顾鸣仲有腹疾近三十年。朝宽暮急。每一大发。腹胀十余日方减。食湿面及房劳。其应如响。腹左隐隐
微高。鼓呼吸触之。 有声。以痞块法治之。内攻外贴。究莫能疗。余为悬内照之鉴。先与明之。后乃
治之。人身五积六聚之证。心肝脾肺肾之邪。结于腹之上下左右。及当脐之中者。皆高如覆盂者也。胆
胃大小肠膀胱命门之邪。各结于其本位。不甚形见者也。此证乃肾脏之阴气。聚于膀胱之阳经。有似于痞块
耳。何以知之。肾有两窍。左肾之窍。从前通膀胱。右肾之窍。从后通命门。邪结于腹之左畔。即左肾与膀
胱为之府也。六腑惟胆无输泻。其五腑受五脏浊气传入。不能久留。即为输泻者也。今肾邪传于膀
胱。膀胱溺其输泻之职。旧邪未行。新邪踵至。势必以渐透入膜原。如革囊裹物者然。经曰。膀胱者州都之
官。津液藏焉。气化则能出矣。然则肾气久聚不出。岂非膀胱之失其运化乎。夫人一团之腹。大小肠膀胱俱
居其中。而胞又居膀胱之中。惟其不久留输泻。是以宽乎若有余地。今肾之气。不自收摄。悉输膀
胱。膀胱蓄而不泻。有同胆腑之清净无为。其能理乎。宜其胀也。有与生俱焉者矣。经曰。肾病者善胀。尻以
代踵。脊以代头。倘膀胱能司其输泻。何致若此之极耶。又曰。巨阳引精者三。曰太阳膀胱经。吸引精气者。
其胀止于三日。此之为胀。且数十年之久。其吸引之权安在哉。治法补肾水而致充足。则精气深藏。而
膀胱之胀自消。补膀胱而令气旺。则肾邪不蓄。而输化之机自
裕。所以然者。以肾不补不能藏。膀胱不补不能泻。然补肾易而补膀胱则难。以本草诸药。多泻少补也。经于
膀胱之予不足者。断以死期。后人莫解其故。吾诚揣之。岂非以膀胱愈不足则愈胀。胀极势必逆传于肾。肾胀
极。势必逆传于小肠。小肠胀极。势必逆传于脾。乃至通身之气。散漫而无统耶。医者于未传之
先。蚤见而预图之。能事殚矣。
胡卣臣先生曰。言腹中事。如张炬而游洞天。愈深愈朗。
顾鸣仲患有腹部疾病近三十年。早晨症状较轻，傍晚加重。每次病情大发作时，腹胀持续十余天才能缓解。食用湿面或房事劳累后，症状立即响应出现。腹部左侧隐隐微高，鼓动呼吸时触摸有声响。此前用治疗痞块的方法处理，内服攻伐药物，外贴膏药，终究无法治愈。我通过悬镜内照般的诊断方法，先向他阐明病机，然后才进行治疗。
人体五积六聚的病证，是心、肝、脾、肺、肾五脏之邪气，结聚在腹部的上下左右及肚脐中央部位，这些部位的肿块高高隆起，像倒扣的盂一样。胆、胃、大小肠、膀胱、命门之邪气，各自结聚在它们本来的位置，不太容易显现出明显的形态。这个病证乃是肾脏的阴气，聚结于膀胱的阳经，看起来有点像痞块罢了。怎么知道是这样呢？肾有两个窍道，左肾的窍道从前方向通连膀胱，右肾的窍道从后方向通连命门。邪气结聚在腹部的左侧，那就是左肾与膀胱作为其府库所在。六腑中只有胆没有输泻功能，其余五腑接受五脏传来的浊气，不能长久停留，就会进行输泻排出。现在肾中的邪气传给了膀胱，膀胱失去了其输泻的功能，旧的邪气未去，新的邪气接踵而至，势必逐渐透入膜原（半表半里之间），就像革囊包裹物体一样。医经说：膀胱是州都之官，津液藏存于此，经过气化作用才能排出。既然这样，那么肾气长久聚结而不排出，难道不是膀胱失去了运化功能吗？
人的一团腹部，大小肠和膀胱都居住在其中，而胞宫又居住在膀胱之中。正因为它们不能长久停留浊气并进行输泻，所以腹部显得宽敞好像有余地。现在肾的气机不能自我收摄，全部输送给膀胱，膀胱蓄积而不排泄，这就如同胆腑保持清净无为的状态一样，它还能调理好吗？这必然导致腹胀，这是与生俱来就有的病理基础。医经说：肾病的人容易腹胀，严重时臀部代替脚踵站立，脊背代替头部前倾。如果膀胱能掌管好它的输泻功能，怎么会发展到如此极端的程度呢？又说：巨阳经（足太阳膀胱经）引导精气运行正常的话，腹胀只持续三天。这种腹胀却长达数十年之久，那吸引精气的权力在哪里呢？
治疗方法应当补肾水使其充足，那么精气就能深藏，膀胱的胀满自然消除；补益膀胱使其气机旺盛，那么肾邪就不会蓄积，输化的机能自然充裕。之所以这样，是因为肾不补就不能藏精，膀胱不补就不能泄浊。然而补肾容易，补膀胱却难，因为本草书中的药物，大多具有泻的作用而少具有补的作用。医经对于膀胱给予不足的情况，断言会有死期，后人都不明白其中的缘故。我仔细揣测，难道不是因为膀胱越不足就越胀满，胀满到极点势必逆向传变给肾，肾胀满到极点，势必逆向传变给小肠，小肠胀满到极点，势必逆向传变给脾，以至于全身之气散漫而没有统摄吗？医生如果在病邪尚未传变之前，早早发现并预先谋划治疗，那就尽了医生的职责了。
胡卣臣先生说：“谈论腹中的病症，就像举着火把游览洞天福地一样，越深入越明朗。”
Gu Mingzhong suffered from an abdominal disease for nearly thirty years. Symptoms were mild in the morning and severe in the evening. During each major exacerbation, abdominal distension persisted for more than ten days before subsiding. The condition responded immediately to the consumption of damp noodles or sexual exertion. There was a vague, slight elevation on the left side of the abdomen, producing audible sounds upon palpation during respiration. Previous treatments using methods for *pi* masses (abdominal masses), including internal purgatives and external plasters, ultimately failed to cure him. I employed a diagnostic approach akin to looking into an inner mirror, first explaining the pathology to him, and then proceeding with treatment.
