发明曰西北二方地形高寒经曰阴者其精奉于上其寒在外故曰寒则气浮知阴之寒凉西北二
方之
气为主用也异法方宜论云北方之人脏寒生满病亦谓适寒凉者胀皆秋冬之气也在人则为肺肾冬
天之时寒凉在外六阳在于坤土之中坤土者人之脾胃也五脏之病外寒则必内热脉经所谓五脏脉
小皆
为消瘅之病消瘅者消谷善饥北方之地无不能食者此也阴胜阳虚下之则愈正谓此也病机云诸腹
胀大皆属于热下之则胀已此理悉矣
谨按胀主下之一法亦大略言尔故出方宜之论若泛用之多往往腹胀是失运化之职也然是证
虽主于下盖病因寒热积湿气血机本不同于治可不为分例云
局方紫沉通气汤治三焦气涩不能宣通腹胀便涩
(方见气证门)
济生紫苏子汤治忧思多度致伤脾胃心腹胀满喘促烦闷肠鸣气走漉漉有声大小便不利脉虚
紧而涩
苏子(一两) 大腹皮 草果仁 半夏 浓朴(制) 木香 陈皮 木通 白术 枳实 人
参甘草(各半两)
上 咀每四钱入姜枣煎
按此二方手足太阴之剂也
三因大半夏汤治肝气不平胜克于脾脾郁不行结聚涎沫闭于脏气腑气不舒胃则胀满其脉弦
迟故知中虚胃冷胀满服此可下气进食
半夏(洗) 桂心(各五钱) 附子 人参 甘草(炙) 浓朴(制) 当归 茯苓 枳实(炒
各三钱) 川椒(炒八十粒)
上锉每四大钱入姜枣煎
禹余粮丸治中满气胀喘满及水气胀
蛇含石(三两 ) 真针砂(五两) 禹余粮(三两同上砂炒)
以上三物为主其次量人虚实入下项药
木香 牛膝 蓬术(炮) 白蒺藜 桂心 川芎 白豆蔻 茴香(炒) 三棱 羌活 茯苓
干姜 青皮 陈皮 附子(炮) 当归(各半两)
上为末拌匀以汤浸蒸饼去水捣匀丸如梧子大每五十丸空心温酒下
按此治寒胀消积药也气血之剂阴阳之气下陷者可用故存之与前方并足太阴例
东垣木香顺气汤治浊气在上则生 胀
木香(三分) 浓朴(四分) 青皮 陈皮 益智仁 茯苓 泽泻 干生姜 半夏 吴茱萸
(汤洗各二分) 当归(五分) 升麻 柴胡(各一分) 草豆蔻(煨三分) 苍术(三分)
上 咀水煎
按此足太阳阳明厥阴药也
木香塌气丸治中焦腹胀
萝卜子(炒) 陈皮(去白各五钱) 胡椒 草豆蔻(煨) 木香 青皮(各三钱) 蝎梢(去
毒二钱半)
上为细末水糊为丸梧子大每三十丸温米饮下忌服油腻白粥百日量人大小与服阴囊肿用青
盐干姜白面为末水调贴之
中满分消汤治中满寒胀寒疝大小便不通阴躁足不收四肢厥逆食入反出下虚中满腹中寒心
下痞下焦躁寒沉厥奔豚不收并宜服之
益智仁 半夏 茯苓 木香 升麻(各三分) 吴茱萸 草豆蔻 黄 (各五分) 川乌头
泽
泻人参 青皮 当归 生姜 麻黄 柴胡 干姜 黄连 毕澄茄 黄柏(各二分为热因寒
用)
上 咀只作一服水煎
按此二方治寒胀之剂也
广术溃坚汤治中满腹胀内有积块坚硬如石令人坐卧不安大小便涩滞上气喘促通身虚肿
浓朴 黄芩 益智仁 草豆蔻 当归(各五钱) 黄连(六钱) 半夏(七钱) 广术 升麻
红
花吴茱萸(各二钱) 甘草(生) 柴胡 泽泻 神曲 青皮 陈皮(各三钱) 渴者加干葛(
四钱)
上 咀每七八钱水煎食前温服
中满分消丸治中满鼓胀气胀水气胀大热胀
黄芩 黄连 枳实(炒) 半夏(制各五钱) 姜黄 白术 人参 甘草(炙) 猪苓(各一
钱) 生干姜 白茯苓 砂仁(各一钱) 浓朴(一两) 知母(四钱) 泽泻 陈皮(各三钱)
上为细末水浸蒸饼为丸梧子大每百丸焙热白汤下食后寒因热用故焙服
按此并治热胀之剂也又湿热之药
Innovation states: The terrain of the northwest regions is high and cold. The *Neijing* (Classic of Internal Medicine) says: "Yin essence is offered upwards, its cold is external." Thus it is said that "cold causes Qi to float." It can be known that Yin-cold and cooling Qi is the dominant climate of the northwest regions. The *Suwen: Yifa Fangyi Lun* (Treatise on Different Methods and Appropriate Prescriptions) states: "People in the north suffer from fullness diseases due to cold internal organs." This also refers to those who adapt to cold and cool environments suffering from distension, which are all related to the Qi of autumn and winter. In the human body, this corresponds to the Lung and Kidney. During winter, cold and cool Qi is external, while the Six Yang Qi resides within Kun Earth. Kun Earth refers to one's Spleen and Stomach. For diseases of the Five Zang Organs, external cold inevitably leads to internal heat. As stated in the *Mai Jing* (Pulse Classic), "small pulses in the five Zang organs indicate Xiao Dao disease" (wasting-thirst disease characterized by excessive hunger). People in northern lands are generally able to eat well; this is the reason. When Yin prevails and Yang is deficient, purgation can lead to recovery; this is precisely what is meant here. The *Bingji* (Pathogenesis) states: "All cases of abdominal distension and enlargement belong to Heat." Using purgation resolves the distension; this theory is entirely correct.
