详见气证门
陈无择云五积久而必心腹胀满但内所因不待成积即致也亦当随其脏气而平治之
谨按胀满属寒或内伤或诸气或因病数服通利药脾胃虚而致者为甚多属湿热者少至积成者
亦甚
有之但古方多不分治如禹余粮丸类燥热气血之剂于内郁之火岂得不反有所助耶夫治是疾遇大
实满燥实痞闭气滞或始由内伤脉洪实者非下之不可然有服下剂过多或泻痢后所至或素脾胃虚
弱不能运化而成者皆宜补脾行湿盖此际正气已衰矣况积而胀乎故云平治之又如血蓄血瘀致者
当从血药治之寒者热之热者寒之结者散之清浊混者分消之或升降其气或消导皆宜适事为故可
也
内经云清气在下则生飧泄浊气在上则生 胀此阴阳反作病之逆从也发明曰夫 胀者以寒
热温
凉论之此何胀也曰此饮食失节为胀乃受病之始也湿热亦能为胀右关脉洪缓而沉弦脉浮于上是
风湿热三气相合而为病也是脾胃之令不行阴火亢甚乘于脾胃盛则左迁而阳道不行是六腑之气
已绝于外大盛能令母实风气外绝风气外绝者是谷气入胃清气营气不行便是风气也异呼同类即
胃
气者是也经云虚则兼其所胜土不胜者肝之邪也是脾胃之土不足火木大胜者也经云浊阴出下窍
浊阴走五脏浊阴归六腑浊阴归地此平康不病之常道反此则为胀也经云饮食不节起居不时者阴
受之阴受之则入五脏入五脏则 满闭塞调经论云下脘不通则胃气热热气熏胸中故内热下脘者
幽门也人身之中上下有七冲门皆下冲上也幽门上冲吸门吸门者会厌也冲其吸入之气不得下归
于
肾肝为阴火动相拒故咽膈不通致浊阴之气不得下降而大便干燥不行胃之湿与客阴之火俱在其
中则腹胀作矣治在幽门使幽门通利泄其阴火润其燥血生益新血幽门通利则大便不闭吸门亦不
受邪其膈咽得通 胀腹满俱去矣是浊阴得下归地矣故经曰中满者泻之于内此法是也
详见“气证门”。
陈无择说：五积（寒、热、风、湿、食五种邪气积聚）日久必然导致心腹胀满，但体内的病因不必等到形成积块就会致病，也应当根据各脏腑的气机特点进行调和治疗。
谨按：胀满病症属于寒证，或因内伤，或因各种气机失调，或因为患病后多次服用通利药物导致脾胃虚弱而引起的情况非常多；属于湿热引起的较少；至于形成积块导致的胀满，也是有的。但是古方大多不加以区分治疗，例如禹余粮丸这类燥热气血的药剂，对于体内郁结的火邪，难道不是反而有所助长吗？治疗这种疾病，遇到大实、大满、大燥、大痞、闭塞、气滞，或者起初由内伤引起且脉象洪实的患者，非用攻下法不可。然而，有因服用泻下药过多，或腹泻痢疾之后所致，或素来脾胃虚弱不能运化水谷而形成的，都适宜补脾祛湿。因为此时正气已经衰弱，何况是积滞导致的胀满呢？所以说要“平治”（调和治理）。又如因血蓄、血瘀导致的，应当从血分药治疗。寒者用热药，热者用寒药，结聚者消散它，清浊混杂者分消它，或者升降其气机，或者消食导滞，都应当根据具体情况适当处理即可。
《内经》说：“清气在下则生飧泄，浊气在上则生䐜胀。”这是阴阳反作，病势逆从的表现。王履（号发明）解释说：所谓䐜胀，如果用寒热温凉来论述，这是什么胀呢？回答说：这是饮食失节导致的胀，是受病的开始。湿热也能导致胀满。右关脉（候脾胃）洪缓而沉，弦脉浮于上，这是风湿热三气相合而致病。这也是脾胃的令行不通，阴火亢盛，乘袭脾胃，盛则向左迁移而阳道不行，这是六腑之气已在体表断绝。大盛的风气能使母脏（肝木生心火，此处指五行相生关系中的影响）实证。风气在体表断绝，风气在体表断绝就是谷气进入胃中，清气和营气不能运行，这就是风气。异呼同类，即胃气是也。经书说：“虚则兼其所胜”，土不胜者，是肝之邪气。这是脾胃之土不足，火木大胜的缘故。经书说：“浊阴出下窍，浊阴走五脏，浊阴归六腑，浊阴归地。”这是健康无病的常道。与此相反就会发生胀满。经书说：“饮食不节，起居不时者，阴受之。”阴受之则入五脏，入五脏则䐜满闭塞。《调经论》说：“下脘不通则胃气热，热气熏胸中，故内热。”下脘，就是幽门。人身之中，上下有七冲门，都是下冲上。幽门上冲至吸门，吸门是会厌。冲其吸入之气不得下归于肾肝为阴火动，相拒故咽膈不通，致浊阴之气不得下降而大便干燥不行。胃之湿与客阴之火俱在其中，则腹胀作矣。治在幽门，使幽门通利，泄其阴火，润其燥血，生益新血。幽门通利则大便不闭，吸门亦不受邪，其膈咽得通，䐜胀腹满俱去矣。是浊阴得下归地矣。故经曰：“中满者泻之于内。”此法是也。
See the section on "Qi Disorders."
