治宜行血通络。二仁通幽汤。（光桃仁九粒、郁李净仁二钱、归尾钱半、小茴三分拌炒川楝子一钱、藏红花
五分、酒炒生锦纹钱半、桂枝尖四分、《叶案》验方。）磨冲良方桃奴丸。（桃奴。延胡索、 鼠粪、香附、
官桂、砂仁、五灵脂、光桃仁各三钱、共研匀细、如弹子大、约重一钱、辰砂为衣、陈氏《妇人良方》。）
先通其瘀以消胀。继用四物绛覆汤。养营活络以善后。（三）寒胀。阴气凝聚。久而不散。内攻胃肠。则为寒
中胀满。便泄溺涩等证。内经所谓藏寒生满病是也。治宜温中泄满。苓术朴附汤（浙茯苓五钱、生于术钱半、
真川朴一钱、淡附片七分、广皮一钱、木瓜五分、《叶案》验方。）送下木香塌气丸（公丁香、胡椒各三钱、
郁李净仁四钱、炒白丑、枳实各一两、槟榔、广木香、蝎尾各五钱、为细末、饭丸、绿豆大、每服十丸、加
至十五丸、王好古《医垒元戎》方。）先温其中以宽胀。继用白术和中汤。送下加味桂苓丸。（紫 桂五钱、
浙茯苓二两、生于术、真川朴各一两、姜汁和丸、如桐子大、每服二十粒至三十粒、《叶案》验方。）温
中通阳以除根。若命门火衰。脾胃虚寒。不能克化水饮。致成寒水臌胀者。必服神效虎 丸（虎 一具、川
朴片十五两、大戟四两、杜酥五钱、烧酒米糊打丸、金箔为衣、每服三四钱、凌晓五《饲鹤亭集》方、
善治寒水臌胀、兼治痰饮痞结、翻胃噎膈、呕吐泄泻等症。）始克收温中宽膨之功。其他扁鹊玉壶丸（制透
倭硫黄八两、糯米糊为丸、每服一钱、开水送下。）《局方》半硫丸（生半夏、倭硫黄各一两、
开水泡七次、姜汁为丸、每服一二钱、米饮下。）亦皆寒胀之要药。（张寿甫曰、生倭硫黄治愈沉寒锢冷之病
甚多、先由己徐徐尝试、确知其功效甚奇、又甚稳妥、然后敢以之治病、较之制熟者其效更捷、愚谓近来上海
药局、皆备析净毒质之倭硫黄、尤无流弊。）（四）热胀。多因于肝郁络瘀。或湿热盘踞中焦。少腹坚胀。左胁
聚气。口苦不饥。溺赤便艰。形瘦肢冷。舌赤苔黄。《内经》所谓诸胀腹大。皆属于热是也。治宜通络泻肝。
龙荟绛覆汤（新绛二钱、旋复花、蜜炙延胡、川楝子各钱半、生白芍五钱、青皮一钱、鲜葱须二分、用淡海蛰四
两、大地栗六个、鲜刮淡竹茹五钱、煎汤代水、王孟英验方。）吞送当归龙荟丸二三钱。极苦泄热。略佐微辛
以通络。若湿热郁积于中。而成胀满者。只须清热导湿。朴果四皮饮（川朴、广皮、猪苓各钱半、浙苓皮、大
腹皮各三钱、草果仁、青皮各一钱、用冬瓜皮子各一两、煎汤代水、《叶案》验方、）送下中满分消丸（子芩一
两二钱、川朴一两、川连、枳实、仙半夏各五钱、炒知母四钱、广皮、泽泻各三钱、浙苓、砂仁、干姜各二钱、
党参、于术、猪苓、姜黄、炙草各一钱、共研匀细、蒸饼为丸、如小桐子大、每服三钱、李东垣验方。）苦辛
通降。略佐疏郁以和中。（五）虚胀。多因于脾胃衰弱。气虚中满。腹虽膨胀。按之不痛。便溏肠鸣。舌白脉
软。暮宽朝急气虚。朝宽暮急血虚。朝暮急气血俱虚。《内经》所谓足太阴虚则膨胀也。治宜温养阳气。初用
参术健脾汤（太子参、生于术、浙茯苓、姜半夏、广皮、川朴各钱半、生麦芽、炒山楂、春砂仁各一钱、尤
在泾《金匮翼》方。）继投健脾制肝汤（太子参、生于术各钱半、制苍术、浙茯苓、陈广皮各一钱、炒子芩、
原麦冬、真川朴各八分、广木香四分、气下陷者、加川柴胡五分、升麻三分、血虚、加归身、生白芍各钱半、
痰盛者、加姜半夏三钱、远志肉钱半、丹溪翁方。）补中理气以宽胀。胀消十之七八。则用香砂理中汤。温健
脾胃以善后。（六）实胀。虽属气郁。然或由积水。或由积饮。或由积食。或由湿热陈积。而无不由回血管
之障碍。余每于治胀药中。佐以行血通络之品。大旨以四七绛覆汤为君。（川朴、仙半夏、紫苏嫩枝、旋复花包煎各钱半、新绛二钱、赤苓三钱、鲜葱须五分、广橘络八分、用鲜茅根、杜赤豆各一两、煎汤代水、廉臣验方。）随证佐以丸散。
屡奏殊功。如积水。轻则送下神芎导水丸。重则送下三化神 丸。（煨甘遂、红牙大戟、醋炒芫花各五钱、黑
丑拌炒生锦纹各一两、轻粉一钱、共为细末、再同轻粉拌匀、熟红枣肉为丸、如赤小豆大、初服五丸、每服加
五丸、加至快利为度、张子和《儒门事亲》方。）积食。轻则送下木香槟榔丸。重则送下秘制五香丸。（杜
藿香、甘松、降香各一两、枳壳八钱、沉香、母丁香各五钱、巴霜三钱、共研极匀、米糊为丸、如芥菜子大、
辰砂为衣、每服四五分、廉臣验方。）湿热陈积。轻则送下枳实导滞丸。重则送下三霜散。（百草霜三钱、
薄荷霜、巴霜各六分、生锦纹、生三棱、生莪术、扁蓄、瞿麦各二钱、共研极匀、每服四五分、廉臣验方。）
惟积饮。《千金》五香汤最灵。（千金霜一钱煎汤、磨上沉香、广木香、白檀香、紫降香、母丁香五汁各
两小匙、和匀同服、薛生白验方、）（七）痰胀。证治方药。已详于夹痰伤寒勘语中。惟妇人血裹痰饮。汪朴齐
名曰痰臌类孕。腹大异常。偶一腹痛。即肠鸣辘辘。如车水声。溺涩便艰。甚则气喘倚息。不能平卧。六脉
滑大无伦。按之坚实。予曾三遇其症。皆由专门产科家。于痰体停经症。误认为妊。连进清滋安胎药。致痰饮
不行。与血互结而成。每仿汪氏法。用滚痰二陈汤（姜水炒生锦纹钱半、青礞石火硝 透三钱、竹沥半夏、
赤苓、槟榔、广皮各三钱、川朴、制南星、生三棱、生莪术各钱半、桂心五分、汪朴斋《产科心法》方。）
日下二三行。所下者皆色如赭石成块。挑开内裹白潺。从此腹渐消而宽。继用林氏香橼丸（炒莱菔子六两、
陈香橼四两、醋制香附、广皮、赤苓、泽泻、生三棱、生莪术各二两、净楂肉、小青皮各一两、神曲糊丸、
如绿豆大、每服一二钱、日三服、空心用绿萼梅七朵、泡汤送下、林药樵验方。）煎香砂二陈汤送下。
疏中蠲痰以除根。终用六君子汤去炙草。加制香附竹沥姜汁。补中涤痰以善后。（八）水胀。体实暴病者
易治。方法已详于前。体虚久病者难疗。予于临证实验上。用《济生》实脾饮送下《济生》肾气丸下或
用东垣补中益气汤送下扁鹊玉壶丹。或用参术健脾汤送下天真丸。或用香砂理中汤送下禹余粮丸。如水投石。一无成效。益信洄溪云胀俱在肠外三焦膈膜之间。其为病虽是
正虚。终属邪实。慎用补法。其言确有卓识也。由是改变方针。从疏达三焦。开泄膈膜着想。竟用修园消水圣
愈汤加味。（桂枝尖、黑附块、北细辛、蜜炙麻黄、生甘稍各一钱、知母三钱、焙蝼蛄下截七只、生姜皮钱
半、大红枣二枚、用生 皮一两、干蟾皮一只、煎汤代水。）温凉并用。通补兼施。要在生 皮善达三焦。干
蟾皮专通肾络。蝼蛄又为利水之能品。故加用之。外用蓖麻油品松节油。用药制棉浸擦膈脘腹。自上至下。日
擦四五次。似此内外并治。始得肠鸣如桴鼓。初则津津汗出。继则小溲如注。腹胀骤退。而两足仍肿。内用牡
蛎泽泻汤（左牡蛎生打四钱、泽泻、花粉各钱半、川桂枝五分、白茯苓三钱、川朴一钱、叶案验方。）外用毫针
浅刺足跗。以放其水之出路。乃奏全功。此为阴水之寒胀而设。然阳水之热胀。较阴水寒胀为尤多。王孟英
曰。水胀初起。虽有寒有热。久则寒少而热多。每因肝气不疏。则郁而为火。肺气不肃。则液郁为痰。脾气不
达。则滞其枢机。胃气不通。则废其容纳。四气皆愆。愆则邪留着而为胀。不愆则气健运而渐消。前哲治胀。
多用温补。反阻气机。是不调其愆而反锢其疾。疾日锢。腹愈胀。气日愆。血愈枯。此酿成单腹胀之由来也。
治法首重调愆。展以轻清。每用北沙参、淡竹茹、丝瓜络、银花、川楝子、枇杷叶、冬瓜皮、川柏、归须、生
白芍等。以气蒸水煮芦根生藕汤煎药。继参以西洋参、细生地、川连、花粉、生苡仁、焦山栀等。出入为方。
服至匝月。忽然汗出涔涔。肿胀皆退。予每仿其法而治此症。参以行血通络之品。如鲜茅根、杜赤豆、绛通
草、马鞭草、念篦须、鲜葱须、天仙藤、络石藤等。随症加减。每多获效。（九）谷胀。即食胀。多由肝气怫
郁。恣饮贪食。停滞中焦。其症恶闻食臭。吞酸嗳气。恶心呕逆。胸膈痞塞。食入则脘腹益胀。便艰溺涩。
《内经》所谓饮食自倍。肠胃乃伤。又云饮食不节。起居不时者。阴受之。阴受之则入五脏。入五脏则 满
闭塞。中满者泻之于内是也。治法轻则消而去之。疏郁消滞汤（莱菔子三钱拌炒川连六分、川朴、广皮、丹皮各钱
半、焦山栀、双钩藤各三钱、小青皮、薄荷梗各一钱、《叶案》验方。）送下枳实导滞丸。重则攻而下之。二陈平
胃汤（仙半夏、新会皮、小枳实、川朴各钱半、六神曲、净楂肉、赤苓各三钱、制苍术八分、生甘稍四分、
《简明医要》验方。）送下木香槟榔丸。若屡下而胀仍不消。此由肝郁络瘀。或由湿热入络。用开郁通络饮合雪
羹。（陈香团皮、酒炒延胡、新绛、木瓜各钱半、广郁金生打三钱、远志、通草、佛手片各一钱、生苡仁四
钱、蜜炙蜣螂一对、先用丝瓜络一枚、路路通十枚、淡海蛰四两、大地栗六个、煎汤代水、若消滞、加红曲二
钱、鸡内金三钱、达下、加车前子五钱、降气、加苏子二钱、川贝三钱、薛瘦吟验方。）或用三露五汁饮（银
花露、藿香露、枇杷叶露各一瓢、用生藕汁、芦根汁、梨汁、广郁金汁各四瓢、生姜汁四滴、重汤炖温、冲入
三露、和服、孟英验方。）送下木香三棱丸。（青木香、破故纸、茴香、黑丑、甘遂、芫花、大戟、京三棱、
