Belly Swollen Like a Spider and Gasping for Air?

Patient search words: swollen belly / belly as big as a spider / abdominal distension / wheezing / can’t get a breath / can’t eat / can’t sleep / urination and defecation blocked

Corresponding medical terms: drum distension (single-abdomen distension) · ascites · severe liver-cirrhosis-type abdominal fluid · spleen-stomach qi deficiency · mixed deficiency and excess

The opening: a dying princess lies in the Lu royal household during the Ming Wanli era

The case we tell today is the one that made the Ming imperial physician Doctor Gong Tingxian famous at a single stroke — a patient every other doctor had abandoned, brought back step by step. After he cured the Princess of Lu, his fame spread through the whole realm, and he later entered the Imperial Medical Academy as a palace physician.

💬 Note from Doctor Luo: Doctor Gong Tingxian was an imperial physician of the Ming dynasty, a native of Jinxi, Jiangxi, honored with the title “Champion of the Medical Grove” (医林状元). He lived to the age of 97 and wrote a large shelf of books including Wan Bing Hui Chun (《万病回春》, A Hundred Diseases Return to Spring) and Shou Shi Bao Yuan (《寿世保元》). He was already well known before — but what truly made his name resound across the country was this very case.

Who was the patient? A belly swollen like a spider, arms and legs frighteningly thin

This patient was no ordinary person — she was the consort of the Prince of Lu. How sick was she? Her belly was swollen huge, bulging like a spider, while her arms and legs grew thinner and thinner; she coughed, brought up phlegm, and wheezed until only a single breath was left; both urination and defecation were blocked; she could not eat and could not sleep at night — sleepless night after sleepless night.

Most frightening of all was the pulse — the pulse had gone chaotic, leaping about wildly, too disordered even to count. The Prince himself said: hundreds of physicians had been summoned and countless medicines tried, with “争无寸效” — not a trace of effect. The patient lay there at her last gasp, and everyone felt she was finished.

💬 Note from Doctor Luo: You see patients like this in hospitals today — belly swollen huge, wheezing, a puffy sheen on the face, arms and legs thin, wired up to monitors, lying in bed at the end of their strength. This kind of abdominal distension is what Chinese medicine calls gu zhang (drum distension), and it is a genuinely critical condition.

The prince’s test: with a belly this swollen, why on earth use tonics?

The difficulty was not only the severity of the illness. The Prince of Lu was an extremely careful man — he demanded a clear explanation of every medicine: “Can ginseng be used? The weather is turning cold — aren’t huang qin (scutellaria) and huang lian (coptis) rather cold? Won’t dihuang (rehmannia) be cloying and stagnating? His belly is swollen and damp — won’t dihuang clog it further? The belly is this blocked, so shouldn’t we use the dividing-and-draining method — promote urination where urine should flow, promote bowel movement where stool should pass, and purge downward? Yet you use tonics instead — won’t you be aiding the evil qi and worsening the disease?”

Doctor Gong Tingxian answered unhurriedly: using tonics to treat distension is called “塞因塞用” — treating blockage by filling. At the very start it may seem even more distended, but taken long enough it opens. Why? Because when upright qi is sufficient, the body has the strength to transform and move. Why is the belly so distended right now? The upright qi is insufficient, unable to transform and transport, so dampness, fluids and phlegm are trapped inside and cannot dissolve. If you force them open with qi-moving, purging or water-draining herbs, each push only makes the deficiency worse. Build the upright qi up, and the body can dissolve the blockage on its own.

💬 Note from Doctor Luo: The prince actually had a fair bit of medical knowledge. The idea that “ginseng locks the evil qi inside” was extremely popular through history — the Qing physician Xu Lingtai often said it. But look at Zhang Zhongjing: ginseng appears in Xiao Chai Hu Tang (Minor Bupleurum Decoction), and ginseng is added to Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction) — if evil qi were present, why wasn’t he afraid? Doctor Luo’s view is that Xu Lingtai sometimes argued just for the sake of arguing; that kind of blanket objection has problems.

