食，但饮米汤。喻曰∶腹中原是大黄推荡之滞粪，以膀胱胀大，撑住大肠不得出耳。于是以五苓散与之，以通
膀胱之气。药才下咽，即觅圊，小便先出，大便随之，滞下半桶而愈。一月后小患伤风，取药四剂，与荤酒杂
进，及伤风未止，并谓治胀，亦属偶然矣。（温补法。）
吴圣符单腹胀，腹大如箕，坚硬如石，胃中时生酸水，吞吐皆然，经年罔效。盖由医辈不察病之所起，与
病成而变之理耳，惟肾气丸一方，犹是前人成法。但此病用之，譬适燕而南其指也。夫肾气丸为肿胀之圣药者，
以能收摄肾气，使水不泛溢耳。今小水一昼夜六七行，水无泛溢之虞也。且谓益火之源，以消阴翳耳。今酸味
皆从火化，尚可更益其火乎？又谓指腹胀为食积，用局方峻攻，不足论矣。原是疾起于脾气不宣，郁而成火，
使初时用火郁发之之法，升阳散火，病霍然矣。迨至郁之愈湮渐为胀满，则身中之气，一如天地不交而成否塞，
病成而变矣。犹进槟榔、浓朴、莱菔之类，以耗气助火，于是病转于胃。胃中之热有如曲 ，俟谷饮一入，顷
刻酿成酢味。夫新谷芳甘，胃所喜也，旧谷酸腐，胃所恶也，故有时新入而旧出矣。人身天真之气，全在胃口。
（似是而非之语，节之不尽。）土曰稼穑作甘者也，木曰曲直作酸者也。甘反作酸，木来侮土，（喻君但知肿胀
为脾气不宣，未知此病原由木郁也。）至春木旺则难治矣。今欲反酸为甘，但有用刚药一法，以气味俱雄之药，
能变胃而不受胃变也。参伍以协其平，但可用刚中之柔，不可用柔中之刚。八味丸柔中之刚也，于六味作酸药中，
入二味止酸药，乌能取效？惟连理汤丸刚有柔以济其刚，可收去酸之绩矣。酸去而后治胀，破竹之势乃成。（原
注∶善后多年，闻用黄柏、知母之属，始得全效，更奇，何奇之有？）门人问曰∶圣符之病，酸止胀消，已奏全
绩，不知意外尚有何患？请示善后之法。喻曰∶圣符之病，乃自脾入传于胃，今酸去胀消，亦自胃复返于脾，善
后之法，以理脾为急，而胃则次之。设胃气未和，必不能驱疾。然使胃能容受，而脾未能健运，则倦怠多睡，
惟乐按摩者有之。受食稍多，身重异常者有之。登高涉险，则觉上重下轻，举足无力者有之。食后喜溉沸汤，借
资于有形者之热者有之。其病之余，夏热为瘅，秋清为疟，燥胜脾约，湿胜脾泻者有之。故理脾则百病不生，
不理脾则诸疾续起，久之乃入于胃也。至若将息失宜，饮食房劳所犯，脾先受之，犹可言也。设忿怒之火一动，则
挟木邪直侵胃土，原病陡发，不可言也。又其始焉酸胀，胃中必另创一膜囊。若赘庞者，乃肝火冲入，透开胃膜，
故所聚之水，暗从木化变酸，久之渐满，膜囊垂大，其腹之胀，以此为根。观其新谷入口，酸物迸出，而芳谷不
出，及每食饴糖，如吸筒入喉，酸水随即涌出，皆可征也。若非另一窠臼，则其呕时，宜新腐迸出，如膈气之类，
何得分别甚清耶？余订善后之方，用六君子煎，调赤石脂末，盖因其膜囊既空，而以是填之，俾不为异日患
耳。昔治广陵一血蛊，服
药全消，左胁肋露病根一条，如小枕状，以法激之，呕出黑污斗许，余从大便泄去始消。每思蛊胀，不论气、
血、水、痰，总必自辟一字，方可久聚。《内经》论五脏之积，皆有定所，何独于六腑之聚久为患，如蛊胀等
类者，遂谓漫无根柢区界乎？是亦可补病机之未逮。（雄按∶天真在胃，的是名言。下文木来侮土，未尝不知为
木郁也。）
李士材治何太学，夏月好饮水，一日候文宗发放，自晨抵暮，为炎威所迫，饮水计十余碗，归寓便胀闷不
能食，越旬日，腹如抱瓮，气高而喘。诊之，皮薄而光，水积不化也。且六脉坚实，其病暴成，法当利之。遂
以舟车丸，每服三钱，香薷汤送。再剂，二便涌决如泉。复进一钱五分，腹减如故，用六君子汤十帖而愈。
（洁净府法。）
方太和大怒后复大醉，至明日目下如卧蚕，（脾受水湿。）居七日，肢体皆肿，不能转侧，二便不通，
烦闷欲绝。诊之，脉沉且坚，当逐其水。用疏凿饮子，一服二便快，再服四肢宽。更以五皮饮，三日随愈。
钱赏之酒色无度，秋初腹胀，冬杪遍体肿急，脐背平，在法不治。乃与大剂肾气方料煎服，兼进理中汤，
服五日无效。可见病重药轻，药即中病，亦复无济。古今如此延误而死者颇多，虚实症皆有之也。李欲辞归，
彼自知必死，坚求再治，即不起无怨也。勉用人参一两，生附子二钱，牛膝、茯苓各五钱，二日之间，去小便
约四十余碗，腹有皱纹。计服人参四斤，附子、姜、桂各一斤，半载而痊。（极虚大补法。）
李都宪积劳多郁，肢体胀满，以自知医，辄用胃苓汤加枳壳，三月以来，转加痞闷。脉之，沉涩而软，视
其色黄白而枯，此虚症也，宜大温大补。始犹不信，争之甚力，仅用参二钱，稍觉宽舒，欲加桂、附，执不肯
从。李曰∶症坐虚寒，喜行攻伐，已见既执，良言不纳，虽有扁、仓，岂能救耶？两月果殁。
徐锦衣禀畀素壮，病余肥甘过度，腹胀气粗。诊之，脉盛而滑，按之不甚虚。宜以利气之剂，少佐参、术。
惑于旁议，旦暮更医。李复诊曰∶即畏参不用，攻击之剂，决不可投也。后与他医商之，仍用理脾疏气之剂而
安。（消补兼行法。）
吴孚先治一人患肿胀，皮绷急。脉之系脾肾虚，用二陈去甘草，加人参、干姜、肉桂、木香、茯苓、大腹
皮、姜皮、车前，十帖腹有皱纹。复与《金匮》肾气丸，一料全愈。（先理脾，后补肾法。）
张路玉治王庸若，水肿呕逆，溲便涓滴不通。或用五苓、八正不应，六脉沉细如丝。因与金液丹十五丸，
溺如泉涌而势顿平。后以《济生》肾气，培养而安。（与张抱赤症治同。）
顾文学鼓胀喘满，昼夜不得寝食者二旬。医用大黄，三下不除。更医先与发散，次用削克破气二十余剂，
少腹至心下遂坚满如石，腰胁与胯中皆疼痛如折。诊之，脉弦大而革，按之渐小，举指复大，大便八九日不通，
小便虽少，清白如常。此因削克太过，中气受伤，浊气上逆。与生料六味地黄丸加肉桂三钱，沉香三分，下黑
锡丹二钱，导其浊阴。是夜即胀减六七，胸中觉饥，进粥，但腰胯疼软，如失两肾之状。再剂胸腹全宽，少腹
反觉微硬，不时攻动，此大便欲行，津液耗竭，不能即去故也。诊其脉，仅存一丝，改用独参汤加当归、枳壳，
大便略去结块，痛稍可，少腹遂和。又与六味地黄，仍加肉桂、沉香，调理而安。（收残救败法。）
卢不远治瞿、娄、周、马，皆少年水肿，肢体洪盛，胪腹膨胀，水道不通，饮食绝口。有以为疸者，为鼓
者，为气者。诊之，以药克济，乃针足上出水，皆石余。次日胀小减，三日大减，足尚肿。又针之，服以八味
丸，以温其肾，期年皆孕。娄调护善，子母两全。马失调护，子母俱毙。此盖肾中阳气不足，阴气有余，遂聚
水而病作。饮食汤药用水，而不能导之转助长，乃致于此，非针去水，则菀陈之瘀何从而泄？水去肾衰，非温
补之，则浊凝之阴必致复聚，肾中之火气复然，周身之阳气有蒂，天癸自行，生育可必。如流离之后，所宜爱
养，得之则生聚，否则待毙耳。
杨乘六治汪司农，年近六旬，春仲病腹胀兼作痛，饮食不进。群医不应，且增甚。诊之，六脉洪大滑甚，
重按益加有力如年壮气实人，面色则 白而带萎黄，舌色则青黄而兼胖滑。简阅前方，则皆香附、乌药、浓朴、
木香、山楂、神曲、半夏、陈皮、藿香、元胡、枳壳、桔梗、莱菔子、大腹皮等，一派消导宽快之属。曰∶若
但据脉症，则诸方殊得当也，第面色白上加黄，且 而萎，舌色黄里见青，且胖而滑，则症之胀痛，与脉之洪
盛，皆非实候矣。此由心境不舒，思虑郁怒，亏损肝脾，致两经虚而脏寒生满，且作痛耳，乃拟养荣汤倍人参
加附子与之。彼以切中病情，立煎饮之，一剂减，再剂瘥。
