弟 寒湿肿胀，水渍经隧，少腹阴囊腿足通肿，大腹按之硬，
缺盆平，肢冷目黄，面颊俱浮，便滑溺少，脉沉迟而虚，背寒腹热，坐不得卧，病在水分。法先分消，佐以
通阳。防己、木通、大腹皮（洗）、猪苓、茯苓、薏米、半夏、砂仁壳、附子、姜。三服肿退肢暖。命却咸食
淡，然后主以健运，佐以淡渗。去防己、木通、腹皮、附子加生术、鸡内金（炙）、半夏曲（炒）、杜仲。数服食
进，微汗出，囊湿便干，此经腑水湿俱有出路。惟诊左尺虚，酌肾气汤桂心、牛膝、车前、茯苓、山药、椒目、
茵陈、五加皮，薏米。十数服悉愈。后用八味丸调理得安。
侄孙 由腿胫肿入腹，渐至胸胁坚满，法在不治。姑与分消之剂，得汗，肿略退，然寒湿内蕴，非温通
不愈。用浓朴、桂心、附子、牛膝、茯苓、大腹皮、砂仁壳、老姜。三服由面目退及胸腹，又数服腿足肿全消。
王 阴疟服劫药，疟止。面色晦黑，决其后必病胀，不信。予曰∶劫痰暂效，邪原未净，一也；
今卯月中旬木火司令，一逢辰上，湿痰内动，脾阳失运，必变中满，二也；毒品易犯食忌，三也；面黑无泽，肾
水侮土，小便不利，四也。后果如言，视其目窠微肿如新卧起状，知其裹水。先用实脾利水之剂，再用金匮
肾气丸料煎汤数十服，肿胀悉退。药乍止，时交未月，湿土已旺，渐胀小溲不利，又服前丸两月全愈。
族某 躯长体壮，病肿胀。或用破气消滞之品，胀益剧，行立肠几裂出，脐突，缺盆平，法本不治。
诊其脉细如丝，度必劳力伤精，脾肾两惫之症。询所由，自言长途辇重，池间出浴，酒后入房，忽觉溺涩，
通是浊血，惊眩欲仆，食减腹膨，绷急欲死。遂用肾气丸料大剂煎服，减附子、丹、泽，熟地炒炭用，一剂
腹有绉纹，再剂缺盆现，溺爽膈宽。又数服腹胀渐退，仍用加减肾气丸服。经言用力举重，若入房过度，
汗出浴水，则伤肾，故与肾气方合。后不守禁忌，饱食山芋及未熟鸡蛋，胀复作。求治，予言前方必不验，
卒如言。
房兄 病后失调，面浮跗肿，腹膨食少，小水短涩，腰膝乏力。经言诸湿肿满，皆属于脾。然土衰必
补其母，非命火不能生脾土。且肾为胃关，关门不利，故聚水。必得桂、附之阳蒸动肾
气，其关始开，积水乃下，经所谓膀胱气化则能出也。用桂、附、参、术、炮姜、茯苓、车前、牛膝、砂仁、
陈皮、山药为丸。一料而安。
陈 伤酒病单腹胀，诊其脉知脾阳虚。用葛花解酲汤加牛膝，枳 子，腹宽展，能进食矣。后用参术健
脾丸去炙草、大枣，加益智仁（煨）、砂仁壳。服愈。
韦 病后感寒腹痛，渐成胀满，脉沉微，溺少，食入胀加。腑阳不行，治以温通，则胀已。大茴香、大
腹皮（洗）、草果、木通、砂仁、益智仁（煨）、茯苓、广皮、煨姜。空心四服而愈。
石 腹胀不饥，小水不利，脉沉涩，腑气痹窒不宣。用砂仁壳、枳壳、木通、茯苓、益智仁、草果（俱煨）、
五谷虫、鸡内金（俱炙）、莱菔子（炒研）。数服愈。
陈 五旬以上病单腹胀，食后作饱，得气泄略宽。明系胃病，服谬药，浸至胁满跗冷，脉来沉濡，左关
微弦。症由腑气久衰，疏泄失职，气分延虚，渐干水分，致嗌干口燥，小水不清，化源乏力矣。通阳佐以益肾，
通阳则传送速，益肾则气化行，腹胀自宽。沙苑子、韭子、怀牛膝（酒蒸。各钱半）、益智仁（煨）、橘白、
砂仁壳（各一钱）、茯苓（三钱）、杞子、大腹皮（洗，各二钱）、枳壳（麸炒，钱二分）。十服胀宽口润，
便爽跗温，右脉渐起，惟两尺虚不受按。加补骨脂。核桃肉，去腹皮、枳壳。食宜淡，戒腥腻难化及一切壅
气食物。再以猪肚纳卵蒜其中，扎定，淡者食之。腑气通则纳食不壅，服之甚通畅，胀去七八矣。又加沉香、
牡蛎十数服，小腹之硬者亦软焉。
族女 脘胀嗳腐，经迟腹痛，间发寒热。按东垣云∶胃为卫之本，脾乃营之源。脾胃阳衰，纳运不旺，
致胀满瘀停，宜乎营卫失度，冲任不调矣。仿《内经》浊气在上则生 胀之例，以通阳降浊。二陈汤去甘草，
加白蔻壳、韭子、益智子（俱炒）、小茴香、谷芽、神曲（俱炒）、香附（姜汁制）、煨姜。数服诸症皆平。
沈氏 胎前腹满，产后面目肢体浮肿，咳频溺少，此肺气不降，水溢高原也。或劝用肾气汤，予力阻不可。
一服而小水点滴
全无，胀益甚，脉虚濡欲绝。用五皮饮参茯苓导水汤，去白术、木瓜、槟榔、腹皮，加杏仁、苏梗、栝蒌皮、
冬瓜皮、制半夏。数服肿消，腹渐宽矣。后用茯苓、半夏、生术、砂仁、薏仁、陈皮、苏子、木香、浓朴，
水泛丸。服两料遂平。
按∶肺为水之上源，主气。此症水阻气分，以肺不能通调水道，下输膀胱，故溢则水留而为胀。其
症年余无汗，得苏杏微汗而肿消，得五皮行水而便利，兼仿《内经》开鬼门、洁净府遗法也。
李氏 有年，食入气壅，绕脐积冷，胀连胸胁，溺少便溏，脉沉微。全是腑阳向衰，浊阴凝结。前用二
苓、木通开太阳之里，砂仁、陈、夏理太阴之滞，干姜、浓朴、薏仁温通利湿，冷胀减，便溺爽，而胸痹未舒，
犹是中脘清阳不旋之故。其家用俗传牛口中蚀出 稻草煎汤，服甚适。予仿用仲景栝蒌薤白白酒汤，加半夏、
青皮、浓朴、乌药、木香。旋转清阳，可以纳谷。
张氏 腹 胀连带脉，腰围紧掣如束，脉坚而搏指，此病久兼入奇经。宜通其腑，并理带脉。枳实、
大腹皮、怀中膝（酒蒸。各钱半）、砂仁、木通（各八分）、当归须、茯苓、郁李仁（各二钱）、郁金（六分）。
四剂胀宽，带脉亦不紧掣矣。后去郁李仁、枳实，加沉香（磨汁三匙）。数服全愈。
姜氏 五旬余，腹膨中空，外绷急，食入不加胀，头眩耳鸣，口干舌硬，溺赤沫，便艰，足重坠，
脉沉微。症属三焦湿郁生火，《内经》亦谓诸腹胀大，皆属于热。诸病跗肿，皆属于火。若郁热不除，遂成鼓
胀不治。用山栀、大腹皮、黄柏、知母（俱酒炒）、生地、麦冬、丹皮、赤苓、冬瓜皮、车前子。数服已效。
后去黄柏、丹皮，加海金砂、萆 ，服得安。
眭妪 脾宜升则健，胃宜降则和。今脘中食入作饱，腑气不司下行，医用流气之剂，更致腰痛带下吐瘀，
