灵枢胀论谓∶五脏六腑，皆各有胀，诸胀者，皆因厥气在下，营卫留止，寒气逆上，真邪相攻，两气
相搏，乃合而为胀也。故凡治胀病，必会通圣经诸条之旨，然后能识脏腑之部分，邪气之盛衰，盖名曰厥
气者逆气也，寒气者浊阴也，逆气下塞，浊阴上干，卫气滞留，营血凝止，营卫不调，寒邪得以乘虚而
入，真邪相持，互结不解，脏虚邪即入脏，腑虚邪即
入腑，故有五脏六腑诸胀之见症，治法分别列后。
心胀者，烦心短气，卧不安。心为君主之官，神明出焉，寒邪来犯，心阴郁遏，阴阳交战则短气，火
被水克为心烦，心肾不交，则卧不安也。当宜发扬神明，以安心脏，俾离火空照，则阴翳自散。
川桂枝（四分） 光杏仁（三钱） 生甘草（五分） 朱茯神（三钱） 酸枣仁（三钱） 紫丹参（三钱）
炙远志（一钱） 川郁金（一钱五分） 琥珀屑（冲服，六分） 姜皮（五分） 沉香片（四分） 朱灯心（二扎）
肺胀者，虚满喘咳。肺为至高之脏，位主上焦，职司清肃。寒客于肺，肺气壅塞，清肃之令，不得下
行。先哲云∶喘咳之为病，在肺为实，在肾为虚，此肺金之实喘也。宜温肺散寒，射干麻黄汤加减，如寒
包热者，麻杏石甘汤治之。
净麻黄（四分） 嫩射干（八分） 光杏仁（三钱） 生甘草（六分） 象贝母（三钱） 仙半夏（二钱）
薄橘红（八分） 桑白皮（二钱） 炙款冬（一钱五分） 栝蒌皮（二钱） 清水炒枇杷叶（去毛、包，二钱）
脾胀者，善哕，四肢烦 ，体重不能胜衣，卧不安。脾为太阴而主四肢，脾弱生湿，湿阻中宫，真阳不运，
土德日衰，寒邪乘之，浊阴凝聚而为哕，为体
重，为烦 也。脾与胃为表里，脾病胃亦病，胃不和则卧不安。宜温运太阴，而化湿浊。
熟附片（一钱五分） 生白术（一钱五分） 炮姜炭（八分） 云茯苓（三钱） 仙半夏（二钱） 青陈皮（各一
钱） 大砂仁（八分） 炒薏仁（八钱） 炒谷麦芽（各三钱） 制川朴（一钱）
肝胀者，胁下满而痛引少腹。胁乃肝之分野，少腹乃厥阴之界，寒客厥阴，木失条达，厥气横逆鸱
张，故胁满而少腹痛也。宜疏泄厥气，而散寒邪。
软柴胡（一钱） 炒赤白芍（各一钱五分） 金铃子（二钱） 延胡索（一钱） 细青皮（一钱） 春砂壳（八分）
川郁金（一钱五分） 广木香（六分） 青橘叶（一钱五分） 小茴香（八分） 台乌药（一钱） 江枳壳（一钱）
肾胀者，腹满引背，央央然腰髀痛。肾为水脏，腰为肾府，寒着于肾，下元虚寒，真阳埋没，阴邪充
斥，故腹满而腰髀痛也。宜温肾助阳，而驱浊阴，俾得阳光普照，则阴霾自消。
熟附块（一钱五分） 生白术（二钱） 西秦艽（二钱） 川牛膝（三钱） 浓杜仲（三钱） 补骨脂（一钱五分）
青陈皮（各一钱） 台乌药（一钱） 小茴香（一钱） 广木香（六分） 嫩桑枝（四钱） 生姜（三片）
胃胀者，腹满，胃脘痛，鼻闻焦臭，妨于食，大便难。胃为阳土，主司出纳，寒邪乘之，胃气不
通，不通则痛。胃既受病，水谷停滞中宫，欲化不化，反变败浊，故鼻闻焦臭而妨碍饮食也。谷气不
行，阳不通达，受盛传导，皆失所司，故大便难，与腑实便闭者不同。宜平胃散合脾约麻仁丸加减。
制苍术（一钱） 制川朴（一钱） 陈广皮（一钱） 细青皮（一钱） 江枳壳（一钱） 大砂仁（研，八分）
广郁金（一钱五分） 全栝蒌（切，三钱） 脾约麻仁丸（包，五钱） 广木香（四分）
大肠胀者，肠鸣而痛濯濯，冬日重感于寒，则飧泄不化。大肠为传导之官，变化糟粕而出焉，寒客大
肠，变化无权，清浊混淆，则生飧泄；虚寒气滞，则肠鸣而痛濯濯也。宜温中化浊，分利阴阳。
熟附块（八分） 炮姜炭（六分） 生白术（二钱） 广木香（八分） 陈广皮（一钱） 猪茯苓（各三钱）
大砂仁（研，一钱） 制小朴（八分） 大腹皮（二钱） 六神曲（三钱）
小肠胀者，少腹 胀，引腰而痛。小肠为受盛之官，化物出焉。位居胃之下口，大肠之上口，寒客小
肠，物无由化，水液不得渗于前，糟粕不得归于后，故为少腹 胀，引腰而痛，小溲必不利也。宜通幽化
浊，滑利二便。
细青皮（一钱五分） 赤茯苓（三钱） 台乌药（一钱） 细木通（酒炒，一钱五分） 栝蒌仁（研，三钱）
车前子（二钱） 广木香（六分） 江枳壳（二钱） 青橘叶（一钱五分） 光杏仁（三钱） 生姜（三片）
膀胱胀者，少腹满而气癃。膀胱为州都之官，津液藏焉，气化则能出矣。寒客膀胱，湿郁下焦，气化
不及州都，水道窒塞不通，故少腹满而气癃，即今之癃闭也。宜打开上闸，以通下源，如提壶挈盖之意。
苦桔梗（二钱） 光杏仁（三钱） 云茯苓（三钱） 细木通（八分） 车前子（三钱） 瞿麦穗（二钱）
冬葵子（四钱） 怀牛膝（二钱） 滋肾通关丸（包，三钱） 荸荠梗（三钱）
三焦胀者，气满于皮肤中，轻轻然而不坚。三焦即募原，为决渎之官，水道出焉。寒气逆于三焦，决
