浓朴、草果、姜皮为使。一日两服。另用紫苏、忍冬藤、萝卜种煎汤。一日浴一次。至四
日。肿胀消十之八。乃用参苓白术散。以紫苏煎汤调。日服二次。小水黄。又加木通煎汤煎
药。六帖后。去紫苏。加木瓜、滑石。最后加连翘、栀子。八帖全愈。
震按此三条。皆和平浅近。法却是医门之布帛菽粟。断不可缺。傅江二案用药加减。及
补泻进退。又有细针密线道理。
〔附〕明成化间。钦天监台官张景芳得腹胀病。危剧。遇一庞眉叟授以方。用杏仁、陈
皮、海螵蛸等分为末。佐以谷树叶、槐树叶、桃枝各七件。午时汲水煎三四沸。至星上时。
再煎一沸。患者就浴。令壮人以手汤中按摩脐之上下百数。少时转失气。病即退矣。
震按此方不及江氏。当合参之为更妙。他如田螺、大蒜、车前草捣饼贴脐。及蜘蛛随药
中煎熟服之。溺长胀退等说。俱不见效。故不录。
李士材治钱赏之遍体肿急。脐突背平。法在不治。举家坚请用药。以金匮肾气丸料大剂
煎服。兼进理中汤。五日不效。乃以人参一两。生附三钱。牛膝、茯苓各五钱。小便忽通。
进食。计服人参四斤。附子、桂、姜各斤余而安。
太学何宗鲁。夏月好饮水。一日学院发放。自早起候至未申。为炎威所逼。饮水计十余
碗。归寓便胀闷不能食。越旬日。胀如抱瓮。气高而喘。士材曰。皮薄而光。水停不化也。
且六脉坚实。其病暴成。法当利之。遂以舟车丸。每服三钱。香薷汤送。再剂而二便涌决如
泉。复进一钱五分。腹减如故。用六君子十帖。即愈。
震按此二案。峻补急攻。如狮子抟象。全副神力。学人要看其病因。观其论脉。即知前
贤非蠹心大胆也。
又治光禄卿吴伯玉夫人。患腹满而痛。喘急异常。大便不通。饮食不进。医用理气利水
药。二十日不效。李诊之。脉大而数。右尺为甚。令人按腹。手不可近。乃曰。此大肠痈也
脉数为脓已成。用黄 、角刺、白芷、银花、甘草节之类。加葵根一两。煎一碗。顿服之
未申痛甚。至夜半而脓血大下。昏晕不支。即与独参汤稍安。更与十全大补。一月而愈。
震按此案亦胀满证中必不可少之案。
孙一奎治马二尹。年五十五。过食鳗肉卷饼。心腹胀痛。市医遽用硝黄下之。大便不行
胀痛愈增。继至者。以木香槟榔丸、大小承气汤。连服十日。胀痛益甚。粒米不进。大便
并不行。小水亦仅点滴。后医以硝黄不效。杂进备急丸、白饼子、十枣汤、黑白丑之属。服
数
日。不惟大便不行。并小便点滴亦无矣。胀不可言。众医大叫称怪。一人为灸中脘三十壮。
毫不为动。因断三日后当死。孙至。观其色苍黑。神藏不露。声音亮。惟腹大如覆箕。不能
反侧。诊其脉。两手皆滑大。两尺尤有力。询其病源。阅其前方。骇然以为未闻未见也。因
思一治法。先进香砂六君子汤。参术各用二钱。众医皆惊。谓中满胀痛。二便俱闭。如何用
补。况苍黑之人。尤忌参术乎。孙曰。此非鼓胀证。乃内伤证也。当始伤时。犹在上鬲。法
当用吐。经所谓在上者因而越之也。不用吐而用下药以伤其脾。脾伤则失运动之职。是以愈
下愈伤。愈伤愈胀。脾气全然不动。药亦全然不行矣。故用六君子以醒其脾。香砂以助其运
动。再用吐法。吐出前药。始有生机。此方非治病。乃治药也。且予非虑大便不行。独虑行
之不止耳。医曰。求其行而不得。何以不止为虑。孙曰。君试思常人能服硝黄几何。巴豆牵
牛几何。今幸其未行。药性未动。尚可为计。一行而诸药性动。譬瓶水底漏。其中能蓄点滴
哉。危矣。医又问多服下药而大便不行。何也。孙曰。此易知之。始为食伤。继为药伤。所
伤在上中二焦。下元未损。故两尺脉尚有神气。难经曰。人之有尺。如树之有根也。内经曰
肾者胃之关。盖肾主大便。观其色苍黑。神藏气固。皆由根本未动。赖此犹可为耳。服药
后。腹中大痛。一奎谓其药力已动。改用人参芦、防风芦、升麻、桔梗各三钱。煎服少顷。
用鹅翎探吐之。前服药物。一涌而出十数碗。病者喜曰。目前有光矣。此巳时也。孙曰。酉
时大便必行。可备人参数斤以备不虞。至午。进至宝丹一帖。以温中气。未申间。腹中
有声。浊气下滚。顷刻腹宽数寸。至晚。大便行一次。小水略通。孙即用人参、白术各五钱
炮姜三钱。茯苓二钱。陈皮一钱。木香、甘草各五分。令急煎服。四鼓又大便一次。小水
