东垣云∶寒胀多，热胀少，皆主于脾胃。虚者，宜用六君子汤。若喘而气短者，脾肺气虚也
，用异功散补之。若服克伐之类而喘胀益甚者，脾肺之气复伤也。用前汤加半夏、升麻。若
既下而不喘，则邪气去而肺气宁也，不必用药。或病久，小便不利，或四肢浮肿者，脾肺之
气虚，不能通调水道也，用金匮加减肾气丸主之。或手足逆冷，睡而露睛，脾胃虚寒也。用
六君子加炮姜。手足不冷，睡而露睛，脾胃虚弱也，用六君子汤。若面色青，木克土也，用
六君、木香、柴胡，更当调治其母，节其饮食，恐药饵过剂，复伤胃气故也。
治验
一小儿腹胀，面赤痰喘，大便秘，壮热饮冷，此形病俱实，用紫霜丸一服，诸症益甚，面色
顿白，饮汤不绝。余以为邪气退而真气复伤，故面白而喜汤。用白术散大剂煎汤令恣饮，良
久而睡，翌日顿安。
一小儿伤食腹胀，胸满有痰，余治以异功散而痊。后复伤食，腹胀兼痛，或用药下之，痛胀
益甚，而加气喘，此脾胃伤而致肺虚也，用六君子加桔梗，调补而痊。
一小儿腹胀恶食，发热恶心，症类外感。余曰∶此饮食停滞也。用保和丸，一服诸症顿退，
惟腹胀，用异功散而痊。
一小儿伤食腹胀，服克伐之剂，小便涩滞。又服五苓散之类，饮食渐减，小便不通，四肢顿
肿。余朝用金匮肾气丸去附子，夕用补中益气汤而安。
一小儿伤风咳嗽痰涌，用六君、桔梗、桑皮、杏仁而愈。复饮食停滞，作泻腹胀，仍用六君
、山楂、浓朴而安。后停食作呕，或用药下之，更加咳嗽。余谓此属脾肺俱虚，欲行调补。
彼以为缓，乃发表克滞，前症益甚，更加摇头。余用天麻散倍加钩藤钩及异功散寻愈。
一小儿五岁，食粽后切牙欲吐，顷间腹胀昏愦，鼻青黄赤，此脾土伤而食厥也。令用鸡翎探
吐，出酸物顿醒，节其饮食，勿药而愈。
一小儿胸腹胀，发热顿闷，以手按腹即哭，此饮食停滞也，先用保和丸一服，前症即愈，更
加烦渴，按其腹不哭，此宿食去而脾胃复伤也。用五味异功散加柴胡治之，顿瘳。
一小儿腹胀，大便青白，腹左一块，面色痿黄，齿龈赤烂，食少滞颐余用异功散，调补中气
为主，佐以大芜荑汤，清疳治热，月余诸症稍愈。仍服异功散及蚵蟆丸，外贴阿魏膏，两月
块消，左胁微痛，用四君子汤、九味芦荟丸而愈。
褐子丸 治疳肿胀
萝卜子（一两，微炒） 陈皮 青皮（炒） 槟榔 五灵脂 蓬术（煨） 黑牵牛（头末各半，炒） 赤茯苓
木香（二钱五分）
上为末，面糊丸，绿豆大，每服十五丸，紫苏汤下。
金匮加减肾气丸
熟地黄（八两） 干山药 山茱萸（各四两） 泽泻 白茯苓 牡丹皮（各三两） 肉桂 附子（炮） 车前
子（炒） 牛膝（酒微炒。各一两）
上各另为末，米糊丸，小豆大，每服三四十丸，空心食前白汤下。
紫霜丸（方见噤风）
大柴胡汤（方见痉症）
五苓散（方见五淋）
保和丸（方见虚羸）
天麻散（方见百 内嗽）
大芜荑汤
蚵蟆丸
九味芦荟丸（三方见疳症）
李东垣说：寒性腹胀多见，热性腹胀少见，这些病症都主要与脾胃有关。属于虚证的，适宜使用六君子汤。如果伴有气喘且气短症状的，是脾肺之气虚弱，用异功散来补益。如果服用攻伐类药物后，气喘和腹胀反而更加严重的，说明脾肺之气再次受到损伤，应在前面的方剂中加入半夏、升麻。如果已经通过泻下治疗且不再气喘，说明邪气已去而肺气安宁，不必再用药。或者病程较长，出现小便不利，或四肢浮肿的情况，这是脾肺之气虚弱，不能通调水道所致，用金匮加减肾气丸主治。如果出现手足逆冷，睡觉时眼睛半睁（露睛），这是脾胃虚寒，用六君子汤加炮姜。如果手足不冷，但睡觉时露睛，这是脾胃虚弱，用六君子汤。如果面色发青，这是木克土（肝木乘脾土）的表现，用六君子汤、木香、柴胡，更应当调理其母亲（指哺乳期母亲的饮食情志等），节制患儿的饮食，恐怕药物剂量过大，会再次损伤胃气。
治验案例：
有一个小儿腹胀，面赤痰喘，大便秘结，高热喜饮冷水，这是形证俱实，用了紫霜丸一服，各种症状反而加重，面色顿时变白，不停地喝热汤。我认为这是邪气退去但真气又受损伤，所以面色白且喜欢热汤。于是用白术散大剂量煎汤让他随意饮用，很久之后睡着了，第二天完全康复。
有一个小儿因伤食导致腹胀，胸满有痰，我用异功散治疗而痊愈。后来再次伤食，腹胀兼有疼痛，有人用下药治疗，疼痛和腹胀更加严重，并加上气喘，这是脾胃受伤导致肺虚，我用六君子汤加桔梗，调补后痊愈。
有一个小儿腹胀恶食，发热恶心，症状类似外感。我说：这是饮食停滞。用保和丸，一服后各种症状立刻消退，只有腹胀未除，再用异功散治疗而痊愈。
有一个小儿伤食腹胀，服用攻伐药剂后，小便涩滞。又服用五苓散之类的药，饮食逐渐减少，小便不通，四肢突然浮肿。我早上用金匮肾气丸去掉附子，晚上用补中益气汤，病情安定。
有一个小儿伤风咳嗽痰多涌出，用六君子汤、桔梗、桑白皮、杏仁治愈。后又因饮食停滞，腹泻腹胀，仍然用六君子汤、山楂、厚朴而安。后来停食作呕，有人用下药治疗，更加咳嗽。我认为这属于脾肺俱虚，打算进行调补。家属认为见效慢，于是用发表克滞的方法，前症更加严重，加上摇头的症状。我用天麻散加倍加入钩藤钩以及异功散，不久痊愈。
有一个五岁小儿，吃粽子后切牙想吐，一会儿腹胀昏愦，鼻部呈现青黄赤色，这是脾土受伤导致的食厥。让人用鸡翎探喉催吐，吐出酸物后立刻清醒，节制饮食，不用药而愈。
