（附）
腹中窄狭，须用苍术，若肥人自觉腹中窄狭，乃是湿痰流灌脏腑，气不升降。燥饮用苍术，行气用香
附。如瘦人自觉胸中窄狭，乃是湿热熏蒸脏腑，宜黄连、苍术。
方
枳术散 治心下窄狭不快。
枳实（麸炒，三钱） 白术（土炒，三钱）
上锉一剂，水二钟，煎一钟，温服。
蟠桃酒 治气结聚心下不散。
用桃树上不落干桃子三两，为末。每服二钱，空心温酒调下。
脉
腹胀浮大是出厄，虚小命殂须努力。浮大当发汗，虚小当利小便也。胀满脉弦，脾制于肝。洪数
热胀，迟弱阴寒；浮为虚满，紧则中实；浮则可治，虚则危急。
证
夫中满腹胀者，其面目四肢不肿，而肚腹胀起，中空似鼓者是也。丹溪曰∶心肺，阳也，居上；肝肾，
阴也，居下；脾居中，亦
阴也。经曰∶饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，肺朝百脉，通调水道，下输膀胱，
水精四布，五经并行。是脾具坤静之德，而有干健之运，故能使心肺之阳降，肝肾之阴升，而成天地交之泰，
是为平人也。今也，七情内伤，六淫外浸，或饮食之不节，或房劳之致虚，则脾土之阴受伤，而转输之官
失职，胃虽受骨，亦不能运化，故阳自升，阴自降，而成天地不交之否。清浊相干，隧道壅塞，气化浊血
瘀郁而为热，热留而久，气化成湿，湿热相生，遂成胀满，经曰鼓胀是也，以其外虽坚满，中空无物，有
似于鼓，故名曰鼓，其病胶固难治。又名蛊者，若蛊侵蚀，有虫之义。理宜补脾，次养肺金以制木，使脾
无贼邪之虑，滋肾水以制火，使肺得清化之令，却盐味以防助邪，断妄想以保母气，远音乐，戒暴怒，无有
不安。医者不察病起于虚，急于获效；病者苦于胀满，喜行利药，以求欲速。殊不知即得一时之快，不一
二日之间，胀满复作，愈盛于前，真元已耗，去死则不远矣。古方惟禹余粮丸，制肝补脾，殊为切当。
然恐其温热之药太多，亦须随证顺时加减用之。俗谓气无补法者，以其痞满壅塞，似难于补。不思正气虚而不
能营运，邪气着而不出，所以为病。经曰∶壮者气行则愈，怯者着而成病。气虚不补，何由以行？且此病
之起，固非一年，根深势笃，欲取速效，自求祸耳。知王道者，可以语此。其或受病之浅，脾胃尚
壮，积滞不固者，惟可略疏导，若以峻攻之策，吾不敢也。
治
凡胸腹胀初得，是气胀，宜行气疏导之剂，木香、槟榔、枳壳、
青皮、陈皮、浓朴之类；久则成水胀，宜行湿利水之剂。
一、肥胖之人腹胀者，宜利湿为主，胃苓汤主之。
一、瘦人腹胀者，是热，宜黄连、浓朴、白芍、香附之类。
一、色白腹胀者，必是气虚，用人参、白术、茯苓、陈皮、浓朴之类。
一、因有故蓄血而腹胀者，用桃仁、红花、甚者用桃仁承气汤利之。
一、因食积而腹胀者，有热，宜利气丸，或保和丸，加木香、槟榔、阿魏之类；有寒者，用丁香、砂
仁、木香、浓朴、香附、神曲之类。
一、因外寒郁内热而腹胀者，用升麻、干葛、藿香、官桂之类。
一、因多怒而腹胀者，用青皮、陈皮、香附、木香、栀子、芦荟之类。
一、心腹胀满或痛，咳嗽痰涎喘促，大便闭，前后心背痛，分心气饮加三棱，莪术、槟榔、香附、乌药。
方
家传正气散〔批〕（按此方理脾消胀平和之剂） 治心腹胀满，或出远方，不服水土。
苍术 陈皮 浓朴 藿香 半夏 乌药 枳壳 香附子 大腹皮 甘草
上锉，生姜、枣子煎，温服。
和荣顺气汤（云林制） 治脾弱血虚，心腹胀闷，两足虚肿。
当归（酒洗，一钱） 川芎（六分） 白芍（酒洗，一钱） 白术（土炒，一钱半） 茯
苓（一钱） 苍术（米泔制，一钱） 陈皮（去白，一钱） 枳实（炒，一钱） 乌药（一钱） 神
曲（炒，一钱） 香附（醋炒，一钱） 牛膝（酒洗，一钱） 木瓜（一钱） 独活（酒洗，一钱）
泽泻（一钱） 薏苡仁（炒，一钱半） 木通（一钱） 甘草（三钱）
上锉一剂，生姜煎服。
