胃气实则胀也。脉大坚，便秘，按之痛。仲景云∶腹满按之痛者为实，可下之。经云∶
中满者泻之于内，又云∶下之则胀已是也。
沉香交泰丸 治胀而大便燥结者。
沉香 橘红 白术（各二钱） 浓朴（五钱） 吴茱萸 枳实 青皮 木香 茯苓 泽泻
当归（各二钱） 大黄（酒浸，一两）
为末，蒸饼为丸，梧子大，每服五十丸，加至七八十丸，温汤下，微利为度。
四妙丸 治老幼腹胀，血气凝滞，用此宽肠顺气。
商州枳壳（浓而绿片者，去穣，四两分作四份） 一用苍术（一两同炒） 一用茴香（一两
同炒） 一用莱菔子（一两同炒） 一用干漆（一两同炒）
炒黄后，去四味，只取枳壳为末，以四味煎汁煮面糊丸，桐子大，每食后米饮下五十丸
。
中气虚衰，脾胃不健而三焦痞塞，是为气虚中满。经云∶足太阴虚则鼓胀也。其脉软，
其色白，其症腹胀，按之不痛，溏泄肠鸣，宜温养阳气为主，塞因塞用也。
参术健脾汤
人参 白术 茯苓 陈皮 半夏 缩砂 浓朴（姜制，各一钱） 炙草（三分）
水姜煎服。一方无甘草，有麦芽、山楂，因甘能满中。
积者，累积之谓，由渐而成，重而不移。聚者，聚散之谓，作止不常，痛无定所。故曰
积者阴气，聚者阳气。
积聚之病，非独痰食气血，即风寒外感，亦能成之。然痰食气血，非得风寒，未必成积
。风
寒之邪，不遇痰食气血，亦未必成积。经云∶卒然多食饮则肠满，起居不节，用力过度，则
络脉伤，血溢肠外，与寒相搏，并合凝聚，不得散而成积，此之谓也，经论心肝肾皆有积，
心曰伏梁，心下坚直，如梁木也。肝曰肥气，胁下气聚如复杯也。肾曰奔豚，往来上下如豚
之奔也。又有伏瘕、疝瘕、瘕聚、血瘕。伏瘕者，伏结于内。疝瘕者，冲痛如疝。瘕聚者，
聚散不常。血瘕者，血凝成瘕也。《难经》又补脾肺之积。脾曰痞气，气痞而不运。肺曰息
贲，响有声也。巢氏又有 瘕之辨，谓其病不动者， 也；虽有癖而可推移者，瘕也。 者
征也，有形可见也；瘕者假也，假物成形也。张子和又分九积。酒积者，目黄口干。食积者
酸心腹满。气积者，噫气痞塞。涎积者，咽如拽锯。痰积者，涕唾稠粘。癖积者，两胁刺
痛。水积者，足肿胀满。血积者，打扑肭疼。肉积者，赘瘤核 。各治法详见本方。
许学士云∶大抵治积，或以所恶者攻之，所喜者诱之，则易愈。如 砂、阿魏治肉积；
、麦芽治酒积；水蛭、虻虫治血积；木香、槟榔治气积；牵牛、甘遂治水积；雄黄、腻粉治
痰积；礞石、巴豆治食积。各从其类也。若用群队之药分其势，则难取效。
胃气充实则发生胀满。脉象大而坚，大便干结不通，按压腹部感到疼痛。张仲景说：腹部胀满且按压疼痛的属于实证，可以用攻下法治疗。医经中说：胸腹痞满的要从内部泻除，又说：用攻下法治疗后胀满消除，指的就是这种情况。
沉香交泰丸：治疗因胀满导致大便干燥结硬的患者。
药材组成：沉香、橘红、白术（各二钱）、浓朴（五钱）、吴茱萸、枳实、青皮、木香、茯苓、泽泻、当归（各二钱）、大黄（酒浸，一两）。
制法与用法：将上述药物研成细末，用蒸饼制成梧桐子大小的药丸。每次服用五十丸，逐渐增加至七八十丸，用温开水送服，以轻微腹泻为度。
四妙丸：治疗老人和儿童腹胀，以及血气凝滞的情况，使用此方可以宽肠顺气。
药材组成：商州枳壳（选择厚实绿色的切片，去除瓤，四两分为四份）；其中一份与苍术（一两）同炒；一份与小茴香（一两）同炒；一份与莱菔子（一两）同炒；一份与干漆（一两）同炒。
制法与用法：炒至黄色后，去掉另外四种药材，只保留枳壳研成细末。用那四种药材煎煮汁液，熬制成面糊状药丸，大小如梧桐子。每次饭后用米汤送服五十丸。
中气虚弱衰退，脾胃功能不健运，导致三焦气机痞塞不通，这称为气虚引起的中满。医经中说：足太阴脾经虚损则会出现鼓胀。其脉象软弱，面色苍白，症状表现为腹部胀满，但按压时不疼痛，伴有溏泄和肠鸣音，治疗应以温养阳气为主，采用“塞因塞用”（以补开塞）的方法。
参术健脾汤：
药材组成：人参、白术、茯苓、陈皮、半夏、缩砂仁、浓朴（姜制，各一钱）、炙甘草（三分）。
用法：加水、生姜煎服。另一版本方剂没有甘草，而是加入麦芽、山楂，因为甘味药容易导致中焦胀满。
积证，是指累积而成的病症，由逐渐发展而形成，质地坚硬沉重且位置固定不移。聚证，是指聚散无常，发作停止没有规律，疼痛部位不固定。所以说：积证属于阴气，聚证属于阳气。
积聚这类疾病，不仅仅是由于痰、食、气、血停滞所致，即使是风寒外感邪气，也能形成积聚。然而，痰、食、气、血停滞，如果不遇到风寒邪气，未必会形成积证。风寒邪气，如果不遇到痰、食、气、血停滞，也未必会形成积证。医经中说：突然饮食过量则肠道胀满，起居作息不节制，用力过度，则络脉受损，血液溢出肠外，与寒邪相互搏结，合并凝聚，不能消散，从而形成积证，说的就是这种情况。医经论述心、肝、肾都有积证：心的积证叫伏梁，心下坚硬挺直，像房梁木头一样；肝的积证叫肥气，胁下气聚集成形，像倒扣的杯子；肾的积证叫奔豚，感觉气往来上下运行，像小猪奔跑一样。还有伏瘕、疝瘕、瘕聚、血瘕等。伏瘕，是指潜伏结聚于体内；疝瘕，是指冲痛剧烈如同疝气；瘕聚，是指聚散无常；血瘕，是指血液凝结形成瘕块。《难经》又补充了脾和肺的积证：脾的积证叫痞气，气机痞塞而不运化；肺的积证叫息贲，呼吸有声。巢元方又有对癥和瘕的辨别，认为病位不动的是癥；虽然有癖块但可以推移的是瘕。癥是征验的意思，是有形可见的；瘕是假借的意思，是假借物而形成的形状。张子和又将积分为九种：酒积，表现为目黄口干；食积，表现为反酸、心中不适、腹部胀满；气积，表现为嗳气、痞塞不通；涎积，表现为咽喉如有拽锯之声；痰积，表现为鼻涕唾沫稠厚粘腻；癖积，表现为两胁刺痛；水积，表现为足部肿胀满闷；血积，表现为跌打损伤后的隐痛；肉积，表现为赘生肿瘤或核块。各种治疗方法详见本方记载。
