圣符病单腹胀。腹大如箕。紧硬如石。胃中时生酸水。吞吐皆然。经年罔效。盖由医辈用孟浪成法。
不察病之所起。与病成而变之理。增其势耳。昨见云间老医煎方。庞杂全无取义。惟肾
气丸一方。犹是前人已试之法。但此病用之。譬适燕而南其指也。夫肾气丸为肿胀之圣药者。以能收摄肾气。
使水不泛溢耳。今小水一昼夜六七行。沟渠顺导。水无泛滥之虞也。且谓益火之源。以消阴翳耳。今酸味皆
从火化。尚可更益其火乎。又有指腹胀为食积。用局方峻攻。尤属可骇。仆不得不疏明其旨。夫圣
符之疾。起于脾气不宣。郁而成火。使当时用火郁发之之法。升阳散火。病已豁然解矣。惟其愈郁愈湮。渐至
胀满。则身中之气。一如天地不交而成痞塞。病成而变矣。证似无火。全以火为之根。不究其根。但治其胀。
如槟榔浓朴莱菔子之类。皆能耗气助火。于是病转入胃。日渐一日。煎熬津液。变成酸汁。胃口有
如醋瓮。胃中之热。有如曲 。俟谷饮一入。顷刻酿成酢味矣。有时新谷方咽。旧谷即为迸出。若互换者。缘新
谷芳甘未变。胃爱而受之。其酸腐之余。自不能留也。夫人身天真之气。全在胃口。今暗从火化。津液升腾屑
越。已非细故。况土曰稼穑。作甘者也。木曰曲直。作酸者也。甘反作酸。木来侮土。至春月木旺
时。必为难治。及今可治。又治其胀。不治其酸。曾不思酸水入腹。胀必愈增。不塞源而遏流。其势有止极耶。
试言其概。治火无过虚补实泻两法。内郁虽宜从补。然甘温除热泻火之法。施
于作酸日。其酸转增。用必无功。故驱其酸而反其甘。惟有用刚药一法。刚药者。气味俱雄之药。能变胃而
不受胃变者也。参伍以协其平。但可用刚中之柔。不可用柔中之刚。如六味丸加桂附。柔中之刚也。于六
味作酸药中。入二味止酸药。当乎不当乎。刚中之柔。如连理汤是也。刚非过刚。更有柔以济其刚。可
收去酸之绩矣。酸去而后治胀。破竹之势已成。迎刃可解。锢疾顿蠲。脾君复辟。保合太和。常有天命矣。谓
用药者后先铢两间。可无审乎。
善后多年。闻用黄柏知母之属。始得全效。更奇。
刚柔诸药。为丸服之。胸中如天地交而成泰。爽不可言。胀病遂不劳余力而愈。
附论善后之法 门人请曰。吾师治病。每每议先于药。究竟桴鼓相应。纤毫不爽。今果酸止胀消。脐收腹
小。奏全绩矣。不识意外尚有何患。恳同善后之法。究极言之。余答曰。悉乎哉问也。内经病机。刘河间阐
发颇该。至于微茫要渺。不能言下尽传。吾为子益广其义。夫病有逆传顺传种种不同。所谓病成之
机则然。至于病去之机。从来无人道及。前论圣符之病。乃自脾入传于胃。今酸去胀消。亦自胃返于脾。故
善后之法。以理脾为急。而胃则次之。其机可得言也。设胃气未和。必不能驱疾。惟胃和方酸减谷增。渐
复平人容蓄之常。然胃喜容蓄。脾未喜健运。倦怠多睡。惟乐按摩者有之。受食一盏。身若加重。受食三
盏。身重若加一钧者有之。步履虽如常候。然登高涉险。则觉下轻上重。举足无力。身重肢疲。头昏气急者有
之。脾阳弗旺。食后喜溉沸汤。借资于有形之热者有之。其病之余。有夏热为瘅。秋凉为疟。燥胜脾约。湿
胜脾泄者有之。故理脾则百病不生。不理脾则诸疾续起。久之乃入于胃也。至若将息失宜。饮食房劳
所犯。脾先受之。犹可言也。设忿怒之火一动。则挟木邪直侵胃土。原病陡发。不可言也。语以一
朝之忿。亡身及亲为惑。垂戒
深矣。又其始焉酸胀。胃中必另创一膜。囊如赘庞者。乃肝火冲入。透开胃膜。故所聚之水。暗从木化变
酸。久久渐满。膜囊垂大。其腹之胀。以此为根。观其新谷入口。酸物迸出。而芳谷不
出。及每食饴糖。如汲筒入喉。酸水随即涌出。皆可征也。若非另一窠臼。则其呕时宜新腐俱出。如膈气
之类。何得分别甚清耶。昨游玉峰。渠家请授他医调摄之旨。及语以另辟膜囊。其医
不觉失笑曰。若是。则先生真见隔垣矣。吁嗟。下士闻道。固若此乎。订方用六君子汤。煎调赤石脂末。
其医不解。岂知吾意中因其膜囊既空。而以是填之。俾不为异日患乎。吾昔治广陵一血蛊。服药百日后。
大腹全消。左胁肋始露病根一长条。如小枕状。以法激之。呕出黑污斗许。余从大便泄去。始消。每思蛊胀。
不论气血水痰。总必自辟一宇。如寇贼蟠据。必根据山傍险。方可久聚。内经论五脏之积。皆有定所。何独于六
腑之聚久为患如鼓胀等类者。遂谓漫无根柢区界乎。是亦可补病机之未逮。
附窠囊证据 许叔微本事方曰。微患饮 三十年。始因少年夜坐写文。左向伏几。是以饮食多坠左边。
中夜必饮酒数杯。又向左卧。壮时不觉。三五年后。觉酒止从左下有声。胁痛食减
嘈杂。饮酒半盏即止。十数日必呕酸水数升。暑月止右边有汗。左边绝无。遍访名医及海上方。间或中病。
止得月余复作。其补如天雄附子矾石。利如牵牛大戟甘遂。备尝之矣。自揣必有
囊。如水之有科臼。不盈科不行。但清者自行。而浊者停滞。无路以决之。故积至五七日。必呕而去。脾土恶
湿。而水则流湿。莫若燥脾以去湿。崇土以填科臼。乃制苍术丸。服三月而疾除。
繇此观之。痰饮小患。尚有科臼。岂胀满大病。反无科臼乎。但许公酸水积至数升。必尽呕去。故不下渗
