腹胀身热及失血，四末清脱泻数行，肿起四肢后入腹，利旋满肿腹筋青，唇黑脐突
阴囊腐，缺盆脊背足心平，脉大时绝或虚涩，肿胀逢之却可惊。
【注】腹胀身热，阳盛胀也，若吐衄泻血，则阴亡矣。四肢瘦冷，阴盛胀也，若数泻不
止，则中脱矣。先肿胀腹，后散四肢者可治。先肿四肢，后归入腹者不治，肿胀之病多实，
服利下之药，旋消旋起，则为正不胜邪，亦不治，腹筋青涨高起，胀肿苍黑，脐肿突出，
阴囊肿腐，缺盆脊背肿平，足心肿平，则五脏伤，皆不治也。脉大而时绝，或虚涩细，则
气血败，皆死脉也。
木香流气饮
肤胀脉胀通身胀，单腹鼓胀四肢平，肤胀木香流气饮，脉胀加姜黄抚芎。
【注】肤胀，皮肤胀也；脉胀，经脉胀也。此二胀皆通身胀也。单腹胀、四肢不胀，鼓
胀、其胀如鼓，此二胀，皆腹胀四肢不胀也。肤胀宜用木香流气饮，脉胀亦用此汤，更加
姜黄、抚芎也。方在诸气门。
浓朴散 下瘀血汤
单腹鼓胀分气血，气实肠覃浓朴榔，木枳青陈遂大戟，血实石瘕下瘀汤。
【注】单腹胀。鼓胀，当分气血而治。肠覃亦气病也，故同气实胀者一治之，皆用浓
朴散，即浓朴、槟榔、木香、枳壳、青皮、陈皮、甘遂、大戟。石瘕亦血病也，故同血实
胀者一治之，宜用下瘀血汤，即大黄、桃仁、 虫、甘遂也。
寒胀中满分消汤 热胀中满分消汤
气虚胀病分寒热，中满分消有二方，寒胀参 归苓朴，半夏吴萸连二姜，升柴乌麻
青柏泽，毕澄草蔻益木香，热缩六君知猪泽，枳朴芩连干姜黄。
【注】胀有虚、实、寒、热，若胀而形气虚少寒者，宜用寒胀中满分消汤，即人参、黄
、当归、茯苓、浓朴、半夏、吴萸、黄连、干姜、生姜、升麻、柴胡、川乌、麻黄、青
皮、黄柏、泽泻、毕澄茄、草豆蔻、益智、木香也，胀而形气虚少热者，宜用热胀中满分
消汤。即缩砂、人参、白术、茯苓、炙草、广皮、半夏、知母、猪苓、泽泻、枳壳、浓朴、
黄芩、黄连、干姜、姜黄也。
[Original Text] Abdominal distension with body heat and blood loss, cold extremities with collapse and frequent diarrhea; edema starting in the limbs and then entering the abdomen; purgatives cause temporary relief of fullness and swelling but it recurs immediately, abdominal veins turn blue; black lips, protruding umbilicus, rotting scrotum; flat supraventricular fossa (Quepen), back, and soles of feet; pulse is large but intermittent or weak and choppy. These signs in swelling diseases are truly alarming.
[White Vernacular Translation] Abdominal distension accompanied by body heat, or accompanied by hemorrhage; cold extremities with signs of collapse, and frequent episodes of diarrhea; edema begins in the four limbs and subsequently spreads to the abdomen; after taking purgative herbs, the abdominal fullness and swelling temporarily subside only to recur immediately, with blue abdominal veins exposed; black lips, protruding umbilicus, and rotting scrotum; the supraventricular fossa (Quepen), back, and soles of the feet become swollen and flat (loss of physiological concavity); the pulse is surging yet intermittent, or weak, thready, and choppy. When these signs appear in swelling diseases, they indicate critical conditions that are alarming and often fatal.
