河间方有麝香、龙胆，无琥珀，易名苦葶苈膏，治法与此方同。
〔仲〕腹满，口舌干燥，此肠胃间有水气，防己椒苈丸主之。
防己 椒目 葶苈（炙） 大黄（各一两）
上四味，末之，蜜为丸如桐子大。先食饮服十丸，日三服。稍增，口中自有津液。渴者，加芒硝五钱。
〔无〕葶苈丸 治肿满腹大，四肢枯瘦，小便涩浊。
甜葶苈（隔纸炒） 荠菜根（等分）
上为末，蜜丸如弹子大。每服一丸，陈皮汤嚼下。只三丸，小便清数，丸当依旧。（以上葶苈、椒目行湿。）
〔罗〕白丸子 治单腹胀，神效。（方见水胀门。）
〔洁〕治水气蛊胀，洁净府，楮实子丸。
楮实子（一斗，水二斗熬成膏子） 白丁香（一两半） 茯苓（三两）
上二味为末，用楮实膏为丸，如桐子大。不计丸数，从少至多，服至小便清利及腹胀减为度。次服中治丸，
末治药调养，疏启其中。忌甘苦。峻补其下，宜五补七宣丸。（白丁香为行湿之剂。中治丸即白术散，用白术、
泽泻等分以为末，茯苓煎汤调下。末治即黄 建中之类方，并见水肿门。）
〔世〕治蛊。用虾蟆一枚；去内肠，入蝼蛄七个，新瓦上焙干为末丸，酒服。如无蝼蛄，用缩砂七粒，（本
草云∶虾蟆味辛寒有毒，主邪气，破瘕坚。）
〔《素》〕黄帝问曰∶有病心腹满，旦食则不能暮食，此为何病？岐伯对曰∶名为鼓胀。帝曰∶治之奈何？
岐伯曰∶治之以鸡矢醴，一剂知，二剂已。帝曰∶其时有复发者何也？岐伯曰∶此饮食不节，故时有病也。虽
然，其病且已，时故当病，气聚于腹也。（腹中论 王注∶鸡矢大利小便，微寒，用汤渍服之。洁古云∶以酒调服。）
〔无〕五积，久必心腹胀满。肝为肥气，心为伏梁，肺为息奔，脾为痞气，肾气奔豚，如斯之类，从五积
法治之可也。
〔丹〕朱恕八哥，肚肿，因湿气起自五月，能饮酒，左胁有块，两足时有肿。
白术 三棱（醋炒） 木通 陈皮 大腹皮 赤茯苓 海金沙（各五分） 甘草（二分） 炒朴（五分） 肉桂（三
分）
煎汤下保和丸三十、温中丸三十、抑青丸十丸。
〔垣〕广术溃坚丸 治中满腹胀，内有积坚硬如石，形如盘，令人坐卧不宁，大小便涩滞，为喘气促，面色痿黄。
浓朴（五分，生） 黄芩（五分） 黄连（六分） 草豆蔻（五分） 益智（五分） 半夏（七分） 蓬术（二分）
甘草（生） 红花（一钱） 柴胡 升麻 吴茱萸 泽泻（各二分） 神曲（三分） 归梢（五分） 青皮（二分） 陈
皮（一分） 葛根（四分，治虚渴）
上锉，如麻豆大，水二盏，煎至一盏，去渣，稍热服。忌酒面。二服之后，中满减半。止有积不消，再立
方，名曰半夏浓朴汤。
浓朴（八分） 半夏（一钱） 吴茱萸 肉桂 红花 黄连（各一分） 桃仁（七分） 苏木（五分） 京三棱 苍
术白术 柴胡 葛根（不渴不用） 甘草（生。各三分） 归梢 猪苓 干姜 升麻（各四分） 草豆蔻（二钱） 泽
泻（六分） 木香 青皮 陈皮 黄芩（生，各二分） 昆布（少） 神曲
上锉，如麻豆大，作一服，根据前煎服之。禁忌如前。服此药二服后，前证又减一半，却于前药中加减之。
浓朴（五分） 黄芩（二分） 甘草（炙，五分） 吴茱萸（一分） 益智（二分） 砂仁（一分） 豆蔻（三分）
半夏（四分） 黄 （四分） 红花（少） 归梢（一钱） 黄连（一分）
上锉，如麻豆大，作一服，水二大盏，煎至一盏，去渣，稍热服，食前。忌苦寒药泄大便，又忌鱼、兔肉
并盐物、房事等项。
〔丹〕心腹膨 ，内多食积所致。
南星（一两半） 半夏 栝蒌仁（研，和烂。各一两） 香附（童便浸） 黄连（姜炒。各二两） 礞石（硝 ）
萝卜子（五钱） 麝香（少） 连翘（五钱）
上用面糊为丸。
腹肿不宽满，食肉多。
黄连（一两） 阿魏（半两，醋浸，擂细）
作糊丸，同温中丸，白术汤送下。
食肉多，腹胀，用三补丸料内加香附、半夏曲、蒸饼丸服。（三补方见治寒热。）
〔世〕四炒枳壳丸 治气血凝滞，腹内蛊胀。
枳壳（四两，去穣，切作指面大块，分四处。一两，用苍术一两同炒黄，去苍术；一两，用萝卜子一两
同炒黄，去萝卜子；一两，用干漆一两同炒黄，去干漆；一两，用茴香一两同炒黄，去茴香。止用枳壳为细末）
上用原炒苍术、萝卜子、干漆、茴香四味，同水二碗，煎至一碗，去渣，煮面糊为丸，如桐子大。每服五
十丸，食后米饮下。
〔孙〕殿中丞某郎中妹，十岁，腹痛色不变，按之而大陷，心腹痞膈，病已月余。按《甲乙经》云∶三焦
胀者，气满于皮肤中，壳然石坚。遂与仲景方，浓朴、生姜二两，半夏七钱，甘草半两，人参一钱。每用药一
两五钱，水煎分三服，一日服之。至二十日愈。
〔洁〕枣一斗，置锅内，入水约四指，用大戟并根苗盖遍，盆合之煮熟为度，去大戟不用，旋旋吃枣无时，
枣尽，决效如神。
〔丹〕大戟为末，枣肉丸。每七丸，泄利小水，劫快实者。
〔垣〕沉香交泰丸 治胀，大便燥结，脉沉之洪缓，浮之弦者。
沉香 白术（各三钱） 枳实（炒，一钱） 浓朴（姜制，五钱） 茱萸（汤泡） 白茯苓 泽泻 陈皮
当归（各二钱） 大黄（酒浸，一两） 青皮 木香（各二钱）
上为细末，汤浸蒸饼为丸，桐子大。每服五十丸，加至七八十丸，温汤下，食后。微利止。
沉香海金沙丸 治一切积聚，脾湿肿胀，肚大青筋，羸瘦恶证。
海金沙（五钱半） 沉香（二钱） 轻粉（一钱） 牵牛末（一两）
上为末，研独科蒜如泥为丸，如桐子大。每服三十丸，加至五十丸，煎百沸灯心通草汤空腹送下。更量虚
实加减丸数，取利为度。
〔洁〕治肿木香散 治水肿胀大如鼓，或遍身皆肿。
木香 大戟 白牵牛（各等分）
上细末。用猪腰子一双，批片掺末在内，煨熟，空心服之。如食左腰子则拓左臂，如食右腰子拓右
臂。如肿不能全去，于肚上绕脐满腹，涂甘遂细末，却饮甘草水少许，其肿便去也。
〔《竹》〕香枣丸 治蛊气病有十种。
苦丁香为细末，用熟枣为丸，如桐子大。每服三十丸，煎枣汤送下，空心服之，立效。三服大愈。
〔仲〕病腹满，发热十日，脉浮而数，饮食如故，浓朴七物汤主之。
浓朴（半斤） 甘草 大黄（各三两） 大枣（十枚） 枳实（五个） 桂枝（三两） 生姜（五两）
上七味，以水一斗，煮取四升，温服八合，一日三服。呕者，加半夏五合。下利，去大黄。寒多者，加生
姜至半斤。
上下胀诸方，盖本于经，所谓泄之则胀已之旨也。
〔丹〕治胀专主湿热，治法见前补虚行湿条。
〔垣〕诸腹胀大皆属于热论此乃八益之邪，有余之证，自天外而入，感风寒之邪，自表传里，寒变为
热，作胃实腹病，日晡潮热，大渴引饮，谵语，是太阳阳明并大实大满者，大承气汤下之。少阳阳明微满实者，
小承气汤下之。《内经》曰泄之则胀已，此之谓也。又热论云伤寒变为热，故下之不胀者，以明寒因寒用，故
曰下之胀已，非阴盛生内寒，胃寒胀满之病。假令 疟为胀满，亦有寒胀热胀，是天之邪气伤暑而得之。不即
时发，至秋发者，何也？暑天当时助正气，故邪不能发。至秋暮，暑气衰绝，而疟病作矣。知其寒也，《局方》
用交解饮子者是也。此天之邪气虽有余，病 疟犹以为寒，况不足病为胀满者乎？是知腹胀多为寒病也。何以
言之？《脉经》云∶胃中寒则胀满。《灵枢经》云∶夫饮食不节，起居不时，末传寒中。又云∶腹胀满，
