腹满俗云肚胀有属热者有属寒者阳热则腹满咽干或大小便秘涩或潮热谵语等证阴则腹满吐食不下自利益甚时腹自
痛虽然腹满为里证又有浅深之别经曰表已解内不消非大满犹生寒热则病不除是未全入腑邪犹浅也若大满大实坚有燥屎
可除下之虽四五日不能为祸是已入腑邪已深也腹满固多可下又有虚实之殊经曰腹满不减为实可下去之若腹满时减为虚
则不可下又曰腹满不减减不足言当下之要略曰腹满时减复如故此虚寒从下上也当以温药和之盖虚气留滞亦为之胀但比
实者不至坚痛尔诸经皆有腹满但太阴属脾土位中央又专主腹满之候腹满之证二十余条治法有汗吐下温刺之异又有汗吐
下后成腹胀者治法亦各不同盖胃为津液之主发汗亡阳则胃气虚而不能数布诸气壅滞而为胀满是当温散浓朴生姜甘草半
夏人参汤可也吐后邪气不去加之腹胀满者胸中之邪下传入胃壅而为实故生胀满当须下之调胃承气汤可也邪未入腑而妄
下之表邪乘虚入郁胸中有虚烦气上下不得通利腹为之满故当吐之栀子浓朴汤可也医者能审邪气所起之由来真知邪气所
在之虚实发汗吐下之不瘥温补针艾之适当则十全之功可得也又结胸从心下起至少腹硬满而痛与腹满类也然结胸按之则
痛手不可近腹痛举按常痛手近不甚也又痞亦从心下起至少腹亦与满类也然痞或止留心下腹满但在腹之中也有此为异临
证宜审
太阳 发汗后腹胀满者浓朴生姜甘草半夏人参汤（成 吐后腹胀与下后腹 满皆为实言邪气乘虚入里为实发汗后外
已解也腹胀满知非里实由脾胃津液不足气涩不通壅而为满与此汤和脾胃而降气张 或问太阳篇中发汗后诸证不言太阳
病固所当然亦合列于伤寒之上何故止言发汗后腹胀者浓朴半夏生姜人参汤主之予曰凡言发汗后者以外无表证里无别术
止有腹胀一事而已除此之外即获全安夫伤寒二字岂可易言哉其传变吉凶犹反掌耳可与所余一证而并例哉其诸汗后条目
不殊此意）
浓朴生姜人参甘草半夏汤方
浓朴（炙去皮） 生姜（各半斤） 人参（一两） 半夏（半升洗） 甘草（二两）上五味以水一斗煮取三升去滓
温服一升日三服
伤寒下后心烦腹满卧起不安栀子浓朴汤主之（成 下后但腹满而不心烦则邪气入里为里实但心烦而不腹满则邪气在
胸中为虚烦既烦且满则邪气壅于胸腹间也满者不能坐烦者不能卧故令卧起不安与栀子浓朴汤吐烦泄满）太阳病过经十余
日心下温温欲吐而胸痛大便反溏腹微满郁郁微烦先时自极吐下者调胃承气汤 若不愈不可与但欲呕胸中痛微溏者此非柴
胡证以呕知极吐下也（吴茱萸汤半夏泻汤心详呕吐）太阳病中风以火劫发汗邪风被火热血气流溢失其常度两阳相熏灼其
身发黄阳盛则欲衄阴虚则小便难阴阳俱虚竭身体则枯燥但头汗出剂颈而还腹满微喘口干咽烂或不大便久则谵语甚者至
哕手足躁扰捻衣摸床小便利者可治伤寒腹满谵语寸口脉浮而紧此肝乘脾名曰纵刺期门（腹满谵语者脾胃疾也浮紧者肝脉
也脾病见肝脉木行乘土也经曰水行乘火木行乘土名曰纵此其类矣期门者肝之幕制之以泻肝经盛气）伤寒发热啬啬恶寒大
渴引饮腹满自汗小便利病欲愈此肝乘肺也名曰横刺期门（按伤寒发热恶寒表病也至于自汗出则表已解矣大渴腹满里病也
至于小便利则里自和矣故曰其病欲解欲解则当俟其自愈矣刺期门三字疑衍）
阳明 中风口苦咽干腹满微喘发热恶寒脉浮而紧若下之则腹满小便难也（麻黄汤）三阳合病腹满身重难以转侧口不
仁面垢谵语遗尿发汗则谵语下之则额上生汗手足逆冷若自汗者白虎汤阳明病脉迟食难用饱饱则微烦头眩必小便难此欲
作谷疸虽下之腹满如故所以然者以脉迟故也（栀柏汤）伤寒吐后腹胀满者与调胃承气汤（成 内经云诸腹胀大属于热热
在上焦则吐吐后不解复腹胀满者邪热入胃也与调胃承气汤下其胃热）发汗不解腹满痛者急下之宜大承气汤腹满时减减不
足言当下之宜大承气汤（满痛即是实若时减者非实也下条是发明上文之义且言若但满而不痛虽未可以为实若满而不减者
亦可下也张 或谓减不足言复曰当下之何也此古之文法如果也言腹满不减当下之宜大承气汤此满而不减之谓也若时满
时减者不可以当下而论是减不足言也然承气汤当缀下腹满不减处非可续于减不足言之下也假如太阳篇中云伤寒不便六
七日头痛有热者与承气汤其小便清者知不在里仍在表也当须发汗若头痛者必衄宜桂枝汤缘桂枝当发汗而设非为治衄而
用也以其文法所拘致令后世治衄有麻黄桂枝之误其减不足言之说亦不外乎是理）阳明病下之心中懊 而烦胃中有燥屎者
大承气汤腹微满必初硬后溏不可攻（下后心中懊 而烦者虚烦也当与栀子豉汤若胃中有燥屎者非虚烦也可与大承气汤下
之其腹微满初硬后溏是无燥屎此热不在胃而在上也故不可攻）伤寒七八日身黄如橘子色小便不利腹微满者茵陈蒿汤阳
明病脉迟虽汗出不恶寒者其身必重短气腹满而喘有潮热者此外欲解可攻里也手足 然汗出者此大便已硬也宜大承气汤
