经云。其脉大坚以涩者。胀也。关上脉浮则内胀。迟而滑者胀。脉盛而紧者胀。胀
脉浮大者易治。虚小者难治。
水病腹大如鼓。脉实者生。虚者死。脉洪者生。微细者死。中恶腹大。四肢满。脉大而
缓者生。浮而紧者死。
丹溪云。七情内伤。六淫外感。饮食不节。房劳致虚。脾土之阴受伤。转输之官失职。
胃虽
受谷。不能运化。故阴阳不交。清浊相混。隧道壅塞。郁而为热。热留为湿。湿热相生。遂
成胀满。经云鼓胀者是也。以其外虽坚满。中空无物。有似于鼓。其病胶固。难以治疗。又
名曰蛊。若蛊侵蚀之义。
阴阳愆伏。荣卫凝滞。三焦不能宣行。脾胃不能传布。胀满之所由生也。曰谷胀。曰水胀。
曰气胀。曰血胀。谓之四病。或寒或热。或虚或实。又不可以无别也。若久病羸乏。卒病胀
满。喘息不得。与夫脐心突起。或下痢频数。百方调治。未见一愈者矣。
朝宽暮急者为血虚。暮宽朝急者为气虚。朝暮俱急者。气血俱虚。
脉经曰。胃中寒则胀满。此论内伤不足之邪。乃久病也。寒者非寒冷之寒。乃阳虚之义
故
用参、术以补脾为君。苍术、茯苓、陈皮为臣。黄芩、麦门冬为使。以制肝木。少加浓朴。
以
消腹胀。气不运。加木香。气下陷。加升麻、柴胡提之。血虚。加四物汤。有痰。加半夏。
经云塞因塞用者是也。病胀久。脾胃虚者。虽有大小便不利之症。乃气不运血不润也。当大
补气血为主。慎不可用下药也。鼓胀为病多端。宜照后方加减调治。毋得执泥以误人也。
一论病患初起。心腹胀满。因于食伤脾胃。湿痰气郁。食积而作胀也。用此通治之剂。
宜
香砂和中汤
藿香（一钱二分） 砂仁（一钱二分） 苍术（炒一钱半） 浓朴（姜汁炒） 广陈皮（去白）
半夏
（姜汁炒） 白茯苓（去皮） 神曲（炒） 枳实（麸炒） 青皮（去穣） 山楂肉（各一钱） 白术（
去芦炒一钱半） 甘草（三分）
上锉一剂。生姜煎服。
一论脾虚鼓胀。手足倦怠。短气溏泄者。此调治胀满王道之药。久病虚弱之人。宜服
六君子汤
人参（二钱） 白术（一钱五分去芦炒） 白茯苓（去皮三钱） 半夏（姜制二钱） 陈皮（去
白二
钱） 甘草（八分）
上锉。生姜煎服。一方。加当归、白豆蔻、苏梗。尤妙。
按经曰。塞因塞用。故用补剂以治胀初服则胀。久服则通。此唯精达经旨者知之。庸医
未足
道也。若朝宽暮急为血虚。加当归、川芎。暮宽朝急为气虚。根据本方。朝暮俱急。亦加芎、
归。
一论男妇因于气恼。而心腹胀满。或痰嗽喘急者。予常见因气而作胀满者甚多。用此方
甚效。分心气饮。（方见诸气）根据本方。加槟榔、枳壳、香附、乌药。
木香消胀丸 治症同前。
木香（二钱半） 槟榔（五钱） 陈皮（一两） 大腹皮（一两洗） 枳壳（麸炒一两） 桑白皮
（一两） 苏子（一两） 香附子（一两炒） 萝卜子（五钱炒）
上为细末。水煮稀神曲为丸。如梧桐子大。每服五六十丸。淡姜汤送下。
一论腹胀发热。以阳并阴。则阳实而阴虚。阳盛则外热。阴虚生内热。脉必浮数。浮则
为虚。数则为热。阴虚不能宣导。饮食如故。因致胀满者。谓之热胀。宜用
枳实分消汤
川浓朴（去皮姜汁炒五分） 枳实（麸炒一钱半） 大黄（酒蒸一钱半） 官桂（一钱二分）
甘草（炙一钱五分）
上锉一剂。姜、枣煎服。呕吐。加半夏。自利。去大黄。寒多。加干姜。
一论中满鼓胀、气胀、水胀、热胀。宜
中满分消丸
人参（二钱半） 白术（去芦炒二钱半） 姜黄（二钱半） 猪苓（去黑皮二钱） 甘草（炙二
钱）
砂仁（二钱） 干生姜（二钱） 泽泻（三钱） 陈皮（三钱） 知母（去毛酒炒三钱） 白茯苓（去
皮三钱） 枳实（麸炒三钱） 半夏（姜炒三钱） 黄连（姜汁炒二钱） 黄芩（酒炒三钱） 川浓
朴（姜炒五钱）
上为细末。水浸蒸饼为丸。如梧子大。每服百丸。食远。白汤送下。