蓬莪术、川楝子、葫芦巴、巴戟各一两、巴霜四分、陈仓米三合、砂仁一两五钱、上细切、用好米醋二升、除
砂仁木香外、余药入醋中浸一宿、入锅内煮醋尽干为度、同木香砂仁为细末、醋煮面糊为丸、如绿豆大、每服
五丸或七丸、载虞花溪《医学正传》。）仿洄溪胀必有滞。缓缓下之之法。始克胀消肿退而痊。（十）虫胀。多
因于脾胃虚弱。恣食甘肥生冷。留而为积。积久生虫。如扁虫（即姜片虫）线虫（即钩虫、蛔虫）圆虫（即鳖
瘕）等。其证腹虽胀大。时发攻痛。以手摸之。腹内有块。或一条埂起。痛有来去。乍作乍止。痛止即能饮
食。甚至一痛即厥。呕恶吐涎。口流清水。面白唇红。口馋好甜。或喜食泥土茶叶火炭等物。《内经》所谓肠中有
虫瘕HT 。虫动则胃缓。胃缓则涎出是也。治宜攻积驱虫。轻则使君子汤。（煨香使君子肉二钱、青糖一钱拌
炒净楂肉三钱、何廉臣验方。）送下蒋氏遇仙丹。（黑白丑头末炒香各五钱、枣儿槟榔半生半炒各一两、三
棱、莪术醋炒冬五钱、炙牙皂三钱、共研细匀、青糖为丸、如赤小豆大、小儿服一钱、大人二三钱、蒋仲芳验
方。）或单服鸡肝药。（白雷丸一两、用苍术一两同煮一二十滚、去苍术、切片、使君子肉一两、二味焙干研
细、用不落水鸡软肝一具、男用雌、女用雄、将末药一钱掺上、饭上蒸熟、小儿食之、轻则二三服即愈、重则
六七服而痊、吴门王仙师验方。）重则必须蒋氏珍珠丹（皂荚八钱、枣儿槟榔肉六钱、黑白丑各四钱、巴豆肉
六分、捶碎、包夏布中、四味用阴阳水各一汤碗、煮干取起、去巴豆肉、晒干研细、瓷瓶收藏、每服男用三五
分、女用四六分、小儿只服三分、黑砂糖拌、青糖茶送下、或白蜜汤调下、蒋仲芳验方。）及沉香至珍丸。
（每服三五粒、方载前夹痛伤寒勘语中。）又次论蛊症程钟龄谓非虫即血。非血即虫。但从字面象形。尚非成
蛊之原理。惟石芾南谓郁怒伤肝。肝热血燥。经络凝滞不通。下部回血壅胀。即有水血溢于 膈之里。渐渍渐
深。终成蛊胀。实由肝叶撑张则胀也。肚大筋青不治。夫青筋。非筋也。血络也。青者。血燥而结也。血结则
不独血滞于中。即水饮亦无由吸摄。不能循其常道。下输膀胱。故蛊胀多水。医者见水行水。不审水由肝血燥
结所致。所以不效。其说中西合参。言之成理。语甚精当。惜未对证立方耳。余于临证实验上。每用辛润通
络。以行肝血。自制三仁绛覆汤。（栝蒌仁四钱、柏子仁三钱、光桃仁、泽兰、新绛各二钱、归须、旋复花各
钱半、鲜葱须三分、用鲜茅根二两、全丝瓜络一钱、煎汤代水、）送下诸蛊保命丹。（肉苁蓉三两、红枣、青矾
各一斤、入罐内 烟尽、为末、再将四制香附、生麦芽各一斤为末、和前末糊丸、每服二三十丸、专治单腹胀
大、四肢极瘦、王孟英《内科简效》方。）及通络消蛊丸。（即当归 虫丸、方载夹痛伤寒勘语中、专治络瘀单
胀、叶氏验方。）遵叶氏络瘀则胀之法。往往十全二三。久服收功。终论臌证。通称单腹胀。前哲如程钟龄陈修
治疗应当采用活血通络的方法。使用二仁通幽汤。（光桃仁九粒、郁李净仁二钱、当归尾一钱半、小茴香三分拌炒川楝子一钱、藏红花五分、酒炒生大黄一钱半、桂枝尖四分，此为《叶案》验方。）磨冲服用良方桃奴丸。（桃奴、延胡索、鼠粪、香附、官桂、砂仁、五灵脂、光桃仁各三钱，共研成均匀细粉，制成如弹子大小的药丸，约重一钱，以辰砂为衣，出自陈氏《妇人良方》。）先通过疏通瘀血来消除胀满，随后使用四物绛覆汤，滋养营血、活络通经以巩固疗效。（三）寒胀。阴气凝聚，日久不散，向内侵犯胃肠，导致寒中胀满、腹泻、小便涩痛等症状。这就是《内经》所说的“脏寒生满病”。治疗应当温中散寒、消除胀满。服用苓术朴附汤（浙茯苓五钱、白术一钱半、真厚朴一钱、淡附片七分、广陈皮一钱、木瓜五分，此为《叶案》验方），送服木香塌气丸（公丁香、胡椒各三钱、郁李净仁四钱、炒白牵牛、枳实各一两、槟榔、广木香、蝎尾各五钱，研成细末，饭糊为丸，如绿豆大小，每次服用十丸，逐渐增加至十五丸，出自王好古《医垒元戎》）。先温中宽胀，随后使用白术和中汤，送服加味桂苓丸（紫桂五钱、浙茯苓二两、白术、真厚朴各一两，姜汁和丸，如梧桐子大小，每次服用二十至三十粒，此为《叶案》验方），以温中通阳，从根本上消除病根。如果是命门火衰，脾胃虚寒，不能运化水饮，导致形成寒水臌胀的，必须服用神效虎潜丸（虎骨一具、川厚朴片十五两、大戟四两、杜仲酥五钱，烧酒米糊打丸，金箔为衣，每次服用三四钱，出自凌晓五《饲鹤亭集》方，善于治疗寒水臌胀，兼治痰饮痞结、翻胃噎膈、呕吐泄泻等症），才能取得温中宽膨的功效。其他的扁鹊玉壶丸（制透倭硫黄八两，糯米糊为丸，每次服用一钱，开水送下）、《局方》半硫丸（生半夏、倭硫黄各一两，开水泡七次，姜汁为丸，每次服用一二钱，米饮送下），也都是治疗寒胀的重要药物。（张寿甫说：生倭硫黄治愈沉寒锢冷之病很多，我先由自己慢慢尝试，确知其功效奇特且稳妥，然后才敢用它治病，比制熟者效果更快捷，我认为近来上海药局都备有析净毒质的倭硫黄，尤其没有流弊。）（四）热胀。多因肝郁络瘀，或湿热盘踞中焦所致。表现为少腹坚硬胀满，左胁聚气，口苦不思饮食，小便赤涩，大便困难，形体消瘦，四肢发冷，舌质红苔黄。这是《内经》所说的“诸胀腹大，皆属于热”。治疗应当通络泻肝。服用龙荟绛覆汤（新绛二钱、旋复花、蜜炙延胡索、川楝子各一钱半、生白芍五钱、青皮一钱、鲜葱须二分，用淡海蛰四两、大地栗六个、鲜刮淡竹茹五钱，煎汤代水，出自王孟英验方），吞服当归龙荟丸二三钱。极苦以泄热，略佐微辛以通络。如果湿热郁积于中焦，形成胀满，只需清热导湿。服用朴果四皮饮（川厚朴、广陈皮、猪苓各一钱半、浙茯苓皮、大腹皮各三钱、草果仁、青皮各一钱，用冬瓜皮、冬瓜子各一两，煎汤代水，此为《叶案》验方），送服中满分消丸（子芩一两二钱、川厚朴一两、川黄连、枳实、仙半夏各五钱、炒知母四钱、广陈皮、泽泻各三钱、浙茯苓、砂仁、干姜各二钱、党参、白术、猪苓、姜黄、炙甘草各一钱，共研均匀，蒸饼为丸，如小梧桐子大小，每次服用三钱，出自李东垣验方）。苦辛通降，略佐疏郁以调和脾胃。（五）虚胀。多因脾胃衰弱，气虚导致中满。腹部虽然膨胀，但按压不痛，大便溏薄，肠鸣，舌苔白，脉象软弱。傍晚缓解早晨紧急是气虚，早晨缓解傍晚紧急是血虚，早晚都紧急是气血俱虚。《内经》所说“足太阴虚则膨胀”即是此意。治疗应当温养阳气。初用参术健脾汤（太子参、白术、浙茯苓、姜半夏、广陈皮、川厚朴各一钱半、生麦芽、炒山楂、春砂仁各一钱，出自尤在泾《金匮翼》方）。随后投用健脾制肝汤（太子参、白术各一钱半、制苍术、浙茯苓、陈广陈皮各一钱、炒子芩、原麦冬、真川厚朴各八分、广木香四分，气下陷者，加川柴胡五分、升麻三分；血虚者，加当归身、生白芍各一钱半；痰盛者，加姜半夏三钱、远志肉一钱半，出自丹溪翁方）。补中理气以宽胀。胀满消退十分之七八时，则使用香砂理中汤，温健脾胃以善后。（六）实胀。虽然属于气郁，但或由积水，或由积饮，或由积食，或由湿热陈积，而没有不是由于回血管障碍引起的。我每在治疗胀满的药物中，佐以行血通络之品，大旨以四七绛覆汤为主药。（川厚朴、仙半夏、紫苏嫩枝、旋复花包煎各一钱半、新绛二钱、赤茯苓三钱、鲜葱须五分、广橘络八分，用鲜茅根、杜赤豆各一两，煎汤代水，廉臣验方。）随证佐以丸散，屡奏奇效。如积水，轻则送服神芎导水丸，重则送服三化神功丸。（煨甘遂、红牙大戟、醋炒芫花各五钱、黑牵牛拌炒生大黄各一两、轻粉一钱，共为细末，再同轻粉拌匀，熟红枣肉为丸，如赤小豆大小，初服五丸，每服增加五丸，加至大便通畅为度，出自张子和《儒门事亲》方。）积食，轻则送服木香槟榔丸，重则送服秘制五香丸。（杜藿香、甘松、降香各一两、枳壳八钱、沉香、母丁香各五钱、巴豆霜三钱，共研极匀，米糊为丸，如芥菜子大小，辰砂为衣，每次服用四五分，廉臣验方。）湿热陈积，轻则送服枳实导滞丸，重则送服三霜散。（百草霜三钱、薄荷霜、巴豆霜各六分、生大黄、生三棱、生莪术、扁蓄、瞿麦各二钱，共研极匀，每次服用四五分，廉臣验方。）唯有积饮，《千金》五香汤最灵验。（千金霜一钱煎汤，磨上沉香、广木香、白檀香、紫降香、母丁香五汁各一小匙，和匀同服，薛生白验方。）（七）痰胀。证治方药，已在夹痰伤寒勘语中详细说明。只有妇人血裹痰饮，汪朴齐名为痰臌类孕。腹部异常肿大，偶尔腹痛，即肠鸣辘辘，如车水声，小便涩滞，大便困难，甚至气喘倚息，不能平卧，六脉滑大无伦，按之坚实。我曾三次遇到这种病症，都是由专门产科医生，将痰体停经症误认为妊娠，连续进服清滋安胎药，导致痰饮不行，与血互结而成。我每仿照汪氏法，使用滚痰二陈汤（姜水炒生大黄一钱半、青礞石火硝飞透三钱、竹沥半夏、赤茯苓、槟榔、广陈皮各三钱、川厚朴、制南星、生三棱、生莪术各一钱半、桂心五分，汪朴斋《产科心法》方），每日下行二三行，所下的物质皆色如赭石成块，挑开内裹白色粘液，从此腹部逐渐消退变宽。随后使用林氏香橼丸（炒莱菔子六两、陈香橼四两、醋制香附、广陈皮、赤茯苓、泽泻、生三棱、生莪术各二两、净山楂肉、小青皮各一两，神曲糊丸，如绿豆大小，每次服用一二钱，每日三次，空心时用绿萼梅七朵，泡汤送下，林药樵验方），煎香砂二陈汤送服。