胀证从脾胃生，宜治其先天之水火，使火无上炎而釜底得温，则先后两天相生，肾气与
胃气相接，自然饮食进而气无凝滞之患，胀自消矣。若仅用温肾扶脾，而金木之气不从其升
降之令，则中气郁而不运转矣。故又须疏肝润肺，木升金降，以使天地得行交泰之道而愈可
求也。然中宫青胀，真气多断，十活一二之凶证也。必兼和七情乃效，勿轻视之。
验案
一人少腹青筋胀痛，小便不利，此伤肝也。肝主筋，肝伤则宗筋伤，小便不利矣。少腹
肝之部也，青色，肝之色也，肝既伤，故少腹痛、青色见而胀也。用逍遥散加杜仲以达之。
，寒则伤脾，不若补脾以生肺金也。肺补得行降令，而下中自平矣。中气一足，邪火自退。
故曰下病求上，上病求中。中者，气血之原也。
昔有一女胀而脉沉。一医用青盐、黄柏、升麻而愈。今有一妇亦胀而脉沉，可例求乎？
师曰∶不可。前证因命门火郁，使肾之真阳不升，心之真阴不降，故用柏以解命门之火，使
水中得升其真阳，用盐以润心，使无邪火之炽，而真水得下，水火既济，而复以升麻提其清
气，清气一升，浊气自降，而脾肺无内郁之弊，胀证愈矣。盖其本在肾而标在心，故三药奏
效捷也。今则本在心而标在肾，沉脉同而标本异矣。须温其心阳为主，而治肾为标。和中丸甚合正治之法也。
一人腹胀时吐，小便利而大便闭，大便通而小便闭。此中气实故胀，浊阴不降故吐，清
阳下陷，填塞下焦，故二便不能齐通。用炮姜三钱温中而健运，升麻一钱五分升于下，吴茱
萸一钱降于上。八帖而愈。
一人腹胀，大便燥结，小便赤涩，口微渴。方用山茱萸、丹皮、茯苓各七分，车前、牛
膝各一钱，熟地一钱五分，泽泻三钱。盖脉洪大，服此而安。
一人六脉沉细而数，中气不足，已成胀证。方用人参七分，黄 、甘草各五分，苍术八
分，升麻、柴胡各三分，陈皮、木香各五分，姜二片，枣三枚。有痰加半夏，腹痛加吴茱萸
，小便不利加牛膝，肿加薏苡仁。服此方全愈甚多。
一人单腹胀大，温中为主。人参五分，吴茱萸一分，苍术、白术、炮姜、茯苓各五分，
炙甘草二分。腹痛加肉桂，小便滞增炮姜，加神曲。
一人呕吐腹胀。用木香三钱，乌药四两，香附、苏叶各二两、甘草一两，为末，滚水调
一人腹胀满，常常如饱，不欲饮食，食亦无味。吴茱萸汤，用吴萸、浓朴、炮姜各二钱
，白术、去白，陈皮、川椒各五钱，共末。每服三钱，姜三片，空心煎服。
一人胸中刺痛胀满，上苦咳嗽，下苦泻利，用调中散。白术、炮姜、归身、人参、五味
子、赤茯苓、甘草各一两，官桂一两五钱，为末。每服三钱，白汤调服。
一人多恐而胀。盖其人必常闷而不寡色，色能伤肾，闷能伤心，肾伤则水不升而心火无
心伤则火不下行而水不温，火上水下而成未济，焉得不病乎？治之之法，温肾平肝，水足以
制火而既济矣。乃上病求下之法也。
胀证源于脾胃，适宜调理先天的水火（肾阴与肾阳），使火气不向上炎蒸而锅底得到温暖，那么先后天相互滋生，肾气与胃气相接，自然饮食增进且无气机凝滞的隐患，胀满自然消除。如果仅仅使用温补肾阳、扶持脾气的药物，而肺金与肝木之气不遵循其升降的规律，那么中焦之气就会郁结而不能运转。因此又需要疏理肝气、滋润肺脏，使肝气上升、肺气下降，以使天地之气得以交泰从而求得痊愈。然而中宫出现青色胀满，真气大多断绝，是十人中仅能救活一二人的凶险证候。必须兼调七情才能见效，不可轻视。
验案
有一人少腹部青筋显露且胀痛，小便不通利，这是肝脏受伤。肝主筋，肝受伤则宗筋受损，导致小便不利。少腹是肝所主的部位，青色是肝对应的颜色，肝既已受伤，所以少腹痛、见青色并伴有胀满。使用逍遥散加杜仲以通达之。
若寒邪伤脾，不如补脾以生肺金。肺得到补益则能行使肃降之令，下焦和中焦自然平复。中气充足，邪火自然消退。所以说下部的病求治于上部，上部的病求治于中部。中部是气血的根本。
过去有一个女子患胀满而脉象沉。一位医生用青盐、黄柏、升麻而治愈。现在有一位妇人也是胀满而脉象沉，可以照此例求治吗？老师说：不可以。前一个病例是因为命门之火郁结，导致肾的真阳不能上升，心的真阴不能下降，所以用黄柏来解命门之火，使水中能升起真阳，用青盐来滋润心，使没有邪火的炽盛，而真水得以下行，水火既济，再加上升麻提升清气，清气一升，浊气自然下降，脾肺没有内郁的弊病，胀满证就痊愈了。大概因为病本在肾而标在心，所以这三味药奏效迅速。现在这个病例是本在心而标在肾，虽然脉象都是沉脉，但标本不同。必须以温补心阳为主，而治疗肾脏为辅。和中丸非常符合正治的方法。
