（此症与肿症相因者。宜以治肿之法治之。或内胀而外不肿者。治法稍异）
心腹胀满甚者。宜
平胃散为主。气郁。加麦芽香附各二钱。伤食者。加莱菔子山楂干姜。伤酒。加
干葛三钱。砂仁一钱。痰多。加茯苓三四钱。多呕。加半夏生姜各三钱。胸上胀不横通而胀。
加木通茜草麦冬栝蒌贝母。浊气在上。加柴胡半夏桔梗。心下痞满。加黄连黄芩各一钱。干
姜八分。
腹痛。加生白芍三钱。腹痛因大便不通者。再加大黄二钱。小便不通合五苓散。若贴脐
左右上下胀者。胀必兼痛。为冲脉逆而不舒。去苍术。加红花归芍柴桂治之。若季胁两旁兼
小腹胀痛者。乃厥阴内不交于少阴。外不合于少阳。加柴胡人参半夏桂枝当归治之。（八十）
腹胀喜按者。宜后四方。
附子理中汤。（一百零七）○（虚寒。）
补中益气汤。（五）○ （脾土失调地气不升。） 六君子汤。加干姜。（二）○（脾虚
痰多
腹胀。） 香砂六君子汤。（三）
愚按。以上诸法。治而不应者。必以膀胱为主。喻嘉言云。人身胸中空旷如太虚。地气
上而为云。必天气降而为雨。地气始收藏不动。诚会上焦如雾中焦如沤下焦如渎之意。则云
行雨施。而后沟渎皆盈。水道通决。乾坤有一番新景象。此义首重膀胱一经。经云。膀胱
者。州都之官。津液藏焉。气化。则能出矣。如人之饮酒无算而不醉者。皆膀胱之气化而出
也。膻中位于膈内。膀胱位于腹中。膀胱之气化。则空洞善容。而膻中之气。得以下运。若
膀胱不化。则腹已先胀。膻中之气。安能下达耶。然欲膀胱之气化。其权在于葆肾。肾。以
膀胱为腑者也。肾气动。必先注于膀胱。屡动不已。膀胱胀满。势必连于胸膈。其窒塞之状。
不可名言。肾气不动。则收藏愈固。膀胱得以清净无为。而膻中之气。注之不盈矣。膻中之
气。下走既捷。则不为牵引所乱。而胸中旷若太空矣。此论。可为胸腹满及痰饮症之金针。
（这种病症与水肿病相关联的，应当用治疗水肿的方法来治疗。如果是内部胀满而外部没有浮肿的，治疗方法则稍有不同。）
心腹部胀满严重的，宜以平胃散为主方。若是气机郁滞，加麦芽、香附各二钱；若是饮食积滞，加莱菔子、山楂、干姜；若是饮酒过度，加干葛三钱、砂仁一钱；若是痰多，加茯苓三至四钱；若是呕吐频繁，加半夏、生姜各三钱；若是胸部上方胀满且气机横逆不通，加木通、茜草、麦冬、栝蒌、贝母；若是浊气停留在上部，加柴胡、半夏、桔梗；若是心下痞塞胀满，加黄连、黄芩各一钱、干姜八分。
若是腹痛，加生白芍三钱；若腹痛是因为大便不通畅引起的，再加大大黄二钱；若小便不通，合用五苓散。若是肚脐周围左右上下都胀满的，胀满必然兼有疼痛，这是冲脉之气上逆而不舒畅所致，去掉苍术，加红花、当归、白芍、柴胡、桂枝来治疗。若是两侧季胁部兼有小腹胀痛的，这是厥阴经气内不能交于少阴经，外不能合于少阳经所致，加柴胡、人参、半夏、桂枝、当归来治疗。（第八十条）
腹部胀满喜欢被按压的，适宜使用后面提到的四个方剂。
附子理中汤。（第一百零七条）○（适用于虚寒证。）
补中益气汤。（第五条）○（适用于脾土失调、地气不升的情况。）
六君子汤，加干姜。（第二条）○（适用于脾虚痰多导致的腹胀。）
香砂六君子汤。（第三条）
我按语：以上各种方法，如果治疗无效，必须以膀胱为治疗重点。喻嘉言说：人身胸中空旷如同太虚，地气上升形成云，必须天气下降形成雨，地气才能收藏静止不动。这正符合“上焦如雾、中焦如沤、下焦如渎”的意思，这样云行雨施之后，沟渠河道才会充盈，水道通畅决泄，天地之间呈现一番新景象。这一理论首要重视膀胱这一经。经文说：膀胱是州都之官，津液藏于此，经过气化作用，才能排出体外。就像人喝酒无数却不醉的人，都是依靠膀胱的气化作用将酒液代谢出去。膻中位于膈膜之内，膀胱位于腹腔之中。膀胱的气化功能正常，则腹部空洞善于容纳，膻中之气得以向下运行。如果膀胱不能气化，则腹部首先胀满，膻中之气又怎能下达呢？然而想要恢复膀胱的气化功能，关键在于保养肾气。肾与膀胱互为表里（肾为脏，膀胱为腑）。肾气发动，必先灌注于膀胱，多次发动不已，导致膀胱胀满，势必牵连到胸膈，那种窒塞的状态，无法用言语形容。如果肾气不妄动，则收藏更加坚固，膀胱得以清净无为，膻中之气注入而不会盈满过剩。膻中之气向下运行既快捷，就不会被牵引扰乱，从而胸中空旷如同太空一样。这一论述，可以说是治疗胸腹满闷及痰饮病的金针秘诀。
(This condition is often associated with edema. It should be treated using methods for edema. However, if there is internal distension without external swelling, the treatment method differs slightly.)