胡念庵治俞翰林母，七旬余，平日患嗽喘痰红，常服滋阴凉润之剂，秋月忽患水肿，喘急难卧，日渐肿胀，
饮食少进，进则喘急欲死，诸治无效。诊之，六脉弦大而急，按之益劲而空，曰∶此三焦火气虚惫，不能归根
而浮于外，水随气奔，致充郛郭而溢皮膜，必须重温以化，否则不救。彼云∶吾素内热，不服温补，片姜到口，
痰即带红，今所论固是，第恐热药不相宜也。曰∶有是病，服是药，成见难执，且六脉紧大，阳已无根，即脱
矣。此皆平日久服寒凉所致，若再舍温补不用，恐无生理。乃以桂、附、姜、萸、五味，人参三钱，不三剂，
腹有皱纹。八剂全消，饮食如故。又二剂全愈，痰喘吐红，竟不发矣。
一妇因子远出，饔飧不给，忧愁成病，变为水肿喘急，粥饮不入者月余矣。诊之，六脉欲绝，脐突腰圆，
喘难着席，脾肾之败，不可为矣。因处十味方，令服四剂，喘微定而肿渐消，觉思饮食。复诊其脉，略有起色，
又四剂肿消食进。
壬子秋，余应试北雍，有孝廉张抱赤，久荒于色，腹满如斗，以参汤吞金匮丸，小便差利，满亦差减。阅
旬日而满复如故，肢体厥逆，仍投前药，竟无裨也，举家哀乱，惟治终事。抱赤泣告曰∶若可救我，当终身父
事之。余曰∶能饵金液丹数十粒，虽不敢谓万全，或有生理。乃连服百粒，小便遄行，满消食进。更以补中、
八味并用，遂获全安。（《本草通元》，一见《扁鹊心书》。）
陈以揆子，壮年渔色。一曰腹膨如鼓，喘不能卧。或与消导温补，五苓、八味，了无微效。以揆令吞生硫
黄，每服三分，以腐皮裹咽，日数服，不三日，其胀如失。此予所目击者。
柴屿青治侍御葛述斋夫人，单腹胀兼脾泻下血，食后愈胀，必捶腹少安。众医咸主攻伐。诊之，知肝木乘
脾，脾家受伤，不能统血。力排众议之非，并持《薛案》及《医统正脉》中论说与看，彼尚疑信参半。先服加
减逍遥汤，二剂血止，即继以异功加腹皮一钱，浓朴八分，连进十余剂，其势渐杀。后重用参、术，调理而愈。
（肝脾调治法。）
沈涛祖母，年七十余，自上年患腹胀满，医以鼓胀治之，服沉香、郁金、香附等药，数十剂病转剧，脾滞
腿肿食减。诊之，左关弦洪，右关弦软，此肝木乘脾之象也。先用逍遥散加川连、吴茱萸，连进三剂，胀减泻
止，饭食顿加。复用归芍六味，调理而痊。（肝肾调治法。）
太史汪舒怀令弟，腹大胀满。医以鼓胀屡治不效。诊其右关空大而带濡，余脉如常。此乃脾胃不和兼有水
气，故不思食，而食且不化，与胃苓汤数剂顿安。若果系鼓胀，亦理应补脾，次养肺金，以制肝木，使脾无贼
邪之患。更滋肾水以治火，使肺得清化，却浓味，远房帏，无有不安。倘喜行快利，不审元气，而概用峻剂攻
之，临时得宽，其复转甚。病邪既盛，真气愈伤，遂不可救，司命者其慎旃。（脾湿治法。）
张子和曰∶一男子目下肿如卧蚕状。曰∶目之下阴也，水亦阴也，肾为水之主，故其肿至于目下也。此由
房室交接之时，劳汗遇风，风入皮腠，得寒则闭，风不能出，与水俱行，故病如是，不禁房室则死。
凡腹胀经久，忽泻数升，昼夜不止，服药不验，乃为气脱，用益智子，煎浓汤服立愈。（危氏方。）
喻嘉言治郭台尹，年来似有痨怯意，胸腹不舒，治之罔效，茫不识病之所存也。闻喻治病，先议后药，姑
请治焉。见其精神言动俱如平人，但面色萎黄，有蟹爪纹，（似伤食矣。）而得五虚脉应之，因告之曰∶多怒乎？善
忘乎？口燥乎？便秘乎？胸紧乎？胁胀乎？腹疼乎？答曰∶种种皆然，此何症也？曰∶外症未显，内形已具，
将来血蛊之候也。曰∶何以知之？曰∶合色与脉而知之也。夫血之充周于身也，荣华先见于面。今色黯不华，
既无旧恙，又匪新 ，其所以憔悴不荣者何在？且壮盛之年，而见脉细，损宜一损皮毛，二损肌肉，三损筋骨，
不起于床矣，乃皮毛肌肉步履如故，其所以微弱不健者又何居？因是断为血蛊。腹虽未大，而如瓜瓠然，其
趋于长也易耳。曰∶血蛊乃妇人之疾，男子亦有之乎？曰∶男子病此者甚多，而东方沿海一带，比他处尤多，
医者漫用治水治气之法尝试，夭枉无算，总缘不究病情耳。所以然者，东海擅鱼盐之饶，鱼者甘美之味，多食
使人热中。盐者咸苦之味，其性偏于走血，血为阴象，（象字不妥。）初与热合，不觉其病，日久月增，中焦冲
和之气，亦积渐而化为热矣。气热则结，而血始不流矣，于是气居血中，血裹气外。一似妇人受孕者，然至弥月时，
腹如抱瓮矣。陈修园于此症，拟用六君子加川芎、干姜、防己，共研末，陈米汤糊丸，每服三钱，日三服，
以为执中央从运四旁之法。用意虽精，然以热益热，亦未见其有当也。但孕系胞中，如果熟自落，蛊蟠腹内，
如附赘难疗，又不可同语也。究而论之，岂但东方之水土致然！凡五方之因膏粱浓味，椒、姜、桂、醑成热中
(Continuing from the previous text) Only consume rice gruel. Yu Chang said: The abdomen originally contains stagnant feces that were not expelled by Dahuang (Rhubarb Rhizome and Rhei Radix et Rhizoma). Because the bladder is distended, it presses against the large intestine, preventing defecation. Therefore, he was administered Wuling San (Five-Ingredient Powder with Poria), to promote the Qi mechanism of the bladder. As soon as the medicine was swallowed, he sought the toilet; urination occurred first, followed by defecation. Half a bucket of stagnant feces was expelled, and he recovered. One month later, he suffered a mild Wind-Cold invasion. He took four doses of medicine but consumed them with meat and alcohol. Consequently, the Wind-Cold did not resolve, and the belief that treating abdominal distension was merely accidental persisted. (Warming and Tonifying Method.)
