刘河间云∶肠胃郁结，谷气内发，而不能宣通于肠胃之外，故喜噫下气也。若癫痫劳瘵，气
下泄而不止者，必死。乃真气竭绝，腠理闭塞，谷气不能宣通于肠胃之外，故从肠胃中泄出
。娄全善云∶下气属心虚。经云∶夏脉者心也。心脉不及，下气为泄者是也。经又云∶饮食
入胃，游溢精气，上输于脾；脾气散精，上归于肺；通调水道，下输膀胱；水精四布，五经
并行。此平人也。若七情内伤，六淫外侵，饮食失节，房劳过度，致脾土之阴受伤，转运之
官失职，不能输化，故下气也。又曰∶阴精所奉其人寿；阳精所降其人夭。阴精者，乃五谷
之精，上荣心肺，以降肾肝，故曰其人寿。阳精者，乃胃中之清气，陷入肾肝，不能升浮上
输心肺，故曰其人夭。若饮食过多，肠胃郁结，用平胃散。癫痫劳瘵，用补中益气汤。心气
虚弱，用补心丸。心气虚寒，用补心汤。脾胃虚寒，用理中汤。肝木乘脾，用六君子汤、加木香。脾
气郁结，用加味归脾汤。脾气下陷，用补中益气汤。命门火衰，用八味丸。肾气不足，用六
味地黄丸。
大凡噫气下气者，其脉不及本位。《内经》云∶短则气病，以其无胃气也。诸病见此脉难治
，但纯补胃气为善。
治验（兼仍参虚羸治验）
一小儿脾气素弱，饮食少思，常患虚弱，毕姻后噫气，右关脉弱，不及本部，左关脉弦数而
长，此脾气虚肝木胜之也，用六君、柴胡、炒黑山栀，治之寻愈。后因劳复作，用补中益气
汤加益智二剂而痊。后又劳，复头晕，仍用前汤，更加蔓荆子而愈。
一女子十四岁，性悉多怒噫气，常服木香槟榔丸，胸中爽快，次年出嫁孀居，前症复发，服
清气化痰丸，发热痰甚，服芩、连等药，经行如崩，发热作渴，四肢抽搐，唇口自动，此因
肝盛脾虚，不能统血归经，虚火动而类风也，用加味逍遥散，内归、术各用五钱，加钩藤钩
二钱治之，诸症顿愈。又用加味归脾汤，久服而愈。
一女子早丧母，噫气下气，出嫁后患吞酸胸痞，用六君子送越鞠丸渐愈，又用加味归脾汤而
安。后因怒兼胁痛腹胀，小便淋涩，用加味逍遥散加车前子、龙胆草而愈。
一小儿十一岁，禀胃气充实，饮食过多，胸满噫气，用枳壳散渐愈，又用六君子汤痊愈。至
十七岁，饮食停滞，腹胀兼痛，自用枳壳散，肢体倦怠，噫气下气，余用六君、干姜、肉桂
而愈。
一女子年十六患此，先用参、术之药，不应，用六君子汤送四味茱连丸而愈，后又因怒气劳
役，前症益甚，更兼发热，用柴胡栀子散二剂，随以补中益气汤而痊。
平胃散（方见虚寒）
补心汤（方见喑）
补心丸（即茯神散为丸，方见惊悸）
补中益气汤（方见虚羸）
人参理中汤（方见惊泻）
越鞠丸
六君子汤
加味归脾汤
加味逍遥散（四方见内钓）
本事枳壳散（方见前症）
柴胡栀子散（方见发热）
四味茱连丸（方见噫气）
八味地黄丸（方见肾脏）
Liu Hejian stated: When Qi stagnates in the intestines and stomach, grain Qi arises internally but cannot be diffused and circulated outside the intestines and stomach; therefore, there is a tendency to belch (eructation) and pass flatus. If epilepsy or consumptive disease (lao zhai) occurs with downward leakage of Qi that does not cease, death is inevitable. This is because the True Qi is exhausted and severed, the cou li (skin and interstices) are closed, and grain Qi cannot diffuse outside the intestines and stomach, thus leaking out from within.
Lou Quanshan stated: Passing flatus belongs to Heart Qi deficiency. The Classic says: "The summer pulse corresponds to the Heart." If the Heart pulse is deficient and weak, manifesting as passing flatus and diarrhea, this is the case described. The Classic further states: "When food enters the stomach, its essence floats and overflows, transmitting upward to the Spleen; the Spleen disperses the essence, sending it upward to return to the Lung; [the Lung] regulates water passages, transmitting downward to the Bladder; water essence distributes throughout the four directions, and the five meridians run together." This describes a healthy person. However, if internal injury by the seven emotions, external invasion by the six climatic factors, irregular diet, or excessive sexual activity injures the Yin of Spleen Earth, causing the official responsible for transportation and transformation to fail in its duty, leading to an inability to transport and transform, thus resulting in passing flatus.
It is also said: "When Yin essence is offered upward, one lives long; when Yang essence descends, one dies young." Yin essence refers to the essence of the five grains, which nourishes the Heart and Lung upward and subdues the Liver and Kidney downward, hence longevity. Yang essence refers to the clear Qi in the Stomach; if it sinks into the Liver and Kidney and cannot ascend and float upward to transmit to the Heart and Lung, hence premature death.
