二陈汤(和一) 和胃饮(新和五) 六君子汤(补五) 理阴煎(新热三) 和中汤(寒五八)
金水六君煎(新和一) 温胃饮(新热五) 三圣丸(寒一七一) 和胃二陈煎(新和三) 曲术
丸(和百十) 术连丸(寒一七二) 二术二陈汤(和四) 三补丸(寒一六二) 软石膏丸(寒一七三)
《腹中论》帝曰∶有病心腹满,旦食则不能暮食,此为何病?岐伯曰∶名为鼓胀,治之
以鸡矢醴,一剂知,二剂已。帝曰∶其病有复发者,何也?曰∶此饮食不节,故时有病也。
虽然其病且已时,故当病气聚于腹也。
《经脉篇》曰∶足太阴虚则鼓胀。胃中寒则胀满。
《水胀篇》曰∶肤胀者,寒气客于皮肤之间, 然不坚,腹大,身尽肿,皮
浓,按其腹, 而不起,腹色不变,此其候也。帝曰∶鼓胀何如?岐伯曰∶腹胀,身皆大,
大与肤胀等也,色苍黄,腹筋起,此其候也。
《胀论》帝曰∶脉之应于寸口,如何而胀?岐伯曰∶其脉大坚以涩者,胀也。帝曰∶
何以知脏腑之胀也?曰∶阴为脏,阳为腑。帝曰∶夫气之令人胀也,在于血脉之中耶,脏腑
之内乎?曰∶三者皆存焉,然非胀之舍也。夫胀者,皆在于脏腑之外,排脏腑而郭胸胁,胀
皮肤,故命曰胀。五脏六腑者,各有畔界,其病各有形状。营气循脉,卫气逆为脉胀,卫气
并脉循分为肤胀。心胀者,烦心短气,卧不安。肺胀者,虚满而喘咳。肝胀者,胁下满而痛
引小腹。脾胀者,善哕,四肢烦 ,体重不能胜衣,卧不安。肾胀者,腹满引背,央央
然腰髀痛。六腑胀∶胃胀者,腹满,胃脘痛,鼻闻焦臭,妨于食,大便难。大肠胀者,肠鸣
而痛濯濯,冬日重感于寒,则飧泄不化。小肠胀者,少腹 胀,引腰而痛。膀胱胀者,
少腹满而气癃。三焦胀者,气满于皮肤中,轻轻然而不坚。胆胀者,胁下痛胀,口中苦,善
太息。岐伯曰∶卫气之在身也,常然并脉,循分肉,行有逆顺,阴阳相随,乃得天和,五脏
更始,四时循序,五谷乃化。然后厥气在下,营卫留止,寒气逆上,真邪相攻,两气相搏,
乃合为胀也。(此下针治之法具详本经)
《阴阳应象大论》曰∶浊气在上,则生 胀。
《生气通天论》曰∶因于气,为肿,四维相代,阳气乃竭。
《五脏生成篇》曰∶腹满 胀,支膈 胁,下厥上冒,过在足太阴阳明。
《本神篇》曰∶脾气实则腹胀。肾气实则胀。
《六元正纪大论》曰∶太阴所至为中满,霍乱吐下。太阴所至为重, 肿。土郁之
发,民病心腹胀, 肿身重。
《至真要大论》曰∶诸湿肿满,皆属于脾。诸胀腹大,皆属于热。(按∶以上诸胀,皆
言气之为病也)
《水热穴论》帝曰∶少阴何以主肾?肾何以主水?岐伯曰∶肾者,至阴也,至阴者,盛
水也。肺者,太阴也,少阴者,冬脉也,故其本在肾,其末在肺,皆积水也。帝曰∶肾何以
能聚水而生病?曰∶肾者,胃之关也,关门不利,故聚水而从其类也。故水病下为 肿、
大腹,上为喘呼不得卧者,标本俱病。
《水胀篇》曰∶水始起也,目窠上微肿,如新卧起之状,其颈脉动,时咳,阴股间寒,
足胫肿,腹乃大,其水已成矣。以手按其腹,随手而起,如囊裹水之状,此其候也。
《五癃津液别篇》曰∶阴阳气道不通,四海闭塞,三焦不泻,津液不化,留于下焦,
不得渗膀胱,则下焦胀,水溢则为水胀。
《评热病论》曰∶诸有水气者,微肿先见于目下也。水者,阴也,目下亦阴也,腹者,
至阴之所居,故水在腹者,必使目下肿也。
《经脉篇》曰∶胃病则大腹水肿。
《邪气脏腑病形篇》曰∶胃病者,腹 胀,胃脘当心而痛,上支两胁,隔咽不通,
食饮不下。三焦病者,腹气满,小腹尤坚,不得小便,窘急,溢则水留即为胀。肾脉微大为
石水,起脐已下至小腹HT HT 然,上至胃脘,死不治。
《宣明五气篇》曰∶下焦溢为水。
《逆调论》曰∶不得卧,卧则喘者,是水气之客也。夫水者,循津液而流也。肾者水藏
,主津液,主卧与喘也。
《阴阳别论》曰∶阴阳结斜,多阴少阳,曰石水,少腹肿。三阴结,谓之水。
《汤液醪醴论》帝曰∶其有不从毫毛生而五脏阳已竭也,津液充郭,其魄独居,孤精于
内,气耗于外,形不可与衣相保,此四极急而动中,是气拒于内而形施于外,治之奈何?岐
伯曰∶平治于权衡,去宛陈 ,是以微动四极,温衣,缪刺其处,以复其形,开鬼门,
洁净府,精以时复,五阳已布,疏涤五脏,故精自生,形自盛,骨肉相保,巨气乃平。按以
上诸胀,皆言水之为病也。