Doctor Luo also marveled at this: by the Ming Wanli era, prejudice against ginseng had already grown quite large. The Princess of Lu had been gravely ill for so long, yet across the whole household and among all the outside physicians summoned, no one dared use ginseng — all because of the fear that “ginseng seals in the evil qi.” A person depleted to that degree, and still nobody dared.

The first formula: Modified Buzhong Yiqi Tang, with ginseng and atractylodes doubled

Doctor Gong Tingxian had made up his mind: support the upright qi as the main approach. His first formula was Li Dongyuan’s Buzhong Yiqi Tang (Tonify the Middle and Benefit Qi Decoction) — with ginseng and atractylodes doubled, plus bai shao (white peony), huang qin, huang lian, mu xiang (costus root) and sha ren (amomum). How were the doses arranged? Ginseng 4 qian (about a dozen grams), huang qi (astragalus) 2 qian, bai zhu (atractylodes) 3 qian — all genuinely substantial doses; while huang qin and huang lian were used at only 3 to 5 fen — a tiny pinch.

💬 Note from Doctor Luo: This is where the ancients were so clever — large amounts of sweet-warm spleen-tonifying herbs, forever paired with just a trace of damp-heat-clearing herbs. In modern terms, the spleen-tonifying herbs feed the beneficial bacteria of the gut microbiome, letting them multiply; the tiny bit of heat-clearing medicine keeps the harmful bacteria in check so they don’t overrun. If you studied this ratio in gut-microbiome research today, it would be genuinely instructive. Five fen is 1.5 grams — not even two grams.

After this one modified Buzhong Yiqi Tang had been taken for thirty-odd doses, the pulse changed — left three positions flooding and rapid, right three positions flooding and rapid, the qi kou (cunkou pulse) tight and full. It was still a rapid pulse, but nothing like the wild leaping of before: now there was a possibility of life.

The second formula: Liuwei Dihuang Wan at the fifth watch — medicine timed to the clock

The pathology was not so simple — the spleen and stomach were deficient AND the kidney water was insufficient; kidney-water insufficiency produced great lung fire and insufficient lung yin; on top of that there was liver wood too vigorous and damp-heat. Strengthening the spleen calls for sweet-warm herbs; nourishing kidney water calls for yin-nourishing herbs; and one must also soothe the liver and clear damp-heat — on the surface these demands contradict one another. Doctor Gong’s solution was to separate the medicines by the hour of the day:

Every day at the fifth watch (3–5 a.m.), one dose of Liuwei Dihuang Wan (Six-Flavor Rehmannia Pill). Why that hour? From 3 to 5 a.m. is the time when the lung channel is on duty. The patient’s lungs had heat; lung heat had drained the kidney yin; so at the lung channel’s own hour he nourished kidney yin, lowered lung fire and supplemented lung yin — for a person with dry lungs, heat in the lung channel and deficient kidney water, taking Liuwei Dihuang Wan at the fifth watch works especially well.

💬 Note from Doctor Luo: This Liuwei Dihuang Wan was even specially prepared — raw Huai yam stir-fried with good wine, steamed in a pot, then sha ren (amomum) and fu ling (poria) added, soaked in wine and heated, dried out, the sha ren and fu ling removed, and the mass cut fine with a bamboo knife. Do we need to do this in ordinary practice? No. But here the patient was critically ill with heavy dampness in the spleen and stomach, and yin-nourishing had to be handled with care — so sha ren and fu ling were used to restrain the cloying greasiness of the prepared rehmannia. Doctor Gong was an extremely meticulous man; study a case like this closely and you will find that every single usage has its reason.

When dawn came, at the chen hour (7–9 a.m.), one dose of the decoction — that same Modified Buzhong Yiqi Tang — to lift the yang. He also prepared Shenzhu Gao (Ginseng and Atractylodes Paste) — ginseng and atractylodes boiled into a paste, mixed into the decoction. At the wu hour (11 a.m.–1 p.m.), one dose of Taihe Wan (Supreme Harmony Pill) or Ruilian Wan (Lotus Pill); and in the evening, another dose of the decoction. Day after day like this, without interruption.