若汗多微发热恶寒者表未解也其热不潮未可与承气若腹大满不通者可与小承气汤微和胃气勿令大泄下阳明病脉浮而紧
口苦咽干腹满而喘发热汗出不恶寒反恶热身重（五苓散白虎汤）阳明病潮热大便微硬者大承气汤若不大便六七日恐有燥
屎少与承气汤汤入腹中不转失气者此但初硬后溏不可攻攻之必胀满不能食欲饮水者饮水则哕后发热者必大便复硬宜小
承气汤阳明中风脉弦浮大短气腹都满胁下及心痛久按之气不通鼻干不得汗嗜卧身及面目悉黄小便难潮热时哕者与小柴
胡汤脉但浮无余证者麻黄汤
太阴 为病腹满而吐食不下自利益甚时腹自痛若下之必胸下结硬（理中汤丸不渴四逆汤张 或谓凡伤寒初受者皆在
太阳然后传于阳明少阳也病有自阴经而入者未审何经先受也夫太阳先受也病自阳经发者为外感风寒邪从表入故太阳先
受之也病自阴经起者为内伤生冷冻饮料食过多故从太阴入也夫太阴者脾也以饮食生冷则伤脾故腹满而吐食不下自利不渴手
足自温等证也）桂枝加芍药桂枝加大黄二证（已见前条）
少阴 病六七日腹胀不大便者急下之宜大承气汤（成 此少阴入腑也六七日少阴之邪入腑之时阳明内热壅甚腹满不
大便也阳明病土胜肾水则干急与大承气汤以救肾水）
厥阴 下利清谷不可汗汗出必腹满（四逆汤）下利腹胀满身体疼痛者先温其里四逆汤乃攻其表桂枝汤（下利腹满者
里有虚寒先与四逆汤温里身疼痛为表未解利止里和与桂枝汤攻表）伤寒哕而腹满视其前后何部不利利之则愈（成 哕而
腹满气上而不下也视其前后部有不利者则利之以降其气前部小便也后部大便也或用五苓散小承气汤）
禁忌 不大便六七日少与小承气汤不转失气者不可攻攻之则腹满不能食（论见不大便）腹满吐利者忌下（论见太阴）
腹满脉浮紧口苦咽干者忌汗下针（论见自汗）腹满脉迟者忌下（论见前脉迟条）腹满脉弱自利设用大黄芍药宜减之（论
见太阴病条）
附
活 若饮食不节寒中阴经胸膈不快腹满闭塞唇青手足冷脉沉细少情绪或腹痛急作理中汤加青皮每服一二剂胸即
快
矣枳实理中丸五积散尤妙胀腹满者宜桔梗半夏汤
桔梗半夏汤 治伤寒心腹痞满时发疼痛
桔梗（微炒） 半夏（姜制） 橘红（各一两）上 咀每服四钱生姜三片水煎服
海 少阴证小便遗沥大便遗失其人病六七日身重目不能视体如冰腹胀满与物则咽不与则不求其脉沉细而微疾按
之
有力宜急下之与大承气汤
腹部胀满，俗称肚胀，有属于热证的，也有属于寒证的。阳热证则出现腹部胀满、咽喉干燥，或者大小便闭塞涩滞，或者潮热、说胡话等症状；阴寒证则出现腹部胀满、呕吐食物不能下咽、腹泻逐渐加重，有时腹部自行疼痛。虽然腹部胀满是里证，但又有浅深之别。经典论述说：表证已解，体内没有积滞，如果不是大满大实，仍然会有寒热症状，那么病邪就不能去除，这是邪气尚未完全进入腑，病邪尚浅。如果是大满大实坚硬，有燥屎内结，可以用攻下法，即使过了四五天也不会造成祸害，这是邪气已经深入腑，病邪已深。腹部胀满大多可以攻下，但又有虚实之分。经典说：腹部胀满持续不减的是实证，可以用攻下法去掉它；如果腹部胀满时轻时重，是虚证，则不可攻下。又说：腹部胀满持续不减，即使减轻也微不足道，应当当下之。《金匮要略》说：腹部胀满时轻时重，过后又恢复原状，这是虚寒之气从下向上逆，应当用温药调和。因为虚气留滞也会引起胀满，只是比实证不至于坚硬疼痛罢了。各经都有腹部胀满，但太阴经属脾土，位居中央，专门主管腹部胀满的候象。腹部胀满的证候有二十多条，治疗方法有发汗、催吐、攻下、温法、针刺等不同。又有在发汗、催吐、攻下之后形成腹胀的，治疗方法也各不相同。盖因胃为津液之主，发汗导致亡阳，则胃气虚弱而不能频繁布散诸气，气机壅滞而成为胀满，此时应当温散，可用厚朴生姜甘草半夏人参汤。催吐后邪气不去，加上腹部胀满，这是胸中的邪气向下传入胃，壅塞而成实证，所以产生胀满，应当用攻下法，可用调胃承气汤。邪气未入腑而误用攻下，表邪乘虚陷入郁结，胸中有虚烦，气上下不通利，腹部因此胀满，故应当用催吐法，可用栀子厚朴汤。医生若能审察邪气产生的由来，真正知道邪气所在的虚实，发汗、催吐、攻下不愈时用温补，针灸适当，则十全的功效就可以得到。另外，结胸从心下起直到小腹，坚硬胀满且疼痛，与腹部胀满类似。然而结胸按压则痛，手不能靠近；腹痛举按常痛，手近也不甚痛苦。还有痞证也从心下起直到小腹，也与胀满类似。然而痞证往往只停留在心下，腹部胀满只在腹的中部，这里有差异，临证应当审察。