胃脘当心而痛，上支两胁，膈咽不通，饮食不下，取胃之三里。又云∶浊气在上，则生 胀。《灵枢经》云∶
胀取三阳。三阳者，足太阳膀胱寒水为胀，与《内经》通评虚实论说∶腹暴满，按之不下，取足太阳经络者，
胃之募也。正同。又云∶腹满 胀，支膈 胁，下厥上冒，过在太阴阳明。此乃胃中寒热郁遏也。又云∶太
阴之厥，则腹满 胀，后不利，不欲食，食则呕不得卧。按《内经》所说寒胀多如此，老夫但略举其端。其病
者不悟寒胀之多，一切胀满病作热治之，多用三花神佑丸，大黄、牵牛之类下之，或药病不相应，立致夭折。
由是论之，当从《灵枢》、《素问》乎？当从俗医胸臆之论乎？今立治中满 胀寒胀一方，热胀一方，评而用
之，使上下分消其气可也。（中满分消汤治寒胀，分消丸治热胀，二方并见后条。）
〔《灵》〕胃中寒，则腹胀。胃中寒，肠中热，则胀而且泄。（师传篇）
适寒凉者胀，下之则胀已。（五常政论 东垣沉香海金沙丸方见脉实篇。）阴并于下则足寒，足寒则胀也。（厥论）
〔垣〕浊气在上则生 胀阴阳应象论云∶清气在下，则生飧泄；浊气在上，则生 胀，此阴阳反作病之
逆从也。夫 胀者，以寒热温凉论之，此何胀也？曰∶此饮食失节为胀，乃受病之始也。湿热亦能为胀，右
关脉洪缓而沉弦。脉浮于上，是风湿热三脉相合而为病也。是脾胃之令不行，阴火亢甚，乘于脾胃，盛则左迁
而阳道不行，是六腑之气已绝于外。火盛能令母实，风气外绝。风气外绝者，是谷气入胃，清气营气不行，便
是风气也，异呼同类，即胃气者是也。经云∶虚则兼其所胜。土不胜者，肝之邪也，是脾胃之土不足，木火大
胜者也。经云∶浊阴出下窍，浊阴走五脏，浊阴归六腑，浊阴归地。此平康不病之常道，反此则为胀也。阴阳
论云∶饮食不节，起居不时者，阴受之，阴受之则入五脏，入五脏则 胀闭塞。调经篇云∶下脘不通，则胃气
热，热气熏胸中，故内热。下脘者，幽门也。人身之中，上下有七冲门，皆下冲上也。幽门上冲吸门，吸门者，
会厌也。冲其吸入之气，不得下归于肾，肝为阴火动相拒，故咽膈不通，致浊阴之气不得下降，而大便干燥不
行，胃之湿与客阴之火俱在其中，则腹胀作矣。治在幽门，使幽门通利，泄其阴火，润其燥血，生益新血。幽
门通利，则大便不闭，吸门亦不受邪，其膈咽得通， 满腹胀俱去，是浊阴得下归地矣。故经曰∶中满者泻之
于内，此法是也。
沉香交泰丸 治浊气在上，中扰清阳之气，郁而不伸，以为腹胀，服之以利为度。（方见前。）
上治脉洪、便结而胀。
范天秩郎中之内，八月中先因劳役饮食失节，加之忧思气结，病心腹胀满，旦食则不能暮食，两胁刺痛，
诊其脉弦而细。至夜浊阴之气当降而不降， 胀尤甚。大抵阳主运化，饮食劳倦，损伤脾胃，阳气不能运化精
微，聚而不散，即为胀满。先灸中脘，乃胃之募穴，引胃中生发之气，上行阳道，后以顺气汤助之，则浊阴之
气，自此而降矣。
木香顺气汤 治浊气在上，则生 胀。
木香 苍术 草豆蔻（面裹煨。各三分） 浓朴（制，四分） 青皮（一钱） 益智 陈皮 泽泻 白茯
苓（去皮） 半夏 干姜 吴
茱萸（汤泡。各二分） 当归 人参（各五分） 升麻 柴胡（去芦。各一分）
《内经》曰∶留者行之，结者散之。以柴胡、升麻之苦平，行少阳阳明二经，发散清气，营运阳分为君。以生
姜、半夏、草豆蔻、益智仁之甘辛大热，消散中寒为臣。以浓朴、木香、苍术、青皮之辛苦大温，通顺滞气；
以陈皮、当归、人参辛甘温，调和荣卫，滋养中气；浊气不降，宜以苦泄之，吴茱萸之苦热泄之者也；气之
薄者，为阳中之阴，茯苓甘平，泽泻咸平，气薄引浊阴之气自上而下，故以为佐。气味相合，散之泄之，上
之下之，使清浊之气各安其位也。
上 咀，都作一服，水二盏，煎至一盏，去渣温服，食前。忌生冷硬物。
上治脉弦细、胁痛而胀。
中满分消汤 治中满寒胀、寒疝，大小便不通，阴躁足不收，四肢厥逆，食入反出，下虚中满，腹中寒，心下
痞，下焦躁寒沉厥，奔豚不收，二服愈。
黄 （五分） 益智 半夏（各三分） 川乌（一分） 吴茱萸 草豆蔻（各五分） 人参 木香 青皮 当归 黄
连（各二分） 浓朴（五分） 茯苓 泽泻 生姜 麻黄（不去节。各二分） 升麻（三分） 柴胡梢 干姜 荜澄茄
（各二分） 黄柏（五分）
上锉如麻豆大，作一服，水二盏，煎至一盏，去渣稍热服，食前。大忌房劳、酒、面、生冷、硬物、油腻。
〔丹〕治大人小儿，因食果子多而腹胀气急者。肉桂细米饭丸，绿豆大。每服十丸，小儿五粒，热水下。（《经验方》）
〔垣〕《灵枢经》云∶腹满大便不利，上走胸臆，喘息喝喝然，取足少阴。取者，泻也。宜以辛热散之。
良姜 肉桂 益智 草豆蔻仁 浓朴 升麻 甘草 独活（使） 黄柏（少许引用）
又方
桂枝 桔梗 人参 青皮（少许） 陈皮 良姜 白术 泽泻 吴茱萸
四肢湿肿，宜缪刺。先泻其血结，后调其真经。（谓刺去其血结是也。）
河间（刘完素）的方剂中有麝香、龙胆，没有琥珀，改名为苦葶苈膏，治疗方法与此方相同。
〔张仲景〕腹部胀满，口舌干燥，这是肠胃间有水气停留，用防己椒苈丸主治。
防己 椒目 葶苈子（炙） 大黄（各一两）
以上四味药，研成细末，用蜂蜜制成如梧桐子大小的丸药。饭前饮服十丸，每日三次。逐渐增加剂量，口中自然会有津液产生。如果口渴，加芒硝五钱。
〔王好古〕葶苈丸 治疗全身浮肿、腹部胀大，四肢枯瘦，小便涩滞浑浊。
甜葶苈子（隔纸炒） 荠菜根（等分）
以上两味药研成细末，用蜂蜜制成如弹子大小的丸药。每次服用一丸，用陈皮汤送服并嚼碎。只需服用三丸，小便就会变得清澈且次数增多，丸药的用法就恢复常规。（以上葶苈子、椒目具有行湿的作用。）
〔李东垣〕治疗水气蛊胀，通过洁净下焦（利小便），使用楮实子丸。
楮实子（一斗，加水二斗熬成膏状） 白丁香（一两半） 茯苓（三两）
以上两味药（注：原文此处似漏列或指代不清，依文意应为楮实膏与白丁香、茯苓配合，或仅指后两者为末，以膏为丸，此处按原文直译）研成细末，用楮实膏制成如梧桐子大小的丸药。不限丸数，从少到多服用，直到小便清利且腹胀减轻为止。接着服用中治丸，
用末治药进行调养，疏通中焦。忌食甘味和苦味食物。峻补下焦，宜用五补七宣丸。（白丁香是行湿的药物。中治丸即白术散，由白术、泽泻等分研末，用茯苓煎汤调服。末治即黄芪建中汤之类的方剂，均见水肿门。）
〔世传方〕治疗蛊胀。用一只蛤蟆；去掉内脏，放入七个蝼蛄，在新瓦上焙干研末制丸，酒送服。如果没有蝼蛄，用缩砂仁七粒。（《本草》记载：蛤蟆味辛寒有毒，主治邪气，破除瘕坚积聚。）
〔《黄帝内经·素问》〕黄帝问道：有人患心腹满闷，早上吃了东西晚上就不能再吃，这是什么病？岐伯回答说：名叫鼓胀。黄帝说：怎么治疗？岐伯说：用鸡矢醴治疗，服一剂见效，服两剂痊愈。黄帝说：为什么有时还会复发？岐伯说：这是因为饮食不节制，所以时常发病。虽然如此，病势已经平息，但时机到了仍会发病，因为气聚在腹部。（《腹中论》王冰注：鸡矢大利小便，性微寒，用汤剂浸泡后服用。洁古说：用酒调服。）
〔王好古〕五积，日久必然导致心腹胀满。肝积名为肥气，心积名为伏梁，肺积名为息奔，脾积名为痞气，肾积名为奔豚，像这类情况，按照治疗五积的方法处理即可。
