干漆（炒二两） 杏仁（汤浸去皮尖麸炒令黄二两） 神曲（碎炒二两） 麦 （炒三两） 砂（飞研一两）
上为末，以三棱膏，丸如梧桐子大，每服十五丸至二十丸，温米饮下，食后服。（《澹寮》）
柿灵丹，治十种蛊胀，屡验。
黑牵牛（三钱炒三钱生） 大黄（六钱） 广木香（六钱） 阿魏（瓦焙） 丁香 槟榔（各二钱四分）
香附（生用四钱）
七味共为极细末，每用柿饼七个，每个开孔，入药末三分半，仍以柿饼合口，放老米饭上蒸过，慢火瓦上焙
干，每服一饼，早午晚各嚼食一枚，能饮，烧酒送下，不能饮，白
滚汤下，数日即消，起死回生，但忌盐醋百日，永不发也。（《寿世仙丹》）
香蟾丸，治气蛊坚胀，腹膨如鼓。
沉香 木香 橘红 甘遂（各三钱） 砂仁（五钱） 槟榔（七钱）
共为末，用虾蟆，口中去肠，将药末推满其腹，以线缝口，用烧酒砂罐内煮熟，去皮骨，捣烂为丸，好酒
下一钱匕服愈，忌甘草。（《大还》）（按∶《医鉴》金蟾散，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，候撤屁多，乃见
其效。是此方所本。）
散血诸方 人参芎归汤，治血胀。
当归 半夏（制三分） 川芎（一两） 蓬术 木香 缩砂仁 乌药 甘草（炙各半两） 人参 辣桂
五灵脂（炒各一分）
上锉散，每服三钱，姜五片，枣二枚，紫苏四叶煎，食前服。（《直指》）《医通》散血消胀汤，于本方
去人参、枣。
当归活血散。
赤芍药 生地黄 当归须（酒洗一钱） 川芎（八分） 桃仁（去皮尖炒） 红花（酒洗各一钱） 青皮（七分）
牡丹皮 玄胡索（各八分） 香附（童便浸一钱） 蓬术（炮八分） 三棱（炮七分）
水二钟。煎七分，空心服。（《统旨》）
一方，治血鼓，腹如盆胀。
三棱（煨） 莪术 干漆（炒烟尽） 牛膝（炮） 虻虫（糯米炒） 琥珀 肉桂（好者） 砂 水蛭（锻石炒
赤） 大黄（各等分）
上为末，用生地黄自然汁和米醋调匀为丸，如梧桐子大，每服十丸，空心温酒送下，童便下亦可。（《乾坤
生意》）《寿世》名化虫丸。《保命歌括》加味抵当丸，于本方去
砂，加桃仁泥。《大还》蛭虫丸，治血蛊坚胀，腹痛不可按，于本方去牛膝、琥珀、 砂，加没药、桃仁、赤芍、
当归尾、姜黄、木香。
琥珀人参丸，治血蛊。
人参 五灵脂（各一两） 琥珀 肉桂 附子（生各五钱） 赤茯苓 川芎 沉香 穿山甲（ 各三钱）
为末，浓煎苏方汁为丸，每服二钱，早暮温酒各一服。此人参与五灵脂并用，最能浚血。血蛊之的方也。
（《医通》）
灸法 腹中气胀引脊痛，食饮多，身羸瘦，名曰食晦，先取脾输，后取季胁。（《千金》）（原更有
灸法，当阅。）
一人平素嗜酒肉，遂腹胀似鼓胀，为保养，服煎汤，反而犹益胀，及卧则喘如曳锯。予灸关元、承满、脾
俞、三里，顿效。（《石山医案》）
因食滞气痛胀，余尝治一姻家子，年力正壮，素日饮酒亦多，失饥伤饱，一日偶因饭后，胁肋大痛，自服
行气化滞等药，复用吐法尽出饮食，吐后逆气上升，胁痛难止，而上壅胸膈，胀痛更甚，且加呕吐。余用行滞破
气等药，呕痛渐止，而左乳胸肋之下，结聚一块，胀实拒按，脐腹隔闭，不能下达，每于戌亥子丑之时，则胀
不可当。因其呕吐既止，已可用下，凡大黄、芒硝、棱、莪、巴豆等药，及萝卜子、朴硝、大蒜，橘叶捣罨等
法，无所不尽，毫不能效，而愈攻愈胀。因疑为脾气受伤，用补尤觉不便。汤水不入者，凡二十余日，无计可
施，窘剧待毙，只得用手揉按其处，彼云肋下一点，按着则痛连胸腹，及细为揣摸，则正在章门穴也。章门为
脾之募，为脏之会，且乳下肋间，正属虚里大络，乃胃气所出之道路，而气实通于章门。余因悟其日轻夜重，本非有
形之积，而按此连彼，则病在气分无疑也。但用汤药以治气病，本非不善，然经火则气散，而力有不及矣。乃制
神香散（按∶系丁香、白豆蔻二味）使日服三四次，兼用艾火灸章门十四壮，以逐散其结滞之胃气，不三日胀
果渐平，食乃渐进，始得保全。此其证治俱奇，诚所难测。本年春间一邻人，陡患痛胀隔食，全与此同，群医
极尽攻击，竟以致毙，是真不得其法耳，故录此以为后人之式。（《景岳》）（按∶此按妙在灸，故列于斯。）
类证 光禄卿吴伯玉夫人，患腹满而痛，喘急异常，大便不通，饮食不进。医者用理气利水之剂，二十
日不效。余诊之，脉大而数，右尺为甚，令人按腹，手不可近。余曰∶此大肠痈也，脉数为脓已成。用黄 、
皂刺、白芷之类，加葵根一两，煎一碗顿服之。未申痛甚，至夜半而脓血大下，昏晕不支，即与独参汤，稍安，更
与十全大补，一月而愈（此似胀而实非者）。（《必读》）
Dried Lacquer (Ganqi, *Resina Rhois Semecadrii*), stir-fried, 2 liang; Almond Seeds (Xingren, *Semen Armeniacae Amarum*), soaked in hot water, skin and tips removed, bran-fried until yellow, 2 liang; Medicated Leaven (Shenqu, *Massa Medicata Fermentata*), crushed and stir-fried, 2 liang; Wheat (Xiao Mai, *Frumentum Triticum*), stir-fried, 3 liang; Amomum Fruit (Sharen, *Fructus Amomi Rotundus*), flown and ground, 1 liang.
The above ingredients are pulverized into fine powder. Using Sanleng Paste (*Rhizoma Sparganii* paste) as a binder, form pills the size of *Cotinus coggygria* seeds. Take 15 to 20 pills per dose, administered after meals with warm rice gruel. (From *Danliao Fang*)
