仲景云∶胀满按之不痛为虚，痛者为实，可下之。腹胀时减复如故，此为寒，
当与温药。腹满不减，减不足言，须当下之，宜大承气汤。心下坚大如盘，边如旋
杯，水饮所作，枳术汤主之。腹满，口舌干燥，此肠胃间有水气，防己椒苈丸主
之。病腹满，发热十日，脉浮而数，饮食如故，浓朴七物汤主之。脾虚满者，黄
汤。（芍药停湿。）脾实满不运，平胃散。（苍术泄湿。）东垣云∶腹胀满，气不转者，加
浓朴以破滞气，腹中夯闷，此非腹胀满，乃散而不收，可加芍药收之，是知气结而胀，
宜浓朴散之，气散而胀，宜芍药收之。六元政纪论云∶太阴所至为中满，太阴所至
为蓄满，诸湿肿满，皆属脾土。论云∶脾乃阴中之太阴，同湿土之化，脾湿有余，
腹满食不化。天为阳为热，主运化也。地为阴为湿，主长养也。无阳则阴不能生化，
故云藏寒生满病。调经篇云∶因饮食劳倦，损伤脾胃，始受热中，末传寒中，皆由
脾胃之气虚弱，不能运化精微而制水谷，聚而不散而成胀满。经云∶腹满 胀，支
膈胁，下厥上冒，过在太阴、阳明，乃寒湿郁遏也。《脉经》所谓胃中寒则胀满者
是也。腹满，大便不利，上走胸臆，喘息喝喝然，取足少阴。又云∶胀取三阳，三
阳者足太阳寒水为胀，与通评虚实论说，腹暴满，按之不下，取太阳经络胃之募也
正同，取者泻也。经云∶中满者，泻之于内者是也。宜以辛热散之，以苦泻之，淡
渗利之，使上下分消其湿，正如开鬼门，洁净腑，温衣，缪刺其处，是先泻其血络，
后调其真经，气血平，阳布神清，此治之正也。或问诸胀腹大，皆属于热者何也？
此乃病机总辞。假令外伤风寒，有余之邪自表传里，寒变为热，而作胃实腹满，仲
景以大承气汤治之。亦有膏粱之人，湿热郁于内而成胀满者，此热胀之谓也。大抵
寒胀多而热胀少，治之者宜详辨之。诸腹胀大，皆属于热，此乃八益之邪有余之证，
自天外而入，是感风寒之邪自表传里，寒变为热，作胃实腹病，日晡潮热，大渴引
饮，谵语，是太阳、阳明并大实大满者，大承气汤下之。少阳、阳明微满实者，小
承气汤下之。经云∶泄之则胀已，此之谓也。假令 疟为胀满，亦有寒胀、热胀，
是天之邪气，伤暑而得之，不实时发，至秋暑气衰绝而疟病作矣，知其寒也，《局方》
用交解饮子者是也。内虚不足寒湿令人中满，及五脏六腑俱有胀满，更以脉家寒热
多少较之。胃中寒则胀满，浊气在上则生 胀，取三阳。三阳者，足太阳膀胱寒水
为胀，腹暴满，按之不下，取太阳经络者，胃之募也正同。腹满 胀，支膈 胁，
下厥上冒，过在太阴、阳明，此胃之寒湿郁遏也。太阴 胀，后不利不欲食，
食则呕，不得卧。按《内经》所说，寒胀之多如此中满。治法当开鬼门，洁净腑。
开鬼门者，谓发汗也。洁净腑者，利小便也。中满者，泻之于内，谓脾胃有病，当
令上下分消其气，下焦如渎，气血自然分化，不待泄滓秽。如或大实大满，大小便
不利，从权以寒热药下之。或伤酒湿面及味浓之物，膏粱之人，或食已便卧，使湿
热之气不得施化，致令腹胀满，此胀亦是热胀。治热胀，分消丸主之。如或多食寒
凉，及脾胃久虚之人，胃中寒则胀满，或脏寒生满病，以治寒胀中满，分消汤主之。中
满热胀、鼓胀、气胀，皆分消丸主之。中满寒胀，寒疝，大小便不通，阴躁，足不
收，四肢厥逆，食入反出；下虚中满，腹中寒，心下痞，下焦躁寒沉厥，奔豚不收，
皆分消汤主之。中满腹胀，内有积聚，坚硬如石，其形如盘，令人不能坐卧，大小
便涩滞，上喘气促，面色痿黄，通身虚肿，广术溃坚汤主之。二服后中满减半，止
有积不消，再服半夏浓朴汤。阴阳应象论云∶清气在下则生餐泄，浊气在上则生
胀，此阴阳反作，病之逆从也。夫 胀者，以寒热温凉论之，此何腹胀也？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
湿热三脉相合而为病也。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，火盛能令母实，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，水火大胜者也。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。阴阳论云∶
饮食不节，起居不时者，阴受之，阴受之则入五脏，入五脏则 胀闭塞。调经篇云∶
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， 满腹胀俱
去，是浊阴得下归地矣。故经曰∶中满者，泻之于内，此法是也。通幽汤、润肠丸。
胀而大便燥结，脉沉之洪缓，浮之弦者，宜沉香交泰丸。范天 夫人，先因劳役饮
食失节，加之忧思气结，病心腹胀满，旦食则不能暮食，两胁刺痛，诊其脉弦而细，
至夜浊阴之气当降而不降， 胀尤甚。大抵阳主运化，饮食劳倦损伤脾胃，阳气不
能运化精微，聚而不散，故为胀满。先灸中脘，乃胃之募穴，引胃中生发之气上行
阳道，后以木香顺气汤助之，则浊阴之气自此而降矣。经曰∶留者行之，结者散之。
以柴胡、升麻之苦平，行少阳、阳明二经，发散清气，营运阳分为君；以生姜、半
夏、草豆蔻、益智仁之甘辛大热，消散中寒为臣；以浓朴、木香、苍术、青皮之辛苦
大温，通顺滞气，以陈皮、当归、人参辛甘温，调和荣卫，滋养中气，浊气不降，宜
以苦泄之，吴茱萸之苦热，泄之者也，气之薄者，为阳中之阴，茯苓甘平、泽泻咸
平，气薄，引浊阴之气自上而下，故以为佐。气味相合，散之，泄之，上之，下之，
使清浊之气，各安其位也。《灵枢经》云∶腹满，大便不利，上走胸臆，喘息喝喝然，
取足少阴。取者泻也，宜以辛热散之，良姜、肉桂、益智仁、草豆蔻仁、浓朴、升
麻、甘草、独活、使黄柏。（少许引用）又方，桂枝、桔梗、人参、陈皮、青皮、（少许）良姜、
白术、泽泻、吴茱萸。太阴所至为蓄满。辨云∶脾为阴中之太阴。又云∶脾为阴中
之至阴，乃为坤元亘古不迁之土。天为阳火也，地为阴水也，在人则为脾同阴水之
化，脾有余则腹胀满，食不化，故无阳则不能化五谷，脾盛乃大寒为胀满，故
《脉经》云∶胃中寒则胀满。大抵此病，皆水气寒湿为之也。治宜大辛热之剂
必愈，然亦有轻重。木香塌气丸。丹溪云∶脾者、具坤静之德，而有干健之运，
故能使心肺之阳降，肾肝之阴升，而成天地交之泰，是为平人。今也七情内伤，六
淫外感，饮食失节，房劳致虚，脾土之阴受伤，转输之官失职，胃虽受谷不能运化，故
阳升阴降，而成天地不交之否，清浊相混，隧道壅塞而为热，热留为湿，湿热相
生，遂成胀满。经云∶鼓胀是也，以其外虽坚满，中空无物，有似于鼓。以其胶固
难治，又名曰蛊，若虫之侵蚀，而有蛊之义焉。宜补其脾，又须养肺金以制木，使
脾无贼邪之患，滋肾水以制火，使肺得清化之令，却咸味，断妄想，远音乐，无有
不安。医者不察，急于取效，病者苦于胀满，喜行利药以求通快，不知宽得一日半
日，其胀愈甚，而病邪甚矣，真气伤矣。或问方论，或以胃冷中虚，或以旦食则不
能暮食，由至阴居中，五阳不布然也。今丹溪乃云湿热相生，则固无寒者欤？曰初
病因寒饮食，与外受寒气，亦或有之，若丹溪之所言者，则非一日之病，初虽因寒，
阳气被郁，久亦成热矣。经曰∶诸腹胀大，诸病有声，鼓之如鼓，皆属于热是也。
今使心肺之阳降，肾肝之阴升，即是五阳布之也。何必姜、附之热乎。然先以救其
脾胃虚弱者为本，从而视其标之有余者治之，此亦圣人之旨也。《灵枢》胀论谓五脏
六腑皆有胀，其胀皆在脏腑之外，排脏腑而郭胸腹，胀皮肤。胸腹者，脏腑之郭也。
各有畔界，各有形状。荣气循脉，卫气逆为脉胀。卫气并脉，循分肉为肤胀。夫诸
胀者，皆因厥气在下，荣卫留止，寒气逆上，真邪相攻，两气相搏，乃合为胀也。
凡此诸胀，其道在一，明知逆顺，针数不失。泻虚补实，神去其室，致邪失正，真
不可定，粗之所败，谓之天命。补虚泻实，神归其室，久塞其空，谓之良工。以此
而观，则圣人未尝不以补虚为要。曰《灵枢》胀论多言由厥气在下，寒气逆上而为胀
也，更有他邪之可言乎。曰考之《内经》脉要精微篇谓∶胃脉实，气有余则胀。
腹中论谓∶病心腹满，旦食不能暮食，名为鼓胀。有病热者，三阳盛，入于阴，故
病在头与腹，乃 胀而头痛。有病膺肿颈痛，胸满腹胀，名曰厥逆。风论谓∶胃
风鬲塞不通，腹善满，失衣则 胀。调经篇谓∶形有余则腹胀，泾溲不利，志有余
则腹胀餐泄。至真大要篇谓∶诸湿肿满，皆属于脾。六元正纪大论谓∶土郁之发，
心腹胀，肠鸣而数后。水运太过，阴厥，上下中寒，甚则腹大胫肿，寝汗憎寒。
至真大要论谓∶厥阴司天，食则呕，腹胀，溏泄。在泉病腹胀，善噫。少阴司
天，腹 胀，腹大满，彭彭而喘咳。阳明之复，胀而泄，呕苦咳哕。阳明
初之气，病中热胀，面目浮肿。太阴阳明论谓∶饮食起居失节，入五脏则
满闭塞，下为餐泄。缪刺论谓∶有所堕坠，恶血留内，腹中满胀，不得前后，
先饮利药，此上伤厥阴之脉，下伤少阴之络。诊要谓∶手少阴终者，面黑，齿
长而垢，腹胀闭，上下不通而终。足太阴终者，腹胀闭不得息，善噫善呕，呕
则逆，逆则面赤，不逆则上下不通，面黑皮毛焦而终。阴阳别论谓；二阴一阳发
病，善胀，心满善气，为肾胆同逆，三焦不行，气 于上。阴阳应象论，浊气在上，
则生 胀。六元正纪论谓∶太阴所至为 满。又云∶太阴所至为中满。脉解篇谓∶
太阴子也，十一月万物气皆藏于中，故曰病胀；所谓上走心为噫者，阴盛而上走于
阳明，阳明络属心，故上走心为噫；所谓食则呕者，物盛满而上溢，故呕；所谓得
后与气，则快然如衰者，十二月阴气下衰，而阳气且出。《灵枢》水胀篇谓∶鼓胀者，
腹胀身皆大，与肤胀等，色苍黄，腹筋起，此其候也。经脉篇谓∶胃气不足，
胃中寒则胀满，身以前皆寒。有脾是动病，胃脘痛，腹胀，得后与气，则快然
如衰。邪气论谓∶胃病者，腹 胀，胃脘当心而痛，上支两胁，膈咽不通，饮食不