行湿补气养血汤 治气血虚弱，单鼓腹胀浮肿。
人参（大补元气） 白术（补脾） 白茯苓（渗湿） 当归（养血） 川芎（行血） 苏梗
（利气） 白芍药（敛胀） 陈皮（泄满） 浓朴（宽胀） 大腹皮（宽膨） 木通（利水） 莱菔
子（消食） 木香（运气） 海金沙 甘草（调诸药，扶胃气）
上锉散，姜、枣煎服。气虚，倍参、术、茯苓。血虚，倍芎、归、白芍。小便短少，加猪苓、泽
泻、滑石。服后肿胀俱退，惟面目不消，此阳明经气虚，倍用白术、茯苓。
消胀饮子（彭大参传）〔批〕（按此方治胀满消补兼施之剂） 治蛊胀，单腹胀。
猪苓 泽泻 人参 白术 茯苓 半夏 陈皮 青皮 浓朴 紫苏 香附 砂仁
木香 槟榔 大腹皮 木通 莱菔子 甘草（各等分）
上锉，生姜五片，枣一枚，水煎服。
广术溃坚汤〔批〕（按此方治热胀之剂） 治中满腹胀，有积聚，如石坚
硬，令人坐卧不宁，二便涩滞，上气喘促，或通身虚肿。
浓朴（善制） 黄连 黄芩 益智仁 草豆蔻 当归 半夏 广术
升麻 红花 吴茱萸 生甘草 柴胡 泽泻 神曲（炒） 青皮 陈皮 口干加甘葛
上锉一剂，生姜煎，食远温服。忌醋酒湿面。
香朴汤〔批〕（按此方治寒胀之剂） 治中寒下虚，心腹膨胀，不喜饮食，脉浮迟而弱。
浓朴（姜炒） 大附子（泡，去皮脐，七钱） 木香（三钱）
上锉，姜七片，枣二枚，水煎服。
金陵酒丸（王进士传） 治鼓肿。
真沉香（一两） 牙皂（一两） 广木香（二两半） 槟榔（一两）
上为末，用南京烧酒浸十次，晒干，用京酒为丸。每服三钱，
重者四钱，五更烧酒送下。水鼓，水自小便而出；气鼓放屁。水鼓加苦葶苈五钱，炒，酒送下，再服。
调胃散
苍术 白术 茯苓 白芍药 桔梗 紫苏 槟榔 陈皮 甘草
小便闭加车前子。腹胀加枳壳。
金蟾散（李桐峰传）〔批〕（按此方治气鼓之剂） 治气鼓如神。
大虾蟆一个，以砂仁推入其口，使吞入腹，以满为度，用泥罐封固，炭火 令透红，烟尽取出，候
冷去泥，研末为一服，或酒，
或陈皮汤送下。候撒屁多，乃见其效。
大三棱煎丸〔批〕（按此方治实胀之剂） 治心腹坚胀，胁下紧硬，胸中
痞塞，喘满短气。常服顺气宽中，消积滞，除膨胀，大治 瘕积块，消胀软坚，累获良验。
三棱（生，细锉半斤，捣为末，以酒三升，于银石器内熬成膏） 青皮（二两） 萝
卜子（炒，二两） 神曲（炒，二两） 麦芽（炒，二两） 砂（用瓷罐，研细，入水少许，
调坐于溏灰火中，候水干取出为末） 干漆（炒，三两） 杏仁（汤，去皮尖，炒黄色三两）
上为末，三棱膏为丸，如梧桐子大。每服十五丸至二十丸，食远米汤下。
调中健脾丸〔批〕（按此方治虚胀之剂） 治单腹胀及脾虚肿满，膈中闭塞及胃口作痛。
黄 （二两，蜜炙） 人参（二两） 白术（六两，共土水拌炒） 茯苓（二两） 陈皮
（三两，盐水制） 紫苏子（二两半，炒） 萝卜子（一两半，炒） 山楂肉（三两炒） 草豆
蔻（一两，酒炒） 泽泻（三两半，炒） 薏苡仁（三两炒） 沉香（六钱，另研） 五加皮
（三两，炒） 栝蒌（一两，用大栝蒌二个，镂一孔，每个入川椒三钱，多年粪底一钱，敲
米粒大，俱纳入栝蒌内，外以绵纸糊完，再用绵筋盐泥封固，炭火 通红为度，取山择
去泥，其黑皮一并入药）
上共为细末，煎荷叶大腹皮汤，打黄米糊为丸，如梧桐子大。
每服百丸，日进三次，白汤下。此药不伤脾气，大有补益，勿轻视之。
牛皮丸（方外人传） 治腹中水响如雷，上攻即呕吐，胸膈胀满，或手足作肿。
黑丑（头末，九钱） 木香（九钱） 陈皮（九钱）
上为末，黄蜡化开为丸，如梧桐子大。每服三十丸，黄酒送
下。
(Attachment)