Wu Shengfu suffered from isolated abdominal distension (Dan Zhang Fu). His abdomen was as large as a winnowing basket and hard as stone. Acidic fluid frequently generated in his stomach, affecting both swallowing and spitting, yet treatments over a year proved ineffective. This was likely because physicians failed to investigate the origin of the disease and the principles of its transformation after formation. Only Shenqi Wan (Kidney Qi Pill) remained a traditional prescription. However, using this for his condition was like intending to go north to Yan while pointing south. Shenqi Wan is considered a miraculous drug for swelling because it consolidates Kidney Qi, preventing water overflow. Now, his urine frequency was six or seven times a day, indicating no risk of water overflow. Furthermore, the principle is "benefiting the source of fire to eliminate yin shadows." Now, acidic flavors are transformed from fire; can one further benefit fire? Others claimed abdominal distension was due to food retention and used harsh purgatives from the Ju Fang (Formulary Bureau); this is unworthy of discussion. The disease originated from the failure of Spleen Qi to diffuse, leading to stagnation transforming into fire. If the method of "releasing fire from stagnation" had been used initially to raise Yang and scatter fire, the illness would have resolved suddenly. As stagnation deepened and gradually became distension, the Qi in the body resembled the obstruction caused by Heaven and Earth failing to interact, marking the formation and transformation of the disease. At this stage, administering Binglang (Areca Seed), Houpo (Magnolia Bark), and Laifuzi (Radish Seed) consumes Qi and assists fire, transferring the pathology to the Stomach. Heat in the Stomac resembles fermenting yeast; once grain and drink enter, they instantly brew into an acidic flavor. New grain is fragrant and sweet, which the Stomach likes; old grain is sour and putrid, which the Stomach dislikes. Thus, sometimes newly ingested food is expelled before old food is digested. The innate Qi of the human body resides entirely in the Stomach opening. (These are seemingly correct but actually incorrect statements, incompletely excerpted.) Earth is defined as sowing and reaping producing sweetness; Wood is defined as bending and straightening producing acidity. Sweetness turning into acidity indicates Wood insulting Earth. (Yu Chang only knew that distension was due to Spleen Qi stagnation, unaware that the root cause was Liver Wood stagnation.) By spring, when Wood is prosperous, it will be difficult to treat. To reverse acidity back to sweetness, there is only one method using rigid/strong medicines—medicines with potent aromas and flavors that can transform the Stomac's state without being transformed by it. Through comprehensive coordination to achieve balance, one should use rigidity within softness, not softness within rigidity. Bawei Wan (Eight-Ingredient Pill) belongs to rigidity within softness; adding two acid-stopping agents to Liujun Zi (Six-Ingredient Pill), which produces acidity, cannot be effective. Only Lianli Tang (Coptis and Gastrodia Decoction), where rigidity is assisted by