下。又胃是动病，贲响腹胀。本神篇谓∶脾气实则腹胀，泾溲不利。经脉篇谓∶
足太阴之别公孙，虚则鼓胀。师传篇谓∶胃中寒，肠中热，则胀而泄。胀
论篇谓∶荣气顺脉，卫气逆为脉胀。卫气并脉，循分肉为肤胀。脾胀者，善哕，四
肢烦 ，体重不能胜衣，卧不安。胃胀者，腹满，胃脘痛，鼻闻焦臭，妨于食，大
便难。肺胀者，虚满而喘咳。大肠胀者，肠鸣而痛，濯濯有声。肾胀者，腹满引背，
央央然腰髀痛。膀胱胀者，少腹满而气癃。肝胀者，胁下满而痛引少腹。胆胀者，
胁下痛胀，口中苦，善太息。三焦胀者，气满于皮肤中，轻轻然不坚。心胀者，烦
心短气，卧不安。小肠胀者，少腹 胀，引腰而痛。二经诸条之论，各邪所生之胀，
各胀之病状如此。李东垣尝引五常政大要云，下之则胀已者，谓西北二方，地形高
寒，及异法方宜论云，北方之人，脏寒生满病，亦谓适寒凉者胀，皆秋冬之气也。
二者尽由寒凉在外，六阳在于坤土之中，坤土者，人之脾胃也。五脏之病，外寒必
内热，然阴盛阳虚，故下之则愈。又曰∶大抵寒胀多而热胀少，治者宜详辨之。予
因是而思，岂独寒热而已。凡治是病，必会通圣经诸条之旨，然后能识脏腑之部分
形证，邪气之所自来，纵是通腹胀满，卒难究竟者，亦必有胀甚之部，与病先起处，
即可知属何脏腑之气受邪而不行者为先，而后及乎中焦气交之分，于是转运不前，
壅聚通腹胀满也。若脾胃受邪，便先是胃脘心下痞气起，渐积为通腹胀也。腹属脾
也，属脾胃者，则饮食少，属他腑脏者，则饮食如常，此亦可验。又须分其表里浅
深，以胀在皮肤孙络之间者，饮食亦如常，其在肠胃肓膜之间者，则饮食减少，其
气壅塞于五脏，则气促急不食而病危矣。是故病在表者易治，入腑者难治，入脏者
不治。更要分虚寒实热，其脏腑之气本盛，被邪填塞不行者为实。其气本不足，因
张仲景说：腹部胀满，按压时不痛的属于虚证，疼痛的属于实证，实证可以用泻下法治疗。腹胀有时减轻但随后又恢复原状，这是寒证，应当给予温性药物。腹部持续胀满不减，即使有轻微减轻也不足为道，必须用泻下法，适宜使用大承气汤。心下部坚硬肿大如盘，边缘像倒扣的杯子，这是水饮所致，由枳术汤主治。腹部胀满，口舌干燥，这是肠胃间有水气，由防己椒苈丸主治。患腹满病，发热十天，脉象浮而数，饮食正常，由浓朴七物汤主治。脾虚导致的胀满，由黄汤主治（芍药能停湿）。脾实导致运化失常的胀满，由平胃散主治（苍术能泄湿）。李东垣说：腹胀满，气机不运转的，加入浓朴以破滞气；腹中感觉沉重闷塞，这并非单纯的腹胀满，而是气散不收，可以加入芍药来收敛。由此可知，气结导致的胀满，适宜用浓朴疏散它；气散导致的胀满，适宜用芍药收敛它。《六元正纪大论》说：太阴湿土之气所至，表现为中满；太阴湿土之气所至，表现为蓄满。各种湿邪引起的肿胀胀满，都归属于脾土。经文说：脾是阴中之太阴，与湿土的气化相同，脾湿有余，则出现腹满、食物不消化。天属阳属热，主司运化；地属阴属湿，主司长养。没有阳气，阴精就不能生化，所以说脏寒会产生胀满病。《调经篇》说：因为饮食劳倦，损伤脾胃，起初感受热中，后来传变为寒中，这都是由于脾胃之气虚弱，不能运化精微并制约水谷，积聚不散而形成胀满。经文说：腹部胀满，支撑胸膈胁肋，下部厥冷上部昏冒，病位在太阴、阳明，这是寒湿郁遏所致。《脉经》所说的“胃中寒则胀满”就是这种情况。腹部胀满，大便不通，气上冲胸臆，喘息有声，应取足少阴经穴。又说：胀满取三阳经，三阳经中的足太阳寒水导致胀满，这与《通评虚实论》所说“腹部突然胀满，按压不凹陷”，取太阳经络及胃之募穴的观点完全一致，“取”的意思就是泻。经文说：中满的病，应从内部泻治。适宜用辛热药发散它，用苦味药泻下它，用淡味药渗利它，使上下分消湿气，正如开鬼门（发汗），洁净腑（利小便），穿暖衣服，缪刺患处，是先泻其血络，后调理真经，气血平和，阳气布散神志清明，这是治疗的正道。有人问：各种胀大腹部，都属于热证，这是什么意思？这是病机十九条的总括语。假如外伤风寒，有余的邪气从表传入里，寒转变为热，造成胃实腹满，张仲景用大承气汤治疗。也有吃精细食物的人，湿热郁结于内而成胀满，这就是热胀。大抵寒胀多而热胀少，治疗者应该详细辨别。各种腹胀大，都属于热，这是八益之邪有余的证候，从天外而入，是感风寒之邪从表传入里，寒转变为热，造成胃实腹病，日晡时潮热，大渴引饮，谵语，这是太阳、阳明并见的大实大满证，用大承气汤泻下。少阳、阳明微满实的，用小承气汤泻下。经文说：泻下则胀满消除，说的就是这个道理。假如疟疾导致胀满，也有寒胀、热胀，这是天之邪气，伤暑而得之，不按时发作，到了秋天暑气衰绝而疟病发作了，知道它是寒证，《局方》用交解饮子治疗。内虚不足，寒湿使人中满，以及五脏六腑都有胀满，再根据脉家的寒热多少来比较。胃中寒则胀满，浊气在上则生胀满，取三阳经。三阳经中，足太阳膀胱寒水导致胀满，腹部突然胀满，按压不凹陷，取太阳经络，与胃之募穴正同。腹部胀满，支撑胸膈胁肋，下部厥冷上部昏冒，病位在太阴、阳明，这是胃的寒湿郁遏所致。太阴胀，后不利不欲食，食则呕，不得卧。按《内经》所说，寒胀之多如此中满。治法应当开鬼门，洁净腑。开鬼门，就是发汗。洁净腑，就是利小便。中满的病，从内部泻治，意思是脾胃有病，应当令上下分消其气，下焦如渎，气血自然分化，不需要排泄糟粕。如果大实大满，大小便不利，权宜用寒热药泻下。或者因饮酒、面食及味道浓厚的食物，膏粱之人，或者吃完就躺下，使湿热之气不能施化，导致腹胀满，这种胀也是热胀。治疗热胀，由分消丸主治。如果多吃寒凉食物，以及脾胃久虚的人，胃中寒则胀满，或者脏寒生满病，治疗寒胀中满，由分消汤主治。中满热胀、鼓胀、气胀，都由分消丸主治。中满寒胀，寒疝，大小便不通，阴躁，足不收，四肢厥逆，食入反出；下虚中满，腹中寒，心下痞，下焦躁寒沉厥，奔豚不收，都由分消汤主治。中满腹胀，内有积聚，坚硬如石，形状如盘，令人不能坐卧，大小便涩滞，上喘气促，面色萎黄，通身虚肿，由广术溃坚汤主治。服两剂后中满减半，只有积滞不消，再服半夏浓朴汤。《阴阳应象大论》说：清气在下则产生飧泄，浊气在上则产生胀满，这是阴阳反作，病的逆从表现。夫胀病，用寒热温凉来论述，这是什么腹胀呢？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，右关脉洪缓而沉弦，脉浮于上，是风、湿、热三脉相合而致病。这是脾胃的令不行，阴火亢盛，乘袭脾胃，盛则左迁而阳道不行，是六腑之气已绝于外，火盛能使母实，风气外绝。风气外绝，就是谷气入胃，清气、营气不行，便是风气。异呼同类，即胃气是也。经文说：虚则兼其所胜，土不胜者，是肝的邪气。这是脾胃之土不足，水火大胜。经文说：浊阴出下窍，浊阴走五脏，浊阴归六腑，浊阴归地，这是平安不病的常道，违反这个原则就会胀。《阴阳论》说：饮食不节，起居不时者，阴受之，阴受之则入五脏，入五脏则胀闭塞。《调经篇》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。幽门上冲吸门，吸门就是会厌，冲击吸入之气，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。治疗在幽门，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，胀满腹胀俱去，是浊阴得下归地矣。所以经文说：中满者，泻之于内，这个方法是对的。通幽汤、润肠丸。胀而大便燥结，脉沉取洪缓，浮取弦的，适宜沉香交泰丸。范天夫人，先前因为劳役饮食失节，加上忧思气结，病心腹胀满，早上吃饭晚上就不能吃，两胁刺痛，诊其脉弦而细，到了夜晚浊阴之气应当降而不降，胀满尤其严重。大抵阳主运化，饮食劳倦损伤脾胃，阳气不能运化精微，聚而不散，所以为胀满。先灸中脘，乃胃之募穴，引胃中生发之气上行阳道，后以木香顺气汤助之，则浊阴之气自此而降矣。经文说：留者行之，结者散之。用柴胡、升麻的苦平，行少阳、阳明二经，发散清气，营运阳分为君；用生姜、半夏、草豆蔻、益智仁的甘辛大热，消散中寒为臣；用浓朴、木香、苍术、青皮的辛苦大温，通顺滞气，用陈皮、当归、人参辛甘温，调和荣卫，滋养中气，浊气不降，宜以苦泄之，吴茱萸之苦热，泄之者也，气之薄者，为阳中之阴，茯苓甘平、泽泻咸平，气薄，引浊阴之气自上而下，故以为佐。气味相合，散之，泄之，上之，下之，使清浊之气，各安其位也。《灵枢经》说：腹满，大便不利，上走胸臆，喘息喝喝然，取足少阴。取的意思是泻，适宜用辛热散之，良姜、肉桂、益智仁、草豆蔻仁、浓朴、升麻、甘草、独活、使黄柏。（少许引用）又一方，桂枝、桔梗、人参、陈皮、青皮、（少许）良姜、白术、泽泻、吴茱萸。太阴所至为蓄满。辨云：脾为阴中之太阴。又说：脾为阴中之至阴，乃是坤元亘古不迁之土。天为阳火也，地为阴水也，在人则为脾同阴水之化，脾有余则腹胀满，食不化，故无阳则不能化五谷，脾盛乃大寒为胀满，故《脉经》云：胃中寒则胀满。大抵此病，皆水气寒湿为之也。治宜大辛热之剂必愈，然亦有轻重。木香塌气丸。丹溪说：脾具有坤静之德，而有干健之运，故能使心肺之阳降，肾肝之阴升，而成天地交之泰，是为平人。如今七情内伤，六淫外感，饮食失节，房劳致虚，脾土之阴受伤，转输之官失职，胃虽受谷不能运化，故阳升阴降，而成天地不交之否，清浊相混，隧道壅塞而为热，热留为湿，湿热相生，遂成胀满。经文说：鼓胀是也，以其外虽坚满，中空无物，有似于鼓。以其胶固难治，又名曰蛊，若虫之侵蚀，而有蛊之义焉。宜补其脾，又须养肺金以制木，使脾无贼邪之患，滋肾水以制火，使肺得清化之令，却咸味，断妄想，远音乐，无有不安。