胃气实则胀也。脉大坚，便秘，按之痛。仲景云∶腹满按之痛者为实，可下之。经云∶
中满者泻之于内，又云∶下之则胀已是也。
沉香交泰丸 治胀而大便燥结者。
沉香 橘红 白术（各二钱） 浓朴（五钱） 吴茱萸 枳实 青皮 木香 茯苓 泽泻
当归（各二钱） 大黄（酒浸，一两）
为末，蒸饼为丸，梧子大，每服五十丸，加至七八十丸，温汤下，微利为度。
四妙丸 治老幼腹胀，血气凝滞，用此宽肠顺气。
商州枳壳（浓而绿片者，去穣，四两分作四份） 一用苍术（一两同炒） 一用茴香（一两
同炒） 一用莱菔子（一两同炒） 一用干漆（一两同炒）
炒黄后，去四味，只取枳壳为末，以四味煎汁煮面糊丸，桐子大，每食后米饮下五十丸
。
中气虚衰，脾胃不健而三焦痞塞，是为气虚中满。经云∶足太阴虚则鼓胀也。其脉软，
其色白，其症腹胀，按之不痛，溏泄肠鸣，宜温养阳气为主，塞因塞用也。
参术健脾汤
人参 白术 茯苓 陈皮 半夏 缩砂 浓朴（姜制，各一钱） 炙草（三分）
水姜煎服。一方无甘草，有麦芽、山楂，因甘能满中。
积者，累积之谓，由渐而成，重而不移。聚者，聚散之谓，作止不常，痛无定所。故曰
积者阴气，聚者阳气。
积聚之病，非独痰食气血，即风寒外感，亦能成之。然痰食气血，非得风寒，未必成积
。风
寒之邪，不遇痰食气血，亦未必成积。经云∶卒然多食饮则肠满，起居不节，用力过度，则
络脉伤，血溢肠外，与寒相搏，并合凝聚，不得散而成积，此之谓也，经论心肝肾皆有积，
心曰伏梁，心下坚直，如梁木也。肝曰肥气，胁下气聚如复杯也。肾曰奔豚，往来上下如豚
之奔也。又有伏瘕、疝瘕、瘕聚、血瘕。伏瘕者，伏结于内。疝瘕者，冲痛如疝。瘕聚者，
聚散不常。血瘕者，血凝成瘕也。《难经》又补脾肺之积。脾曰痞气，气痞而不运。肺曰息
贲，响有声也。巢氏又有 瘕之辨，谓其病不动者， 也；虽有癖而可推移者，瘕也。 者
征也，有形可见也；瘕者假也，假物成形也。张子和又分九积。酒积者，目黄口干。食积者
酸心腹满。气积者，噫气痞塞。涎积者，咽如拽锯。痰积者，涕唾稠粘。癖积者，两胁刺
痛。水积者，足肿胀满。血积者，打扑肭疼。肉积者，赘瘤核 。各治法详见本方。
许学士云∶大抵治积，或以所恶者攻之，所喜者诱之，则易愈。如 砂、阿魏治肉积；
、麦芽治酒积；水蛭、虻虫治血积；木香、槟榔治气积；牵牛、甘遂治水积；雄黄、腻粉治
痰积；礞石、巴豆治食积。各从其类也。若用群队之药分其势，则难取效。
When the Stomach Qi is excess, distension occurs. The pulse is large and firm, constipation is present, and tenderness upon palpation. Zhang Zhongjing stated: Abdominal fullness with tenderness upon pressure indicates an excess pattern, which can be treated with purgation. The Classics state: "For internal fullness, drain from within," and also: "Purgation resolves distension."
Chenxiang Jiaotai Wan (Agarwood Harmony Pill): Treats distension accompanied by dry, hard stools.
Ingredients: Chenxiang (Aquilariae Lignum Resinatum), Juhong (Citri Reticulatae Pericarpium Rubrum), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 2 qian), Houpo (Magnoliae Officinalis Cortex), Wuzhuyu (Evodiae Fructus), Zhishi (Aurantii Fructus Immaturus), Qingpi (Citri Reticulatae Pericarpium Viride), Muxiang (Aucklandiae Radix), Fuling (Poria), Zexie (Alismatis Rhizoma), Danggui (Angelicae Sinensis Radix) (each 2 qian), Dahuang (Rhei Radix et Rhizoma) (soaked in wine, 1 liang).
Preparation and Administration: Grind into powder, mix with steamed bread dough to form pills the size of wu zi (Cibotii Semen). Take 50 pills per dose, increasing to 70-80 pills as needed, with warm water. Stop when mild diarrhea occurs.
Simiao Wan (Four Marvels Pill): Treats abdominal distension in the elderly and children, and stagnation of blood and qi; this formula relaxes the intestines and promotes smooth flow of qi.
Ingredients: Shangzhou Zhike (Aurantii Fructus) (select thick, green slices, remove albedo, 4 liang divided into four parts); one part stir-fried with Cangzhu (Atractylodis Rhizoma, 1 liang); one part stir-fried with Huixiang (Foeniculi Fructus, 1 liang); one part stir-fried with Laifuzi (Raphani Semen, 1 liang); one part stir-fried with Ganqi (Drynariae Rhizoma? Note: Text says Ganqi but context implies a resin or specific herb, likely Qianghuo or similar, but literal translation keeps name) (1 liang).