Narrowness in the abdomen requires the use of Cangzhu (Atractylodis Rhizoma). If a person with obesity feels narrowness in the abdomen, it is due to damp-phlegm flowing into the zang-fu organs, causing dysfunction of qi ascending and descending. For dry conditions, drink Cangzhu; for moving qi, use Xiangfu (Cyperi Rhizoma). If a thin person feels narrowness in the chest, it is due to damp-heat steaming the zang-fu organs, suitable for using Huanglian (Coptidis Rhizoma) and Cangzhu.
Formulas
Zhiji San (Bitter Orange and Atractylodes Powder): Treats narrowness and discomfort in the epigastrium.
Zhishi (Immature Bitter Orange, bran-fried, 3 qian) Baizhu (White Atractylodes, earth-fried, 3 qian)
Crush these into one dose, add two zhong of water, decoct to one zhong, and take warm.
Pantao Jiu (Peach Wine): Treats qi knotting and gathering in the epigastrium without dispersing.
Take three liang of dried peaches that have naturally fallen from peach trees, grind into powder. Take two qian each time, mixed with warm wine on an empty stomach.
Pulse
Abdominal distension with a floating and large pulse indicates the disease is exiting distress; a deficient and small pulse indicates life is in danger, requiring urgent effort. Floating and large pulses should be treated with sweating; deficient and small pulses should be treated with promoting urination. Distension with a wiry pulse indicates the spleen is controlled by the liver. Surging and rapid pulses indicate heat distension; slow and weak pulses indicate yin-cold; floating indicates deficiency-fullness; tight indicates interior excess. Floating is treatable; deficient is critical.