医者不察，急于取效，病者苦于胀满，喜行利药以求通快，不知宽得一日半日，其胀愈甚，而病邪甚矣，真气伤矣。有人问方论，或以胃冷中虚，或以旦食则不能暮食，由至阴居中，五阳不布然也。如今丹溪却说湿热相生，则固无寒者欤？回答说：初病因寒饮食，与外受寒气，亦或有之，若丹溪之所言者，则非一日之病，初虽因寒，阳气被郁，久亦成热矣。经文说：诸腹胀大，诸病有声，鼓之如鼓，皆属于热是也。如今使心肺之阳降，肾肝之阴升，即是五阳布之也。何必姜、附之热乎。然而先以救其脾胃虚弱者为本，从而视其标之有余者治之，这也是圣人的旨意。《灵枢》胀论谓五脏六腑皆有胀，其胀皆在脏腑之外，排脏腑而郭胸腹，胀皮肤。胸腹者，脏腑之郭也。各有畔界，各有形状。荣气循脉，卫气逆为脉胀。卫气并脉，循分肉为肤胀。夫诸胀者，皆因厥气在下，荣卫留止，寒气逆上，真邪相攻，两气相搏，乃合为胀也。凡此诸胀，其道在一，明知逆顺，针数不失。泻虚补实，神去其室，致邪失正，真不可定，粗之所败，谓之天命。补虚泻实，神归其室，久塞其空，谓之良工。以此而观，则圣人未尝不以补虚为要。曰《灵枢》胀论多言由厥气在下，寒气逆上而为胀也，更有他邪之可言乎。曰考之《内经》脉要精微篇谓：胃脉实，气有余则胀。腹中论谓：病心腹满，旦食不能暮食，名为鼓胀。有病热者，三阳盛，入于阴，故病在头与腹，乃胀而头痛。有病膺肿颈痛，胸满腹胀，名曰厥逆。风论谓：胃风鬲塞不通，腹善满，失衣则胀。调经篇谓：形有余则腹胀，泾溲不利，志有余则腹胀餐泄。至真大要篇谓：诸湿肿满，皆属于脾。六元正纪大论谓：土郁之发，心腹胀，肠鸣而数后。水运太过，阴厥，上下中寒，甚则腹大胫肿，寝汗憎寒。至真大要论谓：厥阴司天，食则呕，腹胀，溏泄。在泉病腹胀，善噫。少阴司天，腹胀，腹大满，彭彭而喘咳。阳明之复，胀而泄，呕苦咳哕。阳明初之气，病中热胀，面目浮肿。太阴阳明论谓：饮食起居失节，入五脏则满闭塞，下为餐泄。缪刺论谓：有所堕坠，恶血留内，腹中满胀，不得前后，先饮利药，此上伤厥阴之脉，下伤少阴之络。诊要谓：手少阴终者，面黑，齿长而垢，腹胀闭，上下不通而终。足太阴终者，腹胀闭不得息，善噫善呕，呕则逆，逆则面赤，不逆则上下不通，面黑皮毛焦而终。阴阳别论谓；二阴一阳发病，善胀，心满善气，为肾胆同逆，三焦不行，气并于上。阴阳应象论，浊气在上，则生胀。六元正纪论谓：太阴所至为胀满。又说：太阴所至为中满。脉解篇谓：太阴子也，十一月万物气皆藏于中，故曰病胀；所谓上走心为噫者，阴盛而上走于阳明，阳明络属心，故上走心为噫；所谓食则呕者，物盛满而上溢，故呕；所谓得后与气，则快然如衰者，十二月阴气下衰，而阳气且出。《灵枢》水胀篇谓：鼓胀者，腹胀身皆大，与肤胀等，色苍黄，腹筋起，此其候也。经脉篇谓：胃气不足，胃中寒则胀满，身以前皆寒。有脾是动病，胃脘痛，腹胀，得后与气，则快然如衰。邪气论谓：胃病者，腹中胀，胃脘当心而痛，上支两胁，膈咽不通，饮食不下。又胃是动病，贲响腹胀。本神篇谓：脾气实则腹胀，泾溲不利。经脉篇谓：足太阴之别公孙，虚则鼓胀。师传篇谓：胃中寒，肠中热，则胀而泄。胀论篇谓：荣气顺脉，卫气逆为脉胀。卫气并脉，循分肉为肤胀。脾胀者，善哕，四肢烦扰，体重不能胜衣，卧不安。胃胀者，腹满，胃脘痛，鼻闻焦臭，妨于食，大便难。肺胀者，虚满而喘咳。大肠胀者，肠鸣而痛，濯濯有声。肾胀者，腹满引背，央央然腰髀痛。膀胱胀者，少腹满而气癃。肝胀者，胁下满而痛引少腹。胆胀者，胁下痛胀，口中苦，善太息。三焦胀者，气满于皮肤中，轻轻然不坚。心胀者，烦心短气，卧不安。小肠胀者，少腹胀，引腰而痛。二经诸条之论，各邪所生之胀，各胀之病状如此。李东垣曾引五常政大要云，下之则胀已者，谓西北二方，地形高寒，及异法方宜论云，北方之人，脏寒生满病，亦谓适寒凉者胀，皆秋冬之气也。二者尽由寒凉在外，六阳在于坤土之中，坤土者，人之脾胃也。五脏之病，外寒必内热，然阴盛阳虚，故下之则愈。又说：大抵寒胀多而热胀少，治者宜详辨之。我因此思考，难道只有寒热而已吗。凡是治疗这个病，必须融会贯通圣经诸条的宗旨，然后能识别脏腑的部分形证，邪气的来源，即使是通体腹胀满，仓促难以究尽的，也一定有胀甚的部位，与病先起处，即可知属何脏腑之气受邪而不行为先，而后及乎中焦气交之分，于是转运不前，壅聚通体腹胀满也。如果脾胃受邪，便先是胃脘心下痞气起，渐积为通体腹胀也。腹属脾也，属脾胃者，则饮食少，属他腑脏者，则饮食如常，这也可以验证。还必须分其表里浅深，以胀在皮肤孙络之间者，饮食亦如常，其在肠胃肓膜之间者，则饮食减少，其气壅塞于五脏，则气促急不食而病危矣。所以病在表者易治，入腑者难治，入脏者不治。更要分虚寒实热，其脏腑之气本盛，被邪填塞不行者为实。其气本不足，因
Zhang Zhongjing stated: Abdominal distension that is painless upon palpation indicates a deficiency pattern, while one that is painful indicates an excess pattern; the latter can be treated with purgation. If abdominal distension decreases intermittently but returns to its original state, this is a cold pattern, and warming herbs should be administered. If abdominal fullness does not decrease, or if any decrease is negligible, purgation is necessary, and Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate. If the epigastrium is hard and large like a plate, with edges resembling an inverted cup, this is caused by fluid retention, and Zhi Zhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction) is the primary treatment. For abdominal distension accompanied by dry mouth and tongue, indicating water qi in the intestines and stomach, Fang Ji Jiao Li Wan (Pycnostephane, Polygala, and Semen Persicae Pill) is indicated. For abdominal distension with fever for ten days, a floating and rapid pulse, and normal appetite, Nong Po Qi Wu Tang (Magnolia Bark Seven Ingredients Decoction) is used. For spleen deficiency causing fullness, Huang Tang (Yellow Decoction) is used (Shaoyao [Peony Root] retains dampness). For spleen excess causing failure of transportation and transformation, Ping Wei San (Calm the Stomach Powder) is used (Cangzhu [Atractylodes Lancea Rhizome] drains dampness). Li Dongyuan said: In cases of abdominal distension where qi fails to circulate, add Nongpo (Magnolia Bark) to break stagnant qi. If there is a heavy, stifling sensation in the abdomen, this is not simple abdominal distension but rather qi scattering without gathering; Shaoyao (Peony Root) can be added to gather it. Thus, it is known that distension due to qi knotting should be dispersed with Nongpo, while distension due to qi scattering should be gathered with Shaoyao. The *Liu Yuan Zheng Ji Lun* states: When Taiyin arrives, it manifests as central fullness; when Taiyin arrives, it manifests as accumulated fullness. All swelling and fullness due to dampness