Preparation and Administration: Stir-fry until yellow, remove the other four herbs, retain only Zhike and grind into powder. Decoct the four removed herbs, use the decoction to make a paste with flour for pills, size of wu zi. Take 50 pills after meals with rice water.
When Middle Qi is deficient and declining, and the Spleen and Stomach fail to transform and transport, leading to obstruction of the Triple Burner, this is called "Zhong Man" (central fullness) due to Qi deficiency. The Classics state: "Deficiency of Foot Taiyin [Spleen] leads to drum-like distension." The pulse is soft, complexion is pale, symptoms include abdominal distension without tenderness upon pressure, loose stools, and borborygmus. Treatment should primarily focus on warming and nourishing Yang Qi, employing the method of "treating blockage with blockage" (using tonification for deficiency-type obstruction).
Shenzhu Jianpi Tang (Ginseng and Atractylodes Spleen-Strengthening Decoction):
Ingredients: Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Suosha (Amomi Fructus Rotundus), Houpo (Magnoliae Officinalis Cortex) (processed with ginger, each 1 qian), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) (3 fen).
Administration: Decoct with water and fresh ginger. Another version excludes Gancao and adds Maiya (Hordei Fructus Germinatus) and Shanzha (Crataegi Fructus), because sweet flavors can cause central fullness.
Ji (Accumulation) refers to gradual accumulation, formed slowly, characterized by heaviness and fixed location. Ju (Gathering) refers to gathering and dispersing irregularly, with intermittent onset and cessation, and pain without a fixed location. Thus, Ji is associated with Yin Qi, and Ju with Yang Qi.
Diseases of Ji and Ju are not caused solely by phlegm, food retention, or stagnation of Qi and Blood; even external contraction of Wind-Cold can lead to their formation. However, phlegm, food, Qi, and Blood stagnation may not form Ji without Wind-Cold. Conversely, Wind-Cold pathogens may not form Ji without encountering phlegm, food, Qi, or Blood stagnation. The Classics state: "Sudden overeating causes intestinal fullness; irregular lifestyle and excessive exertion damage collaterals, causing blood to extravasate outside the intestines. This blood combines with Cold, coagulates, and fails to disperse, forming Ji." The Classics discuss accumulations in the Heart, Liver, and Kidney: Heart accumulation is called Fuliang (Hidden Beam), presenting as hardness below the heart, straight and rigid like a beam. Liver accumulation is called Feiqi (Fat Qi), presenting as gas gathering under the hypochondrium, shaped like an inverted cup. Kidney accumulation is called Bentun (Running Piglet), presenting as sensation of gas moving up and down like a running piglet. There are also Fu Jia, Shan Jia, Jia Ju, and Xue Jia. Fu Jia lies hidden and knotted internally. Shan Jia involves sudden pain resembling hernia. Jia Ju gathers and disperses irregularly. Xue Jia results from blood coagulation forming a mass. The Nan Jing further supplements accumulations in the Spleen and Lung: Spleen accumulation is called Pi Qi (Obstructed Qi), where Qi is obstructed and fails to circulate. Lung accumulation is called Xiben (Breathful Accumulation), characterized by noisy breathing. Chao Yuanfang distinguished between Zheng and Jia: immobile lesions are Zheng; movable masses are Jia. Zheng implies visible signs; Jia implies temporary forms created by external factors. Zhang Zihe categorized nine types of Ji: Wine Ji presents with yellow eyes and dry mouth; Food Ji presents with acid regurgitation and abdominal fullness; Qi Ji presents with belching and obstruction; Saliva Ji presents with throat sensations like sawing; Phlegm Ji presents with thick, sticky sputum; Pi Ji presents with stabbing pain in both hypochondria; Water Ji presents with swollen, full legs; Blood Ji presents with dull pain after trauma; Meat Ji presents with tumors or nodules. Detailed treatments are found in the respective formulas.
Xu Xueshi stated: Generally, treating Ji involves attacking it with substances the patient dislikes, or inducing it with substances the patient likes, facilitating cure. For example: Naosha (Sal Ammoniac) and Awei (Asafetida) treat Meat Ji; Shenqu (Massa Medicata Fermentata) and Maiya treat Wine Ji; Shuizhi (Hirudo) and Mengchong (Ophiorrhiza Mungo? Note: Mengchong usually refers to horseflies, Hirudinis/Tabanidae) treat Blood Ji; Muxiang and Binglang (Arecae Semen) treat Qi Ji; Qianniu (Pharbitidis Semen) and Gansui (Kansui Radix) treat Water Ji; Xionghuang (Realgar) and Nifen (Calomel) treat Phlegm Ji; Mengshi (Fluorite) and Badou (Crotonis Fructus) treat Food Ji. This follows the principle of treating according to category. Using a large group of drugs to scatter the pathogenic factor's momentum makes efficacy difficult to achieve.