腹胀脾虚因久病，胃实多由食滞停，补虚健脾兼理气，攻食消导自然宁。
【注】腹胀之病，脾、胃二经主之。有虚有实，宜分晰焉。虚者因久病内伤其脾，实
者因饮食停滞于胃。虚则补脾，实则消导，调治合宜，其胀自渐除矣！
久病脾虚失运健，或因吐泻暴伤脾，食少即胀精神倦，面黄肌瘦四君宜。
【注】凡小儿久病脾虚，或吐泻暴伤脾气，健运失常，所以饮食不化，食少腹即胀满。现
证精神倦怠，面黄肌瘦，此虚胀也。宜用香朴四君子汤治之。
香朴四君子汤
人参 白术（土炒） 白茯苓 甘草（炙） 香附（制） 浓朴（姜炒）
引用生姜，水煎服。
【方歌】香朴四君治虚胀，参术甘草共茯苓，香附浓朴宜加入，引姜煎服胀即宁。
饮食过度内伤胃，停滞腹胀便不通，潮热烦渴形气壮，平胃承气施治灵。
【注】小儿饮食过度，则胃中停滞，以致腹胀，大便不利，身体潮热，心烦口渴，形
气壮实，此实胀也。轻者，平胃散主之；重者，小承气汤主之。
加味平胃散
南苍术（炒） 浓朴（姜炒） 大腹皮（制） 陈皮 甘草（生） 莱菔子（焙） 山楂 麦芽
（炒） 神曲（炒）
引用生姜，水煎服。
【方歌】加味平胃治实胀，苍术浓朴大腹皮，甘草陈皮莱菔子，山楂麦芽炒神曲。
小承气汤（方见食痛）
腹胀多因脾虚，常由久病引起；胃实多由饮食停滞所致。治疗应补益虚损、健脾并调理气机，通过攻逐食积、消导化滞，身体自然安宁。
【注】腹胀这一病症，主要由脾经和胃经主管。病情有虚证和实证之分，应当仔细辨别。虚证是因为久病内伤导致脾气受损；实证则是由于饮食停滞在胃中。虚证应当补益脾脏，实证应当消食导滞，只要调治得当，腹胀自然会逐渐消除。
久病导致脾虚，失去正常的运化功能，或者因为剧烈呕吐腹泻突然损伤脾气，表现为进食少即感腹胀、精神疲倦，面色萎黄、肌肉消瘦，适宜使用四君子汤（加香附、厚朴）。
【注】凡是小儿久病导致脾虚，或因吐泻突然损伤脾气，致使脾胃健运功能失常，所以饮食不能消化，吃得少腹部就会胀满。出现的症状包括精神倦怠、面色萎黄、肌肉消瘦，这属于虚胀。适宜用香朴四君子汤来治疗。
香朴四君子汤
人参 白术（土炒） 白茯苓 甘草（炙） 香附（制） 浓朴（姜炒）
引用生姜为引，加水煎服。
【方歌】香朴四君汤治疗虚胀，人参、白术、甘草与茯苓同用，加入香附、浓朴，用生姜煎服，腹胀即可平息。
饮食过度内伤胃部，食物停滞导致腹胀、大便不通，伴有午后潮热、心烦口渴、形体气息壮实，适宜使用平胃散或小承气汤治疗，效果灵验。
【注】小儿饮食过度，会导致胃中食物停滞，从而引起腹胀，大便不畅，身体出现潮热，心烦口渴，形体气息壮实，这属于实胀。轻症者，以平胃散为主方；重症者，以小承气汤为主方。
加味平胃散
南苍术（炒） 浓朴（姜炒） 大腹皮（制） 陈皮 甘草（生） 莱菔子（焙） 山楂 麦芽（炒） 神曲（炒）
引用生姜为引，加水煎服。
Abdominal distension is often caused by Spleen deficiency, usually resulting from prolonged illness; Stomach excess is mostly due to food stagnation. Treatment should involve tonifying deficiency, strengthening the Spleen, and regulating Qi. By purging food accumulation and promoting digestion, the body will naturally become tranquil.
[Note] Abdominal distension is primarily governed by the Spleen and Stomach meridians. The condition can be either Deficiency or Excess, which must be carefully differentiated. Deficiency arises from internal injury to the Spleen due to prolonged illness, while Excess results from food stagnation in the Stomach. For Deficiency, tonify the Spleen; for Excess, promote digestion and eliminate stagnation. If treatment is appropriate, the distension will gradually resolve.
Prolonged illness leads to Spleen deficiency and loss of normal transport and transformation functions, or sudden injury to Spleen Qi due to severe vomiting and diarrhea. Symptoms include abdominal distension after eating little, mental fatigue, sallow complexion, and emaciation. Xiangpo Sijunzi Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction with Cyperus and Magnolia Bark) is suitable.
[Note] Whenever a child suffers from Spleen deficiency due to prolonged illness, or sudden injury to Spleen Qi from vomiting and diarrhea, the healthy transport and transformation functions are impaired. Consequently, food cannot be digested, leading to abdominal distension even with small intake. Presenting symptoms such as mental fatigue, sallow complexion, and emaciation indicate Deficiency-type Distension. It is appropriate to treat this with Xiangpo Sijunzi Tang.
Xiangpo Sijunzi Tang
Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Fu Ling (Poria), Gan Cao (Licorice Root, honey-fried), Xiang Fu (Cyperus Rhizome, processed), Hou Po (Magnoliae Officinalis Cortex, stir-fried with ginger juice).
Use fresh ginger as a guide drug, decoct in water, and take orally.
[Formula Song] Xiangpo Sijunzi treats deficiency distension, Ginseng, Atractylodes, Licorice, and Poria combined together, add Cyperus and Magnolia Bark, decoct with ginger to calm the distension.
Excessive diet injures the Stomach internally, causing food stagnation, abdominal distension, and constipation. Accompanied by tidal fever, irritability, thirst, and robust physical constitution, Pingwei San (Pingwei Powder) or Xiaochengqi Tang (Minor Order the Yang Decoction) should be applied for effective treatment.
[Note] Excessive diet in children causes food stagnation in the Stomach, leading to abdominal distension, difficult defecation, tidal fever, irritability, thirst, and a robust physical constitution. This constitutes Excess-type Distension. For mild cases, Pingwei San is the primary formula; for severe cases, Xiaochengqi Tang is the primary formula.
Modified Pingwei San
Cang Zhu (Atractylodis Rhizoma, stir-fried), Hou Po (Magnoliae Officinalis Cortex, stir-fried with ginger juice), Da Fu Pi (Arecae Pericarpium, processed), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Licorice Root, raw), Lai Fu Zi (Radish Seed, baked), Shan Zha (Crataegi Fructus), Mai Ya (Hordei Fructus Germinatus, stir-fried), Shen Qu (Medicated Leaven, stir-fried).
Use fresh ginger as a guide drug, decoct in water, and take orally.
[Formula Song] Modified Pingwei treats excess distension, Atractylodes, Magnolia Bark, and Areca Peel combined, with Licorice, Citrus Peel, and Radish Seed, along with stir-fried Hawthorn, Barley Sprout, and Medicated Leaven.
Xiaochengqi Tang (See "Food Pain" chapter for formula details)