肺经曰关上脉虚即为内胀○迟而滑者为胀○肺盛而紧者为胀○严氏腹胀脉浮者易治○虚
者难治○针经曰其脉大坚似涩者胀也
内经曰诸腹胀大皆属于热又针经曰夫胀者皆在于脏腑之外排脏腑而郭胸胁胀满皮肤故命
曰胀
或厥气在下荣卫留止寒气逆上真邪相攻两气相搏乃合而为胀也又调经篇云因饮食劳倦损伤脾
胃始受热中未传寒中皆由脾胃之气虚实不能运化精微而制水谷聚而不散而成胀满此寒湿郁遏
而胀也大抵小儿多由饮食饥饱生冷甜腻聚结不散或因久患疳积及雪后癖块不消皆能为胀按之
如鼓膨 者是也故有疳胀气胀膈胀虫胀积胀食胀虚胀冷胀锁肚胀病名不同宜各随轻重盛衰
主治庶不瘥误
钱氏云治腹胀者如行兵战寇于林寇未出林以兵攻之必可获寇若出林不可急攻攻则必有失
当以意渐收
之即顺也又云小儿腹胀由脾胃虚气攻作也实者闷乱喘满可下之用紫霜丸白饼子不喘者虚也不
可下若误下致脾虚气上附肺而行肺与脾子母皆虚肺主目胞腮之类脾主四肢母气虚甚主目胞腮
肿也色黄者属脾也治之用榻气丸渐消之未愈渐加丸数不可以丁香木香橘皮豆蔻大温散药治之
使上下分消其气则愈也若虚气已出附肺而行即脾胃内弱每生虚气入于四肢面目矣小儿易为虚
热脾虚不受寒温服寒则生冷服温则生热当识此勿误也胃久虚热多生疸病或引饮不止脾虚不能
胜肾随肺之气上行于四肢若水状肾气浸浮于肺即大喘也此当服榻气丸病愈后面未红者虚衰未
复故也凡治小儿虚腹胀先服榻气丸不愈腹中有食积结粪小便黄时微喘脉伏而实时饮水能食者
可下之瘥脾初虚而后有积所治宜先补脾然后下之下后又补脾即愈也不可补肺恐生虚气耳
《肺经》中说：关部脉象虚弱，就是内胀；脉象迟而滑的，是胀病；肺气盛且脉紧的，也是胀病。严氏认为：腹胀脉象浮的容易治疗；脉象虚的难以治疗。《针经》说：脉象大、坚、似涩的，是胀病。
《内经》说：各种腹部胀大，都归属于热证。又《针经》说：所谓胀病，都在脏腑之外，排挤脏腑，扩张胸胁，导致皮肤胀满，所以命名为“胀”。或者是厥气在下，营卫之气停留停止，寒气逆上，真邪相互攻冲，两气相搏结，从而合而为胀。又《调经篇》说：因为饮食不节、劳倦过度，损伤了脾胃，开始感受热中（热邪在里），未传变为寒中（寒邪在里），都是因为脾胃之气的虚实，不能运化精微物质，制约水谷，导致水谷聚积而不消散，形成胀满。这是寒湿郁遏导致的胀病。大体上小儿多因饮食饥饱不均，或生冷甜腻之物聚结不散，或因长期患有疳积，以及雪后癖块不消，都能导致胀病。按压腹部像鼓一样膨隆的，就是这种情况。所以有疳胀、气胀、膈胀、虫胀、积胀、食胀、虚胀、冷胀、锁肚胀等不同的病名，应当各自根据病情的轻重盛衰来主治，这样才不会误治。
钱乙说：治疗腹胀病，就像军队在林战中打击盗贼。如果盗贼还没走出林子，用兵攻打，一定能抓获盗贼；如果盗贼已经走出林子，就不能急攻，急攻必定会有失当之处，应当凭心意逐渐收服，这就顺理成章了。又说：小儿腹胀是由脾胃虚弱，气机攻冲发作所致。实证表现为闷乱、喘满，可以用下法，使用紫霜丸、白饼子；如果不喘，属于虚证，不可以用下法。如果误用下法，导致脾虚，气机上逆附着于肺，运行于肺与脾之间，由于肺与脾是母子关系，两者皆虚。肺主目胞、腮部等，脾主四肢。母气（脾气）虚甚，会导致目胞、腮部肿胀。面色黄的，属于脾病，治疗时可以使用榻气丸，逐渐消除，未痊愈则逐渐增加丸药数量，不可以用丁香、木香、橘皮、豆蔻等大温散的药物来治疗，使上下分消其气，就能痊愈。如果虚气已经出离，附着于肺而运行，那么脾胃内部虚弱，每产生虚气进入四肢和面目。小儿容易产生虚热，脾虚不能耐受寒温，服用寒凉药则生生冷，服用温热药则生热，应当认识这一点，不要误治。胃久虚热，多生疸病，或者饮水不止。脾虚不能胜肾，随着肺之气上行于四肢，若如水状，肾气浸浮于肺，就会大喘。这应当服用榻气丸。病愈后面色未红的，是因为虚衰尚未恢复的缘故。凡是治疗小儿虚性腹胀，先服用榻气丸，如果未愈，腹中有食积结粪，小便黄，时而微喘，脉伏而实，能饮水进食的，可以用下法。瘥（病愈）后脾初虚而后又有积滞，所治宜先补脾，然后下之，下后又补脾，即可痊愈。不可以补肺，恐怕会产生虚气罢了。
The *Lung Meridian* states: A deficient pulse at the Guan position indicates internal distension; a slow and slippery pulse indicates distension; an excess of Lung Qi with a tight pulse also indicates distension. Yan Shi holds that distension with a floating pulse is easy to treat, whereas one with a deficient pulse is difficult to treat. The *Needle Classic* states: A pulse that is large, firm, and resembles roughness indicates distension.
