若因内伤饮食浓味，大实大满，气滞，脉洪大实者宜下之。若因过服下药泻利后所致，
或脾胃素弱，不能
运化者，皆宜补益助脾行湿。盖此时正气已衰矣，况积而胀乎？故云平治之。又如血蓄血瘀而
致者，当以血药治之。寒者热之，热者清之，结者散之，清浊混淆者分消之。或升降其气，
或消导其邪，皆宜适事为故可也。
丹溪治一人，年五十，嗜酒，病疟半年患胀。诊其脉弦而涩重，则大疟未愈，手足瘦而
腹大如蜘蛛状。予教以参、术为君，当归、川芎、芍药为臣，黄连、陈皮、茯苓、浓朴为佐，
生甘草些小作浓汤饮之，一日定三次。彼亦严守戒忌，一月后疟愈，又半年小便长而胀愈。
中间虽稍有加减，大意只是补气行湿。
一人年四十余，性嗜酒，大便时见血，春间患胀，色黑腹大，形如鬼状，脉涩而数重似弱，
以四物汤加苓、连、木通、白术、陈皮、浓朴、生甘草作汤与之，一月而安。一补气，一补
血，余药大率相出入，皆获安。或曰∶气无补法，今何补气而安？曰∶气无补法，俗论也。痞
闷壅塞，似难于补，不思正气虚者，不能自运。经曰∶壮者气行则愈，怯者着而为病。若不
补气，邪何由行？
一人年近五十，得腹胀，自制禹余粮丸服之。其脉弦涩而数。丹溪曰∶此丸新制， 炼
之火邪尚存，温热之药味太多，宜自加减，不可执方。病者曰∶此方不可加减。服之一月，
口鼻中出黑血，骨立而死。患腹胀按之不痛者为虚，按之痛者实也。腹中满不减，不惊人，
此当下之。舌黄沫下者，下之黄自去，腹满时减，复如故。此为寒，当以温药。
腹满口中苦干燥，腹中有水，是饮也。跗阳脉微弦，法当腹满。不满者，必下部闭塞，
大便难，两脚下疼痛。此虚气寒气从下向上，当以温药服之取瘥。腹满转痛来趣小腹，为欲
自下利也。
如果是由于内伤饮食厚味，导致大实大满、气机阻滞，且脉象洪大有力的，适宜采用攻下法治疗。如果是由于过度服用泻下药导致腹泻之后引起的，或者脾胃素来虚弱，不能运化水谷的，都适宜采用补益脾土、助运化湿的方法。因为此时正气已经衰弱了，何况还有积滞导致的胀满呢？所以说要平和地调理。又比如因血蓄、血瘀而导致的，应当用治血的药物来治疗。寒证用热药治疗，热证用清法治疗，结聚的用散法治疗，清浊混淆的用分消法治疗。或者升降其气机，或者消导其邪气，都应该根据具体情况来处理。
朱丹溪治疗一个人，五十岁，嗜好饮酒，患疟疾半年后出现腹胀。诊察他的脉象弦而涩重，说明疟疾尚未痊愈，手足消瘦而腹部大得像蜘蛛一样。丹溪教他以人参、白术为君药，当归、川芎、芍药为臣药，黄连、陈皮、茯苓、厚朴为佐药，少量生甘草煎成浓汤饮用，一天定三次服用。患者也严格遵守禁忌，一个月后疟疾痊愈，又过了半年小便通畅，腹胀也就好了。中间虽然稍有加减，大意只是补气行湿。
另一个人四十多岁，性格嗜好饮酒，大便时常带血，春季患腹胀，面色黑，腹部大，形状像鬼一样，脉象涩而数重似弱，用四物汤加茯苓、黄连、木通、白术、陈皮、厚朴、生甘草煎汤给他服用，一个月就安稳了。一个补气，一个补血，其余药物大体相似出入，都获得了安宁。有人说：气病没有补法，现在为什么补气却好了？回答说：气无补法是世俗的论调。痞闷壅塞，似乎难以补益，但不思考正气虚的人，不能自行运化。经书说：壮年人气行则愈，体弱者气滞着而为病。如果不补气，邪气从哪里运行出去呢？
另一个人接近五十岁，得了腹胀，自制禹余粮丸服用。他的脉象弦涩而数。丹溪说：这个方子是新制的，炼制时火邪尚存，温热的药味太多，应该自己加减，不可拘泥于原方。病人说：这个方子不可加减。服用一个月后，口鼻中流出黑血，身体枯瘦而死。患腹胀按之不痛的属于虚证，按之痛的属于实证。腹中满闷不减，不令人惊恐，这是应当用攻下法的。舌苔黄且有涎沫下流的，用攻下法后黄苔自去，腹满时减，过后又像原来一样，这属于寒证，应当用温药。
腹部满闷，口中苦燥，腹中有水，这是饮邪。跗阳脉微弦，法度上应当出现腹满。如果不腹满，必定是下部闭塞，大便困难，两脚下面疼痛。这是虚寒气从下向上逆，应当用温药服用以求痊愈。腹满转痛趋向小腹，是想自行下利的征兆。
If the condition arises from internal injury due to rich and heavy diet, resulting in severe excess and fullness, qi stagnation, and a surging, forceful pulse, purgation (Purgative Method) is appropriate. If it is caused by excessive use of purgatives leading to diarrhea, or if the Spleen and Stomach are inherently weak and unable to transform and transport, tonification and aiding the Spleen to resolve dampness are suitable. At this time, the healthy Qi has already declined; how much more so with accumulation causing distension? Therefore, it is said that one should treat it gently. Furthermore, if caused by blood stasis or blood accumulation, blood-invigorating herbs should be used. Cold conditions are treated with heat; heat conditions with clearing; stagnation with dispersing; confusion of clear and turbid substances with separating and eliminating. One may regulate the ascending and descending of Qi, or eliminate and guide out pathogenic factors; all should be adapted to the specific situation.