The conditions of the Five Accumulations (*Wu Ji*) and Six Gatherings (*Liu Ju*) involve pathogenic factors from the Heart, Liver, Spleen, Lung, and Kidney organs knotting in the upper, lower, left, right, and central umbilical regions of the abdomen; these present as high elevations resembling an inverted bowl. Pathogens of the Gallbladder, Stomach, Small Intestine, Large Intestine, Bladder, and Mingmen (Gate of Life) knot at their respective anatomical positions and are not easily manifested externally. This case involves Yin Qi of the Kidney gathering in the Yang Meridian of the Bladder, resembling a *pi* mass. How do we know this? The Kidneys have two orifices: the orifice of the Left Kidney connects anteriorly to the Bladder, and the orifice of the Right Kidney connects posteriorly to the Mingmen. Pathogens knotting on the left side of the abdomen indicate that the Left Kidney and Bladder serve as their residence. Among the Six Fu Organs, only the Gallbladder lacks a mechanism for drainage and discharge; the other five Fu Organs receive turbid Qi transmitted from the Zang Organs and cannot retain it long, instead discharging it. Now, Kidney pathogens have transmitted to the Bladder, which has lost its function of drainage and discharge. Old pathogens remain while new ones follow, inevitably penetrating gradually into the *Moyuan* (Membrane Source, a region between the exterior and interior), similar to a leather bag wrapping objects. The Classics state: "The Bladder is the official of the provincial capital, storing fluids; through Qi transformation, they can be excreted." Thus, if Kidney Qi gathers for a long time without exiting, is it not due to the Bladder's failure in transportation and transformation?
Within the abdominal cavity, the Small Intestine, Large Intestine, and Bladder reside, and the Uterus resides within the Bladder. It is precisely because these organs do not retain pathogens for long and facilitate discharge that the abdomen feels spacious. Now, Kidney Qi fails to self-regulate and is entirely transmitted to the Bladder. The Bladder accumulates but does not discharge, behaving like the Gallbladder maintaining a state of purity and non-action. Can it regulate itself properly? Distension is inevitable, rooted in congenital predisposition. The Classics state: "Patients with Kidney disease often suffer from distension; in severe cases, the buttocks replace the heels, and the spine replaces the head." If the Bladder could manage its drainage, how could it reach such an extreme? Furthermore, it is stated: "When the Juyang (Great Yang) meridian guides Essence and Qi normally, distension lasts only three days." Yet this distension has lasted for decades; where is the power of guiding Essence and Qi?
The treatment method should tonify Kidney Water to ensure sufficiency, allowing Essence and Qi to be deeply stored, thereby naturally resolving Bladder distension. Tonifying the Bladder to strengthen its Qi prevents Kidney pathogens from accumulating, naturally enriching the mechanisms of drainage and transformation. This is because the Kidney cannot store Essence without tonification, and the Bladder cannot drain turbidity without tonification. However, tonifying the Kidney is easy, while tonifying the Bladder is difficult, as most herbs in materia medica have draining properties rather than tonifying ones. The Classics assign a fatal prognosis to insufficiency of the Bladder, a reason later generations failed to understand. Upon careful consideration, is it not because insufficient Bladder leads to greater distension, which eventually transmits reversely to the Kidney? Extreme Kidney distension transmits reversely to the Small Intestine; extreme Small Intestine distension transmits reversely to the Spleen, until the Qi of the entire body scatters without control. A physician who detects this early and plans preemptively before transmission occurs has fulfilled their duty.
Mr. Hu Youchen remarked: "Discussing abdominal pathology is like touring a celestial grotto with a torch; the deeper one goes, the clearer it becomes."