某（五一）食谷不运。 胀呕恶。大便不爽。脉弦色黄。此胃阳式微。升降失司使然。法当温通阳气。（胃阳虚）
吴萸（八分） 半夏（三钱） 荜茇（一钱） 淡干姜（一钱） 生姜汁（五分） 广皮白（一钱半）
陈（三八）诊脉右大而缓。左如小数促。冬季寒热身痛。汗出即解。自劳役饥饱嗔怒之后。病势日加。
面浮足肿。呼吸皆喘。目泪鼻衄。卧着气冲欲起。食纳留中不运。时序交夏。脾胃主候。睹色脉
情形。中满胀病日来矣。盖此症属劳倦致损。初病即在脾胃。东垣云。胃为卫之本。脾乃营
之源。脏腑受病。营卫二气。昼夜循环失度为寒为热。原非疟邪半表半里之症。斯时若有明
眼。必投建中而愈。经言劳者温之。损者益之。建中甘温。令脾胃清阳自立。中原砥定。无事
更迁。仲景亦谓男子脉大为劳。则知内经仲景东垣垂训。真规矩准绳至法。且汗泄积劳。都
是阳伤。医药辛走劫阳。苦寒败胃。病患自述饮蔗即中脘不舒。顷之少腹急痛便稀。其胃阳
为苦辛大伤明甚。又述咳频。冲气必自下上逆。夫冲脉隶于阳明。胃阳伤极。中乏坐镇之真
气。冲脉动。则诸脉交动。浊阴散漫上布。此卧着欲起矣。愚非遥指其胀。正合内经浊气在上。
则生 胀。太阴所至为腹胀相符也。昔有见痰休治痰。见血休治血。当以病因传变推求。故辨论若此。
浓朴 杏仁 人参 茯苓 蜜煨姜 南枣
浓朴杏仁。取其能降气。参苓姜枣。取其创建胃中之清阳。而和营卫也。
吴（二四）单胀溺少。温通颇适。当用大针砂丸一钱二分。八服。（脾阳虚）
某 食下 胀。舌黄。当治脾阳。
生白术（一钱半） 广皮（一钱） 茯苓（三钱） 浓朴（一钱） 木瓜（五分） 淡附子（七分）
徐（三九）攻痞变成单胀。脾阳伤极。难治之症。
生白术 熟附子 茯苓 浓朴 生干姜
钱 食入腹胀。已五十日。且痛必有形攻动。头中微痛。夫痞满属气。痛因气滞。二便既通。其
滞未必在乎肠胃。从太阴脾阳伤。以辛温开泄主之。
桂枝 生白芍 淡干姜 浓朴
又 照方去白芍加生益智仁茯苓。
杨（五十）饮酒聚湿。太阴脾阳受伤。单单腹胀。是浊阴之气锢结不宣通。二便不爽。治以健阳运湿。
生茅术 草果 附子 广皮 浓朴 茯苓 荜茇 猪苓
吴（四三）食下 胀。便溏不爽。肢木不仁。此脾阳困顿。不能默运使然。温通中阳为主。
白术（三钱） 附子（一钱） 炮姜（一钱半） 桂枝木（一钱） 茯苓（三钱） 荜茇（一钱）
僧（四七）俗语云。膏粱无厌发痈疽。淡泊不堪生肿胀。今素有脘痛。气逆呕吐。渐起肿胀。乃太阴脾
脏之阳受伤。不司鼓动营运。阴土宜温。佐以制木治。
生于术 茯苓 广皮 椒目 浓朴 益智仁 良姜
某（六七）左脉弦。胀满不运。便泄不爽。当温通脾阳。
草果仁（一钱） 茯苓皮（三钱） 大腹皮（三钱） 广皮（一钱半） 青皮（一钱） 浓朴（一钱半） 木猪苓
（一钱半） 椒目（五分）
吴 寒热伤中。腹微满。舌白。用治中法。
人参 益智 广皮 茯苓 泽泻 金斛 木瓜
周（五五）久嗽四年。后失血。乃久积劳伤。酒肉不忌。湿郁脾阳为胀。问小溲仅通。大便仍溏。浊阴乘
阳。午后夜分尤剧。
生于术 熟附子
陈（五十）积劳。脾阳伤。食下胀。足肿。
生白术 茯苓 熟附子 草果仁 浓朴 广皮
某 躬耕南亩。曝于烈日。渍于水土。暑湿内蒸为泻痢。邪去正伤。临晚跗肿腹满。乃脾阳已困。
诸气不司营运。浊阴渐尔窃据。内经病机。诸湿肿满。皆属于脾。
生白术 草蔻 茯苓 浓朴 附子 泽泻
邹（三九）深秋霍乱转筋。必有暴冷伤及脾胃。病机一十九条。河间皆谓热。亦属偏见。愈泻愈胀。岂
是实症。夫酒客之湿。皆脾胃阳微不运。致湿邪凝聚。气壅成胀。见胀满彻投攻下。不究致病之因。故曰难调之症。
生白术 草果 熟附子 浓朴 广皮 茯苓
陈（四四）苦寒多用。胃阳久伤。右胁痛。呕酸浊。皆浊阴上干。用辛甘温中补虚痛减。病患述早上腹
宽。暮夜气紧微硬。大便不爽。有单腹胀之忧。（脾胃阳虚）
人参 生白术 茯苓 肉桂 归身 益智 广皮 煨姜
赵（五四）胸腹胀满。久病痰多。
生白术（二两） 茯苓（二两） 浓朴（一两） 肉桂（五钱） 姜汁丸
本草云。浓朴与白术能治虚胀。仿洁古枳术之意也。佐茯苓通胃阳。肉桂入血络。则病邪可却矣。
杨 脉沉小弦。中年已后。阳气不足。痰饮水寒。皆令逆趋。致运纳失和。渐有胀满浮肿。法以辛
温宣通。以本病属脾胃耳。
人参（一钱） 茯苓（三钱） 白芍（一钱半） 淡附子（一钱） 姜汁（三分调）
倪（二十）腹 膨。便不爽。腑阳不行。
生益智 茯苓 生谷芽 广皮 砂仁壳 浓朴
又 六腑不通爽。凡浊味食物宜忌。
鸡肫皮 麦芽 山楂 砂仁 陈香橼
又 脉沉小缓。早食难化。晚食夜胀。大便不爽。此腑阳久伤。不司流行。必以温药疏通。忌食闭
气粘荤。
生白术 附子 浓朴 草果 茯苓 广皮白 槟榔汁
浦（四九）肾气丸。五苓散。一摄少阴。一通太阳。浊泄溺通。腹满日减。不为错误。但虚寒胀病。而用
温补。阅古人调剂。必是通法。盖通阳则浊阴不聚。守补恐中焦易钝。喻氏谓能变胃。而不
受胃变。苟非纯刚之药。曷胜其任。（肾胃阳虚）
议于暮夜服玉壶丹五分。晨进。
人参 半夏 姜汁 茯苓 枳实 干姜
陈（六二）老人脾肾阳衰。午后暮夜。阴气用事。食纳不适。肠鸣 胀。时泄。治法初宜刚剂。俾阴浊不
僭。阳乃复辟。
人参（一钱半） 淡附子（一钱） 淡干姜（八分） 茯苓（三钱） 炒菟丝（三钱） 胡芦巴（一钱）
此治阳明之阳也。若参入白术甘草。则兼走太阴矣。
某（三七）肿胀由足入腹。诊脉细软。不能运谷。当治少阴太阴。（脾肾阳虚）
生白术 浓朴 茯苓 淡附子 淡干姜 荜茇
马（三六）暮食不化。黎明瘕泄。乃内伤单胀之症。脾肾之阳积弱。据理当用肾气丸。
顾（四三）脉微而迟。色衰萎黄。蟹为介属。咸寒沉降。凡阳气不足者。食之损阳。其致病之由。自试二
次矣。久利久泄。古云无不伤肾。今浮肿渐起自下。是水失火而败。若非暖下。徒见泄泻有红。
为脾胃湿热。必致中满败坏。
生茅术 熟地炭 熟附子 淡干姜 茯苓 车前
某 脾肾虚寒多泻。由秋冬不愈。春木已动。势必克土。腹满。小便不利。乃肿病之根。若不益火
生土。日吃疲药。焉能却病。
人参 白术 附子 生益智 菟丝子 茯苓
姚（四八）据说情怀不适。因嗔怒。痰嗽有血。视中年形瘁肉消。渐渐腹胀跗肿。下午渐甚。阳气日夺。
早服肾气丸三钱。昼服五苓散。（肾阳虚）
殷（氏）行动气坠于下。卧着气拥于上。此跗肿昼甚。头胀夜甚。总是中年阳微。最有腹大喘急之
事。济生丸（十服）
某 阳微阴结。肿胀。
附子 苡仁 白术 木防己 泽泻 细辛
朱 阳明胃逆。厥阴来犯。丹溪谓上升之气。自肝而出。清金开气。亦有制木之功能。而痛胀稍缓。议以温胆加黄
连方。（肝胃不和）