For severe fullness and distension in the heart and abdomen, Pingwei San (Stomach-Pacifying Powder) should be used as the principal formula. If due to Qi stagnation, add two qian of Maiya (Hordei Fructus Germinatus) and Xiangfu (Cyperi Rhizoma). If due to food retention, add Laifuzi (Raphani Semen), Shanzha (Crataegi Fructus), and Ganjiang (Zingiberis Rhizoma). If due to alcohol injury, add three qian of Gange (Puerariae Radix) and one qian of Sharen (Amomi Fructus). If there is excessive phlegm, add three to four qian of Fuling (Poria). If there is frequent vomiting, add three qian of Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens). If there is distension in the upper chest that does not spread horizontally, add Mutong (Akebiae Caulis), Qiancao (Rubiae Radix et Rhizoma), Maimendong (Ophiopogonis Radix), Gualou (Trichosanthis Fructus), and Beimu (Fritillariae Bulbus). If turbid Qi remains in the upper part, add Chaihu (Bupleuri Radix), Banxia (Pinelliae Rhizoma), and Jiegeng (Platycodonis Radix). If there is epigastric stuffiness and fullness, add one qian each of Huanglian (Coptidis Rhizoma) and Huangqin (Scutellariae Radix), and eight fen of Ganjiang (Zingiberis Rhizoma).
If there is abdominal pain, add three qian of Sheng Baishao (Paeoniae Radix Alba). If the abdominal pain is caused by constipation, add an additional two qian of Dahuang (Rhei Radix et Rhizoma). If urination is obstructed, combine with Wuling San (Five-Ingredient Powder with Poria). If distension occurs around the navel, extending left, right, above, and below, the distension will necessarily be accompanied by pain. This indicates rebellious and unsmooth Qi of the Chong Mai (Penetrating Vessel). Remove Cangzhu (Atractylodis Rhizoma) and add Honghua (Carthami Flos), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Chaihu (Bupleuri Radix), and Guizhi (Cinnamomi Ramulus) to treat it. If distension and pain occur in the hypochondriac regions on both sides along with lower abdominal pain, this indicates that the Jueyin (Liver) channel fails to interact internally with the Shaoyin (Kidney) channel and externally harmonize with the Shaoyang (Gallbladder) channel. Add Chaihu (Bupleuri Radix), Renshen (Ginseng Radix), Banxia (Pinelliae Rhizoma), Guizhi (Cinnamomi Ramulus), and Danggui (Angelicae Sinensis Radix) to treat it. (Article 80)
For abdominal distension that prefers pressure, the following four formulas are suitable.
Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle) (Article 107) ○ (Indicated for deficiency-cold patterns.)
Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) (Article 5) ○ (Indicated for dysfunction of Spleen Earth and failure of Earth Qi to ascend.)
Liujunzi Tang (Six-Gentlemen Decoction), added with Ganjiang (Zingiberis Rhizoma) (Article 2) ○ (Indicated for spleen deficiency with excessive phlegm causing abdominal distension.)
Xiangsha Liujunzi Tang (Six-Gentlemen Decoction with Cyperi and Amomi) (Article 3)
My Commentary: For the aforementioned methods, if they fail to produce results, the treatment must focus primarily on the Bladder. Yu Jiayan stated: The chest in the human body is empty and vast like the Great Void. When Earth Qi rises to form clouds, it must be met by Heaven Qi descending to form rain, so that Earth Qi can settle and remain still. This truly embodies the meaning of "the Upper Jiao is like mist, the Middle Jiao is like a fermenting vat, and the Lower Jiao is like a ditch." Only when clouds move and rain falls will the ditches and channels fill up, water passages become smooth and clear, and a new scene emerge in the universe. This theory places primary importance on the Bladder channel. The Classic states: "The Bladder is the official of the metropolitan area, storing fluids; through Qi transformation, it can discharge them." Just as some people drink unlimited amounts of alcohol without getting drunk, it is all due to the Qi transformation of the Bladder metabolizing the liquid. Danzhong (Conception Vessel point located at the center of the chest) is located within the diaphragm, while the Bladder is located in the abdomen. When the Bladder's Qi transformation functions normally, the abdomen remains hollow and accommodating, allowing Qi from Danzhong to descend. If the Bladder fails to transform Qi, the abdomen will distend first, and how could the Qi of Danzhong reach the lower part? However, to restore the Qi transformation of the Bladder, the key lies in preserving Kidney Qi. The Kidney and Bladder are interior-exteriorly related (Kidney is the Zang organ, Bladder is the Fu organ). When Kidney Qi moves, it must first pour into the Bladder. Repeated movement leads to Bladder distension, which inevitably affects the chest and diaphragm, creating a state of obstruction indescribable by words. If Kidney Qi does not move recklessly, storage becomes more secure, and the Bladder remains pure and tranquil. Consequently, Qi from Danzhong enters without becoming excessive. Since Qi from Danzhong descends swiftly, it is not disturbed by traction, leaving the chest empty and vast like the sky. This discussion serves as the golden needle (key principle) for treating chest and abdominal fullness as well as fluid-retention conditions.