Belly Bloated with a Lump on the Left Side? What an Imperial Physician Did About It
Patient search terms: bloated belly / bulging belly / big belly / lump on the left side of the belly / diarrhea / stomach pain
Medical terms for this condition: abdominal distension (gu zhang) · single-abdomen distension · spleen deficiency with stagnant qi · damp-heat accumulating internally · dysentery
Opening: his belly was that swollen — so why did the doctor use ginseng to build up?
Friends, today we continue with the medical cases of Doctor Gong Tingxian, the imperial physician of the Ming dynasty. This old master’s cases are superb — listen to them one by one, and the “inner method” (xin fa) of Chinese medicine slowly becomes clear.
Today’s patient is fascinating: his belly was badly swollen, with a lump on the left side — yet the formula Gong Tingxian finally wrote was not one that purges, not one that attacks. It was built on ginseng, slowly building up. He was that swollen — so why build up? Listen to the end and you’ll understand: this is the most brilliant stroke of the whole case.
💬 Note from Doctor Luo: A person whose belly is extraordinarily big and swollen — you look at him and think it’s an excess pattern, as if something were stuffed full inside. But in fact it is very often the spleen and stomach genuinely weakened, the upright qi genuinely deficient. The roots differ: some get it from anger — anger weakens the spleen and stomach; some from losing dietary discipline; some from exhausting themselves with excess. In every case, once the upright qi is injured and the belly swells up huge, the illness is especially hard to treat. Some people look fat, but they are not fat — they are deficient.
Who was the patient? The scholar Li Heshan, with a lump on the left side of his belly
The patient was named Li Heshan. He held an official scholarly title — people called him “chun yuan” (a spring-session degree holder). His problem had lasted for years: a lump on the left side of his belly, as if something were stuck there, with a dull distending sensation — that bloated, drum-like feeling — unresolved for years.
What made it worse: Li Heshan had a favorite indulgence — he loved meat pies, and once he started he couldn’t stop. When he overate meat pies, his belly swelled even worse: the abdomen was distended, full and oppressed. After eating, he felt something pressing upward, full and stuffy inside — utterly miserable.
💬 Note from Doctor Luo: Some people reach a point where they genuinely dare not eat a thing — after eating, the belly swells, full and stuffy, pressing upward. That “full, distended, oppressed” feeling — many friends with weak spleens and stomachs have experienced it.
An illness from eating meat pies: cured in two doses at the first visit
Li Heshan couldn’t take it anymore, so he called in Gong Tingxian. Gong Tingxian took his pulse: all six positions flooding and rapid — the six positions beating fiercely; the qi-kou tight — the right-cun qi-kou pulled taut. He judged at once: inside there was both qi stagnation and dampness, accumulating.
How to treat it? Gong Tingxian prescribed Huoxiang Zhengqi San (Agastache Qi-Correcting Powder), plus shan zha (hawthorn) and shen qu (medicated leaven).
💬 Note from Doctor Luo: Shan zha and shen qu open the appetite and digest food, clearing a path through the spleen and stomach; Huoxiang Zhengqi San removes dampness and moves qi. Clearing food stagnation on one side, draining dampness and moving qi on the other — the thinking is very clear.
What happened? Cured in two doses — two doses and he was well, recovered. Li Heshan must have been delighted: see — a famous physician is a famous physician!
A month later it came back: this time Huoxiang Zhengqi San failed
But the good times didn’t last. A month later, Li Heshan lost dietary discipline — he couldn’t keep his mouth in check, ate badly, and the result was the bloating returned just as before; his belly swelled up again.
This time Gong Tingxian used the same old method, prescribing Huoxiang Zhengqi San again. Several doses — no effect.
Gong Tingxian saw that something was wrong: this illness was more serious than he had thought. He began to examine the root. With this kind of drum-like distension, it is basically caused by a weak spleen and stomach — insufficient spleen-stomach upright qi. When the spleen and stomach cannot transport and transform food essences, the food and fluids gather without dispersing, and that becomes swelling. If the body is not properly cared for and the spleen and stomach are damaged — the clear qi does not rise, and turbid qi fills the chest and abdomen. In a healthy person, clear qi rises and turbid qi descends; now the spleen and stomach are not working, the clear qi sinks while the turbid qi rises instead, filling the chest and abdomen — damp-heat contends, and distension results — drum belly.