于腹。若圣符则积之经年。腹中已容数斗。喉间连谷上涌者。不过数口而已。向非吾
先治胃中酸水。腹内再可加一年之积乎。然腹中之事。言之反
涉于诞。其不以为功也宜矣。昔贤自病三十年始悟。今之医辈。
视人犹己者有几。况己病亦不如所繇耶。其更数医而不能为善后计者。总之未透此关耳。
胡卣臣先生曰。认病机处。溯流穷源。若河汉莫可纪极。然实凿凿有
据。不涉影响。觉十年读书。三次折肱者。未必具此手眼。
圣符患有单腹胀病。腹部大如簸箕，坚硬如石头。胃中时常产生酸水，无论是吞咽还是呕吐都伴有酸味。多年治疗无效。这大概是由于医生们使用鲁莽的成法，不考察疾病的起因以及疾病形成后的变化规律，反而助长了病情。昨天看到云间一位老医生的处方，庞杂混乱毫无章法。只有肾气丸一方，还是前人已经尝试过的办法。但是用这个方子治此病，就像要去北方燕地却向南走一样错误。肾气丸是治疗肿胀的神药，因为它能收敛摄纳肾气，使水液不再泛滥。现在患者小便一昼夜六七次，水道通畅，没有水液泛滥的担忧了。而且该方的作用是“益火之源，以消阴翳”。现在酸味都是由火化生而来，怎么还能再补火呢？又有指腹胀为食积，使用局方中的峻猛攻下药，更是令人惊骇。我不得不阐明其中的旨意。
圣符的疾病，起于脾气不宣通，郁结而成火。如果当时采用“火郁发之”的方法，升阳散火，病就已经豁然解除了。正因为越郁结越闭塞，逐渐导致胀满，那么身体里的气机，就像天地不交泰而形成的痞塞一样，疾病形成并发生了变异。证候看似没有火，实际上全以火为根本。如果不探究其根本，只治疗胀满，像槟榔、厚朴、莱菔子这类药物，都会耗气助火。于是病邪转入胃中，日复一日，煎熬津液，变成酸汁。胃口如同醋坛，胃中的热势如同酒曲发酵。等到谷物饮食一进入，顷刻间就酿造成酸味了。有时新谷刚咽下，旧谷就被迸出，好像互换了一样。这是因为新谷的芳甘味道尚未改变，胃喜欢并接受它；而那些酸腐的残余物，自然不能留存。人体的天真之气，全在于胃口。现在暗中被火化，津液升腾散失，已不是小事。况且土性稼穑，作甘味；木性曲直，作酸味。甘味反作酸味，这是木来侮土。到了春季木旺的时候，一定难以治疗。趁现在还可以治疗，如果只治胀而不治酸，不曾想酸水入腹，胀满必定更加增加。不堵塞源头而遏制水流，这种势头有止境吗？
试述其概要：治疗火邪没有超过虚则补之、实则泻之两法。内郁虽然适宜从补，然而甘温除热泻火的方法，施用于产生酸水的日子里，其酸味反而增加，用药必然无功。所以要驱除酸味而恢复甘味，唯有使用刚药这一法。所谓刚药，是指气味雄烈的药物，能够改变胃的状态而不被胃所改变。通过参伍配合以协调平衡。但只能使用刚中之柔的药，不可使用柔中之刚的药。如六味丸加桂枝、附子，属于柔中之刚。在六味丸这种制作酸药的方剂中加入两味止酸药，合适吗？刚中之柔，如连理汤就是。刚不过分刚烈，更有柔药来济助其刚，可以收到去除酸味的功效。酸去之后再去治疗胀满，破竹之势已成，迎刃而解，顽固疾病顿时消除，脾的功能恢复，保持太和之气，常保天命了。可以说，用药者在先后轻重之间，能不审慎吗？
后来经过多年调养，听说使用黄柏、知母之类的药物，才得到完全疗效，更觉奇妙。将刚柔诸药制成丸剂服用，胸中如同天地交泰而成泰卦，清爽不可言喻。胀病遂不费余力而痊愈。
附论善后之法：门人问道：“老师治病，每每议论先于用药，究竟效果如桴鼓相应，纤毫不爽。现在果然酸止胀消，脐收腹小，奏效全功了。不知意外还有什么隐患？恳请老师一并讲述善后的方法，彻底讲明。”我回答说：“问得详尽啊！《内经》的病机理论，刘河间阐发得很完备。至于细微渺茫之处，不能在言语间全部传达。我为你进一步扩充其义。疾病有逆传顺传种种不同，所谓疾病形成的机理就是这样。至于疾病去除的机理，从来没有人谈及。前论圣符的病，是从脾传入胃；现在酸去胀消，也是从胃返回脾。所以善后的方法，以调理脾脏为急务，而胃脏则居其次。其机理可以讲明了。假设胃气不和，一定不能驱除病邪。只有胃气和顺，才能酸减谷增，逐渐恢复常人容纳消化的常态。然而胃喜欢容纳消化，脾却不喜好健运。倦怠多睡，只喜欢按摩的人有之；吃下一盏食物，身体觉得沉重；吃下三盏食物，身体沉重得像加重了一钧的人有之；步履虽然像平常一样，但是登高涉险，就觉得下轻上重，举足无力，身体沉重四肢疲乏，头晕气急的人有之；脾阳不旺盛，饭后喜欢喝沸汤，借助有形之热来资助的人有之。病后余邪，有因夏热而为瘅病的，有因秋凉而为疟疾的，有因燥胜而导致脾约的，有因湿胜而导致脾泄的。所以调理脾脏则百病不生，不调理脾脏则诸疾续起，久而久之就会传入胃中。至于若调摄失宜，因饮食、房劳所犯，脾先受病，还尚可说。假如愤怒之火一动，则挟带肝木之邪直接侵犯胃土，原发病突然发作，那就不可说了。俗话说‘一朝之忿，亡身及亲’，作为警戒，意义深远了。