疏中蠲痰以除根。最终使用六君子汤去炙甘草，加制香附、竹沥、姜汁，补中涤痰以善后。（八）水胀。体质强壮突发疾病者易治，方法已在前文详述。体质虚弱久病者难疗。我在临证实验中，使用《济生》实脾饮送服《济生》肾气丸，或者用东垣补中益气汤送服扁鹊玉壶丹，或者用参术健脾汤送服天真丸，或者用香砂理中汤送服禹余粮丸，如水投石，毫无成效。更加相信洄溪所说胀满都在肠外三焦膈膜之间，其为病虽是正虚，终属邪实，慎用补法。其言确有卓识。由此改变方针，从疏达三焦，开泄膈膜着想，竟用修园消水圣愈汤加味。（桂枝尖、黑附块、北细辛、蜜炙麻黄、生甘草梢各一钱、知母三钱、焙蝼蛄下截七只、生姜皮一钱半、大红枣二枚，用生商陆皮一两、干蟾皮一只，煎汤代水。）温凉并用，通补兼施。关键在于生商陆皮善于通达三焦，干蟾皮专通肾络，蝼蛄又是利水的能品，所以加用它们。外用蓖麻油配松节油，用药制棉浸擦膈脘腹部，自上至下，每日擦拭四五次。像这样内外并治，才开始肠鸣如桴鼓，起初微微出汗，随后小便如注，腹胀骤退，而两脚仍然浮肿。内服牡蛎泽泻汤（左牡蛎生打四钱、泽泻、花粉各一钱半、川桂枝五分、白茯苓三钱、川厚朴一钱，叶案验方），外用毫针浅刺足跗，以放水之出路，乃奏全功。这是为阴水之寒胀而设的。然而阳水之热胀，较阴水寒胀更为多见。王孟英说：水胀初起，虽有寒有热，久则寒少而热多。每因肝气不疏，则郁而为火；肺气不肃，则液郁为痰；脾气不达，则滞其枢机；胃气不通，则废其容纳。四气皆愆，愆则邪留着而为胀，不愆则气健运而渐消。前哲治疗胀满，多用温补，反阻气机，是不调其愆而反锢其疾。疾日锢，腹愈胀，气日愆，血愈枯，此酿成单腹胀的由来也。治法首重调愆，展以轻清。每用北沙参、淡竹茹、丝瓜络、银花、川楝子、枇杷叶、冬瓜皮、川柏、归须、生白芍等，以气蒸水煮芦根生藕汤煎药。继参以西洋参、细生地、川黄连、花粉、生苡仁、焦山栀等，出入为方。服至匝月，忽然汗出涔涔，肿胀皆退。我每仿照其法治疗此症，参以行血通络之品，如鲜茅根、杜赤豆、绛通草、马鞭草、念篦须、鲜葱须、天仙藤、络石藤等，随症加减，每多获效。（九）谷胀。即食胀。多由肝气怫郁，恣饮贪食，停滞中焦。其症状恶闻食臭，吞酸嗳气，恶心呕逆，胸膈痞塞，食入则脘腹益胀，大便困难，小便涩滞。《内经》所谓“饮食自倍，肠胃乃伤”，又说“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，中满者泻之于内”即是此意。治疗方法轻则消而去之，用疏郁消滞汤（莱菔子三钱拌炒川连六分、川厚朴、广陈皮、丹皮各一钱半、焦山栀、双钩藤各三钱、小青皮、薄荷梗各一钱，此为《叶案》验方），送服枳实导滞丸。重则攻而下之，用二陈平胃汤（仙半夏、新会皮、小枳实、川厚朴各一钱半、六神曲、净山楂肉、赤茯苓各三钱、制苍术八分、生甘草梢四分，出自《简明医要》验方），送服木香槟榔丸。如果屡下而胀仍不消，此由肝郁络瘀，或由湿热入络，用开郁通络饮合雪羹。（陈香团皮、酒炒延胡索、新绛、木瓜各一钱半、广郁金生打三钱、远志、通草、佛手片各一钱、生苡仁四钱、蜜炙蜣螂一对，先用丝瓜络一枚、路路通十枚、淡海蛰四两、大地栗六个，煎汤代水，若消滞，加红曲二钱、鸡内金三钱；达下，加车前子五钱；降气，加苏子二钱、川贝三钱，薛瘦吟验方。）或者用三露五汁饮（银花露、藿香露、枇杷叶露各一瓢，用生藕汁、芦根汁、梨汁、广郁金汁各四瓢，生姜汁四滴，重汤炖温，冲入三露，和服，孟英验方），送服木香三棱丸。（青木香、破故纸、茴香、黑牵牛、甘遂、芫花、大戟、京三棱、蓬莪术、川楝子、葫芦巴、巴戟各一两、巴豆霜四分、陈仓米三合、砂仁一两五钱，上细切，用好米醋二升，除砂仁木香外，余药入醋中浸一宿，入锅内煮醋尽干为度，同木香砂仁为细末，醋煮面糊为丸，如绿豆大小，每次服用五丸或七丸，载虞花溪《医学正传》。）仿照洄溪“胀必有滞，缓缓下之”的方法，始克胀消肿退而痊愈。（十）虫胀。多因脾胃虚弱，恣食甘肥生冷，留而为积，积久生虫，如扁虫（即姜片虫）、线虫（即钩虫、蛔虫）、圆虫（即鳖瘕）等。其证腹部虽然胀大，时常发作攻痛，用手摸之，腹内有块，或一条埂起，痛有来去，乍作乍止，痛止即能饮食，甚至一痛即厥，呕恶吐涎，口流清水，面白唇红，口馋好甜，或喜食泥土茶叶火炭等物。《内经》所谓“肠中有虫瘕，虫动则胃缓，胃缓则涎出”即是此意。治疗应当攻积驱虫。轻则使君子汤（煨香使君子肉二钱、青糖一钱拌炒净山楂肉三钱，何廉臣验方），送服蒋氏遇仙丹（黑白丑头末炒香各五钱、枣儿槟榔半生半炒各一两、三棱、莪术醋炒各五钱、炙牙皂三钱，共研细匀，青糖为丸，如赤小豆大小，小儿服一钱，大人二三钱，蒋仲芳验方）。或者单服鸡肝药（白雷丸一两，用苍术一两同煮一二十滚，去苍术，切片，使君子肉一两，二味焙干研细，用不落水鸡软肝一具，男用雌，女用雄，将末药一钱掺上，饭上蒸熟，小儿食之，轻则二三服即愈，重则六七服而痊，吴门王仙师验方）。重则必须蒋氏珍珠丹（皂荚八钱、枣儿槟榔肉六钱、黑白丑各四钱、巴豆肉六分，捶碎，包夏布中，四味用阴阳水各一汤碗，煮干取起，去巴豆肉，晒干研细，瓷瓶收藏，每次服用男用三五分，女用四六分，小儿只服三分，黑砂糖拌，青糖茶送下，或白蜜汤调下，蒋仲芳验方）及沉香至珍丸。（每服三五粒，方载前夹痛伤寒勘语中。）又次论蛊症，程钟龄谓非虫即血，非血即虫。但从字面象形，尚非成蛊之原理。惟石芾南谓郁怒伤肝，肝热血燥，经络凝滞不通，下部回血壅胀，即有水血溢于膈之里，渐渍渐深，终成蛊胀，实由肝叶撑张则胀也。肚大筋青不治。夫青筋，非筋也，血络也。青者，血燥而结也。血结则不独血滞于中，即水饮亦无由吸摄，不能循其常道，下输膀胱。故蛊胀多水。医者见水行水，不审水由肝血燥结所致，所以不效。其说中西合参，言之成理，语甚精当，惜未对证立方耳。我在临证实验中，每用辛润通络，以行肝血，自制三仁绛覆汤（栝蒌仁四钱、柏子仁三钱、光桃仁、泽兰、新绛各二钱、归须、旋复花各一钱半、鲜葱须三分，用鲜茅根二两、全丝瓜络一钱，煎汤代水），送服诸蛊保命丹（肉苁蓉三两、红枣、青矾各一斤，入罐内烟尽，为末，再将四制香附、生麦芽各一斤为末，和前末糊丸，每服二三十丸，专治单腹胀大、四肢极瘦，王孟英《内科简效》方）及通络消蛊丸。（即当归 虫丸，方载夹痛伤寒勘语中，专治络瘀单胀，叶氏验方。）遵叶氏“络瘀则胀”之法，往往十全二三，久服收功。终论臌证，通称单腹胀，前哲如程钟龄、陈修……
Treatment should employ the method of invigorating blood and unblocking collaterals. Use Er Ren Tong You Decoction (Guizhi Tang [Cinnamon Twig Decoction] is mentioned in the source text as a reference, but the formula listed is: Guang Taoren [Semen Persicae], Yuli Jingren [Semen Pruni Armeniacae], Guiwei [Radix Angelicae Sinensis caulis], Xiaohuixiang [Fructus Foeniculi] stir-fried with Chuan Lianzi [Fructus Toosendan], Zanghonghua [Flos Carthami Tinctorii], Jiuchao Sheng Jinwen [Radix et Rhizoma Rhei prepared with wine], Guizhi Jian [Ramulus Cinnamomi]). Grind and take Tao Nu Wan (Pill of Peach Twig Nodule) from Liang Fang (Tao Nu [Nodus Ramuli Persicae], Yanhusuo [Rhizoma Corydalis], Shufen [Excrement Mus musculus], Xiangfu [Rhizoma Cyperi], Guanguui [Cortex Cinnamomi Cassiae], Sharen [Fructus Amomi], Wulingzhi [Faeces Trogopteri], Guang Taoren [Semen Persicae] each 3 qian, ground into fine powder, formed into pills the size of a bullet, weighing about 1 