💬 Note from Doctor Luo: Why did it work in two doses the first time? Because then the surface excess was dominant — move the qi, digest the food, and it was done. But the second time was different — because the root had never healed. Nudge the body even slightly and the symptoms return, heavier than before. What does that tell you? Insufficient upright qi is the true root. If you only treat the branch and never the root, it will relapse sooner or later.
Gong Tingxian saw it clearly: not true distension, but deficiency distension
This time, the name of Gong Tingxian’s formula says it all, very plainly — Xing Shi Bu Qi Yang Xue Tang: Dampness-Moving, Qi-Boosting, Blood-Nourishing Decoction. I’ll remove the dampness, and give you qi and blood. From the name alone, the goal is clear. This formula treats: weakness of blood and qi, single-abdomen distension, and puffiness — the kind where the belly swells up and bulges out.
💬 Note from Doctor Luo: With drum belly, if spider-web blood vessels appear on the abdomen — blood vessels crawling over the skin of the belly like a spider’s web — it is almost always extremely serious, a sign that blood stasis has formed inside, even bound together with the stasis. This kind of illness always takes time to treat, because insufficient upright qi is the root.
Breaking down the formula: Xing Shi Bu Qi Yang Xue Tang — build up on one side, open the path on the other
Let’s open this formula and look at its layers to understand Gong Tingxian’s intention:
Layer one — boost qi: ren shen (ginseng), bai zhu (atractylodes), fu ling (poria) — what do these do? Strengthen the spleen, drain dampness, boost qi. Add gan cao (licorice) to these and you have the foundation of Sijunzi Tang (Four Gentlemen Decoction).
Layer two — nourish blood: dang gui (Chinese angelica), chuan xiong (ligusticum), plus bai shao (white peony) — this is the foundation of Siwu Tang (Four Substances Decoction), missing only shu di huang (prepared rehmannia). Why leave it out? Because prepared rehmannia is a little rich and cloying — and for a patient whose belly is distended, too much of it would only stagnate the qi. Bai shao has a special role here: it softens the liver, gathers and restrains, “holding in” the distension.
Layer three — move qi, drain dampness: xiang fu (cyperus) moves qi; chen pi (tangerine peel) moves qi and drains dampness; hou po (magnolia bark, ginger-prepared) moves qi and drains dampness; da fu pi (areca peel) drains dampness and promotes urination; stir-fried lai fu zi (radish seed) digests food and moves qi; plus hai jin sha (Lygodium spores) to clear damp-heat, mu tong (akebia stem) to promote urination, and mu xiang (costus root) to move qi — all added in tiny amounts.
The preparation is particular too: the herbs were ground into coarse powder and decocted in water with three slices of fresh ginger.
💬 Note from Doctor Luo: Look at this formula: Sijunzi Tang for boosting qi as the base, Siwu Tang short one herb (prepared rehmannia) for nourishing blood, then a series of herbs to move qi and drain water — xiang fu, chen pi, hou po, da fu pi, lai fu zi, mu tong, hai jin sha. It builds the upright qi on one side while draining downward on the other — supplementing with movement, opening without harming. This is a model of “treat the branch in acute cases, treat the root in chronic cases” — the true royal path is to build up bit by bit.
The result? Cured in more than twenty doses. This time Gong Tingxian focused on building qi and blood — over twenty doses and the illness was gone.
Bonus myth-busting: can ginseng and radish really be taken together?
Speaking of the lai fu zi (radish seed) in this formula, Doctor Luo Dalun paused to debunk a widely spread myth.
💬 Note from Doctor Luo: Many people today say “when taking ginseng you must not eat radish,” claiming radish drains away ginseng’s qi-boosting power. That is not actually true — ginseng and lai fu zi can absolutely be used together. Look at Gong Tingxian’s formulas: in many of them ginseng and lai fu zi appear together. Radish seed digests food and moves qi; ginseng boosts qi; for a person who needs to “boost and open at the same time,” the pair fits perfectly. Don’t let that saying scare you — use it when it’s called for.