一论老人虚人中寒下虚。心腹膨胀。不喜饮食。脉浮迟而弱。此名寒胀。宜
朴香丸
川浓朴（姜汁炒五钱） 大附子（泡去皮脐三钱八分） 木香（一钱半）
上锉一剂。生姜七片。枣二枚。水煎热服。
一论中满寒胀寒疝。大小便不通。阴躁。足不收。四肢厥逆。食入反出。下虚中满。腹
胀心下痞。下焦躁寒沉厥。奔豚不收。宜
中满分消汤
益智（五分） 半夏（姜炒五分） 升麻（二分） 茯苓（五分） 木香（三分） 黄 （炒五分）
吴
茱萸（炒五分） 川乌（二分） 川朴（姜炒五分） 草豆蔻（五分） 人参（三分） 泽泻（三分）
青皮（去穣三分） 当归（五分） 柴胡（二分） 黄连（二分） 澄茄（二分） 黄柏（酒炒三分）
干姜（三分） 生姜（三分）
上锉一剂。水煎服。房劳酒湿面生硬冷物等。一切忌之。
一论中满腹胀。内有积聚。如石坚硬。令人坐卧不宁。二便涩滞。上气喘促。或通身虚
肿。宜
广术溃坚汤
川浓朴（姜炒五分） 黄芩（炒五分） 黄连（五分） 益智仁（五分） 草豆蔻（五分） 当归
（五
分） 半夏（姜炒七分） 蓬莪术（三分） 升麻（二分） 红花（二分） 吴茱萸（二分） 生甘草（
二分） 柴胡（二分） 泽泻（三分） 神曲（五分） 陈皮（五发） 青皮（去穣二分） 口干。加
葛根四分。
上锉一剂。生姜煎服。食远。温服。忌酒醋湿面。
一论浊气在上。则生 胀。清气在下。则生飧泄。宜
木香顺气汤
木香（三分） 浓朴（姜炒四分） 青皮（去穣五分） 陈皮（五分） 益智仁（五分） 泽泻（
五分） 干生姜（五分）
茯苓（五分） 半夏（姜炒五分） 吴茱萸（五分） 当归（五分） 苍术（米泔炒五分） 升麻
（二分） 柴胡（二分） 草豆蔻（三分） 白术（一钱）
上锉一剂。水煎。温服。忌生冷硬物。
一治蛊胀。
黑丑（头末） 木香 甘遂（各一钱）
上为细末。用猪腰一对。俱分破。将药撒在腰子内合住。纸包。炭火烧熟。空心或食一
个。或食二个。大便行脓血见效。一论血蛊。腹如盆胀。积聚痞块。宜
化蛊丸
三棱（煨） 莪术（煨） 干漆（炒尽烟） 砂 虻虫（糯米炒） 水蛭（锻石炒） 琥珀 肉
桂牛膝（去芦酒炒） 大黄（各等分）
上为末。用生地黄自然汁和米醋。调匀为丸。如梧桐子大。每服十丸。空心。温酒服下
童便亦可。
四炒枳壳丸 治脾胃不和。血气凝滞。腹内蛊胀。
枳壳四两。去穣。切作两指面大块。分四处。一两用萝卜子一两炒。去萝卜子不用。一
两
用苍术四两炒。去苍术不用。一两用干漆一两炒。去干漆不用。一两用小茴香一两炒。去小
茴香不用。
上用炒枳壳四两。研末。煮糊为丸。如梧子大。每服五十丸。食后。米汤下。
《黄帝内经》说：脉象大、坚实且涩滞的，是胀病。关部脉浮，说明体内有胀满；脉迟而滑，也是胀病的表现；脉盛大且紧，同样是胀病。胀病的脉象若浮大，容易治疗；若虚弱细小，则难治。
水肿病腹部肿大如鼓，脉实者生，脉虚者死；脉洪大者生，脉微细者死。中恶邪导致腹部肿大，四肢胀满，脉大而缓者生，脉浮而紧者死。
朱丹溪说：七情（喜、怒、忧、思、悲、恐、惊）内伤，六淫（风、寒、暑、湿、燥、火）外感，饮食不节制，房事过度导致身体虚弱，损伤了脾土的阴气，致使负责转输运化的脏腑功能失职。胃虽然受纳食物，但不能运化，因此阴阳不能相交，清浊之气相互混杂，经络通道壅塞阻滞，郁结而生热，热停留转化为湿，湿热相生，最终形成胀满。这就是《内经》所说的鼓胀。因为外表虽然坚硬胀满，但内部中空无物，形状像鼓一样，病情顽固胶着，难以治疗。又名为“蛊”，取蛊虫侵蚀之意。
阴阳失调潜伏，营卫之气凝滞，三焦不能宣通运行，脾胃不能传布津液，这是胀满产生的原因。分为谷胀、水胀、气胀、血胀四种病证，有的属寒，有的属热，有的属虚，有的属实，不可不加辨别。如果是久病体弱消瘦，或者突发胀满，喘息不止，肚脐突出，或者频繁下痢，用各种方法调理治疗，没有见到一个痊愈的。