qian, coated with Chen Sha [Cinnabar], from Chen Shi's *Fu Ren Liang Fang*). First, unblock stasis to reduce distension. Subsequently use Si Wu Jiang Fu Decoction to nourish Ying (nutritive qi) and activate collaterals for consolidation. (3) Cold Distension. Yin Qi condenses and fails to disperse over time, attacking the stomach and intestines internally, resulting in cold middle jiao distension, diarrhea, and dysuria. This corresponds to the *Neijing*'s statement that "cold in the zang organs generates fullness diseases." Treatment should warm the middle and drain fullness. Take Ling Zhu Pu Fu Decoction (Zhe Fuling [Poria], Sheng Baizhu [Atractylodis Macrocephalae Rhizoma], Zhen Chunghoupo [Cortex Magnoliae Officinalis], Dan Fupian [Radix Aconiti Lateralis Preparata], Guangpi [Pericarpium Citri Reticulatae], Mugua [Fructus Chaenomelis], from Ye An's verified prescription) followed by Muxiang Taqi Pill (Gong Dingxiang [Flos Caryophylli], Hujiao [Fructus Piperis Longi], Yuli Jingren [Semen Pruni Armeniacae], Chao Baiqiu [Semen Kochiae Preparatum], Zhishi [Fructus Aurantii Immaturus], Binglang [Semen Arecae], Guang Muxiang [Radix Aucklandiae], Xiwei [Cauda Scorpii] each specific dosage, made into pill with rice paste, size of mung bean, dose 10-15 pills, from Wang Haogu's *Yi Lei Yuan Rong*). First warm the middle to relieve distension, then use Baizhu Hezhong Decoction followed by Jia Wei Guiling Pill (Zigui [Cortex Cinnamomi], Zhe Fuling [Poria], Sheng Baizhu [Atractylodis Macrocephalae Rhizoma], Zhen Chunghoupo [Cortex Magnoliae Officinalis], mixed with ginger juice into pills, size of sophora seed, dose 20-30 pills, from Ye An's verified prescription) to warm the middle and unblock Yang to eradicate the root. If Mingmen Fire declines, Spleen and Stomach are deficient and cold, failing to transform water and fluids, leading to Cold Water Drum Distension, one must take Shenxiao Hu Qian Wan (Tiger Bone, Chunghoupo, Daji [Radix Euphorbiae Pekinensis], Dushu [Cortex Eucommiae], made into pills with liquor and rice paste, coated with gold foil, dose 3-4 qian, from Ling Xiaowu's *Si He Ting Ji*) to achieve the effect of warming the middle and relieving bloating. Other important medicines for cold distension include Bianque Yuhu Wan (prepared O-sulfur, rice paste pills) and *Ju Fang* Ban Liu Wan (Banxia [Rhizoma Pinelliae], sulfur, ginger juice pills). (Zhang Shoufu stated that raw O-sulfur cures many cases of deep-seated cold; he tested it himself... Shanghai pharmacies now prepare purified O-sulfur...). (4) Heat Distension. Often due to Liver Qi stagnation and collateral stasis, or damp-heat occupying the middle jiao. Symptoms include hard distension in the lower abdomen, Qi accumulation in the left hypochondrium, bitter taste, anorexia, red urine, difficult defecation, emaciation, cold limbs, red tongue with yellow coating. This aligns with the *Neijing*: "All distensions with abdominal enlargement belong to heat." Treatment should unblock collaterals and purge the Liver. Take Long Hui Jiang Fu Decoction (Xinjiang [Safflower silk], Xuanfuhua [Flores Inulae], Miyan Yanhu [Rhizoma Corydalis honey-fried], Chuan Lianzi [Fructus Toosendan], Sheng Baishao [Radix Paeoniae Alba], Qingpi [Pericarpium Citri Reticulatae Viride], Xian Congxu [Bulbus Allii Fistulosi], decocted with Dan Haijie [Concha Haliothyae] and Da Dili [Tuber Dioscoreae Hypoglaucae], fresh Dan Zhuru [Caulis Bambusae in Taeniam]) taken with Danggui Longhui Wan (Pill of Angelica and Gardenia) to severely clear heat with bitter flavors, assisted by mild acridity to unblock collaterals. If damp-heat accumulates in the middle causing distension, clear heat