【歌】鼓胀又名单腹胀，外虽坚急内空虚。实人攻下随宜补，虚者调中更益脾。瘀血可行休有慢，食当消
导再无疑。瘦人病此多因火，勿得轻将快利施。
【论】丹溪云∶鼓胀由七情内伤，六淫外侵，饮食不节，房劳致虚。脾土之阴受伤，转运之官失职，胃虽
受谷，不能运化，故阳自升，阴自降，而成天地不交之否。清浊相混，
隧道壅塞，郁而为热，热留为湿，湿热相生，遂成胀满。外虽坚急，中空无物，有似乎鼓，故名曰“鼓”。其
病胶固难治，有若虫侵蚀之义，亦名曰“蛊”，二义俱通。理直补脾，次养肺金以制肝木，使脾无贼邪之患，
滋肾水以治火，使肺得清化。却浓味，远音乐无有不安。更审其虚实，辨其所因，调之补之，清之利之，权轻
重而疗之，自愈矣。若喜行快利，不审元气，而用峻剂攻之，殊不知宽得一日半日，其胀转甚，病邪转洙，真
气愈伤，再不可救，哀哉！惟宜王道药治之，可不慎欤？
谨按∶前证多因过伤饮食、劳力、怒气所致。过食则伤脾，劳力则伤血，怒气则伤肝，三者俱伤，其病必
重，药亦难效。若因久泻而成者，专以脾虚治。一脏受病，犹可施手，扶其脾，利其水，则胀自消矣。此病若
眼下如卧蚕者，必发水肿，能食者轻，不能食者重，绝不食者死。脉浮大者生，沉细者不治，胸膛胀满，脐突
出者死。
【脉】胀满脉弦，脾制于肝。洪数阳热，迟弱阴寒。浮为虚胀，紧则中实。浮大者生，虚小危急。
实
实者，按之坚痛，量人元气，下之泄之，通利后便收拾，用参、术补养脾胃。若内有积块坚痞，保安丸、
广术溃坚汤。有因蓄血腹胀，脉涩而芤大，便黑，桃仁承气汤下尽黑物。（方见血证。）有因食积腹胀，内有
热者，木香槟榔丸。（方见伤食。）内有寒者，木香、浓朴、丁香、砂仁、神曲、香附。有因大怒腹胀者，青
皮、陈皮、香附、木香、栀子仁。外寒郁内腹胀者，升麻、干葛、苍术、防风以解表寒。瘦人腹胀是火，黄连、
浓朴、香附、芍药。肥人腹胀是湿，平胃散。（方见湿证。）
保安丸
治 积心腹内结如拳，上抢心痛，脐腹痛。
大黄（三两，酒蒸） 附子（五钱，去皮、脐，炮） 干姜（一两，炮） 鳖甲（一两半，醋炙黄）
上为末，先将醋一升，煮至四、五合后，和药末丸如梧子大，空心白汤下二十丸，取积下为度。
广术溃坚汤
治中满腹胀有积聚。
浓朴姜（汁炒） 黄芩 益智仁（炒） 草豆蔻（炒） 当归（各五钱） 黄连（六钱） 制半夏
（七钱） 广术（炒） 升麻 红花（酒浸） 吴茱萸（各二钱） 甘草（生） 柴胡 泽泻 广陈皮 神曲
（炒） 青皮（各三钱）
渴者加葛根（四钱。）
每服七钱，生姜三片，煎服，不拘时。
虚
腹胀若朝宽暮急者，属血虚，四物汤（方见血证）。加浓朴、柴胡、山栀、丹皮。暮宽朝急者，属气虚，
四君子去甘草，加陈皮、浓朴、半夏、腹皮。朝暮俱急者，气血两虚也，四君子汤（方见气虚。）加芎、归、
白芍、陈皮、浓朴。
【歌诀】鼓胀又被称为单腹胀，外表虽然坚硬紧绷，内部却是空虚的。对于体质壮实的人，可根据情况采用攻下法，随后适当进补；对于体质虚弱的人，应调理中焦并进一步健脾。瘀血阻滞可行活血化瘀之法，切勿拖延；饮食积滞应当消食导滞，这无需怀疑。消瘦之人患此病多因火邪所致，不可轻易使用峻猛的泻下药。
【论述】朱丹溪说：鼓胀是由于七情内伤、六淫外侵、饮食不节以及房劳过度导致正气虚损。脾土之阴受损，负责转运功能的脏腑失职，胃虽然接受了食物，却无法运化，因此阳气独自上升，阴气独自下降，形成了天地不交泰的“否”卦之象。清浊之气相互混杂，经络通道壅塞阻滞，郁结而化为热，热邪停留则生湿，湿热相生，最终形成胀满。外表虽然坚硬紧绷，中间却空无一物，形状类似鼓，所以称为“鼓”。该病胶着顽固难以治愈，有如同虫类侵蚀的含义，也称为“蛊”，这两个名称的意义都是通顺的。治疗应当以补脾为主，其次滋养肺金以制约肝木，使脾脏免受贼邪侵害，滋补肾水以制约火邪，使肺脏得以清肃化源。避免食用浓腻厚味的食物，远离声色娱乐，身体自然安宁。更要审察患者的虚实，辨别病因，通过调治和补益，清热和利湿，权衡病情的轻重进行治疗，疾病自然会痊愈。如果喜好使用峻猛的泻下药，不审察元气，而用猛烈药物攻伐，殊不知这样只能宽舒一日半日，但胀满反而加重，病邪更加深入，真气更加受伤，到了再也不能救治的地步，真是悲哀啊！只宜采用温和王道的方法用药治疗，怎能不谨慎呢？
