this type of focal distention is mostly due to improper purging of an exterior or half-exterior, half-interior condition in a patient with underlying stomach deficiency. purging aggravates the deficiency and causes the pathogenic factor to enter deeper into the interior, where it produces clumping in the epigastrium and focal distention.

the term focal distention refers to a focused, localized sensation of discomfort, blockage, and distention. clumping in the epigastrium also produces a sensation of fullness. the epigastrium is soft, and palpation will reveal no masses or areas of hardness. there is only slight pain, or no pain at all.

the cold-heat complex in the middle jiao is a condition of simultaneous excess and deficiency brought on by clumping, which generates heat; the heat in turn injures the stomach qi, which leads to cold. this complex disrupts the ascending and descending functions of the spleen and sstomach, prevents the spleen from raising the clear yang, and interferes with the stomach’s function of directing the turbid yin downward. this causes dry heaves or vomiting above, and diarrhea below.

the simultaneous presence of excess and deficiency causes contention in the intestines which is manifested as borborygmus. the disruption of the digestive function leads to reduced appetite. the rising of the turbid yin and clumping of the pathogenic influences in the middle jiao is also reflected in the yellow, greasy tongue coating. the thin, greasy quality of the coating is due to concurrent excess and deficiency. the wiry, rapid pulse reflects internal clumping and heat.

be aware, this condition is not always causes by improper purging. whenever spleen and stomach are disturbed there can be an obstruction of the ascending and descending functions of these organs. if this occurs together with a cold-heat complex, focal distention in the epigastrium and the other symptoms described above will ensue.

(bensky & barolet)