半夏 茯苓 橘红 枳实 竹茹 川连 生白芍
某（二八）舌微黄。瘕逆。脘胸悉胀。当和肝胃。
桂枝木 干姜 青皮 吴萸 川楝子 炒半夏
秦 两年初秋发伤。脉络气血不为流行。而腹满重坠。卧则颇安。脐左动气。卧则尤甚。吐冷沫。
常觉冷气。身麻语塞。肝风日炽。疏泄失职。经以肝病吐涎沫。木侮土位。自多 胀。丹溪云。自
觉冷者非真冷也。两次溃疡之后。刚燥热药。似难进商。议以宣通肝胃为治。有年久恙。贵乎平淡矣。
云茯苓（三钱） 三角胡麻（捣碎滚水洗十次三钱） 浓橘红（一钱） 嫩钩藤（一钱） 熟半夏（炒黄一钱半） 白
旋复花（一钱） 滤清。服一杯。四帖。
又 接服大半夏汤。
熟半夏（炒二钱半） 云苓（小块五钱） 姜汁（调服四分） 人参（同煎一钱）
方（五九）诊脉百至。右缓涩。左弦劲。始而肠鸣泄气。由渐腹满 胀。纳食几废。便难溺少。此皆情怀
少旷。清气不转。肝木侵侮胃土。腑阳窒塞。胀满日甚。据云。先因胃脘心下痛症。气郁显然。非
旦晚图功之象。议河间分消法。（肝郁犯胃兼湿）
杏仁 浓朴 海金沙 陈香橼 郁金 莱菔子 木通 鸡肫皮
王（三七）食入不运。脘中 胀。病由悒郁。经年不愈。视色黄形瘦。按脉小而涩。喜凉饮。恶热。大便未
经通调。九窍不和。皆胃病矣。
川连 鸡肫皮 枳实 广皮 桔梗 栝蒌实 半夏 莱菔子 郁金 杏仁 姜汁竹沥丸。
杨（四十）肝郁乘胃为胀。经年内结有形。用缓消一法。
生茅术 鸡肫皮 川连 生浓朴 淡姜渣 针砂（制）
椒目汤法丸。
毕 湿热。由腑滞及肠中。大便不爽。食入不适。平昔肝木易动。厥阴不主疏泄。少腹形胀。无非
滞气之壅。久则凝瘀日踞。
小温中丸三钱。十服。
程（三十）脉右弦。面黄。腹满。按之漉漉有声。每大便先腹痛。便不能干爽。此胃气不降。阳气自滞。
由乎嗔怒不息。肝木横逆。疏泄失司。 胀之来。皆由乎此。议泄肝通腑。浊宣胀减之义。
杏仁 紫浓朴 猪苓 郁金 椒目 槟榔汁
接服小温中九。
某（五七）不饥不运。少腹胃脘悉满。诊脉左弦。乃肝木犯胃。二腑不主流行。浊阴渐次弥漫。他日单
胀之作。竟有难以杜患者。速速戒恼怒。安闲自在。诚治斯疾之良图。
小温中丸一钱五分。开水送下。
夏 夏四月。脾胃主气。嗔怒怫郁。无不动肝。肝木侮土。而脾胃受伤。郁久气不转舒。聚而为热。
乃壮火害气。宜乎减食 胀矣。当作木土之郁调治。桂附助热。萸地滋滞。郁热益深。是速增其病矣。
钩藤 丹皮 黑山栀 川连 青皮子 紫浓朴 莱菔子 广皮白 薄荷梗
又 胀势已缓。脉来弦实。此湿热犹未尽去。必淡泊食物。清肃胃口。以清渗利水之剂。服五
六日再议。
猪苓 泽泻 通草 海金沙 金银花 茯苓皮 黑 豆皮
又 诊脉浮中沉。来去不为流利。气阻湿郁。胶痰内着。议用控涎丹六分。缓攻。
又 服控涎丹。大便通而不爽。诊右脉弦实。目黄舌燥。中焦湿热不行。因久病神倦。不敢过攻。
议用丹溪小温中丸。每服三钱。乃泄肝通胃。以缓治其胀。
谢 形神劳烦。阳伤。腑气不通。疝瘕阴浊。从厥阴乘犯阳明。胃为阴浊蒙闭。肠中气窒日甚。年
前邪势颇缓。宣络可效。今闭锢全是浊阴。若非辛雄刚剂。何以直突重围。胀满日增。人力难施矣。
生炮川乌头 生淡川附子 淡干姜 淡吴萸 川楝子 小茴香 猪胆汁
唐（氏）紫菀 杏仁 通草 郁金 黑山栀
又 三焦不通。脘痹腹胀。二便皆秘。前方用开手太阴肺。苦辛润降。小溲得利。兼进小温中丸。
泄肝平胃。胀势十减有五。但间日寒热复来。必是内郁之气。阳不条达。多寒战栗。议用四逆
散和解。其小温中丸仍用。
生白芍 枳实 柴胡 黄芩 半夏 杏仁 竹茹 生姜
张（妪）腹臌 胀。大便不爽。得暖气稍快。乃阳气不主流行。盖六腑属阳。以通为补。春木地气来
升。土中最畏木乘。势猖炽。治当泄木安土。用丹溪小温中丸。每服三钱。
张（氏）用镇肝逆理胃虚方法。脉形小弱。吐涎沫甚多。仍不纳谷。周身寒凛。四肢微冷。皆胃中无
阳。浊上僭踞。而为 胀。所谓食不得入。是无火也。（肝犯胃阳虚）
人参 吴萸 干姜 附子 川连 茯苓
丁（三十）嗔怒。气血逆乱。右胁不和。夜食嗳噫 胀。乃肝胃病。治以解郁。宣通气血。（木郁气滞血涩）
钩藤 丹皮 桑叶 生香附 茯苓 神曲 降香木 炒黑楂肉
徐 平素肝气不和。胁肋少腹 胀。气血不调。痰饮渐聚。厥阴阳明同治。
桃仁 延胡 归尾 小茴 香附 半夏 茯苓 橘红 神曲
马（三四）脉实。久病瘀热在血。胸不爽。小腹坠。能食不渴。二便涩少。两进苦辛宣腑。病未能却。此属
血病。用通幽法。
桃仁 郁李仁 归尾 小茴 红花 制大黄 桂枝 川楝子
又 昼日气坠少腹。夜卧不觉。甚则头昏胸闷。今年五月。初用疏滞。继通三焦。续进通幽。其坠
胀仍若。议辛香流气法。
川楝子 延胡 小茴 黑山栀 青木香 橘核 生香附磨汁法丸。
董 初因下血转痢。继而大便秘艰。自左胁下有形。渐致胀大坚满。小便自利。病在血分。久
病两年。形瘦气短。不敢峻攻。若五积成例。议用古禹余粮丸。每日一钱。
郑（氏）得食腹痛。上及心胸。下攻少腹。甚至筋胀。扰于周身经络之间。大便欲解不通畅。此乃肠
胃气阻。故痛随利减。神保丸。（一钱）
【第五一】某患者进食后食物停滞不化。出现腹胀、呕吐、恶心感。大便排出不畅。脉象弦，面色黄。这是胃阳虚弱，气机升降失调所致。治法应当温通阳气。（胃阳虚）
吴茱萸（八分） 半夏（三钱） 荜茇（一钱） 淡干姜（一钱） 生姜汁（五分） 广皮白（一钱半）
【第三八】陈某诊察：右脉大而缓，左脉如小数且急促。冬季时寒热交替、身体疼痛，出汗后即缓解。自从劳累过度、饮食饥饱不均及发怒之后，病情日益加重。
面部浮肿，足部肿胀，呼吸均呈喘息状。流泪，鼻出血，躺下时感觉气冲欲起。进食后食物滞留中焦不能运化。时令进入夏季，正值脾胃主令之时。观察其神色与脉象，中焦痞满胀病的症状即将到来。大概此症属于劳倦导致的损伤，初病即在脾胃。李东垣说：“胃是卫气的根本，脾是营气的源头。”脏腑受病，营卫二气昼夜循环失去节度，表现为寒热交替。这原本不是疟邪在半表半里的病症。此时若有高明医生诊治，必定使用建中汤而痊愈。《内经》说：“劳损者用温补，亏损者用益助。”建中汤味甘性温，能使脾胃清阳之气自立，中焦稳固安定，无需再迁延治疗。张仲景也说：“男子脉大为劳。”可知《内经》、张仲景、李东垣的教诲，真是规矩准绳般的至法。况且汗出泄阳、积劳伤阳，都是阳气受损。药物若用辛散走窜劫夺阳气，或用苦寒败坏胃气，病患自述喝甘蔗汁即感到中脘不适，不久少腹急痛、大便稀溏。其胃阳被苦辛之品大伤，非常明显。又述咳嗽频繁，冲气必然自下向上逆乱。冲脉隶属于阳明胃经，胃阳损伤至极，中焦缺乏镇守的真气，冲脉妄动，则诸脉随之交动，浊阴之气散漫上布，这就是躺下时气冲欲起的原因。我并非凭空推测其将发生腹胀，正符合《内经》“浊气在上，则生䐜胀”以及太阴湿土所致为腹胀的理论。过去有说法：“见痰休治痰，见血休治血”，应当从病因传变推求。故辨论如此。