〔朱丹溪〕朱恕八哥，肚子肿胀，因湿气从五月开始发作，能饮酒，左胁下有肿块，双脚时常肿胀。
白术 三棱（醋炒） 木通 陈皮 大腹皮 赤茯苓 海金沙（各五分） 甘草（二分） 炒厚朴（五分） 肉桂（三分）
煎汤送服保和丸三十丸、温中丸三十丸、抑青丸十丸。
〔李东垣〕广术溃坚丸 治疗中满腹胀，体内有积块坚硬如石，形状如盘，令人坐卧不安，大小便涩滞，气喘急促，面色萎黄。
厚朴（五分，生用） 黄芩（五分） 黄连（六分） 草豆蔻（五分） 益智仁（五分） 半夏（七分） 蓬术（二分）
甘草（生用） 红花（一钱） 柴胡 升麻 吴茱萸 泽泻（各二分） 神曲（三分） 当归梢（五分） 青皮（二分） 陈皮（一分） 葛根（四分，治疗虚渴）
以上药物切碎，如麻豆大小，用水两盏，煎至一盏，去渣，稍热时服用。忌酒和面食。服用两剂后，中满症状减半。如果只有积块不消，再立一方，名叫半夏厚朴汤。
厚朴（八分） 半夏（一钱） 吴茱萸 肉桂 红花 黄连（各一分） 桃仁（七分） 苏木（五分） 京三棱 苍术 白术 柴胡 葛根（不渴不用） 甘草（生用。各三分） 当归梢 猪苓 干姜 升麻（各四分） 草豆蔻（二钱） 泽泻（六分） 木香 青皮 陈皮 黄芩（生用，各二分） 昆布（少量） 神曲
以上药物切碎，如麻豆大小，作为一服药，按照前面的方法煎服。禁忌同上。服用此药两剂后，前述症状又减轻一半，然后在前方的基础上加减用药。
厚朴（五分） 黄芩（二分） 甘草（炙，五分） 吴茱萸（一分） 益智仁（二分） 砂仁（一分） 豆蔻（三分）
半夏（四分） 黄芪（四分） 红花（少量） 当归梢（一钱） 黄连（一分）
以上药物切碎，如麻豆大小，作为一服药，用水两大盏，煎至一盏，去渣，稍热时服用，饭前。忌苦寒药导致大便泄泻，又忌鱼、兔肉以及盐类食物、房事等事项。
〔朱丹溪〕心腹膨隆，多由内停食积所致。
南星（一两半） 半夏 瓜蒌仁（研烂，混合均匀。各一两） 香附（童便浸泡） 黄连（姜炒。各二两） 礞石（硝煅）
萝卜子（五钱） 麝香（少量） 连翘（五钱）
以上药物用面糊制成丸药。
腹部肿胀但不宽满，吃肉较多。
黄连（一两） 阿魏（半两，醋浸，捣细）
制成糊丸，同温中丸一起，用白术汤送服。
吃肉多，腹胀，在三补丸料中加入香附、半夏曲、蒸饼制丸服用。（三补方见治寒热条。）
〔世传方〕四炒枳壳丸 治疗气血凝滞，腹内蛊胀。
枳壳（四两，去瓤，切成手指甲盖大小的块，分四处。一两，用苍术一两同炒黄，去掉苍术；一两，用萝卜子一两同炒黄，去掉萝卜子；一两，用干漆一两同炒黄，去掉干漆；一两，用茴香一两同炒黄，去掉茴香。只用枳壳研成细末）
以上用原炒过的苍术、萝卜子、干漆、茴香四味药，同水两碗，煎至一碗，去渣，煮面糊制成丸药，如梧桐子大小。每次服用五十丸，饭后米饮送服。
〔孙思邈〕殿中丞某郎中的妹妹，十岁，腹痛但面色不变，按压腹部凹陷不起，心腹痞塞膈阻，患病已一个多月。查阅《甲乙经》记载：三焦胀者，气充满于皮肤中，坚硬如石。于是给予张仲景的方剂，厚朴、生姜各二两，半夏七钱，甘草半两，人参一钱。每用药一两五钱，水煎分三次服，一天服完。到二十日痊愈。
〔李东垣〕枣一斗，放在锅内，加入约四指深的水，用大戟及其根苗覆盖在上面，用盆盖住煮熟为止，去掉大戟不用，随时慢慢吃枣，枣吃完，疗效如神。
〔朱丹溪〕大戟研末，枣肉制丸。每次七丸，用于泄利小水，攻逐实证。
〔李东垣〕沉香交泰丸 治疗腹胀，大便燥结，脉沉取洪缓，浮取弦象。
沉香 白术（各三钱） 枳实（炒，一钱） 厚朴（姜制，五钱） 吴茱萸（汤泡） 白茯苓 泽泻 陈皮
当归（各二钱） 大黄（酒浸，一两） 青皮 木香（各二钱）
以上研成细末，用汤浸蒸饼制成丸药，如梧桐子大小。每次服用五十丸，加至七八十丸，温开水送服，饭后。轻微腹泻即止。
沉香海金沙丸 治疗一切积聚，脾湿肿胀，肚大青筋，消瘦恶证。
海金沙（五钱半） 沉香（二钱） 轻粉（一钱） 牵牛末（一两）
以上研成细末，将独头蒜研成泥状制成丸药，如梧桐子大小。每次服用三十丸，加至五十丸，煎滚灯心草通草汤空腹送服。更根据虚实情况加减丸数，以通便为度。
〔李东垣〕治肿木香散 治疗水肿胀大如鼓，或遍身皆肿。
木香 大戟 白牵牛（各等分）
以上研成细末。用猪腰子一对，切片掺入药末在内，煨熟，空腹服用。如果吃左边的腰子则推拓左臂，如果吃右边的腰子则推拓右臂。如果肿胀不能完全消退，在肚子上绕脐满腹涂甘遂细末，然后喝少许甘草水，肿胀便会消除。
〔竹斋〕香枣丸 治疗蛊气病有十种。
苦丁香研成细末，用熟枣制成丸药，如梧桐子大小。每次服用三十丸，煎枣汤送服，空腹服用，立即见效。服用三次大病愈。
〔张仲景〕患腹部胀满，发热十天，脉浮而数，饮食正常，用厚朴七物汤主治。
厚朴（半斤） 甘草 大黄（各三两） 大枣（十枚） 枳实（五个） 桂枝（三两） 生姜（五两）
以上七味药，用水一斗，煮取四升，温服八合，一日三次。呕吐者，加半夏五合。下利者，去大黄。寒多者，加生姜至半斤。
上下腹胀的各种方剂，大概都源于经典，所谓“泄之则胀已”的宗旨。
〔李东垣〕诸腹胀大都属于热证。论述此乃八益之邪，有余之证，自天外而入，感受风寒之邪，自表传里，寒变为热，造成胃实腹病，日晡潮热，大渴引饮，谵语，这是太阳阳明并见的大实大满证，用大承气汤攻下。少阳阳明微满实者，用小承气汤攻下。《内经》说泄之则胀已，说的就是这个意思。又《热论》说伤寒变为热，所以下之不胀，是为了阐明“寒因寒用”，所以说下之胀已，并非阴盛生内寒、胃寒胀满的病。假如疟疾导致胀满，也有寒胀热胀，这是天之邪气伤暑而得之。不即时发作，到秋天发作的，为什么呢？暑天当时助正气，所以邪气不能发作。到秋末，暑气衰绝，而疟病发作了。知道它是寒证，《局方》用交解饮子就是这样的。这种天之邪气虽有余，病疟仍认为是寒，何况不足病导致的胀满呢？由此可知腹胀多为寒病。为什么说呢？《脉经》说：胃中寒则胀满。《灵枢经》说：饮食不节，起居不时，最终传变为寒中。又说：腹胀满，胃脘当心而痛，上支两胁，膈咽不通，饮食不下，取胃经的三里穴。又说：浊气在上，则生䐜胀。《灵枢经》说：胀取三阳。三阳者，足太阳膀胱寒水导致胀，与《内经》通评虚实论说：腹暴满，按之不下，取足太阳经络者，胃之募也。正相同。又说：腹满䐜胀，支膈胁，下厥上冒，过在太阴阳明。这是胃中寒热郁遏所致。又说：太阴之厥，则腹满䐜胀，后不利，不欲食，食则呕不得卧。按《内经》所说的寒胀大多如此，老夫只是略举其端。那些患者不明白寒胀之多，一切胀满病都作热治，多用三花神佑丸，大黄、牵牛之类攻下，或者药病不相应，立刻导致夭折。
由此而论，应当遵从《灵枢》、《素问》吗？还是遵从俗医胸臆之论呢？现在立下治疗中满䐜胀寒胀一方，热胀一方，评价后使用，使上下分消其气即可。（中满分消汤治寒胀，分消丸治热胀，二方并见后条。）
〔《灵枢经》〕胃中寒，则腹胀。胃中寒，肠中热，则胀而且泄。（师传篇）
适寒凉者胀，下之则胀已。（五常政论 东垣沉香海金沙丸方见脉实篇。）阴并于下则足寒，足寒则胀也。（厥论）