《太阴阳明论》曰∶食饮不节,起居不时者,阴受之;阴受之,则入五脏,则 满
闭塞。
《异法方宜论》曰∶北方者,其民乐野处而乳食,脏寒生满病。按以上二条,乃言饮食
之为胀也。
二陈汤(方剂编号:和一) 和胃饮(方剂编号:新和五) 六君子汤(方剂编号:补五) 理阴煎(方剂编号:新热三) 和中汤(方剂编号:寒五八)
金水六君煎(方剂编号:新和一) 温胃饮(方剂编号:新热五) 三圣丸(方剂编号:寒一七一) 和胃二陈煎(方剂编号:新和三) 曲术
丸(方剂编号:和百十) 术连丸(方剂编号:寒一七二) 二术二陈汤(方剂编号:和四) 三补丸(方剂编号:寒一六二) 软石膏丸(方剂编号:寒一七三)
《黄帝内经·腹中论》记载:黄帝问道:有人患心腹部胀满,早晨吃了东西到晚上就不能再吃,这是什么病?岐伯回答说:这种病名叫鼓胀(一种以腹部胀大如鼓为特征的疾病),用鸡矢醴(一种用鸡粪制成的药酒)治疗,服一剂见效,服两剂痊愈。黄帝问:这种病有复发的,是什么原因呢?岐伯说:这是因为饮食不节制,所以时常发病。虽然当病情暂时缓解时,但病气仍然积聚在腹部。
《黄帝内经·经脉篇》说:足太阴脾经虚损就会导致鼓胀。胃中有寒邪就会导致胀满。
《黄帝内经·水胀篇》说:肤胀(一种以皮肤肿胀、按之凹陷不起为特征的病证),是寒气侵入皮肤之间,叩击时发出空空的声音且不坚硬,腹部增大,全身浮肿,皮肤增厚,用手按压腹部,凹陷不能立即恢复,腹部颜色不变,这是它的症状表现。黄帝问:鼓胀又怎样呢?岐伯说:腹部胀大,身体也都肿大,肿大程度与肤胀相等,面色苍黄,腹部青筋暴露,这是它的症状表现。
《黄帝内经·胀论》记载:黄帝问道:脉象在寸口部的反映,怎样的脉象主胀病?岐伯说:脉象大而坚涩的,就是胀病。黄帝问:如何知道脏腑的胀病呢?岐伯说:阴经主脏,阳经主腑。黄帝问:导致人发生胀病的气,是在血脉之中呢,还是在脏腑之内呢?岐伯说:三者(血脉、脏腑、皮肤肌肉间隙)都存在,然而都不是胀病的居所。所谓胀病,都发生在脏腑之外,排挤脏腑,廓张胸胁,胀及皮肤,所以命名为胀。五脏六腑各有界限,它们的病变各有不同的形状。营气循行于脉中,卫气逆行则导致脉胀;卫气并入脉中,循行于分肉之间则导致肤胀。心胀的表现是心烦短气,睡眠不安。肺胀的表现是胸部虚满而喘咳。肝胀的表现是胁下胀满且疼痛牵引小腹。脾胀的表现是容易呃逆,四肢烦闷沉重,身体沉重得连衣服都穿不动,睡眠不安。肾胀的表现是腹部胀满牵引背部,腰部和大腿根部酸痛不适。六腑胀的表现:胃胀表现为腹部胀满,胃脘疼痛,鼻中闻到焦臭味,妨碍进食,大便困难。大肠胀表现为肠鸣且疼痛如水声濯濯,冬天再次感受寒邪,就会发生完谷不化的泄泻。小肠胀表现为小腹胀满,牵引腰部疼痛。膀胱胀表现为小腹胀满且小便不通畅。三焦胀表现为气充满于皮肤之中,轻轻按之不坚硬。胆胀表现为胁下疼痛胀满,口中发苦,喜欢叹气。岐伯说:卫气在体内,通常并行于脉中,循行于分肉之间,运行有顺逆之分,阴阳相随,才能顺应自然和谐,五脏功能更替有序,四季变化循序渐进,五谷才能消化。如果厥气(逆乱之气)在下,营卫之气留滞不行,寒气逆上,正气与邪气相互抗争,两气相搏结,就形成了胀病。(此下针治之法具详本经)
《黄帝内经·阴阳应象大论》说:浊气停留在上部,就会产生胀病。
《黄帝内经·生气通天论》说:因于气机失调,会导致浮肿,四维之气交替失常,阳气就会衰竭。
《黄帝内经·五脏生成篇》说:腹部胀满、胸胁支撑胀痛,下部厥冷上部昏冒,病位在足太阴脾经和足阳明胃经。
《黄帝内经·本神篇》说:脾气实盛会导致腹胀。肾气实盛会导致胀病。
《黄帝内经·六元正纪大论》说:太阴湿土之气所至,会出现中满(脘腹胀满)、霍乱吐泻。太阴之气所至,会出现身体沉重、浮肿。土气郁结发作时,百姓会患心腹胀满、浮肿、身体沉重。
《黄帝内经·至真要大论》说:各种湿邪导致的浮肿胀满,都归属于脾。各种胀病腹部膨大,都归属于热。(按语:以上诸种胀病,都是论述气机作为病因的情况)
《黄帝内经·水热穴论》记载:黄帝问道:少阴经为什么主司肾脏?肾脏为什么主司水液代谢?岐伯说:肾属于至阴,至阴意味着盛藏水液。肺属于太阴,少阴对应冬季的脉象,所以水肿的根本在肾,标末在肺,都是积水所致。黄帝问:肾脏为什么能聚水而生病呢?岐伯说:肾是胃的关口,如果关门不利,就会聚水并随着同类的水邪泛滥。所以水病向下表现为下肢浮肿、大腹水肿,向上表现为喘息呼叫不能平卧,这是标本俱病。