The *Inner Canon* states: All cases of abdominal distension and enlargement belong to Heat. Furthermore, the *Needle Classic* states: Distension occurs outside the Zang-Fu organs, pushing against them and expanding the chest and hypochondrium, causing fullness in the skin; hence it is named "distension." It may arise from Jue Qi (rebellious Qi) below, where Ying and Wei Qi stagnate and stop, Cold Qi rebels upward, and True Pathogenic factors attack each other; the two Qi types clash and combine to form distension. Additionally, the *Tuning the Channels Chapter* states: Due to irregular diet and overexertion damaging the Spleen and Stomach, initially suffering from Heat in the Interior (*Re Zhong*), which has not yet transmitted to Cold in the Interior (*Han Zhong*), all result from the deficiency or excess of Spleen and Stomach Qi failing to transform and transport subtle essence, thereby controlling food and fluids. This leads to accumulation without dispersion, forming distension. This is distension caused by the depression of Cold-Dampness. Generally, children often suffer from distension due to irregular eating habits, consumption of raw/cold or sweet/greasy foods that accumulate and fail to disperse, or due to long-standing *Gan* syndrome (malnutrition syndrome) and unresolved masses after snow. These can all cause distension, characterized by an abdomen that feels like a drum when pressed. Thus, there are different names such as *Gan* distension, Qi distension, Diaphragm distension, Worm distension, Accumulation distension, Food distension, Deficiency distension, Cold distension, and Locked Belly distension. Treatment should be tailored to the severity and progression of each condition to avoid therapeutic errors.
Qian Yi stated: Treating distension is like engaging bandits in a forest battle. If the bandits have not yet left the forest, attacking them with troops will surely capture them. If they have already exited the forest, one must not attack hastily, as this will lead to mishandling; instead, one should gradually subdue them according to circumstances, which aligns with the natural flow. He further stated: Pediatric distension arises from Spleen-Stomach deficiency with rebellious Qi attacks. Excess patterns manifest as oppression, restlessness, wheezing, and fullness, and can be treated with purgation using *Zishuang Wan* (Purple Frost Pill) or *Baibing Zi* (White Cake). If there is no wheezing, it is a deficiency pattern, and purgation is contraindicated. Misusing purgation leads to Spleen deficiency, causing Qi to rebel upward and attach to the Lung. Since Lung and Spleen share a mother-son relationship, both become deficient. The Lung governs the eyelids and cheeks, while the Spleen governs the four limbs. Severe deficiency of the Mother Qi (Spleen Qi) results in swelling of the eyelids and cheeks. Yellow complexion indicates Spleen involvement; treatment involves *Taqi Wan* (Bed Qi Pill), administered gradually until resolved. If not fully cured, increase the dosage gradually. Do not use strongly warming and dispersing herbs like *Dingxiang* (Clove), *Muxiang* (Aucklandia Root), *Chenpi* (Aged Tangerine Peel), or *Doukou* (Cardamom), but rather allow the Qi to dissipate from above and below to achieve recovery. If the deficient Qi has already moved out and attached to the Lung, the Spleen and Stomach interior becomes weak, generating deficient Qi that enters the limbs and face. Children are prone to deficient heat; Spleen deficiency cannot tolerate extreme cold or warmth—cold induces raw/cold conditions, while warmth induces heat. One must recognize this to avoid error. Prolonged Stomach deficiency with heat often generates Jaundice disease or excessive thirst. Spleen deficiency fails to control Kidney Qi, which ascends with Lung Qi to the four limbs. If fluid-like, Kidney Qi floats into the Lung, causing severe wheezing. In such cases, *Taqi Wan* should be administered. After recovery, if the facial color remains pale, it indicates that the deficiency has not yet recovered. For pediatric deficiency-type distension, first administer *Taqi Wan*. If ineffective, and there is fecal impaction in the abdomen, yellow urine, occasional mild wheezing, a deep and solid pulse, and ability to drink/eat, purgation may be used. After recovery, if the Spleen was initially deficient and then accumulated pathogenic factors, the treatment strategy should be to tonify the Spleen first, then purge, and finally tonify the Spleen again to achieve cure. Do not tonify the Lung, as this may generate deficient Qi.