臌症。多是气虚中满。误服枳朴宽胀之药所致。属实者少。属虚者多。
臌症属实者。其来必暴。有气血食饮寒热虫之别。辨症详于心腹九种之中。唯饮气两胁
痛有水气。或呕清水。宜后三方。酌其虚实。加减用之。
备急丸。（五十三）
五积散。（四十二）
平胃散加减。照前血臌。加川芎桃仁。虫臌去甘草。加黄连榧子干姜。或另服乌梅丸四
十九日。
臌病属虚者。其来必渐。若气喘水气盛者。宜黑锡丹。若腹大如箕。四肢消瘦。初因吐
酸而起。后吞吐皆酸。宜附子理中丸加黄连。若单腹胀。初服劫夺之药少效。久用增张。硬
如铁石。昧者见之。方谓何物邪气若此之盛。自明者观之。不过为猛药所攻。即以此身之元
气。转与此身为难。首如驱良民为寇之比。喻嘉言治有三法。一曰培养。宜术附汤。加干姜
陈皮。一曰招纳。宜补中益气汤。加半夏。一曰攻散。宜桂甘姜枣麻细附子汤。金匮枳术汤。
二
术附汤。（一百零五）
补中益气汤。（五）
桂甘姜枣麻辛附子汤。
金匮枳术汤。（俱出金匮方载医诀。）
外有血臌症。医书俱云是妇人之病。唯喻嘉言谓男子恒有之。面色萎黄。有蟹爪纹路。
脉虽虚极。而步履如故。多怒善忘。口燥便秘。胸紧胁胀腹疼。迨胀之既成。腹大如箕。遂
不可救。东南最多。所以然者。东海擅鱼盐之饶。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。
复如抱瓮矣。推而言之。凡五方之膏梁粱味椒姜桂糈成热中者。皆其类也。治之之法。以六
君子汤料加干姜川芎防己为末。以陈米荷叶煎汤泛丸。每服三钱。日两服。夜一服。一月渐
愈。此执中央以运四旁法也。
Distension (Gu) is mostly caused by deficiency of Qi in the middle jiao leading to fullness. It results from the mistaken use of medicines such as Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) that promote Qi movement and relieve distension. Cases belonging to excess are few, while those belonging to deficiency are many.
When Distension belongs to excess, its onset must be sudden. There are distinctions among Blood, Qi, Food, Drink, Cold, Heat, and Parasites. Syndrome differentiation should be detailed within the nine types of abdominal distension. Only for cases involving Fluid retention and Qi stagnation causing pain in both hypochondria with water qi, or vomiting clear fluid, the following three formulas are suitable. They should be used with modifications according to the patient's deficiency or excess.
Beiji Wan (Emergency Aid Pill). (Formula 53)
Wuji San (Five Accumulations Powder). (Formula 42)
Pingwei San modified. Referring to the treatment of Blood Distension mentioned earlier, add Chuan Xiong (Ligusticum Rhizome) and Tao Ren (Peach Seed). For Parasite Distension, remove Gan Cao (Licorice Root), and add Huang Lian (Coptis Rhizome), Fei Zi (Buckeye Seed), and Gan Jiang (Dried Ginger). Alternatively, take Wumei Wan (Mume Pill) alone for forty-nine days.
When Distension belongs to deficiency, its onset must be gradual. If there is panting and abundant water qi, Heixi Dan (Black Tin Pill) is suitable. If the abdomen is large like a winnowing basket and limbs are emaciated, initially starting with acid regurgitation and later experiencing both swallowing and vomiting of acid, Fuzi Lizhong Wan (Aconite Regulate the Middle Pill) added with Huang Lian (Coptis Rhizome) is suitable. If it is isolated abdominal distension, initial use of drastic purgative drugs yields little effect, and prolonged use increases distension. The abdomen becomes hard as ironstone. Uninformed physicians seeing this might ask what pathogenic factor is so severe. From the perspective of knowledgeable physicians, it is merely that harsh medicines have attacked too much, causing the body's original Qi to turn against the body itself, analogous to driving good citizens to become bandits. Yu Jiayan proposed three methods for treatment: one is nourishment, suitable for Shu Fu Tang (Atractylodes and Aconite Decoction) added with Gan Jiang (Dried Ginger) and Chen Pi (Tangerine Peel); one is recruitment/attraction, suitable for Buzhong Yiqi Tang (Decoction for Boosting the Middle and Augmenting Qi) added with Ban Xia (Pinellia Tuber); one is attack and dispersion, suitable for Guigan Jiangzao Maxinfuzi Tang (Cinnamon, Licorice, Ginger, Jujube, Ephedra, Asarum, and Aconite Decoction) and Jin Gui Zhiju Tang (Golden Chamber Atractylodes and Aurantium Decoction).
Shu Fu Tang. (Formula 105)
Buzhong Yiqi Tang. (Formula 5)
Guigan Jiangzao Maxinfuzi Tang.
Jin Gui Zhiju Tang. (All derived from *Jin Gui Yao Lue*, recorded in medical aphorisms.)
Additionally, there is Blood Distension. Medical books all state it is a disease of women, but only Yu Jiayan claimed that men also frequently suffer from it. The complexion is sallow, with crab-claw-like vascular patterns on the skin. Although the pulse is extremely deficient, walking ability remains normal. The patient is prone to anger and forgetfulness, has dry mouth and constipation, chest tightness, hypochondriac distension, and abdominal pain. Once the distension forms, the abdomen becomes large like a winnowing basket, making it incurable. This condition is most common in the southeast. The reason is that the East Sea region excels in fish and salt. Fish is a sweet and delicious taste; excessive consumption causes heat to accumulate in the middle jiao. Salt is salty and bitter; its nature tends to enter the blood level. Blood is a yin manifestation. Initially combining with heat, no illness is perceived. Over time, the harmonious Qi of the middle jiao gradually transforms into heat. When Qi is hot, it coagulates, and blood ceases to flow. Thus, Qi resides within the blood, and blood wraps around the Qi outside, resembling pregnancy in women. By the time of term delivery, it resembles holding an urn. Extending this logic, any rich and greasy foods, spices like pepper, ginger, cinnamon, and refined grains from the five directions that cause heat accumulation in the middle jiao belong to this category. The treatment method uses the ingredients of Liujunzi Tang (Six Gentlemen Decoction) added with Gan Jiang (Dried Ginger), Chuan Xiong (Ligusticum Rhizome), and Fang Ji (Stephania Root), ground into powder. These are made into pills using decoctions of aged rice and lotus leaves. Each dose is three qian, taken twice daily and once at night. Gradual recovery occurs within one month. This is the method of controlling the center to transport the four peripheries.