经云。太阴所至为中满，诸湿肿满。皆属于脾。诸胀腹大。皆属于热。清气在下。则生飧泄。
浊气在上。则生 胀。金匮云。趺阳脉微弦。法当腹满。不满者必便难。两 疼痛。此虚寒从下上
也。当以温药服之。
趺阳以候内因。寸口以候外因。趺阳脾胃之脉而见微弦。为厥阴肝木所侵。侮其阴气。横聚
于腹。法当胀满有加。设不满。阴邪必转攻而上。决无轻散之理。盖阴邪即聚。不温必不散。阴
邪不散。阴窍必不通。故知其便必难。势必逆攻两 而痛。较腹满更进一步也。虚寒之气从下而
上。由腹而 。才见一斑。亟以温药服之。使阴邪从阴窍走散而不至上攻则善矣。
病者腹满。按之不痛为虚。痛者为实。可下之。舌黄未下者。下之黄自去。
腹满时减复如故。此为寒。当与温药。腹满不减。减不足言。当须下之。宜大承气汤。
腹满不减。减不足言。当须下之。宜大承气汤一条。已见伤寒阳明府实证。此腹满时减复如
故。为虚寒。当温之。盖腹满虽因中气虚寒。然下焦之真阳未灭。有时而升。则有时而减。然终
属虚寒。故复如故。而当与温药也。
按之心下满者。此为实也。当下之。宜大柴胡汤。
邪从胸胁而入于阳位。合用大柴胡两解之。与脐腹硬痛承气证不同。
病者痿黄。躁而不渴。胸中寒实而利不止者死。
寸口脉弦者。即胁下拘急而痛。其人啬啬恶寒也。
此论外因之腹满。故脉辨于寸口也。寸口脉弦而胁下拘痛者。其人表气微虚。不能外御其邪。
俾风邪即与水气相合。而为胁下拘痛。表中阳虚故啬啬恶寒也。
夫瘦人绕脐痛。必因风冷。谷气不行。而反下之。其气必冲。不冲者。心下则痞。
瘦人本无痰湿痹着。而绕脐痛者。为肌肉疏薄。风冷得以直入。干于脾土之阴分。土气伤则
不能转运。是以谷气不行。若反下之。徒虚其肠胃。邪气愈逆。因而上冲。经曰。气上冲胸。邪
在大肠故也。不冲者。邪在于胃。客气上逆。则心下痞也。
病腹满。发热十日。脉浮而数。饮食如故。浓朴七物汤主之。
腹满者。邪气入于里也。发热者。阳气达于外也。虽病经十日而脉浮数。邪犹未全入里。况
能食以证胃气之有权。故用小承气合桂枝去芍药汤。两解表里之法。较之桂枝加大黄汤。多枳、朴而少芍药。以枳、
朴专泄壅滞之气。故用之。芍药专收耗散之阴。此腹但满而不痛。与阴血无预。故去之。
腹中寒气。雷鸣切痛。胸胁逆满呕吐。附子粳米汤主之。
腹中寒气奔迫。上攻胸胁。以及于胃。而增呕逆。顷之胃气空虚。邪无所砥。辄入阳位则殆
矣。是以除患之机。所重全在胃气。乘其邪初犯胃。尚自能食。而用附子、粳米之法。温饱其胃。
胃气温饱。则土浓而邪难上越。胸胁逆满之浊阴。得温无敢留恋。必还从下窍而出矣。
痛而闭者。浓朴三物汤主之。
痛而闭塞。无雷鸣呕逆之证者为实。当下之。即用小承气。倍浓朴。而易其名。以其无亢极
之火。故不用承气二字。与理中汤之易名人参汤一义。
东垣曰。经云。诸胀腹大。皆属于热。此八益之邪。有余之证。自外而入。风寒之邪。传入
于里。寒变为热。而作胃实。日晡潮热。大渴引饮。谵语胀满者。承气汤下之。下之则胀已是也。
五脏六腑俱有胀满。更以胀家寒热多少较之。胃中寒则胀满。浊气在上。则生 胀。胃中寒湿菀
遏故也。太阴之厥。则腹满 胀。后不利。不欲食。食则呕。不得卧。按所云寒胀多如此。亦有
膏粱之人。醇酒浓味之湿热不得施化。郁于内而成胀满者。此热胀之谓也。调经篇云。因饮食劳
倦。损伤脾胃。始受热中。末传寒中。皆由脾胃之气。不能运化精微。致水谷聚而不散。遂成胀
满。又有饮食过伤而成 胀飧泄者。经云。清气在下。则生飧泄。浊气在上。则生 胀。此阴阳
反作。病之逆从也。夫饮食不节。起居不时者。阴受之。阴受之则入五脏。入五脏则闭塞不通而
成胀矣。此皆饮食自倍。肠胃乃伤所致。治胀务在调其虚实。适其寒
温。兼寒热补泻之法于战守之间。从少从多。各从其类。可一言而尽也。
张三锡曰。胀满悉属脾虚。运化不及。浊气填塞所致。初起微佐以消化。舒郁为先。势甚而
二便涩滞者。微利之。弱人或稍久。一切病后产后疮疽后。必用参、术、 、芍大补脾气为主。
而佐以消化。浓朴、木香、黄连之类。然王道无近功。必数十帖以渐取效。每见粗工专守下之则
胀已一法。用商陆、牵牛等。一泻即消。三日后复起。然真气因泻而下脱。邪气必复聚而成胀。
遂致不救。可胜道哉。
腹胀诸证。虽属寒者多。属热者少。然世治胀。喜用辛温散气之药。即使湿热作胀。亦必赖
辛温之品以散气。气散则胀满亦宽。但须以去湿热之药为主。而兼辛温为引导则可。然又有火盛
阴虚。热乘血分者。其腹虽胀而不甚大。按之益坚。小便黄赤。大便秘涩。至夜则微热。其脉数
