5.腹胀身热及失血, 四末清脱泻数行, 肿起四肢后入腹, 利旋满肿
腹筋青, 唇黑脐突阴囊腐, 缺盆脊背足心平, 脉大时绝或虚涩, 肿胀
逢之却可惊.
【注】腹胀身热, 阳盛胀也, 若吐衄泻血, 则阴亡矣. 四肢瘦冷, 阴
盛胀也, 若数泻不止, 则中脱矣. 先肿胀腹, 后散四肢者可治. 先肿
四肢, 后归入腹者不治. 肿胀之病多实, 服利下之药, 旋消旋起, 则
为正不胜邪, 亦不治. 腹筋青涨高起, 肿胀苍黑, 脐肿突出, 阴囊肿
腐,缺盆脊背肿平, 足心肿平, 则五脏伤, 皆不治也. 脉大而时绝,
或虚涩细, 则气血败, 皆死脉也.
6.肤胀脉胀通身胀, 单腹鼓胀四肢平, 肤胀木香流气饮, 脉胀加姜
黄抚芎.
【注】肤胀, 皮肤胀也, 脉胀, 经脉胀也. 此二胀皆通身胀也. 单腹
胀,四肢不胀. 鼓胀, 其胀如鼓. 此二胀, 皆腹胀四肢不胀也. 肤胀
宜用木香流气饮, 脉胀亦用此汤, 更加姜黄, 抚芎也. 方在诸气门.
厚朴散 下瘀血汤
7.单腹鼓胀分气血, 气实肠覃厚朴榔, 木枳青陈遂大戟, 血实石瘕
下瘀汤.
【注】单腹胀, 鼓胀, 当分气血而治. 肠覃亦气病也, 故同气实胀者
一治之, 皆用厚朴散, 即厚朴, 槟榔, 木香, 枳壳, 青皮, 陈皮, 甘
遂,大戟. 石瘕亦血病也, 故同血实胀者一治之, 宜用下瘀血汤, 即
大黄, 桃仁,?? 虫, 甘遂也.
寒胀中满分消汤 热胀中满分消汤
8.气虚胀病分寒热, 中满分消有二方, 寒胀参耆归苓朴, 半夏吴萸
连二姜, 升柴乌麻青柏泽, 荜澄草蔻益木香, 热缩六君知猪泽, 枳朴
芩连干姜黄.
【注】胀有虚, 实, 寒, 热, 若胀而形气虚少寒者, 宜用寒胀中满分
消汤, 即人参, 黄耆, 当归, 茯苓, 厚朴, 半夏, 吴萸, 黄连, 干姜
,生姜, 升麻, 柴胡, 川乌, 麻黄, 青皮, 黄柏, 泽泻, 荜澄茄, 草
豆蔻, 益智, 木香也. 胀而形气虚少热者, 宜用热胀中满分消汤, 即
缩砂, 人参, 白术, 茯苓, 炙草, 广皮, 半夏, 知母, 猪苓, 泽泻,
枳壳, 厚朴, 黄连, 干姜, 姜黄也.
5. 腹部胀满、身体发热以及出现失血症状，四肢末端发凉甚至出现脱证（阳气衰微、阴液耗竭的危重状态），腹泻次数频繁且不止；水肿先从四肢开始，随后蔓延至腹部，腹泻后随即感到腹部胀满。腹壁青筋暴露且高高隆起，嘴唇发黑，肚脐突出，阴囊腐烂，锁骨上窝（缺盆）、脊背和足心肿胀平坦无凹陷，脉象洪大但时有间歇，或者脉象虚细涩滞，遇到这种肿胀病症确实令人惊惧。
【注】腹部胀满且身体发热，属于阳热亢盛导致的胀满；如果伴有呕吐、鼻出血或便血，则意味着阴液已经亡失。四肢消瘦寒冷，属于阴寒内盛导致的胀满；如果伴有频繁腹泻不止，则意味着中气下陷脱失。先出现腹部肿胀，随后扩散到四肢的，尚可治疗；先出现四肢肿胀，随后才波及腹部的，难以治愈。肿胀类疾病多属实证，服用泻下药后，症状暂时消退却又立即复发，这说明正气不能战胜邪气，也是难治之症。腹壁青筋怒张高起，皮肤肿胀呈苍黑色，肚脐肿突，阴囊肿烂，锁骨上窝、脊背和足心肿胀平坦，说明五脏受损，均属于不治之症。脉象洪大但时有间歇，或者脉象虚细涩滞，说明气血败坏，均属于死脉。
6. 肤胀和脉胀表现为全身肿胀，单腹胀表现为只有腹部鼓胀而四肢正常。肤胀适用木香流气饮，脉胀则在原方基础上加入姜黄和抚芎（川芎）。
【注】肤胀，是指皮肤肿胀；脉胀，是指经脉肿胀。这两种胀病都是全身肿胀。单腹胀，是指只有腹部胀满而四肢不胀。鼓胀，是指腹部胀大像鼓一样。这两种胀病，都是腹部胀满而四肢不胀。肤胀适宜使用木香流气饮，脉胀也使用此方，另外再加姜黄和抚芎。该方剂记载在诸气门章节中。
7. 单腹胀（鼓胀）需要区分是气实还是血实来治疗。气实引起的肠覃（腹腔内的积聚物，属气分病），用厚朴散，即由厚朴、槟榔、木香、枳壳、青皮、陈皮、甘遂、大戟组成。血实引起的石瘕（腹腔内的坚硬肿块，属血分病），用下瘀血汤，即由大黄、桃仁、䗪虫、甘遂组成。
8. 气虚导致的胀病需要区分寒热两种情况，中满分消汤有两个方子。寒胀用参耆归苓朴等药，包括半夏、吴茱萸、黄连、干姜、生姜、升麻、柴胡、川乌、麻黄、青皮、黄柏、泽泻、荜澄茄、草豆蔻、益智仁、木香。热胀用缩砂六君知猪泽等药，包括枳壳、厚朴、黄芩、黄连、干姜、姜黄。
【注】胀病有虚、实、寒、热的区别。如果胀满且形体气息虚弱并伴有寒象的，适宜使用寒胀中满分消汤，该方由人参、黄芪、当归、茯苓、厚朴、半夏、吴茱萸、黄连、干姜、生姜、升麻、柴胡、川乌、麻黄、青皮、黄柏、泽泻、荜澄茄、草豆蔻、益智仁、木香组成。如果胀满且形体气息虚弱并伴有热象的，适宜使用热胀中满分消汤，该方由缩砂仁、人参、白术、茯苓、炙甘草、广陈皮、半夏、知母、猪苓、泽泻、枳壳、厚朴、黄连、干姜、姜黄组成。