厚朴 杏仁 人参 茯苓 蜜煨姜 南枣
厚朴、杏仁，取其能降气；参、苓、姜、枣，取其建立胃中清阳，调和营卫。
【第二四】吴某单腹胀，小便少。温通法颇为适宜。当用大针砂丸一钱二分，服八剂。（脾阳虚）
某患者食后腹胀，舌苔黄。应当治疗脾阳。
生白术（一钱半） 广皮（一钱） 茯苓（三钱） 厚朴（一钱） 木瓜（五分） 淡附子（七分）
【第三九】徐某攻下痞块后变成单腹胀。脾阳损伤至极，为难治之症。
生白术 熟附子 茯苓 厚朴 生干姜
钱某食入后腹胀，已五十日。且疼痛必有形之物攻动，头部微痛。痞满属于气滞，疼痛因气机阻滞。二便既已通畅，其阻滞未必在肠胃。从太阴脾阳受伤角度，以辛温开泄为主治法。
桂枝 生白芍 淡干姜 厚朴
复诊：照原方去掉白芍，加生益智仁、茯苓。
【五十】杨某饮酒导致湿气聚集，太阴脾阳受伤。单单腹部胀大，这是浊阴之气锢结不通。二便不畅。治以健运脾阳、运化湿气。
生茅术 草果 附子 广皮 厚朴 茯苓 荜茇 猪苓
【四三】吴某食后腹胀，大便溏薄不畅，肢体麻木不仁。这是脾阳困顿，不能默默运化所致。以温通中阳为主。
白术（三钱） 附子（一钱） 炮姜（一钱半） 桂枝木（一钱） 茯苓（三钱） 荜茇（一钱）
【四七】僧人俗语云：“膏粱无厌发痈疽，淡泊不堪生肿胀。”今素有脘痛，气逆呕吐，渐起肿胀，乃太阴脾脏之阳受伤，不能鼓动营运。阴土宜温，佐以制肝木之法。
生于术 茯苓 广皮 椒目 厚朴 益智仁 良姜
【六七】某患者左脉弦，胀满不运，便泄不爽。应当温通脾阳。
草果仁（一钱） 茯苓皮（三钱） 大腹皮（三钱） 广皮（一钱半） 青皮（一钱） 厚朴（一钱半） 木猪苓（一钱半） 椒目（五分）
吴某寒热伤及中焦，腹部微满，舌苔白。用治中法。
人参 益智 广皮 茯苓 泽泻 金斛 木瓜
【五五】周某久咳四年，后失血，乃久积劳伤，又不忌酒肉，湿郁脾阳导致腹胀。问其小便仅通利少许，大便仍溏薄。浊阴乘袭阳气，午后及夜分尤其严重。
生于术 熟附子
【五十】陈某积劳，脾阳伤，食后腹胀，足肿。
生白术 茯苓 熟附子 草果仁 厚朴 广皮
某患者躬耕田野，曝晒于烈日，浸渍于水土，暑湿内蒸导致泻痢。邪气去而正气伤，傍晚脚背浮肿、腹部胀满，乃脾阳已困，诸气不能营运，浊阴逐渐占据。《内经》病机云：“诸湿肿满，皆属于脾。”
生白术 草蔻 茯苓 厚朴 附子 泽泻
【三九】邹某深秋霍乱转筋，必有暴冷伤及脾胃。《病机十九条》，刘河间多谓属热，亦属偏见。愈泻愈胀，岂是实证？夫酒客之湿，皆因脾胃阳微不运，致湿邪凝聚，气壅成胀。见胀满就投攻下药，不究致病之因，故曰难调之症。
生白术 草果 熟附子 厚朴 广皮 茯苓
【四四】陈某苦寒药多用，胃阳久伤。右胁痛，呕酸浊，皆浊阴上干。用辛甘温中补虚，痛减。病患述早上腹部宽舒，暮夜气紧微硬，大便不爽，有单腹胀之忧。（脾胃阳虚）
人参 生白术 茯苓 肉桂 归身 益智 广皮 煨姜
【五四】赵某胸腹胀满，久病痰多。
生白术（二两） 茯苓（二两） 厚朴（一两） 肉桂（五钱） 姜汁丸
本草云：厚朴与白术能治虚胀，仿洁古枳术之意也。佐茯苓通胃阳，肉桂入血络，则病邪可却矣。
杨姓患者脉沉小弦。中年以后，阳气不足。痰饮水寒，皆令逆趋，致运纳失和，渐有胀满浮肿。法以辛温宣通，因本病属脾胃耳。
人参（一钱） 茯苓（三钱） 白芍（一钱半） 淡附子（一钱） 姜汁（三分调）
【二十】倪某腹部膨隆，便不爽。腑阳不行。
生益智 茯苓 生谷芽 广皮 砂仁壳 厚朴
复诊：六腑不通爽，凡浊味食物宜忌。
鸡肫皮 麦芽 山楂 砂仁 陈香橼
复诊：脉沉小缓，早食难化，晚食夜胀，大便不爽。此腑阳久伤，不司流行。必以温药疏通，忌食闭气粘荤。
生白术 附子 厚朴 草果 茯苓 广皮白 槟榔汁
【四九】浦某肾气丸、五苓散，一摄少阴，一通太阳，浊泄溺通，腹满日减，不为错误。但虚寒胀病，而用温补，阅古人调剂，必是通法。盖通阳则浊阴不聚，守补恐中焦易钝。喻氏谓能变胃，而不受胃变。苟非纯刚之药，曷胜其任。（肾胃阳虚）
议于暮夜服玉壶丹五分，晨进。
人参 半夏 姜汁 茯苓 枳实 干姜
【六二】陈某老人脾肾阳衰，午后暮夜，阴气用事，食纳不适，肠鸣腹胀，时泄。治法初宜刚剂，俾阴浊不僭，阳乃复辟。
人参（一钱半） 淡附子（一钱） 淡干姜（八分） 茯苓（三钱） 炒菟丝（三钱） 胡芦巴（一钱）
此治阳明之阳也。若参入白术甘草，则兼走太阴矣。
【三七】某患者肿胀由足入腹，诊脉细软，不能运谷，当治少阴太阴。（脾肾阳虚）
生白术 厚朴 茯苓 淡附子 淡干姜 荜茇
【三六】马某暮食不化，黎明瘕泄，乃内伤单胀之症。脾肾之阳积弱，据理当用肾气丸。
顾某脉微而迟，色衰萎黄。蟹为介属，咸寒沉降。凡阳气不足者，食之损阳。其致病之由，自试二次矣。久利久泄，古云无不伤肾。今浮肿渐起自下，是水失火而败。若非暖下，徒见泄泻有红，为脾胃湿热，必致中满败坏。
生茅术 熟地炭 熟附子 淡干姜 茯苓 车前
某患者脾肾虚寒多泻，由秋冬不愈，春木已动，势必克土。腹满，小便不利，乃肿病之根。若不益火生土，日吃疲药，焉能却病。
人参 白术 附子 生益智 菟丝子 茯苓
【四八】姚某据说情怀不适，因嗔怒，痰嗽有血，视中年形瘁肉消，渐渐腹胀跗肿，下午渐甚，阳气日夺。早服肾气丸三钱，昼服五苓散。（肾阳虚）
殷氏行动气坠于下，卧着气拥于上，此跗肿昼甚，头胀夜甚，总是中年阳微，最有腹大喘急之事。济生丸（十服）
朱姓患者阳明胃逆，厥阴来犯。丹溪谓上升之气，自肝而出，清金开气，亦有制木之功能，而痛胀稍缓。议以温胆加黄连方。（肝胃不和）
半夏 茯苓 橘红 枳实 竹茹 川连 生白芍
【二八】某患者舌微黄，瘕逆，脘胸悉胀，当和肝胃。
桂枝木 干姜 青皮 吴萸 川楝子 炒半夏
秦姓患者两年初秋发伤，脉络气血不为流行，而腹满重坠，卧则颇安，脐左动气，卧则尤甚，吐冷沫，常觉冷气，身麻语塞，肝风日炽，疏泄失职。经以肝病吐涎沫，木侮土位，自多䐜胀。丹溪云：自觉冷者非真冷也。两次溃疡之后，刚燥热药，似难进商。议以宣通肝胃为治，有年久恙，贵乎平淡矣。
云茯苓（三钱） 三角胡麻（捣碎滚水洗十次三钱） 浓橘红（一钱） 嫩钩藤（一钱） 熟半夏（炒黄一钱半） 白旋复花（一钱） 滤清，服一杯，四帖。
复诊：接服大半夏汤。
熟半夏（炒二钱半） 云苓（小块五钱） 姜汁（调服四分） 人参（同煎一钱）