早晨症状轻、傍晚加重的是血虚；傍晚症状轻、早晨加重的是气虚；早晚都加重的是气血俱虚。
《脉经》说：胃中有寒就会胀满。这是论述内伤不足之邪，属于久病。这里的“寒”不是指寒冷之寒，而是指阳虚的含义。所以用人参、白术来补脾作为君药，苍术、茯苓、陈皮作为臣药，黄芩、麦门冬作为使药，用来制约肝木，少加浓朴以消除腹胀。如果气机不运行，加木香；如果气机下陷，加升麻、柴胡来提升。血虚，加四物汤。有痰，加半夏。《内经》说的“塞因塞用”就是这个道理。患胀病日久，脾胃虚弱的人，即使有大便小便不通利的症状，也是因为气不运行、血不滋润所致。应当以大补气血为主，千万不要使用泻下药。鼓胀这种病有多种类型，应该参照后面的方剂加减调治，不要固执拘泥以免误人。
第一种论述：病患初起时，心腹胀满，是因为饮食损伤脾胃，湿痰气郁，食积而导致胀满。用这个通用的方剂：宜用香砂和中汤。
藿香（一钱二分）、砂仁（一钱二分）、苍术（炒一钱半）、浓朴（姜汁炒）、广陈皮（去白）、半夏（姜汁炒）、白茯苓（去皮）、神曲（炒）、枳实（麸炒）、青皮（去瓤）、山楂肉（各一钱）、白术（去芦头炒一钱半）、甘草（三分）。
以上锉成粗末，一剂药，生姜煎服。
第二种论述：脾虚导致的鼓胀，手足倦怠，短气，大便稀溏。这是调理胀满的王道药物，久病虚弱的人适宜服用：六君子汤。
人参（二钱）、白术（一钱五分，去芦头炒）、白茯苓（去皮三钱）、半夏（姜制二钱）、陈皮（去白二钱）、甘草（八分）。
以上锉成粗末，生姜煎服。另一方案，加入当归、白豆蔻、苏梗，效果更佳。
按语：《内经》说：“塞因塞用”，所以用补剂治疗胀满，初服时可能感觉更胀，久服后则通畅。这只有精通经典旨意的人才知道，平庸的医生不足以与之谈论。如果早晨轻傍晚重为血虚，加当归、川芎；傍晚轻早晨重为气虚，根据本方，早晚都重，也加川芎、当归。
第三种论述：男女因为气恼，导致心腹胀满，或者咳嗽气喘急迫。我常见因气而发作胀满的情况很多，用这个方子非常有效：分心气饮。（方剂见诸气章节）根据本方，加槟榔、枳壳、香附、乌药。
木香消胀丸：主治症状同上。
木香（二钱半）、槟榔（五钱）、陈皮（一两）、大腹皮（一两，洗）、枳壳（麸炒一两）、桑白皮（一两）、苏子（一两）、香附子（一两，炒）、萝卜子（五钱，炒）。
以上研为细末，用水煮稀神曲糊为丸，如梧桐子大小。每次服用五六十丸，淡姜汤送下。
第四种论述：腹胀发热，因为阳气并入阴分，导致阳实阴虚。阳盛则体表发热，阴虚则体内生热。脉象必定浮数，浮则为虚，数则为热。阴虚不能宣导，饮食如常，因此导致胀满，称为热胀。宜用枳实分消汤。
川浓朴（去皮姜汁炒五分）、枳实（麸炒一钱半）、大黄（酒蒸一钱半）、官桂（一钱二分）、甘草（炙一钱五分）。
以上锉成粗末，一剂药，姜、枣煎服。呕吐，加半夏；自利（腹泻），去掉大黄；寒多，加干姜。
第五种论述：中满鼓胀、气胀、水胀、热胀，宜用中满分消丸。
人参（二钱半）、白术（去芦头炒二钱半）、姜黄（二钱半）、猪苓（去黑皮二钱）、甘草（炙二钱）、砂仁（二钱）、干生姜（二钱）、泽泻（三钱）、陈皮（三钱）、知母（去毛酒炒三钱）、白茯苓（去皮三钱）、枳实（麸炒三钱）、半夏（姜炒三钱）、黄连（姜汁炒二钱）、黄芩（酒炒三钱）、川浓朴（姜炒五钱）。
以上研为细末，用水浸泡蒸饼为丸，如梧桐子大小。每次服用一百丸，饭后，白开水送下。
第六种论述：老人虚人感受寒邪，下焦虚寒，心腹膨胀，不喜欢饮食，脉浮迟而弱，这名叫寒胀。宜用朴香丸。
川浓朴（姜汁炒五钱）、大附子（泡过去皮脐三钱八分）、木香（一钱半）。
