鼓。即肿满也。不论五脏六腑。新久虚实。一味补中益气汤尽之。但有郁而成者。和中丸妙。
（妙在陈皮木瓜两味。）即种
种初起俱可。舍是而别有方法。吾不信也。又有一种寒水侮土者。其肿必先头面四肢起。然后及
于腹中。惟此症可以补中益气汤。吞金匮加减肾气丸。（此症单服补中固不效。单服金匮亦不效。
）然当治之于早。不然水势冲中。士崩岸败。无济于事矣。又有中虚而挟燥膨满者。竟用补中益
气汤送玄明粉三钱。其应如响。）又有一种食鼓者。乃是饮食所伤。初起必先雀目。（俗传鸡盲入
肚者。即此症也。）医家不信。只治眼目。不知乃是鼓之根也。此时当急用清剂以治之。经曰。
开鬼门。洁净府。去郁除。陈是也。然古法太峻。今定一保中丸。久服自愈。（保中亦未始不峻。
久服必伤中气。用宜斟酌。张盱江云。胀满悉属脾虚运化不及。浊气填塞所致。初起微佐以消化
舒郁为先。势甚而二便涩滞者微利之。弱人或稍久。一切痢后疮疽后产后。必参术 芍。大补脾气
为主。而佐以消化。浓朴木香黄连之类。然王道无近功。必数十服以渐取效。常见用商陆牵牛
等行水法。一泻即消。然三日后复起而死者。比比皆是。良由病家求。速效。医家不明理。天人
天年。悲哉。历考古今明医。无逾于东垣丹溪薛新甫王损庵矣。岂肯旷日持久。而不知克伐之功
速耶。其如中气何。可与高明言。难与俗人道耳。东庄云。治肿胀任其效否。当以前法为枢机
。疏凿浚川神 等方。非万分禀浓。形盛气实。不可妄用。丹溪补脾保肺清火。实不易之则也。
和中丸
陈皮（一两） 木瓜（一两去穣） 人参（三两） 白术（三两） 干姜（一两） 甘草（
一两）
上为末。蒸饼丸。食前白汤下三五十丸。
金匮加减肾气丸
治脾肾虚寒。腰重脚肿。湿饮留积。小便不利。或肚腹肿胀。四肢浮肿。气喘痰甚。或已成
水症。其效如神。
茯苓（三两） 泽泻（一两） 山药（一两） 萸肉（一两） 丹皮（一两） 附子（五钱
）肉桂（一两） 牛膝（一两） 车前（一两） 熟地（四两掐碎酒拌杵膏）
上为末。和地黄膏炼蜜为丸。桐子大。每服七八十丸。空心米饮下。
保中丸
枳实（炒） 浓朴（姜汁炒） 黄芩（酒洗） 半夏（姜汁炒） 苍术（米泔浸炒） 陈皮
莱菔子（炒） 三棱 蓬术（等分）
上神曲为丸。
鼓胀，就是身体肿胀满闷。无论是五脏六腑的病变，也不论是新病还是久病、虚证还是实证，都用补中益气汤来治疗即可。但如果是因气郁而形成的鼓胀，用和中丸效果奇妙。（其妙处在于陈皮和木瓜这两味药。）即使是各种类型的鼓胀初起阶段也可以使用。除此之外若另有其他治疗方法，我是不会相信的。
又有一种情况是寒水反侮脾土（肾水寒盛克制脾土），这种肿胀必然先从头面和四肢开始，然后才波及腹部。只有这种病症适合使用补中益气汤，并吞服金匮加减肾气丸。（此症如果单服补中益气汤无效，单服金匮加减肾气丸也无效。）然而应当尽早治疗，否则水势泛滥冲犯中焦，就像堤坝崩溃一样，就无济于事了。
又有中气虚弱兼夹燥热导致腹胀满的情况，直接用补中益气汤送服三钱玄明粉，疗效迅速显著。
还有一种食积导致的鼓胀，这是由于饮食损伤引起的。初起时必然先出现雀目（俗称鸡盲入肚，即指此症）。医生如果不相信这一点，只治疗眼目疾病，不知道这其实是鼓胀的病根。此时应当紧急使用清利之剂来治疗。《内经》说：“开鬼门（发汗），洁净府（利小便）”，去除郁结和陈旧的邪气正是这个道理。然而古法过于峻猛，现在定下保中丸，长期服用自然痊愈。（保中丸也并非不峻烈，长期服用必定损伤中气，使用时应斟酌权衡。张盱江说：胀满都属于脾虚运化不及，浊气填塞所致。初起时稍微佐以消食化滞、舒解郁结的药物为先；病情严重且大小便涩滞不通的，稍微通利一下；体质虚弱的人或病程稍久的，以及一切痢疾后、疮疽后、产后等情况，必须以人参、白术、芍药等大补脾气为主，再佐以消食导滞、厚朴、木香、黄连之类药物。然而王道之法没有近功，必须服用数十副药才能逐渐见效。常见有人使用商陆、牵牛等行水泻下的方法，一泻之下肿胀即刻消退，然而三天后复发死亡的，比比皆是。这都是由于病人追求速效，医生不明医理，断送人天年，可悲啊！
纵观古今名医，没有超过李东垣、朱丹溪、薛己（薛新甫）、王肯堂（王损庵）的了。他们怎么肯旷日持久地治疗，却不知道攻伐类药物见效快呢？这是为了保全中气啊。这话只能与高明之士谈论，难以与世俗之人说道。
东庄说：治疗肿胀无论效果如何，应当以前述方法为枢机。疏凿饮、浚川散、神佑丸等方剂，如果不是禀赋浓厚、形体壮实、正气充足的人，不可妄加使用。朱丹溪提出的补脾、保肺、清火的原则，确实是不可更改的准则。
【方剂】
和中丸
