有外因 有内郁 气虚 血虚
夫肿满之病乃由脾胃虚弱七情内伤六淫外侵饮食失节房劳致虚脾土之阴受伤转输之官失
职胃虽受谷不能运化清浊相干隧道壅塞郁而生热热久成湿湿热相生遂成肿满外虽坚满中空似
鼓经云鼓胀是也治宜补脾又须养肺金以制木使脾无贼邪之虑滋肾水以制火使肺气得清化之令
却盐味以防助病邪断妄想以保母气如此方安世人多以利药取一时之快其胀复作使真气伤而去
死不远悲夫如病浅脾气尚壮若与疏通似乎得理然亦不可与利药也临病之际宜谛视焉
丹溪云朝宽暮急者血虚朝急暮宽者气虚终日急者气血皆虚也肥白人腹胀者是气虚有痰瘦
黑人腹胀者是血虚有热
脉法云腹胀浮大是出厄虚小命殂须努力
诀要曰肿满脉弦脾制于肝洪数热胀迟弱阴寒浮为虚满紧则中实浮则可治虚则危急
一鼓胀名单腹胀乃是脾虚之甚必须远音乐断浓味宜大补中气用 四君子汤 加苍术 陈
皮神曲 浓朴 大剂服
一血虚腹胀宜 四物汤加减用
一肥胖人腹胀者宜 平胃散 合五苓散加减用
一瘦黑人腹胀者是血虚有热宜用 四物汤加 黄连 浓朴之类
一脉实人形壮盛者可攻之宜用 十枣汤 三花丸 二方俱下水肿类
一因怒气伤肝脾胃不和宜用 平肝饮子 调中顺气汤
一因食积腹胀者宜用 平胃散加 神曲 砂仁 槟榔 香附
一因肉积作胀者宜用 平胃散加 草果 砂仁 槟榔 或阿魏丸
一因血蓄作胀者宜用 抵当汤 或参芎汤加 红花 桃仁
一因七情所伤浊气在上生胀宜用 木香顺气汤
大凡肿胀胀满的疾病，是由于脾胃虚弱，加上七情内伤、六淫外侵、饮食不节、房劳过度导致正气亏虚。脾土之阴受伤，负责转输功能的器官失职，胃虽然受纳水谷但不能运化，清浊之气相互干扰，经络隧道壅塞不通，郁滞而生热，热久则生湿，湿热相生，最终形成肿胀胀满。外表虽然坚硬胀满，但内部中空像鼓一样，经书所说的“鼓胀”就是这种病。治疗应当补益脾气，又须滋养肺金以制约肝木，使脾脏没有贼邪（肝木乘脾）的忧虑；滋补肾水以制约心火，使肺气得到清肃下降的指令；戒除咸味以防助长病邪；断绝妄想以保全母气（肾精）。这样身体才能安宁。世人多用通利药物以求一时之快，结果胀满复发，使真气受损，离死亡不远，可悲啊！如果病情较浅，脾气尚且强壮，给予疏通之法似乎合乎道理，但也不可使用通利药物。临证之际应当仔细审视。
朱丹溪说：早晨胀满减轻、傍晚加重的属于血虚；早晨胀满加重、傍晚减轻的属于气虚；整天都胀满急迫的，属于气血皆虚。肥胖白胖之人腹胀，是气虚兼有痰湿；瘦黑之人腹胀，是血虚兼有内热。
脉法云：腹胀而脉象浮大，说明病邪外出，可脱离危险；脉象虚小，则预示生命将尽，必须努力救治。
诀要曰：肿胀胀满若见弦脉，说明脾脏受制于肝脏；洪数脉为热胀；迟弱脉为阴寒；浮脉为虚满；紧脉为中焦实证；浮脉表示可治；虚脉表示危急。
第一种情况：鼓胀，又称单腹胀，这是脾气极度虚弱的表现，必须远离音乐娱乐，断绝浓腻厚味的食物，宜用大剂量的药物大补中气，方用四君子汤，加入苍术、陈皮、神曲、厚朴，大剂量服用。
第四种情况：瘦黑之人腹胀，属于血虚有热，宜用四物汤加黄连、厚朴之类。
第五种情况：脉象实、形体壮盛的人，可以使用攻下法，宜用十枣汤或三花丸，这两个方子都属于攻逐水肿类的方剂。
第六种情况：因愤怒伤肝，导致脾胃不和，宜用平肝饮子或调中顺气汤。
第七种情况：因食积导致腹胀，宜用平胃散加神曲、砂仁、槟榔、香附。
第八种情况：因肉食积滞导致腹胀，宜用平胃散加草果、砂仁、槟榔，或者阿魏丸。
There are external causes, internal emotional stagnation, Qi deficiency, and Blood deficiency.