belong to Spleen Earth. The classics state: The Spleen is the Taiyin within Yin, sharing the transformation of damp earth. Excess spleen dampness leads to abdominal fullness and indigestion. Heaven is Yang and Heat, governing transformation and circulation; Earth is Yin and Damp, governing growth and nourishment. Without Yang, Yin cannot transform and generate, hence "cold in the zang organs generates fullness diseases." The *Tiao Jing Pian* states: Due to dietary irregularities and overexertion damaging the Spleen and Stomach, heat initially enters the interior (Re Zhong), eventually transmitting to cold (Han Zhong). This is all due to weakness of Spleen and Stomach qi, which fails to transform subtle essence and control food and fluids, leading to accumulation and distension. The classics say: Abdominal fullness, supporting the diaphragm and hypochondrium, with cold in the lower jiao and dizziness in the upper jiao, lies in the Taiyin and Yangming channels; this is due to cold-damp stagnation. As stated in the *Mai Jing*: "Cold in the Stomach causes abdominal fullness." For abdominal fullness, difficulty defecating, qi rushing to the chest and epigastrium, and wheezing, treat the Foot Shaoyin channel. It is also said: For distension, treat the Three Yang channels. The Foot Taiyang Cold Water channel causes distension. This aligns with the *Tong Ping Xu Shi Lun*, which states: For sudden abdominal fullness that does not depress upon pressure, treat the Taiyang channel network and the Front-Mu point of the Stomach. "Treat" here means to drain. The classics state: For central fullness, drain from within. Use acrid-hot herbs to disperse, bitter herbs to purge, and bland herbs to leach out dampness, allowing the dampness to be eliminated from above and below, just as opening the ghost gate (inducing sweating) and cleansing the fu organs (promoting urination), wearing warm clothes, and performing Miao acupuncture at the affected area. This involves first draining the blood collaterals, then regulating the true meridians, so that qi and blood are balanced, yang is distributed, and spirit is clear; this is the correct method of treatment. Someone asked: Why do various cases of abdominal distension and enlargement belong to heat? This is a general statement from the *Bing Ji*. For example, external wind-cold pathogens transmit from the exterior to the interior, transforming from cold to heat, causing Stomach excess and abdominal fullness; Zhang Zhongjing treats this with Da Cheng Qi Tang. There are also those who consume rich foods, where damp-heat stagnates internally causing distension; this is called heat distension. Generally, cold distension is more common than heat distension, so practitioners must distinguish carefully. Various abdominal enlargements belonging to heat refer to excess syndromes of the eight beneficial pathogens entering from outside, such as wind-cold transmitting from exterior to interior, transforming into heat, causing Stomach excess abdominal disease, afternoon tidal fever, extreme thirst, delirium; this is a severe excess syndrome of Taiyang and Yangming, treated with Da Cheng Qi Tang. For mild excess of Shaoyang and Yangming, Xiao Cheng Qi Tang is used. The classics say: Purging resolves distension, referring to this. If malaria causes distension, there are also cold and heat types. This is heavenly pathogenic qi, contracted from summerheat, manifesting irregularly until autumn when summerheat fades and malaria occurs; knowing it is cold, the *Ju Fang* uses Jiao Xie Yin Zi (Intersecting Resolution Drink). Internal deficiency and insufficiency of cold-damp cause central fullness, and all five zang and six fu organs can have distension; compare these based on the degree of cold and heat in the pulse. Cold in the Stomach causes fullness; turbid qi staying in the upper jiao generates distension; treat the Three Yang channels. The Foot Taiyang Bladder Cold Water channel causes distension; sudden abdominal