谨按：上述病症多因饮食过度损伤、劳累过度、愤怒所致。饮食过度会损伤脾脏，劳累过度会损伤血液，愤怒会损伤肝脏，这三者都受到损伤，病情必然严重，药物也难以见效。如果是因长期腹泻而形成的，专门按照脾虚来治疗。一个脏器受病，还可以施治，扶持脾脏，利去水湿，胀满自然消除。此病如果眼下像卧蚕一样浮肿，必定会并发水肿，能进食的病情较轻，不能进食的病情较重，完全不能进食的预后不良（死亡）。脉象浮大的预后良好，沉细的无法治愈，胸膛胀满、肚脐突出的预后不良（死亡）。
【脉诊】胀满病的脉象若见弦脉，是脾脏受制于肝脏的表现。脉象洪数属于阳热证，脉象迟弱属于阴寒证。脉浮表示虚胀，脉紧表示中焦实证。脉浮大者预后良好，脉虚小者病情危急。
实证：腹部按之坚硬疼痛，需衡量患者元气的强弱，采用攻下或泄下的方法，待大便通畅后，再用人参、白术补养脾胃。如果体内有坚硬的积块痞块，可用保安丸、广术溃坚汤。有因蓄血导致腹胀的，脉象涩而芤大，大便黑色，用桃仁承气汤攻下，直到排出黑色粪便为止。（方剂见血证章节。）有因食积导致腹胀且内有热邪的，用木香槟榔丸。（方剂见伤食章节。）内有寒邪的，用木香、厚朴、丁香、砂仁、神曲、香附。有因大怒导致腹胀的，用青皮、陈皮、香附、木香、栀子仁。外感寒邪郁闭导致腹胀的，用升麻、干葛、苍术、防风以解表寒。消瘦之人腹胀属火邪，用黄连、厚朴、香附、芍药。肥胖之人腹胀属湿邪，用平胃散。（方剂见湿证章节。）
保安丸
治疗心腹内结如拳头大小，向上冲击心痛，脐部腹痛。
大黄（三两，酒蒸） 附子（五钱，去皮、脐，炮制） 干姜（一两，炮制） 鳖甲（一两半，醋炙至黄）
以上研为末，先取醋一升，煮至四到五合后，混合药末制成梧桐子大小的丸药，空腹时用白开水送服二十丸，以排出积滞为度。
广术溃坚汤
治疗中焦胀满且有积聚。
厚朴（姜汁炒） 黄芩 益智仁（炒） 草豆蔻（炒） 当归（各五钱） 黄连（六钱） 制半夏（七钱） 广术（炒） 升麻 红花（酒浸） 吴茱萸（各二钱） 甘草（生用） 柴胡 泽泻 广陈皮 神曲（炒） 青皮（各三钱）
口渴者加葛根（四钱）。
每次服用七钱，生姜三片，煎服，不拘时间。
虚证：腹胀如果早晨缓解傍晚加重，属于血虚，用四物汤（方剂见血证章节）。加厚朴、柴胡、山栀、丹皮。如果傍晚缓解早晨加重，属于气虚，用四君子汤去掉甘草，加陈皮、厚朴、半夏、腹皮。如果早晚都加重，属于气血两虚，用四君子汤（方剂见气虚章节）加川芎、当归、白芍、陈皮、厚朴。
[Song]
Guzhang (Drum Distension), also known as Dan Zhangdu (Single Abdominal Distension), presents with a hard and tense exterior but an empty interior. For robust individuals, purgative methods may be applied according to circumstances, followed by appropriate tonification; for deficient individuals, regulate the Middle Jiao and further strengthen the Spleen. For blood stasis, promote blood circulation without delay; for food retention, employ digestion-promoting and guiding methods without doubt. In emaciated individuals, this disease is often due to Fire; do not lightly administer drastic purgatives.