继至。胀痛渐减。次日大便泻十余次。因以是方。煎丸并进。计泻七十二日。服人参二斤余
而收功。
〔附〕喻嘉言治袁仲卿之子。仆水救出。大热呻吟。儿科以惊风丸散与服。二日遂昏迷
不醒。胸高三寸。颈软息微。喻诊之曰。脉无根。仅如蛛丝。不可为矣。以汤二茶匙。滴入
口中。微有吞意。因思病虽因惊而得。其实跌仆水中。感冷湿之气而发热。胃中食物不化。
当比夹食伤寒例治。乃以金石寒冷药镇坠其邪。深入脏腑。神识因而不清。其食停胃中者。
得寒凉而不运。所进之药。皆在胃口之上。不能透入。转积转多。以致胸高而突。宜以理中
药运转前药。或有生机。即煎理中汤一盏。灌入喉中。大爆一口。果然从前二日所受之药。
一齐俱出。胸突顿平。颈亦稍硬。但脉仍不出。人亦不醒。喻曰。此为食尚未动。关窍堵塞
之故。再灌前药些少。热亦渐退。乃用元明粉一味化水。连灌三次。下黑粪甚多。继以生津
药调理而愈。
震按以药换药。与孙公先后一辙。故并载于此以便览。
查少川向有哮喘。每发时。以麻黄、石膏、杏仁、枳壳、细茶大剂煎服。立刻见效。屡
发屡服。而嗜酒纵欲。不避风寒。渐至腹大如覆箕。两腿光肿如柱。内外廉疥疮中。清水涓
涓不绝。腥气逼人。不能伏枕而卧者五月。医者骇辞不治。孙东宿至。见其坐高椅之上。气
喘身热。又畏寒甚。周遭环火五盆。首戴绒帽。笼以貂套。套外复束一帕。鼻用绒套笼之。
诊其脉浮大无力。睇其色。白中隐青。因问恶寒身热。从何时起。答以十日。孙曰。予得之
矣。此病是气虚中满。法当温补下元。人徒知利小水。不知小水不利者。由下焦之气不充。
不能渗从膀胱故道而行。若利之急。则泛滥而横流肌肤。下于阴囊。甚则胀裂崩塌而出矣。
必待下焦元气壮盛。斯能升降变化。水自行而胀自消耳。至如近来之恶寒身热。由寒邪在表
而然。合先散之。胸膈焦辣者。乃阴盛格阳。虚阳之火。被寒气驱逼上行。非真热也。亦待
下元一温。热自下行。用苏叶、细辛、羌活、防风、苍术、陈皮、白豆蔻、人参、炙草、生
姜。一帖而得微汗。遂撤火盆。去首帕。独鼻寒如初。乃用防风、黄 二两煎汤熏之。一日
三熏。鼻套亦除。但呕恶不止。用人参温胆汤加丁香。一帖而止。又谓鲤鱼能利水。一日尽
二斤。半夜胀极。复告急于孙。孙曰。病势如是。敢纵恣若此乎。等闲之剂。曷能消释。沉
思久之。以平胃散一两。入橄榄肉一两。煎服。两剂而定。独腹胀小水不利。不能伏枕为苦
乃以附子理中汤。加砂仁、补骨脂、赤豆、桂心。连进四帖。小水略长。继以尊重丸。每
服五丸。日三服。五日后。小水通利。可贴席而睡矣。
震按此证甚险恶。用药亦平庸。而投剂辄效。恐未必然。惟防 熏法及平胃散加橄榄二
法。颇巧。理中尊重二方补泻互用。亦巧。
周慎斋治一人。腹胀时吐。小便利则大便闭。大便通则小便闭。周曰。此证中气实。故
胀。浊阴不降而逆于上。故吐。清阳下陷。填塞下焦。故二便不能齐通。用炮姜三钱。温中
而健运。升麻一钱五分。升阳于下。吴茱萸一钱。降浊于上。八帖愈。
又治一女。胀而脉觉。用黄柏、青盐、升麻而愈。门人问其故。慎斋曰。此因命门火郁
使肾之真阳不升。心之真阴不降。故用黄柏以解命门壮火。使水中得升其真阳。用青盐以
润心。使无邪火之炽而得下其真水。水火既济。而复以升麻提其青气。青气一升。浊气自降
而脾肺无内郁之弊。胀证愈矣。盖其本在肾而标在心。故三药奏效捷也。
震按慎斋立论最高。定方最奇。然以此三味治胀。殊未敢信。易思兰治齿胀亦用此方。
则于理为近。
张路玉治王庸若。呕逆水肿。溲便涓滴不通。或用五苓八正。不应。六脉沉细如丝。因
与金液丹十五丸。溺如泉涌而势顿平。后以济生肾气培养而安。
李时珍治一士妻。自腰以下 肿。面目俱肿。喘急欲死。不能伏枕。大便溏泄。小便短
少。脉沉而大。沉主水。大主虚。乃病后冒风所致。是名风水。用千金神秘汤加麻黄。
一
服。喘定十之五。再以胃苓汤吞深师薷术丸。二日小便长。肿消十之七。调理数日全安。
震按金液丹、神秘汤人所罕用。而善用之则各奏奇功。因思古方。具在简册。特患寻不
