《经》曰∶足太阴虚则臌胀。又曰∶胃中寒则胀满。又曰∶浊气在上，则生 胀。夫腹胀由脾肺气虚，不能
健运，以致作胀，有虚胀、实胀、寒胀、热胀之别。大抵虚胀寒胀，已居十之八九，实胀热胀，只居十之二三。
何则？实热之证，人所易见，或因伤食，或因伤寒入里，故易知而易治。虚寒之证，由中气衰虚，脾气不化而胀，
故难见而难医。苟以虚寒认为实热，则去题万里，其变不可胜言矣。因作腹胀解。
小儿久病脾虚，或吐泻暴伤脾气，健运失常，所以饮食不化，食少腹即胀满，现证精神倦怠，面黄肌瘦，此
虚胀也。古法主香朴四君子汤（如人参、土炒白术、茯苓、炙甘草、制香附、姜炒浓朴，引用生姜）。
〔真按〕小儿虚胀，多因久病内伤其脾，或因服药攻下太过，皆成腹胀。方用吉林参须五分，紫浓朴一钱，
真广皮钱半，制金钱术钱半，白云苓钱半，草蔻仁五分，南木香五分，炙甘草五分。兼寒者，加熟附子五分。
小儿饮食过度，则胃中停滞，以致腹胀大便不利，身体潮热，心烦口渴，形气壮实，此实胀也。轻者古法主
加味平胃汤（如炒苍术、炒浓朴、大腹皮、生甘草、陈皮、莱菔子、焙山楂、炒麦芽、炒神曲，引用生姜）。
重者，古法主小承气汤（方见前）。
〔真按〕小儿实胀，多因腹中原有食积，或饮食过饱，故结于中，其候胃口胸前高胀，身热口渴，倦卧不语，
腹痛微喘，目闭不开，显然虚极之象，小儿此证最多，若非详细审察，但见其四肢不举，口闭不开，误为慢惊，
而用宁神导痰之剂，则误儿不浅，咎将谁归。方用小枳实一钱，白蔻仁一钱，南山楂钱半，炒麦芽一钱，范志曲
一钱，生锦纹五分。玄明粉钱半，生甘草五分，生条芩一钱，引用莱菔子八分、大腹子五分。
《黄帝内经》说：足太阴脾经虚弱会导致鼓胀。又说：胃中有寒就会感到胀满。还说：浊气停留在上部，就会产生胀病。腹胀是由于脾肺之气虚弱，不能正常运化水谷精微，从而导致腹部胀大，分为虚胀、实胀、寒胀、热胀几种类型。大体上，虚胀和寒胀占了八九成，实胀和热胀只占两三成。为什么呢？实热证候，人们容易看见，可能是因为饮食积滞，也可能是因为伤寒邪气入里化热，所以容易诊断也容易治疗。虚寒证候，是因为中气衰败虚弱，脾气无法运化而产生胀满，所以难以发现且难以医治。如果把虚寒证误认为是实热证，那就差之千里，其产生的变证不可胜数。因此撰写了这篇关于腹胀的解析。
小儿久病导致脾气虚弱，或者因呕吐腹泻突然损伤脾气，致使脾胃运化功能失常，所以食物不能消化，吃得少肚子就胀满，表现出精神疲倦乏力，面色萎黄，身体消瘦，这是虚胀。古代医法主要使用香朴四君子汤（包含人参、土炒白术、茯苓、炙甘草、制香附、姜炒浓朴，煎药时加入生姜作为药引）。
[陈守真按语] 小儿虚胀，多因久病内伤脾脏，或者因为服药攻下太过，都形成腹胀。方子用吉林参须五分，紫浓朴一钱，真广皮一钱半，制金钱术一钱半，白云苓一钱半，草蔻仁五分，南木香五分，炙甘草五分。兼有寒象的，加熟附子五分。
小儿饮食过度，导致胃中停滞，从而引起腹胀、大便不通畅，身体出现潮热，心烦口渴，形体气势壮实，这是实胀。轻症者，古代医法主要使用加味平胃汤（包含炒苍术、炒浓朴、大腹皮、生甘草、陈皮、莱菔子、焙山楂、炒麦芽、炒神曲，煎药时加入生姜作为药引）。重症者，古代医法主要使用小承气汤（方剂见前文）。
[陈守真按语] 小儿实胀，多因腹中原有食积，或者饮食过饱，导致邪气结聚在中焦，其症状表现为胃口和胸前部位高起胀满，身体发热口渴，疲倦嗜卧不愿说话，腹痛伴有轻微气喘，眼睛紧闭不睁开，这显然是极度虚弱的表象。小儿患此证非常多，如果不是详细审察病情，只见其四肢不动、口闭不开，就误认为是慢惊风，而使用宁神导痰的药物，那么对小儿的伤害就不浅，责任归咎于谁呢？方子用小枳实一钱，白蔻仁一钱，南山楂一钱半，炒麦芽一钱，范志曲一钱，生锦纹五分。玄明粉一钱半，生甘草五分，生条芩一钱，煎药时加入莱菔子八分、大腹子五分作为药引。
The *Classic of Internal Medicine* (*Huangdi Neijing*) states: Deficiency of the Foot-Taiyin Spleen meridian leads to distension and swelling (Gu Zhang). It also states: Cold in the Stomach leads to fullness and distension. Furthermore, it states: When turbid Qi remains in the upper jiao, distension arises. Abdominal distension is caused by deficiency of Lung and Spleen Qi, which fails to perform normal transportation and transformation, resulting in abdominal bloating. It is categorized into deficiency distension, excess distension, cold distension, and heat distension. Generally speaking, deficiency and cold distensions account for eight or nine out of ten cases, while excess and heat distensions account for only two or three out of ten. Why is this? Excess-heat patterns are easily observed by people; they may arise from food stagnation or from Taiyang cold pathogen penetrating inward and transforming into heat. Therefore, they are easy to diagnose and treat. In contrast, deficiency-cold patterns result from the decline and deficiency of Middle Qi, where Spleen Qi fails to transform and transport, leading to distension. Thus, they are difficult to detect and treat. If deficiency-cold is mistaken for excess-heat, the diagnosis will be completely off the mark, and the resulting complications will be countless. Hence, this analysis on abdominal distension is presented.
