周梦觉曰∶医学中，刘李朱张而下，瓣香敬祝者，汪子 庵，独于气鼓症，列之湿门中，殊不谓然。究其源，
方书俱然，不自 庵始。余考其症，是气也，当列于气门。气以类而方明，病虽难而易治。夫气之功用，全赖脾
土为之转运，土旺而气乃周流四体；土衰而气遂停中洲，贯注躯壳，充盈腠理，郁而为热，气鼓成焉。经曰∶诸
胀腹大，皆属于热是也。其为症也，四肢日见瘦羸，肚腹日见胀满，任人揉按，痛痒不关，稍进 粮，饱闷难受，
脾愈虚，肝益肆其侮；气愈积，热益张其威，脉之弦且数。其所由来者，有明征矣。治是症者，当青筋未大见，
脐心未
大突，缺盆未大满之时，重用黄连以解其热，清金以制肝盛，培土不受肝邪。药草固有维持之力，尤宜却咸味，
断妄想，存神静虑，以养无形之土，不治气而气自宣通，多有得安者。其名不一，曰单胀，以其独胀于腹也。曰
鼓胀，以其中空无物也。曰蛊胀，若虫食物而中空也。曰热胀，由热而胀也。曰气胀，由气而胀也。统名之，曰
气鼓也。彼水胀寒胀，列于湿门宜也，原于此症毫不相涉。东垣，一代伟人，中满分消丸，亦尚未分晰也。
梦觉黄连人参汤
人参（一钱） 黄连（一钱） 焦术（一钱） 麦冬（一钱） 青皮（一钱） 肉桂（六分） 炙甘草（一钱）
东垣中满分消汤
浓朴（一两） 枳壳 黄连 黄芩 法半夏（各五钱） 陈皮 知母 泽泻（各三钱） 茯苓 砂仁 干姜
（各二钱） 人参 白术 甘草 猪苓（各一钱）
蒸饼为丸，每服三二钱不等，白开水下。
唐容川曰∶血鼓之证，胁满小腹胀，满身上有血丝缕，烦躁漱水，小便赤，大便黑，腹上青筋是也。医书俱
云是妇人之病。惟喻嘉言谓男子恒有之。面色萎黄，有蟹爪纹络，脉虽极虚，而履步如故，多怒善忘，口燥便秘，
胁胀腹疼。迨胀之既成，腹大如箕，遂不可救，东南最多，所以然者，东南饶鱼盐。鱼者甘美之味，多食令人热
中；盐者，咸苦之味，其性偏于走血。血为阴象，初与热合，不觉其病，日久月增，中焦冲和之气，亦渐为热
矣。气热则结，而血不流矣。于是，气居血中，血裹气外，一似妇人受孕者然。至弥月时，腹如抱瓮。推而言之，
凡五方之膏粱浓味，椒姜桂糈成热中者，皆其类也。治之之法，以六君子汤加干姜、川芎、防己为末，陈米荷叶
煎汤，泛丸白汤下。执中央以运四旁法也。
容川又曰∶谨按喻氏之论，其言血鼓之原，最为详确。惟所
主之方，与气热则结，而血不流通之说，未能吻合。盖六君子与所加之药，于治痰膨为宜，且须寒饮方为切合。
如论所谓，宜用清和理气之品。攻剂代抵当丸主之，和剂丹栀逍遥散，加姜黄香附治之。诸书皆用桃奴散，或琥
珀散治之。第两方用温药，亦血因寒凝之剂。与喻氏所论，又有不同，医者审证择用可也。
容川又曰∶又有石瘕肠覃，状如怀子，腹日以大。月事以时下者为肠覃，以寒气客于肠外，气病而血不病也，
宜橘核丸主之。月事不以时下者为石瘕，乃寒气客于子门，子门闭塞，恶血当下不下，衄以留止，故成石瘕。是
气病而血亦病也。宜琥珀散、桃奴散治之，后服温经汤。
单腹胀者为血膨。若四肢皆胀，或先后四肢肿起，其色红者，谓之血肿。亦有不红者，血从水化而为水，故
不红也。或得于吐衄之后，瘀血化水而肿。或得于妇人经水不行，血化为水而肿。既化为水，则兼治之，五皮饮
加当归、白芍蒲黄丹皮桃仁治之，或用干漆雄黄醋丸，麦芽汤下亦可。又凡鼓胀浮肿，但要分阴症、阳症，阴症
脉沉涩弦紧，必有寒痰诸症，宜用中满分消汤加桃仁。阳证脉数口渴，便短气逆等证，宜小柴胡汤加知母、石膏、
防己、丹皮、桃仁、猪苓、茯苓、车前子治之。
六君子汤（见煎咳嗽方内）
代抵当丸
大黄（一钱酒炒） 莪术（一钱） 山甲珠（三片） 红花（一钱） 丹皮 当归（各三钱） 牛膝（二钱）
夜明砂（三钱）
每次三五钱不等，可以随时酌量。
丹栀逍遥散
当归（一钱） 白芍（一钱） 茯苓（一钱） 白术（一钱） 丹皮（一钱） 栀子（一钱） 柴胡（七分）
甘草（一钱）
橘核丸
橘核（一钱） 香附（一钱） 楝子（一钱） 楂核（一钱） 荔核（一钱） 吴萸
小茴（各五分）
研末寒食面为丸，淡盐汤送下。量儿之大小，以为服之多少。
桃奴散
肉桂（五分） 五灵脂（一钱） 香附子（一钱） 砂仁（七分） 桃仁（一钱） 延胡索（一钱） 桃奴（一钱）
雄鼠屎（一钱）
琥珀散
琥珀（一钱） 三棱（一钱） 莪术（一钱） 丹皮（一钱） 肉桂（五分） 延胡索（一钱） 乌药（一钱）
当归（一钱） 赤芍（一钱） 生地（一钱） 刘寄奴（一钱）
五皮饮（见前伤湿方内）
小柴胡汤（见前咳嗽方向）
涂蔚生曰∶喻氏气居血中，血裹气外一语，已将血鼓之概略闸发。使后治血膨者，得其途径，不至盲无适从，
斯诚有功世道之文。而经唐氏之详为指解，尤属南针直指，证治照然。予曾遇一老妇，患吐血后，遂得血臌之症。
前医为之破气下水者，均属无效，已频于危。余鉴前医之用药失当，复深究喻氏唐氏之言，为之用六君子汤加血
竭、桃仁、广木香，顿见巨效。旋以战事发生，蒋士杰死守信阳城中，内外间隔，该妇遂陨于命。虽属时势为之，
无可如何，而前贤之于此症正法正治，变法变治，总属不吾少欺。可为吾之经验上胆识上，增一番之长进矣。
Zhou Mengjue stated: Among physicians revered since Liu Wansu, Li Dongyuan, Zhu Danxi, and Zhang Congzheng, Wang Zian (Wang Ang) alone classified Qi Drum (Qi Distension) under the category of Dampness, a view I do not endorse. Tracing its origin, this classification appears in all medical formularies and did not originate with Wang Zian. Upon examining this syndrome, it is a Qi disorder and should be categorized under Qi disorders. By classifying according to Qi, the formulas become clear; although the disease is