渎失职，气与水逆走腠理，其水不得从膀胱而泄。气本无形，水质不坚，故气满于皮肤中，轻轻然而不
坚，与肤胀等耳。当行气利水，五苓五皮加减。
川桂枝（五分） 生白术（一钱五分） 桑白皮（二钱） 鲜姜皮（一钱） 陈广皮（一钱） 赤猪苓（各三钱）
江枳壳（一钱） 福泽泻（一钱五分） 大腹皮（二钱） 广木香（六分） 冬瓜皮
（一两，煎汤代水）
胆胀者，胁下痛胀，口中苦，善太息。胆为中正之官，决断出焉，惟其气血皆少，为清净之府，而内
寄相火。寒客于胆，胆与肝为表里，胆病而肝亦病，胆汁上溢，故口苦；肝气怫郁，故胁痛胀善太息也。宜
和解枢机，而泄厥阴。
柴胡（一钱） 当归（二钱） 白芍（一钱五分） 栀子皮（一钱五分） 白蒺藜（三钱） 云苓（三钱）
陈皮（一钱） 枳壳（一钱） 合欢皮（二钱） 川郁金（一钱五分） 佛手（八分）
由是观之，五脏六腑之胀，属寒者多而属热者少，属实者多而属虚者少。中满分消，治寒胀也；丹
溪小温中丸，治热胀也；金匮工在疾下，治实胀也；济生肾气，治虚胀也。为司命之职，苟不辨明清切，
而笼统处方，岂不自欺欺人乎？
The *Ling Shu: Treatise on Distension* states: The five zang organs and six fu organs each have their own distensions. All types of distension arise because jue qi (rebellious qi) is located below, while ying qi (nutritive qi) and wei qi (defensive qi) remain stagnant. Cold pathogen rebels upward; true qi and evil pathogen attack each other, and the two qi forces contend, resulting in distension. Therefore, when treating any distension disease, one must integrate the principles of various passages from the Classics to identify the locations of the zang and fu organs, and the excess or deficiency of the pathogenic factors. "Jue qi" refers to rebellious qi; "cold pathogen" refers to turbid yin. Rebellious qi obstructs downward, turbid yin invades upward, causing wei qi to stagnate and ying blood to coagulate. When ying and wei are disharmonious, cold pathogen enters through the deficiency. True qi and evil pathogen contend and knot together unresolved. If the zang is deficient, the pathogen enters the zang; if the fu is deficient, the pathogen enters the fu. Thus, symptoms of distension in the five zang and six fu organs appear. Treatment methods are listed below.
Distension of the Heart presents with vexation, shortness of breath, and restless sleep. The Heart is the sovereign official, from which shen ming (spiritual consciousness) emerges. When cold pathogen attacks, heart yin is depressed, leading to a battle between yin and yang, causing shortness of breath; fire is controlled by water, causing vexation; lack of communication between heart and kidney results in restless sleep. One should promote the manifestation of shen ming to calm the heart, allowing the Li Fire (Heart Yang) to shine brightly so that yin shadows naturally dissipate.
