经曰∶诸腹胀大，鼓之如鼓，皆属于热。又曰∶腹满 胀，肢膈 胁，下厥上冒，过在太阴
、阳明。乃寒湿郁遏也。是证虽因七情劳役，饮食失节，房室斫丧及风寒暑湿，皆能致此，然怒
气抑遏而成者多。盖郁怒日积，则肝木气盛而脾土受克。脾能生养万物，为一身之主，虽具坤静
之德，而有干健之造。脾土既虚，胃虽纳受水 而转输之官失职，不能司消化之令，营运精微，
分布灌溉，致使心肺之阳不降，肾肝之阴不升，而成天地不交之否。清浊混淆而成壅塞，湿气不
流郁而为热，湿热留积，因成胀满。若四肢齐肿，是为水肿，治之尚易。如单腹胀，胶固难除。
脉盛而坚，迟而滑者为胀。浮大顺，虚小逆。治宜和中顺气，健脾利水。
主方 陈皮 茯苓 苍术 浓朴 枳实 香附（各一钱） 猪苓 泽泻 大腹皮 木通（各
八分） 木香（五分，另磨） 砂仁（七分，另研） 加生姜、灯心水煎，调木香、砂仁服。
如肿甚，兼用神佑丸二服（方见痰门）。以指按之有凹不起者属虚，加扁豆、白术、当归（各
八分）；以手按之随手凸起者属实，加三棱、蓬术、槟榔、青皮、益智；便秘加大黄（酒煮），
邪去正虚加人参；气下陷加升麻、柴胡（各三分）；不食而呕加藿香；先胀而后喘者治在脾，加
扁豆、麦芽、葶苈（少许）；先喘而后胀者治在肺，加黄连、黄芩、麦门冬；痰加南星、半夏曲；朝
宽暮急属血虚，加当归、红花（酒洗，少许）；去胀，草果；热加栀子、黄连；暮宽朝急属气虚，加
人参、白术；寒加干姜、肉桂、藿香、丁香、茴香、吴茱萸。腰以上肿，宜发微汗，参苏饮（方
见伤风）之类；郁加抚芎、神曲、益智、草豆蔻、乌药。腰以下肿，宜利小便，加石莲子、滑石
。下气加沉香、苏梗；痛加姜黄、玄胡。
五子五皮饮 治壮实人初感可用，病略减，止服。
栀子皮 大腹皮 生姜皮 茯苓皮 陈皮 萝卜子 香附子 车前子 葶苈子 苏子 上水
煎服。
苏子汤 忧思过度，致伤心脾，腹胀喘促，呕逆肠鸣，二便不利。
紫苏子（一两） 大腹皮 草果 半夏 浓朴 木香 陈皮 木通 白术 枳实 人参
甘草（各五钱）
上每服五钱，水盏半，姜三片、枣一枚，煎七分服。
木香顺气汤 治浊气在上，则生 胀。
木香 草蔻（面包煨） 苍术（制。各三分） 浓朴（制，四分） 当归（五分） 升麻 柴
胡（各二分）
上咀作一服。水二盏煎服，忌生冷、硬物、恼怒、房劳。
鸡屎醴散 治心腹胀满，旦食不能暮食，致成呕逆、鼓胀。鸡屎醴（鸡屎炒极热，入好酒
沃之，阴干） 大黄 桃仁（各等分）
上为末，每服二钱。水盏半，姜三片，煎七分，食前服。
简便方 治腹胀。
草豆蔻为末，每服五分，木瓜煎汤下。
又 槟榔为末，每二钱，水煎服。
又 独蒜煨熟去皮，棉裹纳下部，中冷即易。又治关格、腹胀，大小便秘。
又 用葶苈炒紫色，酒浸七日，研烂，每服三匙，好酒送下。
The *Classic of Internal Medicine* states: Various conditions characterized by abdominal distension and enlargement, where percussion yields a drum-like sound, all belong to Heat syndromes. It further states: Abdominal fullness, limb obstruction, hypochondriac discomfort, lower extremity coldness with upper body dizziness or confusion, the pathology lies in the dysfunction of the Taiyin (太阴) and Yangming (阳明) meridians, caused by the stagnation and constraint of Cold-Dampness (寒湿). Although this syndrome can be induced by emotional disturbances, overwork, irregular diet, sexual excess, and external pathogens such as Wind-Cold (风寒), Summer-Heat (暑湿), it is most frequently caused by the constraint of Anger Qi (怒气). Prolonged accumulation of depression and anger leads to an exuberance of Liver Wood Qi (肝木气盛), which overacts upon Spleen Earth (脾土). The Spleen nourishes all things and serves as the master of the body; although it possesses the tranquil virtue of Kun (坤静), it also has the creative potency of Qian (干健). When Spleen Earth becomes deficient, although the Stomach receives water and grain, its function as the official of transportation and transformation fails, unable to execute digestive commands, transport refined essences, and distribute irrigation throughout the body. This results in the failure of Heart-Lung Yang to descend and Kidney-Liver Yin to ascend, forming the state of "Pi" (否 - Stagnation/Non-interaction) where Heaven and Earth do not communicate. Clear and turbid Qi become confused, leading to blockage; Dampness fails to flow, stagnates, and transforms into Heat. The retention and accumulation of Damp-Heat result in distension and fullness. If swelling occurs simultaneously in all four limbs, it is classified as Edema (水肿), which is relatively easy to treat. However, isolated abdominal distension (Single Abdominal Distension 单腹胀) is stubborn and difficult to eradicate. A pulse that is large, firm, slow, or slippery indicates Distension. A floating and large pulse is a favorable sign (Shun 顺); a deficient and small pulse is unfavorable (Ni 逆). Treatment should focus on harmonizing the Middle Jiao, regulating Qi, strengthening the Spleen, and promoting diuresis.