【五九】方某诊脉百至，右缓涩，左弦劲。始而肠鸣泄气，由渐腹满胀，纳食几废，便难溺少。此皆情怀少旷，清气不转，肝木侵侮胃土，腑阳窒塞，胀满日甚。据云，先因胃脘心下痛症，气郁显然，非旦晚图功之象。议河间分消法。（肝郁犯胃兼湿）
杏仁 厚朴 海金沙 陈香橼 郁金 莱菔子 木通 鸡肫皮
【三七】王某食入不运，脘中胀，病由悒郁，经年不愈。视色黄形瘦，按脉小而涩，喜凉饮，恶热，大便未经通调，九窍不和，皆胃病矣。
川连 鸡肫皮 枳实 广皮 桔梗 栝蒌实 半夏 莱菔子 郁金 杏仁 姜汁竹沥丸。
杨某（四十）肝郁乘胃为胀，经年内结有形，用缓消一法。
生茅术 鸡肫皮 川连 生浓朴 淡姜渣 针砂（制）
椒目汤法丸。
毕姓患者湿热，由腑滞及肠中，大便不爽，食入不适。平昔肝木易动，厥阴不主疏泄，少腹形胀，无非滞气之壅，久则凝瘀日踞。
小温中丸三钱，十服。
程某（三十）脉右弦，面黄，腹满，按之漉漉有声。每大便先腹痛，便不能干爽。此胃气不降，阳气自滞，由乎嗔怒不息，肝木横逆，疏泄失司，胀之来，皆由乎此。议泄肝通腑，浊宣胀减之义。
杏仁 紫浓朴 猪苓 郁金 椒目 槟榔汁
接服小温中丸。
【五七】某患者不饥不运，少腹胃脘悉满，诊脉左弦，乃肝木犯胃，二腑不主流行，浊阴渐次弥漫，他日单胀之作，竟有难以杜患者。速速戒恼怒，安闲自在，诚治斯疾之良图。
小温中丸一钱五分，开水送下。
夏姓患者夏四月，脾胃主气，嗔怒怫郁，无不动肝。肝木侮土，而脾胃受伤，郁久气不转舒，聚而为热，乃壮火害气，宜乎减食胀矣。当作木土之郁调治。桂附助热，萸地滋滞，郁热益深，是速增其病矣。
钩藤 丹皮 黑山栀 川连 青皮子 紫浓朴 莱菔子 广皮白 薄荷梗
复诊：胀势已缓，脉来弦实，此湿热犹未尽去，必淡泊食物，清肃胃口，以清渗利水之剂，服五六日再议。
猪苓 泽泻 通草 海金沙 金银花 茯苓皮 黑豆皮
复诊：诊脉浮中沉，来去不为流利，气阻湿郁，胶痰内着，议用控涎丹六分，缓攻。
复诊：服控涎丹，大便通而不爽，诊右脉弦实，目黄舌燥，中焦湿热不行，因久病神倦，不敢过攻。议用丹溪小温中丸，每服三钱，乃泄肝通胃，以缓治其胀。
谢姓患者形神劳烦，阳伤，腑气不通，疝瘕阴浊，从厥阴乘犯阳明，胃为阴浊蒙闭，肠中气窒日甚，年前邪势颇缓，宣络可效。今闭锢全是浊阴，若非辛雄刚剂，何以直突重围，胀满日增，人力难施矣。
生炮川乌头 生淡川附子 淡干姜 淡吴萸 川楝子 小茴香 猪胆汁
唐氏紫菀 杏仁 通草 郁金 黑山栀
复诊：三焦不通，脘痹腹胀，二便皆秘，前方用开手太阴肺，苦辛润降，小溲得利，兼进小温中丸，泄肝平胃，胀势十减有五。但间日寒热复来，必是内郁之气，阳不条达，多寒战栗。议用四逆散和解，其小温中丸仍用。
生白芍 枳实 柴胡 黄芩 半夏 杏仁 竹茹 生姜
张妪腹臌胀，大便不爽，得暖气稍快，乃阳气不主流行。盖六腑属阳，以通为补。春木地气来升，土中最畏木乘，势猖炽，治当泄木安土，用丹溪小温中丸，每服三钱。
张氏用镇肝逆理胃虚方法，脉形小弱，吐涎沫甚多，仍不纳谷，周身寒凛，四肢微冷，皆胃中无阳，浊上僭踞，而为胀。所谓食不得入，是无火也。（肝犯胃阳虚）
人参 吴萸 干姜 附子 川连 茯苓
丁某（三十）嗔怒，气血逆乱，右胁不和，夜食嗳噫胀，乃肝胃病，治以解郁，宣通气血。（木郁气滞血涩）
钩藤 丹皮 桑叶 生香附 茯苓 神曲 降香木 炒黑楂肉
徐姓患者平素肝气不和，胁肋少腹胀，气血不调，痰饮渐聚，厥阴阳明同治。
桃仁 延胡 归尾 小茴 香附 半夏 茯苓 橘红 神曲
马某（三四）脉实，久病瘀热在血，胸不爽，小腹坠，能食不渴，二便涩少，两进苦辛宣腑，病未能却。此属血病，用通幽法。
桃仁 郁李仁 归尾 小茴 红花 制大黄 桂枝 川楝子
复诊：昼日气坠少腹，夜卧不觉，甚则头昏胸闷。今年五月，初用疏滞，继通三焦，续进通幽，其坠胀仍若。议辛香流气法。
川楝子 延胡 小茴 黑山栀 青木香 橘核 生香附磨汁法丸。
董姓患者初因下血转痢，继而大便秘艰，自左胁下有形，渐致胀大坚满，小便自利，病在血分，久病两年，形瘦气短，不敢峻攻。若五积成例，议用古禹余粮丸，每日一钱。
郑氏得食腹痛，上及心胸，下攻少腹，甚至筋胀，扰于周身经络之间，大便欲解不通畅，此乃肠胃气阻，故痛随利减。神保丸。（一钱）
[51] A certain patient experienced food stagnation after eating. Symptoms included abdominal distension, vomiting, and a sense of nausea. Bowel movements were unsatisfactory. The pulse was wiry, and the complexion was yellow. This is due to deficient stomach Yang, resulting in impaired ascending and descending functions. The treatment method should be to warm and unblock Yang Qi. (Stomach Yang Deficiency)
Evodiae Fructus (Wuyu, 8 fen) Pinelliae Rhizoma Preparatum (Banxia, 3 qian) Piperis Longi Fructus (Bibo, 1 qian) Zingiberis Rhizoma Preparatum (Dan Jiang, 1 qian) Zingiberis Rhizoma Recens (Sheng Jiang Zhi, 5 fen) Citri Reticulatae Pericarpium Album (Guang Pi Bai, 1.5 qian)
[38] Patient Chen: Examination revealed a large and slow right pulse, and a left pulse resembling a small number with urgency. In winter, alternating chills and fever with body pain occurred, resolving upon sweating. Since excessive labor, irregular diet, and anger, the condition has worsened daily.