《黄帝内经·水胀篇》说:水病刚开始发生时,眼睑下方微微肿胀,像刚睡醒的样子,颈部动脉搏动明显,时常咳嗽,大腿内侧感觉寒冷,小腿浮肿,腹部才变大,此时水病已经形成。用手按压腹部,随手而起,像囊袋包裹着水的样子,这是它的症状表现。
《黄帝内经·五癃津液别篇》说:阴阳气道不通,四海闭塞,三焦不能通泻,津液不能正常转化,滞留于下焦,不能渗入膀胱,就会导致下焦胀满,水液外溢就成为水胀。
《黄帝内经·评热病论》说:凡是患有水气病的,轻微浮肿首先出现在眼下。水是阴邪,眼下也是阴位,腹部是至阴之所居,所以水停在腹部,必然导致眼下浮肿。
《黄帝内经·邪气脏腑病形篇》说:胃病表现为腹部胀满,胃脘当心部位疼痛,向上支撑两胁,咽喉阻隔不通,饮食难以下咽。三焦病表现为腹部气机胀满,小腹部尤其坚硬,小便不通,窘迫急迫,水液溢出停留就形成胀病。肾脉微大诊断为石水(一种水积于下的重症),从脐下至小腹硬起,向上延伸至胃脘,属于死症,难以治愈。
《黄帝内经·逆调论》说:不能平卧,一躺下就喘息的,是水气侵犯所致。水液是沿着津液通道流动的。肾是水脏,主司津液,同时也主宰睡眠和喘息。
《黄帝内经·阴阳别论》说:阴阳之气结聚偏斜,多阴少阳,称为石水,表现为小腹部肿胀。三阴经气结聚,称为水病。
《黄帝内经·汤液醪醴论》记载:黄帝问道:有一种病不是从毫毛体表生发,而是五脏阳气已经衰竭,津液充满胸腹,魄独居于内,孤精耗散于内,元气耗散于外,形体消瘦无法保持与衣服的贴合,这导致四肢紧急而动扰内脏,这是气拒于内而形体受损于外,该如何治疗?岐伯说:要权衡平治,去除宛陈(瘀血积滞),因此要轻微活动四肢,穿着温暖衣物,采用缪刺法针刺相应部位,以恢复形体,开鬼门(发汗),洁净府(利小便),精气按时恢复,五脏阳气得以布散,疏涤五脏,所以精气自生,形体自盛,骨肉相保,大气乃平。按语:以上诸种胀病,都是论述水液作为病因的情况。
《黄帝内经·太阴阳明论》说:饮食不节制,起居不规律的,阴经受邪;阴经受邪,则病入五脏,导致腹部胀满闭塞。
《黄帝内经·异法方宜论》说:北方地区,百姓喜欢野外居住且以乳食为主,脏寒容易产生胀满病。按语:以上两条,是论述饮食作为胀病因子的情况。
Erchen Tang (Cinnamon Twig and Dried Tangerina Peel Decoction) [Ref: He Yi] Heweiyin (Stomach-Harmonizing Drink) [Ref: Xin He Wu] Liu Junzi Tang (Six Gentlemen Decoction) [Ref: Bu Wu] Liyin Jian (Yin-Regulating Infusion) [Ref: Xin Re San] Hezhong Tang (Middle-Jiao-Harmonizing Decoction) [Ref: Han Wu Ba] Jinshui Liujun Jian (Metal-Water Six Gentlemen Infusion) [Ref: Xin He Yi] Wenweiyin (Stomach-Warming Drink) [Ref: Xin Re Wu] Sansheng Wan (Three Sages Pill) [Ref: Han Yi Qi Yi] Hewei Erchen Jian (Stomach-Harmonizing Erchen Infusion) [Ref: Xin He San] Quzhu Wan (Qu-Magnolia Pill) [Ref: He Bai Shi] Shulian Wan (Atractylodes-Coptis Pill) [Ref: Han Yi Qi Er] Eru Erchen Tang (Two Atractodises and Erchen Decoction) [Ref: He Si] Sanbu Wan (Three Tonics Pill) [Ref: Han Yi Liu Er] Ruan Shigao Wan (Soft Gypsum Pill) [Ref: Han Yi Qi San]