诊脉右关沉微。经所谓浊气在上则生 胀也。药以辛温通阳泄浊为宜。制半夏、砂仁壳、枳壳、益智仁、韭子、
茯苓、陈皮、栝蒌皮、谷芽、杜仲、煨姜。数服诸症俱除。
纪氏 先因右胁痛，继而脘腹满闷，食入胀加。腑气失降，实由肝失疏泄。左关脉不甚弦，右寸近滑，
恐属妊兆。泄肝通腑，
仍不碍胎为稳。椒目、砂仁壳、茯苓、栝蒌皮、杏仁、陈皮、木香。数服而平。
赵 童年色萎腹蛊，脉疾寒热，无汗溺涩。以肾气汤治。牛膝、益智仁、车前子、茯苓、薏米、熟地、
牡蛎。数服病减，加参、桂、砂仁壳。服愈。
张 小腹乃肝肾部分、胀满溺涩，已属下焦气化失司。今通大腹肿硬如石，脉右弦大，左虚涩，症属单
胀。治宜通阳，勿用守补。党参、茯苓、牛膝炭。沙苑子。益智仁（煨）、杞子炭、沉香（磨汁）。数服溺
爽胀宽。
张 黄胆积年不愈，近成单胀，腹坚满，食减便泻，乃气不化水。然神脉颓弱，难挽之 。姑用牡蛎、
薏仁、茯苓、车前子、茵陈、砂仁壳。益智仁、牛膝、桂心。腹软溺利。伊芳兄复请，终以沉 辞之。
本 阴水腹大，肿硬如石，脉缓肢冷囊肿。用肾气汤。桂心（五分）、附子（三分）、蒸牛膝（二钱）、
车前子（一钱）、茯苓（三钱）、大腹皮（钱半）。椒目（二十粒）。八服囊湿如淋，腹软溺利，加干姜、
山药（研末）。大腹皮（煎汤） 泛丸。以通阳崇土防水而安。
张 胁痛胀，少腹肿硬，误服攻荡劫剂，胀剧，气注睾丸，脉沉小，右弦涩，乃肝失疏泄，气郁留浊。
治先理肝以泄浊，浓朴（七分）、小茴香、青皮（各钱二分）、枳壳（钱半）、茯苓、橘核（各二钱）、
大腹皮（三钱）、延胡（八分）、椒目（二十粒）、车前子（三分）。四服胁痛疝坠俱止。但腹右硬痛不任偏卧，
食不加胀，二便如常，按脉论症，单胀何疑。然病因脏损，治在通摄兼施。浓朴（五分）、枳壳（钱半）、牡蛎、
茯苓（各三钱）、归须、橘核（各二钱）、牛膝（一钱）、桂心（三分）。四服症平。后仿肾气丸，用牛膝、
车前、桂心、茯苓、山药、当归、牡蛎、白芍、萸肉，蜜丸。愈。
金氏 中年经断，脘腹胀大，季胁紧掣如束，食下满，超时痛，便泻日数行，晡后股胫重坠，脉阳搏阴微，
症由瘕聚胞宫，气闭 留，可导使下。失治则冲病及带，腰围 急，中下焦气机钝窒，运纳无权，满痛瘕泄，
气虚下陷，由来渐矣，前年立法温通腑阳，胀宽能纳。今先主通降，胀缓再议。半夏曲、茯苓、草
果（煨），砂仁壳、苏子、橘白、大腹皮、川椒目、降香。三服满痛除。专调带络，为其气虚则 急而陷下也。
潞参、升麻、益智子、沙苑子、茯神、牛膝炭、当归须。三五服后，腰肋松而股胫复常。
邹 六旬外，由泄泻渐次足肿，入腹为胀，延及通腹坚满，面浮肢肿，水湿不运，溏泻未止。若论平昔嗜
饮便红，宜丹溪小温中丸分理湿热。然脉来沉小，两尺如丝，明系脾肾久衰，火土俱弱，致气钝湿壅，清浊混
淆。此消导破气，决非治法。但温理脾肾，兼佐泄湿，自可向安。炮姜（三分）、肉蔻、神曲（炒。各一钱）、
益智仁（煨，钱半），茯苓（三钱）、牛膝（蒸）、砂仁壳（各一钱半）、大腹皮（洗二钱）、车前子、
橘白（各八分）、冬瓜皮（二钱）、倒蚀牛口 稻草（二两。煎汤代水。）数服肿退泻止。去姜、蔻、神曲，
加沙苑子、半夏曲、粳米（炒）。数十服胀全消。匝月后不节荤茹湿面，复胀，溺少，仍用牛膝、车前、茯苓、
益智仁、炮姜、莱菔子、砂仁、麦芽、鸡内金（俱炒）。胀消而健。
韦 胸高突，腹肿硬，面黄鼻衄，足肿溺涩，夜分不寐。想成童后恣啖生冷，秋冬以来，邪痼气窒，延
春身热膝冷，食入胀加，脏腑经脉窒痹。治先分理湿热，佐以软坚。栝蒌仁、山栀、茯苓、砂仁壳、大腹皮、
车前子、牛膝、炒神曲、杏仁、生牡蛎、椒目。六七剂胀宽肿软者十四五。知肝失疏泄，脾失运输，分消中宜
佐畅肝运脾。用陈皮、郁金、苏梗、当归、石斛、山栀、茯苓、薏苡、鸡内金（炙黄）、牡蛎，表里分消，
而溺利汗出矣。惟晡后阳升，颊热头眩，溺色浑，行则气急，惧当春鼻仍易衄。治在降阳和阴。熟地、牛
膝（俱炒炭）、丹皮、山栀、石斛、薏仁、赤苓、大腹皮、冬桑叶、灯心、小麦。溺清眩热已，惟宵则气急，
寐不甚稳。去赤苓，加茯神、蒌霜、桑皮（蜜炙）、防己、炙草。数服气舒而胸突渐平，腹宽而膝冷渐和。
Brother: Edema caused by cold-dampness, with water fluids soaking the meridians and collaterals. Generalized swelling of the lower abdomen, scrotum, legs, and feet; hardness upon palpation of the greater abdomen; flattening of the clavicular fossa (Quepen); cold limbs; yellow eyes; edema of the face and cheeks; loose stools; scanty urination; pulse is deep, slow, and deficient; chills on the back but heat in the abdomen; inability to lie down, only able to sit. The pathology lies in "Water Division" (dysfunction of fluid metabolism). The treatment principle is first to separate and eliminate via diuresis, assisted by unblocking Yang. Prescription: