Abdominal Distension and Heaviness
F, 47 years old. 47-year-old woman with chronic post-meal abdominal distension, intermittent nausea, general heaviness sensation and pasty stools.
The patient
- Age and sex
- 47 years · F
- Chief complaint
- 47-year-old woman with chronic post-meal abdominal distension, intermittent nausea, general heaviness sensation and pasty stools.
- Tongue
- Pale and swollen body, with thick, white and greasy coating.
- Pulse
- Slippery (Hua) and slow (Chi) pulse, especially in the right Guan (關) position.
Symptoms
- Abdominal distension after meals
- Nausea, especially in the morning
- Sensation of heaviness in head and body
- Pasty or soft stools
- Lack of appetite
- Sweet or nauseating taste in the mouth
Warning signs to rule out
- Persistent early satiety, repeated vomiting, weight loss or anaemia. → Refer for endoscopy. These signs do not belong to a functional Dampness picture.
- Persistent, increasing abdominal distension with early satiety and a change in bowel habit, in a woman over forty-five. → Gynaecological assessment: this is the silent presentation of ovarian cancer and it is mistaken for indigestion for months.
- Difficulty swallowing, pain that wakes the patient at night, or black stools. → Gastroenterology referral without waiting to see how treatment evolves.
Case resolution
Think through the pattern first, then expand the resolution
- Pattern
- Damp-Phlegm Accumulation in Spleen-Stomach
- Meridians involved
- Spleen, Stomach
- Pathogenic factors
- Internal Dampness (Shi), Phlegm (Tan), Deficiency of Spleen transforming Yang
Thick, greasy tongue coating and slippery pulse are the pathognomonic signs of Damp-Phlegm. The deficient Spleen cannot transform fluids, which accumulate as Dampness. Dampness obstructs the Middle Jiao (digestion), causing distension, nausea and heaviness. A sweet or nauseating taste in the mouth is a typical sign of Dampness in the Spleen.
Differential diagnosis
Shares: Distension after eating, nausea and a thick tongue coating.
Sets it apart: Food stagnation is acute, follows a specific excess, gives sour-smelling belching and aversion to food, and improves after a bowel movement. Here the distension is daily and months old, unrelated to any particular meal.
Shares: Abdominal distension and intermittent nausea.
Sets it apart: In disharmony the symptom rises and falls with emotional state, with costal tightness, belching and a wiry (Xian) pulse. Here food is what drives it, not emotion, and the pulse is slippery.
Shares: Heaviness, nausea and pasty stools.
Sets it apart: Damp-Heat adds a bitter, pasty mouth, epigastric burning, foul stools, a yellow coating and a rapid pulse. This patient's coating is white and thick: this is cold Dampness, and bitter cold herbs would make it worse.
Treatment
Principle: Strengthen the Spleen, dry Dampness and transform Phlegm, while descending Stomach Qi.
| Point | Role | Technique |
|---|---|---|
| CV12 | Stomach Mu and influential point of the Fu organs: the central point for a distended epigastrium. | Perpendicular 0.5-1 cun. Never on a full stomach. |
| ST36 | Supports the Center while Dampness is drained, so as not to deplete what is already weak. | Perpendicular 1-1.5 cun, tonifying. |
| SP9 | The drainage point for Dampness par excellence. | Perpendicular 1-1.5 cun, reducing. |
| ST40 | Fenglong: it transforms Phlegm, the thickened form of Dampness and the reason diet alone does not resolve the picture. | Perpendicular 1-1.5 cun, reducing. |
| PC6 | Descends rebellious Qi: the point for nausea. | Perpendicular 0.5-1 cun. |
| ST25 | Large Intestine Mu: it regulates transit when stools are pasty. | Perpendicular 1-1.5 cun. Contraindicated in pregnancy. |
Formula: Ping Wei San. Dries Dampness and restores movement to the Center. When Phlegm dominates, with nausea and a very greasy coating, combine with Er Chen Tang.
- Frequency
- One session weekly for six to eight weeks. In this pattern diet is the treatment and needles accelerate it, not the other way round.
Home care
- Eat without a screen and chew until the mouthful is broken down: the Spleen starts in the mouth.
- Eat dinner light and before half past eight; Dampness is manufactured at night.
- Remove fried food, dairy and sugar for six weeks, then reintroduce them one at a time to see which one it was.
- Walk for fifteen minutes after meals instead of lying down.
Progress
- Session 1 · day 0 Daily post-meal distension that forces her to loosen her clothes, nausea two or three times a week, and pasty stools. CV12, ST36, SP9 and PC6. Dairy, fried food and sugar are removed, and the late dinner is changed. Nausea resolves within a week; the distension barely shifts.
- Session 2 · day 7 No nausea, but the distension persists and the coating remains white and very greasy. ST40 is added and Ping Wei San is combined with Er Chen Tang: the Dampness has thickened into Phlegm and draining alone is not enough. Distension goes from daily to three days a week.
- Session 3 · day 21 Distension now appears only after eating out. The patient reads this as a failure; in fact it is the diagnosis confirmed. The session is spent reviewing what she eats out, and ST25 is added for transit. The rest of the scheme is kept. Two consecutive weeks without distension, including two meals out.
- Session 4 · day 42 Formed stools daily, no distension, and a visibly thinner coating. Treatment ends, with an orderly reintroduction of the removed foods, one every five days. She identifies dairy as her main trigger and maintains the result.
- Discharge
- Treatment ends after three weeks without post-meal distension and with formed stools, having already reintroduced normal food. Discharging during the restrictive diet discharges the diet, not the patient.
- Watch for relapses
- Seasons of eating out and humid months. The first sign to return is a greasy coating in the morning, before any distension appears.
Health notice. Educational and study content. It describes concepts of Traditional Chinese Medicine and does not replace diagnosis or treatment by a healthcare professional. Needling, medicinal herbs and invasive techniques must be applied by trained professionals. Safety guide.