着对头帽子耳。又按神秘汤。乃生脉散合二陈汤。去麦冬、茯苓。加紫苏、桑白皮、桔梗、
槟榔。以生姜三片为引。施于此证恰好。加麻黄更好。并非八寸三分通行之帽也。
厚朴、草果、姜皮作为引经药。每日服用两次。另外用紫苏、忍冬藤、萝卜籽煎汤。每天洗浴一次。到了第四天，肿胀消退了十分之八。于是改用参苓白术散，用紫苏煎汤调服。每日服用两次。小便颜色发黄，又加入木通煎汤来煎煮药物。服用六剂后，去掉紫苏，加入木瓜、滑石。最后加入连翘、栀子。再服用八剂后完全痊愈。
俞震按语：这三条医案，用药都平和浅近，但其中的法度却是医学界的布帛菽粟（即像布匹粮食一样不可或缺的基础）。傅江两位医生的医案中，药物的加减以及补泻手法的进退，都有精细缜密的道理。
〔附〕明代成化年间，钦天监台官张景芳得了腹胀病，病情危急严重。遇到一位长眉毛的老者传授给他一个方子，用杏仁、陈皮、海螵蛸等分研为末。佐以谷树叶、槐树叶、桃枝各七件。在午时汲水煎煮三四沸。等到星宿升起时，再煎一沸。患者浸泡其中洗浴。让壮年人用手在水中按摩脐部上下数百次。不久转放屁，病随即退去。
俞震按语：这个方子不如江氏的医案好，应当参考合并使用会更妙。其他如田螺、大蒜、车前草捣烂成饼贴敷脐部，以及蜘蛛随药物中煎熟服用，排尿增多肿胀消退等说法，都不见疗效，所以不收录。
李士材治疗钱赏之，遍体肿胀急迫，肚脐突出，背部平坦，按照常规属于不治之症。全家坚决请求用药。用金匮肾气丸的大剂量煎服。同时进服理中汤。五天没有效果。于是用人参一两，生附子三钱，牛膝、茯苓各五钱。小便忽然通畅。开始进食。共计服用人参四斤，附子、桂枝、干姜各一斤多而痊愈。
太学何宗鲁，夏天喜欢喝水。一天学院发放俸禄，从早起等候到未申时，被炎热威逼，饮水计十余碗。回到寓所便胀闷不能进食。过了十天，腹部肿胀像抱着瓮一样，气逆而上喘息。李士材说，皮肤薄而光亮，是水液停聚不化。而且六脉坚实，此病暴起，法当利水。于是用舟车丸，每次服用三钱，用香薷汤送服。再服两剂后，大小便涌出决堤如泉。又进服一钱五分，腹部减小如初。用六君子汤十剂，即痊愈。
俞震按语：这两个医案，峻补急攻，如同狮子搏象，全副神力。学习者要看其病因，观察其论脉，就知道前贤并非粗心大胆之人。
又治疗光禄卿吴伯玉夫人，患腹部满痛，喘息急促异常，大便不通，饮食不进。医生用理气利水的药，二十天没有效果。李士材诊察，脉大而数，右尺部尤为明显。让人按压腹部，手不敢靠近。于是说，这是大肠痈。脉数为脓已成。用黄芪、皂角刺、白芷、金银花、甘草节之类。加入葵根一两，煎一碗，顿服。未到申时疼痛加剧，到半夜脓血大下，昏晕不支。立即给予独参汤稍安。再给予十全大补汤，一个月而愈。
俞震按语：这个医案也是胀满证中必不可少的案例。
孙一奎治疗马二尹，年龄五十五岁。过食鳗鱼肉卷饼，心腹胀痛。市井医生急忙用硝黄（芒硝、大黄）攻下。大便不行，胀痛更加增加。继至的医生，用木香槟榔丸、大小承气汤，连续服用十天，胀痛更加严重。粒米不进，大便并不行，小便也仅点滴。后医认为硝黄无效，杂进备急丸、白饼子、十枣汤、黑白丑之类的药。服用几天，不仅大便不行，连小便点滴也没有了。肿胀不可言状。众医生大叫称怪。有一人为其灸中脘穴三十壮，毫无反应。因此断定三天后当死。孙一奎到来，观察其面色苍黑，神气内藏不露，声音洪亮，只有腹部大如倒扣的箕，不能翻身侧卧。诊其脉，两手皆滑大，两尺部尤其有力。询问其病源，查阅其前方，骇然以为从未听说见过。于是思考一种治法，先进服香砂六君子汤，人参、白术各用二钱。众医生都惊讶，认为中满胀痛，二便俱闭，如何能用补法？况且面色苍黑的人，尤其忌讳人参、白术。孙一奎说，这不是鼓胀证，乃是内伤证。当初受伤时，病位还在上膈，法当用吐法。经书所说“在上者因而越之”。不用吐法而用下药来损伤其脾，脾伤则失去运动的功能，所以是愈下愈伤，愈伤愈胀。脾气全然不动，药力也全然不行。所以用六君子汤来醒脾，香砂来助其运动。再用吐法，吐出前服药物，始有生机。这个方子不是治病，而是治药。况且我并非担心大便不行，唯独担心行之不止。