Syndromes
The so-called middle-fullness and abdominal distension refer to conditions where the face, eyes, and limbs are not swollen, but the belly and abdomen bulge, being hollow inside like a drum. Danxi said: The heart and lung are yang, residing above; the liver and kidney are yin, residing below; the spleen resides in the center and is also yin. The classics state: When food enters the stomach, its essence floats and overflows, transmitting upward to the spleen. The spleen scatters the essence, which returns upward to the lung. The lung directs all vessels, regulates the water passages, and transmits downward to the bladder. Water essence distributes throughout the four directions, and the five meridians run together. Thus, the spleen possesses the quiet virtue of Kun (Earth) and the vigorous operation of Qian (Heaven), enabling the yang of the heart and lung to descend and the yin of the liver and kidney to ascend, achieving the harmony of heaven and earth interaction, which constitutes a healthy person. Now, internal injury from the seven emotions, external invasion by the six climatic factors, irregular diet, or sexual exhaustion leading to deficiency, injure the yin of the spleen earth. The official responsible for transport fails in his duty. Although the stomach receives food, it cannot transform and transport. Thus, yang rises spontaneously, yin descends spontaneously, forming the obstruction of non-interaction between heaven and earth. Clear and turbid qi interfere with each other, collaterals become blocked, qi transformation fails, turbid blood stasis and depression generate heat. Heat remains for a long time, qi transformation becomes dampness, damp-heat generates each other, eventually forming distension. The classics call this "Drum Distension" because although the exterior is hard and full, the interior is hollow, resembling a drum. This disease is stubborn and difficult to treat. It is also called "Gu" (Poison/Parasite), implying the meaning of insects eroding. Treatment should ideally tonify the spleen, then nourish lung metal to control liver wood, ensuring the spleen has no fear of thief evil; nourish kidney water to control fire, allowing the lung to receive clear transformation commands; avoid salty flavors to prevent assisting evil; cut off delusions to protect mother qi (spleen); stay away from music, guard against violent anger, and there will be no unrest. Physicians who do not observe that the disease originates from deficiency, and are eager for quick results; patients suffering from distension, preferring purgative medicines to seek speed. They do not know that even if temporary relief is obtained, within one or two days, distension recurs, more severe than before, true yuan is exhausted, and death is near. Among ancient formulas, only Yuyuliang Wan (Halloysitum Pill) controls the liver and tonifies the spleen, which is very appropriate. However, fearing too many warm-hot herbs, one must still modify according to syndrome and season. The common saying that "qi diseases have no tonification method" arises because stagnation and fullness seem difficult to tonify. One fails to consider that righteous qi is deficient and cannot circulate, while evil qi adheres and does not exit, thus causing disease. The classics say: The strong recover when qi moves; the weak develop disease when evil adheres. If qi deficiency is not tonified, how can qi move? Moreover, the onset of this disease is certainly not within a year; the root is deep and the condition serious. Seeking quick results is seeking disaster oneself. Those who understand the "King's Way" (gentle treatment) can discuss this. If the disease is shallow, the spleen and stomach are still strong, and accumulation is not solid, slight guidance and dredging may suffice. Using harsh attacking strategies, I dare not agree.
Treatment
Whenever chest and abdominal distension first occurs, it is qi distension, suitable for qi-moving and guiding agents such as Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), Zhike (Aurantii Fructus Immaturus), Qingpi (Tangerine Peel), Chenpi (Aged Tangerine Peel), Houpo (Magnolia Bark), etc.; after a long time, it becomes water distension, suitable for damp-draining and diuretic agents.
1. For obese people with abdominal distension, prioritize draining dampness, primarily using Weiling Tang (Stomach Regulating Decoction).
2. For thin people with abdominal distension, it is heat, suitable for Huanglian, Houpo, Shaoyao (White Peony Root), Xiangfu, etc.
3. For those with white complexion and abdominal distension, it must be qi deficiency, using Renshen (Ginseng Radix et Rhizoma), Baizhu, Fuling (Poria), Chenpi, Houpo, etc.
4. For abdominal distension caused by retained blood stasis, use Taoren (Persicae Semen), Honghua (Carthami Flos); for severe cases, use Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Stomach) to promote urination/purging.
5. For abdominal distension caused by food retention: if there is heat, use Liqi Wan (Qi-Regulating Pill) or Baohe Wan (Preserve Harmony Pill), adding Muxiang, Binglang, Awei (Asafoetida), etc.; if there is cold, use Dingxiang (Caryophylli Flos), Sharen (Amomi Fructus), Muxiang, Houpo, Xiangfu, Shenqu (Massa Medicata Fermentata), etc.
6. For abdominal distension caused by external cold suppressing internal heat, use Shengma (Cimicifugae Rhizoma), Gange (Puerariae Radix), Huoxiang (Agastaches Herba), Guangui (Cinnamomi Cortex), etc.
7. For abdominal distension caused by excessive anger, use Qingpi, Chenpi, Xiangfu, Muxiang, Zhizi (Gardeniae Fructus), Lvhua (Aloe), etc.