Fangji (Stephaniae Tetrandrae Radix), Mutong (Akebiae Caulis), Dafupi (Arecae Pericarpium, washed), Zhuling (Polyporus), Fuling (Poria), Yimi (Coicis Semen), Banxia (Pinelliae Rhizoma), Sharenqiao (Amomi Fructus Shell), Fuzi (Aconiti Lateralis Radix Preparata), Jiang (Zingiberis Rhizoma). After three doses, swelling receded and limbs warmed. Ordered abstinence from salty food and a bland diet. Then, focus on strengthening and transporting Spleen Qi, assisted by bland leaching. Remove Fangji, Mutong, Dafupi, Fuzi; add Shengzhu (Atractylodis Macrocephalae Rhizoma raw), Jineijin (Galli Gigerii Endothelium Corneum, roasted), Banxiaqu (Pinelliae Fermentatum), Duzhong (Eucommiae Cortex). After several doses, appetite improved, slight sweating occurred, scrotal dampness decreased, and stools became dry. This indicates that water-dampness in both the meridians and fu-organs has found an outlet. However, the left Chi pulse was weak. Prescribed Shenqi Tang modified: Guixin (Cinnamomi Ramulus), Niuxi (Achyranthis Bidentatae Radix), Cheqianzi (Plantaginis Semen), Fuling (Poria), Shanyao (Dioscoreae Rhizoma), Jiaomu (Semen Lepidii et Descurainiae), Yinchen (Artemisiae Scopariae Herba), Wujiaopi (Acanthopanacis Cortex), Yimi (Coicis Semen). After more than ten doses, complete recovery. Subsequently,调理 (regulation) with Bawei Wan (Eight-Ingredient Pill) ensured stability.
Nephew: Edema started in the calves and shins, gradually spreading to the abdomen, then to hardness and fullness in the chest and hypochondrium. According to standard protocols, this is considered untreatable. Tentatively administered a separating and eliminating formula. Sweating occurred, and swelling slightly receded. However, internal accumulation of cold-dampness requires warming and unblocking for cure. Prescription: Houpo (Magnoliae Officinalis Cortex), Guixin (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Preparata), Niuxi (Achyranthis Bidentatae Radix), Fuling (Poria), Dafupi (Arecae Pericarpium), Sharenqiao (Amomi Fructus Shell), Laojiang (Zingiberis Rhizoma Recens). After three doses, swelling receded from face and eyes to chest and abdomen. After several more doses, leg and foot swelling completely disappeared.
