TCM Case Report

Patient: Mr. Yang, male, 60 years old

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Chief Complaint

Epigastric distension and fullness with discomfort, chest oppression, and poor appetite.

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Present Illness

(Based on patient communication and prescription) The patient developed middle burner stagnation due to dietary irregularities, leading to obstruction of qi flow. Current symptoms included chest oppression, epigastric fullness, and unsmooth or constipated bowel movements.

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Tongue and Pulse

(Clinical findings to be supplemented) Typically observed: thick greasy tongue coating; wiry or deep-forceful pulse.

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Pattern Identification

The condition is mainly due to qi stagnation in the middle burner with gastrointestinal food accumulation, leading to obstruction of qi movement. • Milder cases: Qi stagnation in the spleen and stomach, manifesting as distension and fullness. • Severe cases: Food accumulation with excess in the bowels, presenting with marked distension, resistance to palpation, and constipation due to obstructed fu-organ qi.

Syndrome Differentiation: • Spleen–Stomach Qi Stagnation (mild) • Food Accumulation with Fu-Organ Excess (severe)

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Treatment Principle

Regulate qi and relieve fullness, eliminate food stagnation; in excess patterns, purge accumulation and unblock the bowels.

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Formula and Herb Analysis

Key Herb: Aurantii Fructus (Zhi Ke)

• 6–15 g: Moves qi, relieves distension and fullness; suitable for general qi stagnation and epigastric oppression.

• 50–100 g: Powerfully disperses qi, resolves focal distension, and purges the bowels; indicated for severe food retention, substantial excess obstruction, and blocked fu-organ qi.

👉 Demonstrates the principle: different dosages lead to different therapeutic effects.

• Small dose: Gently regulates qi movement.

• Large dose: Strongly disperses excess and unblocks the intestines.

Possible combinations:

• Chen Pi (Pericarpium Citri Reticulatae), Hou Po (Cortex Magnoliae Officinalis): Move qi, relieve distension.

• Lai Fu Zi (Semen Raphani), Shan Zha (Fructus Crataegi): Eliminate food stagnation.

• Da Huang (Radix et Rhizoma Rhei): Purge accumulation and unblock the bowels (for severe cases).

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Therapeutic Effect

Follow-up (WeChat, 2025/9/9): After taking three decoctions, symptoms completely resolved.

The effect was “as swift and striking as the sound of a drum.” • In mild cases, symptoms of distension and oppression are quickly relieved. • In severe cases, high-dose Zhi Ke rapidly eliminates obstruction, restores bowel movement, and resolves stagnation.