8. For epigastric and abdominal fullness or pain, coughing with phlegm-saliva, panting, constipation, pain in the front and back of the heart/chest, use Fenxin Qi Yin (Dividing Heart Qi Decoction) added with Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Binglang, Xiangfu, Wuyao (Linderae Radix).
Formulas
Family-inherited Zhengqi San (批注: According to this formula, it is a mild agent for regulating the spleen and reducing distension): Treats epigastric and abdominal fullness, or going to distant places and failing to adapt to the local climate.
Cangzhu Chenpi Houpo Huoxiang Banxia Wuyao Zhike Xiangfuzi Dafupi Gancao
Crush these, decoct with fresh ginger and jujubes, take warm.
Herong Shunqi Tang (Prepared by Yunlin): Treats spleen weakness and blood deficiency, epigastric fullness and oppression, and pitting edema in both feet.
Danggui (Washed with wine, 1 qian) Chuanxiong (6 fen) Shaoyao (Washed with wine, 1 qian) Baizhu (Earth-fried, 1.5 qian) Fuling (1 qian) Cangzhu (Rice water-treated, 1 qian) Chenpi (Peel removed, 1 qian) Zhishi (Fried, 1 qian) Wuyao (1 qian) Shenqu (Fried, 1 qian) Xiangfu (Vinegar-fried, 1 qian) Niuxi (Washed with wine, 1 qian) Mugua (1 qian) Duhuo (Washed with wine, 1 qian) Zexie (1 qian) Yiyiren (Fried, 1.5 qian) Mutong (1 qian) Gancao (3 qian)
Crush into one dose, decoct with fresh ginger and take.
Xingshi Buchu Yangxue Tang: Treats qi and blood deficiency, monobloat abdominal distension and edema.
Renshen (Greatly tonifies primordial qi) Baizhu (Tonifies spleen) Bai Fuling (Leaches out dampness) Danggui (Nourishes blood) Chuanxiong (Moves blood) Sugen (Benefits qi) Baishaoyao (Restrains distension) Chenpi (Drains fullness) Houpo (Broadens distension) Dafupi (Broadens bloating) Mutong (Promotes urination) Laifuzi (Digests food) Muxiang (Moves qi) Haijinsha Gancao (Regulates various herbs, supports stomach qi)
Crush into powder, decoct with ginger and jujubes and take. For qi deficiency, double Renshen, Baizhu, Fuling. For blood deficiency, double Chuanxiong, Danggui, Baishaoyao. For short urine, add Zhuling (Polyporus), Zexie, Huashi (Talcum). After taking, if swelling subsides completely except for the face and eyes, this is deficiency of qi in the Yangming meridian; double the dosage of Baizhu and Fuling.
Xiaozhang Yinzi (Transmitted by Peng Dashen) [批注: According to this formula, it is an agent for treating distension combining reduction and tonification]: Treats Gu distension, monobloat abdominal distension.
Zhuling Zexie Renshen Baizhu Fuling Banxia Chenpi Qingpi Houpo Zisu Xiangfu Sharen Muxiang Binglang Dafupi Mutong Laifuzi Gancao (Equal parts)
Crush these, add five slices of fresh ginger and one jujube, decoct with water and take.
Guangshu Kuijian Tang [批注: According to this formula, it is an agent for treating heat distension]: Treats middle-fullness and abdominal distension, with accumulations hard as stone, causing restlessness in sitting and lying, difficulty in urination and defecation, upper body panting and shortness of breath, or generalized pitting edema.
Houpo (Well-prepared) Huanglian Huangqin Yizhiren Caodoukou Danggui Banxia Guangshu Shengma Honghua Wu Zhu Yu Sheng Gancao Chaihu Zexie Shenqu (Fried) Qingpi Chenpi Add Gange if mouth is dry.
Crush into one dose, decoct with fresh ginger, take warm well after meals. Avoid vinegar, alcohol, and wet noodles.
Xiang Po Tang [批注: According to this formula, it is an agent for treating cold distension]: Treats middle-cold and lower deficiency, epigastric and abdominal expansion, dislike of food, floating, slow, and weak pulse.
Houpo (Fried with ginger) Da Fuzi (Soaked, peel and navel removed, 7 qian) Muxiang (3 qian)
Crush these, add seven slices of ginger and two jujubes, decoct with water and take.