Zhu Danxi treated a fifty-year-old man who loved alcohol and had suffered from malaria for half a year before developing abdominal distension. His pulse was wiry, choppy, and heavy, indicating that the malaria had not yet resolved; his limbs were emaciated while his abdomen was large like a spider. Zhu advised using Ginseng Radix et Rhizoma (Renshen, 人参) and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) as sovereign drugs, Angelicae Sinensis Radix (Danggui, 当归), Ligusticum Chuanxiong Rhizoma (Chuanxiong, 川芎), and Paeoniae Radix Alba (Shaoyao, 芍药) as minister drugs, Coptidis Rhizoma (Huanglian, 黄连), Citri Reticulatae Pericarpium (Chenpi, 陈皮), Poria (Fuling, 茯苓), and Magnoliae Officinalis Cortex (Houpo, 厚朴) as assistant drugs, with a small amount of Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) decocted into a strong tea, taken three times daily. The patient strictly observed dietary restrictions. After one month, the malaria subsided; after another six months, urination became normal, and the distension resolved. Although there were slight modifications during treatment, the main principle was tonifying Qi and moving dampness.
Another man, over forty years old, also loved alcohol and often had blood in his stool. In spring, he developed abdominal distension, with a dark complexion and an enlarged abdomen resembling a ghostly form. His pulse was choppy, rapid, heavy, and seemed weak. He was given a decoction of Four Substances Decoction (Sìwù Tāng, 四物汤) plus Poria (Fuling, 茯苓), Coptidis Rhizoma (Huanglian, 黄连), Akebiae Caulis (Mutong, 木通), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Citri Reticulatae Pericarpium (Chenpi, 陈皮), Magnoliae Officinalis Cortex (Houpo, 厚朴), and raw Licorice Root (Sheng Gancao, 生甘草). He stabilized within one month. One case involved tonifying Qi, the other tonifying Blood; the remaining herbs varied slightly, yet both recovered. Someone asked: "It is said there is no tonification method for Qi disorders; why did tonifying Qi lead to recovery?" The reply was: "The idea that Qi disorders cannot be tonified is a vulgar opinion. While bloating and obstruction seem difficult to treat with tonification, one must consider that those with deficient Healthy Qi cannot self-regulate. The Classics state: 'Those who are robust recover as Qi moves; the frail suffer disease when Qi stagnates.' Without tonifying Qi, how can pathogenic factors be expelled?"
Another man, nearly fifty, suffered from abdominal distension and took self-made Yuyuliang Wan (Yúyúliáng Wán, 禹余粮丸). His pulse was wiry, choppy, and rapid. Danxi said: "This formula is newly prepared; fire toxicity remains from processing, and there are too many warm-hot herbs. You should modify it yourself; do not adhere rigidly to the prescription." The patient replied: "This formula cannot be modified." After one month of taking it, black blood flowed from his mouth and nose, and he died emaciated. Abdominal distension that is painless upon pressure indicates deficiency; pain upon pressure indicates excess. Fullness in the abdomen that does not decrease suggests the need for purgation. Yellow tongue coating with saliva indicates that purgation will remove the yellow coating. Fullness that decreases intermittently but returns resembles cold patterns, requiring warm herbs.
Abdominal fullness with bitter and dry mouth, and water retention in the abdomen, indicates fluid retention (Yin Pathogen). A faint and wiry pulse at the Fuyang point suggests abdominal fullness. If there is no fullness, there must be lower body obstruction, difficult defecation, and pain in the lower legs. This is due to deficient cold Qi rising from below, requiring warm herbs for recovery. Abdominal fullness turning painful and radiating to the lower abdomen indicates an impending spontaneous bowel movement.