实而细小。不可误作食积湿热治。盖消导则阴愈伤。去湿则津愈涸矣。宜用极苦极寒之药。如当
归龙荟丸。或四物汤加宣胡二连、芦荟。俱用醋制。可一服而效也。有气虚不能裹血。血散作胀。
必其人大便不坚。或时结时溏。溏则稍减。结则渐加。小便清利。甚则浑白如泔。其脉缓大而滞。
气口益甚。慎不可用辛温耗气之药。宜四君子去白术。加木香、泽泻、当归、芍药。以固其气中之
血。有血虚不能敛气。气散作胀。必其人烦热便燥。小便黄数。其脉浮数而弦。人迎尤甚。慎不
可用苦寒伤胃之药。宜四物汤去地黄。加黄 、肉桂、甘草、煨姜以和其血中之气。外因六气成
胀。藿香正气散。内因七情成胀。沉香降气散。忧思过度致伤脾胃。心腹膨胀。喘促烦闷肠鸣。
气走漉漉有声。大小便不利。脉虚而涩。局方七气汤。浊气在上。则生 胀。生姜泻心汤加木香、
浓朴。脾胃不温不能腐熟水谷而胀。附子理中汤。肾脏虚寒不能生化脾土而胀。济生肾气丸。中
满腹内坚硬如盘。不能坐卧。大小便涩滞。上气喘促。面色痿黄。通身虚肿者。此寒热错杂。胶
固于中。营卫血气凝滞于内也。分消汤、分消丸。详寒热多少。或加减用之。诸七气选用亦可。
气口脉紧滑。恶心饱闷。口干内热者。是食积。枳实导滞丸。饱食奔走。或跌扑凝血不散。或妇
人血聚而成肿胀。腹上有青紫筋。腹中按之疼。脉来弦涩。当作蓄血治之。怒甚气逆。腹胁胀满。
两手脉弦。青皮、陈皮、木香、山栀、柴胡、枳壳、归尾、桃仁、芍药、薄桂。嗜酒之人。病腹
胀如斗。前后溲便俱有血。用利药转加。其脉数而涩。此得之湿热伤脾阴。不能统血。胃虽受谷。
脾不输运。故成痞胀。当理脾气。祛湿热。兼养血之剂。如枳实、黄连、炮姜、半夏、茯苓、当
归、芍药、阿胶、乌梅、砂仁之类。白芍、乌梅收脾阴。黄连、枳实泻胀满。归、胶补营血。苓、
半去涎饮。砂仁醒脾气也。倘触动平昔所蓄之湿热。胀满逆上喘急者多死。下利不止者亦死。
〔诊〕脉来缓大者属气虚。弦数者为血热。气口紧盛或滑为停滞。濡滑为湿热。弦细为肝邪乘
脾。人迎浮弦为风气内乘。弦细而数为阴邪上逆。若虚大无根。为脾胃气衰。沉细短涩。为肾脏
气绝。
石顽治太史钱宫声媳。去秋疟久大虚。饮食大减。经水不调。季冬略行一度。今春时发寒热。
腹满不食。服宽胀利水药不应。拟进破血通经之剂。邀石顽相商。其脉左寸厥厥动摇。右关与两
尺虽微弦。而重按久按。却滑实流利。惟右寸左关虚濡而数。寻之涩涩少力。此阴中伏阳之象。
洵为胎脉无疑。良由中气虚乏。不能转运其胎。故尔作胀。前医曰。自结 迄今。距十二载。从
来未曾受孕。病后元气大虚。安有怀娠之理。石顽曰。向之不孕。必有其故。今病后余热留于血
室。因而得妊。亦恒有之。细推病机。每粥食到口。辄欲作呕。惟向晚寒热之际。得热饮入胃。其寒
热顿减。岂非胃气虚寒。水精不能四布。留积而为涎液。汪洋心下乎。俗名恶阻是也。其腹满便
难之虚实。尤须明辨。金匮有云。趺阳脉微弦。法当腹满。不满必便难。乃虚寒从下上也。当以
温药服之。况大便之后。每加胀急。以里气下通。浊阴乘机上扰。与得下临时宽快迥殊。其治虽
当安胎为主。但浊阴之气。非藉辛温不能开导其结。遂疏四君子汤。益入归、芍以收营血之散。
稍借肉桂为浊阴之向导。使母气得温中健运之力。胎息无浊阴侵犯之虞。桂不伤胎。庞安常先有
明试。余尝屡验之矣。服后寒热渐止。腹胀渐宽。饮食渐进。胎息亦渐形着而运动于脐上。至仲
夏。因起居不慎。而胎漏下血。前医犹认石瘕而进破积之方。乃明谕脉证。左寸动滑。断属干象。
而与扶脾药得安。后产一子。举家称快。设不审而与通经破血。能保子母双全之庆乎。
飞畴治谢元海。因夏月常饮火酒。致善食易饥。半月后。腹渐胀满。大便艰涩。而食亦日减。
医用削克清火俱不效。左脉细数。右脉涩滞。此始为火助胃强而善食。继为火灼胃液而艰运。艰
运则食滞而胀满。胀满则食减。今宜断食辛烈。乘元气未漓。祛其滞而回其液。日久则费调理也。
因用枳实导滞汤去黄连、白术。加葛根。一服大便通利而滞行。又用健脾理气。三日后以小剂生
脉加葳蕤、煨葛根。不半月而愈。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the dampness of Taiyin (Taiyin Wet Earth) prevails, it leads to fullness in the middle jiao; various swellings and distensions caused by dampness all belong to the Spleen. Various abdominal enlargements all belong to Heat syndromes. If Clear Yang fails to ascend and remains below, it generates stool with undigested food (Sun Xie). If Turbid Yin fails to descend and remains above, it generates abdominal distension.