太阳病篇：发汗后出现腹部胀满的，用厚朴生姜甘草半夏人参汤。（成无己注：吐后腹胀与下后腹部胀满都说是实证，指邪气乘虚入里成为实证。发汗后外证已解，腹部胀满知道不是里实，是由脾胃津液不足，气机涩滞不通，壅塞而成为胀满，给予此汤调和脾胃并降气张氏按：有人问太阳篇中发汗后的各种证候不说太阳病，这固然理所当然，但也应该列在伤寒之上，为什么只说发汗后腹胀者用厚朴半夏生姜人参汤主治？我说：凡是说发汗后的，是因为外无表证，里没有其他变术，只有腹胀这一件事而已。除此之外就获得全安。伤寒二字岂可轻易言说？其传变吉凶如反掌之间。可以与其余一个证候并列举例吗？那些发汗后的条目不与此意相同。）
厚朴生姜甘草半夏人参汤方
厚朴（炙去皮） 生姜（各半斤） 人参（一两） 半夏（半升洗） 甘草（二两）以上五味药，用水一斗，煮取三升，去渣滓，温服一升，每日三次服用。
伤寒攻下后心烦、腹部胀满、卧起不安的，用栀子厚朴汤主治。（成无己注：下后仅腹部胀满而不心烦，则是邪气入里成为里实；仅心烦而不腹部胀满，则是邪气在胸中成为虚烦。既心烦且胀满，则是邪气壅于胸腹之间。胀满者不能坐，心烦者不能卧，所以令卧起不安。给予栀子厚朴汤以吐烦泄满。）太阳病经过十余日，心下温温欲吐而胸痛，大便反而溏薄，腹部微满，郁郁微烦，先前曾极度催吐或攻下的，用调胃承气汤。如果不愈，不可给予，只想呕吐、胸中痛、大便微溏的，这不是柴胡证，通过呕吐知道是极度催吐或攻下所致。（吴茱萸汤、半夏泻心汤详见呕吐条。）太阳病中风，用火劫发汗，邪风被火灼烧，热血气流溢，失去常态，两阳相熏灼，身体发黄。阳盛则想流鼻血，阴虚则小便难，阴阳俱虚竭，身体枯燥，只有头部出汗，齐颈而还，腹部胀满，微喘，口干，咽喉烂，或者不大便，久则说胡话，严重的甚至干哕，手足躁扰，捻衣摸床。小便利的可以治。伤寒腹部胀满、说胡话，寸口脉浮而紧，这是肝乘脾，名叫纵，刺期门穴。（腹部胀满、说胡话是脾胃的病，浮紧是肝脉，脾病见肝脉，木行乘土。经典说：水行乘火，木行乘土，名叫纵，这是同类。期门穴是肝之幕制，用以泻肝经盛气。）伤寒发热，啬啬恶寒，大渴引饮，腹部胀满，自汗，小便利，病欲愈，这是肝乘肺，名叫横，刺期门穴。（按：伤寒发热恶寒是表病，至于自汗出则表已解。大渴、腹部胀满是里病，至于小便利则里自和了。所以说病欲解，欲解则应当等待其自愈。刺期门三字疑似衍文。）
阳明病篇：中风口苦、咽干、腹部胀满、微喘、发热、恶寒、脉浮而紧，如果攻下则腹部胀满、小便难。（麻黄汤）三阳合病，腹部胀满，身体沉重难以转侧，口不仁，面垢，说胡话，遗尿。发汗则说胡话，攻下则额上生汗，手足逆冷。如果自汗出的，用白虎汤。阳明病脉迟，进食难以吃饱，吃饱则微烦，头眩，必定小便难，这是将要作谷疸。虽然攻下，腹部胀满依旧。之所以这样，是因为脉迟的缘故。（栀柏汤）伤寒催吐后腹部胀满的，给予调胃承气汤。（成无己注：《内经》说：各种腹胀大都属于热。热在上焦则吐，吐后不解，复现腹胀满，是邪热入胃，给予调胃承气汤以下其胃热。）发汗后病不解，腹部胀满痛的，急下之，宜大承气汤。腹部胀满时轻时重，减轻也微不足道的，当下之，宜大承气汤。（满痛即是实证，如果时减者非实证。下条是发明上文之义，且说如果仅胀满而不痛，虽未可以为实证，如果胀满而不减的，也可以攻下。张氏按：有人问“减不足言”又说“当下之”，为什么呢？这是古文的文法。如果说腹部胀满不减当下之，宜大承气汤，这是指胀满而不减的情况。如果时满时减的，不可以当下而论，是“减不足言”。然而承气汤应当附在“腹满不减”处，不可续于“减不足言”之下。假如太阳篇中说伤寒不便六七日，头痛有热的，给予承气汤，其小便清的，知道不在里仍在表，应当须发汗。如果头痛的必衄，宜桂枝汤。缘桂枝当发汗而设，非为治衄而用。以其文法所拘，致使后世治衄有麻黄桂枝之误。“减不足言”的说法也不外乎这个理。）阳明病攻下后心中懊憹而烦，胃中有燥屎的，用大承气汤。腹部微满，必定初硬后溏，不可攻。（下后心中懊憹而烦是虚烦，应当给予栀子豉汤。如果胃中有燥屎的，非虚烦，可给予大承气汤下之。其腹部微满，初硬后溏，是无燥屎，此热不在胃而在上，故不可攻。）伤寒七八日，身黄如橘子色，小便不利，腹部微满的，茵陈蒿汤。阳明病脉迟，虽然出汗但不恶寒，身体必定重，短气，腹部胀满而喘，有潮热的，这是外欲解，可攻里。手足濈然汗出的，这是大便已硬，宜大承气汤。如果汗多，微发热恶寒的，表未解。其热不潮，未可与承气汤。如果腹部大满不通的，可与小承气汤，微和胃气，勿令大泄下。阳明病脉浮而紧，口苦，咽干，腹部胀满而喘，发热，汗出，不恶寒，反恶热，身体重。（五苓散、白虎汤）阳明病潮热，大便微硬，用大承气汤。如果不大便六七日，恐有燥屎，少与承气汤。汤入腹中不转失气的，这只是初硬后溏，不可攻。攻之必胀满不能食。想饮水的，饮水则干哕。后发热的，必定大便复硬，宜小承气汤。阳明中风，脉弦浮大，短气，腹部都满，胁下及心痛，久按之气不通，鼻干，不得汗，嗜卧，身及面目悉黄，小便难，潮热，时干哕的，与小柴胡汤。脉但浮无余证的，麻黄汤。