以上锉成粗末，一剂药，生姜七片，大枣二枚，水煎热服。
第七种论述：中满寒胀、寒疝，大小便不通，阴躁（下部躁动不安），足部无力收持，四肢厥冷，食物吃进去反吐出来，下虚中满，腹胀心下痞塞，下焦躁寒沉厥，奔豚气不收。宜用中满分消汤。
益智（五分）、半夏（姜炒五分）、升麻（二分）、茯苓（五分）、木香（三分）、黄芪（炒五分）、吴茱萸（炒五分）、川乌（二分）、川朴（姜炒五分）、草豆蔻（五分）、人参（三分）、泽泻（三分）、青皮（去瓤三分）、当归（五分）、柴胡（二分）、黄连（二分）、澄茄（二分）、黄柏（酒炒三分）、干姜（三分）、生姜（三分）。
以上锉成粗末，一剂药，水煎服。房劳、饮酒、吃面食、生冷硬物等，一切都要禁忌。
第八种论述：中满腹胀，内有积聚，像石头一样坚硬，让人坐卧不宁，二便涩滞，上气喘促，或者全身虚肿。宜用广术溃坚汤。
川浓朴（姜炒五分）、黄芩（炒五分）、黄连（五分）、益智仁（五分）、草豆蔻（五分）、当归（五分）、半夏（姜炒七分）、蓬莪术（三分）、升麻（二分）、红花（二分）、吴茱萸（二分）、生甘草（二分）、柴胡（二分）、泽泻（三分）、神曲（五分）、陈皮（五分）、青皮（去瓤二分）。口干，加葛根四分。
以上锉成粗末，一剂药，生姜煎服，饭后温服。忌酒、醋、湿面。
第九种论述：浊气在上，则生胀满；清气在下，则生完谷不化的泄泻。宜用木香顺气汤。
木香（三分）、浓朴（姜炒四分）、青皮（去瓤五分）、陈皮（五分）、益智仁（五分）、泽泻（五分）、干生姜（五分）、茯苓（五分）、半夏（姜炒五分）、吴茱萸（五分）、当归（五分）、苍术（米泔水炒五分）、升麻（二分）、柴胡（二分）、草豆蔻（三分）、白术（一钱）。
以上锉成粗末，一剂药，水煎，温服。忌生冷硬物。
第十种治疗：蛊胀。
黑丑（头末）、木香、甘遂（各一钱）。
以上研为细末，用猪腰一对，剖开，将药撒在腰子内合住，用纸包好，炭火烧熟。空腹吃一个或两个，大便排出脓血即见效。
第十一种论述：血蛊，腹部像盆一样胀大，有积聚痞块。宜用化蛊丸。
三棱（煨）、莪术（煨）、干漆（炒尽烟）、虻虫（糯米炒）、水蛭（锻石炒）、琥珀、肉桂、牛膝（去芦头酒炒）、大黄（各等分）。
以上研为末，用生地黄自然汁和米醋，调匀为丸，如梧桐子大小。每次服用十丸，空腹，温酒送下，童便也可以。
第十二种：四炒枳壳丸。治疗脾胃不和，血气凝滞，腹内蛊胀。
枳壳四两，去瓤，切作两指宽的大块，分成四份。一份用萝卜子一两炒，去掉萝卜子不用；一份用苍术四两炒，去掉苍术不用；一份用干漆一两炒，去掉干漆不用；一份用小茴香一两炒，去掉小茴香不用。
以上用炒过的枳壳四两，研为末，煮糊为丸，如梧桐子大小。每次服用五十丸，饭后，米汤送下。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the pulse is large, firm, and choppy, it indicates distension. A floating pulse at the Guan position suggests internal distension; a slow and slippery pulse also indicates distension; a vigorous and tight pulse similarly points to distension. Distension with a floating and large pulse is easy to treat; one with a deficient and small pulse is difficult to treat.