softness, can achieve the result of removing acidity. After acidity is removed, treating distension proceeds smoothly like splitting bamboo. (Original note: Years later in follow-up care, it was heard that using Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) finally achieved complete cure. How strange, what is strange about it?) A disciple asked: For Shengfu's illness, stopping acidity and reducing distension has already yielded full results. What other unexpected complications might arise? Please instruct on follow-up care. Yu Chang said: Shengfu's illness transferred from Spleen to Stomac. Now that acidity is gone and distension reduced, it returns from Stomac to Spleen. The priority in follow-up care is regulating the Spleen, with the Stomac secondary. If Stomach Qi is not harmonized, diseases cannot be expelled. However, if the Stomac can accept food but the Spleen fails to transport and transform, symptoms such as fatigue, excessive sleepiness, and preference for massage may occur. Eating slightly more food may cause abnormal heaviness. Climbing heights or traversing dangers may feel heavy above and light below, with weak legs. Preferring boiling water after meals relies on the heat of有形 (material things). Residual pathogens may manifest as Dan syndrome in summer heat, malaria in autumn clarity, Spleen constraint due to dryness, or Spleen diarrhea due to dampness. Therefore, regulating the Spleen prevents hundred diseases; neglecting it leads to continuous ailments, eventually entering the Stomac. Regarding improper rest, dietary excess, or sexual indulgence, the Spleen is affected first, which is understandable. But if anger triggers fire, carrying Wood pathogenic factors directly invading Stomac Earth, the original disease will suddenly erupt, which is beyond description. Also, initially with acid distension, a membrane sac must have formed in the Stomac, like a polyp. This is Liver Fire penetrating the Stomac membrane. The accumulated water secretly transforms into acidity via Wood. Over time, it fills up, the sac hangs large, becoming the root of abdominal distension. Observing new grain entering while acidic matter bursts out, and aromatic grain does not exit, or eating malt sugar causing acid water to surge like a straw, all verify this. If not another cavity, vomiting should expel new and rotten matter together, like in Ge Qi (Diaphragm Qi disorder), how could the distinction be so clear? My prescribed follow-up formula uses Liujunzi Decoction mixed with Chishizhi powder. Since the membrane sac is empty, this fills it to prevent future trouble. Previously, I treated a patient in Guangling with Blood Gu (Blood Parasite Distension). Medicine eliminated it completely, leaving a root under the left hypochondrium like a small pillow. Provoking it caused vomiting of black filth, and the rest passed through stool, then subsided. I often think that for Gu distension, whether Qi, Blood, Water, or Phlegm, it must create its own