另外，起初出现酸胀时，胃中必定另外创生一层膜，囊状如同赘生物，这是肝火冲入，透开胃膜，所以所积聚的水液，暗中随木气变化而变酸，久久渐渐充满，膜囊垂大，腹部的胀满以此为根。观察新谷入口，酸物迸出，而芳香的谷物不出，以及每次食用饴糖，如同汲筒入喉，酸水随即涌出，都可以验证这一点。如果不是另有一个窠臼（病位），那么呕吐时应该新旧之物俱出，像膈气之类，怎么会分别得如此清楚呢？昨天游览玉峰，当地人家请我传授给其他医生调摄的要旨。当我告诉他们另有膜囊存在时，那位医生不觉失笑道：‘如果是这样，那先生真是有透视墙壁的能力了。’唉！下士闻道，固然是这样的。订方使用六君子汤，煎煮后调入赤石脂末。那位医生不理解，岂知我的意图是因为他那个膜囊既然空了，就用这些药物填补它，使其不成为日后的祸患呢？我以前治疗广陵一位血蛊患者，服药一百天后，大腹全消，左胁肋才露出病根一条，如小枕头状。用方法激发它，呕出黑污斗许，其余从大便泄去，才开始消退。每想到蛊胀，不论气血水痰，总必定自行开辟一个空间，如同寇贼盘踞，必须依据山傍险，才可以长久聚集。《内经》论述五脏之积，都有定所，为什么唯独对于六腑之聚久为患如鼓胀等类疾病，就说漫无根柢区界呢？这也足以补充病机理论的不足。
附窠囊证据：许叔微在《本事方》中说：我患有饮病三十年，开始因为少年时夜间坐着写文章，向左伏在几案上，所以饮食多坠向左边。半夜必饮酒数杯，又向左卧。壮年时不觉察，三五年后，觉得酒声只从左下发出，胁痛食减嘈杂，饮酒半盏即止。十几天必呕酸水数升。暑月只在右边出汗，左边绝无。遍访名医及海上方，偶尔中病，只得月余又复发。其补益如天雄、附子、矾石，利下如牵牛、大戟、甘遂，我都尝遍了。自己揣测必定有囊，如水之有科臼，不盈科不行，但清者自行，而浊者停滞，无路以决之，所以积至五七日，必呕而去。脾土恶湿，而水则流湿。莫若燥脾以去湿，崇土以填科臼。于是制苍术丸，服三月而疾除。
由此观之，痰饮小患，尚有科臼，难道胀满大病，反而没有科臼吗？只是许公酸水积至数升，必尽呕去，所以下渗于腹。若圣符则积之经年，腹中已容数斗，喉间连谷上涌者，不过数口而已。若非我先治胃中酸水，腹内再可加一年之积乎？然而腹中之事，言之反涉于诞妄，不被认为是功劳也是应当的。昔贤自病三十年始悟，现在的医生们，视人犹己者有几个？何况自己的病也不如所由来的那样清晰呢。那些更换多位医生而不能做好善后计划的，总之是没有看透这一关罢了。
胡卣臣先生说：认识病机之处，溯流穷源，若河汉般不可纪极。然而确实凿凿有据，不涉影响。我觉得十年读书，三次折肱（喻指经验丰富）的人，未必具备这样的手眼。
Shengfu suffered from monobdominal distension (single abdominal swelling). The abdomen was large as a winnowing basket, tight and hard as stone. Acidic fluid frequently generated in the stomach; both swallowing and vomiting yielded acidic taste. Treatment over many years proved ineffective. This was likely due to physicians employing rash, established methods without investigating the origin of the disease or the principles of its transformation after formation, thereby exacerbating the condition. Yesterday, I saw a prescription by an elderly physician from Yunjian. It was complex and chaotic, lacking any logical basis. Only the Shenqi Wan (Kidney Qi Pill) remained, a method already tested by predecessors. However, using this for such a disease is like intending to go north to Yan but pointing south. Shenqi Wan is considered a divine medicine for swelling because it can gather Kidney Qi, preventing water from overflowing. Now, with urination occurring six or seven times a day, the channels are smooth, and there is no danger of water