经云∶浊气在上则生 胀,太阴所至为臌胀。即腹胀。病能篇云∶骤胀属热。
膨胀水肿一原病,皆是脾虚不得运。气入于脏膨胀成,腹大身瘦食不进。实土分消是妙
方,二苓二术陈皮香(木香)。香附朴砂桑泽(泽泻)腹(皮),沉香磨汁兼水姜。腹实痛块红
筋系,血臌归芍红(花)丹(皮)尝。水臌水腹若
秘结,五苓散加腹皮入。食积臌胀大腹凝,槟牵(牛)菔子棱蓬术。气实臌胀或吐酸,胁肋痛
胀并面黑。分心(气饮)羌桂苓夏通,青皮桑腹甘苏(梗)芍。气虚胀满劳役来,气急溏泄元气
衰。补中益气汤必用,分条而治休疑猜。地气为云天为雨,大地下变否为臌。脾土之阴既受
伤,转运之司亦失所。胃虽受谷不营运,清浊相淆隧道阻。郁而为热热为湿,湿热相生病即
取。此病宜补不宜攻,燥湿补中是为主。
陈参曰∶气陷则跗肿,气呆则脘闷。
又曰∶木乘土位,清阳不得舒展,浊气痞塞而攒踞也。
又曰∶虚肿胀由足入腹,治在少阴肾、太阴脾。
脾阳单胀(宜健阳运湿,温通脾阳)
五苓散见前 紫朴 陈广皮 木瓜 人参 炮姜 大腹皮 附子 煨草果 草蔻
益智 荜茇 茅术 干姜 川桂木 川椒
肾气
加减八味丸、《济生》肾气丸。
养阳明
大半夏汤 半夏 人参 白蜜
陈参曰∶冲脉隶于阳明,胃阳伤极,中乏坐镇之真气。冲脉动则诸脉皆震动,浊阴散
漫,由此卧着欲立矣。
疏厥阴
逍遥散 当归 白芍 柴胡 茯苓 白术 山栀 甘草 生姜 薄荷 加味丹皮
何书田曰∶六腑为阳,以通为补。通阳则浊阴不聚,守补恐中焦易钝。喻嘉言谓能变胃
而不受胃变。脏寒生满病,燥暖水脏之阳,是培火生土法。喘胀要旨,开鬼门以取汗,洁净
府以利水,无非宣通表里。
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。
古语云∶膏粱无厌发痈疽,淡泊不能生 胀。
《黄帝内经》说:浊气停留在上部就会发生胀病,太阴经邪气所致表现为臌胀。这就是腹胀。《素问·病能篇》说:突然发生的胀属于热证。
膨胀和水肿,其根源都是脾虚导致无法运化水湿。气侵入脏腑形成膨胀,表现为腹部膨大、身体消瘦、饮食不进。运用实土(健脾)和分消(利湿行气)的方法是妙方,可用茯苓、白术、陈皮、木香。加上香附、厚朴、砂仁、桑白皮、泽泻、大腹皮,再用沉香磨汁,配合生姜和水煎服。如果腹部坚实、疼痛且有红色筋脉显露,这是血臌,可尝试使用当归、白芍、红花、丹皮。如果是水臌,伴有腹水和便秘,可在五苓散中加入大腹皮。如果是食积导致的臌胀,大腹凝结,可用槟榔、牵牛子、莱菔子、三棱、莪术。如果是气实导致的臌胀,或伴有吐酸水、胁肋胀痛且面色发黑,可用分心气饮,包含羌活、桂枝、茯苓、半夏、通草、青皮、桑白皮、大腹皮、甘草、苏梗、白芍。如果是气虚导致的胀满,因劳累诱发,伴有气急、便溏、元气衰败,必须使用补中益气汤,应分条辨证治疗,不要犹豫猜疑。地气上升为天云,天气下降为雨水,大地变化异常则导致臌胀。脾土的阴液既已受伤,负责转运的机能也就失去了依托。胃虽然受纳食物但不能运化,清浊之气相互混淆,经络通道阻塞。郁结而化为热,热与湿结合,疾病随即产生。此病适宜用补法而不适宜用攻伐法,燥湿健脾和中是主要治法。
脾阳虚单见腹胀(宜健运阳气以祛湿,温通脾阳)
五苓散(见前文) 紫朴(厚朴) 陈皮 木瓜 人参 炮姜 大腹皮 附子 煨草果 草豆蔻 益智仁 荜茇 苍术 干姜 川桂枝 川椒
陈修园说:冲脉隶属于阳明胃经,若胃阳损伤至极,中焦缺乏镇守的真气。冲脉妄动则诸脉皆震动,浊阴之气散漫无序,因此患者卧下时感觉欲站立不稳。
疏泄厥阴肝气
逍遥散 当归 白芍 柴胡 茯苓 白术 山栀 甘草 生姜 薄荷 加味丹皮
何书田说:六腑属阳,以通畅为补。通阳则浊阴不聚,单纯守补恐怕中焦容易呆钝。喻嘉言认为能改变胃的状态而不被胃的状态所改变。脏寒产生满闷之病,通过燥暖水脏之阳,这是培火生土的方法。治疗喘胀的要旨,开鬼门(发汗)以取汗,洁净府(利小便)以利水,无非是为了宣通表里。
《黄帝内经》说:病势从上往下发展的,治疗其上部的病因。又说:病势从上往下发展且下部症状加重的,必须先治上部而后治下部。
The *Yellow Emperor's Inner Canon* states: When turbid Qi remains in the upper part, distension occurs; when Taiyin (Taiyin Meridian) is affected, it manifests as鼓胀 (Gu Zhang, abdominal distension with fluid accumulation). This is abdominal distension. The *Chapter on Disease Capacities* states: Sudden distension belongs to Heat syndrome.