太阴病篇：作为病，腹部胀满而吐，食不下，自利益甚，时腹自痛。如果攻下，必定胸下结硬。（理中汤丸，不渴者四逆汤。张氏按：有人问凡伤寒初受者皆在太阳，然后传于阳明、少阳。病有自阴经而入者，未审何经先受。夫太阳先受，病自阳经发者为外感风寒，邪从表入，故太阳先受之。病自阴经起者为内伤生冷饮食过多，故从太阴入。夫太阴者脾也，以饮食生冷则伤脾，故腹部胀满而吐，食不下，自利不渴，手足自温等证。）桂枝加芍药汤、桂枝加大黄汤二证（已见前条）。
少阴病篇：病六七日，腹部胀满不大便的，急下之，宜大承气汤。（成无己注：这是少阴入腑。六七日是少阴之邪入腑之时，阳明内热壅甚，腹部胀满不大便。阳明病土胜肾水则干，急与大承气汤以救肾水。）
厥阴病篇：下利清谷，不可汗，汗出必腹部胀满。（四逆汤）下利，腹部胀满，身体疼痛的，先温其里，四逆汤，乃攻其表，桂枝汤。（下利腹部胀满是里有虚寒，先与四逆汤温里。身疼痛为表未解，利止里和，与桂枝汤攻表。）伤寒干哕而腹部胀满，视其前后何部不利，利之则愈。（成无己注：干哕而腹部胀满，气上而不下。视其前后部有不利者则利之以降其气。前部小便也，后部大便也。或用五苓散、小承气汤。）
禁忌：不大便六七日，少与小承气汤，不转失气的，不可攻。攻之则腹部胀满不能食。（论见不大便条）腹部胀满、吐利的，忌下（论见太阴条）。腹部胀满、脉浮紧、口苦咽干的，忌汗下针（论见自汗条）。腹部胀满、脉迟的，忌下（论见前脉迟条）。腹部胀满、脉弱、自利，设用大黄、芍药宜减之（论见太阴病条）。
附录
活人书：若饮食不节，寒中阴经，胸膈不快，腹部胀满闭塞，唇青，手足冷，脉沉细，少情绪，或腹痛急作，理中汤加青皮，每服一二剂，胸即快矣。枳实理中丸、五积散尤妙。胀腹部胀满的，宜桔梗半夏汤。
桔梗半夏汤：治伤寒心腹痞满，时发疼痛。
桔梗（微炒） 半夏（姜制） 橘红（各一两）以上切碎，每服四钱，生姜三片，水煎服。
海藏医案：少阴证，小便遗沥，大便遗失，其人病六七日，身重，目不能视，体如冰，腹胀满，与物则咽，不与则不求，其脉沉细而微疾，按之有力，宜急下之，与大承气汤。
Abdominal fullness, commonly known as abdominal distension, can belong to heat syndromes or cold syndromes. In Yang-heat syndromes, there is abdominal fullness and dry throat, or constipation and difficult urination/defecation, or tidal fever and delirium. In Yin-cold syndromes, there is abdominal fullness, vomiting of food that cannot be swallowed, worsening diarrhea, and sometimes spontaneous abdominal pain. Although abdominal fullness is a interior syndrome (Li Zheng), it has differences in depth. The classics state: If the exterior syndrome has resolved and there is no internal accumulation, but if it is not severe fullness, chills and fever will persist, meaning the pathogen is not eliminated; this indicates the pathogen has not fully entered the Fu organs and is still shallow. If there is severe fullness, solidity, and hardness with dry feces, purgative methods can be used; even after four or five days, it will not cause harm, indicating the pathogen has deeply entered