overflow. Furthermore, the principle is "benefiting the source of fire to eliminate yin shadows." Currently, the acidic taste is transformed from fire. How can one further benefit the fire? Others identify abdominal distension as food stagnation and use harsh purgatives from the *Ju Fang* (Formulary of the Bureau of Medical Practitioners), which is even more shocking. I must clarify the rationale. Shengfu's illness originated from the failure of Spleen Qi to circulate freely, leading to depression and transformation into fire. If the method of "releasing fire when depressed" had been used at that time—raising Yang and dispersing fire—the illness would have resolved instantly. Instead, due to increasing depression and blockage, it gradually progressed to distension. The Qi in the body became like Heaven and Earth failing to interact, resulting in obstruction. The disease formed and transformed. Although the symptoms seemed devoid of fire, fire was entirely the root. Not investigating the root but treating only the distension with herbs like Areca Seed (Binglang), Magnolia Bark (Houpo), and Radish Seed (Laifuzi) consumes Qi and aids fire. Thus, the pathogen entered the Stomach, worsening day by day, boiling down Body Fluids to become acidic juice. The Stomach opening resembled a vinegar jar, and the heat within was like yeast fermentation. Once grain or drink entered, it instantly brewed into an acidic taste. Sometimes, newly swallowed grain was immediately ejected along with old grain, as if exchanged. This occurred because new grain, still aromatic and sweet, was favored and accepted by the Stomach, while the acidic residue could not remain. The innate Qi of the human body resides entirely in the Stomach opening. Now, it secretly transforms via fire, with fluids rising and scattering, which is no minor issue. Moreover, Earth governs sowing and reaping, producing sweetness; Wood governs bending and straightening, producing acidity. Sweetness transforming into acidity indicates Wood insulting Earth (Liver Wood overacting on Spleen