Distension and edema share a common origin: all are due to Spleen deficiency failing to transport and transform. When Qi enters the Zang organs, distension forms, characterized by an enlarged abdomen, emaciated body, and loss of appetite. A brilliant formula involves strengthening Earth (tonifying the Spleen) and dispersing accumulation (promoting diuresis and moving Qi), using Poria (Fuling), Atractylodes macrocephala (Baizhu), Tangerine Peel (Chenpi), and Aucklandia (Muxiang). Add Cyperus (Xiangfu), Magnolia Bark (Houpo), Amomum (Sharen), Mulberry Root Bark (Sangbaipi), Alisma (Zexie), and Areca Seed (Dafupi); grind Agarwood (Chenxiang) into juice and decoct with Ginger (Shengjiang) and water. If the abdomen is solid, painful, with red veins visible, this is Blood Gu (Blood Distension); try Angelica Sinensis (Danggui), White Peony Root (Baishao), Safflower (Honghua), and Moutan Cortex (Danpi). For Water Gu (Water Distension) with abdominal swelling and constipation, add Dafupi to Wuling San (Five-Ingredient Powder with Poria). For food-stagnation distension with coagulation in the large abdomen, use Betel Nut (Binglang), Morning Glory Seed (Qianniu), Radish Seed (Lanzisu), Burreed Tuber (Sanleng), and Turmeric Tuber (Ezhu). For Qi-excess distension accompanied by acid regurgitation, hypochondriac pain and distension, and dark complexion, use Fenxin Qi Yin (Decoction for Dividing Heart Qi), containing Notopterygium (Qianghuo), Cinnamon Twig (Guizhi), Poria (Fuling), Pinellia (Banxia), Thunberg Fritillary Vine (Tongcao), Green Tangerine Peel (Qingpi), Mulberry Root Bark (Sangbaipi), Areca Peel (Dafupi), Licorice (Gancao), Perilla Stem (Sugeng), and White Peony Root (Baishao). For Qi-deficiency distension triggered by overwork, accompanied by shortness of breath, loose stools, and decline of Yuan Qi (Original Qi), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) must be used; treat according to specific patterns without hesitation. Earth Qi rises to become clouds, Heaven Qi descends to become rain; abnormal changes in the earth lead to Gu. Once the Yin of Spleen Earth is injured, the pivot of transportation also loses its foundation. Although the Stomach receives grain, it cannot transport and transform; Clear and Turbid mix chaotically, blocking the meridians. Stagnation generates Heat, which combines with Dampness, causing disease. This condition is suitable for tonification, not for purgation; drying Dampness and tonifying the Middle Jiao are the primary methods.