Main Formula: Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus Immaturus), Xiangfu (Cyperi Rhizoma) (each 1 qian); Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Dafupi (Arecae Pericarpium), Mutong (Akebiae Caulis) (each 8 fen); Muxiang (Aucklandiae Radix) (5 fen, ground separately), Sharen (Amomi Fructus Rotundus) (7 fen, crushed separately). Add fresh ginger and Dengxincao (Junci Medulla) to decoct in water; take the decoction mixed with the Muxiang and Sharen powders.
If swelling is severe, administer Shenyao Wan (Divine Protection Pill) twice (see Phlegm section for formula). If pressing the abdomen with a finger leaves an indentation that does not rise immediately, it belongs to Deficiency; add Bian Dou (Dolichos Lablab Seed), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix) (each 8 fen). If pressing with the hand causes the abdomen to bulge back immediately, it belongs to Excess; add Sanleng (Sparganii Rhizoma), Pengzhu (Curcumae Rhizoma), Binglang (Arecae Semen), Qingpi (Citri Reticulatae Pericarpium Viride), Yizhi Ren (Alpiniae Oxyphyllae Fructus). For constipation, add Dahuang (Rhei Radix et Rhizoma) (wine-boiled); if pathogenic factors are expelled but Zheng Qi (Righteous Qi) is deficient, add Renshen (Ginseng Radix et Rhizoma); if Qi sinks, add Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) (each 3 fen); for anorexia with vomiting, add Huoxiang (Agastaches Herba); for distension preceding wheezing, treat the Spleen, add Bian Dou, Maiya (Hordei Fructus Germinatus), Tingli Zi (Semen Lepidii seu Descurainiae) (a little); for wheezing preceding distension, treat the Lung, add Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix); for phlegm, add Nanting (Arisaematis Rhizoma Preparatum), Banxia Qu (Pinelliae Fermentum); for morning relief and evening urgency, indicating Blood Deficiency, add Danggui, Honghua (Carthami Flos) (wine-washed, a little); to reduce distension, use Caoguo (Tsaoko Fructus); for Heat, add Zhizi (Gardeniae Fructus), Huanglian; for evening relief and morning urgency, indicating Qi Deficiency, add Renshen, Baizhu; for Cold, add Ganjiang (Zingiberis Rhizoma), Rougui (Cinnamomi Cortex), Huoxiang, Dingxiang (Caryophylli Flos), Huixiang (Foeniculi Fructus), Wuzhuyu (Evodiae Fructus). For swelling above the waist, induce mild sweating using formulas like Shen Su Yin (Ginseng and Perilla Decoction) (see Wind Injury section); for Qi constraint, add Fukxiong (Ligusticum striata var. hunanense root), Shenqu (Massa Medicata Fermentata), Yizhi Ren, Caodoukou (Alpinia Katsumadai Seed), Wuyao (Linderae Radix). For swelling below the waist, promote urination by adding Shilianzi (Nelumbinis Nucula), Huashi (Talcum). To direct Qi downward, add Chenxiang (Aquilariae Lignum Resinatum), Sugen (Perillae Caulis); for pain, add Jianghuang (Curcumae Longae Rhizoma), Xuanyuan (Cyperi Tuber).