[Discussion]
Zhu Danxi stated: Guzhang arises from internal injury of the Seven Emotions, external invasion of the Six Excesses, irregular diet, and deficiency caused by sexual indiscretion. The Yin of the Spleen Earth is damaged, causing the official responsible for transportation and transformation to fail its duty. Although the Stomach receives grain, it cannot transform and transport it. Consequently, Yang rises independently, and Yin descends independently, forming the state of "Pi" (Obstruction) where Heaven and Earth do not interact. Clear and turbid Qi mix together, blocking the meridians and collaterals. This stagnation generates Heat, and lingering Heat produces Dampness. Dampness and Heat generate each other, eventually resulting in distension. The exterior appears hard and tense, yet the center is empty, resembling a drum, hence the name "Guzhang." The disease is stubborn and difficult to treat, carrying the meaning of being eroded by insects, thus also named "Gu" (Poison/Insect Distension); both meanings are applicable. Treatment should primarily tonify the Spleen, then nourish Lung Metal to control Liver Wood, preventing the Spleen from suffering from "thief-evil" attacks. Nourish Kidney Water to control Fire, allowing the Lung to achieve clear transformation. Avoid rich and greasy foods, stay away from music and entertainment, and the body will naturally remain peaceful. Furthermore, examine deficiency and excess, differentiate the cause, and treat by regulating and tonifying, clearing and draining, weighing the severity to heal. It will recover on its own. If one prefers using drastic purgatives without examining Yuan Qi, and uses harsh agents to attack, little does one know that while relief may last only half a day or a day, the distension worsens, the pathogenic factor deepens, and the True Qi is further injured, reaching a point of no return. How tragic! Only gentle, kingly-way medicinal treatments should be used. Can one not be cautious?
Note: The aforementioned conditions are mostly caused by excessive dietary intake, overexertion, and anger. Excessive eating damages the Spleen; overexertion damages Blood; anger damages the Liver. If all three are damaged, the disease will be severe, and medication will be difficult to be effective. If formed due to chronic diarrhea, treat specifically for Spleen Deficiency. When one Zang organ is diseased, treatment is still possible; support the Spleen and promote water metabolism, and the distension will subside spontaneously. If there is edema under the eyes resembling a sleeping silkworm, edema will definitely develop. Those who can eat have mild disease; those who cannot eat have severe disease; those who absolutely cannot eat will die. A floating and large pulse indicates survival; a deep and fine pulse indicates untreatability. Chest and abdominal fullness with protruding umbilicus indicates death.
[Pulse Diagnosis]
A distension pulse appearing Xian (Wiry) indicates the Spleen is controlled by the Liver. Hong (Surging) and Shuo (Rapid) indicate Yang Heat; Chi (Slow) and Ruo (Weak) indicate Yin Cold. Fu (Floating) indicates Empty Distension; Jin (Tight) indicates Interior Excess. Fu Da (Floating and Large) pulses indicate survival; Xu Xiao (Deficient and Small) pulses indicate critical danger.
