有实、有虚。实者，按之坚而痛；虚者，按之不坚不痛。实者，宜下之、削之，次补之；虚者，温之、升之，补为
要。朝宽暮急者，血虚；暮宽朝急者，气虚；日夜急者，气血俱虚。臌胀又名曰蛊，即所谓单腹胀也。（其详在《格致
余论》中。）治法大补中气，行湿为主，此脾虚之甚，必须远音乐，断浓味。有气虚者，大剂参、术，佐以陈皮、茯苓、
黄芩、苍术之类；有血虚者，以四物为主，随证加减。实兼人壮盛者，或可用攻药，便用收拾，以白术为主。气虚中满，
四君子加芎、归、芍药、黄连、陈皮、浓朴、生甘草。胃虚腹胀，调中汤∶人参、白术、陈皮、甘草、半夏、浓朴、生
姜。腹胀挟虚分消丸治之。寒而腹胀挟虚者，分消汤治之。寒胀，沉香尊重丸治之。腹胀挟内伤虚证，木香顺
气汤并沉香交泰丸。伤寒、痞满、燥实四证，而人壮者，或杂证腹满如四证者，用大承气汤。太阴病，腹胀满，四
肢肿，或一身肿，胸痞，不食，小便少，大便难或溏，或脾
胀善哕，大满体重，服索矩三和汤。脾湿而腹胀满，面黄溺涩，胃苓汤。下虚腹胀气上，四物加人参、陈皮、木
通、甘草、连翘；有食积者，吞保和丸。饮酒人胀，小便混浊，夜发足肿，桂苓甘露饮加人参。甘葛、藿香、木香。
腹胀不觉满，食肉多所致者，黄连（一两为末） 阿魏（半两醋浸）研如糊，为丸，同温中丸白术汤下。食肉多腹
胀，三补丸起料，加香附、下甲，炊饼丸服。浓朴治腹胀，因其味辛也，须用姜制。一云∶胀病必用参、 、白术
大剂补脾，则其气自动，白术又为君主之药，必带浓朴宽满。一人气弱腹膨浮肿，用参、归、茯苓、芍药各一钱，
白术二钱，川芎七分半，陈皮、腹皮、木通、浓朴、海金沙各五分，紫苏梗、木香各三分，数服后浮肿尽去。余头
面未消，此阳明气虚，故难得退，再用白术、茯苓。一妇人，腹久虚胀单胀者，因气馁不能运，但面肿手足，或肿
气上行，阳分来应，尚可治，参、术、芎、归为主，佐以白芍药之酸敛胀，滑石燥湿兼利水，大腹皮敛气，紫苏梗、莱
菔子、陈皮泄满，海金沙、木通利水，木香营运，生甘草调诸药。一妇，气虚单胀面带肿，参、术、茯苓、浓朴、大
腹皮、芎归、白芍、生甘草、滑石。一人嗜酒，病疟半年，患胀腹如蜘蛛；一人嗜酒，便血后患胀，色黑而腹大形
如鬼状（俱见《医要》）。上二者，一补其气，一补其血，余药大率相出入，而皆获安。
Distension and fullness of the abdomen (Gu Zhang) presents as either excess or deficiency. In excess patterns, palpation reveals hardness and pain; in deficiency patterns, palpation reveals neither hardness nor pain. For excess patterns, purgative methods (Xia Fa) and reduction methods (Xiao Fa) are indicated, followed by tonification; for deficiency patterns, warming (Wen Zhi) and ascending (Sheng Zhi) methods are indicated, with tonification being paramount. If symptoms ease in the morning but worsen in the evening, it indicates Blood Deficiency (Xue Xu); if they ease in the evening but worsen in the morning, it indicates Qi Deficiency (Qi Xu); if they are urgent day and night, it indicates combined Qi and Blood Deficiency (Qi Xue Ju Xu). Distension and fullness is also known as Gu distension, referring to what is called "single abdominal distension" (Dan Fu Zhang). (Details can be found in *Ge Zhi Yu Lun*.) The treatment principle focuses on greatly tonifying Middle Qi (Zhong Qi) while promoting dampness resolution. This represents severe Spleen Deficiency (Pi Xu), requiring avoidance of music/entertainment and rich/greasy foods. In cases of Qi Deficiency, large doses of Ginseng (Renshen) and Atractylodes Macrocephala Rhizome (Baizhu) are used, assisted by Tangerine Peel (Chenpi), Poria (Fuling), Scutellaria Root (Huangqin), and Atractylodes Lancea Rhizome (Cangzhu). In cases of Blood Deficiency, Four Substances Decoction (Sì Wù Tāng) is the main formula, modified according to symptoms. If excess patterns accompany a robust constitution, attacking medicines may be used, but once bowel movements occur, recovery should be managed primarily with Atractylodes Macrocephala Rhizome (Baizhu). For middle-fullness due to Qi Deficiency, Four Gentlemen Decoction (Sì Jūn Zǐ Tāng) is added with Ligusticum