the Fu organs. Abdominal fullness is mostly treatable with purgatives, but there are distinctions between excess and deficiency. The classics state: Abdominal fullness that does not decrease indicates an excess pattern, which can be treated with purgatives. If abdominal fullness decreases intermittently, it indicates a deficiency pattern, and purgatives should not be used. It is also stated: Abdominal fullness that does not decrease, or where any decrease is negligible, requires immediate purgation. *Jin Gui Yao Lue* states: Abdominal fullness that decreases intermittently and returns to normal is due to deficiency-cold qi rising from below; it should be harmonized with warm medicines. Qi stagnation due to deficiency also causes distension, but it is not as hard and painful as in excess patterns. All meridians can present with abdominal fullness, but the Taiyin meridian belongs to Spleen Earth, located centrally, and specifically governs abdominal fullness. There are over twenty types of abdominal fullness syndromes, with treatment methods varying among sweating, emesis, purgation, warming, and acupuncture. Abdominal distension resulting from prior sweating, emesis, or purgation also requires different treatments. The Stomach is the master of fluids and qi; excessive sweating leads to loss of Yang, weakening Stomach Qi, which fails to distribute Qi effectively, causing stagnation and distension. This should be treated with warming and dispersing methods using Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction). If distension persists after emesis because pathogens remain, it is because chest pathogens have descended into the Stomach, creating excess stagnation; this requires purgation using Tiaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction). If purgation is misused before pathogens enter the Fu organs, exterior pathogens may sink and stagnate, causing