Shiling Dan (Persimmon Spirit Pill), treats ten types of Gu distension, with frequent verified efficacy.
Black Morning Glory Seeds (Heiqian Niu, *Semen Pharbitidis*), raw and stir-fried, 3 qian each; Rhubarb Root (Dahuang, *Radix et Rhizoma Rhei*), 6 qian; Guang Mu Xiang (Bark of *Vladimiria souliei*), 6 qian; Asafoetida (awei, *Resina Ferulae*), baked on tile; Clove (Dingxiang, *Flos Caryophylli*); Areca Nut (Binglang, *Semen Arecae*), 2.4 qian each; Cyperus Rhizome (Xiangfu, *Rhizoma Cyperi Rotundi*), raw, 4 qian.
The seven ingredients are combined and ground into an extremely fine powder. For each dose, take seven persimmons, cut a hole in each, insert 0.35 qian of the powder into each hole, then close the persimmon. Steam them over old rice until thoroughly cooked, then dry them on tiles over slow fire. Take one persimmon per dose, chew and swallow one each morning, noon, and evening. If capable of drinking alcohol, administer with roasted liquor; if not, administer with boiling water. The distension will subside within a few days, potentially reviving the dying. However, salt and vinegar must be avoided for one hundred days to prevent recurrence. (From *Shoushi Xiandan*)
Xiangchan Wan (Fragrant Toad Pill), treats Qi Gu causing hard distension, with the abdomen swollen like a drum.
Agarwood (Chenxiang, *Lignum Aquilariae Resinatum*); Costus Root (Muxiang, *Radix Aucklandiae*); Exocarpium Citri Reticulatae (Juhong, *Pericarpium Citri Reticulatae Rubrum*); Kansui Root (Gansui, *Radix Euphorbiae Kansui*), 3 qian each; Amomum Fruit (Sharen, *Fructus Amomi Rotundus*), 5 qian; Areca Nut (Binglang, *Semen Arecae*), 7 qian.
Grind all into powder. Take one toad, remove its internal organs, push the powder into its abdomen, and suture the mouth with thread. Boil it in a clay pot with strong liquor until cooked. Remove skin and bones, pound into a paste, and form pills. Take one qian-bi (a spoonful shaped like a dagger blade) with good liquor to cure. Avoid Licorice Root (Gancao, *Radix Glycyrrhizae*). (From *Dahuan Dan*) (Note: *Jinyian*'s Jinchansan uses one large toad, pushing Amomum Fruit into its mouth so it swallows into the abdomen until full. Seal in a clay pot, roast over charcoal until red-hot, smoke exhausted, then remove. After cooling, remove mud, grind to powder for one dose, taken with liquor or Tangerine Peel Decoction. Efficacy is seen when flatulence increases significantly. This formula originates from this method.)