The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: A FuYang pulse (palpated at the dorsalis pedis artery, reflecting Stomach and Spleen Qi) that is slightly wiry indicates that abdominal distension should occur according to the method. If there is no distension, there must be difficulty in defecation and pain in both hypochondriac regions. This is due to deficiency-cold invading from below upwards. It should be treated with warm herbs.
The FuYang pulse is used to diagnose internal causes, while the CunKou pulse (radial artery) is used to diagnose external causes. The FuYang pulse reflects the Stomach and Spleen; if a slight wiry appearance is seen, it indicates invasion by Jueyin Liver Wood, which insults the Yin Qi of the Spleen, accumulating horizontally in the abdomen. According to the method, severe distension should ensue. If distension does not occur, it implies that the Yin pathogen has turned to attack upwards, and there is absolutely no possibility of mild dispersion. Once Yin pathogens gather, they will not disperse without warming. If Yin pathogens do not disperse, the Yin orifices (anterior and posterior) will necessarily be obstructed. Therefore, we know defecation must be difficult. The pathological trend will inevitably attack the hypochondrium causing pain, which is a step further than simple abdominal distension. Deficiency-cold Qi moves upwards from below, affecting the hypochondrium from the abdomen; this reveals only a glimpse of the situation. It is urgent to administer warm medicines so that Yin pathogens disperse through the Yin orifices and do not attack upwards, which would be ideal.