fullness not depressed by pressure corresponds to treating the Taiyang channel network and Stomum Front-Mu point. Abdominal fullness supporting the diaphragm and hypochondrium, with lower extremity cold and upper dizziness, lies in Taiyin and Yangming, due to Stomach cold-damp stagnation. Taiyin distension involves difficulty defecating, lack of appetite, vomiting after eating, and inability to lie down. According to the *Nei Jing*, cold distension often presents as central fullness. Treatment should involve opening the ghost gate (sweating) and cleansing the fu organs (diuresis). Opening the ghost gate means inducing sweat; cleansing the fu organs means promoting urination. Treating central fullness by draining from within means that when the Spleen and Stomach are diseased, qi should be eliminated from above and below. The lower jiao is like a drainage ditch, and qi and blood naturally separate without needing to purge feces. However, in cases of severe excess and fullness with bowel/bladder obstruction, temporarily use cold or hot purgatives. Or, due to alcohol, wheat products, and rich flavors, or lying down immediately after eating, preventing the transformation of damp-heat, causing abdominal distension; this is also heat distension. Fen Xiao Wan (Divide and Eliminate Pill) treats heat distension. For those who eat excessive cold foods or have chronic Spleen-Stomach deficiency, cold in the Stomach causes fullness, or cold in the zang organs generates fullness; Fen Xiao Tang (Divide and Eliminate Decoction) treats cold distension and central fullness. Fen Xiao Wan treats central fullness, heat distension, drum distension, and qi distension. Fen Xiao Tang treats central fullness, cold distension, cold hernia, bowel/bladder obstruction, yin restlessness, inability to flex the feet, cold limbs, regurgitation of food, lower jiao deficiency with central fullness, cold in the abdomen, epigastric stuffiness, lower jiao cold and sinking cold, and running piglet failing to subside. Guang Shu Kui Jian Tang (Curcuma and Smilax Hardness-Resolving Decoction) treats central fullness and abdominal distension with internal accumulations hard as stone, shaped like a plate, preventing sitting or lying, difficult urination/defecation, shortness of breath, sallow complexion, and generalized edema. After two doses, if central fullness halves but accumulation remains, Ban Xia Nong Po Tang (Pinellia and Magnolia Bark Decoction) is given. The *Yin Yang Ying Xiang Da Lun* states: Clear qi descending below causes sundew diarrhea; turbid qi ascending above causes distension; this is inversion of yin and yang, representing reverse pathology. Regarding distension, using cold, heat, warmth, and coolness to analyze it: what kind of abdominal distension is this? It is distension due to dietary irregularities, the initial stage of disease. Damp-heat can also cause distension. A surging, slow, deep, and wiry pulse at the right Guan position, floating above, indicates combined wind, damp, and heat pathogens. This dysfunction of the Spleen-Stomach allows Yin fire to hyperactive and attack the Spleen-Stomach; when excessive, it moves left, blocking the Yang pathway, leading to extinction of Six Fu qi externally. Fire excess makes the mother organ excess, and wind qi is cut off externally. Wind qi cut off externally means grain qi enters the Stomach, but clear and Ying qi fail to circulate, constituting wind qi. Heterogeneous calls to homogeneous, i.e., Stomach qi. The classics state: Deficiency involves the element it overcomes; when Earth fails, Liver pathogen arises. This indicates Spleen-Stomach Earth deficiency with excessive Water and Fire. The classics state: Turbid yin exits via lower orifices, travels to five zang, returns to six fu, and returns to Earth; this is the normal state of health. Violating this causes distension. The *Yin Yang Lun* states: Irregular diet and起居 lead to Yin invasion; Yin invasion enters the five zang, causing distension