Excess Patterns:
The abdomen feels hard and painful upon pressure. Assess the patient's Yuan Qi strength. Apply purgative or draining methods. After bowel movements become unobstructed, use Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome) to tonify and nourish the Spleen and Stomach. If there are hard accumulations and masses inside, use Bao'an Wan (Security Pill) or Guangzhu Kuijian Tang (Curcuma Decoction to Melt Hardness). For abdominal distension due to retained blood, with a Se (Choppy) pulse that is Kou (Hollow) and Large, and black stool, use Tao Ren Chengqi Tang (Peach Kernel Magnolia Bark Decoction) until black material is completely discharged. (Formula see Blood Syndromes chapter.) For abdominal distension due to food retention with internal Heat, use Muxiang Binglang Wan (Costus and Areca Nut Pill). (Formula see Food Retention chapter.) For internal Cold, use Muxiang (Costus Root), Houpo (Magnolia Bark), Dingxiang (Clove), Sharen (Amomum Fruit), Shenqu (Medicated Leaven), and Xiangfu (Cyperus Rhizome). For abdominal distension due to great anger, use Qingpi (Green Tangerina Peel), Chenpi (Aged Tangerina Peel), Xiangfu, Muxiang, and Zhizi Ren (Gardenia Seed). For abdominal distension due to external Cold stagnating internally, use Shengma (Cimicifuga Rhizome), Gange (Kudzu Root), Cangzhu (Atractylodes Lancea Rhizome), and Fangfeng (Saposhnikovia Root) to release exterior Cold. Abdominal distension in emaciated individuals is due to Fire; use Huanglian (Coptis Rhizome), Houpo, Xiangfu, and Shaoyao (Peony Root). Abdominal distension in obese individuals is due to Dampness; use Pingwei San (Stomach-Calming Powder). (Formula see Dampness Syndromes chapter.)
Bao'an Wan (Security Pill)
Treats heart and abdominal knots like fists, upward rushing pain in the heart, and pain in the umbilical region.
Dahuang (Rhubarb Rhizome, 3 liang, steamed with wine) Fuzi (Prepared Aconite Lateral Root, 5 qian, peeled and de-navel, processed) Ganjiang (Dried Ginger, 1 liang, processed) Biejia (Tartar Testudo Shell, 1.5 liang, fried with vinegar until yellow)
Grind into powder. First, boil one sheng of vinegar down to four or five he. Mix with the powder and form pills the size of wutong seeds. Take 20 pills with warm water on an empty stomach. Stop when the accumulation is expelled.
Guangzhu Kuijian Tang (Curcuma Decoction to Melt Hardness)
Treats middle jiao fullness and abdominal distension with accumulations.
Houpo (Magnolia Bark, stir-fried with ginger juice) Huangqin (Scutellaria Root) Yizhiren (Alpinia Oxyphylla Fruit, stir-fried) Caodoukou (Cardamom Fructus, stir-fried) Danggui (Angelica Sinensis Radix, 5 qian each) Huanglian (Coptis Rhizome, 6 qian) Zhibanxia (Prepared Pinellia Tuber, 7 qian) Guangzhu (Curcuma Zedoaria Rhizome, stir-fried) Shengma (Cimicifuga Rhizome) Honghua (Carthamus Flower, soaked in wine) Wuzhuyu (Evodia Fruit, 2 qian each) Gancao (Licorice Root, raw) Chaihu (Bupleurum Root) Zexie (Alisma Rhizome) Guangchenpi (Aged Tangerina Peel, 3 qian each) Shenqu (Medicated Leaven, stir-fried) Qingpi (Green Tangerina Peel, 3 qian)
If thirsty, add Gegen (Kudzu Root, 4 qian).
Take 7 qian per dose, with 3 slices of fresh ginger, decocted in water. Take at any time.
Deficiency Patterns:
Abdominal distension that is relieved in the morning and urgent in the evening belongs to Blood Deficiency; use Siwu Tang (Four Substances Decoction). Add Houpo, Chaihu, Shanzhi (Gardenia Fruit), and Danpi (Moutan Cortex). Distension that is relieved in the evening and urgent in the morning belongs to Qi Deficiency; use Sijunzi Tang (Four Gentlemen Decoction) removing Gancao, adding Chenpi, Houpo, Banxia (Pinellia Tuber), and Fupi (Areca Pericarp). Distension that is urgent both morning and evening belongs to Dual Qi and Blood Deficiency; use Sijunzi Tang adding Xiong (Ligusticum Rhizome), Gui (Angelica Sinensis Radix), Baishao (White Peony Root), Chenpi, and Houpo.