empty irritability in the chest and blocking Qi flow, leading to abdominal fullness; this requires emesis using Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction). Physicians who can accurately diagnose the origin and nature (excess/deficiency) of pathogens, and appropriately apply sweating, emesis, purgation, warming, tonification, and acupuncture, can achieve complete cures.
Regarding Jie Xiong (Chest Binding): It starts from the epigastrium down to the lower abdomen, presenting with hardness, fullness, and pain, similar to abdominal fullness. However, Jie Xiong is tender to pressure and cannot be touched, whereas abdominal pain is painful upon palpation but tolerates touch. Pi Syndrome (Stagnation) also starts from the epigastrium down to the lower abdomen, resembling fullness. However, Pi often stays only in the epigastrium, while abdominal fullness is central in the abdomen; these differences must be carefully examined clinically.
Taiyang Chapter: After sweating, if abdominal fullness occurs, use Houpo Shengjiang Gancao Banxia Renshen Tang. (Cheng Wuji notes: Distension after emesis or purgation is termed excess, as pathogens enter the interior due to deficiency. After sweating, the exterior is resolved; abdominal fullness indicates it is not interior excess, but rather insufficient fluids and Qi in the Spleen and Stomach, causing stagnation and fullness. This formula harmonizes the Spleen and Stomach and directs Qi downward. Zhang Jingyue asks: Why does the Taiyang chapter list post-sweating symptoms without specifying "Taiyang Disease"? I reply: Post-sweating conditions imply no exterior syndrome and no other interior changes, leaving only abdominal fullness as the primary issue. Otherwise, the patient would be well. "Shang Han" (Cold Damage) implies serious transmission and prognosis; such cases cannot be casually grouped with minor post-sweating symptoms.)