5. Abdominal distension accompanied by fever and hemorrhage, cold extremities with signs of collapse (a critical state of Yang deficiency and Yin exhaustion), frequent and unceasing diarrhea; edema starting in the four limbs and then spreading to the abdomen, followed immediately by abdominal fullness after purging. Distended and prominent subcutaneous veins on the abdomen, blackened lips, protruding umbilicus, putrefaction of the scrotum, flattening of swelling in the supraclavicular fossa (Quepen), back, and soles of the feet, a pulse that is large but intermittent, or deficient, thready, and choppy. Encountering such swelling conditions is indeed alarming.
[Note] Abdominal distension with fever indicates distension due to excessive Yang heat; if accompanied by vomiting blood, epistaxis, or hematochezia, it signifies the loss of Yin fluids. Thin and cold extremities indicate distension due to excessive Yin cold; if accompanied by incessant frequent diarrhea, it signifies the sinking and loss of Middle Qi. If swelling starts in the abdomen and spreads to the limbs, it is treatable; if swelling starts in the limbs and then involves the abdomen, it is untreatable. Swelling diseases are mostly excess patterns. If symptoms temporarily resolve after taking purgatives but recur immediately, it indicates that righteous Qi cannot overcome pathogenic factors, which is also untreatable. Prominent and raised abdominal veins, skin swollen and dark cyanotic, protruding umbilicus, putrefying scrotum, flattened swelling in the supraclavicular fossa, back, and soles indicate damage to the Five Zang organs, all of which are untreatable. A pulse that is large yet intermittent, or deficient, thready, and choppy, indicates the deterioration of Qi and Blood, all of which are death pulses.
6. Skin distension (Fuzhang) and vessel distension (Maizhang) present as generalized body swelling. Single abdominal distension presents as a drum-like abdomen with normal limbs. For skin distension, Muxiang Liuqi Yin (Wood Fragrance Qi-Regulating Decoction) is indicated. For vessel distension, add Jianghuang (Turmeric Rhizome) and Fuxiong (Ligusticum Chuanxiong Rhizome) to this formula.