有一个小儿胸腹胀满，发热顿闷，用手按压腹部就哭，这是饮食停滞，先用保和丸一服，前症即愈，随后出现烦渴，按压腹部不哭了，这是宿食去除但脾胃又受损伤，用五味异功散加柴胡治疗，立刻好转。
有一个小儿腹胀，大便青白，腹部左侧有一块硬块，面色萎黄，齿龈赤烂，食少且食物残渣滞留下巴，我用异功散为主调补中气，佐以大芜荑汤，清疳积治热，月余各种症状稍好。继续服用异功散及蚵蟆丸，外用阿魏膏贴敷，两个月后肿块消除，左胁微痛，用四君子汤、九味芦荟丸而愈。
褐子丸 治疗疳肿胀
萝卜子（一两，微炒） 陈皮 青皮（炒） 槟榔 五灵脂 蓬术（煨） 黑牵牛（头末各半，炒） 赤茯苓 木香（二钱五分）
以上研为细末，用面糊做丸，如绿豆大小，每次服用十五丸，紫苏汤送下。
金匮加减肾气丸
熟地黄（八两） 干山药 山茱萸（各四两） 泽泻 白茯苓 牡丹皮（各三两） 肉桂 附子（炮） 车前子（炒） 牛膝（酒微炒。各一两）
以上各药分别研为细末，用米糊做丸，如小豆大小，每次服用三四十丸，空腹饭前用白开水送下。
紫霜丸（方见噤风）
大柴胡汤（方见痉症）
五苓散（方见五淋）
保和丸（方见虚羸）
天麻散（方见百 内嗽）
大芜荑汤
蚵蟆丸
九味芦荟丸（三方见疳症）
Li Dongyuan stated: Cold-type abdominal distension is common, while heat-type abdominal distension is rare; all are primarily related to the Spleen and Stomach. For deficiency patterns, Liujunzi Tang (Six Gentlemen Decoction) is appropriate. If accompanied by panting and shortness of breath, it indicates Qi deficiency of the Spleen and Lung; Yigong San (Extraordinary Efficacy Powder) should be used to tonify. If panting and distension worsen after taking purgative or attacking herbs, it signifies further injury to the Qi of the Spleen and Lung. In such cases, Banxia (Pinellia Rhizome) and Shengma (Cimicifugae Rhizoma) should be added to the previous formula. If purgation has been performed and panting ceases, it means the pathogenic factor has departed and the Lung Qi is tranquil; no medication is necessary. Alternatively, in prolonged illness, if there is difficulty in urination or edema of the four limbs, this is due to Qi deficiency of the Spleen and Lung failing to regulate water passages; Jinkui Ji Jian Shenqi Wan (Modified Kidney Qi Pill from the Golden Cabinet) is indicated. If there is cold reversal of the hands and feet, and eyes open during sleep (exposed eyes), this indicates Spleen-Stomach deficiency-cold; Liujunzi Tang with Paojiang (Prepared Ginger) should be used. If the hands and feet are not cold but eyes are exposed during sleep, this indicates Spleen-Stomach weakness; Liujunzi Tang alone should be used. If the complexion is green, it suggests Wood overacting on Earth (Liver Wood invading Spleen Earth); Liujunzi Tang, Muxiang (Aucklandiae Radix), and Chaihu (Bupleuri Radix) should be used. Furthermore, the mother’s condition should be regulated, and the child’s diet restricted, lest excessive medication re-injure Stomach Qi.