The *Abdominal Discussion* chapter of the *Huangdi Neijing* (Yellow Emperor's Inner Canon) records: The Yellow Emperor asked, "There is a disease characterized by fullness in the heart and abdomen; after eating in the morning, one cannot eat in the evening. What is this disease?" Qibo replied, "It is named Drum Distension (Gu Zhang, a condition characterized by abdominal distension resembling a drum). It can be treated with Jishi Li (Chicken Excrement Fermented Liquid); one dose brings improvement, two doses bring recovery." The Yellow Emperor asked, "Why does this disease recur?" Qibo said, "This is due to irregular diet, hence the occasional recurrence of illness. Although the disease may temporarily subside, the pathogenic Qi remains accumulated in the abdomen."
The *Meridian Chapter* states: Deficiency of the Foot-Taiyin Spleen Meridian leads to Drum Distension. Cold in the Stomach leads to distension and fullness.
The *Water Swelling Chapter* states: Skin Distension (Fu Zhang, a condition characterized by skin swelling that does not pit easily) occurs when cold pathogens lodge between the skin and muscles. Percussion yields a hollow sound, it is not firm, the abdomen enlarges, the whole body swells, the skin thickens, and pressing the abdomen leaves an indentation that does not immediately recover, while the abdominal color remains unchanged; these are its signs. The Yellow Emperor asked, "What about Drum Distension?" Qibo said, "The abdomen is distended, and the whole body is enlarged, to the same extent as Skin Distension; the complexion is dark yellow, and abdominal veins are prominent; these are its signs."