医生说，求其行而不得，何以担心不止。孙一奎说，你试着思考常人能服硝黄多少？巴豆牵牛多少？现在幸好其未行，药性未动，尚可为计。一旦行下而诸药性动，譬如瓶底漏水，其中还能蓄积点滴吗？危险了。医生又问多服下药而大便不行，为什么呢？孙一奎说，这很容易知道。起初为食伤，继而为药伤。所伤在上中二焦，下元未损，所以两尺脉尚有神气。《难经》说，人之有尺，如树之有根也。《内经》说，肾者胃之关。盖肾主大便，观其色苍黑，神藏气固，皆由根本未动，赖此犹可为耳。服药后，腹中大痛。孙一奎谓其药力已动，改用人参芦、防风芦、升麻、桔梗各三钱，煎服少顷。用鹅翎探吐。前服药物，一涌而出十数碗。病人高兴地说，目前有光了。此时是巳时。孙一奎说，酉时大便必行，可备人参数斤以备不测。到了午时，进至宝丹一帖，以温中气。未申间，腹中有声，浊气下滚，顷刻腹部宽数寸。到了晚上，大便行一次，小便略通。孙一奎立即用人参、白术各五钱，炮姜三钱，茯苓二钱，陈皮一钱，木香、甘草各五分，令急煎服。四鼓又大便一次，小便继至，胀痛渐减。次日大便泻十余次。因此以是方，煎丸并进。共计泻七十二日，服人参二斤余而收功。
〔附〕喻嘉言治疗袁仲卿之子，从水中救出，大热呻吟。儿科医生给服惊风丸散。两天遂昏迷不醒。胸高三寸，颈软息微。喻嘉言诊察说，脉无根，仅如蛛丝，不可为矣。用汤二茶匙，滴入口中，微有吞意。于是想病虽因惊而得，其实跌仆水中，感冷湿之气而发热，胃中食物不化，应当比夹食伤寒例治。乃用金石寒冷药镇坠其邪，深入脏腑，神识因而不清。其食停胃中者，得寒凉而不运，所进之药，皆在胃口之上，不能透入，转积转多，以致胸高而突。宜以理中药运转前药，或有生机。即煎理中汤一盏，灌入喉中，大爆一口，果然从前二日所受之药，一齐俱出。胸突顿平，颈亦稍硬。但脉仍不出，人亦不醒。喻嘉言说，此为食尚未动，关窍堵塞之故。再灌前药些少，热亦渐退。乃用元明粉一味化水，连灌三次，下黑粪甚多。继以生津药调理而愈。
俞震按语：以药换药，与孙公先后一辙，所以并载于此以便浏览。
查少川向来有哮喘。每次发作时，用麻黄、石膏、杏仁、枳壳、细茶大剂煎服，立刻见效。屡发屡服，而嗜酒纵欲，不避风寒，渐至腹大如覆箕，两腿光肿如柱。内外廉疥疮中，清水涓涓不绝，腥气逼人，不能伏枕而卧者五月。医者骇辞不治。孙东宿到来，见其坐高椅之上，气喘身热，又畏寒甚。周遭环火五盆，首戴绒帽，笼以貂套，套外复束一帕，鼻用绒套笼之。诊其脉浮大无力，睇其色，白中隐青。因问恶寒身热，从何时起。答以十日。孙一奎说，予得之矣。此病是气虚中满，法当温补下元。人徒知利小水，不知小水不利者，由下焦之气不充，不能渗从膀胱故道而行。若利之急，则泛滥而横流肌肤，下于阴囊，甚则胀裂崩塌而出矣。必待下焦元气壮盛，斯能升降变化，水自行而胀自消耳。至于近来之恶寒身热，由寒邪在表而然。合先散之。胸膈焦辣者，乃阴盛格阳，虚阳之火，被寒气驱逼上行，非真热也。亦待下元一温，热自下行。用苏叶、细辛、羌活、防风、苍术、陈皮、白豆蔻、人参、炙草、生姜。一帖而得微汗，遂撤火盆，去首帕，独鼻寒如初。乃用防风、黄芪二两煎汤熏之。一日三熏，鼻套亦除。但呕恶不止，用人参温胆汤加丁香，一帖而止。又谓鲤鱼能利水，一日尽二斤，半夜胀极，复告急于孙。孙一奎说，病势如是，敢纵恣若此乎。等闲之剂，曷能消释。沉思久之，以平胃散一两，入橄榄肉一两，煎服。两剂而定。独腹胀小水不利，不能伏枕为苦。乃以附子理中汤，加砂仁、补骨脂、赤豆、桂心。连进四帖，小水略长。继以尊重丸，每服五丸，日三服。五日后，小水通利，可贴席而睡矣。
俞震按语：此证甚险恶，用药亦平庸，而投剂辄效，恐未必然。惟防己熏法及平胃散加橄榄二法，颇巧。理中尊重二方补泻互用，亦巧。
周慎斋治疗一人，腹胀时吐，小便利则大便闭，大便通则小便闭。周慎斋说，此证中气实，故胀。浊阴不降而逆于上，故吐。清阳下陷，填塞下焦，故二便不能齐通。用炮姜三钱，温中而健运。升麻一钱五分，升阳于下。吴茱萸一钱，降浊于上。八帖愈。