Wang: Suffered from Yin Malaria (Cold Malaria). Took Jie Yao (malaria-arresting drugs), malaria ceased. Complexion was dark and dull. I predicted he would inevitably develop distension later, but he did not believe me. I said: The arrestant drugs provide temporary relief, but the pathogenic root remains, point one; currently it is mid-Mao month, Wood and Fire are commanding, once Chen earth arrives, damp-phlegm will stir internally, Spleen Yang will lose its transport function, leading to central fullness, point two; toxic drugs easily lead to dietary indiscretions, point three; dark complexion without luster indicates Kidney Water insulting Spleen Earth, with difficult urination, point four. The outcome followed my prediction. Observation showed slight edema in the eye bags, resembling waking up, indicating internal water retention. First used a formula to solidify the Spleen and promote urination. Then used decoction of Jin Gui Shenqi Wan ingredients for dozens of doses, swelling completely receded. After stopping medication, entering Wei month when damp-earth is prosperous, gradual abdominal distension and difficult urination recurred. Resumed the previous pill for two months, fully recovered.
Clansman: Tall and robust physique, suffering from edema/distension. Used qi-breaking and stagnation-resolving agents, causing distension to worsen significantly. Intestines nearly protruded during walking/standing, umbilicus protruded, clavicular fossa flattened. By protocol, untreatable. Pulse fine as a silk thread. Deduced labor injury depleting essence, leading to exhaustion of both Spleen and Kidney. Inquiry revealed long-distance heavy lifting, bathing in ponds, sexual intercourse after drinking alcohol. Suddenly felt dysuria, passing turbid blood, frightened and dizzy, wanting to collapse. Reduced appetite, abdominal bloating, tension feeling like death. Prescribed large dose of Shenqi Wan ingredients, reducing Fuzi, Danshen, Zexie; Chushu Di (Stewed Rehmanniae Radix Preparata) charred. One dose showed wrinkles on abdomen; second dose revealed clavicular fossa, smooth urination, relaxed epigastrium. Several more doses reduced distension. Continued with modified Shenqi Wan. Classics state: heavy lifting, excessive intercourse, sweating then bathing in water injure the Kidney. Thus, Shenqi Formula matches. Later ignored taboos, ate sweet potatoes and undercooked eggs, distension recurred. Seeking treatment, I said the previous prescription would fail. Outcome proved correct.