Clinical Cases:
One infant presented with abdominal distension, red face, phlegm-panting, constipation, high fever, and a desire for cold drinks. This was a pattern of excess in both form and pathology. After one dose of Zishuang Wan (White Frost Pill), symptoms worsened, the face turned pale, and the infant continuously drank hot soup. I reasoned that the pathogenic factor had receded but the True Qi was injured, hence the pale face and preference for hot soup. I prescribed a large dose of Baizhu San (Atractylodis Macrocephalae Powder) decocted in water for free consumption. After a long time, the infant slept and recovered completely the next day.
One infant suffered from abdominal distension due to food stagnation, with chest fullness and phlegm. I treated him with Yigong San, resulting in recovery. Later, he suffered from food stagnation again, presenting with abdominal distension and pain. Another practitioner used purgatives, causing severe pain and distension, accompanied by panting. This indicated Spleen-Stomach injury leading to Lung deficiency. I treated him with Liujunzi Tang plus Jiegeng (Platycodonis Radix), and he recovered after regulation and tonification.
One infant presented with abdominal distension, aversion to food, fever, and nausea, resembling an external contraction. I diagnosed this as food stagnation. One dose of Baohe Wan (Harmonize the Stomach Pill) caused immediate relief of all symptoms except abdominal distension, which was resolved using Yigong San.
One infant with abdominal distension due to food stagnation took attacking herbs, resulting in scanty and difficult urination. Subsequently, Wuling San (Five-Ingredient Powder with Poria) was administered, leading to reduced appetite, urinary retention, and sudden edema of the four limbs. I prescribed Jinkui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet) without Fuzi (Aconiti Lateralis Radix Preparata) in the morning, and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) in the evening, resulting in stabilization.
