张 脉左弦。右浮涩。始因脘痛贯胁。继则腹大高凸。纳食减少难运。二便艰涩不爽。此乃有年
操持萦虑太甚。肝木拂郁。脾土自困。清浊混淆。胀势乃成。盖脏真日漓。腑阳不运。考古治胀
名家。必以通阳为务。若滋阴柔药。微加桂附。凝阴冱浊。岂是良法。议用局方禹粮丸。暖其水
脏。攻其秽浊。俟有小效。兼进通阳刚补是为虚症内伤胀满治法。至于攻泻劫夺。都为有
形而设。与无形气伤之症不同也。（肝郁犯脾）局方禹余粮丸。
陈（妪）久郁。伤及脾胃之阳。面无华色。纳粥欲呕。大便溏泄。气陷则跗肿。气呆则脘闷。有中满之
忧。用治中法。（肝犯脾胃）
人参 生益智 煨姜 茯苓 木瓜 炒广皮
程（女）脉数。恶心。脘胀。（肝脾不和夹暑邪）
炒半夏 广皮 藿香（黄连一分煎水拌） 茯苓 郁金
又 暑伤脾胃。则肝木犯土。左腹膨。泄泻。
人参 浓朴 广皮 炒泽泻 茯苓 木瓜 炙草 炒楂肉
又 人参 炒柴胡 炒白芍 炒黄芩 茯苓 炙草 生姜 大枣
宋 食入脘胀。此属胃病。视色苍形瘦。自述饮酒呕吐而得。又述耳鸣肉 。是木火犯中。郁勃
病甚。议用逍遥减白术。合左金方。（木火犯土）
朱（四三）瘰 马刀。都是肝胆为病。病久延及脾胃。腹满便涩。舌黄微渴。非温补可服。泄木火以疏
之。和脾胃以调之。冀其胀势稍减。
吴萸拌川连 生于术 川楝子 炒山楂 黑山栀 浓朴 青皮 椒目
唐（女）气臌三年。近日跌仆呕吐。因惊气火更逆。胸臆填塞胀满。二便皆通。自非质滞。喜凉饮。面
起瘅瘰。从病能篇骤胀属热。
川连 淡黄芩 半夏 枳实 干姜 生白芍 铁锈针
颜（六三）今年风木加临。太阴阳明不及。遂为 胀。小便不利。两跗皆肿。大便涩滞。治在腑阳。用
分消汤方。（肝犯脾胃阳虚有湿）
生于术 茯苓 泽泻 猪苓 浓朴 椒目 海金沙汤煎。
吴 今岁厥阴司天加临。惊蛰节。病腹满喘促。肢肿面浮。寒热汗出。皆木乘土位。清阳不得
舒展。浊气痞塞僭踞。故泄气少宽。姑拟通腑以泄浊。
生于术 茯苓 椒目 紫浓朴 泽泻 淡姜渣
朱（四九）郁勃久坐。中焦不运。寒热。小溲不通。腹膨胀满。脉小而涩。全是腑阳失司。与泄木通腑分
消法。四苓加椒目浓朴大腹皮青皮。
陈 壮盛年岁。形消色夺。诊脉右小促。左小弦劲。病起上年秋季。脘中卒痛。有形梗突。病后陡
遇惊触。渐次食减不适。食入不运。停留上脘。腹形胀满。甚则胁肋皆胀。四肢不暖。暮夜渐温。
大便旬日始通。便后必带血出。清早未食。自按脐上气海。有瘕形甚小。按之微痛。身动饮水。
寂然无踪。天气稍冷。爪甲色紫。细推病属肝脾。气血不通。则为郁遏。久则阳微痹结。上下不
行。有若否卦之义。阅医药或消或补。总不见效者。未知通阳之奥耳。（肝脾不和清阳痹结）
薤白 桂枝 栝蒌仁 生姜 半夏 茯苓
又 薤白汁 桂枝木 栝蒌实 川楝子皮 半夏 茯苓 归须 桃仁 延胡 姜汁 二汁法丸。
某 胀满跗肿。小溲短涩不利。便泄不爽。当开太阳为主。（湿浊凝滞小溲不行当开太阳）
五苓散加椒目。
某（六七）少腹单胀。二便通利稍舒。显是腑阳窒痹。浊阴凝结所致。前法专治脾阳。宜乎不应。当开
太阳为要。五苓散加椒目。
郑 两投通里窍法。痛胀颇减。无如阴阳不分。舌绛烦渴。不欲纳谷。想太阳膀胱不开。阳明胃
不司阖。法当仍与通阳腑为要。但五苓桂术。断不适用。议用甘露饮意。
猪苓 茯苓 泽泻 寒水石 椒目 炒橘核
程 今年长夏久热。热胜阳气外泄。水谷运迟。湿自内起。渐渐浮肿。从下及上。至于喘咳不能
卧息。都是浊水凝痰。阻遏肺气下降之司。但小溲不利。太阳气亦不通调。此虽阳虚症。若肾
气汤中萸地之酸腻。力难下行矣。
茯苓 桂枝木 杏仁 生白芍 干姜 五味 生牡蛎 泽泻
马（五一）初起胸痹呕吐。入夏跗 少腹悉肿。食谷不运。溲短不利。此阳气式微。水谷之湿内蕴。致
升降之机失司。当开太阳。姑走湿邪。
猪苓（三钱） 桂枝木（八分） 茯苓皮（三钱） 泽泻（一钱） 防己（一钱半） 浓朴（一钱）
四帖。
邱（六岁）六龄稚年。夏至湿热外薄。所食水谷之气。蒸为湿滞。阻遏气机。脾不转运。水道不通。腹笥
满胀。幼科但知消导。不晓通腑泄湿。致脾气大困。泄泻不分阴阳。参苓之补。仅救消涤之害。
不能却除湿滞。故虽受无益于病。病根都在中宫。泄肝以安胃。分利以通腑。必得小溲频利。
冀有中 之机。
猪苓 泽泻 海金沙 通草 椒目
吴 平昔湿痰阻气为喘。兹因过食停滞。阴脏之阳不运。阳腑之气不通。二便不爽。跗肿腹满。
诊脉沉弦。犹是水寒痰滞。阻遏气分。上下皆不通调。当从三焦分治。顷见案头一方。用菟丝
子升少阴。吴茱萸泄厥阴。不知作何解释。不敢附和。仍用河间分消定议。（湿壅三焦肺气不降）
大杏仁 莱菔子 猪苓 泽泻 葶苈子 浓朴 桑白皮 广皮 细木通
又 三焦分消。泄肝通腑。二便不爽如昔。诊脉浮小带促。闻声呼息不利。是气分在上结阻。以
致中下不通。喘胀要旨。开鬼门以取汗。洁净腑以利水。无非宣通表里。务在治病源头。据脉
症参详。急急开上为法。合金匮风水反登义矣。
麻黄 杏仁 石膏 甘草 苡仁
朱 初因面肿。邪干阳位。气壅不通。二便皆少。桂附不应。即与导滞。滞属有质。湿热无形。入肺
为喘。乘脾为胀。六腑开合皆废。便不通爽。溺短混浊。时或点滴。视其舌绛口渴。腑病背胀。脏
病腹满。更兼倚倒左右。肿胀随着处为甚。其湿热布散三焦。明眼难以决胜矣。经云从上之
下者治其上。又云从上之下。而甚于下者。必先治其上。而后治其下。此症逆乱纷更。全无头
绪。皆不辨有形无形之误。姑以清肃上焦为先。
飞滑石（一钱半） 大杏仁（去皮尖十粒） 生苡仁（三钱） 白通草（一钱） 鲜枇杷叶（刷净毛去筋手内揉
三钱） 茯苓皮（三钱） 淡豆豉（一钱半） 黑山栀壳（一钱） 急火煎五分服。
此手太阴肺经药也。肺气窒塞。当降不降。杏仁微苦则能降。滑石甘凉。渗湿解热。苡仁通
草。淡而渗气分。枇杷叶辛凉。能开肺气。茯苓用皮。谓诸皮皆凉。栀豉宣其陈腐郁结。凡此
气味俱薄。为上焦药。仿徐之才轻可去实之义。
某 暴肿气急。小溲涩少。此外邪壅肺。气分不通。治当从风水皮水。宣其经隧。以能食能寝为
佳。勿得诛伐无过之地。
前胡 蜜炙麻黄 牛蒡子 姜皮 紫菀 杏仁 茯苓皮 广皮
王 髀尻微肿。小腿下 肿甚。乃腑阳不行。病甚于暮。宜辛香通其经腑之郁。（下焦寒湿流经）
生于术 炮川乌 北细辛 茯苓 汉防己 川独活
又 中满用余粮丸获效。得暖下泄浊之力。腹胀已去。而髀尻足跗肌肉肿浮。夫脏寒生满病。
暖水脏之阳。培火生土是法。究竟阳未全复。四末流行未布。前议幽香通其下焦经脉。果得
肿减。议用加味活络丹。
炮川乌 干地龙 乳香 没药 北细辛 桂枝木
用油松节三两。酒水各半。煎汁法丸。
汪 肿自下起。胀及心胸。遍身肌肤赤瘰。溺无便滑。湿热蓄水。横渍经隧。气机闭塞。呻吟喘急。
湿本阴邪。下焦先受。医用桂附 术。邪蕴化热。充斥三焦。以致日加凶危也。（湿热壅塞经隧）
川通草（一钱半） 海金沙（五钱） 黄柏皮（一钱半） 木猪苓（三钱） 生赤豆皮（一钱半） 真北细辛（一
分）
又 前法肿消三四。仍以分消。
川白通草 猪苓 海金沙 生赤豆皮 葶苈子 茯苓皮 晚蚕砂
又 间日寒战发热。渴饮。此为疟。乃病上加病。饮水结聚。以下痛胀。不敢用涌吐之法。暂与开
肺气壅遏一法。
大杏仁 蜜炒麻黄 石膏
又 湿邪留饮。发红瘰。胸聚浊痰。消渴未已。用木防己汤。
木防己（一钱） 石膏（三钱） 杏仁（三钱） 苡仁（二钱） 飞滑石（一钱半） 寒水石（一钱半）
通草煎汤代水。
陈 进神芎导水丸二日。所下皆粘腻黄浊形色。余前议腑气窒塞。水湿粘滞。浊攻犯肺为痰
嗽。水渍脉隧为浮肿。大凡经脉六腑之病。总以宣通为是。内经云。六腑以通为补。今医不分
脏腑经络。必曰参术是补。岂为明理。然肢节足跗之湿。出路无由。必针刺以决其流。此内外
冀可皆安。戊己丸三钱。用二日后。再进前药一服。