陈皮（一两）、木瓜（一两，去瓤）、人参（三两）、白术（三两）、干姜（一两）、甘草（一两）。
以上药材研为细末，用蒸饼糊为丸，饭前用白开水送服三五十丸。
金匮加减肾气丸
治疗脾肾虚寒，腰部沉重脚部浮肿，湿饮停留积聚，小便不利，或者肚腹肿胀，四肢浮肿，气喘痰多，或者已经形成水臌症，疗效如神。
茯苓（三两）、泽泻（一两）、山药（一两）、山茱萸肉（一两）、牡丹皮（一两）、附子（五钱）、肉桂（一两）、牛膝（一两）、车前子（一两）、熟地黄（四两，掐碎后用酒拌捣成膏）。
以上药材研为细末，加入地黄膏和炼蜜制成丸药，如梧桐子大。每次服用七八十丸，空腹时用米汤送下。
保中丸
枳实（炒制）、厚朴（姜汁炒制）、黄芩（酒洗）、半夏（姜汁炒制）、苍术（米泔水浸后炒制）、陈皮、莱菔子（炒制）、三棱、蓬术（莪术，各等分）。
以上药材用神曲糊为丸。
**Gu Zhang (Drum Distension)** refers to swelling and fullness. Regardless of whether the pathology involves the five zang organs or six fu organs, whether it is a new or chronic condition, and whether it presents as deficiency or excess, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be used exclusively. However, if the distension arises from qi stagnation, He Zhong Wan (Harmonize the Middle Pill) is efficacious. (Its efficacy lies in the combination of Chen Pi [Tangerine Peel] and Mu Gua [Chaenomeles Fruit].) It can also be used at the initial stage of various types of Gu Zhang. I do not believe in any other methods outside of this.
There is another type where cold water insults the spleen earth (kidney water coldness overacting on spleen earth). In such cases, swelling necessarily begins in the head, face, and four limbs, before spreading to the abdomen. Only for this specific presentation is Bu Zhong Yi Qi Tang suitable, taken together with Jin Gui Jia Jian Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet). (For this condition, taking Bu Zhong Yi Qi Tang alone is ineffective, and taking Jin Gui Jia Jian Shen Qi Wan alone is also ineffective.) However, treatment must begin early; otherwise, the pathogenic water will flood the middle jiao, leading to a collapse like a breached dam, rendering treatment futile.
There is also a case of middle-jiao deficiency complicated by dryness and distension. In such instances, use Bu Zhong Yi Qi Tang to administer Xuan Ming Fen (Mirabilite), three qian, which yields immediate results.