If a patient presents with abdominal distension, pressing it yields no pain, indicating a Deficiency syndrome; pain upon pressing indicates an Excess syndrome, which can be treated with purgatives. If the tongue coating is yellow and purgatives have not yet been used, the yellow coating will disappear after purgation.
If abdominal distension decreases intermittently but returns to its previous state, this is a Cold syndrome, and warm medicines should be administered. If abdominal distension persists without relief, and any reduction is negligible, purgation is necessary, preferably using Da Cheng Qi Tang (Major Order the Qi Decoction).
The statement "Abdominal distension persists without relief, and any reduction is negligible, purgation is necessary, preferably using Da Cheng Qi Tang" appears in the discussion of Yangming Fu Organ Excess Syndromes in the *Shanghan Lun*. Here, "abdominal distension decreases intermittently but returns to its previous state" indicates a deficiency-cold syndrome, requiring warming. Although abdominal distension may result from deficiency-cold of the Middle Qi, the True Yang of the Lower Jiao has not extinguished. Occasionally, it rises, causing intermittent reduction in distension. However, it ultimately belongs to deficiency-cold, so the distension returns, necessitating warm medicines.
Fullness in the epigastrium upon pressing indicates an Excess syndrome, requiring purgation, preferably using Da Chai Hu Tang (Major Bupleurum Decoction).
Pathogens entering the Yang regions from the chest and hypochondrium require Da Chai Hu Tang to resolve both exterior and interior simultaneously. This differs from the Cheng Qi Tang syndromes characterized by hardness and pain around the umbilicus and abdomen.
If a patient presents with sallow complexion, irritability without thirst, cold-excess in the chest, and unceasing diarrhea, the prognosis is fatal.
A wiry pulse at the CunKou position indicates stiffness and pain in the hypochondrium, accompanied by aversion to cold.
This discusses abdominal distension caused by external factors, hence the differentiation via the CunKou pulse. A wiry CunKou pulse with hypochondriac stiffness and pain indicates weak exterior Qi unable to defend against pathogens externally, allowing Wind pathogens to combine with Water-Qi, causing hypochondriac stiffness and pain. The deficiency of Yang Qi in the exterior and interior results in aversion to cold.
Thin individuals suffering from periumbilical pain likely suffer from Wind-Cold obstructing the movement of Grain Qi. If purgatives are incorrectly used, Qi will counterflow upwards. If it does not counterflow, Epigastric Pi (Glomus) will form.
Thin individuals typically lack Phlegm-Dampness obstruction. Periumbilical pain in them occurs because their muscles are thin and sparse, allowing Wind-Cold to penetrate directly and interfere with the Yin aspect of Spleen Earth. Injury to Earth Qi impairs transport and transformation, leading to stagnation of Grain Qi. Incorrect use of purgatives only empties the intestines and stomach, causing pathogens to rebel and rush upwards. As the *Neijing* states: "Qi rushes to the chest" because the pathogen is in the Large Intestine. If it does not rush, the pathogen is in the Stomach; rebellious Guest Qi causes Epigastric Pi.
For abdominal distension with fever for ten days, floating and rapid pulse, and normal appetite, Nong Pu Qi Wu Tang (Cinnamon Twig and Magnolia Bark Seven Substance Decoction) is indicated.
Abdominal distension indicates pathogens entering the interior; fever indicates Yang Qi reaching the exterior. Despite ten days of illness, the floating and rapid pulse suggests pathogens have not fully entered the interior. Furthermore, the ability to eat demonstrates that Stomach Qi still holds authority. Thus, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) combined with Gui Zhi Qu Shao Yao Tang (Cinnamon Twig Decoction minus Peony) is used to resolve both exterior and interior. Compared to Gui Zhi Jia Huang Qi Tang (modified), this formula contains more Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) and less Shao Yao (Peony). Zhi Shi and Hou Po specifically drain stagnant Qi, while Shao Yao collects dissipating Yin. Since this case involves distension without pain and does not affect Yin Blood, Shao Yao is removed.
For cold Qi in the abdomen causing borborygmus (rumbling sounds) and cutting pain, rebellious fullness in the chest and hypochondrium, and vomiting, Fu Zi Mi Tang (Aconite and Rice Decoction) is indicated.
