初因面肿。邪干阳位。气壅不通。二便皆少。桂附不应。即与导滞。滞属有质。
湿热无形。入肺为喘。乘脾为胀。六腑开阖皆废。便不通爽。溺短混浊。时或点滴。
视其舌绛口渴。腑病背胀。脏病腹满。更兼倚倒左右。肿胀随着处为甚。其湿热
布散三焦。明眼难以决胜矣。经云。从上之下者治其上。又云。从上之下而甚于
下者。必先治其上。而后治其下。此症逆乱纷更。全无头绪。皆不辨有形无形之
误。姑以清肃上焦为先。
飞滑石 大杏仁 生苡仁 白通草 鲜枇杷叶 茯苓皮 淡豆豉 黑山栀壳
诊脉右大而缓。左手小数促。冬季寒热身痛。汗出即解。自劳役饥饱嗔怒
之后。病势日加。面浮足肿。呼吸皆喘。目泪鼻衄。卧着气冲欲起。食纳留中不运。
时序交夏。脾胃主候。睹色脉情形。中满胀病日来矣。盖此症属劳倦致损。初病
即在脾胃。东垣云。胃为卫之本。脾乃营之源。脏腑受病。营卫二气。昼夜循环失
度。为寒为热。原非疟邪半表半里之症。斯时若有明眼。必投建中而愈。经言。劳
者温之。损者益之。建中甘温。令脾胃清阳自立。中原砥定。无事更迁。仲景亦谓
男子脉大为劳。则知内经东垣仲景垂训。真规矩准绳至法。且汗泄积劳。都是
阳伤。医药辛走劫阳。苦寒败胃。病患自述。饮蔗即中脘不舒。顷之少腹急痛。便
稀。其胃阳为辛苦大伤。明甚。又述咳频冲气。必自下上逆。夫冲脉隶于阳明。胃
阳伤极。中乏坐镇之真气冲脉动则诸脉皆动。浊阴散漫上布。此卧着欲起矣。
愚非遥指其脉。正合内经浊气在上。则生 胀。太阴所至。为腹胀相符也。有昔
见痰休治痰。见血休治血。当以病因传变推求。故辨论若此。
浓朴 杏仁 人参 茯苓 蜜煨姜 南枣
壮盛年岁。形消色夺。诊脉右小促。左小弦劲。病起上年秋季。脘中卒痛。有
形梗突。病后陡遇惊触。渐次食减不适。食入不运。停留上脘。腹形胀满。甚则胁肋皆胀。四肢不暖。暮夜
渐温。大便旬日始通。便后必带血出。清早未食。自按脐上气海。有瘕形甚小。按之微痛。身动饮水。
寂然无踪。天气稍冷。爪甲色紫。细推病属肝脾。气血不通。则为郁遏。久则阳微痹结。上下不行。
有若否卦之义。阅医药或消或补。总不见效者。未知通阳之奥耳。
薤白 桂枝 栝蒌仁 生姜 半夏 茯苓
平昔湿痰阻气为喘。兹因过食停滞。阴脏之阳不运。阳腑之气不通。二便
不爽。跗肿腹满。诊脉沉弦是由水寒痰滞。阻遏气分。上下皆不通调。当从三焦
分治。顷见案头一方。用菟丝子升少阴。吴茱萸泄厥阴。不知作何解释。不敢附
和。仍用河间分消定议。
大杏仁 莱菔子 猪苓 泽泻 葶苈子 浓朴 桑白皮 广皮 细木通
两年初秋发疡。脉络气血。不为流行。而腹满重坠。卧则颇安。脐左动气。卧
则尤甚。吐冷沫。常觉冷气。身麻语塞。肝风日炽。疏泄失职。经以肝病吐涎沫。木
侮土位。自多 胀。丹溪云。自觉冷者。非真冷也。两次溃疡之后。刚燥热药。似难
进商。议以宣通肝胃为治。有年久恙。贵乎平淡矣。
云茯苓 三角胡麻 浓橘红 嫩钩藤 熟半夏 白旋复花
脉微而迟。色衰萎黄。蟹为介属。咸寒沉降。凡阳气不足者。食之损阳。其致
病之由。自试二次矣。久利久泄。古云无不伤肾。今浮肿渐起自下。是水失火而
败。若非暖下。徒见泻泄有红。为脾胃湿热。必致中满败坏。
生茅术 熟地炭 熟附子 淡干姜 茯苓 车前子
脉左弦右浮涩。始因脘痛贯胁。继则腹大高凸。纳食减少难进。二便艰涩
不爽。此乃有年操持。萦虑太甚。肝木怫郁。脾土自困。清浊混淆。胀势乃成。盖脏
真日纳。腑阳不运。考古治胀名家。必以通阳为务。若滋阴柔药。微加桂附。凝阴
浊。岂是良法。议用局方禹粮丸。暖其水脏。攻其秽浊。俟有小效。兼进通阳刚