又治疗一女，胀而脉觉，用黄柏、青盐、升麻而愈。门人问其故。慎斋说，此因命门火郁使肾之真阳不升，心之真阴不降，故用黄柏以解命门壮火，使水中得升其真阳。用青盐以润心，使无邪火之炽而得下其真水。水火既济，而复以升麻提其青气。青气一升，浊气自降而脾肺无内郁之弊，胀证愈矣。盖其本在肾而标在心，故三药奏效捷也。
俞震按语：慎斋立论最高，定方最奇，然以此三味治胀，殊未敢信。易思兰治疗齿胀亦用此方，则于理为近。
张路玉治疗王庸若，呕逆水肿，溲便涓滴不通。或用五苓八正，不应。六脉沉细如丝。因与金液丹十五丸，溺如泉涌而势顿平。后以济生肾气培养而安。
李时珍治疗一士人之妻，自腰以下浮肿，面目俱肿，喘急欲死，不能伏枕。大便溏泄，小便短少。脉沉而大，沉主水，大主虚。乃病后冒风所致，是名风水。用千金神秘汤加麻黄。一服，喘定十之五。再以胃苓汤吞深师薷术丸。二日小便长，肿消十之七。调理数日全安。
俞震按语：金液丹、神秘汤人所罕用，而善用之则各奏奇功。因思古方，具在简册，特患寻不着对头帽子耳。又按神秘汤，乃生脉散合二陈汤，去麦冬、茯苓，加紫苏、桑白皮、桔梗、槟榔，以生姜三片为引。施于此证恰好，加麻黄更好，并非八寸三分通行之帽也。
Houpo (Magnoliae Officinalis Cortex), Caoguo (Tsaoko Fructus), and Jiangpi (Zingiberis Perioconium) are used as guiding herbs. Take twice a day. Separately, decoct Zisu (Perillae Folium), Rendongteng (Lonicerae Japonicae Caulis), and Luobo Zhong (Brassicae Rapae Semen) for soup. Bathe once daily. By the fourth day, the swelling had subsided by eighty percent. Then, Shenling Baizhu San (Ginseng and Atractylodes Macrocephala Powder) was prescribed, mixed with Zisu decoction. Taken twice daily. The urine was yellow, so Mutong (Akebiae Caulis) was added to decoct the medicine. After six doses, Zisu was removed, and Mugua (Chaenomelis Fructus) and Huashi (Talcum) were added. Finally, Lianqiao (Forsythiae Fructus) and Zhizi (Gardeniae Fructus) were added. After eight more doses, full recovery was achieved.
Yu Zhen's commentary: These three cases all employ mild and straightforward methods, yet their principles constitute the basic necessities of medical practice, indispensable like cloth and grain. The modifications of herbs and the progression of tonification and purgation in the cases of Doctors Fu and Jiang demonstrate meticulous reasoning.