Facial edema and foot swelling are present; respiration is wheezing. Tearing and epistaxis occur. When lying down, there is a sensation of Qi rushing upward. Food remains stagnant in the middle jiao without transformation. As the season transitions to summer, when the Spleen and Stomach are dominant, observing the complexion and pulse indicates that middle jiao fullness and distension are approaching. Generally, this syndrome belongs to damage caused by fatigue and overwork. The initial pathology lies in the Spleen and Stomach. Li Dongyuan stated: "The Stomach is the root of Wei (Defensive) Qi, and the Spleen is the source of Ying (Nutritive) Qi." When organs and viscera are diseased, the cyclical flow of Ying and Wei Qi throughout day and night loses its rhythm, manifesting as cold and heat. This is originally not a Shaoyang syndrome of malaria pathogens between the interior and exterior. At this time, if treated by a skilled physician, Jianzhong Tang would surely lead to recovery. The Classic states: "For exhaustion, use warming; for deficiency, use tonification." Jianzhong Tang is sweet and warm, enabling the clear Yang of the Spleen and Stomach to stand firm, stabilizing the central pillar, avoiding further delay. Zhang Zhongjing also said: "In men, a large pulse indicates consumption." Thus, the teachings of the Classic, Zhang Zhongjing, and Li Dongyuan serve as true standards and rules. Moreover, sweating depletes Yang, and accumulated fatigue injures Yang; both result in Yang injury. Medicines that are acrid and dispersing may rob Yang, while bitter-cold medicines may damage the Stomach. The patient reported that drinking sugarcane juice caused discomfort in the epigastrium, followed shortly by acute lower abdominal pain and loose stools. It is evident that the Stomach Yang was severely injured by bitter and acrid substances. The patient also described frequent coughing, indicating that Chong Qi must be reversing upward from below. The Chong Mai (Penetrating Vessel) is affiliated with the Stomach Meridian of Foot-Yangming. When Stomach Yang is extremely damaged and the middle jiao lacks the true Qi to anchor it, the Chong Mai moves chaotically, causing all vessels to react. Turbid Yin scatters and spreads upward, which explains the sensation of Qi rushing upward when lying down. I am not speculating remotely about the distension; this aligns perfectly with the Classic's statement: "When turbid Qi is above, distension occurs," and matches the Taiyin manifestation of abdominal fullness. As the saying goes: "Do not treat phlegm when seeing phlegm; do not treat blood when seeing blood." One must deduce from the transmission and transformation of the pathogenic cause. Hence this discussion.
Magnoliae Officinalis Cortex (Houpo), Armeniacae Semen Amarum (Xingren), Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Honey-roasted Ginger (Mi Wei Jiang), Jujubae Fructus (Nanzao).
Houpo and Xingren are used for their ability to descend Qi. Renshen, Fuling, Jiang, and Nanzao are used to establish clear Yang in the Stomach and harmonize Ying and Wei.
[24] Patient Wu presents with isolated abdominal distension and scanty urination. Warming and unblocking methods are quite suitable. Use Dazhensha Wan (Large Needle Sand Pill) 1.2 qian, taken eight times. (Spleen Yang Deficiency)
A certain patient experiences abdominal distension after eating, with a yellow tongue coating. Treatment should focus on warming Spleen Yang.
Atractylodis Macrocephalae Rhizoma (Baizhu, 1.5 qian), Citri Reticulatae Pericarpium (Guangpi, 1 qian), Poria (Fuling, 3 qian), Magnoliae Officinalis Cortex (Houpo, 1 qian), Chaenomelis Fructus (Mugua, 5 fen), Aconiti Lateralis Radix Preparata (Fuzi, 7 fen).
[39] Patient Xu developed isolated abdominal distension after purging痞 (fullness/lump). Spleen Yang is extremely damaged; this is a difficult-to-treat case.
Atractylodis Macrocephalae Rhizoma (Baizhu), Aconiti Radix Preparata (Fuzi), Poria (Fuling), Magnoliae Officinalis Cortex (Houpo), Zingiberis Rhizoma (Ganjiang).
Patient Qian experiences abdominal distension after eating for 50 days. Pain involves movable masses. There is slight headache. Fullness belongs to Qi stagnation; pain is due to Qi obstruction. Since bowel and bladder movements are patent, the obstruction likely does not lie in the Intestines or Stomach. From the perspective of Taiyin Spleen Yang injury, treat primarily with acrid-warm opening and draining.
Cinnamomi Ramulus (Guizhi), Paeoniae Radix Alba (Baishao), Zingiberis Rhizoma Preparatum (Jiang), Magnoliae Officinalis Cortex (Houpo).
Follow-up: Remove Baishao from the original prescription, add Alpiniae Oxyphyllae Fructus (Yizhiren) and Poria (Fuling).
[50] Patient Yang consumed alcohol, leading to dampness accumulation and injury to Taiyin Spleen Yang. Isolated abdominal distension results from turbid Yin qi being bound and unable to circulate freely. Bowel and bladder movements are unsatisfactory. Treat by strengthening Yang and transforming dampness.
Atractylodis Rhizoma (Cangzhu), Tsaoko Fructus (Caoguo), Aconiti Radix Preparata (Fuzi), Citri Reticulatae Pericarpium (Guangpi), Magnoliae Officinalis Cortex (Houpo), Poria (Fuling), Piperis Longi Fructus (Bibo), Polyporus (Zhuling).
[43] Patient Wu experiences abdominal distension after eating, loose and unsatisfactory stools, and numbness/insensitivity of limbs. This is due to Spleen Yang being trapped and unable to transform silently. The primary treatment is to warm and unblock Middle Yang.
Atractylodis Macrocephalae Rhizoma (Baizhu, 3 qian), Aconiti Radix Preparata (Fuzi, 1 qian), Zingiberis Rhizoma Preparatum (Pao Jiang, 1.5 qian), Cinnamomi Ramulus (Guizhi Mu, 1 qian), Poria (Fuling, 3 qian), Piperis Longi Fructus (Bibo, 1 qian).
Monk [47]: Folk saying goes, "Excessive rich food causes carbuncles; excessive bland food causes swelling." Currently suffering from epigastric pain, rebellious Qi with vomiting, gradually developing swelling. This is due to injury of Taiyin Spleen Yang, which fails to drive circulation and transformation. Yin Earth requires warming, assisted by methods to subdue Liver Wood.
Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Citri Reticulatae Pericarpium (Guangpi), Zanthoxyli Semen (Jiaomu), Magnoliae Officinalis Cortex (Houpo), Alpiniae Oxyphyllae Fructus (Yizhiren), Galangalis Rhizome (Liangjiang).