[Note] Abdominal distension with body heat indicates distension due to excessive Yang-heat; if vomiting, epistaxis, or bloody stool occurs, it means Yin fluids have been exhausted. Thin and cold extremities indicate distension due to excessive Yin-cold; if diarrhea persists without stopping, it means Middle Qi has collapsed downward. If abdominal swelling appears first and then dissipates into the limbs, it is treatable; if limb swelling appears first and then gathers into the abdomen, it is untreatable. Swelling diseases are mostly excess patterns. If symptoms temporarily subside and immediately recur after taking draining and water-promoting drugs, it indicates that Righteous Qi cannot overcome Pathogenic factors, and it is also untreatable. Distended and elevated abdominal veins, dark and rough skin, protruding swollen umbilicus, rotting scrotum, and flat swelling of the supraventricular fossa, back, and soles (loss of normal depression) indicate damage to the Five Zang organs, all of which are untreatable fatal conditions. A pulse that is large yet intermittent, or weak, thready, and choppy, indicates exhaustion of Qi and Blood, all of which are death pulses.
Muxiang Liuqi Yin (Trogopterus Dung and Aquilaria Flowing Qi Decoction)
Skin distension and vessel distension involve whole-body swelling; single-abdomen drum distension involves flat limbs. For skin distension, use Muxiang Liuqi Yin; for vessel distension, add Jianghuang (Curcuma Longae Rhizoma) and Fuxiong (Chuanxiong Rhizoma).
[White Vernacular Translation] Skin distension (Fuzhang) and vessel distension (Maizhang) manifest as whole-body swelling. Single-abdomen distension (Danfuzhang) manifests with normal, non-swollen limbs. For skin distension, use Muxiang Liuqi Yin (Trogopterus Dung and Aquilaria Flowing Qi Decoction); for vessel distension, use this same decoction plus Jianghuang (Curcuma Longae Rhizoma) and Fuxiong (Chuanxiong Rhizoma).
[Note] Skin distension refers to swelling of the skin; vessel distension refers to swelling of the meridians. Both types involve whole-body swelling. Single-abdomen distension and Drum distension (Guzhang) are characterized by abdominal distension like a drum, while the limbs do not swell. Skin distension is suitable for treatment with Muxiang Liuqi Yin (Trogopterus Dung and Aquilaria Flowing Qi Decoction); vessel distension also uses this formula, additionally adding Jianghuang (Curcuma Longae Rhizoma) and Fuxiong (Chuanxiong Rhizoma). The formula is recorded in the chapter on various qi disorders.
Noupo San (Magnolia Bark Powder) and Xiayuxue Tang (Downward Stasis-Blood Decoction)
Single-abdomen drum distension distinguishes between Qi and Blood. Qi excess with Changtan (Intestinal Polyp/Tumor) uses Noupo and Binglang; Muxiang, Zhike, Qingpi, Chenpi, Gansui, and Daji. Blood excess with Shijia (Stone Fibroid) uses Xiayuxue Tang.
[White Vernacular Translation] Single-abdomen distension and drum distension should be treated by distinguishing whether the pathology lies in Qi or Blood. Changtan (intestinal tumors/polyps caused by Qi stagnation) is treated similarly to Qi-excess distension using Noupo San (Magnolia Bark Powder), which consists of Houpo (Magnoliae Officinalis Cortex), Binglang (Arecae Semen), Muxiang (Aucklandiae Radix), Zhike (Aurantii Fructus Immaturus), Qingpi (Citri Reticulatae Pericarpium Viride), Chenpi (Citri Reticulatae Pericarpium), Gansui (Kansui Radix), and Daji (Euphorbiae Pekinensis Radix). Shijia (uterine fibroids/stones caused by Blood stasis) is treated similarly to Blood-excess distension using Xiayuxue Tang (Downward Stasis-Blood Decoction), which consists of Dahuang (Rhei Radix et Rhizoma), Taoren (Persicae Semen), Ezhong (Myiophaga), and Gansui (Kansui Radix).
[Note] Single-abdomen distension and drum distension should be differentiated by Qi and Blood levels for treatment. Changtan is also a Qi disorder, thus treated identically to Qi-excess distension using Noupo San (Magnolia Bark Powder), composed of Houpo (Magnoliae Officinalis Cortex), Binglang (Arecae Semen), Muxiang (Aucklandiae Radix), Zhike (Aurantii Fructus Immaturus), Qingpi (Citri Reticulatae Pericarpium Viride), Chenpi (Citri Reticulatae Pericarpium), Gansui (Kansui Radix), and Daji (Euphorbiae Pekinensis Radix). Shijia is also a Blood disorder, thus treated identically to Blood-excess distension using Xiayuxue Tang (Downward Stasis-Blood Decoction), composed of Dahuang (Rhei Radix et Rhizoma), Taoren (Persicae Semen), Ezhong (Myiophaga), and Gansui (Kansui Radix).