Brother Fang: Post-illness maladjustment. Facial edema, dorsal foot swelling, abdominal distension, poor appetite, scanty and astringent urine, weak waist and knees. Classics state: all dampness-induced swelling and fullness belong to the Spleen. However, when Earth is deficient, one must tonify its Mother (Fire); without Mingmen Fire, Spleen Earth cannot be generated. Kidney is the gate of the Stomach; if the gate is unfavorable, water accumulates. Must rely on Yang energy from Guizhi (Cinnamon Twig) and Fuzi to vaporize Kidney Qi, opening the gate so accumulated water descends. As classics say: Bladder Qi transformation allows excretion. Prescription: Guizhi, Fuzi, Renshen (Ginseng), Baizhu (Atractylodis Macrocephalae Rhizoma), Paojiang (Prepared Ginger), Fuling (Poria), Cheqianzi (Plantaginis Semen), Niuxi (Achyranthis Bidentatae Radix), Sharen (Amomi Fructus), Chenpi (Citri Reticulatae Pericarpium), Shanyao (Dioscoreae Rhizoma) made into pills. One supply brought peace.
Chen: Illness due to alcohol, presenting as isolated abdominal distension. Pulse indicated Spleen Yang deficiency. Ge Hua Jie Cheng Tang (Kudzu Flower Decoction to Resolve Intoxication) plus Niuxi (Achyranthis Bidentatae Radix), Zhizi (Araliae Cordatae Fructus - *Note: Text says 'Zi', likely Zhizi or similar, context implies resolving damp-heat/stagnation*). Abdomen expanded, able to eat. Subsequently used Shenzhu Jianpi Wan (Ginseng and Atractylodes Spleen-Strengthening Pill), removing Zhigancao (Honey-fried Licorice) and Dazao (Jujube), adding Yizhiren (Alpiniae Oxyphyllae Fructus baked), Sharenqiao (Amomi Fructus Shell). Cured.
Wei: Post-illness cold invasion causing abdominal pain, gradually forming distension. Pulse deep and minute, scanty urine, distension worsens after eating. Fu-Yang obstruction, treat with warming and unblocking, distension resolves. Prescription: Dachuixiang (Foeniculum Vulgare Fruit), Dafupi (Arecae Pericarpium, washed), Caoguo (Tsaoko Cardamomi Fructus), Mutong (Akebiae Caulis), Sharen (Amomi Fructus), Yizhiren (Alpiniae Oxyphyllae Fructus baked), Fuling (Poria), Guangpi (Tangerine Peel), Weijiang (Baked Ginger). Taken on empty stomach, four doses cured.
Shi: Abdominal distension, no hunger, difficult urination. Pulse deep and choppy. Fu-Qi blocked and stagnant. Prescription: Sharenqiao (Amomi Fructus Shell), Zhike (Aurantii Fructus), Mutong (Akebiae Caulis), Fuling (Poria), Yizhiren (Alpiniae Oxyphyllae Fructus), Caoguo (Tsaoko Cardamomi Fructus, all baked), Wugu Chong (Silkworm), Jineijin (Galli Gigerii Endothelium Corneum, all roasted), Laifuzi (Radish Seed, fried and ground). Several doses cured.
Chen: Over fifty years old, isolated abdominal distension. Fullness after eating, relieved by flatulence. Clearly Stomach disease. Mismedicated, progressing to hypochondriac fullness and cold feet. Pulse deep and soft, Left Guan slightly wiry. Pathology: Long-term decline of Fu-Qi, failure of dispersion and drainage, Qi aspect extending to deficiency, gradually affecting Water aspect. Resulting in dry throat/mouth, unclear urine, weak source of transformation. Unblock Yang assisted by tonifying Kidney. Unblocking Yang speeds transmission; tonifying Kidney promotes Qi transformation, naturally relieving distension. Prescription: Shayuanzi (Astragali Complanati Semen), Jiu Zi (Allii Tuberosi Semen), Huai Niuxi (Achyranthis Bidentatae Radix wine-steamed, each 1 qian half), Yizhiren (Alpiniae Oxyphyllae Fructus baked), Ju Bai (Tangerine Albedo), Sharenqiao (Amomi Fructus Shell, each 1 qian), Fuling (Poria, 3 qian), Qizi (Lycii Fructus), Dafupi (Arecae Pericarpium, washed, each 2 qian), Zhike (Aurantii Fructus bran-fried, 0.2 qian). Ten doses: distension eased, mouth moist, stool smooth, feet warm, Right pulse rising. Only both Chi pulses weak/unpressable. Added Buguzhi (Psoraleae Fructus), Hetao Rou (Walnut Kernel). Removed Dafupi, Zhike. Diet: bland, avoid greasy/hard-to-digest and Qi-stagnating foods. Use pig stomach stuffed with garlic eggs, tied, cooked blandly. Fu-Qi smooth, food intake unobstructed, very effective, distension reduced by 70-80%. Added Chenxiang (Aquilaria Lignum), Muli (Concha Ostreae) for over ten doses, hardness in lower abdomen softened.