Houpo Shengjiang Gancao Banxia Renshen Tang Formula:
Houpo (Bark of Magnolia officinalis, processed, peeled) 16g, Shengjiang (Fresh Ginger) 16g, Renshen (Ginseng) 3g, Banxia (Pinellia Tuber, washed) 75ml, Gancao (Licorice Root) 6g. Boil these five ingredients in 10 units of water to obtain 3 units. Strain and take 1 unit warm, three times daily.
After purgation in Shang Han, if there is irritability (Fan) and abdominal fullness with restlessness (unable to lie or sit comfortably), use Zhizi Houpo Tang. (Cheng Wuji notes: Purgation alone causing fullness without irritability indicates interior excess. Irritability alone without fullness indicates empty irritability in the chest. Both indicate pathogenic stagnation in the chest and abdomen. Fullness prevents sitting; irritability prevents lying. Zhizi Houpo Tang clears irritability and reduces fullness.) If Taiyang disease persists for over ten days, with a sensation of warmth in the epigastrium, desire to vomit, chest pain, loose stools, mild abdominal fullness, and slight vexation, especially if previously subjected to extreme emesis or purgation, use Tiaowei Chengqi Tang. If ineffective, do not use it. Vomiting, chest pain, and loose stools indicate extreme prior emesis/purgation, not Chai Hu (Bupleurum) syndrome. (See Wuzhuyu Tang and Banxia Xiexin Tang for vomiting details.) If Taiyang Wind Strike is treated with fire-induced sweating, wind-fire combines, disturbing blood and Qi, causing jaundice. Excess Yang leads to nosebleeds; Yin deficiency leads to difficult urination. Both Yin and Yang are depleted, body becomes dry, only head sweats up to the neck. Abdominal fullness, slight wheezing, dry mouth, sore throat, constipation, delirium, severe cases show hiccups, restless limbs, picking at clothes. If urine flows freely, it is treatable. In Shang Han, abdominal fullness and delirium with floating-tight pulse indicate Liver attacking Spleen (Zong); puncture Qimen (LR14). (Fullness/delirium is Spleen/Stomach disease; floating-tight is Liver pulse; Wood overacting on Earth. Qimen drains excess Liver Qi.) Fever, aversion to cold, intense thirst, abdominal fullness, spontaneous sweating, and free urination indicate Liver attacking Lung (Heng); puncture Qimen. (Fever/cold is exterior; sweating resolves exterior. Thirst/fullness is interior; free urination harmonizes interior. The disease resolves spontaneously; "puncture Qimen" may be a textual error.)
Yangming Chapter: Stroke with bitter taste, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, floating-tight pulse. Purgation leads to fullness and difficult urination. (Mahuang Tang). San Yang He Bing (Combined Three Yang) presents with abdominal fullness, heavy body, difficulty turning, numb mouth, greasy face, delirium, urinary incontinence. Sweating worsens delirium; purgation causes sweating on forehead and cold extremities. Spontaneous sweating indicates Baihu Tang (White Tiger Decoction). Slow pulse in Yangming, inability to eat much, post-meal vexation, dizziness, difficult urination suggests Grain Jaundice. Purgation fails to relieve fullness due to slow pulse. (Zhibo Tang). Emesis followed by abdominal fullness requires Tiaowei Chengqi Tang. (Nei Jing states all large abdominal swellings are heat-related. Heat in upper jiao causes vomiting; if fullness persists, heat enters Stomach; purge with Tiaowei Chengqi Tang.) Unresolved condition after sweating with painful abdominal fullness requires urgent purgation with Dachengqi Tang (Major Order the Qi Decoction). Intermittent abdominal fullness with negligible relief also requires Dachengqi Tang. (Painful fullness is excess; intermittent is not. "Negligible relief" emphasizes persistent fullness requiring purgation. Zhang Jingyue notes textual ambiguity: Dachengqi Tang applies to persistent fullness, not intermittent. Confusion arises from classical phrasing.) Post-purgation irritability with dry feces in Stomach requires Dachengqi Tang. Mild fullness with hard-then-loose stools indicates no dry feces; heat is above Stomach, so do not purge. (Irritability alone is empty irritability; treat with Zhizi Chi Tang. Dry feces require Dachengqi Tang.) Yellow skin like orange peel, difficult urination, mild abdominal fullness after 7-8 days of Shang Han requires Yinchen Hao Tang (Artemisia Capillaris Decoction). Slow pulse in Yangming, sweating without aversion to cold, heavy body, shortness of breath, abdominal fullness, wheezing, tidal fever indicates exterior resolving and interior ready for attack. Continuous sweating on hands/feet indicates hard stool; use Dachengqi Tang. Profuse sweating with slight fever/chills means exterior unresolved. No tidal fever means do not use Chengqi. Severe fullness/blockage allows Xiao Chengqi Tang (Minor Order the Qi Decoction) to gently harmonize Stomach Qi. Wind Strike in Yangming with string-taut-floating-large pulse, shortness of breath, generalized fullness, hypochondriac pain, nasal dryness, inability to sweat, lethargy, jaundice, difficult urination, tidal fever, hiccups: give Xiaochaihu Tang (Minor Bupleurum Decoction). Floating pulse alone without other symptoms: Mahuang Tang.