complex, it is easy to treat. The function of Qi relies entirely on the transportation and transformation of Spleen Earth. When Spleen Earth is robust, Qi circulates throughout the four limbs; when Spleen Earth declines, Qi stagnates in the Central Plains (middle jiao), permeating the body shell and filling the interstices, where it郁结s into heat, resulting in Qi Drum. The Classics state: "All cases of abdominal distension and enlargement belong to Heat." The manifestations of this syndrome include daily emaciation of the four limbs and daily abdominal fullness. Regardless of massage or pressure, there is no sensation of pain or itching. Even slight intake of food causes unbearable fullness and oppression. As Spleen Qi becomes more deficient, Liver Qi increasingly overacts upon it; as Qi accumulates more, Heat exerts greater dominance, and the pulse becomes wiry and rapid. The etiology has clear signs. To treat this syndrome, one must act before the superficial veins are prominently visible, before the umbilicus protrudes significantly, and before the supraclavicular fossae are full. Use heavy doses of Huanglian (Coptidis Rhizoma) to resolve Heat, clear Lung Metal to restrain excessive Liver Wood, and tonify Spleen Earth so it is not invaded by Liver pathogenic factors. While herbs have their sustaining power, it is especially important to avoid salty flavors, eliminate delusional thoughts, and maintain spiritual tranquility to nourish the formless Spleen Earth. Without directly treating Qi, Qi will naturally flow freely, and many patients recover. This syndrome has various names: Dan Zhang (Single Distension) because it distends only the abdomen; Gu Zhang (Drum Distension) because it is hollow inside; Gu Zhang (Gu Distension) resembling insect-eaten wood that is hollow; Re Zhang (Heat Distension) caused by Heat; Qi Zhang (Qi Distension) caused by Qi stagnation. Collectively, they are named Qi Drum. Water Distension and Cold Distension are appropriately classified under Dampness, but this syndrome has no relation to them. Li Dongyuan was a great master of his generation, yet his Zhongman Fenxiao Wan (Middle Fullness Dispersing Pill) failed to distinguish this syndrome clearly.
Mengjue Huanglian Renshen Tang (Coptis and Ginseng Decoction)
Renshen (Ginseng Radix et Rhizoma, 1 qian), Huanglian (Coptidis Rhizoma, 1 qian), Jiaozhu (Fried Atractylodis Macrocephalae Rhizoma, 1 qian), Maidong (Ophiopogonis Radix, 1 qian), Qingpi (Citri Reticulatae Pericarpium Viride, 1 qian), Rougui (Cinnamomi Cortex, 6 fen), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma, 1 qian).