Another type is food-induced Gu Zhang, caused by dietary injury. At its onset, it invariably presents with Que Mu (Night Blindness/Aleukia, colloquially known as "chicken blindness entering the belly"). Physicians who disbelieve this and treat only the eyes fail to realize that this is the root of the distension. At this stage, one must urgently employ clearing agents. As stated in the Classics: "Open the ghost gate (induce sweating), cleanse the net house (promote urination)," thereby removing stagnation and eliminating stale pathogens. However, ancient methods are too harsh. The current prescription, Bao Zhong Wan (Protect the Middle Pill), is recommended; long-term consumption leads to self-healing. (Note: Bao Zhong Wan is not without its harshness; long-term use may damage middle qi, so dosage should be carefully considered. Zhang Xujiang stated: All distensions belong to spleen deficiency with inadequate transformation and transportation, resulting in turbid qi filling the spaces. In the early stages, slightly assist with digestive and qi-regulating herbs first. If the condition is severe with obstructed urination and defecation, mildly promote drainage. For weak individuals or those with prolonged illness, as well as post-dysentery, post-ulcer, or postpartum states, prioritize tonifying spleen qi with Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala Rhizome), and Bai Shao (White Peony Root), assisted by digestive herbs such as Hou Po (Magnolia Bark), Mu Xiang (Vladimiria Root), and Huang Lian (Coptis Rhizome). However, the kingly way of medicine yields no quick results; dozens of doses are required for gradual efficacy. It is common to see the use of Shang Lu (Phytolacca Root) and Qian Niu (Morning Glory Seed) to drain water, causing immediate reduction of swelling. Yet, relapse and death within three days are frequent. This is largely due to patients seeking quick fixes and physicians lacking theoretical understanding, thereby shortening natural lifespans. How tragic! Looking back at famous physicians of past and present, none surpass Li Dongyuan, Zhu Danxi, Xue Xinpu (Xue Ji), and Wang Sun'an (Wang Kentang). Would they have endured prolonged treatments if they did not know that attacking/purgative methods yield faster results? But what about the middle qi? These words can be spoken to the enlightened, but are difficult to explain to the vulgar.)
Dongzhuang stated: When treating swelling, regardless of the outcome, one should take the aforementioned methods as the pivot. Formulas such as Shu Zuo Yin (Discharge Irrigation Decoction), Jun Chuan San (Unclog River Powder), and Shen You Wan (Divine Protection Pill) should not be used recklessly unless the patient has robust constitution, strong physique, and abundant qi. Zhu Danxi’s principles of tonifying the spleen, protecting the lungs, and clearing fire are indeed unchangeable standards.
**He Zhong Wan (Harmonize the Middle Pill)**
Chen Pi (Tangerine Peel, 1 liang), Mu Gua (Chaenomeles Fruit, 1 liang, remove core), Ren Shen (Ginseng, 3 liang), Bai Zhu (Atractylodes Macrocephala Rhizome, 3 liang), Gan Jiang (Dried Ginger, 1 liang), Gan Cao (Licorice Root, 1 liang).
Grind into powder, make pills with steamed wheat cake paste. Take 30-50 pills with warm water before meals.
**Jin Gui Jia Jian Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet)**
Indicated for spleen-kidney yang deficiency with cold, heavy sensation in the lower back, edema of the feet, retention of damp-fluids, difficulty in urination, abdominal swelling, limb edema, asthma with excessive phlegm, or established hydrothorax/ascites. Efficacy is miraculous.
Fu Ling (Poria, 3 liang), Ze Xie (Alisma Rhizome, 1 liang), Shan Yao (Chinese Yam Rhizome, 1 liang), Yu Rou (Cornus Fruit, 1 liang), Dan Pi (Moutan Cortex, 1 liang), Fu Zi (Aconite Lateral Root, 5 qian), Rou Gui (Cinnamon Bark, 1 liang), Niu Xi (Achyranthes Root, 1 liang), Che Qian (Plantago Seed, 1 liang), Shu Di (Prepared Rehmannia Root, 4 liang, crushed and mixed with wine, pounded into paste).
Grind into powder, mix with Rehmannia paste and refined honey to form pills the size of tung tree seeds. Take 70-80 pills on an empty stomach with rice gruel.
**Bao Zhong Wan (Protect the Middle Pill)**
Zhi Shi (Immature Bitter Orange, stir-fried), Hou Po (Magnolia Bark, stir-fried with ginger juice), Huang Qin (Scutellaria Root, washed with wine), Ban Xia (Pinellia Tuber, stir-fried with ginger juice), Cang Zhu (Atractylodes Lancea Rhizome, soaked in rice wash water and stir-fried), Chen Pi (Tangerine Peel), Lai Fu Zi (Radish Seed, stir-fried), San Leng (Sparganium Rhizome), Peng Zhu (Curcuma Zedoaria Rhizome, equal parts).
Make pills using Shen Qu (Medicated Leaven).