Earth). In spring, when Wood is prosperous, it will be difficult to treat. While it is still treatable, treating only distension and not acidity ignores that acidic fluid entering the abdomen will increase distension. Without blocking the source and stopping the flow, will the momentum ever cease? Let me outline the general approach. Treating fire involves only two methods: tonification for deficiency and purgation for excess. Although internal depression should ideally be treated with tonification, the method of using sweet-warm herbs to remove heat and purge fire, when applied during periods of acidity production, increases acidity and proves useless. Therefore, to drive out acidity and restore sweetness, one must use "rigid medicines." Rigid medicines are those with potent flavors and aromas that can alter the Stomach's state without being altered by it. Balancing them through comprehensive coordination allows for the use of "rigidity within softness," but not "softness within rigidity." For example, Liuwei Wan (Six-Ingredient Pill with Rehmannia) plus Cinnamon Twig (Guizhi) and Aconite Root (Fuzi) represents softness within rigidity. Adding two anti-acidity herbs to Liuwei Wan, which produces acidity, is inappropriate. Lianli Tang (Coptis and Poria Decoction) represents rigidity within softness. The rigidity is not excessive, aided by soft herbs to achieve the effect of removing acidity. After acidity is removed, treating distension becomes easy, like splitting bamboo. Stubborn diseases vanish instantly, Spleen function recovers, Taihe (Great Harmony) is preserved, and natural destiny is maintained. Can practitioners not be prudent regarding the sequence and dosage of medications?
Years later, it was heard that using Phellodendron Bark (Huangbai) and Anemarrhena Rhizome (Zhimu) finally achieved complete efficacy. More remarkably, taking rigid and soft herbs as pills made the chest feel like Heaven and Earth interacting to form the hexagram Tai (Peace), indescribably refreshing. The distension healed effortlessly.