In children, prolonged illness can weaken Spleen Qi, or acute vomiting and diarrhea can suddenly injure Spleen Qi, disrupting normal transportation and transformation. Consequently, food is not digested; even with little intake, the abdomen becomes full and distended. The presenting symptoms include mental fatigue, sallow complexion, and emaciation. This is deficiency distension. Ancient methods primarily prescribe Xiangpo Sijunzi Tang (Cinnamon Twig and Magnolia Bark Four Gentlemen Decoction), containing Renshen (Ginseng Radix), Tu Chao Baizhu (Earth-fried Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Zhi Gancao (Honey-fried Licorice Root), Zhi Xiangfu (Prepared Cyperi Rhizoma), Jiang Chao Houpo (Ginger-fried Magnolia Bark), with Shengjiang (Fresh Ginger) as a guiding herb.
[Chen Shouzhen’s Note] Children’s deficiency distension often results from prolonged illness injuring the Spleen internally, or from excessive use of purgative medicines, both leading to abdominal distension. The formula uses Jilin Renshen Xu (Jilin Ginseng Tendril) 5 fen, Zi Houpo (Purple Magnolia Bark) 1 qian, Zhen Guangpi (Authentic Tangerine Peel) 1.5 qian, Zhi Jinshu (Prepared Atractylodis Macrocephalae Rhizoma) 1.5 qian, Bai Yunling (White Poria) 1.5 qian, Cao Kou Ren (Grass Cardamom Seed) 5 fen, Nan Muxiang (Southern Costus Root) 5 fen, Zhi Gancao (Honey-fried Licorice Root) 5 fen. If accompanied by cold signs, add Shu Fuzi (Prepared Aconite Lateralis Radix) 5 fen.
When children overeat, food stagnates in the Stomach, causing abdominal distension and difficulty in defecation. Symptoms include tidal fever, irritability, thirst, robust physical constitution, and strong Qi. This is excess distension. For mild cases, ancient methods primarily prescribe Jiawei Pingwei Tang (Modified Earth Regulating Decoction), containing Chao Cangzhu (Fried Atractylodis Lanceae Rhizoma), Chao Houpo (Fried Magnolia Bark), Dafupi (Areca Peel), Sheng Gancao (Raw Licorice Root), Chenpi (Tangerine Peel), Laifuzi (Radish Seed), Bei Shanzha (Roasted Hawthorn Fruit), Chao Maiya (Fried Hordeum Sprout), Chao Shenqu (Fried Mass Medicamentii Fermentati), with Shengjiang (Fresh Ginger) as a guiding herb. For severe cases, ancient methods primarily prescribe Xiao Chengqi Tang (Minor Order the Qi Decoction) (see previous text).
[Chen Shouzhen’s Note] Children’s excess distension often stems from pre-existing food accumulation in the abdomen or overeating, causing pathogens to knot in the Middle Jiao. The presentation includes high distension at the epigastrium and chest, body heat, thirst, lethargy with unwillingness to speak, abdominal pain with slight panting, and eyes closed tightly. These appear to be obvious signs of extreme deficiency. This pattern is very common in children. If one does not examine carefully and mistakes the immobility of limbs and closed mouth for Slow Convulsion (Man Jing Feng), thereby using sedating and phlegm-resolving formulas, the harm to the child will be profound. Who would bear the responsibility? The formula uses Xiao Zhishi (Small Immature Bitter Orange) 1 qian, Bai Kou Ren (White Cardamom Seed) 1 qian, Nan Shanzha (Southern Hawthorn Fruit) 1.5 qian, Chao Maiya (Fried Hordeum Sprout) 1 qian, Fan Zhi Qu (Fan-style Mass Medicamentii Fermentati) 1 qian, Sheng Jinwen (Raw Rheum Palmatum Rhizoma) 5 fen. Xuanmingfen (Mirabilite) 1.5 qian, Sheng Gancao (Raw Licorice Root) 5 fen, Sheng Tiaohuang Qin (Raw Scutellaria Baicalensis Root) 1 qian, with Laifuzi (Radish Seed) 8 fen and Dafuzi (Areca Seed) 5 fen as guiding herbs.