Han Zhang Zhongman Fenxiao Tang (Cold Distension Middle-Fullness Resolving Decoction) and Re Zhang Zhongman Fenxiao Tang (Heat Distension Middle-Fullness Resolving Decoction)
Qi-deficiency distension distinguishes Cold and Heat. There are two formulas for Zhongman Fenxiao. Cold distension uses Renshen, Danggui, Fuling, Houpo, Banxia, Wuyu, Lian, Ganjiang, Shengjiang, Shengma, Chaihu, Chuanwu, Mahuang, Qingpi, Huangbai, Ze Xie, Bidengqie, Caodoukou, Yizhi, and Muxiang. Heat distension uses Suosha, Renshen, Baizhu, Fuling, Zhigancao, Guangpi, Banxia, Zhimu, Zhuling, Ze Xie, Zhike, Houpo, Huangqin, Huanglian, Ganjiang, and Jianghuang.
[White Vernacular Translation] Distension caused by Qi deficiency must be differentiated into Cold and Heat patterns. There are two formulas under "Zhongman Fenxiao" (Middle-Fullness Resolving). For Cold distension, use Ren Shen (Ginseng Radix), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Hou Po (Magnoliae Officinalis Cortex), along with Ban Xia (Pinelliae Rhizoma), Wu Zhu Yu (Evodiae Fructus), Huang Lian (Coptidis Rhizoma), Gan Jiang (Zingiberis Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens), Sheng Ma (Bupleuri Radix? Note: Context implies Cimicifugae Rhizoma usually, but text says Shengma), Chai Hu (Bupleuri Radix), Chuan Wu (Aconiti Radix Preparata), Ma Huang (Ephedrae Herba), Qing Pi (Citri Reticulatae Pericarpium Viride), Huang Bo (Phellodendri Cortex), Ze Xie (Alismatis Rhizoma), Bi Cheng Qie (Schisandrae Fructus? Note: Usually Piperis Longi Fructus in some contexts, but Bi Cheng Qie is Schisandra/Long Pepper depending on era, here likely Piperis Longi Fructus based on formula composition), Cao Dou Kou (Amomi Fructus Rotundus), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), and Mu Xiang (Aucklandiae Radix). For Heat distension, use Suo Sha (Amomi Fructus), Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata), Guang Pi (Citri Reticulatae Pericarpium), Ban Xia (Pinelliae Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Zhi Ke (Aurantii Fructus Immaturus), Hou Po (Magnoliae Officinalis Cortex), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Gan Jiang (Zingiberis Rhizoma), and Jiang Huang (Curcumae Longae Rhizoma).
[Note] Distension presents as Deficiency, Excess, Cold, or Heat. If distension is accompanied by deficient form and Qi with Cold signs, use Han Zhang Zhongman Fenxiao Tang (Cold Distension Middle-Fullness Resolving Decoction), composed of Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Hou Po (Magnoliae Officinalis Cortex), Ban Xia (Pinelliae Rhizoma), Wu Zhu Yu (Evodiae Fructus), Huang Lian (Coptidis Rhizoma), Gan Jiang (Zingiberis Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Chuan Wu (Aconiti Radix Preparata), Ma Huang (Ephedrae Herba), Qing Pi (Citri Reticulatae Pericarpium Viride), Huang Bo (Phellodendri Cortex), Ze Xie (Alismatis Rhizoma), Bi Cheng Qie (Piperis Longi Fructus), Cao Dou Kou (Amomi Fructus Rotundus), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), and Mu Xiang (Aucklandiae Radix). If distension is accompanied by deficient form and Qi with Heat signs, use Re Zhang Zhongman Fenxiao Tang (Heat Distension Middle-Fullness Resolving Decoction), composed of Suo Sha (Amomi Fructus), Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata), Guang Pi (Citri Reticulatae Pericarpium), Ban Xia (Pinelliae Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Zhi Ke (Aurantii Fructus Immaturus), Hou Po (Magnoliae Officinalis Cortex), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Gan Jiang (Zingiberis Rhizoma), and Jiang Huang (Curcumae Longae Rhizoma).