In edema where the abdomen is swollen like a drum, a solid pulse indicates survival, while a deficient pulse indicates death. A surging pulse indicates survival, whereas a minute and fine pulse indicates death. In cases of sudden evil invasion causing abdominal swelling and full limbs, a large and slow pulse indicates survival, while a floating and tight pulse indicates death.
Zhu Danxi stated: Internal injury from the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright), external contraction by the Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), irregular diet, and excessive sexual activity leading to deficiency, all damage the Yin of the Spleen Earth. This impairs the function of the organs responsible for transformation and transportation. Although the Stomach receives food, it cannot digest and transform it. Consequently, Yin and Yang fail to interact, Clear and Turbid Qi mix chaotically, and the meridians become obstructed. Stagnation generates Heat, which remains and transforms into Dampness. The mutual generation of Damp-Heat eventually results in distension. This is what the Classics refer to as Drum Distension. It is so named because although the exterior appears hard and full, the interior is hollow, resembling a drum. The disease is stubborn and difficult to treat. It is also called "Gu" (Poisonous Worm), implying the erosive nature of worms.
When Yin and Yang are disordered and latent, and Ying (Nutritive) and Wei (Defensive) Qi stagnate, the San Jiao (Triple Burner) fails to circulate freely, and the Spleen and Stomach fail to distribute fluids. These are the causes of distension. They are classified into four types: Grain Distension, Water Distension, Qi Distension, and Blood Distension. Some are Cold, some Heat, some Deficient, some Excess; they must not be confused. If a patient has been ill for a long time and is emaciated, or suddenly develops distension with panting, protruding umbilicus, or frequent dysentery, no cure will be found despite various treatments.
If symptoms are lighter in the morning and worse in the evening, it indicates Blood Deficiency. If lighter in the evening and worse in the morning, it indicates Qi Deficiency. If severe both morning and evening, it indicates combined Qi and Blood Deficiency.
The *Mai Jing* (Pulse Classic) states: Cold in the Stomach leads to distension. This discusses pathogenic factors from internal injury and insufficiency, typically chronic. Here, "Cold" does not refer to cold temperature but signifies Yang Deficiency. Therefore, Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) are used as Sovereign herbs to tonify the Spleen. Cang Zhu (Atractylodes Rhizoma Chinensis), Fu Ling (Poria), and Chen Pi (Citrus Reticulatae Pericarpium) serve as Ministers. Huang Qin (Scutellaria Root) and Mai Men Dong (Ophiopogon Tuber) act as Guides to restrain Liver Wood. A small amount of Hou Po (Magnolia Bark) is added to reduce abdominal distension. If Qi fails to move, add Mu Xiang (Aucklandiae Radix). If Qi sinks, add Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix) to lift it. For Blood Deficiency, add Si Wu Tang (Four Substances Decoction). For Phlegm, add Ban Xia (Pinellia Tuber). This illustrates the principle of "Treating Obstruction with Obstruction" (Sai Yin Sai Yong). In chronic distension with Spleen-Stomach deficiency, even if there is difficulty in urination or defecation, it is due to lack of Qi movement and Blood nourishment. Treatment should focus on greatly tonifying Qi and Blood. One must strictly avoid using purgative drugs. Drum Distension has many variations; treatment should follow the subsequent formulas with modifications. Do not adhere rigidly to one method, lest you harm patients.
First discussion: At the onset of illness, epigastric and abdominal fullness caused by dietary injury to the Spleen and Stomach, damp-phlegm, Qi stagnation, and food accumulation leading to distension. Use this general formula: Xiang Sha He Zhong Tang (Agastache and Amomum Harmonizing the Middle Decoction).
Huoxiang (Patchouli Herb), Sharen (Amomum Fruit), Cang Zhu (Atractylodes Rhizoma Chinensis, stir-fried), Hou Po (Magnolia Bark, ginger juice stir-fried), Guang Chen Pi (Citrus Reticulatae Pericarpium, pith removed), Ban Xia (Pinellia Tuber, ginger juice stir-fried), Bai Fu Ling (Poria, peeled), Shen Qu (Medicated Leaven, stir-fried), Zhi Shi (Immature Bitter Orange, bran stir-fried), Qing Pi (Green Citrus Peel, albedo removed), Shan Zha Rou (Crataegi Fructus, each 1 qian), Bai Zhu (Atractylodes Macrocephala Rhizome, de-rhizomatized and stir-fried, 1.5 qian), Gan Cao (Licorice Root, 0.3 qian).
Decoct one dose with fresh ginger.