Blood-Dispersing Formulas
Renshen Xionggui Tang (Ginseng, Ligusticum, and Angelica Decoction), treats Blood distension.
Angelica Root (Danggui, *Radix Angelicae Sinensis*); Prepared Pinellia Tuber (Banxia, *Rhizoma Pinelliae Preparatum*), 3 fen; Szechwan Lovage Rhizome (Chuanxiong, *Rhizoma Chuanxiong*), 1 liang; Curcuma Zedoaria Rhizome (Ezhu, *Rhizoma Curcumae*); Costus Root (Muxiang, *Radix Aucklandiae*); Cardamom Fruit (Suosharen, *Fructus Amomi Tsaoko*); Litsea Fruit (Wuyao, *Fructus Litseae*); Honey-fried Licorice Root (Zhi Gancao, *Radix Glycyrrhizae Preparata*), 0.5 liang each; American Ginseng (Renshen, *Radix Panacis Quinquefolii*); Hot Cinnamon Bark (Lagui, *Cortex Cinnamomi*); Trogopterus Dung (Wulingzhi, *Faeces Trogopterori*), stir-fried, 1 fen each.
Cut into pieces for decoction. Take 3 qian per dose, add five slices of ginger, two jujubes, and four leaves of Perilla, decoct, and take before meals. (From *Zhizhi Fang*) *Yitong*'s Sanxue Xiaozhang Tang removes Ginseng and Jujube from this formula.
Danggui Huoxue San (Angelica Blood-Invigorating Powder).
Red Peony Root (Chishaoyao, *Radix Paeoniae Rubra*); Rehmannia Root (Shengdihuang, *Radix Rehmanniae Recens*); Angelica Root Tips (Dangguixu, *Radix Angelicae Sinensis*), wine-washed, 1 qian; Szechwan Lovage Rhizome (Chuanxiong, *Rhizoma Chuanxiong*), 8 fen; Peach Kernels (Taoren, *Semen Persicae*), skin and tips removed, stir-fried; Safflower Flowers (Honghua, *Flos Carthami Tinctorii*), wine-washed, 1 qian each; Green Tangerine Peel (Qingpi, *Pericarpium Citri Reticulatae Viride*), 7 fen; Moutan Cortex (Mudanpi, *Cortex Moutan*); Corydalis Rhizome (Yanhusuo, *Rhizoma Corydalis*), 8 fen each; Cyperus Rhizome (Xiangfu, *Rhizoma Cyperi Rotundi*), soaked in child's urine, 1 qian; Curcuma Zedoaria Rhizome (Ezhu, *Rhizoma Curcumae*), processed, 8 fen; Burreed Tuber (Sanleng, *Rhizoma Sparganii*), processed, 7 fen.
Add two zhong of water, decoct to 0.7 zhong, and take on an empty stomach. (From *Tongzhi*)
Another formula, treats Blood Drum, where the abdomen is swollen like a basin.
Burreed Tuber (Sanleng, *Rhizoma Sparganii*), baked; Curcuma Zedoaria Rhizome (Ezhu, *Rhizoma Curcumae*); Dried Lacquer (Ganqi, *Resina Rhois Semecadrii*), stir-fried until smoke ceases; Achyranthes Root (Niuxi, *Radix Achyranthis Bidentatae*), processed; Blister Beetle (Mengchong, *Mylabris*); Amber (Hupo, *Electrum*); Cinnamon Bark (Rougui, *Cortex Cinnamomi*, high quality); Amomum Fruit (Sharen, *Fructus Amomi Rotundus*); Leech (Shuizhi, *Hirudo*), fried with calcined alkali until red; Rhubarb Root (Dahuang, *Radix et Rhizoma Rhei*), equal parts.
Pulverize the above. Mix with natural juice of fresh Rehmannia Root and rice vinegar to form pills the size of *Cotinus coggygria* seeds. Take ten pills per dose on an empty stomach, delivered with warm liquor; child's urine may also be used. (From *Qiankun Shengyi*) Named *Huachong Wan* in *Shoushi*. *Jiawei Didang Wan* in *Baoming Gekuo* removes Amomum and adds Peach Kernel Paste to this formula. *Zhicong Wan* in *Dahuan Dan*, treating Blood Gu hard distension with unbearable abdominal pain upon pressure, removes Achyranthes, Amber, and Amomum, adding Myrrh, Peach Kernel, Red Peony Root, Angelica Tail, Turmeric Rhizome, and Costus Root to this formula.
Hupo Renshen Wan (Amber and Ginseng Pill), treats Blood Gu.