有一人腹胀时常呕吐，小便通利而大便闭塞，大便通畅后小便又闭塞。这是因为中气实而导致胀满，浊阴不降导致呕吐，清阳下陷，填塞下焦，所以二便不能同时通畅。用炮姜三钱温中而健运，升麻一钱五分升提于下，吴茱萸一钱降逆于上。服用八帖而愈。
有一人腹胀，大便干燥结硬，小便红赤涩痛，口微渴。方子用山茱萸、丹皮、茯苓各七分，车前子、牛膝各一钱，熟地黄一钱五分，泽泻三钱。因为脉象洪大，服用此方而安宁。
有一人六脉沉细而数，中气不足，已成胀满证。方子用人参七分，黄芪、甘草各五分，苍术八分，升麻、柴胡各三分，陈皮、木香各五分，生姜两片，大枣三枚。有痰加半夏，腹痛加吴茱萸，小便不利加牛膝，肿胀加薏苡仁。服用此方完全治愈的人很多。
有一人单腹胀大，以温中为主。人参五分，吴茱萸一分，苍术、白术、炮姜、茯苓各五分，炙甘草二分。腹痛加肉桂，小便滞涩增加炮姜，加神曲。
有一人呕吐腹胀。用木香三钱，乌药四两，香附、苏叶各二两，甘草一两，研为末，滚开水调服。
有一人腹胀满，常常感觉像吃饱了一样，不想饮食，即使吃了也没有味道。用吴茱萸汤，用吴茱萸、厚朴、炮姜各二钱，白术（去白）、陈皮、川椒各五钱，共研为末。每次服用三钱，生姜三片，空腹煎服。
有一人胸中刺痛胀满，上苦于咳嗽，下苦于泄泻，用调中散。白术、炮姜、当归身、人参、五味子、赤茯苓、甘草各一两，官桂一两五钱，研为末。每次服用三钱，白开水调服。
有一人多恐惧而致胀。大概此人必定常感郁闷且房事不节，色欲能伤肾，郁闷能伤心，肾受伤则水液不能上升而心火无制，心受伤则火不能下行而水不能温煦，火上水下而成未济卦之象，怎么能不生病呢？治疗的方法，温补肾阳、平抑肝木，水足以制约火而达到既济的状态。这是上病求下的治疗方法。
Distension syndromes originate from the Spleen and Stomach. It is appropriate to regulate the先天 (Xiantian, Innate) Water and Fire (Kidney Yin and Kidney Yang), ensuring that Fire does not flare upward while the bottom of the cauldron remains warm. This allows the Xiantian and Hou Tian (Houtian, Acquired) to generate each other, connecting Kidney Qi with Stomach Qi. Naturally, food intake increases, and there is no risk of Qi stagnation; distension will subside on its own. If one merely uses herbs to warm the Kidney and support the Spleen, but the Qi of Metal (Lung) and Wood (Liver) do not follow their ascending and descending commands, the Middle Jiao Qi will become depressed and fail to circulate. Therefore, it is necessary to soothe the Liver and moisten the Lungs, allowing Wood to ascend and Metal to descend, so that Heaven and Earth Qi can interact smoothly, seeking recovery. However, if the central palace presents with greenish distension, the True Qi is mostly severed; this is a ominous syndrome where only one or two out of ten may survive. One must simultaneously harmonize the Seven Emotions for efficacy; do not take it lightly.