薛（十九）腹满下至少腹。三阴都已受伤。而周身疥疮。数年不断。脉络中必有湿热。就腹痛泄泻。腑
阳不通。不独偏热偏寒之治。常用四苓散。
猪苓（三钱） 茯苓（三钱） 泽泻（一钱半） 生于术（一钱） 椒目（五分）
倪（妪）湿热香港脚。上攻心胸。脘中满胀。呕逆。乃湿上甚为热化。与苦辛先平在上之满胀。用泻心
法。（湿热香港脚）
川连 黄芩 枳实 半夏 姜汁 杏仁
汤 囊肿腹胀。此属疮蛊。（湿郁疮蛊）
茯苓皮 海金沙 白通草 大腹皮绒 浓朴 广皮
猪苓 泽泻
某（三六）性躁。气有余便是火。肝胆中木火入络。成形为胀。便溺皆赤。喉痛声嘶痰血。肝病过膈犯
肺。久延为单腹胀难治。（木火入络）小温中丸三钱。
吴（五五）气逆 胀。汨汨有声。已属络病。难除病根。（气逆入络）
老苏梗 生香附 浓朴 白蔻仁 土栝蒌 桔梗 枳壳 黑山栀
汪 脉右涩。左弱。面黄瘦。露筋。乃积劳忧思伤阳。浊阴起于少腹。渐至盘踞中宫。甚则妨食呕
吐。皆单鼓胀之象大着。调治最难。欲驱阴浊。急急通阳。（阳虚单胀浊阴凝滞）
干姜 附子 猪苓 泽泻 椒目
又 通太阳之里。驱其浊阴。已得胀减呕缓。知身中真阳。向为群药大伤。议以护阳。兼以泄浊法。
人参 块茯苓 生干姜 淡附子 泽泻
又 阴浊盘踞中土。清阳蒙闭。腹满 胀。气逆腹痛。皆阳气不得宣通。浊阴不能下走。拟进白通法。
生干姜 生炮附子 冲猪胆汁。
黄（三八）停滞单胀。并不渴饮。昼则便利不爽。夜则小溲略通。此由气分郁痹。致中焦不运。先用大
针砂丸。每服一钱五分。暖其水脏以泄浊。
某 向有宿痞。夏至节一阴来复。连次梦遗。遂腹形坚大。二便或通或闭。是时右膝痈肿溃疡。
未必非湿热留阻经络所致。诊脉左小弱。右缓大。面色青减。鼻准明亮。纳食必腹胀愈加。四
肢恶冷。热自里升。甚则衄血牙宣。全是身中气血交结。固非积聚停水之胀。考古人于胀症。
以厘清气血为主。止痛务在宣通。要知攻下皆为通腑。温补乃护阳以宣通。今者单单腹胀。
当以脾胃为病薮。太阴不运。阳明愈钝。议以缓攻一法。
川桂枝（一钱） 熟大黄（一钱） 生白芍（一钱半） 浓朴（一钱） 枳实（一钱） 淡生干姜（一钱）
三帖。
又 诊脉细小。右微促。畏寒甚。右胁中气。触入小腹。着卧即有形坠着。议用局方禹余粮丸。暖
水脏以通阳气。
早晚各服一钱流水送八服。
又 脉入尺。弦胜于数。元海阳虚。是病之本。肝失疏泄。以致 胀。是病之标。当朝用玉壶丹。午
用疏肝实脾利水。分消太阳太阴之邪。
紫浓朴（炒一钱半） 缩砂仁（炒研一钱） 生于术（二钱） 猪苓（一钱） 茯苓（块三钱） 泽泻（一钱）
又 脉弦数。手足畏冷。心中兀兀。中气已虚。且服小针砂丸。每服八十粒。开水送。二服。以后药压之。
生于术 云茯苓 广皮 煎汤一小杯。后服。
又 脉如涩。凡阳气动则遗。右胁汨汨有声。坠入少腹。可知肿胀非阳道不利。是阴道实。水谷
之湿热不化也。议用牡蛎泽泻散。
左牡蛎（四钱泄湿） 泽泻（一钱半） 花粉（一钱半） 川桂枝木（五分通阳） 茯苓（三钱化气） 紫浓朴（一
钱）
午服。
又 脉数实。恶水。午后手足畏冷。阳明中虚。水气聚而为饮也。以苓桂术甘汤劫饮。牡蛎泽泻
散止遗逐水。照前方去花粉加生于术三钱。
又 手足畏冷。不喜饮水。右胁汨汨有声。下坠少腹。脉虽数而右大左弦。信是阳明中虚。当
用人参熟附生姜。温经补虚之法。但因欲回府调理数日。方中未便加减。且用前方。调治太阳太阴。
生于术（三钱） 左牡蛎（生四钱） 泽泻（炒一钱） 云苓（三钱） 生益智（四分） 桂枝木（四分） 炒浓
朴（一钱） 午后食远服。
朝服小温中丸五十粒。开水送。仍用三味煎汤压之。
杨（十六）味过辛酸。脾胃气伤结聚。食入则胀满。曾服礞石大黄丸。滞浊既下不愈。病不在乎肠中。
前贤治胀治满。必曰分消。攻有形不效。自属气聚为瘕。疏胃宜清。调脾当暖。此宗前贤立法。（脾胃气窒不和）
生茅术 广皮 丁香皮 黄柏 草豆蔻 川黄连 浓朴 茯苓 泽泻 水法丸。
张（患者）：脉象左手弦，右手浮而涩。起初因胃脘疼痛放射至胁肋，随后腹部增大且高高凸起，进食减少且难以运化，大小便艰涩不畅。这是因为年事已高，操劳思虑过度，导致肝木疏泄失常、气机郁滞，脾土功能自困，清阳与浊阴混淆，胀满之势由此形成。盖因脏腑真气日渐耗损，六腑阳气不能运化。查阅古代治疗胀满的名家医案，必定以通阳为要务。如果使用滋阴柔润的药物，仅微加桂枝、附子，会导致阴寒凝滞、浊邪内停，这并非良法。建议采用《局方》禹余粮丸，以温暖下焦水脏，攻逐体内秽浊之物。待见到些许疗效后，再兼用通阳刚补之法，这是治疗虚损内伤所致胀满的方法。至于攻下泻夺之法，都是针对有形实邪而设的，与无形之气损伤的病证不同。（病机：肝气郁结侵犯脾胃）
陈（老年女性）：长期情志抑郁，损伤了脾胃的阳气。面色无光泽，吃粥欲呕吐，大便溏泄。气机下陷则足背浮肿，气机呆滞则胃脘闷堵，有发展为中满证的担忧。采用治疗中焦的方法。（病机：肝气侵犯脾胃）
人参 生益智仁 煨生姜 茯苓 木瓜 炒广陈皮
程（女性）：脉数，恶心，胃脘胀满。（病机：肝脾不和兼夹暑邪）
炒半夏 广陈皮 藿香（黄连一分煎水拌制） 茯苓 郁金
又诊：暑邪损伤脾胃，则肝木乘克脾土，左侧腹部膨隆，泄泻。
人参 厚朴 广陈皮 炒泽泻 茯苓 木瓜 炙甘草 炒山楂肉
又诊：人参 炒柴胡 炒白芍 炒黄芩 茯苓 炙甘草 生姜 大枣
宋（患者）：进食后胃脘胀满，此属胃病。观察其面色苍老形体消瘦，自述因饮酒呕吐而致病。又述耳鸣、肌肉跳动，这是木火之邪侵犯中焦，郁勃病势严重。建议采用逍遥散减去白术，合用左金丸。（病机：木火犯土）
朱（四十三岁）：瘰疬、马刀瘿，都是肝胆的疾病。病程长久延及脾胃，腹部胀满，大便涩滞，舌苔黄，轻微口渴，不可服用温补药物。应泄降木火以疏利气机，调和脾胃以调理机能，期望胀满之势稍减。
吴茱萸拌川黄连 生白术 川楝子 炒山楂 黑山栀 厚朴 青皮 椒目
唐（女性）：气臌三年，近日跌仆后呕吐，因惊吓导致气火更加上逆，胸膈填塞胀满，大小便均通畅。并非体质瘀滞，喜欢凉饮，面部出现黄疸和瘰疬。根据《病能篇》，突然发生的胀满属于热证。
黄连 淡黄芩 半夏 枳实 干姜 生白芍 铁锈针
颜（六十三岁）：今年风木之气加临，太阴、阳明二经气不及，遂发生胀满。小便不利，双足背皆肿，大便涩滞。治疗在于恢复腑阳，使用分消汤方。（病机：肝气侵犯脾胃，阳虚有湿）
生白术 茯苓 泽泻 猪苓 厚朴 椒目 海金沙汤煎服。
吴（患者）：今年厥阴司天加临，惊蛰节气时，发病腹部胀满喘促，四肢浮肿面部浮肿，寒热汗出，这都是木气乘克土位，清阳不得舒展，浊气痞塞僭越占据所致，所以排气后稍微宽舒。暂拟通腑以泄浊的方法。
生白术 茯苓 椒目 紫厚朴 泽泻 淡姜渣
朱（四十九岁）：郁勃久坐，中焦不运，寒热，小便不通，腹部膨胀胀满，脉小而涩，全是腑阳失于职守。采用泄木通腑、分消的方法。四苓散加椒目、厚朴、大腹皮、青皮。
陈（患者）：正值壮年，却形体消瘦面色枯槁。诊脉右手小促，左手小弦劲。病起于上年秋季，胃脘中突发疼痛，有有形梗突之物。病后陡遇惊恐触动，逐渐食欲减退不适，进食后不运化，停留于上脘，腹部形状胀满，严重时胁肋皆胀，四肢不温暖，夜晚逐渐转温，大便十天才能通畅，便后必带血出。清晨未进食时，自行按压脐上气海穴，有瘕积形迹很小，按压微痛，身体活动或饮水后，寂然无踪。天气稍冷，指甲颜色发紫。仔细推究病属肝脾，气血不通，则为郁遏，日久则阳气微弱痹结，上下不行，有若《易经》否卦之义。阅看之前的医药，或消或补，总不见效，是因为不懂得通阳的奥妙罢了。（病机：肝脾不和，清阳痹结）
薤白 桂枝 瓜蒌仁 生姜 半夏 茯苓
又诊：薤白汁 桂枝木 瓜蒌实 川楝子皮 半夏 茯苓 归须 桃仁 延胡索 姜汁 二汁法丸。
某（患者）：胀满足背浮肿，小便短涩不利，大便泄泻不爽。应当以开通太阳经为主。（病机：湿浊凝滞，小便不行当开太阳）