Two food-therapy pills: Taihe Wan and Ruilian Wan — lotus-leaf rice and a pork stomach both went in

Both of these pills are excellent food-therapy tonics for the spleen and stomach:

Taihe Wan (Supreme Harmony Pill): ginseng, bai zhu, fu ling, ban xia (pinellia), zhi shi (immature bitter orange), chen pi (tangerine peel), huang lian, dang gui (angelica), chuan xiong (ligusticum), xiang fu (nutgrass rhizome), bai shao, shen qu (medicated leaven), mai ya (malt), shan zha (hawthorn), mu xiang — ground into fine powder, lotus leaves as large as a palm decocted into a soup to cook granary rice, the cooked rice mixed with the powder into pills the size of wutong seeds, 3 qian per dose, sent down with rice water.

Ruilian Wan (Lotus Pill): ginseng, bai zhu, fu ling, shan yao (Chinese yam), lian zi rou (lotus seeds), qian shi (euryale seeds), bai bian dou (white hyacinth beans), chen pi, gan cao (licorice) — a pork stomach boiled until completely soft, pounded more than a thousand strokes into a thin paste, mixed with the powder into pills, also wutong-seed size, 3 qian per dose with rice water.

💬 Note from Doctor Luo: Ruilian Wan’s thinking is very close to the later Bazhen Gao (Eight-Treasure Cake) — ginseng, bai zhu, fu ling, shan yao, lian zi rou, qian shi; add yi mi (job’s tears) and bai bian dou and you have the Eight Treasures. Ruilian Wan is Doctor Gong’s own formula. He valued food therapy so highly that he also made Baixue Gao (Snow-White Cake), saying that if old people eat a bit at all three meals every day, they will surely live long. While researching this case, Doctor Luo himself went to an online shop (Yugu Shanfang) and ordered four boxes of Ruilian powder — he makes the formula into a powder to drink.

Steady progress: fifty doses, a hundred doses, every suffering gone

And so the days went: Liuwei Dihuang Wan at the fifth watch, Buzhong Yiqi Tang at the chen hour, the pills at noon, the decoction in the evening. After fifty-odd doses, the symptoms lessened; after over a hundred doses (roughly three months), “苦楚皆无” — every last suffering was gone.

But there were relapses: the princess could not give up her temper (she was quick to anger), could not keep a light diet (she couldn’t even manage to eat a little less), and loved to worry. When spring came, liver qi grew stronger and spleen qi more exhausted, and the illness relapsed. Doctor Gong was concerned: the disease was hard to shake off. Yet he reassured her: heaven favors the good; with slow care, life can be prolonged. In this way they cared for her more than half a year more — in total six to seven jin of ginseng were consumed — and at last she “始获全安”: she was completely cured, pulled back from the very brink of death.

💬 Note from Doctor Luo: Mark this well — a critically ill patient whom nobody dared treat with ginseng was finally saved precisely by ginseng. The earlier physicians attacked, purged and drained water, and every approach made her worse. Doctor Gong simply held to the root — “deficiency” — supported the upright qi as the main approach, built it up little by little, and let the body’s own strength slowly recover. Only then could she live. That is the core thinking of this case: for a disease like drum distension, how could the treatment possibly not center on tonifying the deficiency?

Champion of the Medical Grove: one cure, and the whole world knew

The Prince of Lu was overjoyed. He said to Doctor Gong: “You are truly the number one national hand under heaven!” (天下夺魁之国手) — the finest physician in the realm! Everyone was full of admiration. Later the Prince presented him with a plaque reading “医林状元” — Champion of the Medical Grove. Doctor Gong Tingxian was very modest, saying that he was a shallow person who hardly dared accept such lofty praise.

💬 Note from Doctor Luo: From this point on, Doctor Gong’s fame spread throughout the land, and he later became a palace physician. Afterward, the Prince treated him almost like a brother; through this he came to know many celebrated people, and the poems they wrote for him he collected into his own books — rather like Doctor Zhang Xichun, who also gathered friends’ gift-poems into his Records of Chinese Medicine with Western Reference (《医学衷中参西录》).

The narrator’s commentary: with a settled mind, would you dare take on such a patient?