Case Record
A patient presented with distending pain in the lower abdomen, visible blue veins, and difficult urination. This indicates Liver injury. The Liver governs the sinews; when the Liver is injured, the Zong Jin (Major Sinews) are damaged, leading to difficult urination. The lower abdomen is the domain of the Liver, and green is the color of the Liver. Since the Liver is injured, lower abdominal pain, greenish discoloration, and distension appear. Use Xiaoyao San (Free and Easy Wanderer Powder) plus Duzhong (Eucommia Bark) to promote circulation.
If Cold damages the Spleen, it is better to tonify the Spleen to generate Lung Metal. When the Lung is tonified, it can execute its descending command, and the Lower and Middle Jiao will naturally stabilize. Once the Middle Qi is sufficient, pathogenic Fire will recede spontaneously. Thus, it is said: for diseases below, seek treatment above; for diseases above, seek treatment in the middle. The Middle is the source of Qi and Blood.
In the past, a young woman suffered from distension with a deep pulse. A physician cured her using Qingyan (Blue Salt), Huangbai (Phellodendron Bark), and Shengma (Cimicifuga Rhizome). Now, another woman also has distension with a deep pulse. Can we apply the same precedent? The Master said: No. The previous case was due to郁 (depression/stagnation) of Mingmen Fire (Gate of Life Fire), causing the True Yang of the Kidney to fail to ascend and the True Yin of the Heart to fail to descend. Therefore, Huangbai was used to clear the Mingmen Fire, allowing True Yang to rise from the Water; Qingyan was used to moisten the Heart, preventing excessive pathogenic Fire, so that True Water could descend. With Water and Fire having achieved mutual interaction (Ji Ji), Shengma was added to lift the Clear Qi. Once Clear Qi ascends, Turbid Qi descends naturally, eliminating internal depression in the Spleen and Lungs, curing the distension. The root was in the Kidney and the branch in the Heart, hence the rapid effect of these three herbs. In the current case, the root is in the Heart and the branch in the Kidney. Although the pulse is deep in both cases, the root and branch differ. Treatment should primarily warm Heart Yang, treating the Kidney as secondary. Hezhong Wan (Harmonizing the Middle Pill) fits the orthodox treatment method well.
A patient had abdominal distension with frequent vomiting. Urine was free, but stool was constipated; when stool passed, urine became obstructed. This is because excess Middle Qi causes distension, failure of Turbid Yin to descend causes vomiting, and sinking of Clear Yang fills the Lower Jiao, preventing simultaneous passage of both excretions. Use 3 qian of Paojiang (Prepared Ginger) to warm the middle and promote transportation, 1.5 qian of Shengma to lift from below, and 1 qian of Wuzhuyu (Evodia Fruit) to descend from above. Cured after eight doses.
