out plainly: "chest and diaphragm not opened, rebellious qi hard to resolve, qi rushing upward, pain, vomiting, distension and fullness, phlegm-fluid binding — when all other medicines have failed, this medicine is the best of all" — it is made precisely for this kind of "a breath of qi stuck inside that no treatment can move" distension and pain.
Taking medicine alone was not enough. Doctor Zhang Jingyue first burned moxa on Zhangmen (LR13) for fourteen cones — opening the gate of stomach qi — and only then had him drink Shenxiang San to regulate the qi.
💬 Note from Doctor Luo: And the result? "Bu san ri, zhang guo jian ping" — within three days, the distension was indeed leveling out! Then "shi nai jian jin" — he gradually began to eat again. A man who had been hungry for twenty-odd days could finally take food, and "sui de bao quan" — his life was saved. That coordination of inner and outer methods is the second lesson of today’s story: use acupoints and medicine together.
The swelling settled in three days — and now a lesson about a case where the patient died
The illness cured, Doctor Zhang Jingyue said something worth pondering: "Ci zheng zhi ju qi, cheng suo nan ce" — "This illness came strangely, and the treatment was a wonder I improvised on the spot." He also recorded a painful contrast:
💬 Note from Doctor Luo: That same spring, one of Doctor Zhang Jingyue’s neighbors fell ill with almost exactly the same disease — distension and pain, unable to eat. The physician who was called took one look and attacked downward with all his might, purging hard. And the result? "Jing yi zi bi" — the man died. Same kind of distension: one recovered in three days, the other lost his life. The difference lay entirely in failing to distinguish deficiency from excess, failing to recognize a disease of the qi aspect. Doctor Zhang Jingyue wrote this case down as a warning for later generations. That is the writing of an honest man.
Three things to take away: distinguish true from false, use points with herbs, and barely boil aromatic herbs
With the story told, Doctor Luo summed up three practical takeaways.
💬 Note from Doctor Luo: First, learn to tell true symptoms from false ones. This patient’s distension was so severe that it was all too easy to read it as excess, as stagnant accumulation, and reach for the purging method. Doctor Zhang Jingyue made that very mistake — but when attacking failed and the more he attacked the more it swelled, he woke up at once: this was injured spleen qi, deficiency with qi stagnation — not something tangible inside. These false appearances are everywhere in the clinic: a child coughs, and the parents describe it as terrifying — "please, please save the child, the coughing is unbearable" — so the doctor prescribes a heavy formula, yet when the child arrives he’s hopping around full of energy, just three coughs in the morning and four at night. When you let yourself be led around by the description of symptoms, you misjudge. Second, use medicine and acupoints together. A senior physician once told me: the reason your prescriptions work poorly is that your channels are all blocked — the medicine can’t reach the place where it needs to act. So he first presses the points and works the sinews to open the channels, and only then writes the prescription. We can do the same in self-care: while taking spleen-tonifying medicine (for example, Buzhong Yiqi Wan or Xiangsha Liujun Wan), frequently moxa or press the points of the spleen and stomach channels — for example Zusanli (ST36). Once the channels are open, the medicine works far better. Third, aromatic herbs should be boiled as little as possible — add them late, or simply use powders, and don’t let the medicinal qi evaporate uselessly in the pot.
Bonus: one pill of Muxiang Shunqi Wan saved an old gentleman at the nursing home
To close, Doctor Luo told a true story from his own life to deepen the point:
💬 Note from Doctor Luo: At the nursing home where my mother lives, there was an old gentleman who had recovered well from tumor surgery. One night he got up and ate something from the fridge. The result: his belly swelled up huge, he couldn’t eat, he lay in bed at death’s door — and neither urine nor stool would come out. They took him to the hospital; department heads gathered for a consult and stared at each other — scans showed nothing remarkable, everyone suspected something was stuck inside, but nobody knew what to do. The old lady (his wife) said: no more treatment, take him home — if he dies, he dies in his own courtyard. After they brought him home, they asked my mother: your son understands Chinese medicine — ask him what to do. I said: try Muxiang Shunqi Wan (Aucklandia Qi-Soothing Pill). One pill down, it regulated the qi — the qi dispersed and he was fine. The very next day the old gentleman was strolling in the corridor. You see — all those department heads couldn’t solve it because they were boxed in by the idea that "there’s something in the belly." Once the qi was regulated, the illness was gone. That is the power of the four words "the disease lies in the qi aspect."
When your belly is swollen to the point you can’t eat, don’t rush to think "food stagnation, something stuck" — first distinguish whether it is true excess or qi-aspect deficiency distension, then decide whether to attack or regulate. Doctor Zhang Jingyue’s case teaches us: famous doctors take wrong turns too — but being able to turn back in time, and to distill something real out of the wrong turn, that is the true skill. Shenxiang San, a tiny two-herb powder, paired with moxibustion on Zhangmen (LR13), leveled a life-threatening distension in three days — treating diseases of qi is sometimes exactly this effortless.
Arranged from Doctor Luo Dalun’s commentary on Doctor Zhang Jingyue’s case records; the case is from the Jingyue Quan Shu (Complete Works of Jingyue).