补。是为虚症内伤。胀满治法。至于攻泻劫夺。都为有形而设。与无形气伤之症不同也。
禹余粮丸
今年长夏久热。热胜阳气外泄。水谷运迟。湿自内起。渐渐浮肿。自下及上
至于喘咳。不能卧息。都是浊水凝痰。阻遏肺气下降之司。但小溲不利。太阳亦
不通调。此虽阳虚症若肾气汤中萸地之酸腻。力难下行矣。
茯苓 桂枝木 杏仁 生白芍 干姜 五味 生牡蛎 泽泻
向有宿痞。夏至节一阴来复。连次梦遗。遂腹形坚大。二便或通或闭。是时
右膝痈肿溃疡。未必非湿热留阻经络所致。诊脉左小弱。右缓大。面色清减。鼻
准明亮。纳食必腹胀愈加。四肢恶冷。热自里升。甚则衄血牙宣。全是身中气血
交结。固非积聚停水之胀。考古人于胀症以厘清气血为主。止痛务在宣通。要
知攻下皆为通腑。温补乃护阳以宣通。今者单单腹胀。当以脾胃为病薮。太阴
不运。阳明愈钝。议以缓攻一法。
川桂枝 熟大黄 生白芍 浓朴 枳实 淡生干姜
患风三月。周身流走作肿。手不能握。足不能履。诊其脉。浮大而数。发热口
干。此阴虚生内热。热胜则风生。况风性善行。火热得之。愈增其势。伤于筋脉。则
纵缓不收。逆于肉理。则攻肿为楚也。
生地 黄芩 黄连 红花 羌活
左胁有形。渐次腹大。每投攻下泄夺。大便得泻。胀必少减。继则仍然不通。
频频攻下。希图暂缓。病中胀浮下部。加针刺。以扶水之出。肿消。病仍不去。病患
六年。久已断想此病之愈。要知此病初由肝气不和。气聚成瘕。屡发攻泻。脾胃
反伤。古云脐突伤脾。今之所苦。二便欲出。痛如刀刺。盖气胀。久下再夺其血。血
液枯。气愈结矣。宣通宜以利窍润剂。
琥珀屑 麝香 大黑豆皮 杜牛膝
由夏季目黄神倦。渐至中焦胀满。延至霜降。上吐瘀血。下便污浊。按脉弱
细不调。视色神采不振。兼以呼吸带喘。素有寒疾气逆。其宿饮之蓄。已非一日。
当夏三月。脾胃主令。天气热。地气升。人身气泄。加以饥饱劳役。而遂减食胀满。
是皆病于中。绵延上下矣。夫六腑以通为用。不但腑不用事。其间经脉络脉中。
气血皆令不行。气壅血瘀。胀势愈加。古人治胀病专以宣通为法。而有阴阳之
殊。后之攻劫宣通。如神佑舟车禹功等方。值此久病淹淹。何敢轻试。议以专通
三焦之阳气。驱其锢蔽之浊阴。温补兼进。若不阳气渐苏。难以拟投。引用仲景白通汤。
去须葱白 干姜 猪胆汁 淡附子
起初面部浮肿。邪气侵犯阳位（头面等上部位置）。气机壅滞不通。大小便都减少。使用桂枝、附子治疗无效。随即采用导滞法。积滞属于有形的病理产物。
湿热是无形的病邪。侵入肺脏导致气喘。侵犯脾脏导致腹胀。六腑的开阖功能全部废弛。大便不通畅。小便短少且浑浊。有时仅能点滴排出。
观察患者舌质红绛、口渴。腑病表现为背部胀满。脏病表现为腹部胀满。更兼身体倚靠倾斜，左右侧肿胀随体位变化而加重。其湿热散布于三焦。高明医生也难以迅速决断胜负。《内经》说。病势从上往下发展的，治疗上焦。又说。病势从上往下发展且在下部加重的。必须先治上焦。然后治下焦。此症逆乱繁杂。全无头绪。都是未能辨别有形与无形病邪的错误所致。暂且以清肃上焦为先。
飞滑石 大杏仁 生苡仁 白通草 鲜枇杷叶 茯苓皮 淡豆豉 黑山栀壳
诊脉右脉大而缓。左手脉小数且急促。冬季时寒热交替、身体疼痛。出汗后症状缓解。自从劳累、饥饱不均、发怒之后。病情日益加重。面部浮肿、足部肿胀。呼吸皆喘促。流泪、鼻出血。躺下时气冲欲起。饮食停滞中焦不运化。