Second discussion: Drum distension due to Spleen Deficiency, characterized by fatigue in limbs, shortness of breath, and loose stools. This is a gentle ("Kingly Way") remedy for regulating distension, suitable for chronically ill and weak patients: Liu Jun Zi Tang (Six Gentlemen Decoction).
Ren Shen (Ginseng Root, 2 qian), Bai Zhu (Atractylodes Macrocephala Rhizome, de-rhizomatized and stir-fried, 1.5 qian), Bai Fu Ling (Poria, peeled, 3 qian), Ban Xia (Pinellia Tuber, ginger-processed, 2 qian), Chen Pi (Citrus Reticulatae Pericarpium, pith removed, 2 qian), Gan Cao (Licorice Root, 0.8 qian).
Decoct one dose with fresh ginger. Alternatively, add Dang Gui (Angelica Sinensis Root), Bai Dou Kou (Amomum Cardamomum Fruit), and Su Geng (Perilla Stem) for better effect.
Note: The Classic states "Treating Obstruction with Obstruction," so tonics are used for distension. Initially, distension may worsen, but with prolonged use, it resolves. Only those who deeply understand the Classics know this; mediocre physicians cannot discuss this. If morning light/evening heavy (Blood Deficiency), add Dang Gui and Chuan Xiong (Sichuan Lovage Rhizome). If evening light/morning heavy (Qi Deficiency), modify the base formula. If both morning and evening are heavy, add Chuan Xiong and Dang Gui.
Third discussion: Distension and epigastric/abdominal fullness, or coughing with wheezing, due to emotional distress. I often see many cases of distension caused by Qi stagnation; this formula is very effective: Fen Xin Qi Yin (Dividing Heart Qi Decoction) (See section on Various Qi Disorders). Modify by adding Bing Lang (Areca Seed), Zhi Ke (Immature Bitter Orange), Xiang Fu (Cyperus Rhizome), and Wu Yao (Lindera Root).
Mu Xiang Xiao Zhang Wan (Aucklandia Reducing Distension Pill): Same indications.
Mu Xiang (Aucklandiae Radix, 2.5 qian), Bing Lang (Arecae Semen, 5 qian), Chen Pi (Citrus Reticulatae Pericarpium, 1 liang), Da Fu Pi (Arecae Pericarpium, washed, 1 liang), Zhi Ke (Immature Bitter Orange, bran stir-fried, 1 liang), Sang Bai Pi (Morus Alba Rootbark, 1 liang), Su Zi (Perilla Fruit, 1 liang), Xiang Fu Zi (Cyperi Rhizoma, stir-fried, 1 liang), Luo Bo Zi (Raphani Semen, stir-fried, 5 qian).
Grind into fine powder. Make pills using thin Medicated Leaven paste cooked in water, size of Sophora seeds. Take 50-60 pills per dose, washed down with light ginger soup.
Fourth discussion: Abdominal distension with fever. Yang merging into Yin leads to Yang Excess and Yin Deficiency. Yang Excess causes external heat; Yin Deficiency generates internal heat. The pulse will be floating and rapid; floating indicates Deficiency, rapid indicates Heat. Yin Deficiency fails to guide and discharge, diet remains normal, yet distension occurs. This is called Heat Distension. Use Zhi Shi Fen Xiao Tang (Immature Bitter Orange Dispersing Decoction).
Chuan Hou Po (Magnolia Bark, peeled and ginger juice stir-fried, 0.5 qian), Zhi Shi (Immature Bitter Orange, bran stir-fried, 1.5 qian), Da Huang (Rhei Radix et Rhizoma, wine-steamed, 1.5 qian), Guan Gui (Cinnamomi Cortex, 1.2 qian), Gan Cao (Licorice Root, honey-fried, 1.5 qian).
Decoct one dose with ginger and jujube. For vomiting, add Ban Xia. For spontaneous diarrhea, remove Da Huang. For excess cold, add Gan Jiang (Zingiberis Rhizoma).
Fifth discussion: Epigastric fullness, Drum Distension, Qi Distension, Water Distension, Heat Distension. Use Zhong Man Fen Xiao Wan (Middle Fullness Dispersing Pill).