[Note] Skin distension refers to swelling of the skin; vessel distension refers to swelling of the meridians. Both of these involve generalized body swelling. Single abdominal distension refers to abdominal fullness without limb swelling. Drum distension refers to an abdomen swollen like a drum. Both of these involve abdominal distension without limb swelling. Skin distension is suitable for treatment with Muxiang Liuqi Yin. Vessel distension also uses this decoction, additionally adding Jianghuang and Fuxiong. The formula is recorded in the chapter on various types of distension.
Houpo San (Magnolia Bark Powder) and Xiayuxue Tang (Decoction for Expelling Stasis-Blood)
7. Single abdominal distension (drum distension) should be treated by distinguishing between Qi excess and Blood excess. Intestinal polyps (Changqin - accumulations in the abdomen belonging to Qi disorders) caused by Qi excess are treated similarly to Qi excess distension, using Houpo San, composed of Houpo (Magnolia Officinalis Bark), Binglang (Areca Seed), Muxiang (Vladimiria Root), Zhike (Aurantium Fructus Immaturus), Qingpi (Citrus Reticulata Pericarpium Viride), Chenpi (Citrus Reticulata Pericarpium), Gansui (Kansui Radix), and Daji (Euphorbia Pekinensis Root). Stone fibroids (Shijia - hard masses in the abdomen belonging to Blood disorders) caused by Blood excess are treated similarly to Blood excess distension, using Xiayuxue Tang, composed of Dahuang (Rhubarb Root), Taoren (Persicae Semen), E'chong (Mylabris), and Gansui (Kansui Radix).
Cold Distension and Heat Distension: Zhongman Fenxiao Tang (Decoction for Dispersing Fullness in the Center)
8. Distension caused by Qi deficiency should be distinguished into cold and heat types. There are two formulas for Zhongman Fenxiao Tang. For cold distension, use Ren Shen, Huang Qi, Dang Gui, Fu Ling, Houpo, etc., including Banxia (Pinellia Tuber), Wuyu (Evodia Fruit), Huanglian (Coptis Rhizome), Ganjiang (Zingiberis Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Chuanwu (Aconitum Carmichaelii Lateralis Radix Praeparata), Mahuang (Ephedrae Herba), Qingpi (Citrus Reticulata Pericarpium Viride), Huangbai (Phellodendri Cortex), Ze Xie (Alismatis Rhizoma), Bidengqie (Schizonepetae Fructus), Caodoukou (Amomi Fructus Rotundus), Yizhi (Alpiniae Oxyphyllae Fructus), and Muxiang (Vladimiria Root). For heat distension, use Suosha, Liujun Zi, Zhimu, Zhuling, Ze Xie, etc., including Zhike (Aurantium Fructus Immaturus), Houpo (Magnolia Officinalis Bark), Huangqin (Scutellariae Radix), Huanglian (Coptis Rhizome), Ganjiang (Zingiberis Rhizoma), and Jianghuang (Curcumae Longae Rhizoma).
[Note] Distension has distinctions of deficiency, excess, cold, and heat. If distension is accompanied by weak form and Qi with cold signs, Cold Distension Zhongman Fenxiao Tang is suitable, composed of Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Houpo (Magnolia Officinalis Bark), Banxia (Pinellia Tuber), Wuyu (Evodia Fruit), Huanglian (Coptis Rhizome), Ganjiang (Zingiberis Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Chuanwu (Aconitum Carmichaelii Lateralis Radix Praeparata), Mahuang (Ephedrae Herba), Qingpi (Citrus Reticulata Pericarpium Viride), Huangbai (Phellodendri Cortex), Ze Xie (Alismatis Rhizoma), Bidengqie (Schizonepetae Fructus), Caodoukou (Amomi Fructus Rotundus), Yizhi (Alpiniae Oxyphyllae Fructus), and Muxiang (Vladimiria Root). If distension is accompanied by weak form and Qi with heat signs, Heat Distension Zhongman Fenxiao Tang is suitable, composed of Suosha (Amomi Fructus), Ren Shen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata), Guangpi (Citrus Reticulata Pericarpium), Banxia (Pinellia Tuber), Zhimu (Anemarrhenae Rhizoma), Zhuling (Polyporus), Ze Xie (Alismatis Rhizoma), Zhike (Aurantium Fructus Immaturus), Houpo (Magnolia Officinalis Bark), Huanglian (Coptis Rhizome), Ganjiang (Zingiberis Rhizoma), and Jianghuang (Curcumae Longae Rhizoma).