时令进入夏季。脾胃当令。看面色和脉象情形。中满胀病近日就要发作了。大概此症属于劳倦导致损伤。初病就在脾胃。李东垣说。胃是卫气的根本。脾是营气的源头。脏腑受病。营卫二气。昼夜循环失去节度。表现为寒热。原本不是疟邪在半表半里的病症。此时若有高明医生。必定投用建中汤而痊愈。经书说。劳损者用温法。虚损者用补法。建中汤甘温。使脾胃清阳之气自立。中州稳固。无需再迁延变动。张仲景也说。男子脉大为劳证。由此可知《内经》、李东垣、张仲景的教诲。真是规矩准绳至法。况且汗出泄越、积劳。都是阳气受伤。医药辛散走窜劫伤阳气。苦寒败坏胃气。病患自述。喝甘蔗汁即感到中脘不适。不久小腹部急痛。大便稀溏。其胃阳被辛苦之药大伤。非常明显。又述咳嗽频繁、冲气上逆。必然从下向上逆行。冲脉隶属于阳明胃经。胃阳伤极。中焦缺乏镇守的真气。冲脉动则诸脉皆动。浊阴散漫上行布散。这就是躺下时气冲欲起的原因。
我并非凭空猜测其脉象。正符合《内经》“浊气在上，则生䐜胀”。太阴湿土所至。为腹胀相符也。古人云。见痰休治痰。见血休治血。应当根据病因传变推求。所以辩论如此。
浓朴 杏仁 人参 茯苓 蜜煨姜 南枣
正值壮年。形体消瘦、面色枯槁。诊脉右脉小促。左脉小弦劲。病起于去年秋季。胃脘突然疼痛。有形的梗突感。病后突然遭遇惊吓触动。逐渐食欲减退不适。食物入胃不运化。停留于上脘。腹部胀满。甚至胁肋都胀。四肢不暖。夜晚逐渐转温。大便十天才能通畅。便后必带血出。清晨未进食。自行按压脐上气海穴。有瘕聚形状很小。按压微痛。身体活动饮水。寂静时无踪影。天气稍冷。指甲颜色紫暗。仔细推敲病属肝脾。气血不通。则为郁遏。久则阳气微弱痹结。上下不行。有如否卦之义。阅读之前的医药或消或补。总不见效的原因。是不懂得通阳的奥妙罢了。
薤白 桂枝 栝蒌仁 生姜 半夏 茯苓
平素湿痰阻气导致气喘。这次因为过食停滞。阴脏之阳不运。阳腑之气不通。大小便不爽。足背浮肿、腹部胀满。诊脉沉弦是由水寒痰滞。阻遏气分。上下都不通调。应当从三焦分治。刚才看到案头一方。用菟丝子升提少阴。吴茱萸疏泄厥阴。不知作何解释。不敢附和。仍用刘河间分消定议。
大杏仁 莱菔子 猪苓 泽泻 葶苈子 浓朴 桑白皮 广皮 细木通
两年前初秋发生疮疡。脉络气血。不能流行。而腹满重坠。躺下则颇安。脐左侧动气。躺下则尤其严重。吐冷沫。常觉冷气。身体麻木、言语塞涩。肝风日炽。疏泄失职。经书说肝病吐涎沫。木侮土位。自然多䐜胀。朱丹溪说。自觉冷者。并非真冷。两次溃疡之后。刚燥热药。似乎难以进商榷。议以宣通肝胃为治。年老久病。贵在平淡。
云茯苓 三角胡麻 浓橘红 嫩钩藤 熟半夏 白旋复花
脉微而迟。色衰萎黄。蟹为介类。咸寒沉降。凡阳气不足者。食之损阳。其致病的原因。自己尝试过两次了。久利久泄。古云无不伤肾。现在浮肿渐起自下。是水失火而败。如果不是暖下。徒见泻泄有红。认为是脾胃湿热。必致中满败坏。
生茅术 熟地炭 熟附子 淡干姜 茯苓 车前子
脉左弦右浮涩。起初因脘痛贯穿胁肋。继而腹部大高凸。纳食减少难进。大小便艰涩不爽。这是年老操持。思虑太甚。肝木怫郁。脾土自困。清浊混淆。胀势乃成。盖脏真日纳。腑阳不运。考古治胀名家。必以通阳为务。若滋阴柔药。微加桂附。凝阴浊。岂是良法。议用局方禹粮丸。暖其水脏。攻其秽浊。俟有小效。兼进通阳刚补。是为虚症内伤。胀满治法。至于攻泻劫夺。都为有形而设。与无形气伤之症不同也。
禹余粮丸
今年长夏久热。热胜阳气外泄。水谷运迟。湿自内起。渐渐浮肿。自下及上。至于喘咳。不能卧息。都是浊水凝痰。阻遏肺气下降之司。但小溲不利。太阳亦不通调。此虽阳虚症若肾气汤中萸地之酸腻。力难下行矣。
茯苓 桂枝木 杏仁 生白芍 干姜 五味 生牡蛎 泽泻