Clanswoman: Epigastric distension, belching with rotten smell, delayed menstruation with abdominal pain, intermittent chills and fever. Referencing Dong Yuan: Stomach is root of Wei-Qi, Spleen is source of Ying-Qi. Spleen/Stomach Yang decline, poor intake/transport, leading to distension and stasis. Ying-Wei imbalance, Chong-Ren irregularity. Following Neijing: "Turbid Qi above generates distension." Unblock Yang, descend turbidity. Erchen Tang (Two-Cured Decoction) minus Gancao (Licorice), add Baikouqiao (Cardamomi Fructus Shell), Jiu Zi (Allii Tuberosi Semen), Yizhi Zi (Alpiniae Oxyphyllae Fructus, all fried), Xiaohui Xiang (Foeniculum Vulgare Fruit), Guya (Milii Germen), Shenqu (Medicated Leaven, all fried), Xiangfu (Cyperi Rhizoma ginger-juice processed), Weijiang (Baked Ginger). Several doses resolved all symptoms.
Shi Family: Abdominal fullness before pregnancy, facial/limb edema postpartum, frequent cough, scanty urine. Lung Qi failing to descend, water overflowing the high source (Lung). Advised Shenqi Tang, strongly opposed. One dose resulted in zero urine output, worsening distension, pulse deficient/soft/near extinction. Wupi Yin (Five-Bark Decoction) combined with Shen Fuling Daoshui Tang (Ginseng-Poria Water-Guiding Decoction), removing Baizhu, Mugua, Binglang, Dafupi. Added Xingren (Pruni Semen), Sugeng (Perillae Caulis), Gualou Pi (Trichosanthis Pericarpium), Donggua Pi (Benincasae Exocarpium), Zhi Banxia (Pinelliae Rhizoma Preparata). Several doses reduced swelling, abdomen widened. Subsequently: Fuling, Banxia, Shengzhu, Sharen, Yiren, Chenpi, Suzi, Muxiang, Houpo, water-pelleted. Two supplies settled it.
Commentary: Lung is upper source of water, governs Qi. Here water blocks Qi aspect; Lung fails to regulate waterways, transmit downward to Bladder, thus overflowing and retaining as distension. Patient had no sweat for over a year. Got slight sweat from Su Ye (Perillae Folium) and Xingren, swelling subsided. Got Wupi for water movement, urination facilitated. Combined with Neijing methods: Kai Guimen (open ghost door/sweat), Jing Jifu (cleanse residence/diuresis).
Li Family: Elderly. Food intake causes Qi congestion, cold accumulation around navel, distension connecting to chest/hypochondrium, scanty urine, loose stool. Pulse deep/minute. Entirely Fu-Yang declining, turbid Yin condensing. Previously used Erling (Fuling/Zhuling), Mutong to open Taiyang interior; Sharen, Chenpi, Banxia to regulate Taiyin stagnation; Ganjiang, Houpo, Yiren to warm/unblock/promote dampness. Cold distension reduced, urination/stool smooth, but chest bi (pain/blockage) not relieved. Reason: Middle Jiao Clear Yang not rotating. Household folk remedy: decoction of straw eroded from cow's mouth, taken comfortably. I imitated Zhang Zhongjing's Gualou Xiebai Baijiu Tang (Trichosanthes Rhizome, Macrostemon Tuber, White Wine Decoction), added Banxia, Qingpi, Houpo, Wuyao, Muxiang. Rotate Clear Yang, enable food intake.
Zhang Family: Abdominal distension involving Dai Mai (Girdle Vessel). Waist tight/constricting like a belt. Pulse firm/beating against finger. Disease long-standing, entered extraordinary vessels. Should unblock Fu-organs and regulate Dai Mai. Prescription: Zhishi (Aurantii Fructus Immaturus), Dafupi (Arecae Pericarpium), Huai Niuxi (Achyranthis Bidentatae Radix wine-steamed, each 1.5 qian), Sharen (Amomi Fructus), Mutong (Akebiae Caulis, each 0.8 fen), Dangguixu (Angelicae Sinensis Radix Radical), Fuling (Poria), Yuliren (Prunus Armeniaca Seed, each 2 qian), Yujin (Curcumae Radix, 0.6 fen). Four doses: distension eased, Dai Mai constriction stopped. Later removed Yuliren, Zhishi, added Chenxiang (Aquilaria Lignum, ground juice 3 spoons). Several doses cured.