[Appendix] During the Chenghua reign of the Ming Dynasty, Zhang Jingfang, an official of the Directorate of Astronomy, suffered from severe abdominal distension. He met an old man with long eyebrows who taught him a prescription: equal parts of Xingren (Armeniacae Semen Amarum), Chenpi (Citri Reticulatae Pericarpium), and Haipiaoxiao (Sepiae Endoconcha) ground into powder. Assisted by seven leaves each of Gushu Ye (Oryzae Folium), Huaishu Ye (Meliae Folium), and Taozhi (Persicae Ramulus). Draw water at noon, boil three or four times. When stars appear, boil one more time. The patient bathes in it. Let strong men massage above and below the navel hundreds of times in the water. Soon, flatus passed, and the illness receded.
Yu Zhen's commentary: This prescription is inferior to Dr. Jiang's; it should be combined for better effect. Other methods such as applying paste made from Tianluo (Cipangarapagoda), Dasuan (Allii Sativi Bulbus), and Cheqiancao (Plantaginis Herba) to the navel, or swallowing cooked spiders, claiming increased urination and reduced swelling, showed no efficacy and are therefore not recorded.
Li Shicai treated Qian Shangzhi, who had generalized edema and tension, with a protruding umbilicus and flat back, a condition considered incurable. The family insisted on treatment. A large dose of Jinkui Shenqi Wan (Golden Cabinet Kidney Qi Pill) was decocted and taken, along with Lizhong Tang (Regulate the Middle Decoction). After five days with no effect, Ren Shen (Ginseng Radix et Rhizoma) 1 liang, Sheng Fuzi (Prepared Aconiti Lateralis Radix) 3 qian, Niuxi (Achyranthis Bidentatae Radix), and Fuling (Poria) 5 qian each were used. Urination suddenly resumed, and eating began. In total, 4 jin of Ren Shen, over 1 jin each of Fuzi (Aconiti Lateralis Radix Praeparata), Guizhi (Cinnamomi Ramulus), and Ganjiang (Zingiberis Rhizoma) were consumed before recovery.
He Zonglu, a student at the Imperial Academy, loved drinking water in summer. One day, after waiting from early morning until Wei/Shen hours for salary distribution, he drank over ten bowls due to heat. Upon returning home, he experienced bloating and inability to eat. Ten days later, his abdomen swelled like a jar, with shortness of breath and wheezing. Li Shicai said, "The skin is thin and shiny, indicating stagnant fluid that fails to transform. The six pulses are firm. The disease arose abruptly; the method should be to promote urination." Thus, Zhouche Wan (Boat Cart Pill) was prescribed, 3 qian per dose, delivered with Xiangru Tang (Mosla Decumbens Decoction). After two doses, urination and defecation gushed forth like a spring. Another 1.5 qian was given, reducing the abdomen to normal. Ten doses of Liujunzi Tang (Six Gentlemen Decoction) led to cure.
Yu Zhen's commentary: These two cases involve drastic tonification and aggressive purging, akin to a lion wrestling an elephant, using full strength. Students must examine the etiology and pulse diagnosis to understand that ancient physicians were not reckless.
He also treated the wife of Guanglu Qing Wu Boyu, who suffered from abdominal fullness and pain, extreme wheezing, constipation, and anorexia. Physicians used qi-regulating and diuretic herbs for twenty days without effect. Li Shicai diagnosed a large and rapid pulse, especially at the right Chi position. Abdominal palpation was intolerable. He stated, "This is Da Chang Yong (Large Intestine Abscess). Rapid pulse indicates pus formation." Huangqi (Astragali Radix), Jiaoci Ci (Gleditsiae Sinensis Spina), Baizhi (Angelicae Dahuricae Radix), Yinhua (Lonicerae Japonicae Flos), and Gancao Jie (Glycyrrhizae Radix et Rhizoma nodules) were used, plus 1 liang of Kuigen (Abutilonis Radix). Decocted in one bowl, taken at once. Pain intensified before Shen hour; at midnight, profuse pus and blood were discharged, leading to fainting. Dushen Tang (Single Ginseng Decoction) provided slight relief, followed by Shiquan Dabu Tang (Ten Significant Tonifying Decoction) for a month until cured.
Yu Zhen's commentary: This case is essential for understanding abdominal distension syndromes.