向有宿痞。夏至节一阴来复。连次梦遗。遂腹形坚大。二便或通或闭。是时右膝痈肿溃疡。未必非湿热留阻经络所致。诊脉左小弱。右缓大。面色清减。鼻准明亮。纳食必腹胀愈加。四肢恶冷。热自里升。甚则衄血牙宣。全是身中气血交结。固非积聚停水之胀。考古人于胀症以厘清气血为主。止痛务在宣通。要知攻下皆为通腑。温补乃护阳以宣通。今者单单腹胀。当以脾胃为病薮。太阴不运。阳明愈钝。议以缓攻一法。
川桂枝 熟大黄 生白芍 浓朴 枳实 淡生干姜
患风三月。周身流走作肿。手不能握。足不能履。诊其脉。浮大而数。发热口干。此阴虚生内热。热胜则风生。况风性善行。火热得之。愈增其势。伤于筋脉。则纵缓不收。逆于肉理。则攻肿为楚也。
生地 黄芩 黄连 红花 羌活
左胁有形。渐次腹大。每投攻下泄夺。大便得泻。胀必少减。继则仍然不通。频频攻下。希图暂缓。病中胀浮下部。加针刺。以扶水之出。肿消。病仍不去。病患六年。久已断想此病之愈。要知此病初由肝气不和。气聚成瘕。屡发攻泻。脾胃反伤。古云脐突伤脾。今之所苦。二便欲出。痛如刀刺。盖气胀。久下再夺其血。血液枯。气愈结矣。宣通宜以利窍润剂。
琥珀屑 麝香 大黑豆皮 杜牛膝
由夏季目黄神倦。渐至中焦胀满。延至霜降。上吐瘀血。下便污浊。按脉弱细不调。视色神采不振。兼以呼吸带喘。素有寒疾气逆。其宿饮之蓄。已非一日。当夏三月。脾胃主令。天气热。地气升。人身气泄。加以饥饱劳役。而遂减食胀满。是皆病于中。绵延上下矣。夫六腑以通为用。不但腑不用事。其间经脉络脉中。气血皆令不行。气壅血瘀。胀势愈加。古人治胀病专以宣通为法。而有阴阳之殊。后之攻劫宣通。如神佑舟车禹功等方。值此久病淹淹。何敢轻试。议以专通三焦之阳气。驱其锢蔽之浊阴。温补兼进。若不阳气渐苏。难以拟投。引用仲景白通汤。去须葱白 干姜 猪胆汁 淡附子
Initially, facial edema occurred. Pathogenic factors invaded the Yang regions (upper body/head). Qi stagnation and obstruction ensued. Both urination and defecation decreased. Treatment with Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Prepared Aconite Root) was ineffective. Subsequently, a method to guide out stagnation was employed. Stagnation refers to tangible pathological products.
Damp-heat is an intangible pathogen. Entering the Lung causes wheezing. Invading the Spleen causes distension. The opening and closing functions of all six Fu organs were abolished. Defecation was unsmooth. Urination was short and turbid. Occasionally, only drops could be discharged.