Ren Shen (Ginseng Root, 2.5 qian), Bai Zhu (Atractylodes Macrocephala Rhizome, de-rhizomatized and stir-fried, 2.5 qian), Jiang Huang (Curcumae Longae Rhizoma, 2.5 qian), Zhu Ling (Polyporus, black skin removed, 2 qian), Gan Cao (Licorice Root, honey-fried, 2 qian), Sha Ren (Amomi Fructus, 2 qian), Gan Sheng Jiang (Dried Fresh Ginger, 2 qian), Ze Xie (Alismatis Rhizoma, 3 qian), Chen Pi (Citrus Reticulatae Pericarpium, 3 qian), Zhi Mu (Anemarrhenae Rhizoma, hair removed and wine stir-fried, 3 qian), Bai Fu Ling (Poria, peeled, 3 qian), Zhi Shi (Immature Bitter Orange, bran stir-fried, 3 qian), Ban Xia (Pinellia Tuber, ginger stir-fried, 3 qian), Huang Lian (Coptidis Rhizoma, ginger juice stir-fried, 2 qian), Huang Qin (Scutellariae Radix, wine stir-fried, 3 qian), Chuan Hou Po (Magnolia Bark, ginger stir-fried, 5 qian).
Grind into fine powder. Make pills using steamed wheat cake soaked in water, size of Sophora seeds. Take 100 pills per dose, well after meals, washed down with plain warm water.
Sixth discussion: Elderly or deficient persons contracting Cold with lower Jiao deficiency, causing epigastric/abdominal swelling, aversion to food, with a floating, slow, and weak pulse. This is called Cold Distension. Use Pu Xiang Wan (Magnolia and Aucklandia Pill).
Chuan Hou Po (Magnolia Bark, ginger juice stir-fried, 5 qian), Da Fu Zi (Aconiti Lateralis Radix Praeparata, soaked, peeled, navel removed, 3.8 qian), Mu Xiang (Aucklandiae Radix, 1.5 qian).
Decoct one dose with seven slices of fresh ginger and two jujubes. Drink hot.
Seventh discussion: Epigastric fullness, Cold Distension, Cold Hernia, obstruction of urination and defecation, Yin restlessness (lower body agitation), inability to support the legs, cold extremities, regurgitation of food, lower deficiency with middle fullness, abdominal distension with epigastric stuffiness, lower Jiao cold/restlessness/collapse, unrestrained Ben Tun (Rushing Pig) Qi. Use Zhong Man Fen Xiao Tang (Middle Fullness Dispersing Decoction).
Yi Zhi (Alpiniae Oxyphyllae Fructus, 0.5 qian), Ban Xia (Pinellia Tuber, ginger stir-fried, 0.5 qian), Sheng Ma (Cimicifugae Rhizoma, 0.2 qian), Fu Ling (Poria, 0.5 qian), Mu Xiang (Aucklandiae Radix, 0.3 qian), Huang Qi (Astragali Radix, stir-fried, 0.5 qian), Wu Zhu Yu (Evodiae Fructus, stir-fried, 0.5 qian), Chuan Wu (Aconiti Radix, 0.2 qian), Chuan Hou Po (Magnolia Bark, ginger stir-fried, 0.5 qian), Cao Dou Kou (Cardamomi Fructus, 0.5 qian), Ren Shen (Ginseng Root, 0.3 qian), Ze Xie (Alismatis Rhizoma, 0.3 qian), Qing Pi (Green Citrus Peel, albedo removed, 0.3 qian), Dang Gui (Angelicae Sinensis Radix, 0.5 qian), Chai Hu (Bupleuri Radix, 0.2 qian), Huang Lian (Coptidis Rhizoma, 0.2 qian), Cheng Qie (Litseae Fructus, 0.2 qian), Huang Bo (Phellodendri Cortex, wine stir-fried, 0.3 qian), Gan Jiang (Zingiberis Rhizoma, 0.3 qian), Sheng Jiang (Fresh Ginger, 0.3 qian).
Decoct one dose in water. Avoid sexual activity, alcohol, wheat products, and raw/cold/hard foods.
Eighth discussion: Epigastric fullness and abdominal distension with accumulations that are hard as stone, causing restlessness, sluggish urination/defecation, upper body panting, or generalized edema. Use Guang Zhu Kui Jian Tang (Curcuma Softening Hardness Decoction).
Chuan Hou Po (Magnolia Bark, ginger stir-fried, 0.5 qian), Huang Qin (Scutellariae Radix, stir-fried, 0.5 qian), Huang Lian (Coptidis Rhizoma, 0.5 qian), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus, 0.5 qian), Cao Dou Kou (Cardamomi Fructus, 0.5 qian), Dang Gui (Angelicae Sinensis Radix, 0.5 qian), Ban Xia (Pinellia Tuber, ginger stir-fried, 0.7 qian), Peng E Zhu (Curcumae Rhizoma, 0.3 qian), Sheng Ma (Cimicifugae Rhizoma, 0.2 qian), Hong Hua (Carthami Flos, 0.2 qian), Wu Zhu Yu (Evodiae Fructus, 0.2 qian), Sheng Gan Cao (Licorice Root, 0.2 qian), Chai Hu (Bupleuri Radix, 0.2 qian), Ze Xie (Alismatis Rhizoma, 0.3 qian), Shen Qu (Medicated Leaven, 0.5 qian), Chen Pi (Citrus Reticulatae Pericarpium, 0.5 qian), Qing Pi (Green Citrus Peel, albedo removed, 0.2 qian). For dry mouth, add Ge Gen (Puerariae Lobatae Radix, 0.4 qian).