Cold Qi in the abdomen surges upward, attacking the chest, hypochondrium, and Stomach, increasing vomiting and regurgitation. Soon, Stomach Qi becomes empty, leaving no resistance for pathogens, which then invade Yang regions, leading to danger. Therefore, the key to eliminating disaster lies in preserving Stomach Qi. While pathogens initially invade the Stomach and the patient can still eat, Fu Zi and Mi (Rice) are used to warm and nourish the Stomach. Warmth and nourishment thicken the Earth element, making it difficult for pathogens to rise. The turbid Yin causing rebellious fullness in the chest and hypochondrium, warmed, will not linger and will exit through the lower orifices.
For pain accompanied by constipation, Nong Pu San Wu Tang (Magnolia Bark Three Substance Decoction) is indicated.
Pain with obstruction, without borborygmus or vomiting, indicates an Excess syndrome requiring purgation. Xiao Cheng Qi Tang is used with doubled Hou Po, and the name is changed. Because there is no extreme Fire, the term "Cheng Qi" is omitted, similar to how Li Zhong Tang is renamed Ren Shen Tang.
Li Dongyuan stated: The *Neijing* says, "Various abdominal enlargements all belong to Heat." This refers to excess syndromes of the Eight Benefits pathogens entering from outside. Wind-Cold pathogens transmit to the interior, transforming from Cold to Heat, creating Stomach Excess. Symptoms include tidal fever at dusk, intense thirst, delirium, and distension; these are treated with Cheng Qi Tang purgatives. After purgation, the distension resolves.
Distension can occur in all five Zang and six Fu organs. Differentiate based on the degree of Cold or Heat. Cold in the Stomach causes distension; Turbid Yin remaining above causes abdominal distension due to stagnation of Cold-Damp in the Stomach. Jueyin collapse of Taiyin causes abdominal distension, difficulty in bowel movements, anorexia, vomiting after eating, and inability to lie down. As described, Cold distension often presents thus. However, individuals consuming rich foods and alcohol may develop distension due to Damp-Heat failing to transform and stagnating internally; this is called Heat distension. The *Tiao Jing Pian* states: Due to dietary irregularities and overwork damaging the Spleen and Stomach, one initially suffers Heat Zhong, later transmitting to Cold Zhong. All result from Spleen and Stomach Qi failing to transform essence and grains, causing water and food to accumulate and form distension. Overeating also causes abdominal distension and Sun Xie. The *Neijing* states: "Clear Qi below generates Sun Xie; Turbid Qi above generates abdominal distension." This is the reversal of Yin and Yang, representing inverted pathology. Irregular diet and起居 (daily routine) damage Yin. Damage to Yin enters the Five Zang, causing blockage and distension. All these result from doubling food intake and injuring the intestines and stomach. Treatment of distension must regulate Deficiency and Excess, adapt to Cold and Heat, and employ methods of Cold/Heat and Tonification/Purging flexibly.
Zhang Sanxi stated: Distension all belongs to Spleen Deficiency, failure of transformation, and filling by Turbid Qi. In early stages, mildly assist with digestion and prioritize relieving depression. If severe with obstructed urination and defecation, mildly promote drainage. For weak patients, long-term cases, or post-illness/postpartum/post-ulcer states, primarily tonify Spleen Qi with large doses of Ren Shen (Ginseng), Bai Zhu (Atractylodes), Fu Ling (Poria), and Bai Shao (White Peony), assisted by digestive herbs like Hou Po, Mu Xiang, and Huang Lian. However, the "Kingly Way" (gentle tonification) takes time; dozens of prescriptions may be needed for gradual effect. Crude practitioners often stick to the rule "purge to resolve distension," using Lu Shang (Mercurial Root) and Qian Niu (Morning Glory Seed) for immediate relief. Distension recurs after three days. True Qi escapes downward due to purging, and pathogens reaccumulate, leading to untreatable conditions.