[67] A certain patient has a wiry left pulse, abdominal fullness and stagnation, and unsatisfactory loose stools. Warm and unblock Spleen Yang.
Tsaoko Fructus (Caoguo Ren, 1 qian), Poria Peel (Fuling Pi, 3 qian), Arecae Pericarpium (Dafupi, 3 qian), Citri Reticulatae Pericarpium (Guangpi, 1.5 qian), Citri Reticulatae Pericarpium Viride (Qingpi, 1 qian), Magnoliae Officinalis Cortex (Houpo, 1.5 qian), Polyporus (Zhuling, 1.5 qian), Zanthoxyli Semen (Jiaomu, 5 fen).
Patient Wu suffers from external cold-heat injuring the middle jiao, slight abdominal fullness, and white tongue coating. Use Zhizhong method.
Ginseng Radix et Rhizoma (Renshen), Alpiniae Oxyphyllae Fructus (Yizhi), Citri Reticulatae Pericarpium (Guangpi), Poria (Fuling), Alismatis Rhizoma (Zexie), Dendrobii Caulis (Jinhu), Chaenomelis Fructus (Mugua).
[55] Patient Zhou suffered chronic cough for four years, followed by hematemesis/hemoptysis, due to long-term accumulated fatigue and lack of dietary restrictions regarding alcohol and meat. Dampness traps Spleen Yang, causing distension. Urine output is minimal, and stools remain loose. Turbid Yin attacks Yang, worsening in the afternoon and at night.
Atractylodis Macrocephalae Rhizoma (Baizhu), Aconiti Radix Preparata (Fuzi).
[50] Patient Chen suffers from accumulated fatigue, injured Spleen Yang, postprandial abdominal distension, and foot edema.
Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Aconiti Radix Preparata (Fuzi), Tsaoko Fructus (Caoguo Ren), Magnoliae Officinalis Cortex (Houpo), Citri Reticulatae Pericarpium (Guangpi).
A certain patient worked in the fields under the scorching sun and soaked in water and soil. Summer-dampness steamed internally, causing diarrhea and dysentery. After the pathogen departed, the healthy Qi was injured. Evening onset of dorsal foot edema and abdominal fullness indicates that Spleen Yang is exhausted. All Qi fails to circulate, and turbid Yin gradually occupies the space. The Classic states: "All dampness, swelling, and fullness belong to the Spleen."
Atractylodis Macrocephalae Rhizoma (Baizhu), Amomi Fructus Rotundus (Caokou), Poria (Fuling), Magnoliae Officinalis Cortex (Houpo), Aconiti Radix Preparata (Fuzi), Alismatis Rhizoma (Zexie).
[39] Patient Zou suffered cholera with tendon contraction in late autumn, likely due to sudden cold injuring the Spleen and Stomach. The Nineteen Pathogenesis Statements by Liu Hejian attribute most to heat, which is also a biased view. More diarrhea leads to more distension; how can this be an excess syndrome? Dampness in wine drinkers is due to weak Spleen-Stomach Yang failing to transform, causing dampness to condense and Qi to obstruct, leading to distension. Seeing distension and immediately using purgatives, without investigating the cause, makes it a difficult-to-regulate case.
Atractylodis Macrocephalae Rhizoma (Baizhu), Tsaoko Fructus (Caoguo), Aconiti Radix Preparata (Fuzi), Magnoliae Officinalis Cortex (Houpo), Citri Reticulatae Pericarpium (Guangpi), Poria (Fuling).
[44] Patient Chen used too many bitter-cold medicines, long injuring Stomach Yang. Right hypochondriac pain, vomiting sour turbid fluid, all due to turbid Yin attacking upward. Using acrid-sweet warming and tonifying reduces pain. The patient reports morning abdominal comfort but evening tightness and hardness, with unsatisfactory stools, fearing isolated abdominal distension. (Spleen-Stomach Yang Deficiency)
Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Cinnamomi Cortex (Rougui), Angelicae Sinensis Radix (Guishen), Alpiniae Oxyphyllae Fructus (Yizhi), Citri Reticulatae Pericarpium (Guangpi), Roasted Ginger (Wei Jiang).
[54] Patient Zhao suffers from chest and abdominal fullness, chronic excessive phlegm.
Atractylodis Macrocephalae Rhizoma (Baizhu, 2 liang), Poria (Fuling, 2 liang), Magnoliae Officinalis Cortex (Houpo, 1 liang), Cinnamomi Cortex (Rougui, 5 qian), Ginger Juice pills.
Materia Medica states: Houpo and Baizhu can treat deficiency distension, imitating Jiegu's Zhiju principle. Assisted by Fuling to unblock Stomach Yang, and Rougui entering the blood collaterals, the pathogenic factor can be expelled.
Patient Yang has a deep, small, wiry pulse. After middle age, Yang Qi is insufficient. Phlegm-fluid and cold water reverse downward, causing failure of transportation and reception, gradually leading to distension and edema. The method is acrid-warm dispersion and unblocking, as the disease belongs to the Spleen and Stomach.
Ginseng Radix et Rhizoma (Renshen, 1 qian), Poria (Fuling, 3 qian), Paeoniae Radix Alba (Baishao, 1.5 qian), Aconiti Lateralis Radix Preparata (Fuzi, 1 qian), Ginger Juice (3 fen mixed).
[20] Patient Ni has abdominal bloating and unsatisfactory bowel movements. Fu Yang (Yang of the Bowels) does not function.
Alpiniae Oxyphyllae Fructus (Yizhiren), Poria (Fuling), Hordeum Vulgare Germinatum (Guyafa), Citri Reticulatae Pericarpium (Guangpi), Amomi Fructus Shell (Sharen Qiao), Magnoliae Officinalis Cortex (Houpo).
Follow-up: Six Fu organs are not smooth; avoid heavy-flavored foods.
Chicken Gizzard Membrane (Jizhupi), Malto (Maiya), Crataegi Fructus (Shanzha), Amomi Fructus (Sharen), Citri Exocarpium (Chen Xiangyuan).
Follow-up: Pulse is deep, small, and slow. Hard to digest morning food, night distension after evening food, unsatisfactory stools. This is long-term injury to Fu Yang, failing to circulate. Must use warm medicines to unblock. Avoid foods that trap Qi and sticky meats.
Atractylodis Macrocephalae Rhizoma (Baizhu), Aconiti Radix Preparata (Fuzi), Magnoliae Officinalis Cortex (Houpo), Tsaoko Fructus (Caoguo), Poria (Fuling), Citri Reticulatae Pericarpium Album (Guangpi Bai), Areca Seed (Binglang Zhi).
[49] Patient Pu used Shenqi Wan and Wuling San. One secures Shaoyin, one unblocks Taiyang. Turbid waste drains, urine flows, abdominal fullness decreases daily. This is not erroneous. However, for deficiency-cold distension, using warming tonification, reviewing ancient prescriptions, must employ unblocking methods. Unblocking Yang prevents turbid Yin from gathering;守 (guarding/static) tonification may dull the middle jiao. Yu Yushan said: "Transform the Stomach, but do not let the Stomach transform you." Unless using purely rigid/hot medicines, how can they bear the burden? (Kidney-Stomach Yang Deficiency)
Propose taking Yuhu Dan (Jade Pot Pill) 5 fen at night, and morning intake.
Ginseng Radix et Rhizoma (Renshen), Pinelliae Rhizoma Preparatum (Banxia), Ginger Juice (Sheng Jiang Zhi), Poria (Fuling), Zizyphi Fructus (Zhishi), Zingiberis Rhizoma (Ganjiang).
[62] Elderly Patient Chen has Spleen-Kidney Yang decline. In the afternoon and night, Yin Qi dominates. Eating is uncomfortable, borborygmus, abdominal distension, occasional diarrhea. Initial treatment should use rigid/hot agents to prevent Yin-turbid from usurping, allowing Yang to recover.
Ginseng Radix et Rhizoma (Renshen, 1.5 qian), Aconiti Lateralis Radix Preparata (Fuzi, 1 qian), Zingiberis Rhizoma Preparatum (Jiang, 8 fen), Poria (Fuling, 3 qian), Cuscutae Semen (Tusizi, 3 qian), Phaseoli Semen (Huluba, 1 qian).