and guide out dampness using Puguo Sipai Yin (Chunghoupo, Guangpi, Zhuling [Polyporus], Zhe Lingpi [Exocarpus Fuscospermae Trichosanthis], Dafupi [Pericarpium Benincasae], Caoguo Ren [Semen Amomi Fructus], Qingpi [Pericarpium Citri Reticulatae Viride], decocted with Dongguapi [Exocarpus Citri Grandis] and Dongguazi [Semen Benincasae]) followed by Zhongman Fenxiao Wan (Pill for Resolving Middle Fullness, from Li Dongyuan) to use bitter-acrid descending methods and slightly soothe stagnation to harmonize the middle. (5) Deficiency Distension. Often due to Spleen-Stomach weakness and Qi deficiency causing central fullness. The abdomen is distended but painless on pressure, stools are loose, borborygmus present, white tongue coating, soft pulse. Evening relief/morning urgency indicates Qi deficiency; morning relief/evening urgency indicates Blood deficiency; both indicate Qi and Blood deficiency. This matches the *Neijing*: "Deficiency of Foot Taiyin leads to distension." Treatment should warm and nourish Yang. Initially use Shenzhu Jianpi Decoction (Taizishen [Codonopsis], Sheng Baizhu [Atractylodis Macrocephalae Rhizoma], Zhe Fuling [Poria], Jiang Banxia [Pinellia prepared with ginger], Guangpi [Pericarpium Citri Reticulatae], Chunghoupo [Cortex Magnoliae Officinalis], Sheng Maiya [Semen Hordei Germinatum], Chao Shanzha [Fructus Crataegi], Chun Sharen [Fructus Amomi]) followed by Jianpi Zhi Gan Decoction (Taizishen [Codonopsis], Sheng Baizhu [Atractylodis Macrocephalae Rhizoma], Zhi Cangzhu [Atractylodis Rhizoma preparata], Zhe Fuling [Poria], Chen Guangpi [Pericarpium Citri Reticulatae], Chao Ziqin [Radix Scutellariae], Yuan Maidong [Radix Ophiopogonis], Zhen Chunghoupo [Cortex Magnoliae Officinalis], Guang Muxiang [Radix Aucklandiae]; add Chaihu [Radix Bupleuri], Shengma [Rhizoma Cimicifugae] for sinking Qi; add Guishen [Radix Angelicae Sinensis], Sheng Baishao [Radix Paeoniae Alba] for Blood deficiency; add Jiang Banxia [Pinellia prepared with ginger], Yuanzhi [Radix Polygalae] for phlegm, from Danxi's method) to tonify the middle and regulate Qi to relieve distension. When distension subsides by 70-80%, use Xiangsha Lizhong Decoction to warm and strengthen the Spleen and Stomach for recovery. (6) Excess Distension. Although related to Qi stagnation, it may stem from accumulated water, retained fluids, food retention, or chronic damp-heat, all involving obstruction of venous return. I often add blood-invigorating and collateral-unblocking agents to distension treatments, primarily using Si Qi Jiang Fu Decoction as the chief formula (Chunghoupo [Cortex Magnoliae Officinalis], Xian Banxia [Pinellia], Zi Su Nenzhi [Ramulus Perillae], Xuanfuhua [Flores Inulae] wrapped, Xinjiang [Safflower silk], Chi Ling [Poria cocos var. rubra], Xian Congxu [Bulbus Allii Fistulosi], Guang Jieluo [Retinervium Citri Reticulatae], decocted with Xian Maogen [Rhizoma Imperatae] and Du Chidou [Semen Vigna Aureae]) followed by appropriate pills/powders. For accumulated water, light cases use Shenxiong Dao Shui Wan, heavy cases use San Hua Shen Gong Wan (Weigan Sui [Radix Kansui], Hongya Daji [Radix Euphorbiae Pekinensis], Cu Chao Yuanhua [Flos Genkwa], Hei Qiu [Semen Kochiae], Sheng Jinwen [Radix et Rhizoma Rhei], Qingfen [Calomelas], red date meat pills). For food retention, light cases use Muxiang Binglang Wan, heavy cases use Mizhi Wuxiang Wan (Du Huoxiang [Radix Costi], Gansong [Rhizoma Nardostachyos], Jiangxiang [Lignum Aquilariae Resinatum], Zhiqiao [Fructus Aurantii], Chenxiang [Lignum Aquilariae Resinatum], Mu Dingxiang [Flos Caryophylli], Bashuang [Semens Crotonis preparatum], sandalwood pills). For chronic damp-heat, light