五苓散加椒目。
某（六十七岁）：小腹部单独胀满，大小便通畅则稍舒。显是腑阳窒塞痹阻，浊阴凝结所致。前法专门治疗脾阳，理应无效。应当以开通太阳经为要。五苓散加椒目。
郑（患者）：两次投用通里窍的方法，痛胀颇减。无奈阴阳不分，舌绛红烦渴，不欲进食。想是太阳膀胱不开，阳明胃不司阖。治法应当仍以通阳腑为要。但五苓散、桂枝、白术断不适用。建议采用甘露饮之意。
猪苓 茯苓 泽泻 寒水石 椒目 炒橘核
程（患者）：今年长夏久热，热胜导致阳气外泄，水谷运化迟缓，湿气从内而起，渐渐浮肿，从下肢波及全身，以至于喘咳不能卧息。都是浊水凝痰，阻遏肺气下降的功能。只是小便不利，太阳之气也不通调。这虽是阳虚症，但若在肾气汤中加入山茱萸、熟地之酸腻，力量难以下行。
茯苓 桂枝木 杏仁 生白芍 干姜 五味子 生牡蛎 泽泻
马（五十一岁）：初起胸痹呕吐，入夏后足背、少腹全部肿胀，食谷不运，尿短不利。这是阳气式微，水谷之湿内蕴，导致升降之机失于职守。应当开通太阳经，暂且走散湿邪。
猪苓（三钱） 桂枝木（八分） 茯苓皮（三钱） 泽泻（一钱） 防己（一钱半） 厚朴（一钱）
四帖。
邱（六岁）：六岁稚龄，夏至时节湿热外迫，所食水谷之气，蒸腾为湿滞，阻遏气机，脾不转运，水道不通，腹部胀满。儿科医生只知道消导，不懂通腑泄湿，导致脾气大困，泄泻不分阴阳。参苓之补，仅能补救消涤之害，不能去除湿滞。故虽受补无益于病，病根都在中宫。泄肝以安胃，分利以通腑，必须使小便频利，期望有中气恢复之机。
猪苓 泽泻 海金沙 通草 椒目
吴（患者）：平素湿痰阻气导致气喘，此次因过食停滞，阴脏之阳不运，阳腑之气不通，大小便不爽，足背浮肿腹部胀满。诊脉沉弦，还是水寒痰滞，阻遏气分，上下皆不通调。应当从三焦分治。刚才见案头一方，用菟丝子升提少阴，吴茱萸泄降厥阴，不知作何解释，不敢附和。仍用河间氏的分消定议。（病机：湿壅三焦，肺气不降）
大杏仁 莱菔子 猪苓 泽泻 葶苈子 厚朴 桑白皮 广陈皮 细木通
又诊：三焦分消，泄肝通腑，大小便不爽如旧。诊脉浮小带促，闻声呼吸不利，是气分在上部结阻，以致中下部不通。喘胀的要旨，在于开鬼门取汗，洁净腑利水，无非宣通表里，务必在治病源头。据脉症参详，急急开上为法，符合《金匮要略》风水反登义。
麻黄 杏仁 石膏 甘草 薏苡仁
朱（患者）：初起因面肿，邪气干扰阳位，气壅不通，大小便皆少，桂枝附子不应。即给予导滞。滞属有质，湿热无形，入肺为喘，乘脾为胀，六腑开合皆废，大便不通爽，尿短混浊，时而点滴。视其舌绛口渴，腑病背胀，脏病腹满，更兼倚倒左右，肿胀随着部位加重。其湿热布散三焦，明眼人难以决胜矣。经文说从上之下者治其上，又说从上之下而甚于下者，必先治其上，而后治其下。此症逆乱纷更，全无头绪，皆是不辨有形无形的误治。姑且以清肃上焦为先。
飞滑石（一钱半） 大杏仁（去皮尖十粒） 生薏苡仁（三钱） 白通草（一钱） 鲜枇杷叶（刷净毛去筋手内揉三钱） 茯苓皮（三钱） 淡豆豉（一钱半） 黑山栀壳（一钱） 急火煎五分服。
此乃手太阴肺经药也。肺气窒塞，当降不降，杏仁微苦则能降，滑石甘凉，渗湿解热，薏苡仁通草，淡而渗气分，枇杷叶辛凉，能开肺气。茯苓用皮，谓诸皮皆凉，栀豉宣其陈腐郁结。凡此气味俱薄，为上焦药，仿徐之才轻可去实之义。
某（患者）：暴肿气急，小便涩少。这是外邪壅肺，气分不通。治当从风水皮水论治，宣通其经隧，以能食能寝为佳。勿得诛伐无过之地。
前胡 蜜炙麻黄 牛蒡子 姜皮 紫菀 杏仁 茯苓皮 广陈皮
王（患者）：髀尻微肿，小腿下浮肿甚。乃腑阳不行，病甚于暮夜。宜辛香通其经腑之郁。（病机：下焦寒湿流经）
生白术 炮川乌 北细辛 茯苓 汉防己 川独活
又诊：中满用余粮丸获效，得暖下泄浊之力，腹胀已去，而髀尻足跗肌肉肿浮。夫脏寒生满病，暖水脏之阳，培火生土是法。究竟阳气未全复，四末流行未布。前议幽香通其下焦经脉，果得肿减。议用加味活络丹。
炮川乌 干地龙 乳香 没药 北细辛 桂枝木
用油松节三两，酒水各半，煎汁法丸。
汪（患者）：肿自下起，胀及心胸，遍身肌肤赤瘰，溺无便滑，湿热蓄水，横渍经隧，气机闭塞，呻吟喘急。湿本阴邪，下焦先受，医用桂附白术，邪蕴化热，充斥三焦，以致日加凶危也。（病机：湿热壅塞经隧）
川通草（一钱半） 海金沙（五钱） 黄柏皮（一钱半） 木猪苓（三钱） 生赤豆皮（一钱半） 真北细辛（一分）
又诊：前法肿消三四，仍以分消。
川白通草 猪苓 海金沙 生赤豆皮 葶苈子 茯苓皮 晚蚕砂
又诊：间日寒战发热，渴饮，此为疟，乃病上加病，饮水结聚，以下痛胀，不敢用涌吐之法。暂与开肺气壅遏一法。
大杏仁 蜜炒麻黄 石膏
又诊：湿邪留饮，发红瘰，胸聚浊痰，消渴未已，用木防己汤。
木防己（一钱） 石膏（三钱） 杏仁（三钱） 薏苡仁（二钱） 飞滑石（一钱半） 寒水石（一钱半）
通草煎汤代水。
陈（患者）：进神芎导水丸二日，所下皆粘腻黄浊形色。余前议腑气窒塞，水湿粘滞，浊攻犯肺为痰嗽，水渍脉隧为浮肿。大凡经脉六腑之病，总以宣通为是。内经云，六腑以通为补。今医不分脏腑经络，必曰参术是补，岂为明理。然肢节足跗之湿，出路无由，必针刺以决其流，此内外冀可皆安。戊己丸三钱，用二日后，再进前药一服。
薛（十九岁）：腹满下至少腹，三阴都已受伤，而周身疥疮，数年不断。脉络中必有湿热。就腹痛泄泻，腑阳不通，不独偏热偏寒之治。常用四苓散。
猪苓（三钱） 茯苓（三钱） 泽泻（一钱半） 生白术（一钱） 椒目（五分）
倪（老年女性）：湿热香港脚，上攻心胸，脘中满胀，呕逆，乃湿上甚为热化，与苦辛先平在上之满胀，用泻心法。（病机：湿热香港脚）
川黄连 黄芩 枳实 半夏 姜汁 杏仁
汤（患者）：囊肿腹胀，此属疮蛊。（病机：湿郁疮蛊）
茯苓皮 海金沙 白通草 大腹皮绒 厚朴 广陈皮
猪苓 泽泻
某（三十六岁）：性躁，气有余便是火，肝胆中木火入络，成形为胀，便溺皆赤，喉痛声嘶痰血，肝病过膈犯肺，久延为单腹胀难治。（病机：木火入络）小温中丸三钱。
吴（五十五岁）：气逆腹胀，汨汨有声，已属络病，难除病根。（病机：气逆入络）
老苏梗 生香附 厚朴 白蔻仁 土瓜蒌 桔梗 枳壳 黑山栀
汪（患者）：脉右涩，左弱，面黄瘦，露筋，乃积劳忧思伤阳，浊阴起于少腹，渐至盘踞中宫，甚则妨食呕吐，皆单鼓胀之象大着。调治最难。欲驱阴浊，急急通阳。（病机：阳虚单胀，浊阴凝滞）
干姜 附子 猪苓 泽泻 椒目
又诊：通太阳之里，驱其浊阴，已得胀减呕缓，知身中真阳，向为群药大伤。议以护阳，兼以泄浊法。
人参 块茯苓 生干姜 淡附子 泽泻
又诊：阴浊盘踞中土，清阳蒙闭，腹满腹胀，气逆腹痛，皆阳气不得宣通，浊阴不能下走，拟进白通法。
生干姜 生炮附子 冲猪胆汁。
黄（三十八岁）：停滞单胀，并不渴饮，昼则便利不爽，夜则小便略通。此由气分郁痹，致中焦不运。先用大针砂丸，每服一钱五分，暖其水脏以泄浊。
某（患者）：向有宿痞，夏至节一阴来复，连次梦遗，遂腹形坚大，二便或通或闭。是时右膝痈肿溃疡，未必非湿热留阻经络所致。诊脉左小弱，右缓大，面色青减，鼻准明亮，纳食必腹胀愈加，四肢恶冷，热自里升，甚则衄血牙宣，全是身中气血交结，固非积聚停水之胀。考古人于胀症，以厘清气血为主，止痛务在宣通。要知攻下皆为通腑，温补乃护阳以宣通。今者单单腹胀，当以脾胃为病薮，太阴不运，阳明愈钝。议以缓攻一法。
川桂枝（一钱） 熟大黄（一钱） 生白芍（一钱半） 厚朴（一钱） 枳实（一钱） 淡生干姜（一钱）
三帖。
又诊：诊脉细小，右微促，畏寒甚，右胁中气，触入小腹，着卧即有形坠着。议用局方禹余粮丸，暖水脏以通阳气。
早晚各服一钱流水送八服。
又诊：脉入尺，弦胜于数，元海阳虚，是病之本；肝失疏泄，以致腹胀，是病之标。当朝用玉壶丹，午用疏肝实脾利水，分消太阳太阴之邪。