许学士说：大抵治疗积证，可以用患者厌恶的药物来攻伐它，或用患者喜欢的药物来诱导它，这样容易治愈。例如：硇砂、阿魏治疗肉积；神曲、麦芽治疗酒积；水蛭、虻虫治疗血积；木香、槟榔治疗气积；牵牛子、甘遂治疗水积；雄黄、腻粉治疗痰积；礞石、巴豆治疗食积。这是根据各类积证的特性分别施治。如果使用大队药物分散病势，则难以取得疗效。
When the Stomach Qi is excess, distension occurs. The pulse is large and firm, constipation is present, and tenderness upon palpation. Zhang Zhongjing stated: Abdominal fullness with tenderness upon pressure indicates an excess pattern, which can be treated with purgation. The Classics state: "For internal fullness, drain from within," and also: "Purgation resolves distension."
Chenxiang Jiaotai Wan (Agarwood Harmony Pill): Treats distension accompanied by dry, hard stools.
Ingredients: Chenxiang (Aquilariae Lignum Resinatum), Juhong (Citri Reticulatae Pericarpium Rubrum), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 2 qian), Houpo (Magnoliae Officinalis Cortex), Wuzhuyu (Evodiae Fructus), Zhishi (Aurantii Fructus Immaturus), Qingpi (Citri Reticulatae Pericarpium Viride), Muxiang (Aucklandiae Radix), Fuling (Poria), Zexie (Alismatis Rhizoma), Danggui (Angelicae Sinensis Radix) (each 2 qian), Dahuang (Rhei Radix et Rhizoma) (soaked in wine, 1 liang).
Preparation and Administration: Grind into powder, mix with steamed bread dough to form pills the size of wu zi (Cibotii Semen). Take 50 pills per dose, increasing to 70-80 pills as needed, with warm water. Stop when mild diarrhea occurs.
Simiao Wan (Four Marvels Pill): Treats abdominal distension in the elderly and children, and stagnation of blood and qi; this formula relaxes the intestines and promotes smooth flow of qi.
Ingredients: Shangzhou Zhike (Aurantii Fructus) (select thick, green slices, remove albedo, 4 liang divided into four parts); one part stir-fried with Cangzhu (Atractylodis Rhizoma, 1 liang); one part stir-fried with Huixiang (Foeniculi Fructus, 1 liang); one part stir-fried with Laifuzi (Raphani Semen, 1 liang); one part stir-fried with Ganqi (Drynariae Rhizoma? Note: Text says Ganqi but context implies a resin or specific herb, likely Qianghuo or similar, but literal translation keeps name) (1 liang).