Chen Wuyue stated: When the Five Accumulations (accumulation of five pathogenic factors: cold, heat, wind, dampness, and food) persist for a long time, they inevitably lead to abdominal distension and fullness. However, internal pathogens can cause disease without necessarily forming distinct accumulations. Treatment should be adjusted according to the Qi characteristics of the respective Zang organs.
It is noted that abdominal distension and fullness often stem from cold patterns, internal injury, various Qi disorders, or excessive use of purgative/laxative medications leading to Spleen and Stomach deficiency. Such cases are very common, whereas those caused by Damp-Heat are fewer. Cases resulting from formed accumulations do exist but are less frequent. Ancient formulas often failed to distinguish between these causes. For instance, formulas like Yuyuliang Wan (Hematite Pill), which are drying and heating agents affecting Qi and Blood, might inadvertently exacerbate internal郁 Fire (stagnant Heat). In treating such diseases, when encountering severe excess, fullness, dryness, stagnation, obstruction, or Qi stagnation—especially if initially caused by internal injury with a surging and solid pulse—the purgative method is indispensable. However, cases arising from overuse of purgatives, post-dysentery/diarrhea states, or inherent Spleen and Stomach weakness failing to transform and transport nutrients require tonification of the Spleen and dispersion of Dampness. This is because Zheng Qi (Upright Qi) has already declined, let alone distension due to accumulation. Hence, it is said to treat with "Ping Zhi" (harmonizing regulation). For cases caused by Blood stasis or Blood accumulation, treatment should focus on blood-invigorating herbs. Cold patterns are treated with Heat methods; Heat patterns with Cold methods; stagnation is dispersed; mixed Clear and Turbid Qi is separated; Qi dynamics are regulated via ascending and descending mechanisms; or digestion is promoted. All treatments should be tailored to the specific condition.
The *Neijing* (Inner Canon) states: "When Clear Qi sinks below, it generates undigested stool diarrhea (Sun Xie); when Turbid Qi rises above, it generates abdominal distension (Peng Zhang)." This represents the reversal of Yin and Yang, indicating a reverse pathological progression. Wang Lü (courtesy name Faming) explained: Regarding Peng Zhang (abdominal distension), if analyzed through the lens of Cold, Heat, Warmth, and Coolness, what kind of distension is this? The answer is: This is distension caused by irregular diet, marking the onset of disease. Damp-Heat can also cause distension. A surging, slow, and deep pulse at the Right Guan position (reflecting Spleen/Stomach), combined with a wiry pulse floating above, indicates a combination of Wind, Dampness, and Heat pathogens. This signifies the failure of Spleen and Stomach functions, allowing Yin Fire to hyperactivity and attack the Spleen and Stomach. When excessive, it shifts leftward, obstructing the Yang pathways, leading to the severance of Fu Organ Qi at the exterior. Excessive Wind Qi causes the Mother organ (Liver Wood generating Heart Fire, implying generative cycle influence) to become replete. Severance of Wind Qi at the exterior implies that Grain Qi entering the Stomach fails to generate Clear Qi and Ying Qi (Nutritive Qi), manifesting as Wind Qi. "Yi Hu Tong Lei" (different sounds sharing similar categories) refers to Stomach Qi. The Classics state: "In deficiency, the affected organ incorporates the pathogen of its conquering element." Here, Earth (Spleen) is insufficient to control Liver Wood (Xie Qi). This reflects insufficient Spleen-Stomach Earth and excessive Fire and Wood. The Classics state: "Turbid Yin exits via the lower orifices, moves to the Zang organs, returns to the Fu organs, and settles in the earth." This is the normal state of health. Deviation from this leads to distension. The Classics state: "Irregular diet and improper daily routine affect Yin. When Yin is affected, pathogens enter the Zang organs. Entering the Zang organs leads to distension and obstruction." The *Tiao Jing Lun* (Treatise on Regulating Channels) states: "Obstruction in the Lower Wan leads to Heat in Stomach Qi, which steams upward into the chest, causing internal heat." The Lower Wan refers to You Men (Pylorus). The human body has seven Chong Gates (passages) from top to bottom, all flowing downward but influenced by upward movement. You Men connects upward to Xi Men (Aditus Laryngis/Epiglottis). If inhaled Qi cannot descend to Kidney and Liver, Yin Fire becomes active and resists, causing obstruction in the pharynx and diaphragm. Consequently, Turbid Yin Qi cannot descend, leading to dry and unpassed stool. Dampness in the Stomach combined with invading Yin Fire causes abdominal distension. Treatment focuses on You Men, ensuring its patency to drain Yin Fire, moisten dry Blood, and nourish new Blood. Once You Men is patent, stool passes freely, Xi Men is protected from pathogens, the diaphragm and pharynx open, and distension/fullness resolve. Thus, Turbid Yin returns to the earth. Therefore, the Classics say: "For fullness in the center, purge from within." This is the correct method.