Chen Xiuyuan said: Qi sinking leads to dorsal foot edema; Qi stagnation leads to epigastric stuffiness.
He also said: Liver Wood overacting on Spleen Earth prevents the clear Yang from expanding, causing Turbid Qi to block and accumulate.
He further said: Deficiency-type swelling entering the abdomen from the feet should be treated by focusing on Shaoyin Kidney and Taiyin Spleen.
**Spleen Yang Deficiency Single Distension** (Suitable for strengthening Yang to move Dampness, warming and unblocking Spleen Yang):
Wuling San (see above), Purple Houpo (Magnolia Bark), Chenpi (Tangerine Peel), Papaya (Mugua), Ginseng (Renshen), Prepared Ginger (Paojiang), Dafupi (Areca Peel), Aconite (Fuzi), Roasted Caoguo (Black Cardamom), Cao Kou (Cardamom), Yizhi Ren (Alpinia Oxyphylla), Bibai (Long Pepper), Cang Zhu (Atractylodes lancea), Ganjiang (Dried Ginger), Chuan Guizhi (Cinnamon Twig), Chuanjiao (Sichuan Pepper).
**Kidney Qi**:
Jiajian Bawei Wan (Modified Eight-Ingredient Pill), *Jisheng Fang* Shenqi Wan (Kidney Qi Pill from *Essential Prescriptions for Life*).
**Nourishing Yangming**:
Dabanchang Tang (Major Half-Ginseng Decoction): Banxia (Pinellia), Renshen (Ginseng), Bai Mi (White Honey).
Chen Xiuyuan said: The Chong Mai (Penetrating Vessel) is subordinate to Yangming Stomach. If Stomach Yang is extremely damaged, lacking the true Qi to anchor the middle, the Chong Mai moves, causing all vessels to tremble, and Turbid Yin scatters; thus, lying down feels like standing unsteadily.
**Dispersing Jueyin**:
Xiaoyao San (Free and Easy Wanderer Powder): Danggui (Angelica Sinensis), Baishao (White Peony Root), Chaihu (Bupleurum), Fuling (Poria), Baizhu (Atractylodes Macrocephala), Shanzhi (Gardenia), Gancao (Licorice), Shengjiang (Fresh Ginger), Bohe (Mint), plus modified Danpi (Moutan Cortex).
He Shutian said: The Six Fu organs belong to Yang, and their benefit lies in unblocking. Unblocking Yang prevents Turbid Yin from gathering; merely tonifying may cause the Middle Jiao to become dull. Yu Jiayan stated that one can change the Stomach's state without being changed by it. Cold in the Zang organs causes fullness diseases; drying and warming the Yang of the Water organ (Kidney) is the method of "cultivating Fire to generate Earth." The essence of treating wheezing and distension is opening the "ghost door" (sweating pores) to induce sweat, and cleansing the "clean mansion" (bladder/kidneys) to promote urination, neither of which is other than disseminating and unblocking the exterior and interior.
The *Inner Canon* states: When pathology moves from above downward, treat the upper source. It also states: When pathology moves from above downward and worsens below, one must first treat the upper before treating the lower.
Ancient saying: Indulgence in rich foods leads to carbuncles and sores; excessive blandness fails to prevent distension.