Although most abdominal distension cases are Cold, few are Heat. Yet, physicians often prefer acrid-warm Qi-dispersing herbs. Even for Damp-Heat distension, acrid-warm herbs are relied upon to disperse Qi. Dispersed Qi alleviates distension. However, herbs removing Damp-Heat should be primary, with acrid-warm herbs as guides. For Fire-Excess with Yin Deficiency, where Heat invades the Blood level, the abdomen is distended but not greatly enlarged; pressing makes it harder. Urine is yellow-red, stools are dry, with slight fever at night. Pulse is rapid, solid, yet fine. Do not mistake this for Food Stagnation or Damp-Heat. Digestion harms Yin further; drying Dampness depletes fluids. Use extremely bitter and cold herbs like Dang Gui Long Hui Wan (Angelica Dragon Gallbladder Pill) or Si Wu Tang (Four Substances Decoction) plus Xuan Hu Lian (Scutellaria and Coptis prepared with vinegar) and Lu Hui (Aloe), all vinegar-processed, effective in one dose.
For Qi Deficiency failing to contain Blood, causing Blood dispersion and distension, stools are not hard, alternating between loose and formed. Loose stools reduce distension slightly; formed stools increase it. Urine is clear. Severe cases have urine turbid like rice wash. Pulse is slow, large, and sluggish, especially at Qi Kou. Do not use acrid-warm Qi-consuming herbs. Use Si Jun Zi Tang (Four Gentlemen Decoction) minus Bai Zhu, plus Mu Xiang, Ze Xie, Dang Gui, and Bai Shao to secure Blood within Qi.
For Blood Deficiency failing to gather Qi, causing Qi dispersion and distension, patients are irritable with dry stools and frequent yellow urine. Pulse is floating, rapid, and wiry, especially at Ren Ying. Do not use bitter-cold Stomach-injuring herbs. Use Si Wu Tang minus Di Huang, plus Huang Qi (Astragalus), Rou Gui (Cinnamon Bark), Gan Cao (Licorice), and Wei Jiang (Baked Ginger) to harmonize Qi within Blood.
External Six Qi causing distension: Huo Xiang Zheng Qi San (Agarwood and Evodia Powder - *Note: Text says Huo Xiang Zheng Qi San*). Internal Seven Emotions causing distension: Chen Xiang Jiang Qi San (Aquilaria Descending Qi Powder). Excessive worry/sorrow damaging Spleen/Stomach, causing heart/abdominal distension, panting, irritability, borborygmus, obstructed urination/defecation, deficient and choppy pulse: Ju Fang Qi Qi Tang (Formulary Seven Qi Decoction). Turbid Yin above causing distension: Sheng Jiang Xie Xin Tang (Fresh Ginger Draining Heart Decoction) plus Mu Xiang and Hou Po. Spleen/Stomach cold failing to ripen food causing distension: Fu Zi Li Zhong Tang (Aconite Regulate Middle Decoction). Kidney deficiency-cold failing to generate Spleen Earth causing distension: Ji Sheng Shen Qi Wan (Life-Saving Kidney Qi Pill). Central fullness with hardness like a plate, inability to sit/lie, obstructed urination/defecation, panting, sallow complexion, generalized edema: Cold-Heat complex, stuck in the center,凝滞 (stagnant) Ying/Wei and Blood/Qi. Use Fen Xiao Tang/Wan (Separate and Eliminate Decoction/Pill). Adjust based on Cold/Heat degrees. Qi Qi Tangs may also be selected.
Qi Kou pulse tight and slippery, nausea, fullness, dry mouth, internal heat: Food Stagnation. Use Zhi Shi Dao Zhi Wan (Immature Bitter Orange Directing Stasis Pill). After overeating/rushing or trauma with blood stasis, or women with blood accumulation causing swelling, bluish-purple veins on abdomen, tenderness on pressure, wiry-choppy pulse: Treat as Blood Stasis. Anger causing Qi rebellion, hypochondriac distension, wiry pulses in both hands: Qing Pi, Chen Pi, Mu Xiang, Shan Zhi, Chai Hu, Zhi Ke, Gui Wei, Tao Ren, Bai Shao, Bo Gui. Alcoholics with distension like a bowl, hematuria/hematochezia, worsening with purgatives, rapid-choppy pulse: Damp-Heat injuring Spleen Yin, failing to control Blood. Stomach receives food, Spleen fails to transport, causing Pi-Zhang. Regulate Spleen Qi, remove Damp-Heat, nourish Blood. Use Zhi Shi, Huang Lian, Pao Jiang, Ban Xia, Fu Ling, Dang Gui, Bai Shao, E Jiao, Wu Mei, Sha Ren. Bai Shao/Wu Mei collect Spleen Yin; Huang Lian/Zhi Shi drain distension; Gui/E Jiao nourish Ying-Blood; Fu Ling/Ban Xia remove Phlegm-Fluid; Sha Ren awakens Spleen Qi. If previously accumulated Damp-Heat is triggered, causing rebellious distension and panting, death is likely. Unceasing diarrhea also leads to death.