Respectfully note: The method of primarily using purgation for distension is merely a general statement. Therefore, the discussion in the *Fangyi Lun* implies that if used indiscriminately, it often results in abdominal distension, failing to perform the function of transformation and transportation. However, although this syndrome mainly advocates purgation, the etiology involves Cold, Heat, Accumulation, Dampness, Qi, and Blood, which are fundamentally different. Treatment must not fail to be categorized and exemplified.
Ju Fang Zi Chen Tong Qi Tang (Purple Sediment Promoting Circulation Decoction from the Bureau Formulary): Treats涩滞 (stagnation) of Qi in the San Jiao (Triple Burner) unable to circulate freely, causing abdominal distension and difficult defecation. (Formula see Section on Qi Syndromes)
Jisheng Zi Su Zi Tang (Zi Su Zi Decoction from Jisheng): Treats excessive worry and thought damaging the Spleen and Stomach, resulting in epigastric and abdominal fullness, panting, irritability, borborygmus with gurgling sounds, and difficulty in urination and defecation. The pulse is deficient, tight, and choppy.
Ingredients: Zi Su Zi (Perillae Fructus, 1 liang), Da Fu Pi (Arecae Pericarpium), Cao Guo Ren (Tsaoko Fructus Seed), Ban Xia (Pinelliae Rhizoma), Nong Po (Magnoliae Officinalis Cortex, processed), Mu Xiang (Aucklandiae Radix), Chen Pi (Citri Reticulatae Pericarpium), Mu Tong (Akebiae Caulis), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, each half liang).
Preparation: Coarsely crush the herbs. Take 4 qian per dose, decoct with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus).
Note: These two formulas regulate the Hand and Foot Taiyin meridians.
Sanyin Da Ban Xia Tang (Ban Xia Decoction from Causes): Treats Liver Qi imbalance overacting on the Spleen, causing Spleen stagnation and failure to move, leading to accumulation of phlegm-fluids, blocking Zang and Fu Qi, resulting in Stomach Qi stagnation and distension. The pulse is wiry and slow, indicating deficiency in the middle and cold in the Stomach causing distension. Taking this formula promotes descending of Qi and appetite.