cases use Zhishi Daozhi Wan, heavy cases use San Shuang San (Baicaoshuang [Carbonis Herbae], Boher Shuang [Menthae Haplocalycis Frostum], Bashuang [Semens Crotonis preparatum], Sheng Jinwen [Radix et Rhizoma Rhei], Sheng Sanleng [Rhizoma Sparganii], Sheng Ezhu [Rhizoma Curcumae], Bianxu [Herba Polygoni Avicularis], Qumai [Herba Dianthi]). For retained fluids, Qianjin Wuxiang Tang is most effective (Qianjinsuang [Carbonis Herbae], grinding Chenxiang, Guangmuxiang, Baitanxiang, Zijiangxiang, Mu Dingxiang juices). (7) Phlegm Distension. See previous section on Phlegm-Shanghan. Specifically in women, blood encasing phlegm-fluids, named Tan Gu Lei Yun (Phlegm-Drum resembling pregnancy) by Wang Puqi. Abdomen abnormally large, occasional pain with borborygmus, dysuria, difficult defecation, asthma, inability to lie flat, slippery-large pulses, firm on pressure. Misdiagnosed as pregnancy and treated with cooling-nourishing fetal-calming herbs, causing phlegm-fluids to bind with blood. Use Gun Tan Er Chen Decoction (Jiangshui Chao Sheng Jinwen [Radix et Rhizoma Rhei fried in ginger water], Qingmengshi [Calcareous Schist fire-treated with saltpeter], Zhuli Banxia [Pinellia with bamboo sap], Chi Ling [Poria cocos var. rubra], Binglang [Semen Arecae], Guangpi [Pericarpium Citri Reticulatae], Chunghoupo [Cortex Magnoliae Officinalis], Zhi Nanting [Rhizoma Arisaematis preparatum], Sheng Sanleng [Rhizoma Sparganii], Sheng Ezhu [Rhizoma Curcumae], Guixin [Cortex Cinnamomi]) to induce bowel movements daily, passing ochre-colored clumps. Then use Lin's Xiangyuan Wan (Chao Laifuzi [Semen Raphani], Chen Xiangyuan [Fructus Citri Medicae], Cu Zhi Xiangfu [Rhizoma Cyperi], Guangpi [Pericarpium Citri Reticulatae], Chi Ling [Poria cocos var. rubra], Zexie [Rhizoma Alismatis], Sheng Sanleng [Rhizoma Sparganii], Sheng Ezhu [Rhizoma Curcumae], Jing Zhairou [Sarcotesta Litchi Chinensis], Xiao Qingpi [Pericarpium Citri Reticulatae Viride], Shenqu [Massa Medicata Fermentata] pills) taken with Xiangsha Er Chen Decoction to soothe the middle and eliminate phlegm. Finally, use Liujunzi Decoction minus Zhi Gancao, plus Zhi Xiangfu [Rhizoma Cyperi], Zhuli [Succus Bambusae in Taeniam], Jiangzhi [Succus Zingiberis Recens] to tonify the middle and wash away phlegm. (8) Water Distension. Acute cases in strong constitutions are easy to treat. Chronic cases in weak constitutions are difficult. My experiments showed that using *Jisheng* Shipi Yin with *Jisheng* Shenqi Wan, or Dongyuan Buzhong Yiqi Tang with Bianque Yuhu Dan, or Shenzhu Jianpi Tang with Tianzhen Wan, or Xiangsha Lizhong Tang with Yuyuliang Wan, yielded no results ("like water thrown on stone"). This confirms Huixi's view that distension lies outside the intestines in the Sanjiao and diaphragmatic membranes; although Zheng is deficient, Xie is excess, so tonification must be used cautiously. I changed strategy to soothe Sanjiao and open the diaphragm, using Xiuyuan Xiaoshui Shengyu Decoction modified (Guizhi Jian [Ramulus Cinnamomi], Hei Fuku [Radix Aconiti Lateralis Preparata], Bei Xixin [Radix Asari], Miyan Mahuang [Herba Ephedrae honey-fried], Sheng Gancao Shao [Radix Glycyrrhizae Preparata], Zhimu [Rhizoma Anemarrhenae], Beilougu [Insectus Annelis Preparatus], Shengjiang Pi [Cortex Zingiberis Recens], Dazao [Fructus Jujubae], decocted with Sheng Shangpi [Cortex Phytolaccae Radicis] and Ganchanpi [Cutis Bufonis]) combining warming and cooling, unblocking and tonifying. Key ingredients: Shangpi [Cortex Phytolaccae Radicis] reaches Sanjiao, Ganchanpi [Cutis Bufonis] opens Kidney collaterals, Beilougu [Insectus Annelis Preparatus] promotes urination. External application: Castor