Jiang Family: Over fifty. Abdomen bulging/hollow, externally tense. Eating does not increase distension. Dizziness, tinnitus, dry mouth/tongue stiff, red foamy urine, difficult stool, heavy dragging feet. Pulse deep/minute. Syndrome: Sanjiao dampness depression generating fire. Neijing: All abdominal distensions belong to Heat. All foot edemas belong to Fire. If郁热 (depressed heat) not removed, becomes Drum Distension (untreatable). Prescription: Shanzhi (Gardeniae Fructus), Dafupi (Arecae Pericarpium), Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma, all wine-fried), Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Danpi (Moutan Cortex), Chiling (Red Poria), Donggua Pi (Benincasae Exocarpium), Cheqianzi (Plantaginis Semen). Several doses effective. Later removed Huangbai, Danpi, added Haijinsha (Lygodii Spora), Biboa (Dioscoreae Hypoglaucae Rhizoma). Peace achieved.
Sui Old Woman: Spleen healthy when ascending, Stomach harmonious when descending. Now epigastric fullness after eating, Fu-Qi fails to descend downward. Doctor used Qi-flowing agents, worsening lumbar pain, leukorrhea, vomiting blood. Pulse Right Guan deep/minute. Neijing: "Turbid Qi above generates distension." Medication should be pungent-warm to unblock Yang and drain turbidity. Zhi Banxia, Sharenqiao, Zhike, Yizhiren, Jiu Zi, Fuling, Chenpi, Gualou Pi, Guya, Duzhong, Weijiang. Several doses eliminated all symptoms.
Ji Family: Initially right hypochondriac pain, then epigastric/abdominal fullness, distension worsening after eating. Fu-Qi fails to descend, actually Liver failing to disperse. Left Guan pulse not very wiry, Right Cun near slippery, suspect pregnancy sign. Drain Liver, unblock Fu, ensure safety for fetus. Prescription: Jiaomu (Semen Lepidii et Descurainiae), Sharenqiao, Fuling, Gualou Pi, Xingren, Chenpi, Muxiang. Several doses settled.
Zhao: Childhood sallow complexion, abdominal gu-distension (parasitic/water), rapid pulse with chills/fever, no sweat, astringent urine. Treated with Shenqi Tang. Niuxi, Yizhiren, Cheqianzi, Fuling, Yimi, Shudi, Muli. Several doses reduced illness, added Renshen, Guizhi, Sharenqiao. Cured.
Zhang: Lower abdomen is Liver/Kidney region. Distension/astringent urine indicates Lower Jiao Qi transformation failure. Now whole abdomen swollen/hard as stone. Pulse Right wiry/large, Left deficient/choppy. Syndrome: Single Distension. Treatment: Unblock Yang, do not use static tonification. Dangshen, Fuling, Niuxi Tan (Charred Achyranthes), Shayuanzi, Yizhiren (baked), Qizi Tan (Charred Lycium), Chenxiang (ground juice). Several doses: smooth urine, eased distension.
Zhang: Jaundice chronic, recently formed single distension. Abdomen hard/full, reduced appetite, diarrhea. Qi fails to transform water. Spirit/pulse weak, hard to save. Tentatively: Muli, Yiren, Fuling, Cheqianzi, Yinchen, Sharenqiao, Yizhiren, Niuxi, Guixin. Abdomen soft, urine free. Brother Yi Fang requested again, declined due to severity.
Ben Family: Yin Water, large abdomen, swollen/hard as stone, slow pulse, cold limbs, scrotal swelling. Shenqi Tang. Guixin (0.5 fen), Fuzi (0.3 fen), Zheng Niuxi (2 qian), Cheqianzi (1 qian), Fuling (3 qian), Dafupi (1.5 qian), Jiaomu (20 grains). Eight doses: scrotal dampness like dripping, abdomen soft, urine free. Added Ganjiang, Shanyao (powder), Dafupi (decoction) for water-pellets. Unblock Yang, strengthen Earth, prevent water, achieve peace.
Zhang: Hypochondriac pain/distension, lower abdomen swollen/hard. Mistakenly took purgative/arresting agents, distension worsened, Qi injected into testicles. Pulse deep/small, Right wiry/choppy. Liver failed to disperse, Qi depression leaving turbidity. Treat first by regulating Liver to drain turbidity. Houpo (0.7 fen), Xiaohui Xiang, Qingpi (each 1.2 qian), Zhike (1.5 qian), Fuling, Juhe (each 2 qian), Dafupi (3 qian), Yanhu (0.8 fen), Jiaomu (20 grains), Cheqianzi (0.3 fen). Four doses: pain/hernia stopped. But right abdomen hard/painful, cannot lie on side. Eating doesn't worsen distension, bowel/bladder normal. Pulse/symptoms confirm Single Distension. Etiology: Zang damage. Treatment: Unblock and secure simultaneously. Houpo (0.5 fen), Zhike (1.5 qian), Muli, Fuling (each 3 qian), Guixu, Juhe (each 2 qian), Niuxi (1 qian), Guixin (0.3 fen). Four doses: symptoms flat. Later imitated Shenqi Wan: Niuxi, Cheqian, Guixin, Fuling, Shanyao, Danggui, Muli, Baishao, Yurou, honey-pellets. Cured.