What earns this case the greatest admiration is Doctor Gong’s calm composure. The patient was at death’s door, the Prince was watching, the room was full of onlookers — and he serenely set out his plan: just these four things — Buzhong Yiqi Tang, Liuwei Dihuang Wan, Taihe Wan, Ruilian Wan — two decoctions and two food-therapy pills, with ginseng as the core, used little by little, adjusted slowly.

💬 Note from Doctor Luo: Ponder this approach: large amounts of sweet-warm spleen-tonifying herbs, paired with just a trace of damp-heat-clearing and qi-regulating herbs — xiang fu 7 fen, chen pi 7 fen, zhi shi 5 fen, sha ren 5 fen; no single herb exceeded one qian. He even matched ginseng 3 qian with chao lai fu zi (stir-fried radish seed) 5 fen — ordinarily people say ginseng and radish must never meet, yet he used them together: tonify, with a touch of unblocking. These ratios of “tonify versus clear” and “tonify versus move” show mastery at every turn. He also adjusted dynamically: after the Buzhong Yiqi Tang had run to thirty-odd doses, fearing the lifting was too strong (the patient still had phlegm-wheezing up above), he gradually removed huang qi, then dropped sheng ma and chai hu as well, and switched to a new formula — ginseng, bai zhu, fu ling, dang gui, bai shao, mai men dong (ophiopogon), wu wei zi (schisandra), chai hu, huang lian, huang qin, xiang fu, chen pi, hou po (magnolia bark), zhi shi, sha ren, lai fu zi, gan cao — spleen-tonifying herbs, with a little yin-nourishing (mai men dong, wu wei zi), a little damp-heat clearing, a little qi moving, matched very precisely. Every time Doctor Luo reads this case, he says, he feels a surge of delight and respect. Put yourself in his place: if such a dying patient came to me, would I dare take her on? Do I have that steadiness of mind? Just as Zhang Zhongjing once looked with longing admiration at the case records of Qin Yueren (Bian Que), we should strive to learn such skills ourselves.

Bonus: a 97-year-old “encyclopedia of Chinese medicine”

Why is Doctor Gong Tingxian worth learning from, piece by piece? The man was an encyclopedia of Chinese medicine — and a self-cultivator besides: he did not merely write books, he practiced what he wrote. In the Ming dynasty, when “since ancient times, few people live to seventy,” he lived to 97. His books are crammed with preparation secrets: how to steep medicinal wine, how to make pastes, how to make cakes — he knew all of it himself, and made them for himself and his family. How far did his devotion to food therapy go? Ruilian Wan, Taihe Wan, Baixue Gao… these spleen-tonifying food-therapy formulas were his signature creations.

💬 Note from Doctor Luo: The thick volume Wan Bing Hui Chun is filled with exactly this kind of experience. Doctor Gong’s food-therapy philosophy boils down to one sentence — tonify the spleen through spleen-strengthening herbs, and then supplement it daily through food therapy. When the spleen and stomach are healthy and upright qi is sufficient, every disease has a chance to recover. A physician like this deserves to be studied bit by bit by later generations.

What to take away

1. Drum distension is a true critical illness — and for deficiency-rooted cases, tonifying the deficiency must come first. “Treating blockage by filling” (塞因塞用) sounds paradoxical, but when attacking, purging and water-draining all make the patient worse, building up the upright qi — ginseng included, and plenty of it — is what actually saved the Princess of Lu.
2. Time the medicine to the clock. Liuwei Dihuang Wan at the fifth watch for lung-heat-with-kidney-water-deficiency, the lifting decoction at the chen hour, the food pills at noon — ancient chronomedicine, organized around the channel hours.
3. Big tonics, tiny clears. Heavy sweet-warm spleen-tonifying herbs with a mere 3–5 fen of heat-clearing herbs — a ratio worth studying even today from the standpoint of the gut microbiome.
4. Food therapy, every day. Taihe Wan, Ruilian Wan, Baixue Gao — through the spleen, day after day, is how a constitution is rebuilt.

Case source: the case records of Doctor Gong Tingxian as preserved in Wan Bing Hui Chun (《万病回春》, Ming Wanli era); organized from the public lecture commentary of Doctor Luo Dalun (PhD in TCM diagnostics).