Chuan Guizhi (Cinnamon Twig, 4 fen), Guang Xingren (Apricot Seed, 3 qian), Sheng Gancao (Raw Licorice Root, 5 fen), Zhu Fushen (Poria with Hostwood, 3 qian), Suanzaoren (Ziziphus Seed, 3 qian), Zi Danshen (Salvia Miltiorrhiza Root, 3 qian), Zhi Yuanzhi (Polygala Root, 1 qian), Chuan Yujin (Curcuma Aromatica Rhizome, 1.5 qian), Hupo Xie (Amber Dust, taken with decoction, 6 fen), Jiangpi (Ginger Peel, 5 fen), Chenxiang Pian (Aquilaria Wood Slice, 4 fen), Zhu Dengxin (Acorus Flagellum, 2 bundles).
Distension of the Lung presents with empty fullness, wheezing, and cough. The Lung is the highest organ, residing in the Upper Jiao, responsible for clearing and descending. When cold pathogen lodges in the Lung, lung qi becomes congested, and its function of clearing and descending cannot proceed downward. Ancients stated: Wheezing and cough are excess patterns in the Lung but deficiency patterns in the Kidney. This is an excess wheezing of Metal (Lung). It is suitable to warm the Lung and disperse cold, using Shegan Mahuang Tang (Belamcanda and Ephedra Decoction) with modifications. If it is cold enveloping heat, use Maxing Shigan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction).
Jing Mahuang (Prepared Ephedra Herb, 4 fen), Nen Shegan (Belamcanda Rhizome, 8 fen), Guang Xingren (Apricot Seed, 3 qian), Sheng Gancao (Raw Licorice Root, 6 fen), Xiang Beimu (Fritillaria Thunbergii Bulb, 3 qian), Xian Banxia (Pinellia Tuber, 2 qian), Bo Juhong (Tangerine Peel, 8 fen), Sangbaipi (Mulberry Root Bark, 2 qian), Zhi Kuandong (Coltsfoot Flower, 1.5 qian), Gualou Pi (Trichosanthes Peel, 2 qian), Qingshui Chao Pipaye (Water-fried Loquat Leaf, de-haired and wrapped, 2 qian).
