【伤寒腹胀之症】恶寒发热，自汗口渴，小便不利，小腹胀满，此热结膀胱腹胀之症。
若里热不恶寒，自汗不大便，烦满燥实，此阳明胃实腹胀之症。若腹胀硬痛，小便自利，大便或黑
，此蓄血腹胀之症也。
【伤寒腹胀之因】表邪不解，内传太阳之本，则热结膀胱，小便不利而腹胀。若表已解
，肠胃有实热，大便闭结，则腹亦胀。若血蓄下焦，结硬小腹，则腹亦胀。凡此皆伤寒门腹胀也。
【伤寒腹胀之脉】左尺沉数，膀胱结热。右脉沉实，肠胃实热。两尺沉牢，乃是蓄血。
【伤寒腹胀之治】热邪入里，腹胀满，脉沉数，大便结，承气汤选用，腹胀宜下。若寒热者，
大柴胡汤。若热结膀胱，腹胀，小便不利者，仲景用五苓散，家秘用羌活木通汤，调六一散
。若腹胀小便利，大便黑，桃仁承气汤。
承气汤
大柴胡汤 上二方，见伤寒。
羌活木通汤 见后不得卧。
五苓散
白术 茯苓 猪苓 泽泻 肉桂
桃仁承气汤 见后血鼓胀。
【风湿腹胀之症】发热身重，不能转侧，一身尽痛，心腹胀满，外连头面，此风湿腹胀
之症也。
【风湿腹胀之因】或居处卑湿，或冒湿冲风，脾胃受伤，中州痞塞，而腹胀之症作矣。
【风湿腹胀之脉】脉多浮濡，或见浮缓，或见弦长，或见浮涩。
【风湿腹胀之治】胸前饱闷，防风平胃散。身热恶风，羌独败毒散、荆芥汤。下体重滞
，五苓散。内外皆热，用防风木通汤，此上下分消法也。
防风平胃散
苍术 浓朴 广皮 甘草
加防风。下部胀加防己。
羌活败毒散 见后湿痿。
荆芥汤 见后湿热腹胀。
五苓散 即四苓散加桂。身发热，加防风。
防风木通汤 治风湿神效。
防风 木通
[Symptoms of Abdominal Distension in Cold Damage]
Chills and fever, spontaneous sweating with thirst, difficult urination, and distension in the lower abdomen are symptoms of abdominal distension caused by heat binding in the Bladder (Bladder). If there is internal heat without chills, spontaneous sweating, constipation, restlessness, fullness, dryness, and excess, these are symptoms of abdominal distension caused by Yangming Stomach excess syndrome. If the abdomen is distended, hard, and painful, with free urination and black stools, this is abdominal distension caused by blood stasis accumulation.
[Etiology of Abdominal Distension in Cold Damage]
When exterior pathogens remain unresolved and transmit internally to the root organ of the Taiyang (Sun) channel, heat binds in the Bladder, causing difficult urination and abdominal distension. If the exterior condition has resolved but there is excess heat in the intestines and stomach with closed bowels, the abdomen will also become distended. If blood accumulates in the Lower Jiao (Lower Burner), condensing and hardening in the lower abdomen, the abdomen will also become distended. All of these belong to abdominal distension within the category of Cold Damage.
[Pulse Signs of Abdominal Distension in Cold Damage]
The left Chi (Cun-Kou position at the wrist) pulse is deep and rapid, indicating heat binding in the Bladder. The right pulse is deep and excess, indicating excess heat in the intestines and stomach. Both Chi pulses are deep and firm, indicating blood stasis.
[Treatment of Abdominal Distension in Cold Damage]
When heat pathogens enter the interior, causing abdominal distension, a deep and rapid pulse, and constipation, select Chengqi Tang (Chengqi Tang, Purging Decoctions) for purgative treatment; abdominal distension is suitable for downward draining methods. If there are alternating chills and fever, use Dachaihu Tang (Dachaihu Tang, Great Bupleurum Decoction). If heat binds in the Bladder, causing abdominal distension and difficult urination, Zhang Zhongjing uses Wuling San (Wuling San, Five-Ingredient Powder with Poria); the family secret formula uses Qianghuo Mutong Tang (Qianghuo Mutong Tang, Notopterygium and Akebia Decoction), taken with Liuyi San (Liuyi San, Six-to-One Powder). If there is abdominal distension with free urination and black stools, use Taoren Chengqi Tang (Taoren Chengqi Tang, Peach Kernel Decoction to Order the Qi).
Chengqi Tang
Dachaihu Tang: The above two formulas are seen in the Cold Damage texts.
Qianghuo Mutong Tang: See the section on "Inability to Sleep" later.
Wuling San
Baizhu (Atractylodis Rhizoma), Fuling (Poria), Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Rougui (Cinnamomi Cortex)
Taoren Chengqi Tang: See the section on "Blood Drum Distension" later.
[Symptoms of Abdominal Distension due to Wind-Dampness]
Fever, heavy body, inability to turn or shift position, pain throughout the body, and distension in the heart and abdomen extending outward to the head and face are symptoms of abdominal distension caused by Wind-Dampness.
[Etiology of Abdominal Distension due to Wind-Dampness]
Living in low-lying damp places, or being exposed to dampness and wind, injures the Spleen and Stomach, causing obstruction in the Middle Jiao (Middle Burner), thereby triggering abdominal distension.
[Pulse Signs of Abdominal Distension due to Wind-Dampness]
The pulse is mostly floating and soggy, or may appear floating and slow, string-taut and long, or floating and choppy.
[Treatment of Abdominal Distension due to Wind-Dampness]
For fullness and oppression in the chest, use Fangfeng Pingwei San (Fangfeng Pingwei San, Saposhnikovia Powder to Regulate the Stomach). For fever and aversion to wind, use Qianghuo Baidu San (Qianghuo Baidu San, Notopterygium Powder to Overcome Toxins) and Jingjie Tang (Jingjie Tang, Schizonepeta Decoction). For heaviness and stagnation in the lower body, use Wuling San. For heat inside and outside, use Fangfeng Mutong Tang (Fangfeng Mutong Tang, Saposhnikovia and Akebia Decoction); this is a method of dispersing from top and bottom.
Fangfeng Pingwei San
Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma)
Add Fangfeng (Saposhnikoviae Radix). Add Fangji (Stephaniae Tetrandrae Radix) if there is distension in the lower part.
Qianghuo Baidu San: See the section on "Damp Paralysis" later.
Jingjie Tang: See the section on "Damp-Heat Abdominal Distension" later.
Wuling San: This is Si Ling San (Four-Ingredient Powder with Poria) plus Rougui (Cinnamomi Cortex). If there is fever, add Fangfeng (Saposhnikoviae Radix).
Fangfeng Mutong Tang: Highly effective for treating Wind-Dampness.
Fangfeng (Saposhnikoviae Radix), Mutong (Akebiae Caulis)