Cured — but the doctor’s orders went unheard: “All illness is heaven’s decree”
The illness was cured, and Gong Tingxian gave his usual instructions — this passage is especially important:
“The illness is cured, but the body has not truly recovered” (bing sui yu, er ti wei fu yuan). Your symptoms are gone, but your body has not genuinely returned to health. So you must strictly observe the restrictions, and nourish the body slowly. Don’t think that just because you feel better you can start gorging and indulging — the absence of symptoms does not mean the body is healed. Right now we have only cleared away the obstacles and given it a little support; the body has not truly recovered.
💬 Note from Doctor Luo: Doctors say this kind of thing all the time, but patients don’t always listen. Nourish the body slowly and there are no dramatic, overnight changes — just gradual recovery; but if you let yourself go and abuse it, the decline is very fast. It’s like what teachers said in childhood: progress comes step by step, but becoming a bad student takes only a few days.
You’d think that was the end of it? Not yet. A few months later, Li Heshan came to chat with Gong Tingxian again, and in the middle of the conversation he launched a “grand theory”:
“All illness is heaven’s decree” (fan you bing, jie tian yu ye). Whenever a person falls ill, Heaven decreed it; it’s all written in fate. Whether you recover has nothing to do with taking medicine; observing restrictions is useless too — if Heaven wants you well, you’ll be well. Didn’t Yan Hui and Mencius know how to care for themselves? Why did Yan Hui die young? I’ve cared for myself for six months, following your restrictions, and seen no change at all. So whether the body is well — what has it to do with care and medicine? It’s all fate!
Gong Tingxian heard this and could not argue back — he knew it was twisted reasoning, but the man spoke of “Heaven’s mandate” at every turn and even cited Yan Hui’s example; for the moment, there was truly no answer to give.
💬 Note from Doctor Luo: Gong Tingxian did not answer — because he couldn’t. The theory was nothing but twisted reasoning, but when a man hands everything to “Heaven” and dismisses self-care as worthless, how do you refute him? The old master could only fall silent.
Seeing Gong Tingxian speechless, Li Heshan grew even more confident — and from then on he indulged without restraint — ate whatever he liked, drank whatever he liked, enjoyed himself however he pleased.
The price of indulgence: dysentery, purgatives, and three doctors
Before many days had passed, retribution arrived. Li Heshan suddenly came down with dysentery — tenesmus: he wanted to evacuate but couldn’t do it smoothly, with a dragging, heavy sensation at the anus and cramping pain in the belly, pain beyond bearing, day and night without cease, pouring out watery stools.
The fellow had ideas of his own: he got hold of da huang (rhubarb) and purged himself — thinking a good purge would settle it. But the purge had no effect; he purged several times and nothing changed.
Unable to manage, he called Gong Tingxian again. Gong Tingxian felt his pulse — still all six positions flooding and rapid — and gave him Tiao Zhong Li Qi Tang (Center-Harmonizing Qi-Moving Decoction), two doses; then Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) plus bai shao (white peony) and huang lian (coptis) — it brought slight improvement. Bai shao relieves spasm and pain; huang lian clears damp-heat; Buzhong Yiqi Tang lifts the upright qi upward — a little effect appeared.
But Li Heshan demanded instant results and found it too slow: “Treating me this slowly, I can’t bear it!” — and he turned and changed doctors.
💬 Note from Doctor Luo: This is exactly where it went wrong. The doctors he changed to did not examine the source of the illness — they never looked at how the disease had come about, never knew he had already suffered internal-injury drum belly. A man with a belly that big — the spleen and stomach were already deficient to the extreme, unable to transport and transform the body’s upright qi. But the doctor didn’t consider that: seeing dysentery, he thought “let’s push the poison out,” and prescribed purgatives. When the purging didn’t work, he changed to another doctor, who purged again. More than thirty days of this, purge after purge, with no one building up the upright qi — the original qi nearly collapsed downward.
The result? His anus hurt as if cut by a knife, and his belly swelled like a great drum — the more he was purged, the more his belly bulged.
💬 Note from Doctor Luo: This is no joke. For a person weakened to this degree, the more you purge, the more the belly bulges. You assume it’s an excess and a purge will deflate it? No. Inside, the evil qi swells, while the original qi sinks — the deeper it sinks, the deeper the pain. At that point you should greatly boost the original qi, with lifting as the main strategy. Gong Tingxian had experience here: years before, when he treated the Princess of Lu for drum belly, her belly was also enormous and swollen — he built up slowly, using ginseng in extremely large amounts, over a hundred doses, finally using a hundred jin (about 60 kg) of ginseng to restore the upright qi. But these doctors didn’t know the root was deficient upright qi, and just kept purging downward — far too dangerous!