and obstruction. The *Tiao Jing Pian* states: Obstruction in the lower Wan leads to Stomach heat, steaming the chest, causing internal heat. Lower Wan is the Youmen (Ulpus Gate). The human body has seven Chong Men (Rushing Gates) from top to bottom, all directing upward. Youmen rushes to Xi Men (Suction Gate), which is the epiglottis. Impeding inhaled qi prevents it from returning to the Kidney. Liver Yin fire opposes this, causing throat/diaphragm obstruction, preventing turbid qi descent, leading to dry stool. Stomach dampness and guest Yin fire accumulate, causing abdominal distension. Treatment focuses on Youmen to promote patency, drain Yin fire, moisten dry blood, and generate new blood. Once Youmen is patent, stool flows, Xi Men is protected, throat/diaphragm open, and distension resolves, allowing turbid yin to return to Earth. Thus, the classics say: Drain central fullness from within; this is the correct method. Tong You Tang (Unblock the Obstruction Decoction) and Run Chang Wan (Moisten Intestines Pill) are used. For distension with dry stool, deep pulse surging/slow, superficial pulse wiry, Chen Xiang Jiao Tai Wan (Agarwood Harmony Pill) is indicated. Lady Fan Tian, previously suffering from overexertion and dietary irregularities, compounded by worry and qi knotting, developed epigastric/abdominal distension, unable to eat dinner if she ate breakfast, stabbing pain in both hypochondria, with a string-like and thin pulse. At night, turbid qi should descend but fails, worsening distension. Generally, Yang governs transformation; dietary/exertional damage to Spleen-Stomach weakens Yang qi, failing to transform essence, leading to accumulation and distension. First, moxa Zhongwan (CV12), the Front-Mu point of the Stomach, to guide Stomach rising qi up the Yang pathway, then assist with Mu Xiang Shun Qi Tang (Costus Smooth Qi Decoction) to allow turbid qi to descend. The classics say: Move what remains, scatter what knots. Use Chai Hu and Sheng Ma (bitter-pungent neutral) to enter Shaoyang/Yangming, disperse clear qi, and operate in Yang division as Sovereign; use Sheng Jiang, Ban Xia, Dou Kou, and Yi Zhi Ren (sweet-acrid great-hot) to dissipate middle cold as Minister; use Nong Po, Mu Xiang, Cang Zhu, and Qing Pi (bitter-acrid great-warm) to smooth stagnant qi; use Chen Pi, Dang Gui, and Ren Shen (acrid-sweet warm) to harmonize Ying-Wei and nourish Middle qi. If turbid qi fails to descend, use bitter-draining Wu Zhu Yu (bitter-hot); thin qi is Yin within Yang. Fu Ling (sweet-neutral) and Ze Xie (salty-neutral) have thin qi, guiding turbid yin downward as Assistant. Combining flavors disperses, drains, ascends, and descends, settling clear and turbid qi in their proper positions. The *Ling Shu* states: For abdominal fullness, difficult defecation, qi rushing to chest/wheezing, treat Foot Shaoyin. "Treat" means drain. Use acrid-hot dispersants: Liang Jiang, Rou Gui, Yi Zhi Ren, Dou Kou Ren, Nong Po, Sheng Ma, Gan Cao, Du Huo, and Huang Bo (small amount). Another formula: Gui Zhi, Jie Geng, Ren Shen, Chen Pi, Qing Pi (small amount), Liang Jiang, Bai Zhu, Ze Xie, Wu Zhu Yu. Taiyin arrival causes accumulated fullness. Differentiation states: Spleen is Taiyin within Yin. Also, Spleen is Supreme Yin within Yin, the unmoving Earth of Kun Yuan. Heaven is Yang Fire, Earth is Yin Water. In humans, Spleen transforms like Yin Water. Excess Spleen causes abdominal fullness and indigestion; without Yang, grains cannot transform; Spleen excess leads to great cold and distension. Hence *Mai Jing*: "Cold in Stomach causes fullness." Generally, this disease is caused by water qi and cold-damp. Great acrid-hot agents will cure it, though severity varies. Mu Xiang Ta Qi Wan (Costus Collapsing Qi Pill) is used. Danxi said: The Spleen has the virtue of Kun stillness and Qian movement, allowing Heart/Lung Yang to descend and Kidney/Liver Yin to ascend, achieving Tai (Peace) of Heaven-Earth interaction, constituting a healthy