紫厚朴（炒一钱半） 缩砂仁（炒研一钱） 生白术（二钱） 猪苓（一钱） 茯苓（块三钱） 泽泻（一钱）
又诊：脉弦数，手足畏冷，心中兀兀，中气已虚。且服小针砂丸，每服八十粒，开水送。二服，以后药压之。
生白术 云茯苓 广陈皮 煎汤一小杯，后服。
又诊：脉如涩，凡阳气动则遗，右胁汨汨有声，坠入少腹，可知肿胀非阳道不利，是阴道实，水谷之湿热不化也。议用牡蛎泽泻散。
左牡蛎（四钱泄湿） 泽泻（一钱半） 花粉（一钱半） 川桂枝木（五分通阳） 茯苓（三钱化气） 紫厚朴（一钱）
午服。
又诊：脉数实，恶水，午后手足畏冷，阳明中虚，水气聚而为饮也。以苓桂术甘汤劫饮，牡蛎泽泻散止遗逐水。照前方去花粉加生白术三钱。
又诊：手足畏冷，不喜饮水，右胁汨汨有声，下坠少腹，脉虽数而右大左弦，信是阳明中虚，当用人参熟附生姜，温经补虚之法。但因欲回府调理数日，方中未便加减。且用前方，调治太阳太阴。
生白术（三钱） 左牡蛎（生四钱） 泽泻（炒一钱） 云苓（三钱） 生益智（四分） 桂枝木（四分） 炒厚朴（一钱） 午后食远服。
朝服小温中丸五十粒，开水送。仍用三味煎汤压之。
杨（十六岁）：味过辛酸，脾胃气伤结聚，食入则胀满。曾服礞石大黄丸，滞浊既下不愈，病不在乎肠中。前贤治胀治满，必曰分消，攻有形不效，自属气聚为瘕。疏胃宜清，调脾当暖。此宗前贤立法。（病机：脾胃气窒不和）
生茅术 广陈皮 丁香皮 黄柏 草豆蔻 川黄连 厚朴 茯苓 泽泻 水法丸。
Zhang: The pulse is wiry on the left, and floating and choppy on the right. Initially, epigastric pain radiated to the hypochondrium, followed by abdominal distension with a high, convex appearance, reduced appetite, and difficulty in digestion. Bowel movements and urination were difficult and unsmooth. This condition arises from excessive mental exertion and worry in an elderly patient, leading to liver wood stagnation and spleen earth dysfunction. Clear yang and turbid yin become confused, resulting in distension. As the vital essence of the zang organs depletes daily and the yang qi of the fu organs fails to transport, ancient masters treating distension emphasized the importance of unblocking yang. Using yin-nourishing and softening herbs, merely adding small amounts of Cinnamon Twig (Guizhi) and Aconite Root (Fuzi), would cause yin cold to congeal and turbidity to accumulate, which is not a good method. It is proposed to use Yuliang Wan from the Ju Fang (Formulary Bureau) to warm the water organ (kidney/bladder) and attack turbid pathogens. Once slight improvement is seen, combine with unblocking yang and firm tonification methods. This is the treatment principle for distension caused by deficiency and internal injury. Methods of purging and draining are designed for tangible pathogens and differ from conditions involving intangible qi damage. (Pathogenesis: Liver qi stagnation invading the spleen and stomach)
Chen (Elderly female): Long-term emotional depression has damaged the yang qi of the spleen and stomach. The complexion lacks luster, there is nausea after eating porridge, and loose stools. Qi sinking causes edema of the dorsum of the foot; qi stagnation causes epigastric stuffiness, with a risk of developing fullness in the middle jiao. Use a method to treat the middle jiao. (Pathogenesis: Liver qi invading spleen and stomach)
Ginseng Radix et Rhizoma (Renshen), Raw Alpinia Oxyphylla Fruit (Sheng Yizhi), Roasted Ginger (Wei Jiang), Poria (Fuling), Papaya (Mugua), Stir-fried Tangerine Peel (Chao Guangpi).
Cheng (Female): The pulse is rapid, with nausea and epigastric distension. (Pathogenesis: Liver-spleen disharmony with summer-heat pathogen)
Stir-fried Pinellia Tuber (Chao Banxia), Tangerine Peel (Guangpi), Agastache Herb (Huoxiang [mixed with decoction of one fen of Coptis Rhizome]), Poria (Fuling), Curcuma Aromatica Rhizome (Yujin).
Re-examination: Summer-heat damages spleen and stomach, causing liver wood to overact on earth. Left abdominal distension and diarrhea occur.