Decoct one dose with fresh ginger. Take warm after meals. Avoid alcohol, vinegar, and damp wheat products.
Ninth discussion: Turbid Qi ascending to the Upper Jiao causes distension; Clear Qi descending to the Lower Jiao causes undigested stool diarrhea. Use Mu Xiang Shun Qi Tang (Aucklandia Smooth Qi Decoction).
Mu Xiang (Aucklandiae Radix, 0.3 qian), Hou Po (Magnolia Bark, ginger stir-fried, 0.4 qian), Qing Pi (Green Citrus Peel, albedo removed, 0.5 qian), Chen Pi (Citrus Reticulatae Pericarpium, 0.5 qian), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus, 0.5 qian), Ze Xie (Alismatis Rhizoma, 0.5 qian), Gan Sheng Jiang (Dried Fresh Ginger, 0.5 qian), Fu Ling (Poria, 0.5 qian), Ban Xia (Pinellia Tuber, ginger stir-fried, 0.5 qian), Wu Zhu Yu (Evodiae Fructus, 0.5 qian), Dang Gui (Angelicae Sinensis Radix, 0.5 qian), Cang Zhu (Atractylodes Rhizoma Chinensis, rice water stir-fried, 0.5 qian), Sheng Ma (Cimicifugae Rhizoma, 0.2 qian), Chai Hu (Bupleuri Radix, 0.2 qian), Cao Dou Kou (Cardamomi Fructus, 0.3 qian), Bai Zhu (Atractylodes Macrocephala Rhizome, 1 qian).
Decoct one dose in water. Take warm. Avoid raw, cold, and hard foods.
Tenth treatment: Gu Distension (Parasitic Distension).
Hei Qiu (Brucea Fructus, first flush powder), Mu Xiang (Aucklandiae Radix), Gan Sui (Kansui Radix) (each 1 qian).
Grind into fine powder. Cut open a pair of pig kidneys. Sprinkle the powder inside the kidney halves, bind them together, wrap in paper, and roast over charcoal. Eat one or two on an empty stomach. Effectiveness is indicated by the passage of pus and blood in the stool.
Eleventh discussion: Blood Gu Distension, abdomen swollen like a basin, with accumulations and masses. Use Hua Gu Wan (Dissolving Gu Pill).
San Leng (Sparganii Rhizoma, roasted), E Zhu (Curcumae Rhizoma, roasted), Gan Qi (Dry Resin of Toxicodendron, stir-fried until smoke ceases), Meng Chong (Blatta Orientalis, stir-fried with glutinous rice), Shui Zhi (Hirudo, stir-fried with calcined stone), Hu Po (Electrum), Rou Gui (Cinnamomi Cortex), Niu Xi (Achyranthis Bidentatae Radix, de-rhizomatized and wine stir-fried), Da Huang (Rhei Radix et Rhizoma) (equal parts).
Grind into powder. Mix with natural juice of fresh Sheng Di Huang (Rehmanniae Radix) and rice vinegar. Make pills size of Sophora seeds. Take 10 pills per dose on an empty stomach, washed down with warm wine or child's urine.
Twelfth: Si Chao Zhi Ke Wan (Four-Roasted Immature Bitter Orange Pill). Treats Spleen-Stomach disharmony, Qi-Blood stagnation, and abdominal Gu Distension.
Take 4 liang of Zhi Ke (Immature Bitter Orange), remove albedo, cut into large pieces. Divide into four portions.
Portion 1: Stir-fry with 1 liang of Luo Bo Zi (Raphani Semen), discard the radish seeds.
Portion 2: Stir-fry with 4 liang of Cang Zhu (Atractylodes Rhizoma Chinensis), discard the atractylodes.
Portion 3: Stir-fry with 1 liang of Gan Qi (Dry Resin of Toxicodendron), discard the resin.
Portion 4: Stir-fry with 1 liang of Xiao Hui Xiang (Foeniculi Fructus), discard the fennel.
Take the four portions of roasted Zhi Ke (total 4 liang), grind into powder, make pills with cooked paste, size of Sophora seeds. Take 50 pills after meals, washed down with rice gruel.