Distension of the Spleen presents with frequent hiccups, heavy and uncomfortable limbs, body weight so great that one cannot bear clothes, and restless sleep. The Spleen belongs to Taiyin and governs the four limbs. Spleen deficiency generates dampness; dampness obstructs the Middle Jiao (Spleen and Stomach), preventing the transport of True Yang. Earth virtue declines daily. Cold pathogen takes advantage, causing turbid yin to condense, leading to hiccups, heaviness, and discomfort. The Spleen and Stomach are exterior-interior partners; if the Spleen is diseased, the Stomach is also affected. Disharmony in the Stomach leads to restless sleep. It is suitable to warm and transport Taiyin, resolving damp-turbidity.
Shu Fupian (Prepared Aconite Root, 1.5 qian), Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome, 1.5 qian), Pao Jiangtan (Charred Ginger, 8 fen), Yun Fuling (Poria, 3 qian), Xian Banxia (Pinellia Tuber, 2 qian), Qing Chenpi (Green and Tangerine Peel, 1 qian each), Da Sharen (Amomum Fruit, 8 fen), Chao Yiren (Fried Coix Seed, 8 qian), Chao Gumaicha (Fried Barley and Malt Sprouts, 3 qian each), Zhi Chuanpo (Prepared Magnolia Bark, 1 qian).
Distension of the Liver presents with fullness and pain under the ribs radiating to the lower abdomen. The hypochondrium is the domain of the Liver; the lower abdomen is the boundary of the Jueyin channel. Cold pathogen lodges in Jueyin, causing Wood qi to lose its free flow. Jueqi rebels horizontally and aggressively, resulting in rib fullness and lower abdominal pain. It is suitable to soothe and drain Jueqi and disperse cold pathogen.
Ruan Chaihu (Bupleurum Root, 1 qian), Chao Chi Baishao (Fried Red and White Peony Root, 1.5 qian each), Jinlingzi (Melia Fruit, 2 qian), Yanhusuo (Corydalis Rhizome, 1 qian), Xi Qingpi (Fine Green Tangerine Peel, 1 qian), Chun Shake (Spring Sand Cardamom Shell, 8 fen), Chuan Yujin (Curcuma Aromatica Rhizome, 1.5 qian), Guang Muxiang (Vladimiria Root, 6 fen), Qing Jiuye (Green Orange Leaf, 1.5 qian), Xiaohuixiang (Fennel Fruit, 8 fen), Tai Wuyao (Lindera Root, 1 qian), Jiang Zhike (Citrus Aurantium Fruit, 1 qian).
Distension of the Kidney presents with abdominal fullness radiating to the back, and aching pain in the waist and thighs. The Kidney is the Water organ; the waist is the residence of the Kidney. Cold pathogen adheres to the Kidney, causing deficiency-cold in the Lower Yuan and burying of True Yang, with yin pathogens filling the space. Thus, abdominal fullness and waist/thigh pain occur. It is suitable to warm the Kidney and assist Yang, driving out turbid yin, so that sunlight shines universally and yin mists naturally dissipate.
Shu Fu kuai (Prepared Aconite Chunk, 1.5 qian), Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome, 2 qian), Xi Qinjiao (Sophora Flavescens Root, 2 qian), Chuan Niuxi (Achyranthes Bidentata Root, 3 qian), Nong Duzhong (Eucommia Bark, 3 qian), Buguzhi (Psoralea Fruit, 1.5 qian), Qing Chenpi (Green and Tangerine Peel, 1 qian each), Tai Wuyao (Lindera Root, 1 qian), Xiaohuixiang (Fennel Fruit, 1 qian), Guang Muxiang (Vladimiria Root, 6 fen), Nen Sangzhi (Young Mulberry Twig, 4 qian), Shengjiang (Fresh Ginger, 3 slices).