One infant with wind-cold cough and profuse phlegm was cured using Liujunzi Tang, Jiegeng, Sangbai Pi (Mori Cortex), and Xingren (Armeniacae Semen Amarum). Later, food stagnation caused diarrhea and abdominal distension; Liujunzi Tang, Shanzha (Crataegi Fructus), and Houpo (Magnoliae Officinalis Cortex) were used successfully. Subsequently, food stagnation led to vomiting. A purgative was administered, worsening the cough. I diagnosed this as dual deficiency of the Spleen and Lung and proposed regulation and tonification. The family considered this too slow and opted for releasing the exterior and resolving stagnation, which exacerbated previous symptoms and added head-shaking. I treated him with Tianma San (Gastrodia Powder) with doubled Goutenggou (Uncariae Ramulus cum Uncis) and Yigong San, leading to recovery.
A five-year-old infant developed teeth-grinding and retching after eating zongzi (sticky rice dumplings), followed by abdominal distension, unconsciousness, and nasal discoloration (green, yellow, red). This was diagnosed as Food Jue (syncope due to food) due to Spleen Earth injury. Chicken feathers were used to induce vomiting, expelling sour matter, upon which the infant woke up immediately. Dietary restriction was advised, and the infant recovered without medication.
One infant presented with chest and abdominal distension, sudden fever and stifling sensation, and crying upon abdominal palpation, indicating food stagnation. One dose of Baohe Wan relieved these symptoms. However, irritability and thirst developed, and abdominal palpation no longer caused crying. This indicated that residual food had cleared but the Spleen and Stomach were injured. Treatment with Wuwei Yigong San (Five-Ingredient Extraordinary Efficacy Powder) plus Chaihu resulted in rapid improvement.
One infant presented with abdominal distension, green-white stools, a mass on the left side of the abdomen, sallow complexion, red and ulcerated gums, poor appetite, and food residue around the mouth. I primarily used Yigong San to regulate and tonify Middle Qi, assisted by Da Wuyi Tang (Great Wormwood Decoction) to clear Gi accumulation and heat. After more than a month, symptoms improved slightly. Continued use of Yigong San and Emawang Wan (Toad Pill), along with external application ofawei Gao (Asafoetida Plaster), eliminated the mass within two months. Mild pain in the left hypochondrium remained, which was cured using Sijunzi Tang (Four Gentlemen Decoction) and Jiwei Lujian Wan (Nine-Ingredient Aloe Pill).
Hezi Wan (Brown Seed Pill) for treating Gi swelling:
Luobozhi (Brassicae Semina, 1 liang, lightly stir-fried), Chenpi (Citri Reticulatae Pericarpium), Qingpi (Citri Reticulatae Pericarpium Viride, stir-fried), Binglang (Arecae Semen), Wulingzhi (Trogopterori Faeces), Pengzhu (Curcumae Rhizoma, baked), Hei Qianniu (Stemonidis Rhizoma, first and last portions half each, stir-fried), Chi Fuling (Poria with Red Hosta Root), Muxiang (Aucklandiae Radix, 2 qian 5 fen).
Grind into powder, make pills with wheat paste, size of mung beans. Take 15 pills per dose, washed down with Perilla Decoction.
Jinkui Ji Jian Shenqi Wan (Modified Kidney Qi Pill from the Golden Cabinet):
Shudihuang (Rehmanniae Radix Praeparata, 8 liang), Ganshanyao (Dioscoreae Rhizoma), Shanzhuyu (Corni Fructus, 4 liang each), Zexie (Alismatis Rhizoma), Bai Fuling (Poria, 3 liang each), Mudanpi (Moutan Cortex), Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Preparata, processed), Cheqianzi (Plantaginis Semen, stir-fried), Niuxi (Achyranthis Bidentatae Radix, lightly stir-fried with wine, 1 liang each).
Grind each ingredient separately into powder. Make pills with rice paste, size of adzuki beans. Take 30–40 pills per dose, washed down with plain warm water before meals on an empty stomach.
Zishuang Wan (See Jingfeng chapter for formula)
Da Chaihu Tang (See Jingzheng chapter for formula)
Wuling San (See Wulin chapter for formula)
Baohe Wan (See Xu Lei chapter for formula)
Tianma San (See Bainei Sou chapter for formula)
Da Wuyi Tang
Emawang Wan
Jiwei Lujian Wan (See Gansheng chapter for formulas)