〔李东垣〕浊气在上则生䐜胀。《阴阳应象大论》说：清气在下，则生飧泄；浊气在上，则生䐜胀，这是阴阳反作，病的逆从关系。夫䐜胀者，以寒热温凉来讨论，这是什么胀呢？回答说：这是饮食失节导致的胀，是受病的开始。湿热也能导致胀，右关脉洪缓而沉弦。脉浮于上，是风湿热三脉相合而为病。这是脾胃之令不行，阴火亢甚，乘于脾胃，盛则左迁而阳道不行，是六腑之气已绝于外。火盛能令母实，风气外绝。风气外绝者，是谷气入胃，清气营气不行，便是风气也，异呼同类，即胃气者是也。经云：虚则兼其所胜。土不胜者，肝之邪也，是脾胃之土不足，木火大胜者也。经云：浊阴出下窍，浊阴走五脏，浊阴归六腑，浊阴归地。这是平康不病的常道，反此则为胀也。《阴阳论》说：饮食不节，起居不时者，阴受之，阴受之则入五脏，入五脏则䐜胀闭塞。《调经篇》说：下脘不通，则胃气热，热气熏胸中，故内热。下脘者，幽门也。人身之中，上下有七冲门，皆下冲上也。幽门上冲吸门，吸门者，会厌也。冲其吸入之气，不得下归于肾，肝为阴火动相拒，故咽膈不通，致浊阴之气不得下降，而大便干燥不行，胃之湿与客阴之火俱在其中，则腹胀作矣。治在幽门，使幽门通利，泄其阴火，润其燥血，生益新血。幽门通利，则大便不闭，吸门亦不受邪，其膈咽得通，䐜满腹胀俱去，是浊阴得下归地矣。故经曰：中满者泻之于内，此法是也。
沉香交泰丸 治疗浊气在上，中扰清阳之气，郁而不伸，以为腹胀，服之以利为度。（方见前。）
上面治疗脉洪、便结而胀。
范天秩郎中的妻子，八月中先因劳役饮食失节，加上忧思气结，病心腹胀满，早上吃了东西晚上就不能再吃，两胁刺痛，诊其脉弦而细。到了夜晚浊阴之气应当下降而不能下降，䐜胀尤其严重。大抵阳主运化，饮食劳倦，损伤脾胃，阳气不能运化精微，聚而不散，即为胀满。先灸中脘穴，乃胃之募穴，引胃中生发之气，上行阳道，后用顺气汤帮助它，则浊阴之气，从此而降了。
木香顺气汤 治疗浊气在上，则生䐜胀。
木香 苍术 草豆蔻（面裹煨。各三分） 厚朴（制，四分） 青皮（一钱） 益智仁 陈皮 泽泻 白茯苓（去皮） 半夏 干姜 吴茱萸（汤泡。各二分） 当归 人参（各五分） 升麻 柴胡（去芦。各一分）
《内经》说：留者行之，结者散之。以柴胡、升麻之苦平，行少阳阳明二经，发散清气，营运阳分为君。以生姜、半夏、草豆蔻、益智仁之甘辛大热，消散中寒为臣。以厚朴、木香、苍术、青皮之辛苦大温，通顺滞气；以陈皮、当归、人参辛甘温，调和荣卫，滋养中气；浊气不降，宜以苦泄之，吴茱萸之苦热泄之者也；气之薄者，为阳中之阴，茯苓甘平，泽泻咸平，气薄引浊阴之气自上而下，故以为佐。气味相合，散之泄之，上之下之，使清浊之气各安其位也。
以上锉粗，都作一服，水两盏，煎至一盏，去渣温服，饭前。忌生冷硬物。
上面治疗脉弦细、胁痛而胀。
中满分消汤 治疗中满寒胀、寒疝，大小便不通，阴躁足不收，四肢厥逆，食入反出，下虚中满，腹中寒，心下痞，下焦躁寒沉厥，奔豚不收，二服愈。
黄芪（五分） 益智仁 半夏（各三分） 川乌（一分） 吴茱萸 草豆蔻（各五分） 人参 木香 青皮 当归 黄连（各二分） 厚朴（五分） 茯苓 泽泻 生姜 麻黄（不去节。各二分） 升麻（三分） 柴胡梢 干姜 荜澄茄（各二分） 黄柏（五分）
以上切碎如麻豆大小，作一服药，水两盏，煎至一盏，去渣稍热服，饭前。大忌房劳、酒、面、生冷、硬物、油腻。
〔朱丹溪〕治疗大人小儿，因吃果子多而腹胀气急者。肉桂细米饭丸，绿豆大。每次十丸，小儿五粒，热水送服。（《经验方》）
〔李东垣〕《灵枢经》说：腹满大便不利，上走胸臆，喘息喝喝然，取足少阴。取者，泻也。宜以辛热散之。
良姜 肉桂 益智仁 草豆蔻仁 厚朴 升麻 甘草 独活（使） 黄柏（少许引用）
又方
桂枝 桔梗 人参 青皮（少许） 陈皮 良姜 白术 泽泻 吴茱萸
四肢湿肿，宜缪刺。先泻其血结，后调其真经。（谓刺去其血结是也。）
The formula from Hejian (Liu Wansu) contains Moschus (She Xiang) and Gentianae Radix (Long Dan), but lacks Succinum (Hu Po). It is renamed Kutingli Gao (Bitter Lepidium Paste), and its treatment method is the same as this formula.
[Zhang Zhongjing] Abdominal fullness with dry mouth and tongue indicates water qi stagnating in the intestines and stomach; Fangji Jiaoli Wan (Piperis Methystici and Lepidii Pill) is the primary prescription.
Fangji (Stephaniae Tetrandrae Radix), Jiaomu (Semen Populi), Tingli (Semen Lepidii, roasted), Dahuang (Radix et Rhizoma Rhei, each one liang).
The above four ingredients are powdered, and honey is used to make pills the size of tung tree seeds. Take ten pills before meals with water, three times a day. Gradually increase the dose until saliva naturally flows in the mouth. If thirst occurs, add Mangxiao (Natrii Sulfas) five qian.
[Wang Haogu] Tingli Wan (Lepidium Pill) treats generalized edema, abdominal distension with large abdomen, emaciated limbs, and scanty turbid urination.
Tiantingli (Sweet Semen Lepidii, stir-fried between papers), Qicai Gen (Radix Capsellae, equal parts).
The above two ingredients are powdered, and honey is used to make pills the size of a bullet. Take one pill per dose, chewed down with Chenpi (Pericarpium Citri Reticulatae) decoction. After only three pills, urination becomes clear and frequent, and the pill usage returns to normal. (Above, Tingli and Jiaomu promote dampness elimination.)