Distension of the Stomach presents with abdominal fullness, epigastric pain, smelling burnt odors from the nose, difficulty eating, and difficult defecation. The Stomach is Yang Earth, governing reception and discharge. Cold pathogen attacks, stomach qi fails to circulate; obstruction causes pain. Once the Stomach is diseased, food and water stagnate in the Middle Jiao. Unable to transform, they become foul turbidity, causing the nose to smell burnt odors and hindering diet. Grain qi does not move, Yang qi does not reach, and receiving and transporting functions fail, causing difficult defecation. This differs from fu-organ excess constipation. It is suitable to modify Pingwei San (Peaceful Stomach Powder) combined with Jiyue Maren Wan (Spley-Restricting Hemp Seed Pill).
Zhi Cangzhu (Prepared Atractylodes Lancea Rhizome, 1 qian), Zhi Chuanpo (Prepared Magnolia Bark, 1 qian), Chen Guangpi (Aged Tangerine Peel, 1 qian), Xi Qingpi (Fine Green Tangerine Peel, 1 qian), Jiang Zhike (Citrus Aurantium Fruit, 1 qian), Da Sharen (Amomum Fruit, ground, 8 fen), Guang Yujin (Curcuma Aromatica Rhizome, 1.5 qian), Quan Gualou (Whole Trichosanthes Fruit, sliced, 3 qian), Jiyue Maren Wan (Spley-Restricting Hemp Seed Pill, wrapped, 5 qian), Guang Muxiang (Vladimiria Root, 4 fen).
Distension of the Large Intestine presents with borborygmus and gurgling pain. If exposed to cold again in winter, undigested stool diarrhea occurs. The Large Intestine is the official of transmission, changing waste and expelling it. Cold pathogen lodges in the Large Intestine, impairing transformation, confusing clear and turbid, leading to undigested stool diarrhea. Deficiency-cold and qi stagnation cause borborygmus and gurgling pain. It is suitable to warm the middle, resolve turbidity, and separate yin and yang.
Shu Fu kuai (Prepared Aconite Chunk, 8 fen), Pao Jiangtan (Charred Ginger, 6 fen), Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome, 2 qian), Guang Muxiang (Vladimiria Root, 8 fen), Chen Guangpi (Aged Tangerine Peel, 1 qian), Zhu Fuling (Poria, 3 qian each), Da Sharen (Amomum Fruit, ground, 1 qian), Zhi Xiao Po (Prepared Small Magnolia Bark, 8 fen), Dafupi (Areca Peel, 2 qian), Liushenqu (Six Divine Qu, 3 qian).
Distension of the Small Intestine presents with lower abdominal distension radiating to the waist for pain. The Small Intestine is the official of reception and transformation. Located below the stomach opening and above the large intestine opening, cold pathogen lodges here, preventing food transformation. Fluids cannot secrete anteriorly, and waste cannot return posteriorly. Thus, lower abdominal distension radiates to the waist for pain, and urination is necessarily difficult. It is suitable to open the dark, resolve turbidity, and lubricate both bowels.
Xi Qingpi (Fine Green Tangerine Peel, 1.5 qian), Chi Fuling (Red Poria, 3 qian), Tai Wuyao (Lindera Root, 1 qian), Xi Mutong (Akebia Stem, wine-fried, 1.5 qian), Gualou Ren (Trichosanthes Seed, ground, 3 qian), Cheqianzi (Plantago Seed, 2 qian), Guang Muxiang (Vladimiria Root, 6 fen), Jiang Zhike (Citrus Aurantium Fruit, 2 qian), Qing Jiuye (Green Orange Leaf, 1.5 qian), Guang Xingren (Apricot Seed, 3 qian), Shengjiang (Fresh Ginger, 3 slices).
Distension of the Bladder presents with lower abdominal fullness and urinary retention (Qi Long). The Bladder is the official of the capital, storing fluids; qi transformation allows excretion. Cold pathogen lodges in the Bladder, dampness郁 (stagnates) in the Lower Jiao, qi transformation fails at the capital, and water pathways are blocked. Thus, lower abdominal fullness and urinary retention occur, known today as Long Bi (urinary retention). It is suitable to open the upper gate to unblock the lower source, akin to lifting the lid of a teapot.