American Ginseng (Renshen, *Radix Panacis Quinquefolii*); Trogopterus Dung (Wulingzhi, *Faeces Trogopterori*), 1 liang each; Amber (Hupo, *Electrum*); Cinnamon Bark (Rougui, *Cortex Cinnamomi*); Processed Aconite Root (Fuzi, *Radix Aconiti Lateralis Preparata*), raw, 5 qian each; Red Poria (Chifuling, *Poria cum Radix Pini Rosidi*); Szechwan Lovage Rhizome (Chuanxiong, *Rhizoma Chuanxiong*); Agarwood (Chenxiang, *Lignum Aquilariae Resinatum*); Pangolin Scales (Chuanshanjia, *Manis Squama*), 3 qian each.
Grind into powder. Use concentrated decoction of Su Fang (Sappan Wood) to form pills. Take 2 qian per dose, morning and evening, with warm liquor. The combination of Ginseng and Trogopterus Dung here is most effective at dredging blood. This is the specific formula for Blood Gu. (From *Yitong*)
Moxibustion Method
Abdominal Qi distension radiating to back pain, excessive eating and drinking, emaciation, named "Shihui" (Food Obscurity). First treat Pishu (BL20), then treat the costal margin. (From *Qianjin Fang*) (Original text contains more moxibustion methods, please consult.)
A person who usually indulged in alcohol and meat developed abdominal distension resembling drum distension. To maintain health, he took decoctions, but the distension worsened. When lying down, he panted like a saw being pulled. I treated him with moxibustion on Guanyuan (CV4), Chengman (ST18), Pishu (BL20), and Zusanli (ST36), resulting in immediate efficacy. (From *Shishan Yi'an*)
Due to food stagnation causing Qi pain and distension, I once treated the son of a relative. He was in his prime, drank heavily, and suffered from irregular meals. One day, after a meal, he experienced severe pain in the hypochondrium. He self-medicated with Qi-regulating and stagnation-resolving herbs, then induced vomiting to expel all food. After vomiting, rebellious Qi rose, hypochondriac pain persisted, and distension worsened, obstructing the chest and diaphragm, accompanied by vomiting. I used Qi-moving and stagnation-breaking herbs; vomiting and pain gradually ceased. However, a hard, tender mass formed under the left breast and rib cage, with umbilical and abdominal blockage preventing Qi descent. Distension became unbearable during Xu-Hai-Zi-Chou hours (9 PM - 3 AM). Since vomiting had stopped, purgatives were indicated. I tried Rhubarb, Mirabilite, Burreed, Curcuma, Croton Seed, Radish Seeds, Mirabilite, Garlic, and mashed Tangerine Leaf poultices, without effect; the more I attacked, the more distended he became. Suspecting Spleen Qi injury, tonification seemed inappropriate. For over twenty days, he could not take any fluids or food, facing imminent death. I palpated the area; he pointed out a spot under the rib that caused pain radiating to the chest and abdomen upon pressure. Careful palpation revealed the point was Zhangmen (LR13). Zhangmen is the Front-Mu point of the Spleen and the Hui Meeting point of the Zang organs. The area below the breast and between the ribs corresponds to the Xuli collateral, the pathway of Stomach Qi, which connects to Zhangmen. I realized that since symptoms were lighter during the day and heavier at night, and pressing one area affected another, the pathology was clearly in the Qi level, not a tangible accumulation. Although herbal decoctions for Qi disorders are appropriate, boiling dissipates Qi energy, reducing efficacy. Therefore, I formulated Shenxiang San (consisting of Clove and White Cardamom) for him to take three to four times daily, and applied moxibustion to Zhangmen (14 moxa cones) to disperse the stagnant Stomach Qi. Within three days, distension subsided, appetite returned, and he was saved. This case was uniquely challenging. In the spring of that year, a neighbor suffered identical sudden pain, distension, and food blockage. Other physicians used aggressive attacking methods, leading to his death. This was due to incorrect methodology. I record this as a model for future practitioners. (From *Jingyue Quanshu*) (Note: The brilliance of this commentary lies in the use of moxibustion, hence it is listed here.)
Similar Syndromes
Madam Wu Boyu, wife of the Minister of Light, suffered from abdominal fullness and pain, extreme panting, constipation, and inability to eat. Physicians used Qi-regulating and diuretic agents for twenty days without effect. Upon diagnosis, her pulse was large and rapid, especially in the right Chi position. Abdominal palpation was intolerable. I stated: This is Intestinal Carbuncle (Chang Yong). The rapid pulse indicates pus formation. I prescribed Astragalus, Gleditsia Spine, and Angelica Dahurica, plus one liang of Okra Root, decocted in one bowl and taken at once. Pain intensified during Wei-Shen hours (1 PM - 5 PM). At midnight, pus and blood discharged profusely, leading to fainting. I immediately administered Single Ginseng Decoction, stabilizing her condition, followed by Shiquan Dabu Decoction. She recovered fully in one month (This resembles distension but is not true distension). (From *Bidu*)