论气虚中满 论饱食填塞
天师曰∶塞者，因其塞而塞之也，如人气虚中满是也。凡人气虚，多不能食，食则倒饱，人以为多食
之故，以香砂、枳实等丸消导之。其初未尝不少快，久则腹饱，又消之，久久不已，必变成中满之症矣。腹
高而大，气喘而粗，人又以为臌胀也，用牵牛、甘遂等药以利导其水，水未必去而臌胀益甚，又以为药之
不胜也，又用大黄、巴豆之药下之，又不
应；以为风邪袭之，又以辛散之品，如龙胆草、茵陈之类。杂然纷进，不至死不止。犹然开鬼门，泄净
府，纷纷议论，皆操刀下石之徒也。谁知初起之时，即以补胃健脾之药，先为速治，何至此哉，初用
之方∶用人参一钱，白术二钱，茯苓三钱，陈皮三分，甘草一分，萝卜子一钱，薏仁五钱，芡实五钱，山
药三钱，水煎服。（〔批〕消胀至神汤。）此方绝不去消导，而专以补为事，世医未有不笑其迂，以为
此等药，服之必增胀满。下喉之时，实觉微饱，世医乃夸示曰∶吾言之验如此。而病患与病家，并诸亲友，
俱叹世医，而咎此方之迂而害事也。讵知下喉之时，虽觉微胀，入腹之后，渐觉开爽，连服数剂，不特开
爽，而并无胀满之疾矣。盖中满之疾，原是气虚而成，不补其虚，胀何从解。补药之中，加以萝卜子。
分消其胀气，使人参不敢助邪而反助正；况又有茯苓、薏仁、芡实之类，纯是去湿之药，则水道自行，而
上壅可免；尤妙用甘草一分，以引群药之入于满处。盖中满最忌甘草，而余偏用之，成功于忌之中也。
张公曰∶妙论叠出不穷，大哉，圣人之语。中满固是塞症，饱食填塞于胸膛，亦是塞症也。人皆用
香砂、浓朴消之，而余独不然。方用人参三钱，白术三钱，陈皮一钱，甘草一分，肉桂一钱，神曲三钱，
水煎服。此方妙在全不去消食，反助其饱闷之气。谁知饱食而不消者，由于胃气之不足也。我补其胃气，
则胃强自能运化而入于脾中，又何必用浓朴、枳壳之消导哉。此亦塞治之法也，可与天师方并垂天壤。
华君曰∶法同于余，而论备之。
雷公曰∶我亦有方。中满病，固是胃气之虚，然徒补胃气亦难疗。当补心火，以生胃土。方用人
参三钱，白术五钱，
炒枣仁五钱，远志八分，山药三钱，茯苓三钱，米仁五钱，陈皮三分，神曲三分，麦芽五分，水煎服。
方中全不治满而满自除，正以治心火也。
天师说：所谓“塞治法”，就是针对壅塞的病机，采用补益的方法来治疗。例如人气虚导致的中满证。一般人气虚时，往往食欲不振，进食后容易感到饱胀不适。人们误以为是吃多了的缘故，便用香砂丸、枳实丸等具有消食导滞作用的药物来治疗。起初症状或许能稍见缓解，但久而久之，腹部依然饱胀，再次使用消导药；长期如此，必然演变成严重的中满病症。此时腹部高高隆起且膨大，呼吸急促粗重，人们又将其误认为是臌胀病，于是使用牵牛子、甘遂等峻下逐水药来利水消肿。然而水湿未必能去，臌胀反而更加严重。人们又认为是药力不足以胜病，便改用大黄、巴豆等泻下药攻下；若仍无效，又认为是风邪侵袭，便加入龙胆草、茵陈等辛散祛风的药物。各种药物杂乱无章地混用，直到病人死亡才停止。这种做法，无论是开鬼门（发汗）还是洁净府（利小便），都是那些拿着刀子落井下石的人啊。谁想到在疾病初起之时，若能立即使用补胃健脾的药物进行迅速治疗，何至于发展到这种地步呢？初期使用的方剂是：人参一钱，白术二钱，茯苓三钱，陈皮三分，甘草一分，萝卜子一钱，薏仁五钱，芡实五钱，山药三钱，加水煎服。（批注：此方名为消胀至神汤。）这个方子完全不去使用消导药，而是专门以补益为务。世间的医生没有不嘲笑它迂腐的，认为这类药物服用后必然会增加胀满感。服药入口时，确实会感觉轻微饱胀，世医便夸耀说：“我的话应验得如此准确。”而病患、家属以及各位亲友，都感叹世医高明，并责怪这个方子迂腐且害事。哪里知道服药入口时虽觉微胀，但进入腹中之后，逐渐感觉舒畅开朗，连续服用几剂后，不仅感觉舒畅，而且完全没有了胀满的疾病了。因为中满之疾，原本就是由气虚引起的，不补其虚，胀满如何能解除？在补药之中，加入萝卜子，分消其胀气，使人参不敢助长邪气反而辅助正气；况且又有茯苓、薏仁、芡实等纯然祛湿的药物，则水道自然通畅，从而避免上部的壅塞；尤其妙在用一分甘草，以引导诸药进入胀满之处。通常中满最忌讳使用甘草，而我偏偏使用它，正是在禁忌之中取得了成功。
张公说：精妙的论述层出不穷，圣人的话语真是伟大啊。中满固然是塞症，饱食导致的胸膛填塞，也是塞症。人们都用香附、砂仁、厚朴来消导，而我却不然。我的方剂用人参三钱，白术三钱，陈皮一钱，甘草一分，肉桂一钱，神曲三钱，加水煎服。这个方子的妙处在于完全不去消食，反而助长了饱闷之气。谁知饱食而不消化，是由于胃气不足造成的。我补益其胃气，则胃气强盛自然能够运化食物并传输到脾中，又何必使用厚朴、枳壳等消导药呢？这也是塞治法的一种，可以与天师的方子一同流传于天地之间。
华君说：治疗方法与我相同，但论述更为详尽。
雷公说：我也有方子。中满病，固然是胃气虚弱，但如果只补胃气也难以治愈。应当补益心火，以生养胃土。方剂用人参三钱，白术五钱，炒酸枣仁五钱，远志八分，山药三钱，茯苓三钱，米仁五钱，陈皮三分，神曲三分，麦芽五分，加水煎服。方中完全不治疗胀满，而胀满自除，正是通过治疗心火来实现的。
Tian Shi (Heavenly Master) said: The method of "treating obstruction by tonification" refers to addressing the pathology of blockage by employing tonifying strategies. An example is middle-fullness caused by Qi deficiency. Generally, when a person suffers from Qi deficiency, they often lack appetite; upon eating, they easily experience postprandial fullness and discomfort. People mistakenly attribute this to overeating and therefore use pills such as Xiangsha Wan (Amomum and Sand Ginger Pill) or Zhishi Wan (Immature Bitter Orange Pill), which have actions of promoting digestion and guiding out stagnation, for treatment. Initially, symptoms may provide slight relief, but over time, abdominal fullness persists, leading to repeated use of digestive aids. If this continues indefinitely, it will inevitably evolve into severe middle-fullness syndrome. At this stage, the abdomen becomes distended and enlarged, accompanied by rapid and coarse breathing. People then misdiagnose this as鼓胀 (Gu Zhang / Drum Distension) and employ harsh water-draining herbs like Qianniu Zi (Pharbitis Seed) or Gansui (Kansui Root) to promote diuresis and drain fluid. However, the fluid may not be eliminated, and the distension worsens. Believing that the medication was insufficient to overcome the disease, practitioners then resort to purgatives such as Dahuang (Rhubarb Rhizome) or Badou (Croton Seed). If these also fail, they might attribute the condition to wind-pathogen invasion and add acrid-dispersing herbs like Longdan Cao (Gentiana Root) or Ychen (Artemisia Capillaris). Various medications are administered in a chaotic mixture until death ensues. Such practices, whether involving opening the ghost gate (sweating) or cleansing the pure residence (urination), represent those who wield knives to strike down the already fallen. Who realizes that at the onset of the disease, if one immediately employs herbs to tonify the Stomach and strengthen the Spleen for prompt treatment, how could it reach such a dire state? The initial prescription is: Renshen (Ginseng Radix et Rhizoma) 1 qian, Baizhu (Atractylodis Macrocephalae Rhizoma) 2 qian, Fuling (Poria) 3 qian, Chenpi (Citri Reticulatae Pericarpium) 3 fen, Gancao (Licorice Radix et Rhizoma) 1 fen, Luobozhi (Brassicae Seminum) 1 qian, Yiren (Coicis Semen) 5 qian, Qianshi (Euryales Semen) 5 qian, Shanyao (Dioscoreae Rhizoma) 3 qian, decocted in water. (Commentary: This formula is named Xiaozhang Zhishen Tang [Miraculous Soup for Eliminating Fullness].) This formula entirely avoids digestive agents and focuses exclusively on tonification. Physicians of the world invariably mock it as pedantic, believing that such medicines will inevitably increase fullness. Upon swallowing, patients indeed feel slightly bloated, allowing worldly physicians to boast, "My words have proven accurate." Patients, their families, and relatives all praise these worldly physicians while blaming this formula for being pedantic and harmful. Little do they know that although slight fullness is felt upon ingestion, after entering the abdomen, a sense of openness and comfort gradually emerges. After