Observing the crimson tongue and thirst. Fu organ diseases manifest as back distension. Zang organ diseases manifest as abdominal fullness. Additionally, the body leans to one side or the other, and swelling worsens depending on the position. The damp-heat is dispersed throughout the Sanjiao (Triple Burner). Even skilled physicians find it difficult to quickly determine the outcome. The Classic states: "When the disease progresses from above downwards, treat the upper part." It also states: "When the disease progresses from above downwards and worsens in the lower part, one must first treat the upper part, then the lower part." This case is chaotic and disordered, lacking any clear sequence. This is due to the error of failing to distinguish between tangible and intangible pathogens. For now, clearing and purifying the Upper Jiao is prioritized.
Fei Huashi (Calcined Talcum), Da Xingren (Large Apricot Seed), Sheng Yiyiren (Raw Coix Seed), Bai Tongcao (White Tetrapanax Pith), Xian Pipaye (Fresh Loquat Leaf), Fulingpi (Poria Peel), Dan Douchi (Light Fermented Soybean), Hei Shanzhike (Black Gardenia Husk).
The pulse on the right is large and slow. The left hand pulse is small, rapid, and hurried. In winter, alternating chills and fever with body pain occurred, resolving with sweating. Since labor, irregular diet, and anger, the condition has worsened daily. Facial and foot edema are present. Breathing is wheezy. Tears flow, and epistaxis occurs. Lying down causes Qi rushing upward. Food intake stagnates in the middle and fails to transform.