Appendix: Discussion on Post-Recovery Methods. A disciple asked, "Master, you often discuss before prescribing, yet the results are immediate and accurate. Now that acidity has ceased and distension subsided, with the umbilicus retracting and abdomen shrinking, achieving full recovery, what other hidden dangers might arise? Please explain the post-recovery methods thoroughly." I replied, "Your question is detailed. Liu Hejian elaborated extensively on the pathogenesis in the *Neijing*, but subtle points cannot be fully conveyed verbally. I will expand upon it for you. Diseases transmit in various ways, forward or backward. This is the mechanism of disease formation. However, the mechanism of disease removal has never been discussed. Previously, Shengfu's disease transmitted from Spleen to Stomach. Now, with acidity gone and distension reduced, it returns from Stomach to Spleen. Therefore, post-recovery treatment prioritizes regulating the Spleen, with the Stomach secondary. The mechanism can be explained. If Stomach Qi is not harmonious, pathogens cannot be expelled. Only when Stomach Qi harmonizes does acidity decrease and appetite increase, gradually restoring normal capacity. However, while the Stomach likes containment, the Spleen dislikes vigorous transportation. Fatigue, excessive sleep, and preference for massage occur. Eating one bowl makes the body feel heavy; eating three bowls feels like adding immense weight. Walking normally, climbing heights reveals lightness below and heaviness above, weak legs, heavy limbs, dizziness, and shortness of breath. Weak Spleen Yang leads to preferring boiling water after meals to borrow thermal energy. Residual pathogens may cause damp-heat in summer, malaria in autumn, dryness constraining the Spleen, or dampness causing Spleen diarrhea. Regulating the Spleen prevents myriad diseases; neglecting it causes successive illnesses, eventually affecting the Stomach. Improper care, diet, or sexual fatigue first affects the Spleen, which is understandable. But anger stirring fire carries Wood pathogen directly invading Stomach Earth, causing sudden relapse, which is dangerous. As the saying goes, 'A momentary anger can cost life and harm kin,' a deep warning. Regarding initial acidity and distension, a membrane likely formed in the Stomach, sac-like and protruding, caused by Liver Fire penetrating the Stomach membrane. Accumulated water transformed into acidity via Wood. Over time, it filled, the sac enlarged, becoming the root of abdominal distension. New grain entering causes acidic expulsion, while sweet grain remains. Eating malt sugar triggers acid eruption like a suction tube. These prove the existence of a separate locus. If not, vomiting would expel both new and old content, like in diaphragm qi disorders, but they are distinct. Visiting Yufeng, locals asked me to instruct other doctors on care and the concept of the separate membrane. The doctor laughed, saying, 'If so, Master truly sees through walls.' Alas, inferior scholars hear the Dao thus. The prescribed formula was Liujunzi Tang (Six Gentlemen Decoction) decocted with Red Halloysite Powder (Chishizhi). The doctor did not understand my intent to fill the empty sac to prevent future issues. I once treated a blood gu case in Guangling. After 100 days of medication, the abdomen flattened, revealing a pillow-shaped mass in the left hypochondrium. Stimulating it caused vomiting of black sludge and evacuation via stool, resolving the condition. Gu distension, whether blood, Qi, water, or phlegm, always creates a locus, like bandits occupying fortified positions. The *Neijing* states five-zang accumulations have fixed locations. Why assume six-fu aggregations like drum distension lack roots? This supplements the *Neijing*'s pathogenesis theory.
Appendix: Evidence of Locuses. Xu Shumi in *Ben Shi Fang* stated: "I suffered from drinking disease for 30 years. Initially, writing late at night leaning left caused food to settle on the left. Drinking wine at night lying left went unnoticed in youth. Years later, wine sounds came from the lower left, with hypochondriac pain, reduced appetite, and irritability. Half a cup of wine stopped intake. Every ten days, liters of acidic fluid were vomited. In summer, sweat appeared only on the right, none on the left. Seeking famous doctors and sea prescriptions provided temporary relief, lasting only a month. Tonics like Aconite Root (Fuzi) and Alum, and purgatives like Morning Glory Seed (Qianniu), Great Euphorbia (Daji), and Kansui (Gansui) were tried. I deduced a sac existed, like water needing a basin to flow. Clear fluid flowed, turbid stagnated, with no outlet. Every 5-7 days, vomiting expelled it. Spleen Earth dislikes dampness, water flows to damp places. Drying the Spleen removes dampness; reinforcing Earth fills the basin. I made Cangzhu Wan (Atractylodes Pill), taken for three months, curing the disease. Thus, even minor phlegm-fluid retention has a locus; how could major distension lack one? Xu's acidic fluid was vomited completely, not seeping into the abdomen. Shengfu accumulated for years, holding several dou in the abdomen, with only mouthfuls erupting. Had I not treated gastric acidity first, accumulation would have lasted another year. Discussing intra-abdominal matters seems absurd, so credit is rightly withheld. Ancient sages realized truths after 30 years of illness. How few modern doctors view patients as themselves? Those changing doctors without planning for recovery simply haven't penetrated this barrier. Mr. Hu Youchen said: Understanding pathogenesis, tracing sources to the origin, is boundless like the Milky Way, yet solidly grounded, not speculative. Ten years of study and three broken bones (experience) may not yield such insight."