Wu Zi Wu Pi Yin (Five Seeds and Five Peels Decoction): Suitable for robust individuals in the initial stage of the disease; stop taking it once symptoms slightly subside.
Ingredients: Zhizi Pi (Gardeniae Pericarpium), Dafupi, Shengjiang Pi (Zingiberis Pericarpium), Fuling Pi (Poria with Red Skin), Chenpi, Luobo Zi (Brassicae Chinensis Semens), Xiangfu Zi, Cheqian Zi (Plantaginis Semen), Tingli Zi, Suzi (Perillae Fructus). Decoct in water and take.
Suzi Tang (Perilla Seed Decoction): For excessive worry and thought damaging the Heart and Spleen, causing abdominal distension, rapid breathing, vomiting and regurgitation, borborygmus, and difficulty in urination and defecation.
Ingredients: Zisu Zi (Perillae Fructus) (1 liang), Dafupi, Caoguo, Banxia, Houpo, Muxiang, Chenpi, Mutong, Baizhu, Zhishi, Renshen, Gancao (Licorice Root) (each 5 qian).
Usage: Take 5 qian per dose, with 1.5 cups of water, 3 slices of ginger, and 1 jujube; decoct to 0.7 cup volume and take warm.
Muxiang Shunqi Tang (Aucklandia Regulating Qi Decoction): Treats distension caused by turbid Qi remaining in the Upper Jiao.
Ingredients: Muxiang, Cao Kou (Arecae Fructus wrapped in bread and baked), Cangzhu (prepared, each 3 fen), Houpo (prepared, 4 fen), Danggui (5 fen), Shengma, Chaihu (each 2 fen).
Usage: Coarsely powder for one dose. Decoct in 2 cups of water and take. Avoid raw/cold foods, hard foods, anger, and sexual exertion.
Jishi Li San (Chicken Dropping Wine Powder): Treats epigastric and abdominal fullness, inability to eat dinner after eating breakfast, leading to vomiting, regurgitation, and drum-like distension.
Ingredients: Jishi Li (Chicken droppings stir-fried until very hot, soaked in good wine, dried in shade), Dahuang, Taoren (Peach Kernel) (equal parts).
Usage: Grind into powder. Take 2 qian per dose. Decoct in 1.5 cups of water with 3 slices of ginger to 0.7 cup volume; take before meals.
Simple Prescriptions for Treating Abdominal Distension:
1. Caodoukou powder, 5 fen per dose, taken with Decoction of Papaya.
2. Binglang powder, 2 qian per dose, decocted in water and taken.
3. Roasted single-clove garlic, peeled, wrapped in cotton, inserted into the anus; replace when it feels cool internally. Also treats Guan Ge (Obstruction and Reversal) and abdominal distension with constipation of both stool and urine.
4. Tingli Zi stir-fried until purple, soaked in wine for seven days, ground into paste. Take 3 spoons per dose, washed down with good wine.