Sun Yikui treated Ma Eryin, aged fifty-five, who ate excessive eel meat rolls, causing epigastric and abdominal pain. City doctors hastily used Xiaoya (Purgatives like Mangxiao and Dahuang). Defecation failed, and pain worsened. Subsequent doctors administered Muxiang Binglang Wan (Costus and Areca Seed Pill) and Dachengqi/Xiaochengqi Tangs for ten days, worsening pain. No food intake, no defecation, scanty urination. Later doctors, finding Xiaoya ineffective, gave Beiji Wan, Baibing Zi, Shizao Tang, and Heibai Chou (Black and White Morning Glory Seeds). After several days, both urination and defecation ceased completely. Distension was unbearable. Doctors cried out in confusion. One moxibusted Zhongwan (CV12) thirty cones with no effect, predicting death in three days. Sun arrived, observing dark complexion, hidden spirit, loud voice, but massive abdomen unable to turn. Pulses were slippery and large, especially at Chi positions. Reviewing previous prescriptions, he was shocked. He decided to first administer Xiangsha Liujunzi Tang (Costus and Amomum Six Gentlemen Decoction), Ren Shen and Baizhu 2 qian each. Doctors were astonished, asking how tonics could be used for fullness and blockage, especially for a dark-complexioned person. Sun replied, "This is not Drum Distension, but internal injury. Initially, the pathogen was in the upper jiao; the method should have been vomiting ('Those above, induce vomiting'). Using purgatives damaged the Spleen, losing its transformative function. Hence, purging caused more damage and distension. Spleen qi stagnated, preventing drug action. Liujunzi wakes the Spleen; Xiangsha aids movement. Vomiting will expel previous drugs, restoring vitality. This treats the drugs, not the disease. I fear unceasing diarrhea, not constipation." Doctor asked, "How can we fear unceasing if there is none?" Sun said, "Consider how much Xiaoya a normal person can take? Now, fortunately, they haven't moved, so we can act. Once they move, all drug properties activate, like a leaking bottle; nothing remains. Dangerous." Asked why purgatives didn't work, Sun said, "Initially food injury, then drug injury. Damage is in Upper/Middle Jiao; Lower Yuan is intact, hence Chi pulses have spirit. 'Nan Jing' says Chi is like tree roots. 'Nei Jing' says Kidney is the gate of Stomach. Dark color and hidden spirit indicate root integrity remains." After medication, severe abdominal pain occurred. Sun changed to Ren Shen Lu (Ginseng Stem), Fangfeng Lu, Shengma (Cimicifugae Rhizoma), Jiegeng (Platycodonis Radix) 3 qian each. Decocted, then induced vomiting with goose feather. Dozens of bowls of previous drugs were vomited. Patient rejoiced, "I see light!" It was Si hour. Sun predicted defecation at You hour, advised preparing Ren Shen. At Wu hour, Zhibao Dan was given to warm middle qi. Between Wei/Shen, bowel sounds roared, abdomen expanded inches. Evening: one defecation, slight urination. Sun immediately prescribed Ren Shen, Baizhu 5 qian, Paoyanjiang (Prepared Ginger) 3 qian, Fuling 2 qian, Chenpi 1 qian, Muxiang, Gancao 0.5 fen. Urgent decoction. Fourth watch: another defecation, urination followed, pain decreased. Next day: twelve diarrheal episodes. Same formula continued as decoction and pill. Total diarrhea lasted 72 days, consuming over 2 jin of Ren Shen for recovery.
[Appendix] Yu Jiayan treated Yuan Zhongqing's son, rescued from water, feverish and groaning. Pediatricians gave Jingfeng pills/powders. Two days later, coma, chest elevation 3 cun, weak neck, faint breathing. Yu diagnosed rootless pulse, thread-like, hopeless. Dropped two tea spoons of liquid into mouth; slight swallowing reflex. Reasoning: though triggered by fright, falling in water caused cold-damp invasion and fever. Food stagnation in Stomach should be treated like Cold Damage with food retention. Instead, heavy cold minerals suppressed pathogens deep into organs, clouding spirit. Cold inhibited food transformation. Drugs stayed above stomach, accumulating, causing chest protrusion. Yu suggested using Lizhong Tang to mobilize previous drugs. Decocted and灌ed. Patient belched violently, expelling all previous drugs. Chest flattened, neck stiffened. Pulse still absent, unconscious. Yu said, "Food hasn't moved, orifices blocked." Re-administered small amount of Lizhong Tang, heat subsided. Then dissolved Yuanmingfen (Mirabilite) in water,灌ed three times, passing large amounts of black stool. Followed by fluids-generating herbs for recovery.
Yu Zhen's commentary: Exchanging drugs mirrors Sun's approach, hence recorded together.