specific space to accumulate long-term. The Neijing discusses accumulations in five Zang organs having fixed locations. Why are aggregations in six Fu organs, lasting for years like Gu distension, considered rootless and boundary-less? This can supplement deficiencies in pathogenesis theory. (Xiong's comment: Innate Qi in the Stomac is indeed a famous saying. Regarding Wood insulting Earth below, [Yu Chang] certainly knew it was Wood stagnation.)
Li Shicai treated He Taixue. In summer, he liked drinking water. One day, waiting for the examination commissioner to distribute documents from morning till dusk, pressured by intense heat, he drank over ten bowls. Returning to his lodging, he suffered distension and fullness, unable to eat. Ten days later, his abdomen was like holding an urn, with rebellious Qi and panting. Palpation revealed thin, shiny skin, indicating stagnant water not transforming. Six pulses were firm and solid. The disease arose suddenly; the method should be promoting urination. Thus, Zhouche Wan (Boat and Cart Pill) was used, three qian per dose, taken with Xiangru Decoction (Elsholtzia Decoction). After two doses, urination and defecation gushed like a spring. Another 1.5 qian reduced the abdomen to normal. Ten doses of Liujunzi Decoction (Six-Gentleman Decoction) cured him. (Purifying the Lower Fountain Method.)
Fang Taihe, after great anger and heavy drinking, had eyes swollen like sleeping silkworms the next day (Spleen affected by water-dampness). Seven days later, his limbs swelled, he could not turn, and urination and defecation stopped. He was irritable and nearly died. Palpation showed deep and firm pulses; water should be driven out. Shuqiao Yinzi (Draining and Scouring Decoction) was used. After one dose, urination and defecation were rapid; after two doses, limbs relaxed. Then Wupi Yin (Five-Bark Decoction) was given, curing him in three days.
Qian Shangzhi indulged in wine and sex. Abdominal distension began in early autumn; by late winter, whole-body swelling was urgent, umbilicus and back flattened. According to methods, this was incurable. Large doses of Shenqi formula decoction were given, combined with Lizhong Tang (Regulate the Middle Decoction). Five days passed with no effect. This shows that when the disease is severe and medicine too light, even if the medicine targets the pathogen, it is useless. Many die from such delays in ancient and modern times, in both deficiency and excess patterns. Li wanted to resign; knowing he would die, he insisted on further treatment, promising no resentment if he died. Reluctantly, Ren Shen (Ginseng Root) 1 liang, Sheng Fuzi (Raw Aconite Root) 2 qian, Niuxi (Achyranthes Root) and Fuling (Poria) each 5 qian were used. Within two days, over forty bowls of urine were passed, and wrinkles appeared on the abdomen. Total intake: Ren Shen 4 jin, Fuzi, Ginger, and Rougui (Cinnamon Bark) each 1 jin. Recovery took half a year. (Extreme Deficiency Great Tonification Method.)