[Diagnosis] Slow-large pulse indicates Qi Deficiency. Wiry-rapid indicates Blood Heat. Tight-full or slippery Qi Kou indicates Stagnation. Soft-slippery indicates Damp-Heat. Wiry-fine indicates Liver Pathogen attacking Spleen. Floating-wiry Ren Ying indicates Wind Qi invading internally. Wiry-fine-rapid indicates Yin Pathogen rebelling upwards. Empty-large rootless pulse indicates Spleen/Stomach Qi decline. Deep-fine-short-choppy pulse indicates Kidney Qi exhaustion.
Shi Wen treated the daughter-in-law of Grand Secretary Qian Gongsheng. Last autumn, prolonged malaria caused severe deficiency, reduced diet, and irregular menstruation. Only one period occurred in late winter. This spring, intermittent chills and fever developed, with abdominal distension and anorexia. Abdominal distension-promoting and diuretic drugs failed. Shi Wen proposed blood-breaking and menstruation-inducing agents. Upon consultation, the left Cun pulse was erratic and shaking. Right Guan and both Chi pulses were slightly wiry but slippery, solid, and smooth upon deep/long palpation. Right Cun and Left Guan were deficient, soft, rapid, and searching revealed sluggish force. This indicated Hidden Yang within Yin, undoubtedly a fetal pulse. Likely due to deficient Middle Qi failing to transport the fetus, causing distension. Previous physicians argued pregnancy was impossible after twelve years of infertility and post-illness Qi deficiency. Shi Wen reasoned that residual heat from illness remained in the Blood Chamber, conceiving is common. Analyzing symptoms: nausea upon eating porridge, relief of chills/fever with hot drinks in evening, indicates Stomach Qi deficiency-cold, failure of Water-Essence to distribute, accumulating as saliva/fluid in the epigastrium (commonly known as Morning Sickness/E Zu). Differentiating deficiency/cold vs. excess/heat for distension/constipation is crucial. *Jingui* states: "FuYang pulse wiry... distension... if no distension, constipation... deficiency-cold from below... treat with warm meds." Post-defecation distension worsens because lower Qi opening allows Turbid Yin to rise, distinct from temporary relief after defecation. Treatment prioritizes calming the fetus. However, Turbid Yin requires acrid-warm herbs to open knots. Shi Wen prescribed Si Jun Zi Tang, adding Dang Gui and Bai Shao to gather dispersed Ying-Blood, with a little Rou Gui as a guide for Turbid Yin, strengthening Mother Qi to protect Fetus. Cinnamon does not harm the fetus, as proven by Pang Anchang and verified by Shi Wen. After medication, chills/fever stopped, distension eased, diet improved, and fetal movement became apparent above the umbilicus. In mid-summer, careless living caused threatened miscarriage bleeding. Previous physicians diagnosed Shi Jia (Uterine Fibroids/Mass) and prescribed blood-breaking formulas. Shi Wen clarified the pulse (left Cun moving/sliding indicates pregnancy) and continued Spleen-tonifying herbs. The patient delivered a healthy son. Had Shi Wen used blood-breaking agents, mother and child might not have survived.
Fei Chou treated Xie Yuanhai. Summer consumption of strong liquor led to excessive hunger and appetite. Half a month later, abdominal distension developed, stools became difficult, and appetite decreased. Doctors' attempts at draining and clearing fire failed. Left pulse fine-rapid, right pulse sluggish. Initially, Fire strengthened Stomach Qi (excessive eating); subsequently, Fire scorched Stomach fluids (difficult transport). Transport difficulty caused food stagnation and distension, reducing appetite. Advice: Avoid spicy foods. While Yuan Qi is intact, remove stagnation and restore fluids. Use Zhi Shi Dao Zhi Tang minus Huang Lian and Bai Zhu, add Ge Gen (Kudzu). One dose relieved constipation and stagnation. Then strengthen Spleen and regulate Qi. After three days, use small dose of Sheng Mai San plus Rui Zhu (Polygonatum) and Wei Ge Gen. Recovered in half a month.