taking several doses, not only is there comfort, but the disease of fullness completely disappears. This is because middle-fullness originates from Qi deficiency; without tonifying the deficiency, how can the fullness resolve? Within the tonifying herbs, Luobozhi is added to distribute and dissipate the qi of fullness, ensuring that Renshen does not aid the pathogen but rather supports the righteous Qi. Moreover, with purely damp-resolving herbs like Fuling, Yiren, and Qianshi, the water pathways flow naturally, preventing upper congestion. Particularly ingenious is the use of just 1 fen of Gancao to guide the group of herbs into the area of fullness. Although middle-fullness typically contraindicates the use of Gancao, I deliberately use it, achieving success within the realm of contraindications.
Zhang Gong said: Profound discussions emerge endlessly; the words of the sages are truly great. Middle-fullness is indeed an obstruction syndrome, and chest/epigastric fullness due to excessive eating is also an obstruction syndrome. People generally use Xiangfu (Cyperus Rhizome), Sharen (Amomi Fructus), and Houpo (Magnolia Bark) to promote digestion, but I differ. My prescription uses Renshen 3 qian, Baizhu 3 qian, Chenpi 1 qian, Gancao 1 fen, Rougui (Cinnamon Twig) 1 qian, Shenqu (Massa Medicata Fermentata) 3 qian, decocted in water. The brilliance of this formula lies in its complete avoidance of food-digestion promotion, seemingly aggravating the sensation of satiety and oppression. Yet, the reason food remains undigested is insufficient Stomach Qi. By tonifying Stomach Qi, the Stomach becomes strong enough to transform and transport food to the Spleen naturally, rendering the need for digestive herbs like Houpo or Zhike (Aurantii Fructus) unnecessary. This is also a method of treating obstruction by tonification, worthy of being preserved alongside Tian Shi's formula for eternity.
Hua Jun said: The method aligns with mine, but the discussion is more comprehensive.
Lei Gong said: I also have a prescription. Middle-fullness is indeed due to deficient Stomach Qi, yet merely tonifying Stomach Qi is difficult to cure. One should tonify Heart Fire to generate Stomach Earth. The prescription consists of: Renshen 3 qian, Baizhu 5 qian, Chao Zaoren (Fried Ziziphus Seed) 5 qian, Yuanzhi (Polygalae Radix) 8 fen, Shanyao 3 qian, Fuling 3 qian, Miren (Coicis Semen) 5 qian, Chenpi 3 fen, Shenqu 3 fen, Maiya (Hordei Fructus Germinatus) 5 fen, decocted in water. In this formula, fullness is not directly treated, yet it resolves spontaneously, precisely because the Heart Fire is being addressed.