Li Duchuan, burdened by fatigue and depression, had limb distension. Knowing some medicine, he used Weiling Tang (Stomach-Lining Decoction) plus Zhike (Aurantii Fructus) for three months, worsening bloating. Pulse was deep, choppy, and soft; complexion yellow-white and withered. This is a deficiency pattern; great warming and tonification are needed. Initially disbelieving, he argued strongly, accepting only 2 qian of Ren Shen, feeling slightly relieved. Refusing Gui (Cinnamon Twig) and Fuzi, he persisted. Li said: The pattern is deficiency-cold; preferring attacking methods, you are obstinate and reject good advice. Even with Bian Que or Cang Gong, how could they save you? Two months later, he died.
Xu Jinyin was naturally robust. After illness, he overindulged in rich foods. Abdominal distension and coarse breathing resulted. Pulse was strong and slippery, not very deficient upon pressing. Promoting Qi agents with slight additions of Ren Shen and Baizhu (Atractylodes Macrocephala Rhizome) were suitable. Confused by others' opinions, he changed doctors morning and night. Li re-examined and said: Even if fearing Ren Shen, attacking agents must absolutely not be used. Later consulting other physicians, he used Spleen-regulating and Qi-promoting agents and stabilized. (Simultaneous Elimination and Tonification Method.)
Wu Fuxian treated a patient with swelling and tight skin. Pulse indicated Spleen-Kidney deficiency. Erchen Tang (Two-Aged Decoction) minus Gancao (Licorice Root), plus Ren Shen, Ganjiang (Dried Ginger), Rougui, Muxiang (Aucklandiae Root), Fuling, Dafupi (Arecae Pericarpium), Jiangpi (Zingiberis Pericarpium), and Cheqian (Plantago Seed) were used. Ten doses produced abdominal wrinkles. Then Jinkui Shenqi Wan (Golden Cabinet Kidney Qi Pill) was given, curing him in one batch. (First Regulate Spleen, Then Tonify Kidney Method.)
Zhang Luyu treated Wang Yongruo with edema, retching, and complete urinary/fecal retention. Wuling San and Bazheng San were ineffective. Six pulses were deep and fine as threads. Jin Ye Dan (Golden Liquid Pill) 15 pills were given. Urine gushed like a spring, and the condition calmed. Later, Jisheng Shenqi Wan (Kidney Qi Pill from the Generous Life Hall) was used for cultivation and recovery. (Same treatment as Zhang Baochi's case.)
Gu Wenxue suffered from鼓胀 (Drum Distension) with panting and fullness, unable to sleep or eat for twenty days. Physicians used Dahuang (Rhubarb), purging three times without success. Another physician first used dispersing agents, then cutting and breaking Qi agents for over twenty doses. The lower abdomen to epigastrium became hard as stone; waist, hypochondrium, and groin hurt like breaking. Pulse was string-taut, large, and革 (leather-like), diminishing upon pressure, enlarging upon lifting. Bowels hadn't moved for eight or nine days; urine was scant but clear. This was due to excessive cutting damaging Middle Qi, causing turbid Qi to rebel upward. Shengliao Liujun Dihuang Wan (Raw Material Six-Ingredient Rehmannia Pill) plus Rougui 3 qian, Chenxiang (Aquilaria Wood) 0.3 fen, and Heixi Dan (Black Tin Pill) 2 qian were given to guide turbid Yin downward. That night, distension reduced by 60-70%; chest felt hungry, porridge was eaten. Waist and groin were sore and weak, as if kidneys were lost. Second dose widened chest and abdomen; lower abdomen felt slightly hard, moving occasionally. This indicated bowel movement desired, but fluids exhausted, preventing immediate passage. Pulse was barely a thread. Dushen Tang (Single Ginseng Decoction) plus Danggui (Angelica Sinensis Root) and Zhike was used. Bowels passed clumps slightly, pain eased, lower abdomen harmonized. Liujun Dihuang Wan plus Rougui and Chenxiang was used for regulation and recovery. (Rescuing the Remnant and Saving Collapse Method.)
Lu Bu Yuan treated Qu, Lou, Zhou, and Ma, all young men with edema, swollen limbs, distended bellies, blocked water passages, and no appetite. Diagnosed as Jaundice, Drum Distension, or Qi Distension. Treatment suppressed the pathogen; needling the feet drained stones worth of water. Next day, distension slightly reduced; third day, greatly reduced, feet still swollen. Needled again, then Bawei Wan (Eight-Ingredient Pill) given to warm Kidneys. Within a year, all conceived. Lou cared well, mother and child survived. Ma neglected care, both died. This was Kidney Yang deficiency with Yin excess, accumulating water. Diet and medicine added water but couldn't guide it, exacerbating the condition. Without needling to drain water, how could stasis be released? After water loss, Kidney declined; without warming and tonifying, condensed Yin would re-accumulate. Kidney fire reignited, body Yang rooted, Tian Gui (Menstruation/Semen) functioned, pregnancy certain. Like refugees needing care, obtaining it brings life; otherwise, awaiting death.