[Luo Tianyi] Bai Wanzi (White Pill) treats isolated abdominal distension with miraculous effect. (Formula see Water Distension section.)
[Li Dongyuan] To treat water qi gu distension by cleansing the lower jiao (promoting urination), use Chushizi Wan (Cudrania Pill).
Chushizi (Fructus Cudrae, one dou boiled with two dou water into paste), Baidingxiang (Excrement Mustelidae, one and a half liang), Fuling (Poria, three liang).
The above two ingredients [Note: Text implies mixing paste with powders] are powdered, and chushizi paste is used to make pills the size of tung tree seeds. Do not limit the number of pills; start from a small amount and increase until urination is clear and profuse and abdominal distension subsides. Then take Zhongzhi Wan (Middle-Treating Pill).
Use Mo Zhi Yao (Powder Treatment Medicine) for conditioning, to open and unblock the middle jiao. Avoid sweet and bitter foods. For severe tonification of the lower jiao, use Wubu Qixuan Wan (Five Tonify Seven Disperse Pill). (Baidingxiang is a dampness-dispelling agent. Zhongzhi Wan is Baizhu San, made of equal parts Baizhu and Zexie powdered, taken with Fuling decoction. Mo Zhi refers to formulas like Huangqi Jianzhong Tang, all seen in the Edema section.)
[Worldly/Popular Formula] To treat Gu distension. Use one toad; remove internal organs, insert seven earthworms, roast on a new tile until dry, powder, make pills, take with wine. If earthworms are unavailable, use seven grains of Shasaren (Amomi Fructus Rotundus). (Bencao states: Toad is acrid, cold, toxic, treats evil qi, breaks firm masses.)
[Su Wen] The Yellow Emperor asked: There is a disease with heart and abdominal fullness, where one cannot eat dinner if they ate breakfast. What is this disease? Qibo replied: It is named Guzhang (Drum Distension). The Emperor asked: How to treat it? Qibo said: Treat with Jishi Li (Chicken Dropping Fermented Liquid); one dose brings improvement, two doses bring cure. The Emperor asked: Why does it sometimes recur? Qibo said: This is due to irregular diet, hence the occasional illness. Although so, when the disease seems resolved, it may still occur because qi gathers in the abdomen. (Fu Zhong Lun, Wang Bing's commentary: Chicken droppings greatly promote urination, slightly cold, taken as a decoction. Jieguy says: Take mixed with wine.)
[Wang Haogu] Wu Ji (Five Accumulations), if prolonged, inevitably lead to heart and abdominal fullness. Liver accumulation is named Feiqi (Fat Qi), Heart accumulation is Fuliang (Hidden Beam), Lung accumulation is Xiben (Breath Rush), Spleen accumulation is Piqi (Stagnant Qi), Kidney accumulation is Bentun (Running Piglet). For such cases, treating according to the methods for Wu Ji is appropriate.