Taiyin Chapter: Disease presents with abdominal fullness, vomiting, inability to eat, worsening diarrhea, spontaneous abdominal pain. Purgation causes epigastric knotting/hardness. (Lizhong Wan/Tang; if no thirst, Sini Tang). Zhang Jingyue notes: Taiyin diseases often stem from internal injury by cold/raw food damaging Spleen, causing fullness, vomiting, diarrhea, lack of thirst, and warm extremities. (Guizhi Ji Shaoyao Tang and Guizhi Ji Dahuang Tang mentioned previously).
Shaoyin Chapter: Six to seven days of disease with abdominal fullness and constipation requires urgent purgation with Dachengqi Tang. (Cheng Wuji notes: Shaoyin entering Fu organs. Day 6-7 is when Shaoyin pathogens enter Fu. Yangming internal heat obstructs, causing fullness/constipation. Yangming Earth overacting on Kidney Water necessitates urgent Dachengqi Tang to save Kidney Water).
Jueyin Chapter: Diarrhea with undigested food prohibits sweating; sweating causes abdominal fullness. (Sini Tang). Diarrhea, abdominal fullness, body pain: First warm the interior with Sini Tang, then attack the exterior with Guizhi Tang. (Fullness/diarrhea is interior deficiency-cold; body pain is exterior unresolved. Warm interior first, then exterior). Hiccups with abdominal fullness: Check anterior (urine) and posterior (stool) obstructions; unblock them to cure. (Cheng Wuji notes: Hiccups/fullness indicate rebellious Qi. Unblock urine/stool to descend Qi. Use Wuling San or Xiao Chengqi Tang).
Contraindications: Constipation for 6-7 days: Try small dose of Xiao Chengqi Tang. If no flatus, do not purge (causes fullness/anorexia). Abdominal fullness with vomiting/diarrhea: Contraindicate purgation. Fullness with floating-tight pulse, bitter taste, dry throat: Contraindicate sweating/purgation/acupuncture. Fullness with slow pulse: Contraindicate purgation. Fullness with weak pulse and diarrhea: Reduce/avoid Dahuang (Rhubarb) and Shaoyao (Peony).
Appendix: Huo Ren Shu: Irregular diet injuring Yin meridians with cold causes chest discomfort, abdominal fullness/blockage, blue lips, cold extremities, deep-thin pulse, depression, or acute abdominal pain. Lizhong Tang + Qingpi (Tangerine Peel) brings relief. Zhishi Lizhong Wan or Wuji San are excellent. For abdominal distension, Jiegeng Banxia Tang (Platycodon and Pinellia Decoction) treats heart/epigastric stagnation and pain.
Formula: Jiegeng (Platycodon Root, stir-fried), Banxia (Pinellia, ginger-processed), Juhong (Tangerine Red Peel) each 30g. Chop, take 12g per dose with 3 slices of ginger, decoct in water.
Haizang Case: Shaoyin syndrome with dribbling urine, fecal incontinence. Patient ill for 6-7 days, heavy body, blind, cold body, abdominal fullness. Will swallow food if offered, otherwise ignores it. Pulse deep-thin-rapid, forceful on pressure. Urgent purgation required with Dachengqi Tang.