肿起，渐致腹大脐突，小便短涩，大便燥闭，喘嗽吐痰不得卧。此因阴虚三焦火旺，合冲脉之火，同逆而上，
水从火溢，积于肺而为嗽，散于阴络而为肿，随五脏之虚，入而聚之而为胀。仍以前法加车前、牛膝，两服全
瘳。○王祺永患单腹胀，初服破气药，肿与脐平，改服《金匮》肾气汤，痰嗽不休。予谓肾气汤用车前、牛膝，
迅速降下，何以气反上逆而作痰嗽？视其面淡黄中微有红纹，此虫结于血中，非下不可。祺永犹豫，予谓体虽
虚怯，贼在腹中，岂可妄补！以逐秽汤与服，腹内雷鸣，少顷下恶物满桶，更进一剂，虫血尽倾。徐以补中益
气汤加减调之，半月始痊。○孙岱庵下部蓄血，腹肿如箕，医用金匮肾气，饮食不进，眩晕谵言，六脉全伏。予
下以桃仁承气汤，立安。（程华仲）
徐姓小儿单胀数月，百治无功，予谓气分不效，宜治血分，所谓络瘀则胀也。用归须、桃仁、延胡索、穿
山甲、蜣螂、 虫、五灵脂、山楂为丸，服之而愈。（叶天士）
吴生讳震者诘予曰∶鼓有虫乎？予曰∶有之。《本事方》云∶脐腹四肢悉肿者为水。但只腹胀，四肢不甚
肿者为蛊。注谓蛊即鼓也，古以蛊鼓同名。且蛊，以三虫为首，岂无旨哉。生曰，子何敏也？予嫂病鼓三年，
腹大如箕，胀痛肢瘦，屡医不瘳。吴俗死用火葬，火烧至腹，声响如炮，虫从腹中爆出，不下千万，大者尺余，
腹中复生小虫。虫在人腹，蕃息若此，曷不令人胀死，惜乎诸书未有言及者，予闻之恍然，然犹未亲见其异。
后有王乡宦子，其腹胀大，有块如瓜，肢瘦发热，已半年矣。医以退热消胀之剂，投之胀甚热炽，喉耳俱生疮。
诊其脉则滑数，望其唇则红，按其腹则痛，又嗜肥甘。予思凡腹痛者，唇色必淡，当不嗜食，今若此，得非虫
乎？投阿魏消积丸，下虫数十，大者二，一红一黑，各长尺余，虫下热减胀消，益信前闻不虚。（孙一奎）
附方
壮原汤 治下焦虚寒，中满腹胀。人参 白术 茯苓 肉桂 附子 干姜 砂仁 陈皮 破故纸。
鼓胀奇方 用黄牛粪阴干炒末，每服一两，酒煎滤渣，三服即愈。
又方 用雄猪肚一个洗净，装入大蒜头四两，放沙锅内，河水煮熟，不放盐，空心服之甚效。
水鼓方 用活鳢鱼一尾去鳞肠，再用黑矾五分，松萝茶三钱，蒜八瓣，共入鱼腹，瓷器中蒸熟，令病患吃
鱼，连茶蒜吃更妙。从头吃起，病从头消，从尾吃起，病从脚消。
气鼓方 用大虾蟆一只剖肚，填入砂仁，泥裹火 ，去泥研末，陈皮汤调服，放屁即愈。
治鼓胀神效方 用晒干猪尿胞一个，高粱烧酒六两，生大黄三钱，胆矾三钱，共研为末，同装胞内，用
线札口。绵带系悬项下，帖于当脐，将布缚住，五昼夜一换，轻者三个，重者六个，鼓消而愈。
腹部肿胀，逐渐导致腹部增大、肚脐突出，小便短少涩滞，大便干燥闭塞，气喘咳嗽、吐痰且无法平卧。这是因为阴虚导致三焦火旺，加上冲脉之火一同逆乱向上，水液随火势溢出，积聚在肺脏而引发咳嗽，散布于阴络而引发肿胀，随着五脏的虚弱，病邪进入并聚集而形成胀满。仍然使用之前的方法，加入车前子、牛膝，服用两剂后完全痊愈。
○王祺永患有单腹胀（仅腹部肿胀），起初服用破气药，肿胀消退至与肚脐齐平，改为服用《金匮要略》中的肾气汤后，痰嗽不止。我对他说，肾气汤中用车前子、牛膝，能迅速降泄下行，为什么气反而上逆产生痰嗽？观察他的面色淡黄中微有红纹，这是虫结聚在血中，非用攻下法不可。王祺永犹豫不决，我对他说，身体虽然虚弱怯弱，但贼邪在腹中，怎么可以妄加补益！于是给予逐秽汤服用，腹内雷鸣，不久排出充满一桶的恶臭污物，再进一剂，虫血排尽。随后慢慢用补中益气汤加减调理，半个月才痊愈。
○孙岱庵下部蓄血，腹部肿胀如箕状，医生使用金匮肾气汤，导致饮食不进，眩晕胡言乱语，六脉全部伏匿。我使用桃仁承气汤攻下，立刻安定。（程华仲记载）
徐姓小儿患单腹胀数月，各种治疗无效，我认为气分治疗不效，应当治血分，所谓络脉瘀阻则胀。使用当归须、桃仁、延胡索、穿山甲、蜣螂、䗪虫、五灵脂、山楂制成丸药，服用后痊愈。（叶天士记载）
吴生名震的人问我：“鼓胀中有虫吗？”我说：“有的。”《本事方》说：脐腹四肢都肿的是水气病。只有腹部胀大，四肢不太肿的是蛊胀。注解认为蛊就是鼓，古代蛊和鼓同名。而且蛊，以三种虫为首，难道没有深意吗？吴生说，您怎么这么敏锐？我的嫂子患鼓胀三年，腹部大如箕，胀痛肢体消瘦，多次医治未愈。吴地风俗死后用火葬，火烧到腹部，声响如炮，虫子从腹中爆出，不下千万条，大的有一尺多长，腹中又生出小虫。虫子在人腹中，繁殖如此厉害，为什么不让人胀死，可惜各书都没有提及此事，我听了恍然大悟，然而还没有亲眼见过这种奇异现象。后来有王乡宦的儿子，他腹部胀大，有肿块如瓜，肢体消瘦发热，已经半年了。医生用退热消胀的药剂，投服后胀更甚、热更炽，喉耳都生疮。诊其脉滑数，望其唇色红，按腹部则痛，又嗜好肥甘厚味。我想凡是腹痛的人，唇色必淡，应当不爱吃东西，现在像这样，莫非是虫吗？投用阿魏消积丸，排出虫子几十条，大的两条，一红一黑，各长一尺多，虫下后热减胀消，更加相信之前的听闻不虚。（孙一奎记载）
附方
壮原汤：治疗下焦虚寒，中满腹胀。人参、白术、茯苓、肉桂、附子、干姜、砂仁、陈皮、破故纸。
鼓胀奇方：用黄牛粪阴干炒末，每次服用一两，酒煎滤去渣滓，服用三次即愈。
又一方：用雄猪肚一个洗净，装入大蒜头四两，放在沙锅内，用河水煮熟，不放盐，空腹服用非常有效。