[Zhu Danxi] Zhu Shu Bagu had a swollen belly, caused by dampness starting in May. He could drink alcohol, had a mass in the left hypochondrium, and his feet were occasionally swollen.
Baizhu (Atractodis Macrocephalae Rhizoma), Sanleng (Sparganii Rhizoma, vinegar-fried), Mutong (Akebiae Caulis), Chenpi (Citri Reticulatae Pericarpium), Dafupi (Arecae Pericarpium), Chi Fuling (Red Poria), Haijinsha (Lygodii Spora, each five fen), Gancao (Glycyrrhizae Radix, two fen), Chao Puhuo (Prepared Magnolia Bark, five fen), Rougui (Cinnamomi Cortex, three fen).
Decoct and take with Baohe Wan (Harmonize the Stomach Pill) thirty pills, Wenzhong Wan (Warm the Middle Pill) thirty pills, and Yiqing Wan (Suppress the Green Pill) ten pills.
[Li Dongyuan] Guangshu Kuijian Wan (Curcuma Softening Hardness Pill) treats middle-fullness abdominal distension, with internal accumulations hard as stone, shaped like a plate, causing restlessness in sitting and lying, obstructed urination and defecation, panting, and sallow complexion.
Houpo (Magnoliae Officinalis Cortex, five fen, raw), Huangqin (Scutellariae Radix, five fen), Huanglian (Coptidis Rhizoma, six fen), Caodoukou (Cardamomi Fructus, five fen), Yizhi (Alpiniae Oxyphyllae Fructus, five fen), Banxia (Pinelliae Rhizoma, seven fen), Pengshu (Curcumae Radix, two fen).
Gancao (Licorice Root, raw), Honghua (Carthami Flos, one qian), Chaihu (Bupleuri Radix), Shengma (Cimicifugae Rhizoma), Wuzhuyu (Evodiae Fructus), Zexie (Alismatis Rhizoma, each two fen), Shenqu (Massa Medicata Fermentata, three fen), Guishao (Angelicae Sinensis Radix tip, five fen), Qingpi (Citri Reticulatae Pericarpium Viride, two fen), Chenpi (Citri Reticulatae Pericarpium, one fen), Gegen (Puerariae Radix, four fen, for treating deficiency-thirst).
Cut into pieces the size of hemp seeds. Use two cups of water, decoct to one cup, strain, and take slightly warm. Avoid alcohol and wheat products. After two doses, middle-fullness reduces by half. If only the accumulation remains unresolved, establish another formula named Banxia Houpo Tang (Pinellia and Magnolia Decoction).
Houpo (Magnoliae Officinalis Cortex, eight fen), Banxia (Pinelliae Rhizoma, one qian), Wuzhuyu, Rougui, Honghua, Huanglian (each one fen), Taoren (Persicae Semen, seven fen), Sumu (Sappan Lignum, five fen), Jing Sanleng (Sparganii Rhizoma), Cangzhu (Atractodis Rhizoma), Baizhu, Chaihu, Gegen (omit if no thirst), Gancao (raw, each three fen), Guishao, Zhuling (Polyporus), Ganjiang (Zingiberis Rhizoma), Shengma (each four fen), Caodoukou (two qian), Zexie (six fen), Muxiang (Aucklandiae Radix), Qingpi, Chenpi, Huangqin (raw, each two fen), Kunbu (Laminariae Thallus, small amount), Shenqu.
Cut into pieces the size of hemp seeds. Prepare as one dose, decoct and take as before. Contraindications remain the same. After two doses of this medicine, previous symptoms reduce by half again, then adjust the previous formula.
Houpo (five fen), Huangqin (two fen), Gancao (roasted, five fen), Wuzhuyu (one fen), Yizhi (two fen), Sharen (Amomi Fructus, one fen), Doukou (Cardamomi Fructus, three fen).
Banxia (four fen), Huangqi (Astragali Radix, four fen), Honghua (small amount), Guishao (one qian), Huanglian (one fen).
Cut into pieces the size of hemp seeds. Prepare as one dose, use two large cups of water, decoct to one cup, strain, take slightly warm before meals. Avoid bitter-cold medicines that cause diarrhea, and avoid fish, rabbit meat, salted foods, and sexual intercourse.
[Zhu Danxi] Heart and abdominal distension is mostly caused by internal food retention.
Nanxing (Arisaematis Rhizoma, one and a half liang), Banxia, Gualouren (Trichosanthis Semen, ground and mixed well, each one liang), Xiangfu (Cyperi Rhizoma, soaked in child's urine), Huanglian (stir-fried with ginger, each two liang), Mengshi (Calamina, treated with saltpeter).
Luoboziren (Raphani Semen, five qian), She Xiang (Moschus, small amount), Lianqiao (Forsythiae Fructus, five qian).
Make pills using flour paste.
Abdominal swelling without wide fullness, consuming much meat.
Huanglian (Coptidis Rhizoma, one liang), Aw ei (Ferulae Resina, half liang, soaked in vinegar, ground fine).
Make paste pills, take together with Wenzhong Wan, delivered with Baizhu Tang (Atractodes Decoction).
Consuming much meat, abdominal distension: Add Xiangfu and Banxia Qu (Pinellia Ferment) to the Sanbu Wan (Three Tonify Pill) material, make pills with steamed dough and take. (Sanbu formula see Treating Chills and Fever section.)
[Worldly/Popular Formula] Si Chao Zhiqiao Wan (Four-Fried Immature Bitter Orange Pill) treats qi and blood stagnation, internal gu distension.
Zhiqiao (Immature Bitter Orange Fruit, four liang, remove pith, cut into finger-nail sized large pieces, divide into four parts. One liang stir-fried with one liang Cangzhu until yellow, discard Cangzhu; one liang stir-fried with one liang Luoboziren until yellow, discard Luoboziren; one liang stir-fried with one liang Ganqi (Dry Lacquer) until yellow, discard Ganqi; one liang stir-fried with one liang Huixiang (Fennel) until yellow, discard Huixiang. Use only Zhiqiao powdered finely).
Use the original fried Cangzhu, Luoboziren, Ganqi, and Huixiang, boil with two bowls of water until one bowl remains, strain, cook flour paste to make pills the size of tung tree seeds. Take fifty pills after meals with rice drink.
[Sun Simiao] The younger sister of a certain Langzhong (Director) under Dianzhong Cheng was ten years old, with abdominal pain but unchanged complexion, pressing the abdomen left an indentation. Heart and abdominal blockage persisted for over a month. According to the *Jia Yi Jing*: "Distension of the Sanjiao means qi fills the skin, hard as stone." Thus, Zhang Zhongjing's formula was given: Houpo and Shengjiang (Fresh Ginger) two liang each, Banxia seven qian, Gancao half liang, Renshen (Ginseng Radix) one qian. Each dose of one liang five qian was decocted in water and divided into three servings, taken within one day. Cured in twenty days.
[Li Dongyuan] One dou of dates, placed in a pot, add water about four fingers deep. Cover completely with Daji (Euphorbiae Pekinensis Radix) and its stems/leaves. Cover with a basin and cook until done. Remove Daji and do not use it. Eat dates slowly at any time. When the dates are finished, the effect is miraculous.
[Zhu Danxi] Daji powdered, made into pills with date flesh. Seven pills per dose, to drain fluids and attack excess conditions rapidly.
[Li Dongyuan] Chenxiang Jiaotai Wan (Agarwood Harmonizing Heaven Pill) treats distension, dry constipation, pulse deep and surging/slow, floating and wiry.