Chuanxiong Rhizome (Chuān Xiōng), Angelica Sinensis Radix (Dāngguī), Peony Root (Shaoyao), Coptis Rhizome (Huánglián), Tangerine Peel (Chén pí), Magnolia Bark (Hòupò), and Licorice Root (Gāncǎo - raw). For stomach-deficiency abdominal distension, Regulate the Middle Decoction (Tiáo Zhōng Tāng) is used: Ginseng (Rénshēn), Atractylodes Macrocephala Rhizome (Báizhú), Tangerine Peel (Chénpí), Licorice Root (Gāncǎo), Pinellia Tuber (Bànbxià), Magnolia Bark (Hòupò), and Fresh Ginger (Shēngjiāng). For abdominal distension complicated by deficiency, Divide and Eliminate Pill (Fēn Xiāo Wán) is used. For cold-type abdominal distension complicated by deficiency, Divide and Eliminate Decoction (Fēn Xiāo Tāng) is used. For cold distension, Agastache Respecting Pill (Chénxiāng Zūnzhòng Wán) is used. For abdominal distension complicated by internal injury and deficiency patterns, Wood Fragrance Smooths Qi Decoction (Mùxiāng Shùnqì Tāng) and Agastache Harmonizes Yin-Yang Pill (Chénxiāng Jiāotài Wán) are used. For Taiyang Cold Damage (Shānghán), Pi-Man (Pihou), Dryness-Excess (Zàoshí) syndromes, in patients with robust constitutions, or miscellaneous diseases presenting with abdominal fullness resembling these four syndromes, Major Order the Yang Decoction (Dà Chéngqì Tāng) is used. For Taiyin Disease (Tàiyīn Bìng), presenting with abdominal fullness, swelling of the four limbs, or whole-body swelling, chest oppression, anorexia, oliguria, difficult or loose stools, or Spleen distension with frequent hiccups, great fullness, and heavy body, Suoju Sanhe Decoction (Suǒjǔ Sānhé Tāng) is administered. For Spleen-Dampness causing abdominal fullness, yellow complexion, and dysuria, Stomach-Poria Decoction (Wèilíng Tāng) is used. For lower-jiao deficiency causing abdominal distension with Qi rebellion, Four Substances Decoction (Sì Wù Tāng) is added with Ginseng (Rénshēn), Tangerine Peel (Chénpí), Akebia Stem (Mùtōng), Licorice Root (Gāncǎo), and Forsythia Fruit (Liánqiào); if there is food stagnation, Harmony Preserving Pill (Bǎohé Wán) is swallowed. For drinkers with abdominal distension, turbid urine, and nocturnal foot swelling, Cinnamon Twig and Poria Decoction (Guìlíng Gānlù Yǐn) is used with Ginseng (Rénshēn), along with Kudzu Root (Gāngě), Patchouli Herb (Huòxiāng), and Aucklandia Root (Mùxiāng). For abdominal distension where fullness is not perceived, caused by excessive meat consumption, use Coptis Rhizome (Huánglián - 1 liang powdered) and Asafoetida (Āwèi - 0.5 liang vinegar-soaked), ground into a paste, made into pills, and taken with Baizhu Decoction alongside Warm the Middle Pill (Wēnzhōng Wán). For abdominal distension from excessive meat consumption, Three Tonics Pill (Sān Bǔ Wán) is used as the base, adding Cyperus Rhizome (Xiāngfù) and Oyster Shell (Xiàjiǎ), formed into steamed dough pills. Magnolia Bark (Hòupò) treats abdominal distension due to its pungent flavor; it must be processed with ginger. One view states that distension diseases require large doses of Ginseng (Rénshēn), [Missing Character], and Atractylodes Macrocephala Rhizome (Báizhú) to tonify the Spleen, allowing Qi to move spontaneously; since Baizhu is the sovereign herb, it must be paired with Hòupò to relieve fullness. For a person with weak Qi, abdominal bloating, and edema, use Ginseng (Rénshēn), Angelica Sinensis Radix (Dāngguī), Poria (Fúlín), and Peony Root (Sháoyào) each 1 qian, Atractylodes Macrocephala Rhizome (Báizhú) 2 qian, Ligusticum Chuanxiong Rhizome (Chuānxiōng) 0.75 qian, Tangerine Peel (Chénpí), Areca Seed (Fúpí), Akebia Stem (Mùtōng), Magnolia Bark (Hòupò), and Gold Sand Grass (Hǎijīnshā) each 0.5 qian, Perilla Stem (Zǐsū Gěng) and Aucklandia Root (Mùxiāng) each 0.3 qian. After several doses, edema disappears. If head and face swelling remain, this indicates Yangming Qi Deficiency, making it hard to resolve; use Baizhu and Fuling again. For a woman with long-standing deficiency-type single abdominal distension, due to depleted Qi failing to transport, presenting only with facial and extremity swelling, or Qi swelling upward responding to Yang aspects, which is treatable, use Ginseng (Rénshēn), Atractylodes Macrocephala Rhizome (Báizhú), Ligusticum Chuanxiong Rhizome (Chuānxiōng), and Angelica Sinensis Radix (Dāngguī) as the main herbs, assisted by White Peony Root (Bái Sháoyào) for its sour astringency to constrain distension, Talcum (Huáshí) to dry dampness and promote urination, Areca Seed (Dàfúpí) to constrain Qi, Perilla Stem (Zǐsū Gěng), Radish Seed (Láifuzǐ), and Tangerine Peel (Chénpí) to drain fullness, Gold Sand Grass (Hǎijīnshā) and Akebia Stem (Mùtōng) to promote urination, Aucklandia Root (Mùxiāng) to circulate Qi, and Raw Licorice Root (Shēng Gāncǎo) to harmonize the herbs. For a woman with Qi-deficiency single distension and facial swelling, use Ginseng (Rénshēn), Atractylodes Macrocephala Rhizome (Báizhú), Poria (Fúlín), Magnolia Bark (Hòupò), Areca Seed (Dàfúpí), Ligusticum Chuanxiong Rhizome (Chuānxiōng), Angelica Sinensis Radix (Dāngguī), White Peony Root (Bái Sháoyào), Raw Licorice Root (Shēng Gāncǎo), and Talcum (Huáshí). For a person addicted to alcohol who suffered malaria for half a year and developed abdominal distension like a spider; and another person addicted to alcohol who developed distension after hematochezia, with black complexion and a giant abdomen resembling a ghost (both seen in *Yi Yao*). For the above two cases, one tonifies Qi, the other tonifies Blood; the remaining herbs vary slightly, yet all achieved peace/recovery.