Yang Chengliu treated Wang Sinong, nearly sixty, suffering abdominal distension and pain in mid-spring, unable to eat. Physicians failed, condition worsened. Pulse was洪大滑甚 (surging, large, slippery, extreme), stronger upon deep pressure like a vigorous youth. Complexion was pale with withered yellow; tongue green-yellow, fat, and slippery. Reviewing previous prescriptions: Xiangfu (Cyperi Rhizome), Wuyao (Lindera Root), Houpo, Muxiang, Shanzha (Hawthorn Fruit), Shenqu (Medicated Leaven), Banxia (Pinellia Tuber), Chenpi (Tangerine Peel), Huoxiang (Patchouli Herb), Yuanhu (Corydalis Rhizome), Zhike, Jiegeng (Platycodon Root), Laifuzi, Dafupi—all promoting digestion and relieving fullness. Yang said: Based solely on pulse and symptoms, these formulas seem appropriate. But the complexion white with yellow, pale and withered, tongue yellow inside green, fat and slippery, indicates that distension/pain and surging pulse are not excess signs. This was due to emotional discomfort, worry, depression, and anger damaging Liver and Spleen, causing deficiency in both meridians, cold in viscera generating fullness and pain. Yang prescribed Yangrong Tang (Nourishing Younger Brother Decoction) doubled Ren Shen plus Fuzi. Finding it accurate, he brewed and drank it immediately. Reduced after one dose, cured after two.
Hu Nian'an treated the mother of Yu Hanlin, over seventy. Usually suffered cough, panting, and blood in sputum, taking cooling and moistening agents. In autumn, sudden edema, panting difficult to lie down, daily swelling, poor appetite, deathly panting upon eating, all treatments failed. Pulse was string-taut, large, and urgent, harder and hollow upon pressure. Hu said: This is deficiency exhaustion of Sanjiao Fire Qi, unable to root and floating outward. Water follows Qi rushing, filling the body and overflowing membranes. Must warmly transform; otherwise, no rescue. She said: I usually have internal heat, refuse warming tonics; even a slice of Jiang (Ginger) causes blood in sputum. Your theory is correct, but fear hot medicines are unsuitable. Hu said: Have the disease, take the medicine. Prejudices are hard to hold. Pulse tight and large, Yang has no root, impending collapse. Caused by long-term cold/cool medicine use. If abandoning warming tonics, likely no life. Gui (Cinnamon Twig), Fuzi, Jiang, Yuzhu (Polygonatum Odoratum Rhizome - *Note: Text says Yu, likely Shanzhuyu Cornus or similar, but context implies warming herbs*), Wuweiizi (Schisandra Fruit), Ren Shen 3 qian were used. Not even three doses, abdominal wrinkles appeared. Eight doses fully resolved, appetite normal. Two more doses cured completely; cough, panting, and blood never recurred.
A woman, whose son traveled far, lacked food, became ill with worry, developing edema and panting, unable to eat porridge or drink for over a month. Pulse nearly vanished, umbilicus protruded, waist round, panting prevented lying flat. Spleen-Kidney collapse, incurable. A ten-ingredient formula was prescribed. Four doses slightly settled panting and reduced swelling; appetite returned. Re-palpation showed pulse improving. Four more doses resolved swelling and restored diet.
In autumn of Renzi year, I took exams at Northern Imperial Academy. Xiaolian Zhang Baochi, having indulged excessively in sex, had abdomen full as a bucket. Taking Ren Shen soup to swallow Jinkui Wan, urination improved slightly, fullness reduced slightly. Ten days later, fullness returned, limbs cold. Previous medicine gave no benefit. Family mourned, preparing funeral. Baochi wept and said: If you can save me, I will serve you as a father. I said: Swallow dozens of Jin Ye Dan pills. Though not guaranteed, there may be hope. He took 100 pills continuously. Urination flowed rapidly, fullness disappeared, appetite returned. Combined with Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) and Bawei Wan, he recovered fully. (*Bencao Tongyuan*, also seen in *Bianque Xinshu*.)
Chen Yikui's son, a young man indulging in sex, had abdomen drum-like, panting unable to lie down. Given digestive/warming tonics, Wuling, Bawei, with no effect. Yikui ordered swallowing raw Liu Huang (Sulfur), 3 fen per dose, wrapped in bean curd skin, several times a day. Within three days, distension vanished. This I witnessed personally.