person. Now, emotional injury, external six evils, dietary irregularity, and sexual exhaustion injure Spleen Yin. The official of transportation fails; although the Stomach receives grain, it cannot transform. Thus Yang rises and Yin falls, creating Pi (Stagnation) of non-interaction. Clear and turbid mix, tunnels block, generating heat; heat stays becoming damp; damp-heat generates distension. The classics call this Drum Distension because it is hard externally but empty inside, like a drum. Due to stubborn difficulty in treatment, it is also called Gu (Poison/Worm), implying erosion like insects. Tonify the Spleen, nourish Lung Metal to control Wood so Spleen faces no thief pathogens, nourish Kidney Water to control Fire so Lung receives clear transformation commands, avoid salty flavors, cease delusions, stay away from music, and peace will follow. Unobservant physicians seek quick results; patients suffering from distension prefer diuretics for relief, unaware that temporary ease worsens distension, pathogen strength, and true qi damage. Some ask about formulas: some attribute it to Cold Stomach/Middle Deficiency or inability to eat dinner after breakfast due to Supreme Yin occupying center and Five Yang failing to distribute. Danxi says damp-heat generation implies no cold? I reply: Initial cause may be cold diet or external cold, but Danxi's description implies chronic illness. Initially due to cold, Yang qi is constrained, eventually becoming heat. Classics: All abdominal distensions, sounds like drums, belong to heat. Now, lowering Heart/Lung Yang and raising Kidney/Liver Yin distributes Five Yang. Why need Ginger/Aconite heat? Save Spleen-Stomach deficiency as root, then treat excess branch symptoms; this is the Sage's intent. *Ling Shu* Zhang Lun states all zang/fu have distension, located outside organs, pushing organs against chest/abdomen wall, swelling skin. Chest/abdomen are walls of organs. Each has boundaries and shapes. Ying qi follows vessels; Wei qi reverses causing Mai Zhang (Vessel Distension). Wei qi merges with vessels, following muscle spaces causing Fu Zhang (Skin Distension). All distensions arise from Jue qi below, Ying-Wei stagnation, Cold qi reversing upward, True/Evil conflict, combining to form distension. The principle is one: know reversal/order, needle count unerring. Drain deficiency, tonify excess; if Spirit leaves room, pathogen wins, truth lost, ruin attributed to fate. Tonify deficiency, drain excess; Spirit returns, emptiness filled, called skilled artisan. Thus Sages prioritize tonifying deficiency. Does *Ling Shu* only mention Jue/Cold? Check *Nei Jing*: *Mai Yao Jing Wei Pian* says Stomach pulse excess, qi surplus causes distension. *Fu Zhong Lun* says Heart/Abdominal fullness, morning meal/no evening meal is Drum Distension. Heat disease, Three Yang excess entering Yin, head/abdomen distension/headache. Ying swelling/Neck pain, Chest/Abdominal fullness is Jue Ni. *Feng Lun* says Stomach Wind obstruction, frequent fullness, cold exposure worsens. *Tiao Jing Pian* says Form excess causes abdominal distension/urinary difficulty; Will excess causes distension/sundew diarrhea. *Zhi Zhen Da Yao Pian* says All damp swelling/fullness belong to Spleen. *Liu Yuan Zheng Ji Da Lun* says Earth depression causes heart/abdominal distension/bowel sounds/frequent stools. Water transport excess causes Yin Jue/cold above/below/large abdomen/shin swelling/sweat/chills. *Zhi Zhen Da Yao Lun* says Jueyin ruling heaven causes vomiting/abdominal distension/loose stools. Ruling earth causes distension/belching. Shaoyin ruling heaven causes abdominal distension/enlargement/panting/cough. Yangming recovery causes distension/diarrhea/bitter vomiting/cough/hiccups. Yangming First Qi causes mid-heat distension/facial swelling. *Tai Yin Yang Ming Lun* says Diet/lifestyle irregularities entering five zang cause fullness/obstruction/sundew diarrhea. *Miao Ci Lun* says Trauma/stasis inside causes abdominal