Ginseng Radix et Rhizoma (Renshen), Magnolia Bark (Houpo), Tangerine Peel (Guangpi), Stir-fried Alisma Rhizome (Chao Zexie), Poria (Fuling), Papaya (Mugua), Honey-fried Licorice Root (Zhi Cao), Stir-fried Hawthorn Fruit (Chao Shazhirou).
Re-examination: Ginseng Radix et Rhizoma (Renshen), Stir-fried Bupleurum Root (Chao Chaihu), Stir-fried White Peony Root (Chao Baishao), Stir-fried Scutellaria Root (Chao Huangqin), Poria (Fuling), Honey-fried Licorice Root (Zhi Cao), Fresh Ginger (Shengjiang), Jujube (Dazao).
Song: Epigastric distension after eating indicates stomach disease. The complexion is sallow and the body emaciated. He reports the illness started after drinking alcohol and vomiting. He also mentions tinnitus and muscle twitching, indicating wood-fire invading the middle jiao with severe stagnation. It is proposed to use Xiaoyao San minus Atractylodes Macrocephala Rhizome (Baizhu), combined with Zuojin Wan. (Pathogenesis: Wood-fire invading earth)
Zhu (43 years old): Scrofula and mar刀的瘿 are diseases of the liver and gallbladder. The illness has prolonged and affected the spleen and stomach, causing abdominal fullness and constipation. The tongue coating is yellow with slight thirst. Warm tonification is contraindicated. One should drain wood-fire to soothe the liver and harmonize the spleen and stomach to regulate function, hoping to reduce the distension slightly.
Evodia Fruit (Wuzhuyu) mixed with Coptis Rhizome (Chuanlian), Raw Atractylodes Macrocephala Rhizome (Sheng Yushu), Toosendan Fruit (Chuanlianzi), Stir-fried Hawthorn Fruit (Chao Shanzha), Gardenia Fruit (Heishanzhi), Magnolia Bark (Houpo), Green Tangerine Peel (Qingpi), Pepper Seeds (Jiaomu).
Tang (Female): Qi distension for three years. Recently, after a fall and vomiting, fright caused qi and fire to rebel further, filling the chest and diaphragm with distension. Bowel movements and urination are patent. It is not due to physical stasis; she prefers cold drinks. Jaundice and scrofula appear on the face. According to the "Chapter on Disease Capacities," sudden distension belongs to heat.
Coptis Rhizome (Lian), Light Scutellaria Root (Dan Huangqin), Pinellia Tuber (Banxia), Immature Bitter Orange (Zhishi), Dried Ginger (Ganjiang), Raw White Peony Root (Sheng Baishao), Iron Rust Needle (Tiexiu Zhen).
Yan (63 years old): This year, wind-wood qi prevails, while Taiyin and Yangming qi are insufficient, leading to distension. Urination is difficult, and both dorsums of the feet are swollen. Bowel movements are sluggish. Treatment focuses on fu-yang. Use Fenxiao Tang formula. (Pathogenesis: Liver qi invading spleen-stomach, yang deficiency with dampness)
Raw Atractylodes Macrocephala Rhizome (Sheng Yushu), Poria (Fuling), Alisma Rhizome (Zexie), Polyporus (Zhuling), Magnolia Bark (Houpo), Pepper Seeds (Jiaomu), Decocted with Goldthread Water (Haijinsha Tang).
Wu: This year, Jueyin governs the heaven. At the Awakening of Insects solar term, abdominal fullness and panting occurred. Limbs and face are swollen, with alternating chills and fever and sweating. All these result from wood overacting on earth, preventing clear yang from spreading and allowing turbid qi to block and usurp positions. Thus, passing gas brings slight relief. Tentatively prescribe unblocking the fu organs to drain turbidity.