oil with turpentine oil applied to chest/abdomen. Internal + external treatment led to borborygmus, sweating, profuse urination, and reduced abdominal distension, though legs remained swollen. Internal: Muli Zexie Decoction (Muli [Concha Ostreae], Zexie [Rhizoma Alismatis], Huafen [Radix Platycodi], Guizhi [Ramulus Cinnamomi], Baifuling [Poria], Chunghoupo [Cortex Magnoliae Officinalis]); external: shallow needle pricking foot dorsum to drain water. This treats Yin Water Cold Distension. However, Yang Water Heat Distension is more common. Wang Mengying noted that long-standing distension turns from cold to heat due to Liver Qi stagnation turning to fire, Lung Qi failing to descend creating phlegm, Spleen Qi failing to move creating stagnation, Stomach Qi failing to receive creating blockage. Antiquity physicians used warming tonics, obstructing Qi mechanism. Treatment should prioritize regulating these deviations with light-clearing herbs (Beishashen [Radix Glehniae], Dan Zhuru [Caulis Bambusae in Taeniam], Sigualuo [Retinervium Trichosanthis], Yinhua [Flos Lonicerae Japonicae], Chuan Lianzi [Fructus Toosendan], Pipaye [Folium Eriobotryae], Dongguapi [Exocarpus Citri Grandis], Chuanbai [Cortex Phellodendri], Guixu [Radix Angelicae Sinensis caulis], Sheng Baishao [Radix Paeoniae Alba]) decocted in Reed Root and Lotus Root soup, later adding Xiyangshen [Radix Panacis Quinquefolii], Xi Shengdi [Radix Rehmanniae Preparata], Chuanlian [Radix Et Rhizoma Rhdomatis], Huafen [Radix Platycodi], Sheng Yiren [Semen Coicis], Jiao Shanzhi [Fructus Gardeniae Preparata]. After a month, sudden sweating reduces swelling. I add blood-invigorating herbs like Xian Maogen [Rhizoma Imperatae], Du Chidou [Semen Vigna Aureae], Jiang Tongcao [Medulla Tetrapanacis], Mabiancao [Herba Verbena officinalis], etc. (9) Grain Distension (Food Distension). Due to Liver Qi depression and excessive eating/drinking stagnating in the middle. Symptoms: aversion to food odor, acid regurgitation, belching, nausea, chest oppression, worsened distension after eating, difficult defecation/urination. Matches *Neijing*: "Diet doubles, intestines/stomach injured." Light cases: Shuyu Xiaozhi Tang (Laifuzi [Semen Raphani], Chuanlian [Radix Et Rhizoma Rhdomatis], Chunghoupo [Cortex Magnoliae Officinalis], Guangpi [Pericarpium Citri Reticulatae], Danpi [Cortex Moutan], Jiao Shanzhi [Fructus Gardeniae Preparata], Shuang Gouteng [Ramulus Uncariae cum Uncis], Xiao Qingpi [Pericarpium Citri Reticulatae Viride], Bohe geng [Herba Menthae]) followed by Zhishi Daozhi Wan. Heavy cases: Erchen Pingwei Tang (Xian Banxia [Pinellia], Xin Hui Pi [Pericarpium Citri Reticulatae], Xiao Zhishi [Fructus Aurantii Immaturus], Chunghoupo [Cortex Magnoliae Officinalis], Liushenqu [Massa Medicata Fermentata], Jing Zhairou [Sarcotesta Litchi Chinensis], Chi Ling [Poria cocos var. rubra], Zhi Cangzhu [Atractylodis Rhizoma preparata], Sheng Gancao Shao [Radix Glycyrrhizae Preparata]) followed by Muxiang Binglang Wan. If purgatives fail, indicating Liver stagnation/collateral stasis or damp-heat entering collaterals, use Kaiyu Tongluo Yin combined with Xue Geng (Chen Xiang Tuanpi [Pericarpium Citri Reticulatae], Jiuchao Yanhu [Rhizoma Corydalis], Xinjiang [Safflower silk], Mugua [Fructus Chaenomelis], Guang Yujin [Radix Curcumae], Yuanzhi [Radix Polygalae], Tongcao [Medulla Tetrapanacis], Foshoupian [Rhizoma Bletillae], Sheng Yiren [Semen Coicis], Miyan Qianglang [Larva Vespaе], Silk mesh, Lulutong [Fructus Liquidambaris], Dan Haijie [Concha Haliothyaе], Da Dili [Tuber Dioscoreae Hypoglaucae] decoction; add Hongqu [Massa Medicata Fermentata Rubra], Jineijin [Endothelium Corneum Gigeriae