As the season transitions to summer, when the Spleen and Stomach are dominant. Observing the complexion and pulse situation, Zhongman Distension Disease (Middle Fullness Distension) is imminent. Generally, this case belongs to damage caused by fatigue and overwork. The initial pathology lies in the Spleen and Stomach. Li Dongyuan said: "The Stomach is the root of Wei Qi (Defensive Qi). The Spleen is the source of Ying Qi (Nutritive Qi)." When Zang and Fu organs are diseased, Ying and Wei Qi lose their normal circadian rhythm, manifesting as cold and heat. This was originally not a Shaoyang syndrome (half-exterior, half-interior) of Malaria. At that time, if a skilled physician had been present, Jianzhong Tang (Middle-Building Decoction) would have been prescribed for recovery. The Classics state: "For exhaustion, use warming methods. For deficiency, use tonification." Jianzhong Tang is sweet and warm, establishing the clear Yang of the Spleen and Stomach, stabilizing the Middle Jiao, avoiding further delay. Zhang Zhongjing also stated: "A large pulse in men indicates consumption/deficiency." Thus, the teachings of the Neijing, Li Dongyuan, and Zhang Zhongjing serve as true standards and rules. Moreover, sweating and accumulated fatigue both injure Yang. Medicines that are acrid and dispersing rob Yang; bitter and cold medicines damage the Stomach. The patient reported that drinking sugarcane juice caused discomfort in the Zhongwan region, followed shortly by acute pain in the lower abdomen and loose stools. The Stomach Yang was clearly severely damaged by acrid and bitter medicines. The patient also described frequent coughing and rebellious Chong Qi (Penetrating Vessel Qi) rising from below. The Chong Meridian belongs to the Yangming Stomach. When Stomach Yang is extremely injured, the Middle Jiao lacks the true Qi to anchor it. When the Chong vessel moves, all vessels move. Turbid Yin scatters and spreads upwards. This explains why lying down causes Qi rushing upward.
My analysis is not baseless but aligns with the Neijing: "Turbid Qi residing in the upper part generates distension." It also corresponds to Taiyin dampness causing abdominal distension. As the ancients said: "Do not treat phlegm just because you see phlegm; do not treat blood just because you see bleeding." One should deduce based on the transmission and transformation of the etiology. Hence this discussion.
Noupu (Magnolia Bark), Xingren (Apricot Seed), Renshen (Ginseng Root), Fuling (Poria), Mi Wei Jiang (Honey-fried Ginger), Nanzao (Southern Date/Jujube).
In the prime of life, yet emaciated and sallow-complexioned. The pulse on the right is small and hurried; the left is small, wiry, and forceful. The illness began last autumn with sudden epigastric pain and a tangible lump. After the illness, a sudden fright occurred, leading to gradual loss of appetite and discomfort. Food enters but fails to transform, stagnating in the upper epigastrium. The abdomen becomes distended, extending to the hypochondriac region. Limbs are cold. Warmth returns gradually at night. Defecation occurs only after ten days, accompanied by blood. Pressing the Qihai point above the navel on an empty stomach reveals a small mass with slight tenderness. Movement and drinking water make it disappear. In colder weather, nail beds turn purple. Careful analysis suggests Liver and Spleen pathology. Qi and Blood obstruction leads to stagnation. Over time, Yang becomes weak and bi-blocked, preventing circulation up and down. This resembles the hexagram Pi (Stagnation). Previous treatments using draining or tonifying methods failed because the profound principle of promoting Yang circulation was unknown.
Xiebai (Macrostemon Bulb), Guizhi (Cinnamon Twig), Gualouren (Trichosanthes Seed), Shengjiang (Fresh Ginger), Banxia (Pinellia Rhizome), Fuling (Poria).
Normally, damp-phlegm obstructing Qi causes wheezing. This time, excessive eating led to stagnation. The Yang of the Yin organs fails to transport; the Qi of the Yang organs fails to circulate. Defecation and urination are unsmooth. Ankle edema and abdominal distension are present. The pulse is deep and wiry, indicating Cold-Damp and Phlegm-Stagnation obstructing the Qi level. Up and down are blocked. Treatment should differentiate according to the Three Jiao. I saw a prescription using Tusizi (Dodder Seed) to ascend Shaoyin and Wuzhuyu (Evodia Fruit) to drain Jueyin. I do not understand the rationale and dare not agree. Instead, I adopt Liu Hejian's method of separating and eliminating.
Da Xingren (Large Apricot Seed), Laifuzi (Radish Seed), Zhuling (Polyporus), Zexie (Alisma Rhizome), Tinglizi (Lepidium Seed), Noupu (Magnolia Bark), Sangbaipi (Mulberry Root Bark), Guangpi (Tangerine Peel), Xi Mutong (Akebia Stem).