Raw Atractylodes Macrocephala Rhizome (Sheng Yushu), Poria (Fuling), Pepper Seeds (Jiaomu), Purple Magnolia Bark (Zi Houpo), Alisma Rhizome (Zexie), Light Ginger Residue (Dan Jiangzha).
Zhu (49 years old): Prolonged sitting with stagnant qi leads to middle jiao dysfunction, chills and fever, urinary retention, and abdominal distension. The pulse is small and choppy, indicating complete failure of fu-yang. Use methods to drain wood, unblock fu organs, and dissipate accumulation. Si Ling San plus Pepper Seeds (Jiaomu), Magnolia Bark (Houpo), Areca Seed (Dafupi), and Green Tangerine Peel (Qingpi).
Chen: In the prime of life, yet emaciated with a dull complexion. The pulse is small and rapid on the right, and small and wiry-taut on the left. The illness began last autumn with sudden epigastric pain and a palpable mass. After being startled, appetite decreased, food failed to digest, and remained in the upper jiao, causing abdominal distension, extending to the hypochondrium. Limbs are cold at night but warm later. Bowel movements only occur every ten days, accompanied by blood. Pressing the Qihai point above the navel on an empty stomach reveals a small mass with mild tenderness. Movement or drinking water makes it disappear. When the weather is cold, nail beds turn purple. Careful analysis points to liver-spleen pathology: blocked qi and blood lead to stagnation, eventually causing yang deficiency and bi-blockage, preventing upward and downward movement, resembling the Hexagram Pi (Obstruction). Previous treatments with either reducing or tonifying methods failed because they did not understand the subtleties of unblocking yang. (Pathogenesis: Liver-spleen disharmony, obstruction of clear yang)
Allium Macrostemon Bulb (Xiebai), Cinnamon Twig (Guizhi), Trichosanthes Seed (Gualou Ren), Fresh Ginger (Shengjiang), Pinellia Tuber (Banxia), Poria (Fuling).
Re-examination: Juice of Allium Macrostemon Bulb (Xiebai Zhi), Cinnamon Twig Wood (Guizhi Mu), Trichosanthes Fruit (Gualou Shi), Cortex of Toosendan Fruit (Chuanlianzi Pi), Pinellia Tuber (Banxia), Poria (Fuling), Safflower Root (Guixu), Peach Kernel (Taoren), Corydalis Rhizome (Yanhu), Ginger Juice (Jiangzhi). Pill made with two juices.
Certain Patient: Distension and edema of the dorsum of the foot, short and scanty urine, loose stools that are not smooth. Treatment should primarily open the Taiyang channel. (Pathogenesis: Damp-turbidity congealing, obstructing urination requires opening Taiyang)
Wu Ling San plus Pepper Seeds (Jiaomu).
Certain Patient (67 years old): Isolated lower abdominal distension, relieved slightly when bowel and bladder movements are patent. This clearly indicates obstruction of fu-yang and congealing of turbid yin. Previous methods focused solely on spleen-yang and were ineffective. Opening the Taiyang channel is essential. Wu Ling San plus Pepper Seeds (Jiaomu).
Zheng: Two doses of methods opening interior orifices reduced pain and distension significantly. However, yin and yang are indistinguishable, the tongue is crimson with irritability and thirst, and there is no desire to eat. It seems Taiyang Bladder fails to open and Yangming Stomach fails to close. The method should still prioritize unblocking fu-yang. However, Wu Ling San, Guizhi, and Baizhu are absolutely unsuitable. It is proposed to adopt the intent of Ganlu Yin.
Polyporus (Zhuling), Poria (Fuling), Alisma Rhizome (Zexie), Calcitum (Hanshui Shi), Pepper Seeds (Jiaomu), Stir-fried Tangerine Kernel (Chao Juhe).
Cheng: During the long summer of this year, prolonged heat caused yang qi to leak outward, slowing the transformation of water and grain. Dampness arose internally, leading to gradual edema spreading from below upwards, causing panting and coughing unable to lie flat. This is due to turbid water condensing into phlegm, obstructing the descending function of lung qi. Since urination is difficult, Taiyang qi is also not regulated. Although this is a yang deficiency syndrome, using Eucommia Bark (Yuzhu) and Rehmannia Root (Dihu) in Shenqi Tang, which are sour and cloying, would hinder downward movement.
Poria (Fuling), Cinnamon Twig Wood (Guizhi Mu), Apricot Seed (Xingren), Raw White Peony Root (Sheng Baishao), Dried Ginger (Ganjiang), Schisandra Berry (Wuweizi), Raw Oyster Shell (Sheng Muli), Alisma Rhizome (Zexie).
Ma (51 years old): Initially presented with chest bi and vomiting. In summer, edema appeared on the dorsum of the foot and lower abdomen. Food was not digested, and urination was short and difficult. This is due to declining yang qi and internal accumulation of dampness from water and grain, causing loss of ascending and descending mechanisms. One should open Taiyang and temporarily disperse dampness.
Polyporus (San qian), Cinnamon Twig Wood (Ba fen), Poria Skin (San qian), Alisma Rhizome (Yi qian), Stephania Root (Yi qian ban), Magnolia Bark (Yi qian). Four doses.
Qiu (6 years old): At six years old, during the Summer Solstice, external damp-heat forced itself inward. The qi of consumed food and water steamed into damp stagnation, blocking qi mechanism. Spleen failed to transport, and water passages were blocked, causing abdominal distension. Pediatricians only knew how to promote digestion, failing to unblock the fu organs and drain dampness, severely damaging spleen qi. Diarrhea did not distinguish between yin and yang. Tonics like Ginseng and Poria only remedied the harm of digestive clearing but could not remove damp stagnation. Thus, supplementation was useless; the root lies in the central palace. Draining liver to calm stomach and separating/drainling to unblock fu organs are needed. Frequent urination must be achieved to hope for recovery of middle qi.
Polyporus (Zhuling), Alisma Rhizome (Zexie), Goldthread Water (Haijinsha), Tetrapanax Pith (Tongcao), Pepper Seeds (Jiaomu).
Wu: Usually suffers from asthma due to damp-phlegm blocking qi. Now, due to overeating and stagnation, the yang of yin organs fails to transport, and qi of yang organs is blocked. Bowel and bladder movements are unsmooth, with edema of the dorsum of the foot and abdominal distension. The pulse is deep and wiry, indicating cold-water and phlegm stagnation blocking qi distribution, with no regulation above or below. Treatment should address the Triple Burner separately. Seeing a prescription using Dodder Seed (Tusizi) to ascend Shaoyin and Evodia Fruit (Wuzhuyu) to drain Jueyin, I do not understand the explanation and dare not agree. Instead, I adhere to He Jian's method of separate dissipation. (Pathogenesis: Dampness congesting Triple Burner, lung qi failing to descend)
Large Apricot Seed (Da Xingren), Radish Seed (Laifuzi), Polyporus (Zhuling), Alisma Rhizome (Zexie), Lepidium Seed (Tinglizi), Magnolia Bark (Houpo), Mulberry Root Bark (Sangbaipi), Tangerine Peel (Guangpi), Fine Akebia Caulis (Xi Mutong).
Re-examination: Separate dissipation of Triple Burner, draining liver and unblocking fu organs. Bowel and bladder movements remain unsmooth as before. Pulse is floating, small, and rapid. Breathing is difficult upon hearing sounds. This indicates qi blockage in the upper jiao, causing mid-lower obstruction. The key to treating panting and distension is opening the skin (sweating) and cleansing the fu organs (diuresis), aiming to ventilate exterior and interior, addressing the source. Based on pulse and symptoms, urgently opening the upper jiao is the method, aligning with the meaning of Fengshui in Jingui Yaolue.
Ephedra Stem (Mahuang), Apricot Seed (Xingren), Gypsum (Shigao), Licorice Root (Gancao), Coix Seed (Yiyiren).