The *Discussion on Distension* chapter records: The Yellow Emperor asked, "How do pulse manifestations at the Cun Kou position indicate distension?" Qibo said, "A pulse that is large, firm, and choppy indicates distension." The Yellow Emperor asked, "How can one distinguish distension of the Zang and Fu organs?" Qibo said, "Yin meridians correspond to Zang organs, and Yang meridians correspond to Fu organs." The Yellow Emperor asked, "Does the Qi causing distension reside within the blood vessels, or inside the Zang and Fu organs?" Qibo said, "All three exist, but none is the primary seat of distension. Distension resides outside the Zang and Fu organs, pushing against them, expanding the chest and hypochondrium, and swelling the skin; thus it is named Distension. The five Zang and six Fu organs have their boundaries, and each has distinct pathological shapes. Ying (Nutritive) Qi circulates within the vessels; if Wei (Defensive) Qi reverses, it causes Vessel Distension. If Wei Qi merges with the vessels and circulates along the muscle intervals, it causes Skin Distension. Heart Distension manifests as mental restlessness, shortness of breath, and restless sleep. Lung Distension manifests as empty fullness in the chest, wheezing, and coughing. Liver Distension manifests as fullness and pain under the hypochondrium radiating to the lower abdomen. Spleen Distension manifests as frequent hiccups, heaviness and discomfort in the four limbs, inability to bear the weight of clothing, and restless sleep. Kidney Distension manifests as abdominal fullness radiating to the back, and persistent pain in the waist and thighs. Fu Organ Distension: Stomach Distension manifests as abdominal fullness, epigastric pain, smelling burnt odors from the nose, difficulty eating, and difficult defecation. Large Intestine Distension manifests as borborygmus and gurgling pain; if exposed to cold in winter, it leads to undigested diarrhea. Small Intestine Distension manifests as lower abdominal fullness radiating to the lower back with pain. Bladder Distension manifests as lower abdominal fullness and urinary retention. Sanjiao (Triple Burner) Distension manifests as Qi filling the skin, feeling light but not firm upon pressure. Gallbladder Distension manifests as pain and fullness under the hypochondrium, bitter taste in the mouth, and frequent sighing. Qibo said: "Wei Qi normally runs alongside the vessels, circulating through the muscle intervals, with smooth and reverse flows, Yin and Yang following each other, thereby achieving harmony with nature, allowing the five Zang organs to function cyclically, the four seasons to proceed in order, and grains to be digested. However, if Jue Qi (rebellious Qi) accumulates below, Ying and Wei Qi stagnate, cold Qi rebels upward, and true Qi conflicts with pathogenic Qi, the two energies clash, resulting in distension. (Detailed acupuncture treatments for this follow in the original text.)"
The *Major Discussion on Yin-Yang Correspondence to Phenomena* states: When turbid Qi stays in the upper part, distension arises.
The *Discussion on Life-Giving Heaven* states: Due to Qi dysfunction, edema occurs; if the four extremities alternate abnormally, Yang Qi will be exhausted.
The *Chapter on Generation of the Five Zang Organs* states: Abdominal fullness and distension, support-like pain in the chest and hypochondrium, lower jiao coldness with upper jiao cloudiness, indicate pathology in the Foot-Taiyin and Foot-Yangming meridians.
The *Chapter on Original Spirit* states: Excess of Spleen Qi leads to abdominal distension. Excess of Kidney Qi leads to distension.
The *Major Discussion on the Six Yuan and Correct Chronicles* states: When Taiyin arrives, central fullness, cholera, vomiting, and diarrhea occur. When Taiyin arrives, there is heaviness and edema. When Earth Qi is depressed and erupts, people suffer from heart and abdominal distension, edema, and body heaviness.
The *Major Discussion on the Most Essential and True* states: All dampness-induced edema and fullness belong to the Spleen. All distensions with abdominal enlargement belong to Heat. (Note: The above distensions all discuss Qi as the pathogen.)