Ku Jiegeng (Platycodon Root, 2 qian), Guang Xingren (Apricot Seed, 3 qian), Yun Fuling (Poria, 3 qian), Xi Mutong (Akebia Stem, 8 fen), Cheqianzi (Plantago Seed, 3 qian), Qumaisui (Dianthus Flower Spike, 2 qian), Dongkuizi (Malva Seed, 4 qian), Huai Niuxi (Achyrathes Bidentata Root, 2 qian), Zishen Tongguan Wan (Nourish Kidney Unblock Pass Pill, wrapped, 3 qian), Qiji Geng (Water Chestnut Stem, 3 qian).
Distension of the San Jiao (Triple Burner) presents with qi fullness in the skin, feeling light but not firm. The San Jiao is the Mu Yuan (origin membrane), the official of drainage, where waterways emerge. Cold pathogen rebels in the San Jiao, drainage fails, qi and water reverse into the interstices. Water cannot drain via the Bladder. Qi is formless, water quality is not firm, so qi fills the skin, feeling light but not firm, similar to skin distension. One should move qi and promote urination, using Wuling Wupi San (Five Ling Five Peel Powder) with modifications.
Chuan Guizhi (Cinnamon Twig, 5 fen), Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome, 1.5 qian), Sangbaipi (Mulberry Root Bark, 2 qian), Xian Jiangpi (Fresh Ginger Peel, 1 qian), Chen Guangpi (Aged Tangerine Peel, 1 qian), Chi Zhuling (Red Polyporus, 3 qian each), Jiang Zhike (Citrus Aurantium Fruit, 1 qian), Fu Zexie (Alisma Rhizome, 1.5 qian), Dafupi (Areca Peel, 2 qian), Guang Muxiang (Vladimiria Root, 6 fen), Donggua Pi (Winter Melon Peel, 1 liang, decocted as water substitute).
Distension of the Gallbladder presents with pain and distension under the ribs, bitter taste in the mouth, and frequent sighing. The Gallbladder is the official of justice, from which decision-making arises. Its qi and blood are scant, it is a pure organ, harboring Ministerial Fire internally. Cold pathogen lodges in the Gallbladder; since Gallbladder and Liver are exterior-interior partners, Gallbladder disease affects the Liver. Gallbladder juice overflows upward, causing bitter taste; Liver qi stagnates, causing rib pain/distension and frequent sighing. It is suitable to harmonize the pivot and drain Jueyin.
Chaihu (Bupleurum Root, 1 qian), Danggui (Angelica Sinensis Root, 2 qian), Baishao (White Peony Root, 1.5 qian), Zhizi Pi (Gardenia Bark, 1.5 qian), Bai Jili (Tribulus Fruit, 3 qian), Yun Ling (Poria, 3 qian), Chenpi (Tangerine Peel, 1 qian), Zhike (Citrus Aurantium Fruit, 1 qian), Hehuanpi (Albizia Bark, 2 qian), Chuan Yujin (Curcuma Aromatica Rhizome, 1.5 qian), Foshou (Finger Citron, 8 fen).
From this, we see that distensions of the five zang and six fu organs are mostly cold-pattern rather than heat-pattern, and mostly excess-pattern rather than deficiency-pattern. Zhongman Fenxiao Wan (Middle Fullness Resolving Pill) treats cold distension; Danxi Xiaowenzhong Wan (Danxi's Small Warming Middle Pill) treats heat distension; *Jingui Yaolue* advocates urgent purging to treat excess distension; Jisheng Shenqi Wan (Jisheng Kidney Qi Pill) treats deficiency distension. As healers, if one does not clearly distinguish patterns through pulse diagnosis and prescribing, but prescribes indiscriminately, is this not deceiving oneself and others?