Zhu: Initially, facial swelling occurred due to pathogenic factors interfering with yang positions, blocking qi. Urine and stool were scant. Guizhi and Fuzi were ineffective. Then, promoting stagnation was used. Stagnation involves tangible matter, whereas damp-heat is intangible. Entering the lung causes panting; attacking the spleen causes distension. The opening and closing of all six fu organs fail. Bowels are not smooth, urine is short and turbid, sometimes dropping drop by drop. The tongue is crimson with thirst. Fu organ disease presents with back distension; zang organ disease with abdominal fullness. Leaning to left or right, swelling worsens in those areas. Damp-heat spreads through the Triple Burner, making victory difficult even for experts. The classic states: "For those coming from above and going down, treat the upper." And: "For those coming from above and worsening below, first treat the upper, then the lower." This case is chaotic and disordered, lacking direction, due to failing to distinguish between tangible and intangible. Tentatively, clear and purge the upper jiao first.
Calcined Talcum Fei Huashi (One qian half), Large Apricot Seed Da Xingren (Ten grains, peeled and core removed), Raw Coix Seed Sheng Yiyiren (Three qian), Bai Tongcao (One qian), Fresh Loquat Leaf Xian Pipaye (Brush clean hairs, remove veins, rub in hand Three qian), Poria Skin Fulingpi (Three qian), Light Fermented Soybean Dan Douchi (One qian half), Black Gardenia Husk Heishanzhi Qiao (One qian). Decoct rapidly with a small amount of water.
These are medicines for the Hand-Taiyin Lung Meridian. Lung qi is obstructed and fails to descend. Apricot seed is slightly bitter and can descend. Talcum is sweet and cool, leaching dampness and resolving heat. Coix seed and Akebia caulis are light and leach qi aspect. Loquat leaf is acrid and cool, opening lung qi. Using Poria skin implies all skins are cool. Gardenia and Fermented soybean vent stale and stagnant accumulation. These substances have thin flavors and act on the upper jiao, imitating Xu Zhicai's principle that "light can remove excess."
Certain Patient: Sudden swelling and急促 breathing, scanty and astringent urine. This is external pathogen congesting the lung, blocking qi distribution. Treatment should follow Fengshui and Pishui patterns, ventilating the meridians. Good signs include ability to eat and sleep. Do not attack innocent areas.
Peucedanum Root (Qianhu), Honey-fried Ephedra Stem (Mi Zhi Mahuang), Bullace Seed (Niubangzi), Ginger Skin (Jiangpi), Aster Flower (Ziwan), Apricot Seed (Xingren), Poria Skin (Fulingpi), Tangerine Peel (Guangpi).
Wang: Slight swelling of the buttocks and severe swelling below the calves. This is due to non-functioning fu-yang, worsening in the evening. Acrid-aromatic herbs should be used to unblock the郁 of meridians and fu organs. (Pathogenesis: Lower jiao cold-damp flowing through meridians)
Raw Atractylodes Macrocephala Rhizome (Sheng Yushu), Prepared Sichuan Aconite Root (Pao Chuanwu), Northern Asarum (Bei Xixin), Poria (Fuling), Hanfangji (Hanfangji), Notopterygium Root (Chuan Duhuo).
Re-examination: Middle fullness responded well to Yuliang Wan, gaining the power of warming below and draining turbidity. Abdominal distension resolved, but buttocks and foot edema persist. Cold in zang organs causes fullness diseases. Warming the yang of the water organ and cultivating fire to generate earth is the method. Ultimately, yang is not fully restored, and circulation to the four extremities is incomplete. The previous proposal to use aromatic herbs to unblock lower jiao meridians indeed reduced swelling. It is proposed to use Jiawei Huoluo Dan.
Prepared Sichuan Aconite Root (Pao Chuanwu), Dry Earthworm (Gan Dilong), Frankincense (Ruxiang), Myrrh (Moyao), Northern Asarum (Bei Xixin), Cinnamon Twig Wood (Guizhi Mu).
Decoct three liang of Oil Pine Joint (Yousongjie) in half wine and half water, make pills with the juice.
Wang: Swelling starts from below, distending to the heart and chest. Red scrofula appears on the skin. Urination and defecation are difficult. Damp-heat accumulates water, flooding meridians, blocking qi mechanism, causing groaning and急促 panting. Dampness is a yin pathogen, affecting the lower jiao first. Doctors used Guizhi, Fuzi, and Baizhu, causing pathogen to transform into heat, filling the Triple Burner, worsening daily. (Pathogenesis: Damp-heat congesting meridians)
Chuan Tongcao (One qian half), Goldthread Water (Wu qian), Phellodendron Bark (Yi qian ban), Mu Zhuling (Three qian), Raw Red Bean Skin (Yi qian half), True Northern Asarum (Yi fen).
Re-examination: Previous methods reduced swelling by three or four parts. Continue with separate dissipation.
Chuan Baotongcao, Polyporus (Zhuling), Goldthread Water (Haijinsha), Raw Red Bean Skin (Sheng Chidoupi), Lepidium Seed (Tinglizi), Poria Skin (Fulingpi), Silkworm Sand (Wancansha).
Re-examination: Alternating chills and fever every other day, thirst, indicating malaria, a complication. Drinking water causes accumulation, lower pain and distension. Vomiting induction is contraindicated. Temporarily use a method to open lung qi congestion.
Large Apricot Seed (Da Xingren), Honey-fried Ephedra Stem (Mi Chao Mahuang), Gypsum (Shigao).
Re-examination: Dampness pathogen retaining fluid, red scrofula, turbid phlegm accumulating in chest, diabetes not resolved. Use Mufangji Tang.
Stephania Root (Mufangji - One qian), Gypsum (Shigao - Three qian), Apricot Seed (Xingren - Three qian), Coix Seed (Yiyiren - Two qian), Calcined Talcum (Fei Huashi - One qian half), Calcitum (Hanshui Shi - One qian half). Decoct with Akebia Caulis (Tongcao) as water substitute.
Chen: Took Shenxiong Dao Shui Wan for two days, passing sticky, yellow, turbid material. Previously, I discussed fu qi obstruction, sticky water-dampness, turbid pathogens attacking lung causing phlegm-cough, and water soaking meridians causing edema. Generally, diseases of meridians and fu organs require ventilation and unblocking. The Neijing states: "The six fu organs benefit from unblocking." Current doctors do not distinguish zang-fu and meridians, claiming Ginseng and Atractylodes are tonics. How can this be wise? For dampness in limbs and feet, there is no exit route; acupuncture must be used to drain it, hoping for internal and external peace. Take Wuji Wan three qian for two days, then resume previous medicine.
Xue (19 years old): Abdominal fullness extending to lower abdomen, all three yin meridians injured. Persistent scabies for years indicates damp-heat in meridians. Regarding abdominal pain and diarrhea, fu-yang is blocked. Treatment is not just biased towards heat or cold. Commonly use Si Ling San.
Polyporus (San qian), Poria (San qian), Alisma Rhizome (Yi qian ban), Raw Atractylodes Macrocephala Rhizome (Yi qian), Pepper Seeds (Wu fen).
Ni (Elderly female): Damp-heat podagra attacks heart and chest, causing epigastric fullness and vomiting. This is dampness transforming into heat when rising excessively. Use bitter-acrid methods to first level upper fullness, employing Xiexin Fa. (Pathogenesis: Damp-heat podagra)
Coptis Rhizome (Chuanlian), Scutellaria Root (Huangqin), Immature Bitter Orange (Zhishi), Pinellia Tuber (Banxia), Ginger Juice (Jiangzhi), Apricot Seed (Xingren).
Tang: Scrotal swelling and abdominal distension, belonging to Chuang Gu. (Pathogenesis: Damp-stagnation Chuang Gu)
Poria Skin (Fulingpi), Goldthread Water (Haijinsha), Bai Tongcao, Areca Peel Rong (Dafupi Rong), Magnolia Bark (Houpo), Tangerine Peel (Guangpi).
Polyporus (Zhuling), Alisma Rhizome (Zexie).