Chenxiang (Aquilariae Lignum Resinatum), Baizhu (each three qian), Zhishi (Immature Bitter Orange Fruit, fried, one qian), Houpo (prepared with ginger, five qian), Zhuyu (Evodiae Fructus, soaked in boiling water), Baifuling (White Poria), Zexie, Chenpi.
Danggui (Angelicae Sinensis Radix, each two qian), Dahuang (Radix et Rhizoma Rhei, wine-soaked, one liang), Qingpi, Muxiang (each two qian).
Powder finely, soak steamed dough in water to make pills the size of tung tree seeds. Take fifty pills per dose, increase to seventy or eighty, take with warm water after meals. Stop when slight diarrhea occurs.
Chenxiang Haijinsha Wan (Agarwood and Lygodium Pill) treats all accumulations, spleen dampness swelling, large belly with blue veins, emaciation, and malignant signs.
Haijinsha (Lygodii Spora, five qian half), Chenxiang (two qian), Qingfen (Calomelas, one qian), Qianniu end (Semen Pharbitidis, one liang).
Powder finely, grind single-head garlic into paste to make pills the size of tung tree seeds. Take thirty pills per dose, increase to fifty, take on an empty stomach with boiling decoction of Dengxincao (Junci Medullia) and Tongcao (Tetrapanacis Medulla). Adjust dosage based on deficiency or excess, aiming for purgation.
[Li Dongyuan] Zhi Zhong Muxiang San (Treating Swelling Agarwood Powder) treats edema distending like a drum, or generalized swelling.
Muxiang (Costi Radix), Daji, Bai Qianniu (White Semen Pharbitidis, equal parts).
Powder finely. Slice one pair of pig kidneys, sprinkle powder inside, roast until cooked, take on an empty stomach. If eating the left kidney, massage the left arm; if eating the right kidney, massage the right arm. If swelling does not fully resolve, apply Gan Sui (Kansui Radix) fine powder around the navel covering the abdomen, then drink a little Gancao (Licorice) water, and the swelling will disappear.
[Bamboo Pavilion] Xiang Zao Wan (Fragrant Date Pill) treats ten types of Gu Qi disease.
Ku Dingxiang (Bitter Clove Bud) powdered, made into pills with cooked dates the size of tung tree seeds. Take thirty pills per dose, deliver with date decoction on an empty stomach, immediate effect. Three doses bring major recovery.
[Zhang Zhongjing] Disease with abdominal fullness, fever for ten days, pulse floating and rapid, diet normal: Houpo Qiwu Tang (Magnolia Seven-Ingredient Decoction) is the primary prescription.
Houpo (Magnoliae Officinalis Cortex, half jin), Gancao, Dahuang (each three liang), Dazao (Ten Jujubes), Zhishi (Immature Bitter Orange Fruit, five pieces), Guizhi (Cinnamomi Ramulus, three liang), Shengjiang (Fresh Ginger, five liang).
The above seven ingredients, use one dou of water, boil to obtain four sheng. Take eight ge warm, three times a day. If vomiting, add Banxia five ge. If diarrhea, remove Dahuang. If much cold, add Shengjiang to half jin.
Formulas for upper and lower abdominal distension are basically derived from the classics, embodying the principle that "purging resolves distension."
[Zhu Danxi] Treating distension focuses primarily on damp-heat; treatment methods are seen in the preceding "Tonify Deficiency and Move Dampness" section.
[Li Dongyuan] All abdominal distensions and enlargements belong to heat. Discussing this as an excess syndrome of the Eight Benefits pathogen entering from outside, feeling wind-cold pathogen transmitting from exterior to interior, cold transforming into heat, causing stomach excess abdominal disease, afternoon tidal fever, extreme thirst with desire to drink, delirious speech—this is Taiyang and Yangming combined with great excess and fullness, treated with Dachengqi Tang (Major Order the Qi Decoction) to purge. Shaoyang and Yangming with slight fullness and excess are treated with Xiao Chengqi Tang (Minor Order the Qi Decoction) to purge. The *Neijing* says "purging resolves distension," which refers to this. Also, the *Thermal Disease Treatise* says cold diseases transform into heat, so purging prevents distension, clarifying the principle of "treating cold with cold." Thus, it is said purging resolves distension, not referring to Yin excess generating internal cold or stomach cold distension. Suppose malaria causes distension; there are also cold distension and heat distension. This is heavenly pathogenic qi injuring summerheat. Why does it not erupt immediately but erupt in autumn? Because during summer, the righteous qi is assisted, so the pathogen cannot erupt. By late autumn, summerheat qi decays, and malaria erupts. Knowing it is cold, the *Ju Fang* uses Jiaojie Yinzi (Intersecting Resolution Drink). Although this heavenly pathogen has excess, regarding malaria as cold, how much more so for insufficiency diseases causing distension? Thus, we know abdominal distension is mostly a cold disease. Why say this? The *Mai Jing* says: Cold in the stomach causes distension. The *Ling Shu* says: Irregular diet and起居 (daily routine) eventually transmit to cold in the middle. It also says: Abdominal fullness, epigastric pain piercing through to both hypochondria, blockage of diaphragm and throat, inability to eat—take ST36 (Zusanli) of the Stomach meridian. It also says: Turbid qi staying in the upper generates pendulous distension. The *Ling Shu* says: For distension, treat the Three Yang. The Three Yang refers to Foot Taiyang Bladder cold water causing distension, consistent with the *Neijing* Tong Ping Xu Shi Lun saying: Sudden abdominal fullness, pressing does not yield, take Foot Taiyang collaterals, which are the Front-Mu point of the Stomach. Exactly the same. It also says: Abdominal fullness, pendulous distension, supporting diaphragm and hypochondria, lower reversal and upper dizziness, fault lies in Taiyin and Yangming. This is stomach cold-heat stagnation. It also says: Taiyin jue leads to abdominal fullness, pendulous distension, difficulty in defecation, lack of appetite, vomiting after eating, inability to lie down. As described in the *Neijing*, cold distension is mostly like this. I have only briefly mentioned the beginning. Patients who do not realize the prevalence of cold distension treat all distension as heat, mostly using Sanhua Shenyao Wan (Three Flowers Divine Protection Pill), Dahuang, Qianniu, etc., to purge. Sometimes the medicine does not match the disease, leading to immediate death.
From this argument, should one follow the *Ling Shu* and *Su Wen*? Or follow the subjective theories of common physicians? Now I establish one formula for treating middle-fullness pendulous distension cold distension, and one for heat distension, evaluate and use them, allowing the qi to be dispersed and eliminated from above and below. (Zhongman Fenxiao Tang treats cold distension, Fenxiao Wan treats heat distension; both formulas are seen in the following section.)