水鼓方：用活鳢鱼一条去鳞肠，再用黑矾五分，松萝茶三钱，蒜八瓣，共同放入鱼腹中，在瓷器中蒸熟，让病人吃鱼，连同茶蒜一起吃更妙。从头开始吃，病从头消；从尾开始吃，病从脚消。
气鼓方：用大虾蟆一只剖开肚子，填入砂仁，用泥包裹火烤，去掉泥研成末，用陈皮汤调服，放屁即愈。
治鼓胀神效方：用晒干猪尿胞一个，高粱烧酒六两，生大黄三钱，胆矾三钱，共同研为末，一起装入尿胞内，用线扎口。用绵带系挂于项下，贴于肚脐处，用布缚住，五昼夜更换一次，轻者三个，重者六个，鼓消而愈。
Abdominal swelling arises, gradually leading to an enlarged abdomen and protruding umbilicus, scanty and obstructed urination, dry and constipated stool, wheezing, coughing, expectoration of phlegm, and inability to lie flat. This is due to Yin deficiency with hyperactive fire in the Sanjiao (Triple Burner), combined with the rebellious fire of the Chong Mai (Penetrating Vessel) rising upward together. Water overflows following the fire, accumulating in the Lungs causing cough, dispersing into the Yin Collaterals causing swelling, and entering and gathering according to the deficiency of the Five Zang Organs, resulting in distension. The previous method was still used, adding Qianqianzi (Plantago Seed) and Niuxi (Achyranthes Root), and after two doses, complete recovery occurred.
○ Wang Qiyong suffered from Dan Zhang (Simple Abdominal Distension). Initially, he took Qi-Breaking Medicines, and the swelling receded to the level of the umbilicus. He then switched to Shenqi Tang (Kidney Qi Decoction) from *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), but experienced incessant phlegm and cough. I remarked that Shenqi Tang contains Qianqianzi and Niuxi, which rapidly descend; why did the Qi rebel upward causing phlegm and cough? Observing his face, it was pale yellow with slight red streaks, indicating parasites clustered in the Blood. Purging was necessary. Wang hesitated. I said, although the constitution is weak and timid, the 'thief' is in the abdomen; how can one recklessly tonify! I administered Zhuhui Tang (Feces-Expelling Decoction). Thunder rumbled within the abdomen, and shortly after, a bucket full of foul matter was discharged. Another dose was given, expelling all parasite blood. Subsequently, Buzhong Yiqi Tang (Middle-Boosting Qi-Invigorating Decoction) was modified and administered for regulation, and recovery was achieved in half a month.