Chao Shaochuan had chronic asthma. Attacks treated with Mahuang (Ephedrae Herba), Shigao (Gypsum Fibrosum), Xingren (Armeniacae Semen Amarum), Zhike (Aurantii Fructus), and Xiacha (Fine Tea) in large doses, effective repeatedly. However, indulgence in alcohol and sex, exposure to wind-cold, led to massive abdominal distension and pillar-like leg edema. Clear fluid oozed from sores, foul-smelling. Could not lie down for five months. Doctors refused treatment. Sun Dongsu (Sun Yikui) saw him sitting high, panting, hot yet fearing cold greatly. Surrounded by five fire basins, wearing velvet hat, marten fur cover, handkerchief, nose covered. Pulse floating, large, powerless. Complexion white with hints of blue. Asked about chills/fever onset: ten days. Sun diagnosed "Qi deficiency with middle fullness," requiring warming and tonifying Lower Yuan. People only know to drain urine, not that poor urination stems from deficient Lower Jiao qi failing to enter Bladder channels. Aggressive draining causes fluid overflow into skin/scrotum, potentially bursting. Must wait for Lower Yuan qi to strengthen for natural transformation. Recent chills/fever are exterior cold. Disperse first. Burning chest/diaphragm is Yin excess repelling Yang, false heat driven upward by cold. Will resolve when Lower Yuan warms. Prescribed Suzye (Perillae Folium), Xixin (Asari Radix et Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Cangzhu (Atractylodis Rhizoma), Chenpi, Baiddoukou (Amomi Fructus Rotundus), Ren Shen, Zhigancao (Prepared Glycyrrhizae Radix), Shengjiang (Zingiberis Rhizoma Recens). One dose produced slight sweat, fires removed, hat off, only nose remained cold. Fangfeng and Huangqi (Astragali Radix) 2 liang decocted for fumigation, three times daily, nose cover removed. Nausea persisted, treated with Renshen Wendan Tang (Ginseng Phlegm-Resolving Decoction) plus Dingxiang (Caryophylli Flos), stopped in one dose. Advised carp for diuresis (2 jin/day); midnight extreme distension brought panic. Sun said, "Disease this severe, how dare you indulge? Ordinary meds won't help." Pondered, prescribed Pingwei San (Maintain the Middle Powder) 1 liang + Olive flesh 1 liang, decocted. Two doses stabilized. Only abdominal distension and poor urination remained. Prescribed Fuzi Lizhong Tang (Aconite Regulate Middle Decoction) plus Sharen (Amomi Fructus), Buguzhi (Psoraleae Fructus), Chidou (Phaseoli Semen Rubrum), Guixin (Cinnamomi Cortex). Four doses slightly improved urination. Followed by Zunzhong Wan, 5 pills, three times daily. Five days later, urination patent, able to sleep on mat.
Yu Zhen's commentary: Case dangerous, meds ordinary, yet effective—doubtful. Fangji fumigation and Pingwei San with olive are clever. Lizhong and Zunzhong formulas combine tonification and purgation cleverly.
Zhou Shenzhai treated a man with abdominal distension and vomiting. Patent urination caused constipation; patent defecation caused urinary retention. Zhou said, "Middle Qi excess causes distension. Turbid Yin rises causing vomiting. Clear Yang sinks blocking Lower Jiao, preventing simultaneous passage." Used Paoyanjiang 3 qian to warm/move Middle, Shengma 1.5 qian to raise Yang below, Wuzhuyu 1 qian to descend Turbid above. Cured in eight doses.
Also treated a woman with distension and specific pulse, cured by Huangbai (Phellodendri Cortex), Qingyan (Sal Nitratum), Shengma. Disciple asked why. Zhou said, "Mingmen Fire stagnation prevents Kidney True Yang rising and Heart True Yin descending. Huangbai clears Mingmen vigorous fire, allowing True Yang to rise from Water. Qingyan moistens Heart, preventing false fire, allowing True Water to descend. Water/Fire interact. Shengma lifts Green Qi. Rising Green Qi descends Turbid Qi, relieving Spleen/Lung stagnation, curing distension. Root in Kidney, branch in Heart; thus three herbs work fast."
Yu Zhen's commentary: Zhou's theory is high, formulas unique, but skeptical of these three for distension. Yi Silan used this for tooth distension, which aligns better with theory.
Zhang Luyu treated Wang Yongruo with vomiting, edema, complete urinary/fecal retention. Wuling San/Bazheng San failed. Six pulses deep/thin as silk. Given Jin Ye Dan (Golden Liquid Pill) 15 pills. Urination gushed, pressure eased. Later cultivated with Jisheng Shenqi for stability.
Li Shizhen treated a scholar's wife with lower body edema, facial swelling, fatal dyspnea, inability to lie flat, loose stools, scanty urine. Pulse deep/large: Deep=Water, Large=Deficiency. Post-illness wind invasion, named Fengshui (Wind Edema). Used Qianjin Shenmi Tang (Thousand Gold Secret Mysterious Decoction) + Mahuang. One dose reduced dyspnea by half. Then Weiling Tang swallowed with Shenshi Rushu Wan. Two days later, increased urination, 70% swelling reduction. Days of regulation led to full health.
Yu Zhen's commentary: Jin Ye Dan and Shenmi Tang are rarely used, but skilled application yields miracles. Ancient formulas exist in texts; we just fail to find the right match. Shenmi Tang is Shengmai San combined with Erchen Tang, minus Maidong/Fuling, plus Zisu, Sangbaipi, Jiegeng, Binglang, guided by Shengjiang. Perfect for this case, adding Mahuang is better. Not a generic "eight-inch-three-fen" hat.