fullness/blockage, first drink diuretics, injuring Jueyin vessel/Shao Yin collateral. *Zhen Yao* says Hand Shaoyin end: black face, long dirty teeth, abdominal closure, upper/lower blockage death. Foot Taiyin end: abdominal closure/breathlessness, belching/vomiting, vomiting/reversal/red face/non-reversal/blockage/black skin death. *Yin Yang Bie Lun* says Two Yin One Yang disease: distension, heart fullness, belching, Kidney/Gallbladder reversal, Sanjiao stagnation, qi ascending. *Yin Yang Ying Xiang Lun* says Turbid qi above causes distension. *Liu Yuan Zheng Ji Lun* says Taiyin arrival causes distension/central fullness. *Mai Jie Pian* says Taiyin is Zi month, November qi hides inside, hence distension disease; belching going to Heart is Yin excess moving to Yangming (connected to Heart); vomiting is fullness overflowing; relief after stool/gas is December Yin declining/Yang emerging. *Ling Shu* Shui Zhang Pian says Drum Distension: whole body large like Skin Distension, blue-yellow color, abdominal veins prominent. *Jing Mai Pian* says Stomach qi insufficient, Stomach cold causes fullness, anterior body cold. Spleen moving disease: epigastric pain, distension, relief after stool/gas. *Xie Qi Lun* says Stomach disease: abdominal distension, epigastric pain radiating to hypochondria, throat blockage, inability to eat. Stomach moving disease: rumbling distension. *Ben Shen Pian* says Spleen excess causes distension/urinary difficulty. *Jing Mai Pian* says Foot Taiyin collateral Gongsun deficiency causes Drum Distension. *Shi Chuan Pian* says Stomach cold/Intestine heat causes distension/diarrhea. *Zhang Lun Pian* says Ying follows vessels/Wei reverses = Mai Zhang; Wei merges muscles = Fu Zhang. Spleen distension: hiccups, limb irritability, heavy weight, restless sleep. Stomach distension: abdominal fullness, epigastric pain, smelling burnt odor, food aversion, constipation. Lung distension: empty fullness, panting/cough. Large Intestine distension: bowel sounds/pain, gurgling. Kidney distension: abdominal fullness radiating to back, waist/hip pain. Bladder distension: lower abdominal fullness, urinary difficulty. Liver distension: hypochondriac fullness/pain radiating to lower abdomen. Gallbladder distension: hypochondriac pain/distension, bitter taste, sighing. Sanjiao distension: qi fullness in skin, light/not firm. Heart distension: vexation, shortness of breath, restless sleep. Small Intestine distension: lower abdominal distension radiating to waist/pain. These describe various pathogenic distensions. Li Dongyuan cited *Wu Chang Zheng Da Yao*: "Purge and distension resolves" refers to Northwest high/cold terrain. *Yi Fa Fang Yi Lun* says Northern people have cold zang generating fullness, adapting to cold causes distension, all Autumn/Winter qi. Both due to external cold, Six Yang in Kun Earth (Spleen-Stomach). Five zang disease: external cold causes internal heat, but Yin excess/Yang deficiency, so purging cures. He also said: Generally cold distension > heat distension, distinguish carefully. I ponder: Is it only cold/heat? Treat this disease by integrating classic principles to identify organ patterns and pathogen origin. Even general distension has specific severe areas and onset points, identifying which organ qi is blocked, affecting Middle Jiao intersection, causing transport failure and general distension. If Spleen-Stomach affected, epigastric stuffiness starts, accumulating to general distension. Abdomen belongs to Spleen/Stomach; if Spleen-Stomach involved, appetite decreases; if other organs, appetite normal. This verifies diagnosis. Distinguish exterior/interior depth: distension in skin/collaterals keeps appetite; in intestines/membranes reduces appetite; qi blocking five zang causes急促 breathing/anorexia/critical condition. Thus exterior easy to treat, Fu difficult, Zang incurable. Distinguish deficiency/cold/excess/heat: Organ qi originally strong but blocked by pathogen is excess. Originally weak qi...