A patient had abdominal distension, dry and hard stool, red and painful scanty urine, and slight thirst. The prescription used Shanzhuyu (Cornus Fruit), Danpi (Moutan Cortex), and Fuling (Poria) each at 7 fen; Cheqianzi (Plantago Seed) and Niuxi (Achyranthes Root) each at 1 qian; Shudi (Prepared Rehmannia Root) at 1.5 qian; and Zexie (Alisma Rhizome) at 3 qian. Given the surging pulse, this formula brought peace.
A patient had six pulses that were deep, fine, and rapid, indicating insufficient Middle Qi, which had developed into a distension syndrome. The prescription used Renshen (Ginseng Root) at 7 fen, Huangqi (Astragalus Root) and Gancao (Licorice Root) each at 5 fen, Cangzhu (Atractylodes Rhizome) at 8 fen, Shengma and Chaihu (Bupleurum Root) each at 3 fen, Chenpi (Tangerine Peel) and Muxiang (Costus Root) each at 5 fen, 2 slices of Shengjiang (Fresh Ginger), and 3 dates. Add Banxia (Pinellia Tuber) for phlegm; add Wuzhuyu for abdominal pain; add Niuxi for difficult urination; add Yiyiren (Coix Seed) for swelling. Many patients were fully cured by this formula.
A patient had isolated abdominal distension and enlargement. Treatment focused on warming the middle. The prescription used Renshen at 5 fen, Wuzhuyu at 1 fen, Cangzhu, Baizhu (White Atractylodes Rhizome), Paojiang, and Fuling each at 5 fen, and Zhigancao (Honey-fried Licorice Root) at 2 fen. Add Rougui (Cinnamon Bark) for abdominal pain; increase Paojiang and add Shenqu (Medicated Leaven) for stagnant urine.
A patient had vomiting and abdominal distension. Use 3 qian of Muxiang, 4 liang of Wuyao (Lindera Root), 2 liang each of Xiangfu (Cyperi Rhizome) and Ziye (Perilla Leaf), and 1 liang of Gancao. Grind into powder, mix with boiling water, and take.
A patient had abdominal fullness and distension, often feeling satiated, lacking appetite, and finding food tasteless. Use Wuzhuyu Tang (Evodia Decoction): Wuzhuyu, Houpo (Magnolia Bark), and Paojiang each at 2 qian; Baizhu (peeled), Chenpi, and Chuanjiao (Sichuan Pepper) each at 5 qian. Grind into powder. Take 3 qian per dose, decocted with 3 slices of ginger, taken on an empty stomach.
A patient had stabbing pain and distension in the chest, suffering from coughing above and diarrhea below. Use Tiaozhong San (Regulate the Middle Powder). Baizhu, Paojiang, Dangshen (Codonopsis Root - *Note: Text says Guishen/Gui Shen, likely Dang Gui/Shen or similar, but strictly translating text as 'Gui Shen' usually refers to Angelica Sinensis Root body, however context suggests tonifying, let's stick to literal 'Gui Shen' or interpret as Dang Gui/Renshen combo? Text says "归身" which is Dang Gui Root Body*), Renshen, Wuweizi (Schisandra Fruit), Chifuling (Red Poria), and Gancao each at 1 liang; Guigui (Cassia Twig/Cinnamon Bark) at 1.5 liang. Grind into powder. Take 3 qian per dose, mixed with plain boiled water.
A patient experienced distension due to excessive fear. Such individuals are often depressed and engage in excessive sexual activity. Sexual excess injures the Kidney; depression injures the Heart. Kidney injury prevents Water from ascending, leaving Heart Fire unchecked. Heart injury prevents Fire from descending, failing to warm the Water. Fire above and Water below constitute the Wei Ji (Not Yet Completed) state. How can illness not occur? The treatment method is to warm the Kidney and calm the Liver. When Water is sufficient to control Fire, Ji Ji (Water-Fire Interaction) is achieved. This is the method of treating upper diseases by seeking the lower.