This treats Yang of Yangming. If Baizhu and Gancao are added, it also acts on Taiyin.
[37] A certain patient's swelling started from feet moving to abdomen. Pulse is fine and soft. Cannot transform grain. Treat Shaoyin and Taiyin. (Spleen-Kidney Yang Deficiency)
Atractylodis Macrocephalae Rhizoma (Baizhu), Magnoliae Officinalis Cortex (Houpo), Poria (Fuling), Aconiti Lateralis Radix Preparata (Fuzi), Zingiberis Rhizoma Preparatum (Jiang), Piperis Longi Fructus (Bibo).
[36] Patient Ma cannot digest evening food, suffers morning mass-diarrhea. This is internal injury isolated abdominal distension. Spleen-Kidney Yang is chronically weak. Logically, Shenqi Wan should be used.
Patient Gu has a faint and slow pulse, sallow and withered complexion. Crab is a shellfish, salty and cold, sinking. Those with insufficient Yang Qi are harmed by eating it. The cause of illness was tested twice. Chronic diarrhea and dysentery always injure the Kidneys according to ancients. Now edema gradually rises from below; this is Water failing Fire and collapsing. If not warming the lower jiao, merely seeing red in diarrhea as Spleen-Stomach damp-heat will inevitably lead to middle fullness and collapse.
Atractylodis Rhizoma (Cangzhu), Rehmanniae Radix Preparata Charred (Shudi Tan), Aconiti Radix Preparata (Fuzi), Zingiberis Rhizoma Preparatum (Jiang), Poria (Fuling), Plantaginis Semen (Cheqian).
A certain patient has Spleen-Kidney deficiency-cold with frequent diarrhea. Not healing from autumn/winter, Spring Wood moves, inevitably overcoming Earth. Abdominal fullness, difficult urination, are the root of swelling disease. If not boosting Fire to generate Earth, and just taking fatiguing medicines daily, how can the disease be expelled?
Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Aconiti Radix Preparata (Fuzi), Alpiniae Oxyphyllae Fructus (Yizhiren), Cuscutae Semen (Tusizi), Poria (Fuling).
[48] Patient Yao reportedly had emotional distress, anger, phlegm-cough with blood. Middle-aged appearance is emaciated with flesh loss. Gradually abdominal distension and dorsal foot edema, worse in afternoon, Yang Qi depleted daily. Take Shenqi Wan 3 qian early morning, Wuling San during day. (Kidney Yang Deficiency)
Patient Yin feels Qi sinking when walking, Qi congested when lying down. Dorsal foot edema worse by day, head distension worse by night. Always middle-age Yang deficiency, prone to abdominal enlargement and panting. Jisheng Wan (10 doses).
A certain patient has Yang deficiency and Yin binding, swelling.
Aconiti Radix Preparata (Fuzi), Coicis Semen (Yiren), Atractylodis Macrocephalae Rhizoma (Baizhu), Stephaniae Tetrandrae Radix (Mufangji), Alismatis Rhizoma (Zexie), Asari Radix et Rhizoma (Xixin).
Patient Zhu has Yangming Stomach Qi rebellion, Jueyin invasion. Danxi said rising Qi comes from Liver. Clearing Metal opens Qi, also controlling Wood function, slightly relieving pain and distension. Propose Wendan Tang plus Huanglian. (Liver-Stomach Disharmony)
Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Juhong), Zizyphi Fructus (Zhishi), Bambusae Folium (Zhuru), Coptidis Rhizoma (Chuanlian), Paeoniae Radix Alba (Baishao).
[28] A certain patient has slightly yellow tongue, mass-rebellion, complete chest/epigastric distension. Harmonize Liver and Stomach.
Cinnamomi Ramulus (Guizhi Mu), Zingiberis Rhizoma (Ganjiang), Citri Reticulatae Pericarpium Viride (Qingpi), Evodiae Fructus (Wuyu), Meliosmae Fructus (Chuanlianzi), Fried Pinelliae Rhizoma (Banxia).
Patient Qin suffered injury in early autumn two years ago. Collaterals and Qi-Blood did not circulate, causing abdominal fullness and heaviness. Resting provides relief. Qi movement at left umbilicus, worse when lying down. Vomiting cold saliva, feeling cold air, body numbness, speech obstruction. Liver Wind intensifies daily, failure of dispersion and drainage. Classic says Liver disease causes vomiting of saliva; Wood insults Earth position, naturally causing distension. Danxi said: Feeling cold is not true cold. After two ulcerations, rigid-hot medicines are difficult to consider. Propose dispersing and unblocking Liver and Stomach. For chronic illness, mildness is precious.
Poria (Fuling), Sesamum Indicum (Huma), Tangerine Peel (Ju Hong), Uncaria Rhynchophylla (Gouteng), Fried Pinelliae Rhizoma (Banxia), Inulae Flos (Xuanfuhua). Filter, drink one cup, four doses.
Follow-up: Continue Banxiexia Tang.
Fried Pinelliae Rhizoma (Banxia), Poria (Fuling), Ginger Juice (mixed), Ginseng Radix et Rhizoma (Renshen).
[59] Patient Fang pulse reaches 100 beats/min. Right is slow and choppy, Left is wiry and forceful. Initially borborygmus and gas discharge, gradually abdominal fullness/distension. Eating almost ceased. Difficult stool, scanty urine. All due to restricted emotions, clear Qi not turning, Liver Wood insulting Stomach Earth, Fu Yang blocked, distension worsening daily. Claimed prior epigastric pain, obvious Qi depression, not a quick fix. Propose Hejian's separation and elimination method. (Liver Depression invading Stomach with Dampness)
Armeniacae Semen Amarum (Xingren), Magnoliae Officinalis Cortex (Houpo), Chrysosplenii Herba (Haijinsha), Citri Exocarpium (Chen Xiangyuan), Curcumae Radix (Yujin), Raphani Semen (Laifuzi), Akebiae Caulis (Mutong), Chicken Gizzard Membrane (Jizhupi).
[37] Patient Wang cannot transform food after eating, epigastric distension. Disease due to melancholy, unresolved for a year. Complexion yellow, body thin. Pulse small and choppy. Likes cold drinks, dislikes heat. Bowels not regulated. Nine orifices disharmonious, all Stomach diseases.
Coptidis Rhizoma (Chuanlian), Chicken Gizzard Membrane (Jizhupi), Zizyphi Fructus (Zhishi), Citri Reticulatae Pericarpium (Guangpi), Platycodonis Radix (Jiegeng), Trichosanthis Fructus (Gualou Shi), Pinelliae Rhizoma (Banxia), Raphani Semen (Laifuzi), Curcumae Radix (Yujin), Armeniacae Semen Amarum (Xingren), Ginger Juice and Anemarrhenae Decoction Pills.
Patient Yang (40) Liver depression invades Stomach causing distension. Internal formation of tangible mass over a year. Use slow elimination method.
Atractylodis Rhizoma (Cangzhu), Chicken Gizzard Membrane (Jizhupi), Coptidis Rhizoma (Chuanlian), Magnoliae Officinalis Cortex (Houpo), Ginger Residue (Jiangzha), Prepared Needle Sand (Zhensha).
Pepper Seed Soup Method Pills.
Patient Bi has damp-heat, from Fu obstruction to Intestines. Unsatisfactory stools, discomfort after eating. Normally Liver Wood moves easily, Jueyin fails to disperse. Lower abdominal distension is solely Qi stagnation. Long-term leads to blood stasis accumulation.
Xiaowenzhong Wan 3 qian, ten doses.
Patient Cheng (30) Right pulse wiry, yellow face, abdominal fullness, gurgling sound on palpation. Abdominal pain before stool, stool not dry/clean. Stomach Qi does not descend, Yang Qi stagnates. Due to incessant anger, Liver Wood rebels horizontally, dispersion/failure of regulation. Distension comes from this. Propose draining Liver and unblocking Fu, scattering turbid to reduce distension.
Armeniacae Semen Amarum (Xingren), Purple Magnoliae Officinalis Cortex (Houpo), Polyporus (Zhuling), Curcumae Radix (Yujin), Zanthoxyli Semen (Jiaomu), Areca Seed (Binglang Zhi).