Two years ago, early autumn, sores erupted. Collaterals and Qi-Blood failed to circulate smoothly, resulting in abdominal fullness and heaviness. Lying down provided relief. Pulsation to the left of the umbilicus worsened when lying down. Vomiting cold saliva, feeling cold internally, numbness, and speech impediment. Liver Wind intensified, and dredging function failed. The Classics state: "Liver disease causes vomiting of saliva. Wood insults Earth, naturally leading to distension." Zhu Danxi said: "Self-perceived cold is not true cold." After two ulcerations, harsh and drying hot medicines are unsuitable. I propose treating by promoting the circulation of Liver and Stomach Qi. For chronic illness in the elderly, blandness is preferred.
Yun Fuling (Cloud Poria), Sanjiao Huma (Triangular Sesame), Nong Juhong (Strong Tangerine Red Peel), Nen Gouteng (Young Uncaria Vine), Shu Banxia (Prepared Pinellia), Baixuanfuhua (White Inula Flower).
The pulse is faint and slow. Complexion is withered and yellow. Crabs are shellfish, salty and cold, sinking in nature. For those with insufficient Yang, consuming them damages Yang. The cause of illness has been tested twice by the patient. Chronic diarrhea and dysentery always damage the Kidney. Now, edema begins from below. This is Water failing Fire and deteriorating. If not warming the Lower Jiao, merely seeing red in stool and attributing it to Spleen-Stomach Damp-Heat will lead to catastrophic Middle Fullness.
Sheng Maotzu (Raw Atractylodes Macrocephala Rhizome), Shudi Tan (Charred Rehmannia Root), Shu Fuzi (Prepared Aconite Root), Dan Ganjiang (Mild Dried Ginger), Fuling (Poria), Cheqianzi (Plantago Seed).
Pulse is wiry on the left and floating-choppy on the right. Initially, epigastric pain radiated to the hypochondrium. Then, the abdomen became large and convex. Appetite decreased significantly. Defecation and urination were difficult and unsmooth. This resulted from the elderly man's hard work and excessive worry. Liver Wood became depressed, trapping Spleen Earth. Clear and Turbid Qi mixed, forming distension. The Zhen Qi of the Zang organs is consumed daily, while Fu Yang fails to transport. Ancient masters treating distension prioritized promoting Yang. Using Yin-nourishing softening medicines with slight additions of Guizhi and Fuzi would congeal Yin and Turbid Qi, which is not a good method. I propose using Ju Fang Yuliang Wan (Bureau Formula Yu Liang Pill) to warm the Water Organ (Kidney) and attack filth. Once there is slight improvement, combine with promoting Yang and firm tonification. This is the treatment method for deficiency-type internal injury distension. Draining and purging are set for tangible pathogens, different from intangible Qi-injury cases.
Yuyuliang Wan (Yu Yu Liang Pill).
This year, long summer heat prevailed. Heat excess caused Yang Qi to leak outward. Digestion of food and water slowed. Dampness arose internally. Gradually, edema appeared, spreading from below upwards. Wheezing and coughing prevented lying flat. All these are due to turbid water condensing into phlegm, obstructing the Lung's descending function. However, urination is unfavorable, and the Taiyang channel is also unregulated. Although this is a Yang-deficiency case, the sour and cloying properties of Shan Zhu Yu (Cornus Fruit) and Shu Di Huang (Prepared Rehmannia Root) in Shenqi Tang (Kidney Qi Decoction) make it difficult for the medicine to descend.
Fuling (Poria), Guizhimu (Cinnamon Twig Wood), Xingren (Apricot Seed), Sheng Baishao (Raw White Peony Root), Ganjiang (Dried Ginger), Wuwei Zi (Schisandra Berry), Sheng Muli (Raw Oyster Shell), Zexie (Alisma Rhizome).