Chai Yuqing treated Lady Ge Shuzhai, wife of Censor. Isolated abdominal distension with Spleen diarrhea and bloody stools. Distension worsened after eating, relieved by beating abdomen. Physicians advocated attacking methods. Chai diagnosed Liver Wood insulting Spleen, Spleen damaged, unable to control blood. He refuted others' opinions, citing Xue's Cases and Medical Orthodoxy texts. Patient was skeptical. First, Jiajian Xiaoyao Tang (Modified Free and Easy Wanderer Decoction) stopped bleeding in two doses. Then Yicheng Tang (Yi-Cheng Decoction) plus Dafupi 1 qian, Houpo 0.8 fen, continued for over ten doses, condition subsided. Finally, heavy Ren Shen and Baizhu regulated and cured her. (Liver-Spleen Regulation Method.)
Shen Tao's grandmother, over seventy, suffered abdominal distension since last year. Treated as Drum Distension with Chenxiang, Yujin, Xiangfu, etc., for dozens of doses, condition worsened: Spleen stagnation, leg swelling, poor appetite. Left Guan pulse string-taut and surging; Right Guan string-taut and soft. Image of Liver Wood insulting Spleen. Xiaoyao San (Free and Easy Wanderer Powder) plus Chuanlian (Coptis Rhizome) and Wuzhuyu (Evodia Fruit) given for three doses. Distension reduced, diarrhea stopped, appetite increased. Then Guishao Liujun Dihuang Wan (Rehmannia Pill with Angelica and Peony) used for regulation and recovery. (Liver-Kidney Regulation Method.)
Tai Shi Wang Shuhuai's younger brother had large abdominal distension. Treated as Drum Distension repeatedly without effect. Right Guan pulse empty, large, and soggy; others normal. Spleen-Stomach disharmony with Water Qi. No appetite, undigested food. Weiling Tang given for several doses, quickly calm. If truly Drum Distension, Spleen should be tonified, then Lung Metal nourished to control Liver Wood, protecting Spleen from賊邪 (robber pathogen). Kidney Water nourished to control Fire, allowing Lung clear transformation. Avoid rich flavors,远离房帏 (sexual indulgence), and peace will follow. If preferring quick purges, ignoring Yuan Qi, and using harsh agents, temporary relief leads to severe rebound. Pathogen strong, True Qi injured, incurable. Practitioners must be cautious. (Spleen-Dampness Treatment Method.)
Zhang Zihe said: A man had eyes swollen like sleeping silkworms. He said: Below the eyes is Yin; water is Yin. Kidney is master of water, hence swelling here. This was from intercourse when labor sweat met wind. Wind entered skin and pores, closed by cold, unable to exit, traveling with water, thus the disease. If intercourse not banned, death ensues.
For chronic abdominal distension, sudden diarrhea of several sheng, day and night unceasing, medicine ineffective, this is Qi collapse. Yizhi Zi (Alpinia Oxyphylla Fruit) decocted thick and drunk, cures immediately. (Wei's Formula.)
Yu Jiayan treated Guo Taiyin. Yearly seemed consumptive, chest/abdomen uncomfortable, treatments failed, ignorant of disease location. Heard Yu treats by discussing first then prescribing, requested treatment. Spirit and speech like normal person, but complexion withered yellow, crab-claw patterns (like food retention), matching Five Deficiency Pulses. Asked: Angry? Forgetful? Dry mouth? Constipated? Chest tight? Hypochondriac distension? Abdominal pain? Answered: All true. What disease? Yu said: External signs not obvious, internal form established, future Blood Gu symptom. Asked: How know? Yu said: Combining color and pulse. Blood circulating in body, glory appears on face. Now color dark and dull, no old illness, no new injury, why emaciated and lacking luster? Vigorous age, yet fine pulse. Loss should first damage skin/hair, second muscle, third bone/tendon, bedridden. Yet walking normal, why weak? Diagnosed as Blood Gu. Abdomen not large, like a gourd, easy to grow. Asked: Blood Gu is women's disease, do men get it? Yu said: Many men suffer, especially East coast. Physicians blindly try water/Qi treatments, countless deaths, total ignorance of pathogenesis. Reason: East sea abundant in fish/salt. Fish sweet/good, overeating heats middle. Salt salty/bitter, nature moves to blood. Blood is Yin image. Initially combines with heat, disease unnoticed. Months pass, Middle Jiao harmonious Qi gradually transforms to heat. Qi heat knots, blood stops flowing. Qi in blood, blood wraps Qi. Like pregnant woman, until term, abdomen like urn. Chen Xiuyuan proposed Liujunzi plus Chuanxiong, Ganjiang, Fangji, powdered, rice paste pills, 3 qian three times daily,执中央运四旁 (holding center to move four sides). Intent precise, but adding heat to heat, not appropriate. Pregnancy in uterus, fruit falls when ripe; Gu coiled in abdomen, like polyp, hard to treat, cannot compare. Ultimately, not just East water/soil! All regions due to rich foods, pepper, ginger, cinnamon, wine causing heat in middle...