Li Dongyuan's Zhongman Fenxiao Tang (Middle Fullness Dispersing Decoction)
Houpo (Magnoliae Officinalis Cortex, 1 liang), Zhike (Aurantii Fructus, 5 qian), Huanglian (Coptidis Rhizoma, 5 qian), Huangqin (Scutellariae Radix, 5 qian), Fabanxia (Prepared Pinelliae Tuber, 5 qian), Chenpi (Citri Reticulatae Pericarpium, 3 qian), Zhimu (Anemarrhenae Rhizoma, 3 qian), Zexie (Alismatis Rhizoma, 3 qian), Fuling (Poria, 2 qian), Sharen (Amomi Fructus Rotundus, 2 qian), Ganjiang (Zingiberis Rhizoma, 2 qian), Renshen (Ginseng Radix et Rhizoma, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian), Zhuling (Polyporus, 1 qian).
Made into pills using steamed wheat cakes, taken in doses of 2-3 qian with plain boiled water.
Tang Rongchuan stated: The syndrome of Blood Drum presents with hypochondriac fullness, lower abdominal distension, blood thread-like patterns on the body surface, irritability, rinsing the mouth without swallowing, red urine, black stools, and prominent subcutaneous veins on the abdomen. Medical texts generally claim this is a disease exclusive to women. Only Yu Jiayan argued that men frequently suffer from it. Symptoms include sallow complexion, crab-claw-like vascular patterns on the skin, an extremely weak pulse yet normal gait, frequent anger, forgetfulness, dry mouth, constipation, hypochondriac distension, and abdominal pain. Once distension is established, the abdomen enlarges like a winnowing basket, becoming incurable. This disease is most common in Southeast China due to the abundance of fish and salt. Fish, being sweet and delicious, cause internal heat when consumed excessively; salt, being salty and bitter, tends to enter the Blood level. Blood is Yin in nature. Initially combining with Heat, the pathology is unnoticed, but over time, the harmonious Qi of the Middle Jiao gradually transforms into Heat. Heat causes Qi to coagulate, leading to Blood stasis. Thus, Qi resides within the Blood, and Blood wraps around the Qi externally, resembling pregnancy. By the ninth month, the abdomen swells like a jar. Extending this logic, any rich foods (Gao Liang) from the five directions, or pungent spices like pepper, ginger, and cinnamon that cause internal heat, fall into this category. Treatment involves using Liujunzi Tang (Six Gentlemen Decoction) added with Ganjiang (Dried Ginger), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Fangji (Stephaniae Tetrandrae Radix), ground into powder, formed into pills using decoctions of aged rice and lotus leaves, and taken with plain water. This method controls the Center (Spleen/Stomach) to transport the Four Quarters.