If excessive diet causes stagnation in the intestines and stomach, use Pingwei San (Calm the Stomach Powder). For epilepsy or consumptive disease, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For Heart Qi deficiency, use Buxin Wan (Nourish the Heart Pill). For Heart Qi deficiency with cold, use Buxin Tang (Nourish the Heart Decoction). For Spleen and Stomach deficiency-cold, use Lizhong Tang (Regulate the Middle Decoction). If Liver Wood overacts on Spleen Earth, use Liujunzi Tang (Six Gentlemen Decoction) with added Muxiang (Aucklandiae Radix). For Spleen Qi stagnation, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). For Spleen Qi sinking, use Buzhong Yiqi Tang. For decline of Mingmen Fire, use Bawei Wan (Eight-Ingredient Pill). For Kidney Qi insufficiency, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).
Generally, for those who belch or pass flatus, the pulse is deficient relative to its proper position. The Neijing states: "A short pulse indicates Qi pathology, due to the absence of Stomach Qi." Various diseases presenting with this pulse are difficult to treat; only purely tonifying Stomach Qi is beneficial.
Clinical Cases (also referring to cases of emaciation):
A child with inherently weak Spleen Qi, reduced appetite, and frequent weakness developed belching after marriage. The Right Guan pulse was weak and below the normal range, while the Left Guan pulse was wiry, rapid, and long. This indicated Spleen Qi deficiency with Liver Wood excess. Treatment with Liujunzi Tang (Six Gentlemen Decoction), Chaihu (Bupleuri Radix), and stir-fried black Zhizi (Gardeniae Fructus) led to recovery. Later, due to fatigue relapse, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Yizhi Ren (Alpiniae Oxyphyllae Fructus) for two doses cured him. Subsequent fatigue caused dizziness again; using the previous formula with added Manjingzi (Vittariae Spora) resulted in recovery.
A fourteen-year-old girl, prone to anger and belching, frequently took Muxiang Binglang Wan (Aucklandia and Areca Nut Pill) and felt relief in the chest. The following year, after marrying and becoming a widow, her symptoms recurred. She took Qingqi Huatan Wan (Clear Qi and Resolve Phlegm Pill), developing fever and severe phlegm. After taking Huangqin (Scutellariae Radix) and Lianzi (Nelumbinis Semen), she experienced menorrhagia like a flood, fever, thirst, limb convulsions, and automatic movement of lips and mouth. This was due to Liver excess and Spleen deficiency, failing to control blood and keep it in the vessels, with deficient fire stirring up wind-like symptoms. Treatment with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), using Gui Pi Tang (Restore the Spleen Decoction) components where Danggui (Angelicae Sinensis Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) were each used at 5 qian, plus Gouteng (Uncariae Ramulus Cum Uncis) at 2 qian, led to immediate resolution of all symptoms. Long-term use of Jiawei Guipi Tang (Modified Restore the Spleen Decoction) resulted in full recovery.
A girl who lost her mother early suffered from belching and passing flatus. After marriage, she developed acid regurgitation and chest oppression. Treatment with Liujunzi Tang (Six Gentlemen Decoction) administered with Yueju Wan (Yueju Pill) gradually improved her condition, followed by stabilization with Jiawei Guipi Tang (Modified Restore the Spleen Decoction). Later, due to anger accompanied by hypochondriac pain, abdominal distension, and dysuria, treatment with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) added with Cheqianzi (Plantaginis Semen) and Longdancao (Gentianae Radix) resulted in recovery.
An eleven-year-old boy, endowed with robust Stomach Qi but suffering from overeating, presented with chest fullness and belching. Treatment with Zhike San (Citrus Aurantium Powder) gradually improved his condition, followed by complete recovery with Liujunzi Tang (Six Gentlemen Decoction). At age seventeen, food stagnation caused abdominal distension and pain. Self-medication with Zhike San led to limb fatigue, belching, and passing flatus. I treated him with Liujunzi Tang (Six Gentlemen Decoction) added with Ganjiang (Zingiberis Rhizoma) and Rougui (Cinnamomi Cortex), resulting in recovery.
A sixteen-year-old girl suffered from this condition. Initial treatment with Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) was ineffective. She recovered after taking Liujunzi Tang (Six Gentlemen Decoction) administered with Siwei Zhulian Wan (Four-Ingredient Coptis and Evodia Pill). Later, due to anger and labor, her symptoms worsened with added fever. Two doses of Chaihu Zhizi San (Bupleurum and Gardenia Powder) were given, followed by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), leading to recovery.
Pingwei San (Formula see "Deficiency-Cold")
Buxin Tang (Formula see "Aphonia")
Buxin Wan (Is Fushen San made into pills, Formula see "Palpitations")
Buzhong Yiqi Tang (Formula see "Emaciation")
Renshen Lizhong Tang (Formula see "Startling Diarrhea")
Yueju Wan
Liujunzi Tang
Jiawei Guipi Tang
Jiawei Xiaoyao San (These four formulas see "Internal Hook")
Ben Shi Zhike San (Formula see "Previous Symptoms")
Chaihu Zhizi San (Formula see "Fever")
Siwei Zhulian Wan (Formula see "Belching")
Bawei Dihuang Wan (Formula see "Kidney Disease")