[Ling Shu] Cold in the stomach causes abdominal distension. Cold in the stomach and heat in the intestines cause distension with diarrhea. (Shi Zhuan Pian)
Distension from exposure to cold and coolness resolves with purging. (Wu Chang Zheng Lun, Dongyuan's Chenxiang Haijinsha Wan formula seen in Pulse Excess section.) Yin merging downward causes cold feet; cold feet cause distension. (Jue Lun)
[Li Dongyuan] Turbid qi staying in the upper generates pendulous distension. The *Yin Yang Ying Xiang Da Lun* says: Clear qi staying below generates undigested diarrhea; turbid qi staying above generates pendulous distension. This is yin-yang reversal, the逆从 (reversal and compliance) of disease. Regarding pendulous distension, discussing it by cold, heat, warmth, and coolness—what kind of distension is this? Answer: This is distension caused by dietary irregularity, the beginning of the disease. Damp-heat can also cause distension; Right Guan pulse is surging, slow, deep, and wiry. Pulse floating above indicates the combination of wind-damp-heat pulses causing disease. This is the failure of Spleen-Stomach commands, Yin fire hyperactivity attacking the Spleen-Stomach. When excessive, it moves left and the Yang pathway fails, meaning the qi of the Six Fu organs is exhausted externally. Fire excess makes the mother element solid, wind qi cuts off externally. Wind qi cutting off externally means grain qi entering the stomach, clear qi and Ying qi fail to circulate, becoming wind qi. Different sounding but similar category, i.e., Stomach qi. The Classics say: Deficiency involves its conquering element. Earth failing is the Liver's pathogen; this is Spleen-Stomach Earth insufficiency with Wood and Fire excessive victory. The Classics say: Turbid Yin exits lower orifices, Turbid Yin travels to Five Zang, Turbid Yin returns to Six Fu, Turbid Yin returns to Earth. This is the normal state of health without disease; reversing this causes distension. The *Yin Yang Lun* says: Irregular diet and daily routine, Yin receives it; Yin receiving it enters Five Zang; entering Five Zang causes pendulous distension and blockage. The *Tiao Jing Pian* says: Lower Wan (Lower Stomach) obstruction causes Stomach qi heat, hot qi steaming the chest, thus internal heat. Lower Wan is Youmen (Ulpore). In the human body, there are Seven Chong Men (Pass Gates) from top to bottom, all flowing upward from below. Youmen connects upward to Xi Men (Inhalation Gate), which is the Epiglottis. Blocking the inhaled qi prevents it from returning to the Kidney; Liver acts as Yin fire moving to resist, causing throat and diaphragm blockage, preventing turbid qi from descending, leading to dry stool and non-movement. Stomach dampness and guest Yin fire are both present, causing abdominal distension. Treatment focuses on Youmen, making Youmen patent, draining Yin fire, moistening dry blood, generating new blood. When Youmen is patent, stool does not close, Xi Men is not attacked by pathogens, throat and diaphragm become patent, pendulous and abdominal distension both disappear, and turbid Yin returns to Earth. Thus the Classics say: "Fullness in the center is drained internally." This is the correct method.
Chenxiang Jiaotai Wan treats turbid qi staying in the upper, disturbing clear yang qi, stagnating and not extending, causing abdominal distension. Take until beneficial/purgative. (Formula seen previously.)
Above treats pulse surging, constipation, and distension.
Madam Fan Tianzhi, Langzhong's wife, in mid-August, first due to labor and dietary irregularity, plus worry and thought causing qi knotting, suffered heart and abdominal distension, unable to eat dinner if she ate breakfast, stabbing pain in both hypochondria. Her pulse was wiry and thin. At night, turbid qi should descend but does not, making pendulous distension worse. Generally, Yang governs transformation and transportation. Dietary and fatigue injuries damage Spleen-Stomach; Yang qi cannot transform essence and micro-nutrients, gathering without dispersing, resulting in distension. First moxa Zhongwan (CV12), the Front-Mu point of the Stomach, to draw Stomach rising qi up the Yang pathway, then assist with Shunqi Tang (Regulating Qi Decoction), so turbid qi descends from here.
Muxiang Shunqi Tang treats turbid qi staying in the upper, generating pendulous distension.
Muxiang, Cangzhu, Caodoukou (wrapped in flour and roasted, each three fen), Houpo (prepared, four fen), Qingpi (one qian), Yizhi, Chenpi, Zexie, Baifuling (peeled), Banxia, Ganjiang, Wuzhuyu (soaked in boiling water, each two fen), Danggui, Renshen (each five fen), Shengma, Chaihu (remove radix tips, each one fen).
The *Neijing* says: Retained items are moved, knotted items are scattered. Using the bitter-pure nature of Chaihu and Shengma to traverse Shaoyang and Yangming meridians, disperse clear qi, and circulate Yang division as Sovereign. Using the sweet-acrid-hot nature of Shengjiang, Banxia, Caodoukou, and Yizhi to dissipate middle cold as Minister. Using the bitter-acrid-hot nature of Houpo, Muxiang, Cangzhu, and Qingpi to smooth stagnant qi; using the sweet-acrid-warm nature of Chenpi, Danggui, and Renshen to harmonize Ying and Wei, nourish middle qi; since turbid qi does not descend, it should be drained with bitter; Wuzhuyu's bitter-hot drains it. Qi that is thin belongs to Yin within Yang; Fuling is sweet-pour, Zexie is salty-pour, thin qi guides turbid qi from above to below, so they serve as Assistants. Flavors and odors combine, dispersing and draining, ascending and descending, allowing clear and turbid qi to reside in their proper positions.
Coarsely cut, prepare as one dose, use two cups of water, decoct to one cup, strain, take warm before meals. Avoid cold, raw, and hard foods.
Above treats wiry-thin pulse, hypochondriac pain, and distension.
Zhongman Fenxiao Tang treats middle-fullness cold distension, cold hernia, obstruction of urination and defecation, yin restlessness with inability to move legs, cold extremities, regurgitation of food, lower deficiency with middle fullness, abdominal cold, epigastric blockage, lower jiao restless cold and sinking reversal, Bentun (running piglet) not contained. Cured in two doses.
Huangqi (Astragali Radix, five fen), Yizhi, Banxia (each three fen), Chuanwu (Aconiti Radix Preparata, one fen), Wuzhuyu, Caodoukou (each five fen), Renshen, Muxiang, Qingpi, Danggui, Huanglian (each two fen), Houpo (five fen), Fuling, Zexie, Shengjiang, Mahuang (Ephedrae Herba, not removing joints, each two fen), Shengma (three fen), Chaihu Shao (Bupleuri Radix tip), Ganjiang, Bidengqie (Blitae Fructus, each two fen), Huangbai (Phellodendri Cortex, five fen).
Cut into pieces the size of hemp seeds. Prepare as one dose, use two cups of water, decoct to one cup, strain, take slightly warm before meals. Strictly avoid sexual exertion, alcohol, wheat products, cold/raw, hard, and greasy foods.
[Zhu Danxi] To treat adults and children with abdominal distension and shortness of breath due to excessive consumption of fruits. Rougui (Cinnamomi Cortex) fine rice meal pills, size of mung beans. Take ten pills per dose, five grains for children, delivered with hot water. (Experience Formula)
[Li Dongyuan] The *Ling Shu* says: Abdominal fullness with difficult defecation, qi moving up to the chest and epigastrium, panting loudly—treat Foot Shaoyin. "Treat" means to purge. Should be dissipated with acrid-hot herbs.
Liangjiang (Alpiniae Katsumadai Rhizoma), Rougui, Yizhi, Caodoukou Ren, Houpo, Shengma, Gancao, Duhuo (Angelicae Pubescentis Radix, guiding herb), Huangbai (small amount for reference).
Another Formula
Guizhi (Cinnamomi Ramulus), Jiegeng (Platycodonis Radix), Renshen, Qingpi (small amount), Chenpi, Liangjiang, Baizhu, Zexie, Wuzhuyu.
For wet swelling of the four limbs, Miao Ci (Mirror Pricking) is appropriate. First purge the blood knot, then regulate the true meridians. (Meaning pricking to remove blood knots.)