Tang Rongchuan further stated: According to Yu’s discussion, his explanation of the origin of Blood Drum is the most detailed and accurate. However, his prescribed formula does not fully align with the theory that "Heat causes Qi coagulation, leading to Blood stasis." Generally, Liujunzi Tang and its additions are suitable for treating Phlegm-Fluid distension, specifically for Cold-Fluid syndromes. If following the text's description, clearing and harmonizing Qi-regulating agents should be used. For attacking stasis, Daididang Wan (Great Replacing Yang Pill) is primary; for harmonizing, Danzhi Xiaoyao San (Moutan and Gardenia Free and Easy Wanderer Powder) added with Jianghuang (Curcumae Longae Rhizoma) and Xiangfu (Cyperi Rhizoma) should be used. Other texts recommend Taonü San (Peach Twig Powder) or Hupo San (Amber Powder). However, these two formulas use warm herbs, targeting Blood stasis due to Cold coagulation, which differs from Yu’s theory. Physicians should select treatments based on syndrome differentiation.
Tang Rongchuan also stated: There are also Shi Jia (Stone Mass) and Chang Tan (Intestinal Polyp), presenting like pregnancy with progressive abdominal enlargement. If menstruation occurs on time, it is Chang Tan, caused by Cold invading outside the intestines, affecting Qi but not Blood; Juhe Wan (Tangerine Seed Pill) is indicated. If menstruation is irregular, it is Shi Jia, caused by Cold invading the uterine orifice, blocking it, causing lochia to remain instead of discharge, forming a stone-like mass; this affects both Qi and Blood. Hu po San (Amber Powder) and Taonü San (Peach Twig Powder) are indicated, followed by Wenjing Tang (Warming the Menses Decoction).
Single abdominal distension is called Blood Peng (Blood Swelling). If all four limbs swell, or swell sequentially with red discoloration, it is called Blood Edema. If not red, it is because Blood transforms into Water. Some cases follow hematemesis or epistaxis, where Blood stasis transforms into Water causing edema. Others result from amenorrhea in women, where Blood transforms into Water causing edema. Once transformed into Water, treat both: Wupi Yin (Five Barks Decoction) added with Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Puhuang (Typhae Pollen), Danpi (Moutan Cortex), and Tao Ren (Persicae Semen). Alternatively, Ganqi and Xionghuang pills made with vinegar, taken with Maiya decoction. Furthermore, for all drum distensions and edema, distinguish Yin and Yang syndromes. Yin syndrome features deep, choppy, wiry, tight pulses and cold-phlegm symptoms; Zhongman Fenxiao Tang added with Tao Ren is indicated. Yang syndrome features rapid pulse, thirst, scanty urine, and qi rebellion; Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Fangji (Stephaniae Tetrandrae Radix), Danpi (Moutan Cortex), Tao Ren (Persicae Semen), Zhuling (Polyporus), Fuling (Poria), and Cheqianzi (Plantaginis Semen) is indicated.
