Outline:  
Traumatic abdominal distension refers to the abdominal flatulence and fullness caused by posttraumatic accumulation of a large amount of gas in the gastrointestinal tract and blockage of qi flow. It is often caused by accumulation of stagnant blood, stagnation of qi in the liver and spleen and qi deficiency with insufficiency of the spleen. Fracture, dislocation, sprain and contusion in the chest, waist, abdomen and pelvis, and organic injuries in the thoracic, abdominal and pelvic cavities may cause accumulation of blood stasis and stagnation of qi flow, accumulation of turbid qi and blockage of qi of fu-organs. Thus, there will occur abdominal distension. If contusion of chest and abdomen leads to stagnation of qi flow in liver and spleen meridians, it will result in unsmoothness and gradual accumulation of qi of fu-organs. Thus, there will also occur abdominal distension. In the late stage of trauma, the spleen and stomach fails to transform and transport because of their qi deficiency, abdominal distension may also happen.


Major points for diagnosis  
1. The patients mostly have a definite traumatic history.
 
2. There is abdominal distension with tympany in percussion. At the early stage of trauma, there are often symptoms of abdominal pain and constipation.
 
3. X-ray film can confirm whether there are fracture and dislocation at the early stage of trauma. For those who are supposed to have organ rupture of abdominal cavity, a further B-ultrasonic examination and abdominal paracentesis should be done for a definite diagnosis.


Herbal therapy
Internal treatment based on syndrome differentiation
(1)Syndrome of accumulation of stagnant blood
 
Main symptoms and signs:
Abdominal distension and fullness one or two days after trauma, intolerant pain in the injured part, constipation, red tongue with petechiae and yellow-dry coating, choppy or rapid pulse.

Therapeutic method: Eliminating blood stasis by purging.
 
Recipe and herbs:
Modified Taoren Cbengqi Decoction. Specifically, Taoren (Semen Persicae) 10g,Shengdahuang (Radix et Rhizoma Rhei ) (to be decocted later)15 g, Poxiao (Natrii Sulfas) (to be taken following its infusion with the hot decoction)6 g, Danggui (Radix Angelicae Sinensis ) 10 g, Chishaoyao ( RadixPaeniae Rubrae )10 g, Mudanpi ( Cortex Mountan Radicis )10 g, Houpo ( Cortex Magnoliae Officinalis )10 g, Guizhi (Ramulus Cinnamomi Cassiae)6 g and Zhigancao (Radix Glycgrrhizae Praeparata )6 g.
 
(2) Syndrome of stagnation of qi in the liver and spleen
Main symptoms and signs:
Pain in the chest and hypochondrium, abdominal fullness and pain worsened at night, anorexia, belching, constipation, and stringy pulse.
 
Therapeutic method: Regulating qi to remove stagnation.

Recipe and herbs:
Modified Chaihu Shugan Powder. Specifically, Chaihu (Radix Bupleuri)6 g, Chishaoyao (Radix Paeniae Rubrae )10 g, Zhike ( Fructus Citri Aurantii )10 g, Danshen ( Radix Salviae Miltiorrhizae)10 g, Qingpi ( Pericarpium Citri Reticulatae Viride )6 g, Zhixiangfu (Rhizoma Cyperi Rotundi Praeparata)10 g, Chuanlianzi ( Fructus Meliae Toosendan )10 g, Yanhusuo (Rhizoma Corydalis )15 g, Chuanxiong ( Rhizoma Ligustici Chuanxiong)10 g and Gancao ( Radix Glycyrrhizae)3 g.
 
(3) Syndrome of insufficient spleen with qi deficiency
Main symptoms and signs:
Abdominal pain relieved by pressure, sallow complexion, weakness of extremities, poor appetite, diarrhea, pale tongue, feeble and thready pulse.

Therapeutic methods: Strengthening the spleen and replenishing qi.

Recipe and herbs:
Modified Xiangsha Liujunzi Decoction. Specifically, Renshen (Radix Ginseng)10 g, Baizhu ( Rhizoma Atractylodis Macrocephalae )10 g, Fuling ( Poriae )10 g, Xiangfu ( Rhizoma Cgperi Rotundi)10 g, Sharen (FructusAmomi) (to be decocted later)3 g, Huangqi (Radix Astragali seu Hedysari)12 g, Chenpi (Pericarpium Citri Reticulatae)10 g, Huoxiang (Herba Agastaxhis seu Pogostemonis )10 g, Zhibanxia (Rhizoma Pinelliae Praeparata )10 g and Gancao (Radix Glycyrrhizae)5 g.
 
External therapy:     
In the early stage of trauma, the injured part may be topically treated with Xiaoyu Zhitong Paste or Sanse Application; and the mild cases may be topically treated with Zhenghonghua Unction.