Abdominal distention is a feeling of fullness or pressure in the abdomen. It can be acute or chronic and is often due to gastrointestinal issues. Causes include disruption of the natural movement of qi in the body, fluid retention, constipation, and accumulation of pathogenic substances such as phlegm or dampness. These factors can combine to cause bloating and discomfort in the abdomen. Treatment with Chinese medicine often focuses on addressing the underlying causes of the distention.
Diet, Food Stagnation
Consuming more food than the Spleen and Stomach can handle, either because too much is eaten or because the Spleen is already weakened, can obstruct the flow of qi and lead to food stagnation, a common cause of abdominal bloating. When the qi flow is obstructed, complications like constipation can further worsen the bloating.
Eating excessive amounts of cold-natured or raw food can weaken the Spleen's qi and yang, while overindulging in rich, heating, and oily foods can lead to the accumulation of partially-digested food and damp-heat in the intestines. Regularly overloading the middle burner can start a cycle of pathology that has serious effects on health and can be a contributing factor in the development of many modern diseases. Transit time slows down and food remains in the intestines for longer than it should, causing it to ferment and rot. The resulting stagnation in the intestines produces heat, intensifying the process of putrefaction. The overloaded Spleen becomes weakened and produces dampness as a result of its inefficiency. This dampness can solidify into phlegm or phlegm-heat, which can then affect other organs and systems, such as the cardiovascular system (phlegm accumulation in the chest and heart vessels can cause chest pain), the nervous system (tremors, anxiety, insomnia, vertigo, and paralysis), and the skin (cysts, ulcers, chronic sores, and swellings). Phlegm accumulation can eventually evolve into blood stasis, leading to the formation of polyps, nodules, and tumors.
Emotions such as frustration, anger, and resentment can contribute to liver qi constraint, which is a common cause of recurrent abdominal distention. When these emotions are repressed, they can cause low-grade spasms and tension in the smooth muscle of the gut, disrupting the qi dynamic of the middle burner. This can lead to abdominal distention.
In addition, chronic worry, obsessive thinking, and prolonged concentration can weaken the spleen qi, making it susceptible to invasion by liver qi. The spleen qi is responsible for ascension of qi and appropriate equilibrium for the descent of waste materials. If this function is impaired, the qi and waste materials can accumulate and cause abdominal distention.
Prolonged liver qi constraint can also generate heat, which can damage fluids and yin and combine with any dampness present. People with chronic liver qi constraint-related digestive issues may be aware of the effects of stress on their gut, such as stomach cramps, loss of appetite, and bowel disturbances. This type of abdominal distention tends to be intermittent and is closely linked to the emotional state and stress levels of the individual.
Spleen and Stomach Deficiency
Spleen and stomach weakness is often the underlying cause of abdominal distention. The spleen's deficiency can contribute to various patterns, and its weakness can lead to inadequate processing of food. This can cause food qi to accumulate in the middle burner, leading to distention. In addition, the stomach's qi may fail to descend, causing constipation and further distention.
Other factors that can contribute to spleen and stomach weakness include poor dietary and eating habits, lack of physical activity, prolonged illness, and starvation or digestive disorders such as anorexia nervosa and bulimia.
Fluid accumulation due to spleen deficiency is a common cause of generalized abdominal distention. Unlike qi blockages, which are focused in a specific region and may be accompanied by symptoms such as belching, flatulence, and constipation, fluid retention is more widespread and tends to affect women more often than men.
A weakened spleen can also generate dampness and phlegm, further obstructing the qi dynamic and leading to pronounced distention with both excess and deficiency.
Chronic constipation is often a contributing factor to abdominal distention, either in the abdomen as a whole or in the specific area where the constipated stool is located. Constipation itself can be caused by qi obstruction. If qi is not moving, it can cause a lack of impetus behind the stool, preventing it from moving forward and out. Similarly, if the stool is not moving, it can cause qi to back up, leading to further obstruction.
Treatment for gastrointestinal issues involves identifying the specific mechanism or combination of mechanisms that are causing the problem. This may involve restoring the proper flow of qi, addressing fluid retention or constipation, regulating the diet, and incorporating exercise. In cases where the qi dynamic is disrupted, techniques may be used to restore its proper ascent and descent. When fluid retention is contributing to the distention, methods to improve fluid metabolism and promote diuresis may be employed. If constipation is a factor, a laxative, purgative, or qi-regulating method may be used depending on the type and underlying pathology.
Proper regulation of the diet, including the types of food ingested and the way food is eaten, is essential for successful treatment. Neglecting this fundamental aspect of gastrointestinal health can make other treatments less effective. Exercise is also an important component of treatment in cases of excess patterns, particularly when constrained Liver qi or qi stagnation is involved. Exercise can help move qi and strengthen Spleen and Lung function. Simple activities like sustained walking and deep breathing can be sufficient to temporarily move qi.