Preparation and Administration: Stir-fry until yellow, remove the other four herbs, retain only Zhike and grind into powder. Decoct the four removed herbs, use the decoction to make a paste with flour for pills, size of wu zi. Take 50 pills after meals with rice water.
When Middle Qi is deficient and declining, and the Spleen and Stomach fail to transform and transport, leading to obstruction of the Triple Burner, this is called "Zhong Man" (central fullness) due to Qi deficiency. The Classics state: "Deficiency of Foot Taiyin [Spleen] leads to drum-like distension." The pulse is soft, complexion is pale, symptoms include abdominal distension without tenderness upon pressure, loose stools, and borborygmus. Treatment should primarily focus on warming and nourishing Yang Qi, employing the method of "treating blockage with blockage" (using tonification for deficiency-type obstruction).
Shenzhu Jianpi Tang (Ginseng and Atractylodes Spleen-Strengthening Decoction):
Ingredients: Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Suosha (Amomi Fructus Rotundus), Houpo (Magnoliae Officinalis Cortex) (processed with ginger, each 1 qian), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) (3 fen).
Administration: Decoct with water and fresh ginger. Another version excludes Gancao and adds Maiya (Hordei Fructus Germinatus) and Shanzha (Crataegi Fructus), because sweet flavors can cause central fullness.
Ji (Accumulation) refers to gradual accumulation, formed slowly, characterized by heaviness and fixed location. Ju (Gathering) refers to gathering and dispersing irregularly, with intermittent onset and cessation, and pain without a fixed location. Thus, Ji is associated with Yin Qi, and Ju with Yang Qi.
Diseases of Ji and Ju are not caused solely by phlegm, food retention, or stagnation of Qi and Blood; even external contraction of Wind-Cold can lead to their formation. However, phlegm, food, Qi, and Blood stagnation may not form Ji without Wind-Cold. Conversely, Wind-Cold pathogens may not form Ji without encountering phlegm, food, Qi, or Blood stagnation. The Classics state: "Sudden overeating causes intestinal fullness; irregular lifestyle and excessive exertion damage collaterals, causing blood to extravasate outside the intestines. This blood combines with Cold, coagulates, and fails to disperse, forming Ji." The Classics discuss accumulations in the Heart, Liver, and Kidney: Heart accumulation is called Fuliang (Hidden Beam), presenting as hardness below the heart, straight and rigid like a beam. Liver accumulation is called Feiqi (Fat Qi), presenting as gas gathering under the hypochondrium, shaped like an inverted cup. Kidney accumulation is called Bentun (Running Piglet), presenting as sensation of gas moving up and down like a running piglet. There are also Fu Jia, Shan Jia, Jia Ju, and Xue Jia. Fu Jia lies hidden and knotted internally. Shan Jia involves sudden pain resembling hernia. Jia Ju gathers and disperses irregularly. Xue Jia results from blood coagulation forming a mass. The Nan Jing further supplements accumulations in the Spleen and Lung: Spleen accumulation is called Pi Qi (Obstructed Qi), where Qi is obstructed and fails to circulate. Lung accumulation is called Xiben (Breathful Accumulation), characterized by noisy breathing. Chao Yuanfang distinguished between Zheng and Jia: immobile lesions are Zheng; movable masses are Jia. Zheng implies visible signs; Jia implies temporary forms created by external factors. Zhang Zihe categorized nine types of Ji: Wine Ji presents with yellow eyes and dry mouth; Food Ji presents with acid regurgitation and abdominal fullness; Qi Ji presents with belching and obstruction; Saliva Ji presents with throat sensations like sawing; Phlegm Ji presents with thick, sticky sputum; Pi Ji presents with stabbing pain in both hypochondria; Water Ji presents with swollen, full legs; Blood Ji presents with dull pain after trauma; Meat Ji presents with tumors or nodules. Detailed treatments are found in the respective formulas.
Xu Xueshi stated: Generally, treating Ji involves attacking it with substances the patient dislikes, or inducing it with substances the patient likes, facilitating cure. For example: Naosha (Sal Ammoniac) and Awei (Asafetida) treat Meat Ji; Shenqu (Massa Medicata Fermentata) and Maiya treat Wine Ji; Shuizhi (Hirudo) and Mengchong (Ophiorrhiza Mungo? Note: Mengchong usually refers to horseflies, Hirudinis/Tabanidae) treat Blood Ji; Muxiang and Binglang (Arecae Semen) treat Qi Ji; Qianniu (Pharbitidis Semen) and Gansui (Kansui Radix) treat Water Ji; Xionghuang (Realgar) and Nifen (Calomel) treat Phlegm Ji; Mengshi (Fluorite) and Badou (Crotonis Fructus) treat Food Ji. This follows the principle of treating according to category. Using a large group of drugs to scatter the pathogenic factor's momentum makes efficacy difficult to achieve.