Ingredients: Ban Xia (Pinelliae Rhizoma, washed), Gui Xin (Cinnamomi Cortex, each 5 qian), Fu Zi (Aconiti Lateralis Radix Praeparata), Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried), Nong Po (Magnoliae Officinalis Cortex, processed), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Zhi Shi (Aurantii Fructus Immaturus, stir-fried), Chuan Jiao (Sichuan Pepper, stir-fried, 80 grains).
Preparation: Cut into pieces. Take 4 da qian per dose, decoct with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus).
Yu Yu Liang Wan (Yu Yu Liang Pill): Treats middle-fullness Qi distension, panting distension, and water-Qi distension.
Ingredients: She Han Shi (Ophicalcitum, 3 liang), Zhen Zhen Sha (Hematitum, 5 liang), Yu Yu Liang (Haematitum, 3 liang, stir-baked with sand as above).
The above three are the main ingredients. Subsequently, add the following herbs according to the patient's deficiency or excess:
Mu Xiang (Aucklandiae Radix), Niu Xi (Achyranthis Bidentatae Radix), Peng Ze (Curcumae Phaeocaulis Rhizoma, roasted), Bai Ji Li (Tribuli Fructus), Gui Xin (Cinnamomi Cortex), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Dou Kou (Amomi Fructus Rotundus), Hui Xiang (Foeniculi Fructus, stir-fried), San Leng (Sparganii Rhizoma), Qiang Huo (Notopterygii Rhizoma et Radix), Fu Ling (Poria), Gan Jiang (Zingiberis Rhizoma), Qing Pi (Citri Reticulatae Pericarpium Viride), Chen Pi (Citri Reticulatae Pericarpium), Fu Zi (Aconiti Lateralis Radix Praeparata, roasted), Dang Gui (Angelicae Sinensis Radix, each half liang).
Preparation: Grind into fine powder, mix well. Soak steamed cake in water, remove moisture, knead evenly, and make pills the size of wu zi (Chinese mustard seeds). Take 50 pills on an empty stomach with warm wine.
Note: This is a formula treating cold distension and resolving accumulations. It can be used for Qi and Blood agents where Yin and Yang Qi has sunk. Therefore, it is recorded alongside the previous formula under the Foot Taiyin category.
Dong Yuan Mu Xiang Shun Qi Tang (Mu Xiang Regulating Qi Decoction by Dong Yuan): Treats turbid Qi rising to the upper part causing distension.
Ingredients: Mu Xiang (Aucklandiae Radix, 3 fen), Nong Po (Magnoliae Officinalis Cortex, 4 fen), Qing Pi (Citri Reticulatae Pericarpium Viride), Chen Pi (Citri Reticulatae Pericarpium), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Fu Ling (Poria), Ze Xie (Alismatis Rhizoma), Gan Sheng Jiang (Zingiberis Rhizoma Recens), Ban Xia (Pinelliae Rhizoma), Wu Zhu Yu (Evodiae Fructus, rinsed with hot water, each 2 fen), Dang Gui (Angelicae Sinensis Radix, 5 fen), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix, each 1 fen), Cao Dou Kou (Tsaoko Fructus, baked, 3 fen), Cang Zhu (Atractylodis Rhizoma, 3 fen).
Preparation: Coarsely crush. Decoct in water.
Note: This is a formula for the Foot Taiyang, Yangming, and Jueyin meridians.
Mu Xiang Ta Qi Wan (Mu Xiang Settling Qi Pill): Treats middle-jiao abdominal distension.
Ingredients: Luo Bo Zi (Brassicae Napus Semen, stir-fried), Chen Pi (Citri Reticulatae Pericarpium, pith removed, each 5 qian), Hu Jiao (Piperis Longi Fructus), Cao Dou Kou (Tsaoko Fructus, baked), Mu Xiang (Aucklandiae Radix), Qing Pi (Citri Reticulatae Pericarpium Viride, each 3 qian), Xie Shao (Scorpio, venom removed, 2.5 qian).
Preparation: Grind into fine powder, bind with water paste, make pills the size of wu zi. Take 30 pills with warm rice drink. Avoid greasy food and white porridge for 100 days. Adjust dosage according to age and size. For scrotal swelling, use Qing Yan (Natrii Chloridum), Gan Jiang (Zingiberis Rhizoma), and Bai Mian (Tritici Vulgaris Farina) ground into powder, mixed with water for external application.