Galli] for digestion; Cheqianzi [Semen Plantaginis] for draining; Suzi [Fructus Perillae], Chuanbei [Bulbus Fritillariae Thunbergii] for descending Qi) or San Lu Wu Zhi Yin (Silver Flower Dew, Agastache Dew, Loquat Leaf Dew, Lotus Root Juice, Reed Root Juice, Pear Juice, Curcuma Juice, Ginger Juice) followed by Muxiang Sanleng Wan (Qingmuxiang [Radix Aucklandiae], Poguzhi [Semen Crotalariae], Huixiang [Fructus Foeniculi], Heiqiu [Semen Kochiae], Gansui [Radix Kansui], Yuanhua [Flos Genkwa], Daji [Radix Euphorbiae Pekinensis], Jingsanleng [Rhizoma Sparganii], Peng'ezhu [Rhizoma Curcumae], Chuan Lianzi [Fructus Toosendan], Huluba [Semen Trigonellae], Bajiji [Radix Morindae Officinalis], Bashuang [Semens Crotonis preparatum], Chen Cangmi [Oryza Sativa Preparata], Sharen [Fructus Amomi] steeped in vinegar, boiled dry, ground, vinegar-paste pills). Follow Huixi's method of slow purgation for distension with stagnation. (10) Worm Distension. Due to Spleen-Stomach weakness, excessive sweet/greasy/cold foods causing accumulation and worms (Fluke, Hookworm, Roundworm). Symptoms: abdominal distension, intermittent colic, palpable masses or ridges, pain comes and goes, appetite returns when pain stops, syncope during pain, vomiting saliva/water, pale face/red lips, craving sweets/dirt/tea/charcoal. Matches *Neijing*: "Worms in intestines cause stomach relaxation and salivation." Treatment: attack accumulation and expel worms. Light: Shijunzi Tang (Shijunzi [Semen Sterculiae Lychnophorae], Qingtang [Brown Sugar], Chao Zhairou [Sarcotesta Litchi Chinensis]) followed by Jiang's Yuxian Dan (Heibai Qiu [Semen Kochiae], Zao'er Binglang [Semen Arecae], Sanleng [Rhizoma Sparganii], Ezhu [Rhizoma Curcumae], Zhi Yazao [Fructus Gleditsiae Sinensis], brown sugar pills). Or single Chicken Liver Medicine (Leiwanz [Artemisiae Argyi Folium? Note: Source says Bai Leiwanz, likely referring to a vermifuge herb, possibly *Wanshen* or similar, but text says Bai Leiwanz], Cangzhu [Rhizoma Atractylodis], Shijunzi [Semen Sterculiae Lychnophorae], chicken liver). Heavy: Jiang's Zhenzhu Dan (Zaojia [Fructus Gleditsiae Sinensis], Zao'er Binglang [Semen Arecae], Heibai Qiu [Semen Kochiae], Badou Rou [Semen Crotonis], Yin-Yang water decoction, remove Badou, powder) and Chenxiang Zhenzhen Wan. Regarding Gu Syndrome (Ascites), Cheng Zhongling said it is either worm or blood. Shi Feinan said anger injures Liver, Liver heat/blood dryness causes collateral stasis, lower body venous congestion leads to fluid/blood overflow into diaphragm, causing Gu Distension. "Green veins" are blood collaterals, indicating blood dryness/stasis. Water cannot be absorbed without blood movement. Doctors treating water with diuretics fail because they ignore the blood root. Treatment should use acrid-moistening to unblock collaterals and move Liver Blood. Self-made San Ren Jiang Fu Decoction (Gualou Ren [Semen Trichosanthis], Baizi Ren [Semen Platycladi], Guang Taoren [Semen Persicae], Zelan [Herba Lycopi], Xinjiang [Safflower silk], Guixu [Radix Angelicae Sinensis caulis], Xuanfuhua [Flores Inulae], Xian Congxu [Bulbus Allii Fistulosi], decocted with Xian Maogen [Rhizoma Imperatae], Quan Sigualuo [Retinervium Trichosanthis]) followed by Zhu Gu Baoming Dan (Roucongrong [Herba Cistanche], Hongzao [Fructus Jujubae], Qingfan [Vitriolum], smoke-extracted, mixed with Sizhi Xiangfu [Rhizoma Cyperi], Sheng Maiya [Semen Hordei Germinatum] pills) and Tongluo Xiao Gu Wan (Danggui Dizhu Wan) following Ye Tianshi's "Collateral stasis causes distension" principle. Finally, discussing Drum Syndrome (Single Abdominal Distension), ancient sages like Cheng Zhongling, Chen Xiuzhou...