Follow-up: Xiaowenzhong Wan.
[57] A certain patient has no appetite, poor transformation, lower abdomen and epigastrium full. Left pulse wiry. Liver Wood insults Stomach. Two Fu organs fail to circulate. Turbid Yin gradually spreads. Future isolated distension may be hard to prevent. Quickly stop anger, live peacefully. This is indeed a good plan for treating this disease.
Xiaowenzhong Wan 1.5 qian, taken with boiled water.
Patient Xia in April (Summer), Spleen-Stomach dominate Qi. Anger and depression move Liver. Liver Wood insults Earth, injuring Spleen-Stomach. Long-term depression causes Qi not to relax, gathering into Heat. Strong fire harms Qi, reducing appetite and causing distension. Treat as Wood-Earth depression. Guifu (Cinnamon/Aconite) aids heat, Yudi (Evodia/Rehmannia) causes stagnation,郁热 (depressed heat) deepens, speeding up illness.
Uncaria Rhynchophylla (Gouteng), Moutan Cortex (Danpi), Gardeniae Fructus (Zhizi), Coptidis Rhizoma (Chuanlian), Citri Reticulatae Pericarpium Viride (Qingpi Zi), Purple Magnoliae Officinalis Cortex (Houpo), Raphani Semen (Laifuzi), Citri Reticulatae Pericarpium Album (Guangpi Bai), Menthae Haplocalycis Caulis (Bohe Geng).
Follow-up: Distension eased, pulse wiry and solid. Damp-heat not fully gone. Must eat bland food, clear Stomach, use clearing/drainage diuretics for 5-6 days then re-evaluate.
Polyporus (Zhuling), Alismatis Rhizoma (Zexie), Tectonae Caulis (Tongcao), Chrysosplenii Herba (Haijinsha), Lonicerae Japonicae Flos (Jinyinhua), Poria Peel (Fuling Pi), Black Soybean Peel (Heidou Pi).
Follow-up: Pulse floating/middle/deep, not smooth. Qi obstruction, damp depression, sticky phlegm inside. Propose Kongyan Dan 6 fen, slow attack.
Follow-up: After Kongyan Dan, stool passes but unsatisfactory. Right pulse wiry/solid, yellow eyes, dry tongue. Middle jiao damp-heat not moving. Due to chronic illness and mental fatigue, dare not over-attack. Propose Danxi Xiaowenzhong Wan, 3 qian per dose. Drains Liver, unblocks Stomach, treats distension slowly.
Patient Xing physical/mental fatigue, Yang injury, Fu Qi blocked. Hernia/Yin-turbid from Jueyin invading Yangming. Stomach covered by Yin-turbid, Intestinal Qi obstruction worsening. Last year pathogen was mild, unblocking collaterals effective. Now completely blocked by Yin-turbid. Unless using acrid-strong rigid agents, how to break through? Distension increases daily, human effort is limited.
Raw-fried Aconiti Radix (Chuwutou), Raw-light Aconiti Radix (Fuzi), Zingiberis Rhizoma Preparatum (Jiang), Light Evodiae Fructus (Wuyu), Meliosmae Fructus (Chuanlianzi), Foeniculi Fructus (Huixiang), Pig Bile (Zhudanzhi).
Patient Tang: Astelia Flower (Ziwan), Armeniacae Semen Amarum (Xingren), Tectonae Caulis (Tongcao), Curcumae Radix (Yujin), Gardeniae Fructus (Zhizi).
Follow-up: Triple Burner not open, epigastric blockage and abdominal distension. Both bowels/bladder constipated. Previous formula opened Hand-Taiyin Lung, bitter-acrid moistening descent. Urine benefited. Also take Xiaowenzhong Wan. Drains Liver, calms Stomach. Distension reduced by 50%. But alternating chills/fever return. Likely internal depressed Qi, Yang not flowing smoothly, causing chills. Propose Sini San to harmonize. Continue Xiaowenzhong Wan.
Paeoniae Radix Alba (Baishao), Zizyphi Fructus (Zhishi), Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Pinelliae Rhizoma (Banxia), Armeniacae Semen Amarum (Xingren), Bambusae Folium (Zhuru), Zingiberis Rhizoma Recens (Shengjiang).
Elderly Woman Zhang abdominal distension, unsatisfactory stool, slight relief after belching. Yang Qi does not circulate. Six Fu belong to Yang, unblocking is tonification. Spring Wood Qi rises, Earth fears Wood invasion,势头 fierce. Treat by draining Wood and calming Earth. Use Danxi Xiaowenzhong Wan, 3 qian per dose.
Patient Zhang uses method to suppress Liver rebellion and regulate Stomach deficiency. Pulse small/weak, excessive salivation, still cannot eat, whole body cold, limbs slightly cold. All indicate no Yang in Stomach, turbid Qi usurps upward, causing distension. "Food cannot enter" means no Fire. (Liver insulting Stomach Yang Deficiency)
Ginseng Radix et Rhizoma (Renshen), Evodiae Fructus (Wuyu), Zingiberis Rhizoma (Ganjiang), Aconiti Radix Preparata (Fuzi), Coptidis Rhizoma (Chuanlian), Poria (Fuling).
Ding (30) Anger, Qi-Blood chaos, right hypochondrium disharmony, evening belching/distension. Liver-Stomach disease. Treat by resolving depression, dispersing/unblocking Qi-Blood. (Wood Depression, Qi Stagnation, Blood Sluggishness)
Uncaria Rhynchophylla (Gouteng), Moutan Cortex (Danpi), Mori Folium (Sangye), Cyperi Rhizoma (Xiangfu), Poria (Fuling), Massae Fermentatae Medicinalis (Shenqu), Aquilariae Lignum Resinatum (Xiangmu), Stir-fried Hawthorn Flesh (Zhalei).
Patient Xu normally has Liver Qi disharmony, hypochondriac/lower abdominal distension, Qi-Blood imbalance, phlegm-fluid accumulation. Treat Jueyin and Yangming together.
Pruni Semen (Taoren), Corydalis Rhizoma (Yanhu), Angelicae Sinensis Radix Tail (Guiwei), Foeniculi Fructus (Huixiang), Cyperi Rhizoma (Xiangfu), Pinelliae Rhizoma (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Juhong), Massae Fermentatae Medicinalis (Shenqu).
Ma (34) Pulse solid. Chronic blood stasis-heat in blood level. Chest discomfort, lower abdominal heaviness. Can eat, not thirsty. Scanty urine/stool. Two courses of bitter-acrid Fu-unblocking failed. This is Blood disease. Use Tongyou method.
Pruni Semen (Taoren), Prunus Armeniaca Seed (Yuliren), Angelicae Sinensis Radix Tail (Guiwei), Foeniculi Fructus (Huixiang), Carthami Flos (Honghua), Prepared Rheum Radix et Rhizoma (Dahuang), Cinnamomi Ramulus (Guizhi), Meliosmae Fructus (Chuanlianzi).
Follow-up: Daytime Qi sinks to lower abdomen, night sleep unaffected. Severe cases dizziness/chest tightness. May this year, initially used Qi-dispersing, then Triple Burner unblocking, continued Tongyou. Heaviness/distension persists. Propose Acrid-Aromatic Qi-flowing method.
Meliosmae Fructus (Chuanlianzi), Corydalis Rhizoma (Yanhu), Foeniculi Fructus (Huixiang), Gardeniae Fructus (Zhizi), Pogostemonis Herba (Qingmuxiang), Juglandis Semen (Juhe), Fresh Cyperi Rhizoma Juice Pills.
Patient Du initially hematochezia turning to dysentery, then severe constipation. Tangible mass from left hypochondrium, gradually enlarging and hard. Urine free. Disease in Blood level. Chronic for two years, thin body, short breath. Dare not strong attack. Following example of Five Accumulations, propose ancient Yuyuliang Wan, 1 qian daily.
Patient Zheng pain after eating, extending to chest/heart, attacking lower abdomen, even tendon distension, disturbing meridians. Bowel movement desire but not smooth. This is Intestine-Stomach Qi obstruction, so pain reduces with passage. Shenbao Wan (1 qian).