○ Sun Daian had Blood Stasis accumulated in the Lower Jiao, with abdominal swelling like a winnowing basket. Physicians used Jin Gui Shenqi Tang, leading to loss of appetite, dizziness, and delirious speech, with all six pulses completely hidden. I administered Taoren Chengqi Tang (Peach Kernel and Rheum Decoction) to purge, and immediate relief ensued. (Recorded by Cheng Huazhong)
A child surnamed Xu suffered from simple abdominal distension for several months with no effect from various treatments. I stated that treating the Qi aspect was ineffective; one should treat the Blood aspect, as "collateral stasis causes distension." Guixu (Dangling Angelica Rootlet), Taoren (Peach Kernel), Yanhusuo (Corydalis Rhizome), Chuanshanjia (Pangolin Scales), Changlang (Dung Beetle), Ezhong (Ground Beetle), Wulingzhi (Trogopterus Feces), and Shanzha (Hawthorn Fruit) were made into pills, and the patient recovered after taking them. (Recorded by Ye Tianshi)
Wu Zhen asked me: "Are there parasites in Drum Distension?" I replied: "Yes." *Ben Shi Fang* states: Swelling of the navel, abdomen, and all four limbs is Water Disease. Only abdominal distension with minimal limb swelling is Gu Distension. Annotations state that Gu is synonymous with Gu (Drum), and anciently they shared the same name. Moreover, Gu prioritizes three types of parasites; does this not hold significance? Wu said, "How perceptive you are!" My sister-in-law suffered from Drum Distension for three years, with an abdomen large as a basket, painful distension, emaciated limbs, and failed multiple treatments. In Wu customs, the dead are cremated. When fire reached her abdomen, the sound was like cannon fire, and countless parasites burst out, some over a chi long, with smaller ones subsequently born in the abdomen. Parasites multiplying thus in the human abdomen—why do they not cause death by distension? It is regrettable that no books mention this. I was enlightened upon hearing this, yet had not seen it myself. Later, the son of a local official had abdominal distension with a mass like a melon, emaciated limbs, and fever for half a year. Physicians used heat-clearing and distension-reducing formulas, which worsened the distension and intensified the fever, causing sores in the throat and ears. His pulse was slippery and rapid, lips red, abdomen tender on pressure, and he craved rich and sweet foods. I reasoned that those with abdominal pain usually have pale lips and lack appetite; since this case differed, could it be parasites? I administered Awei Xiaoji Wan (Asafoetida Accumulation-Resolving Pill), discharging dozens of parasites, two of which were large, one red and one black, each over a chi long. After the parasites passed, fever subsided and distension resolved, confirming the previous account was not false. (Recorded by Sun Yikui)
Attached Formulas
Zhuang Yuan Tang (Strengthen the Origin Decoction): Treats Deficient-Cold of the Lower Jiao with middle-fullness and abdominal distension. Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Rougui (Cinnamon Bark), Fuzi (Prepared Aconite Root), Ganjiang (Dried Ginger), Sharen (Amomum Fruit), Chenpi (Tangerine Peel), Pogu Zhi (Cibotium Rhizome).
Gu Zhang Qi Fang (Miraculous Formula for Drum Distension): Use dried cow dung, roasted and powdered. Take 1 liang per dose, decoct in wine, filter dregs. Three doses result in cure.
Another Formula: Take one male pig bladder, clean it, insert 4 liang of garlic cloves, place in a clay pot, cook thoroughly in river water without salt. Consume on an empty stomach; very effective.
Shui Gu Fang (Water Drum Formula): Take one live snakehead fish (*Channa argus*), remove scales and intestines. Add 5 fen of Luopan (Black Alum), 3 qian of Songluo Cha (Usnea Tea), and 8 cloves of garlic. Place inside the fish belly, steam in a porcelain vessel until cooked. Have the patient eat the fish; eating with tea and garlic is better. Eating from the head reduces disease from the top; eating from the tail reduces disease from the feet.
Qi Gu Fang (Air Drum Formula): Take one large toad, cut open the belly, fill with Sharen (Amomum Fruit), wrap in mud, roast over fire, remove mud and powder. Mix with Chenpi (Tangerine Peel) decoction and take. Cure occurs upon passing flatus.
Zhi Gu Zhang Shenxiao Fang (Divinely Effective Formula for Treating Drum Distension): Take one dried pig urinary bladder, 6 liang of Sorghum Spirit, 3 qian of raw Dahuang (Rhubarb Root), and 3 qian of Danfan (Alum). Grind into powder, place together inside the bladder, tie the mouth with thread. Hang around the neck with a cotton strap, apply to the umbilicus, and bind with cloth. Change every five days and nights. Mild cases require three bladders, severe cases six. Distension resolves and cure is achieved.