Certain Patient (36 years old): Irritable nature, excess qi becomes fire. Liver-gallbladder wood-fire enters collaterals, forming distension. Urine and stool are red, throat painful, voice hoarse, hemoptysis. Liver disease crosses diaphragm to invade lung, prolonging to single abdominal distension, difficult to treat. (Pathogenesis: Wood-fire entering collaterals) Xiao Wenzhong Wan three qian.
Wu (55 years old): Qi rebellion and abdominal distension, gurgling sounds, already a collateral disease, difficult to eradicate root. (Pathogenesis: Qi rebellion entering collaterals)
Old Perilla Stem (Lao Sugeng), Raw Cyperus Rhizome (Sheng Xiangfu), Magnolia Bark (Houpo), White Cardamom Seed (Baokouren), Earth Trichosanthes Fruit (Tu Gualou), Platycodon Root (Jiegeng), Immature Bitter Orange (Zhike), Black Gardenia (Heishanzhi).
Wang: Pulse right choppy, left weak. Sallow and emaciated face, visible veins. Accumulated labor and worry damage yang. Turbid yin rises from lower abdomen, gradually occupying the center, causing food aversion and vomiting, typical signs of single drum distension. Treatment is very difficult. To drive out turbid yin, urgently unblock yang. (Pathogenesis: Yang deficiency single distension, turbid yin congealing)
Dried Ginger (Ganjiang), Aconite Root (Fuzi), Polyporus (Zhuling), Alisma Rhizome (Zexie), Pepper Seeds (Jiaomu).
Re-examination: Unblocking interior of Taiyang, driving out turbid yin, reduced distension and vomiting. Knowing true yang was previously severely damaged by various drugs, propose protecting yang and draining turbidity.
Ginseng Radix et Rhizoma (Renshen), Block Poria (Kuai Fuling), Raw Dried Ginger (Sheng Ganjiang), Light Aconite Root (Dan Fuzi), Alisma Rhizome (Zexie).
Re-examination: Yin turbidity occupies central earth, obscuring clear yang. Abdominal fullness and distension, qi rebellion and abdominal pain, all due to yang qi failing to ventilate and turbid yin failing to descend. Propose advancing Baitong Fa.
Raw Dried Ginger (Sheng Ganjiang), Raw and Prepared Aconite Root (Sheng Pao Fuzi), mixed with Pig Bile (Chong Zhu Danzhi).
Huang (38 years old): Stagnant single distension, no thirst. Daytime bowel movements unsmooth, nighttime urination slightly patent. This is due to qi aspect郁痹, causing middle jiao dysfunction. First use Da Zhensha Wan, one qian five fen per dose, to warm water organ and drain turbidity.
Certain Patient: History of chronic痞 mass. At Summer Solstice, yin returns, frequent nocturnal emissions, leading to hard and large abdomen. Bowel and bladder movements alternate between patent and blocked. Right knee carbuncle ulcerated, likely due to damp-heat lingering in meridians. Pulse left small and weak, right slow and large. Complexion darkened, nose bright. Eating increases abdominal distension. Limbs fear cold, heat rises from inside, severe cases have epistaxis and bleeding gums. Entirely due to qi-blood knotting in the body, not accumulation or retained water distension. Ancient masters treated distension by clarifying qi and blood, stopping pain by unblocking. Know that purging unblocks fu organs, and tonification protects yang to unblock. Now, single abdominal distension should be treated as a spleen-stomach disease. Taiyin fails to transport, Yangming becomes dull. Propose gentle attacking method.
Cinnamon Twig (Gui Zhi - One qian), Prepared Rhubarb (Shu Dahuang - One qian), Raw White Peony Root (Sheng Baishao - One qian ban), Magnolia Bark (Houpo - One qian), Immature Bitter Orange (Zhishi - One qian), Light Raw Dried Ginger (Dan Sheng Ganjiang - One qian). Three doses.
Re-examination: Pulse small and fine, right slightly rapid, severe chills. Qi in right hypochondrium touches lower abdomen, feeling heavy when lying down. Propose Ju Fang Yuyuliang Wan to warm water organ and unblock yang qi.
Take one qian morning and evening with flowing water, eight doses total.
Re-examination: Pulse entering Chi position, wiry surpassing rapid. Yuanhai yang deficiency is the root; liver failing to soothe causing distension is the branch. Morning use Yuhu Dan, afternoon use soothing liver, strengthening spleen, and diuretic methods to separate dissipate Taiyang and Taiyin pathogens.
Purple Magnolia Bark (Zi Houpo - Stir-fried One qian ban), Amomum Fruit (Suosharen - Stir-fried and ground One qian), Raw Atractylodes Macrocephala Rhizome (Sheng Yushu - Two qian), Polyporus (Zhuling - One qian), Poria (Kuai Fuling - Three qian), Alisma Rhizome (Zexie - One qian).
Re-examination: Pulse wiry and rapid, hands and feet fear cold, palpitations, middle qi already deficient. Take Xiao Zhensha Wan, eighty pills per dose, with boiled water. Two doses, followed by decoction.
Raw Atractylodes Macrocephala Rhizome (Sheng Yushu), Cloud Poria (Yun Fuling), Tangerine Peel (Guangpi). Decoct a small cup of soup, take afterwards.
Re-examination: Pulse like choppy. Whenever yang qi moves, emission occurs. Gurgling sound in right hypochondrium falling into lower abdomen indicates distension is not due to yang pathway obstruction, but yin pathway excess, with water-grain damp-heat failing to transform. Propose Musculus-Zexie San.
Left Oyster Shell (Zuo Muli - Four qian to drain damp), Alisma Rhizome (Zexie - One qian ban), Flower Powder (Huafen - One qian ban), Cinnamon Twig Wood (Chuan Guizhi Mu - Five fen to unblock yang), Poria (Fuling - Three qian to transform qi), Purple Magnolia Bark (Zi Houpo - One qian). Take at noon.
Re-examination: Pulse rapid and solid, aversion to water, hands and feet fear cold in afternoon. Yangming middle deficiency, water qi gathers as fluid. Use Linggui Zhugan Tang to seize fluid, Musculus-Zexie San to stop emission and expel water. Remove Huafen from previous formula, add Raw Atractylodes Macrocephala Rhizome (Sheng Yushu) three qian.
Re-examination: Hands and feet fear cold, no desire to drink, gurgling sound in right hypochondrium falling into lower abdomen. Pulse although rapid, right large and left wiry, confirms Yangming middle deficiency. Should use Ginseng, Prepared Aconite, and Fresh Ginger to warm meridians and tonify deficiency. But returning home for调理, cannot modify formula. Use previous formula to treat Taiyang and Taiyin.
Raw Atractylodes Macrocephala Rhizome (Sheng Yushu - Three qian), Left Oyster Shell (Sheng Zuo Muli - Four qian), Alisma Rhizome (Chao Zexie - One qian), Cloud Poria (Yun Ling - Three qian), Raw Alpinia Oxyphylla Fruit (Sheng Yizhi - Four fen), Cinnamon Twig Wood (Guizhi Mu - Four fen), Stir-fried Magnolia Bark (Chao Houpo - One qian). Take far after afternoon meal.
Morning take fifty Xiao Wenzhong Wan pills with boiled water. Still use three ingredients decoction to suppress.
Yang (16 years old): Overconsumption of acrid and sour flavors damages spleen-stomach qi, causing knotting. Distension after eating. Previously took Mengshi Dahuang Wan, turbid stagnation passed but illness persisted. Illness is not in intestines. Ancients treating distension and fullness always said "separate dissipation." Attacking tangible forms is ineffective; naturally belongs to qi gathering forming masses. Soothing stomach should be clear, regulating spleen should be warm. Following ancients' legislation. (Pathogenesis: Spleen-stomach qi obstruction and disharmony)
Raw Atractylodes Rhizome (Sheng Maozhu), Tangerine Peel (Guangpi), Clove Bark (Dingxiapi), Phellodendron Bark (Huangbai), Galangal Seed (Caodoukou), Coptis Rhizome (Chuanlianhuan), Magnolia Bark (Houpo), Poria (Fuling), Alisma Rhizome (Zexie). Make pills with water.