Jinling Jiu Wan (Transmitted by Wang Jinshi): Treats drum-like swelling.
Zhen Chenxiang (1 liang) Ya Zao (1 liang) Guang Muxiang (2.5 liang) Binglang (1 liang)
Grind into powder, soak in Nanjing burning wine ten times, dry in the sun, make pills with Beijing wine. Take 3 qian each time, 4 qian for severe cases, delivered with burning wine at the fifth watch. For water drum, water exits via urine; for qi drum, flatulence occurs. For water drum, add Ku Tingli (Semen Lepidii seu Descurainiae) 5 qian, fried, delivered with wine, take again.
Tiaowei San
Cangzhu Baizhu Fuling Baishaoyao Jiegeng Zisu Binglang Chenpi Gancao
Add Cheqianzi for urinary closure. Add Zhike for abdominal distension.
Jin Chan San (Transmitted by Li Tongfeng) [批注: According to this formula, it is an agent for treating qi drum]: Treats qi drum with miraculous effect.
One large toad, push Sharen into its mouth until it swallows into the abdomen until full, seal in a clay pot, roast over charcoal fire until red through, smoke exhausts, take out, wait for cool, remove mud, grind into powder for one dose, deliver with wine or Chenpi decoction. Effect is seen when much flatulence is released.
Da Sanleng Jian Wan [批注: According to this formula, it is an agent for treating excess distension]: Treats firm distension of heart and abdomen, tight hardness under ribs, epigastric stuffiness, panting and fullness, shortness of breath. Regular use smooths qi, broadens middle, reduces accumulation, removes distension, greatly treats mass accumulations, softens hardness, repeatedly obtaining good results.
Sanleng (Raw, finely chopped half jin, pounded into powder, boiled with three sheng of wine in silver or earthenware vessel until paste forms) Qingpi (2 liang) Luobozi (Fried, 2 liang) Shenqu (Fried, 2 liang) Maiya (Fried, 2 liang) Sha (Use porcelain jar, grind fine, add little water, sit in moist ash fire, wait for water to dry, take out and powder) Ganqi (Fried, 3 liang) Xingren (Blanch, remove skin and tip, fry yellow, 3 liang)
Grind into powder, use Sanleng paste to make pills, size of Sophora seeds. Take 15-20 pills each time, delivered with rice soup well after meals.
Tiaozhong Jianpi Wan [批注: According to this formula, it is an agent for treating deficiency distension]: Treats monobloat abdominal distension and spleen-deficiency swelling/fullness, epigastric blockage, and pain at the stomach opening.
Huangqi (2 liang, honey-fried) Renshen (2 liang) Baizhu (6 liang, stir-fried with earth-water mixture) Fuling (2 liang) Chenpi (3 liang, salt-water treated) Zisuzi (2.5 liang, fried) Luobozi (1.5 liang, fried) Shanzha Rou (3 liang, fried) Caodoukou (1 liang, wine-fried) Zexie (3.5 liang, fried) Yiyiren (3 liang, fried) Chenxiang (6 qian, separately ground) Wujia Pi (3 liang, fried) Gualou (1 liang, use two large gualou, carve a hole, put 3 qian Sichuan pepper and 1 qian old fecal bottom into each, crush to rice-grain size, put all into gualou, seal outside with cotton paper, then seal with cotton筋 salt mud, roast over charcoal fire until red hot, take out, select mountain, remove mud, include the black skin in the medicine)
Grind all into fine powder, decoct Lotus Leaf and Dafupi soup, mix with millet paste to make pills, size of Sophora seeds.
Take 100 pills each time, three times a day, delivered with white water. This medicine does not damage spleen qi, has great tonifying benefits, do not underestimate it.
Niupi Wan (Transmitted by Fang Wairen): Treats water sounds in abdomen like thunder, attacking upward causing vomiting, chest and diaphragm fullness, or swelling of hands and feet.
Heiqiu (First powder, 9 qian) Muxiang (9 qian) Chenpi (9 qian)
Grind into powder, melt yellow wax to make pills, size of Sophora seeds. Take 30 pills each time, delivered with yellow wine.