Liujunzi Tang (See Cough Formula Section)
Daididang Wan (Great Replacing Yang Pill)
Dahuang (Rhei Radix et Rhizoma, 1 qian, wine-fried), Ezhu (Curcumae Zedoariae Rhizoma, 1 qian), Shanjiazhu (Hominis Ossis Cranium or Pangolin Scales substitute, 3 slices), Honghua (Carthami Flos, 1 qian), Danpi (Moutan Cortex, 3 qian), Danggui (Angelicae Sinensis Radix, 3 qian), Niuxi (Achyranthis Bidentatae Radix, 2 qian), Yeming Sha (Pharostrix Cum Ovis, 3 qian).
Take 3-5 qian per dose, adjusting as needed.
Danzhi Xiaoyao San (Moutan and Gardenia Free and Easy Wanderer Powder)
Danggui (Angelicae Sinensis Radix, 1 qian), Baishao (Paeoniae Radix Alba, 1 qian), Fuling (Poria, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian), Danpi (Moutan Cortex, 1 qian), Zhizi (Gardeniae Fructus, 1 qian), Chaihu (Bupleuri Radix, 7 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian).
Juhe Wan (Tangerine Seed Pill)
Juhe (Tangerine Seed, 1 qian), Xiangfu (Cyperi Rhizoma, 1 qian), Lianzi (Meliae Semen, 1 qian), Zhahé (Hawthorn Seed, 1 qian), Lihe (Lychee Seed, 1 qian), Wuyu (Evodiae Fructus, 5 fen), Xiaohui (Foeniculi Fructus, 5 fen).
Grind into powder, make pills with Han Shi Mian (Cold Food Flour), take with light salt water. Adjust dosage based on patient size.
Taonü San (Peach Twig Powder)
Rougui (Cinnamomi Cortex, 5 fen), Wulingzhi (Trogopterori Faeces, 1 qian), Xiangfuzi (Cyperi Rhizoma, 1 qian), Sharen (Amomi Fructus Rotundus, 7 fen), Tao Ren (Persicae Semen, 1 qian), Yanhusuo (Corydalis Rhizoma, 1 qian), Taonü (Peach Twig, 1 qian), Xiong Shushi (Male Rat Feces, 1 qian).
Hupo San (Amber Powder)
Hupo (Electrum, 1 qian), Sanleng (Sparganii Rhizoma, 1 qian), Ezhu (Curcumae Zedoariae Rhizoma, 1 qian), Danpi (Moutan Cortex, 1 qian), Rougui (Cinnamomi Cortex, 5 fen), Yanhusuo (Corydalis Rhizoma, 1 qian), Wuyao (Linderae Radix, 1 qian), Danggui (Angelicae Sinensis Radix, 1 qian), Chishao (Paeoniae Radix Rubra, 1 qian), Shengdi (Rehmanniae Radix, 1 qian), Liu Jinu (Artemisiae Anomaliae Herba, 1 qian).
Wupi Yin (Five Barks Decoction) (See Wind-Dampness Formula Section)
Xiao Chaihu Tang (Minor Bupleurum Decoction) (See Cough Formula Section)
Tu Weisheng stated: Yu’s phrase "Qi resides within Blood, Blood wraps around Qi externally" elucidates the general mechanism of Blood Drum. This provides a pathway for later physicians treating Blood Peng, preventing blind confusion. This is indeed a contribution to the world. Tang’s detailed explanation serves as a precise guide, making diagnosis and treatment clear. I once treated an elderly woman who developed Blood Drum after hematemesis. Previous doctors used Qi-breaking and water-draining methods without effect, bringing her to the brink of death. Observing their inappropriate medication, and deeply studying Yu and Tang’s theories, I used Liujunzi Tang added with Xuemei (Dragon’s Blood), Tao Ren (Persicae Semen), and Guangmuxiang (Agastaches Rhizoma), achieving immediate dramatic results. Soon after, war broke out, and Jiang Shijie died defending Xinyang City, cutting off communication. The woman eventually died. Although this was due to circumstances beyond control, the orthodox and variant treatments of the ancients for this syndrome did not deceive us. This experience has enhanced my clinical courage and insight.