Watching the patient deteriorate day by day, Gong Tingxian wrote a lament: “The doctors of today seek quick results by quickly damaging the original qi!” — the faster they want results, the more they injure the original qi — how could the patient ever recover? “Alas! The physician does not build up but purges instead; the patient does not understand medical principle but demands quick results — how could he not die? Truly, both sides are at fault!” The doctor fails to build up the upright qi and purges instead; the patient doesn’t understand medical principle and only wants quick results — the patient delays the doctor, the doctor delays the patient — how could such a man not die?
The case ends there. Whether Li Heshan ultimately died, Gong Tingxian did not record — but one suspects it was indeed very dangerous.
Doctor Luo’s summary: drum belly looks like excess; the root is deficiency
This case is about drum belly (gu zhang) — the belly extraordinarily big and swollen. It looks like an excess pattern, as if something were truly stuck inside — in fact it is a deficiency pattern.
💬 Note from Doctor Luo: The ancients went down a great wrong road on this, just like what is called ascites today. At first the ancients believed purging downward could push the water out, and many water-purging, water-expelling formulas were devised — ferocious medicines that drained and drained; some even inserted needles trying to let the water out. But the problem is: this is truly not an excess pattern. Excess patterns exist, but they are acute conditions — not this chronic, long-term kind. This illness is usually a deficiency pattern — upright qi insufficient, upright qi collapsing to a certain degree, unable to transport and transform water, dampness and qi; water, phlegm and stasis block the body, and the bloating comes.
So what to do? The ancients gradually discovered: the true royal path is to build up bit by bit. Later physicians slowly understood — in acute moments you may drain a little (treat the branch in acute cases), but the problem is: once I drain, the water will come back, and the upright qi grows weaker and weaker — with what will you hold the line? So the general approach is supporting the upright as the main strategy, with a little water-draining, diuretic medicine added. Supplementing the upright is the true skill. Look at Gong Tingxian’s formula: Sijunzi Tang as the base to boost qi and blood, plus herbs to move qi and drain dampness — that is the correct treatment.
💬 Note from Doctor Luo: Many doctors in history didn’t understand this. They saw the swelling and said, “Let me purge you — deflate it and it’ll be fine” — either promoting urination or promoting bowel movement, draining and draining. That won’t do. You must build up slowly; only when the upright qi is sufficient can the illness resolve. As for the dysentery Li Heshan later developed — damp-heat could certainly be part of it, and adding huang lian to clear damp-heat was not wrong; but the collapse of the upright qi was the true root. Distinguishing root from branch is the key.
A word for modern readers: bloating in autumn, bloating in the afternoon — first think of the upright qi
Finally, Doctor Luo Dalun brings the lesson of this case down to daily life:
💬 Note from Doctor Luo: When we see someone whose belly is swollen to that degree, with a lump as well, the first reaction is usually “attack it, dissolve it.” This case teaches us: see the root — the root is insufficient upright qi, unable to move the body’s qi mechanism. At that point you must supplement the upright, slowly, bit by bit. I have seen many such people: some begin to bloat every autumn, as soon as the weather turns cold — as yin qi begins to flourish, these people slowly supplement the spleen and drain dampness, and gradually it resolves — proof that the upright qi was insufficient; some bloat every afternoon; some men with bellies that bulge like fat men’s — all of them are deficient in upright qi. So don’t reach for purging or attacking the moment you bloat. First ask: isn’t it time to build up?
💬 Note from Doctor Luo: Why do I tell a case story every day? So that everyone learns more about Chinese medicine in ordinary times, and knows how to regulate and nourish the body. When real storms come, we won’t be caught scrambling. Once you’ve learned, you have a framework in your head — reserve knowledge in peacetime, and you won’t panic when trouble arrives.
Compiled from Doctor Luo Dalun’s explanations of the medical cases of Doctor Gong Tingxian (imperial physician of the Ming dynasty, c. 1580s–1610s).