Zhong Man Fen Xiao Tang (Middle Fullness Resolving Decoction): Treats middle-fullness cold distension, cold hernia, obstruction of urination and defecation, yin restlessness, inability to move feet, cold extremities, vomiting after eating, lower deficiency with middle fullness, cold in abdomen, epigastric stuffiness, lower jiao restless cold, sinking厥 (collapse), Ben Tun (running piglet), and loss of control. All are suitable for taking this.
Ingredients: Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Ban Xia (Pinelliae Rhizoma), Fu Ling (Poria), Mu Xiang (Aucklandiae Radix), Sheng Ma (Cimicifugae Rhizoma, each 3 fen), Wu Zhu Yu (Evodiae Fructus), Cao Dou Kou (Tsaoko Fructus), Huang Qi (Astragali Radix, each 5 fen), Chuan Wu Tou (Aconiti Radix), Ze Xie (Alismatis Rhizoma), Ren Shen (Ginseng Radix), Qing Pi (Citri Reticulatae Pericarpium Viride), Dang Gui (Angelicae Sinensis Radix), Sheng Jiang (Zingiberis Rhizoma Recens), Ma Huang (Ephedrae Herba), Chai Hu (Bupleuri Radix), Gan Jiang (Zingiberis Rhizoma), Huang Lian (Coptidis Rhizoma), Bi Cheng Qie (Long Pepper Fruit), Huang Bo (Phellodendri Cortex, each 2 fen; this employs 'heat for cold' method).
Preparation: Coarsely crush. Prepare as a single dose, decoct in water.
Note: These two formulas are agents for treating cold distension.
Guang Zhu Kui Jian Tang (Guang Zhu Resolving Hardness Decoction): Treats middle-fullness abdominal distension with hard masses inside like stones, causing restlessness in sitting and lying, sluggish urination and defecation, upper body panting, and generalized edema.
Ingredients: Nong Po (Magnoliae Officinalis Cortex), Huang Qin (Scutellariae Radix), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Cao Dou Kou (Tsaoko Fructus), Dang Gui (Angelicae Sinensis Radix, each 5 qian), Huang Lian (Coptidis Rhizoma, 6 qian), Ban Xia (Pinelliae Rhizoma, 7 qian), Guang Zhu (Curcumae Radix), Sheng Ma (Cimicifugae Rhizoma), Hong Hua (Carthami Flos), Wu Zhu Yu (Evodiae Fructus, each 2 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw), Chai Hu (Bupleuri Radix), Ze Xie (Alismatis Rhizoma), Shen Qu (Massa Medicata Fermentata), Qing Pi (Citri Reticulatae Pericarpium Viride), Chen Pi (Citri Reticulatae Pericarpium, each 3 qian). If thirsty, add Gan Ge (Puerariae Lobatae Radix, 4 qian).
Preparation: Coarsely crush. Take 7-8 qian per dose, decoct in water, take warm before meals.
Zhong Man Fen Xiao Wan (Middle Fullness Resolving Pill): Treats middle-fullness drum distension, Qi distension, water distension with large abdomen, and heat distension.
Ingredients: Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Zhi Shi (Aurantii Fructus Immaturus, stir-fried), Ban Xia (Pinelliae Rhizoma, processed, each 5 qian), Jiang Huang (Curcumae Longae Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried), Zhu Ling (Polyporus, each 1 qian), Sheng Gan Jiang (Zingiberis Rhizoma Recens), Bai Fu Ling (Poria, each 1 qian), Sha Ren (Amomi Fructus, 1 qian), Nong Po (Magnoliae Officinalis Cortex, 1 liang), Zhi Mu (Anemarrhenae Rhizoma, 4 qian), Ze Xie (Alismatis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium, each 3 qian).
Preparation: Grind into fine powder. Soak steamed cake in water, make pills the size of wu zi. Take 100 pills, baked hot, with plain boiled water after meals. This employs 'heat for heat' method, hence baked before consumption.
Note: These two formulas are agents for treating heat distension. They are also medicines for damp-heat syndromes.