The *Chapter on Water and Acupoints* records: The Yellow Emperor asked, "Why does the Shaoyin meridian govern the Kidneys? Why do the Kidneys govern water?" Qibo said, "The Kidneys are Supreme Yin; Supreme Yin means storing abundant water. The Lungs are Taiyin; Shaoyin corresponds to Winter pulses. Thus, the root of water accumulation is in the Kidneys, and the branch is in the Lungs; both involve water accumulation." The Yellow Emperor asked, "Why can the Kidneys accumulate water and cause disease?" Qibo said, "The Kidneys are the gate of the Stomach. If the gate is not functional, water accumulates and spreads according to its nature. Therefore, water disease manifests downward as leg edema and abdominal distension, and upward as panting and inability to lie flat; this is simultaneous involvement of root and branch."
The *Water Swelling Chapter* states: At the onset of water disease, the eyelids swell slightly, resembling the appearance after waking up; the neck pulse beats visibly; there is occasional coughing; coldness is felt in the inner thighs; the calves swell; and the abdomen enlarges, indicating that water disease has formed. Pressing the abdomen causes it to rise immediately, like a bag wrapped around water; these are its signs.
The *Chapter on Differentiating Five Obstructions and Body Fluids* states: When Yin-Yang Qi pathways are blocked, the Four Seas are closed, the Sanjiao fails to drain, and body fluids fail to transform, remaining in the lower jiao and failing to渗 (seep) into the Bladder, leading to lower jiao distension. Overflowing water results in Water Distension.
The *Chapter on Evaluating Heat Diseases* states: In all cases of water qi, slight swelling first appears under the eyes. Water is Yin, and the area under the eyes is also Yin. The abdomen is the residence of Supreme Yin. Therefore, when water resides in the abdomen, swelling under the eyes must occur.
The *Meridian Chapter* states: Stomach disease leads to abdominal edema.
The *Chapter on Pathogenic Factors and Zang-Fu Disease Forms* states: Stomach disease manifests as abdominal distension, epigastric pain centered at the heart region, upward support to both hypochondria, obstruction in the throat, and inability to swallow food and drink. Sanjiao disease manifests as abdominal Qi fullness, especially hardness in the lower abdomen, inability to urinate, urgency, and overflow leading to water retention and distension. A slightly large Kidney pulse indicates Stone Water (Shi Shui), starting from below the navel to the lower abdomen, hard and rising, extending up to the stomach; this is incurable and fatal.
The *Chapter on Clarifying the Five Qi* states: Overflow from the lower jiao leads to water.
The *Chapter on Counter-Regulation* states: Inability to lie flat and panting upon lying down is caused by water qi invasion. Water flows along the channels of body fluids. The Kidneys are the Water Storehouse, governing body fluids, and also governing sleep and panting.
The *Chapter on Differentiating Yin-Yang* states: When Yin and Yang knot and skew, with much Yin and little Yang, it is called Stone Water, manifesting as lower abdominal swelling. Knotting of the Three Yin meridians is called Water disease.
The *Chapter on Liquids and Malt Wines* records: The Yellow Emperor asked, "There is a disease not arising from the hair pores, but where the Yang Qi of the five Zang organs is already exhausted, body fluids fill the torso, Po (Corporeal Soul) resides alone internally, isolated essence depletes internally, Qi dissipates externally, the form cannot maintain itself against clothing, causing urgency in the four extremities disturbing the interior. This is Qi rejecting internally and form suffering externally. How should it be treated?" Qibo said, "Balance and regulate using weighing measures, remove stagnant and old blood. Therefore, gently move the four extremities, wear warm clothes, apply Mu Ci (lateral needling) at corresponding sites to restore the form, open the ghost gates (induce sweating), purify the clean mansion (promote urination), let essence recover in time, allow the five Yang Qi to spread, dredge and cleanse the five Zang organs. Thus, essence generates spontaneously, form becomes robust, bone and flesh protect each other, and Great Qi becomes peaceful." (Note: The above distensions all discuss Water as the pathogen.)
The *Chapter on Taiyin and Yangming* states: Irregular diet and improper daily routine injure Yin; injury to Yin allows pathogens to enter the five Zang organs, leading to abdominal fullness and blockage.
The *Chapter on Different Methods and Suitable Areas* states: In the Northern region, people enjoy living outdoors and consuming dairy products; cold in the viscera generates fullness diseases. (Note: The above two passages discuss Diet as the cause of distension.)