Jin Family: Menopause at middle age. Epigastric/abdominal distension. Costal margin tight/constricting. Fullness after eating, pain after time, diarrhea several times daily. Evening heaviness in thighs/shins. Pulse Yang beats, Yin weak. Syndrome: Masses in uterus, Qi closure/stagnation, can guide downward. Untreated, Chong affects Dai, waist tight, Middle/Lower Jiao Qi sluggish, transport/powerless, fullness/pain/masses/diarrhea, Qi deficiency sinking, gradual onset. Previous year legislation: Warm/Unblock Fu-Yang, distension eased, able to eat. Now primarily Descending, discuss later if distension eases. Banxiaqu, Fuling, Caoguo (baked), Sharenqiao, Suzi, Ju Bai, Dafupi, Chuan Jiaomu, Jiangxiang. Three doses: fullness/pain removed. Specifically regulate Dai collaterals, as Qi deficiency leads to tightness/sinking. Lushen, Shengma, Yizhi Zi, Shayuanzi, Fushen, Niuxi Tan, Dangguixu. 3-5 doses: waist/ribs loose, thighs/shins normal.
Zou: Over sixty. From diarrhea gradually foot swelling, entering abdomen as distension, extending to whole abdomen hard/full, facial/limb edema. Water-dampness not transported, loose stool persists. If considering past alcohol preference/red stool, Danxi Xiaowenzhong Wan (Small Warming Center Pill) to separate damp-heat. However, pulse deep/small, both Chi threads-like. Clearly Spleen/Kidney long-declined, Fire/Earth weak, causing Qi sluggish/damp congested, clear/turbid mixed. This elimination/breaking Qi method is definitely wrong. Only warm/regulate Spleen/Kidney, assist draining dampness, naturally towards peace. Paojiang (0.3 fen), Roukou, Shenqu (fried, each 1 qian), Yizhiren (baked, 1.5 qian), Fuling (3 qian), Niuxi (steamed), Sharenqiao (each 1.5 qian), Dafupi (washed 2 qian), Cheqianzi, Ju Bai (each 0.8 fen), Donggua Pi (2 qian), Dao Shi Niu Kou Daocao (Straw eroded from cow's mouth, 2 liang, decoct as water). Several doses: swelling receded, diarrhea stopped. Remove Jiang, Kou, Shenqu. Add Shayuanzi, Banxiaqu, Jingmi (fried). Dozens of doses: distension fully cleared. Month later, indulged in meat/damp noodles, distension recurred, scanty urine. Still used Niuxi, Cheqian, Fuling, Yizhiren, Paojiang, Laifuzi, Sharen, Maiya, Jineijin (all fried). Distension cleared, health restored.
Wei: Chest high/protruding, abdomen swollen/hard, sallow face, epistaxis, foot swelling, astringent urine, insomnia at night. Likely since childhood indulged in cold/raw foods. Since autumn/winter, pathogenic stubbornness/Qi blockage. Spring arrived: body heat, cold knees, distension worsening after eating. Zang/Fu meridinals blocked. Treat first by separating damp-heat, assisting softening hardness. Gualou Ren, Shanzhi, Fuling, Sharenqiao, Dafupi, Cheqianzi, Niuxi, Fried Shenqu, Xingren, Raw Muli, Jiaomu. 6-7 doses: distension eased, swelling softened by 14-15%. Know Liver failed to disperse, Spleen failed to transport. In separation, assist soothing Liver/transporting Spleen. Chenpi, Yujin, Sugeng, Danggui, Shihu, Shanzhi, Fuling, Yiyi, Jineijin (roasted yellow), Muli. Exterior/Interior separation, urine smooth, sweating occurred. Only late afternoon Yang rises, cheek heat/dizziness, cloudy urine, panting when walking, fear spring nosebleeds recur. Treat by descending Yang/harmonizing Yin. Shudi, Niuxi (charred), Danpi, Shanzhi, Shihu, Yiren, Chiling, Dafupi, Dong Sangye (Winter Mulberry Leaf), Dengxin (Juncus), Xiaomai (Triticum). Urine clear, dizziness/heat gone. Only night panting, unstable sleep. Remove Chiling, add Fushen, Lou Shuang, Sangpi (honey-fried), Fangji, Zhigancao. Several doses: Qi comfortable, chest protrusion flattened, abdomen widened, knee cold harmonized.