Generally speaking, diseases of swelling and distension arise from Spleen-Stomach weakness, combined with internal injury by the Seven Emotions (seven types of emotional responses), external invasion by the Six Excesses (six pathogenic factors), irregular diet, and sexual indiscretion leading to deficiency. The Yin of the Spleen Earth is injured, causing the organ responsible for transportation and transformation to lose its function. Although the Stomach receives food, it cannot transform and transport; clear and turbid Qi interfere with each other, meridians and collaterals become obstructed, stagnation generates heat, prolonged heat produces dampness, and the mutual generation of damp-heat eventually results in swelling and distension. Although the exterior appears hard and full, the interior is hollow like a drum. As stated in the classics, this is called "Drum Distension" (Gu Zhang). Treatment should tonify the Spleen Qi, and also nourish Lung Metal to control Liver Wood, ensuring the Spleen is free from the threat of "thief pathogens" (Liver overacting on Spleen); nourish Kidney Water to control Heart Fire, allowing Lung Qi to receive instructions for clear descent; avoid salty flavors to prevent aiding the pathogenic factor; and cut off delusions to preserve the maternal Qi (Kidney Essence). Only then can the body be at peace. People often use purgative or diuretic drugs to seek temporary relief, but the distension recurs, damaging True Qi and bringing death closer. How tragic! If the disease is superficial and Spleen Qi is still strong, using unblocking methods might seem appropriate, yet one must not use purgative/diuretic drugs. At the time of treating the patient, careful observation is required.
Zhu Danxi said: Distension that is better in the morning and worse in the evening indicates Blood deficiency; distension that is worse in the morning and better in the evening indicates Qi deficiency; constant urgency and distension throughout the day indicate both Qi and Blood deficiency. Abdominal distension in fat, pale individuals indicates Qi deficiency with Phlegm; abdominal distension in thin, dark-skinned individuals indicates Blood deficiency with Heat.
The Pulse Method states: Abdominal distension with a floating and large pulse indicates the pathogen is exiting, and the patient will escape danger; a deficient and small pulse indicates impending death, requiring urgent effort in treatment.
The Essentials state: For swelling and distension, a Wiry (Xian) pulse indicates the Spleen is controlled by the Liver; a Surging and Rapid pulse indicates Heat distension; a Slow and Weak pulse indicates Yin-Cold; a Floating pulse indicates Empty distension; a Tight pulse indicates Excess in the Middle Jiao; a Floating pulse indicates treatability; a Deficient pulse indicates critical danger.
1. Drum Distension, also known as Single Abdominal Distension, is caused by extreme Spleen deficiency. One must stay away from music and entertainment, avoid rich and greasy foods, and strongly tonify Middle Qi using Si Jun Zi Tang (Four Gentlemen Decoction) added with Cang Zhu (Atractylodis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Shen Qu (Massa Medicata Fermentata), and Hou Po (Magnoliae Officinalis Cortex), taken in large doses.
2. Abdominal distension due to Blood deficiency should be treated with Si Wu Tang (Four Substances Decoction) modified.
3. Abdominal distension in obese individuals should be treated with Ping Wei San (Powder to Pacify the Stomach) combined with Wu Ling San (Five-Ingredient Powder with Poria) modified.
4. Abdominal distension in thin, dark-skinned individuals, indicating Blood deficiency with Heat, should be treated with Si Wu Tang (Four Substances Decoction) added with Huang Lian (Coptidis Rhizoma) and Hou Po (Magnoliae Officinalis Cortex).
5. Individuals with an Excess pulse and robust physique may undergo purgation. Shi Zao Tang (Ten Date Decoction) or San Hua Wan (Three Flowers Pill) may be used; both formulas belong to the category of draining water edema.
6. Disturbance of the Liver due to anger, leading to disharmony between the Spleen and Stomach, should be treated with Ping Gan Yin Zi (Decoction to Calm the Liver) or Tiao Zhong Shun Qi Tang (Decoction to Regulate the Middle and Smooth Qi).
7. Abdominal distension due to Food Stagnation should be treated with Ping Wei San (Powder to Pacify the Stomach) added with Shen Qu (Massa Medicata Fermentata), Sha Ren (Amomi Fructus), Bing Lang (Arecae Semen), and Xiang Fu (Cyperii Rhizoma).
8. Abdominal distension due to Meat Stagnation should be treated with Ping Wei San (Powder to Pacify the Stomach) added with Cao Guo (Tsaoko Fructus), Sha Ren (Amomi Fructus), Bing Lang (Arecae Semen), or A Wei Wan (Asafoetida Pill).
9. Abdominal distension due to Blood Stasis should be treated with Di Dang Tang (Decoction to Pierce the Accumulation) or Can Xiong Tang (Decoction of Ginseng and Ligusticum) added with Hong Hua (Carthami Flos) and Tao Ren (Persicae Semen).
10. Abdominal distension caused by the Seven Emotions injuring the body, resulting in Turbid Qi remaining in the upper part, should be treated with Mu Xiang Shun Qi Tang (Decoction of Aucklandia to Smooth Qi).