Previously suffering from fixed masses. At the Summer Solstice, when Yin begins to regenerate, repeated nocturnal emissions occurred. Consequently, the abdomen became firm and large. Urination and defecation alternated between patent and obstructed. At that time, a carbuncle ulcerated on the right knee, likely caused by Damp-Heat lingering in the collaterals. The pulse is small and weak on the left, slow and large on the right. Complexion is pale. The nose tip is bright. Eating exacerbates abdominal distension. Limbs fear cold. Heat rises from within. Severe cases involve epistaxis and bleeding gums. This is entirely due to Qi and Blood knotting within the body. It is certainly not distension due to accumulation or stagnant water. Ancients treated distension by clarifying Qi and Blood. Pain relief requires promotion of circulation. Know that purgatives promote bowel movement, while warming tonics protect Yang to promote circulation. Currently, isolated abdominal distension points to the Spleen and Stomach as the source of disease. Taiyin fails to transport, making Yangming dull. I propose a mild attacking method.
Chuan Guizhi (Sichuan Cinnamon Twig), Shu Dahuang (Prepared Rhubarb), Sheng Baishao (Raw White Peony Root), Nongpu (Magnolia Bark), Zhishi (Immature Bitter Orange), Dansheng Ganjiang (Mild Raw Dried Ginger).
Suffering from Wind for three months. Swelling moved around the whole body. Hands could not grasp, feet could not walk. The pulse was floating, large, and rapid. Fever and dry mouth. This is Yin deficiency generating internal heat. Excess heat generates Wind. Moreover, Wind moves easily. Fire and Heat intensify its momentum. Injury to sinews and collaterals causes flaccidity and inability to contract. Reversal into muscle tissue causes painful swelling.
Shengdi (Rehmannia Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Honghua (Safflower), Qianghuo (Notopterygium Rhizome).
A tangible mass in the left hypochondrium gradually enlarged the abdomen. Each time purgatives were used, defecation occurred, and distension slightly decreased. Subsequently, obstruction returned. Frequent purging was attempted to temporarily relieve symptoms. During the illness, distension floated in the lower part. Acupuncture was added to facilitate fluid discharge. Swelling subsided, but the disease remained. The patient has suffered for six years and has long given up hope of cure. Know that this illness initially stemmed from Liver Qi disharmony. Qi gathered to form a mass. Repeated purging injured the Spleen and Stomach. The ancients said: "Umbilical protrusion injures the Spleen." The current suffering involves difficulty in expelling urine and feces, with pain like knife stabbing. This is Qi distension. Long-term purging depletes Blood. When Blood is exhausted, Qi knots further. Promotion of circulation should utilize moistening agents that open orifices.
Hupo Xie (Amber Powder), Shexiang (Musk), Daheidoupi (Large Black Bean Skin), Du Niuxi (Cyathula Root).
From summer jaundice and mental fatigue, gradually progressing to Middle Jiao distension. Extending to Frost Descent, vomiting of stagnant blood occurred above, and foul stool below. The pulse is weak, fine, and irregular. The complexion lacks luster. Breathing includes wheezing. Historically suffering from Cold Disorder with rebellious Qi. The retention of old fluid has existed for some time. During the three summer months, when Spleen and Stomach are dominant, heaven is hot, earth qi rises, and human Qi leaks. Added to irregular diet and labor, appetite decreased and distension increased. The disease originated in the Middle, spreading up and down. The Six Fu organs function through unobstructed flow. Not only do the Fu organs fail to perform their duties, but Qi and Blood in the meridians and collaterals also cease to flow. Qi stagnation and Blood stasis worsen distension. Ancients treated distension specifically by promoting circulation, distinguishing between Yin and Yang. Later aggressive circulating methods, such as Shenyou, Zhouche, and Yugong formulas, are too harsh to try lightly in this chronic, debilitated state. I propose specifically promoting the Yang Qi of the Three Jiao to drive out entrenched Turbid Yin. Warming and tonifying are combined. If Yang Qi does not gradually revive, it is difficult to prescribe further. Borrowing Zhang Zhongjing's Baitong Tang (White Connecting Decoction): Qu Congbai (Remove Scallion White), Ganjiang (Dried Ginger), Zhuyedan (Pig Gallbladder Juice), Dan Fuzi (Mild Prepared Aconite).