经曰∶足太阴虚则鼓胀。又曰∶胃中寒则胀满。又曰∶浊气在上，则生 胀。
夫胀满者，腹胀气满也。由于脾肺气虚，不能健运，所以作胀也。有虚胀、实胀、热
胀、寒胀。大抵虚胀、冷胀，十之七八；实胀、热胀，十之二三。盖实热之证，人所易见，或因伤食，或因伤
寒入里，所以易知而易治；虚冷之证，由中气虚衰，脾气不化而胀，所以难见而难医。若以虚冷之胀，而误
以为实热之胀治之，其变不可胜言矣。
虚胀者，或因吐泻之后，或因服药攻下太过，致成腹胀者。宜温中调气，浓朴温中汤。若虚而兼寒者，加
附、桂。
实胀者，腹中原有食积，或饮食过饱，固结于中。外证则胃口、胸前高胀，身热口渴，倦卧不语，腹痛微
喘，目闭不开，俨然虚极之象。小儿此证最多而难识。昧者不为详审，见其四肢不举，目闭不开，误以为慢惊，
而用宁神导痰之药，千中千死，无一活者。不知大实有羸状，即此是也。急宜下之，集成沆瀣丹、集成三仙丹同
服。
热胀者，或伤寒热邪入里，大便秘结，小便短赤，浑身壮热，面赤烦躁，集成沆瀣丹。
寒胀者，由中气素寒，冷滞郁结，无身热口渴，面唇青，手足厥冷，气喘腹胀。先以塌气丸消之，后以异功
散调其脾胃。
凡遍身疮疥，因淋洗涂搽，逼毒归内而腹胀者，轻则荆防败毒散升散之，重则集成沆瀣丹微利之。疮出胀消
者吉，疮不出者凶。
经谓脏寒生胀满。盖脾为阴中之至阴，因脾湿有余，无阳不能施化。如土之久于雨水，则为泥矣，岂能生育
万物？必待和风暖日，湿去阳生，自然生长也。凡此宜以辛热之药运用之，可也。
经谓下之则胀已，此以湿热饮食有余，脾胃素实，形体气质壮实者言之也。若脾虚内寒，而气不能运精微以
成胀者，只宜以甘温补脾为主，少佐辛热以行壅滞之气，庶使脾土健旺，胀满营运，斯可愈矣。此经之所谓“塞
因塞用”，从治之法耳。医者不察乎此，惟执“下之胀已”，急于获效，病者喜行利药，以求通快。不知暂快一
时，则真气愈伤，胀满愈甚，去死不远矣。
诸家治胀治肿，但知行气利水，克削并行，辄用猛剂下之。此速死之道。不知脾气虚极，而肿而胀，愈下
愈虚，惟劫目前之快，而阴损真元，祸不旋踵，后贤幸加意焉。
《黄帝内经》说：足太阴脾经虚弱会导致鼓胀。又说：胃中有寒邪就会发生胀满。还说：浊气滞留于上部，就会产生胀满。
所谓胀满，是指腹部胀大、气机壅滞的症状。这是由于脾肺之气虚弱，不能正常运化水谷精微，从而产生胀满。胀满分为虚胀、实胀、热胀、寒胀四种类型。大体上，虚胀和冷胀占十分之七八；实胀和热胀占十分之二三。因为实热证候，人们容易看见，往往是由于饮食积滞或伤寒邪气入里化热所致，所以容易诊断也容易治疗；而虚冷证候，由于中气（脾胃之气）虚衰，脾气无法运化而产生胀满，所以容易被忽视且难以医治。如果把虚冷引起的胀满，错误地当作实热胀满来治疗，其产生的变证后果不堪设想。
虚胀，可能是因为呕吐腹泻之后，或者因为服药攻下太过，导致形成腹胀。适宜采用温中调气的方法，使用浓朴温中汤。如果是虚证兼有寒象的，加入附子、桂枝。
实胀，是因为腹中原有食积，或者饮食过饱，食物固结在体内。外在症状表现为胃口处、胸前部高高隆起胀满，身体发热口渴，疲倦嗜卧不说话，腹痛伴有轻微气喘，眼睛闭合不睁开，看起来像是极度虚弱的样子。小儿患这种病症最多而且最难识别。不懂医术的人不进行详细审察，看到患儿四肢不动、眼睛闭合不睁，误认为是慢惊风（一种以抽搐为主要特征的儿科疾病），而使用宁神导痰的药物，千百次治疗千百次死亡，没有一例存活。不知道“大实有羸状”（真实的实证有时表现出虚弱的假象），指的就是这种情况。此时应当紧急使用泻下法，将集成沆瀣丹与集成三仙丹同时服用。
热胀，可能是伤寒热邪入里，导致大便秘结，小便短少色红，全身高热，面色发红烦躁不安，使用集成沆瀣丹。
寒胀，是由于中气原本就寒，冷邪停滞郁结，没有身体发热口渴的症状，面色和嘴唇发青，手脚冰凉，气喘且腹部胀满。先用塌气丸消除胀满，后用异功散调理脾胃。
凡是遍身疮疥，因为淋洗涂搽药物，逼迫毒邪内归而导致腹胀的，轻症用荆防败毒散升散透邪，重症用集成沆瀣丹轻微通利。如果疮疹发出后胀满消退的是吉兆，疮疹发不出的是凶兆。
《内经》说脏寒会产生胀满。大概脾是阴中之至阴，因为脾湿有余，没有阳气就不能施行政令化生万物。就像土地长期处于雨水中，就会变成泥沼，怎么能生育万物呢？必须等待和风暖日，湿气去除阳气生发，才能自然生长。凡属此类情况，适宜运用辛热的药物，是可以的。
《内经》说“用泻下法胀满就会消除”，这是针对湿热饮食积滞有余，脾胃原本结实，形体气质壮实的人来说的。如果是脾虚内寒，气机不能运化精微物质从而导致胀满的，只适宜以甘温补脾为主，稍微佐以辛热药物来运行壅滞的气机，才能使脾土健旺，胀满得以运转，这样才可以痊愈。这就是《内经》所说的“塞因塞用”（用补益的方法治疗闭塞不通的病症），属于从治（顺从病性假象而治）的方法罢了。医生如果不明察这一点，只执着于“下之则胀已”，急于求效，病人喜欢使用利尿通便的药物，以求得一时通畅。不知道暂时痛快一时，真气却更加受伤，胀满更加严重，离死不远了。
各家治疗胀满和浮肿，只知道行气利水，攻伐消削并行，动不动就用猛烈的泻下剂。这是速死之道。不知道脾气极度虚弱，而出现肿和胀，越泻下越虚弱，只是劫取眼前的痛快，而损伤阴液真元，灾祸立刻降临，后来的医生希望多加注意。
The *Classic of Internal Medicine* states: Deficiency of the Foot-Taiyin (Spleen) meridian leads to drum-like distension. It also states: Cold in the Stomach leads to fullness and distension. Furthermore, it states: When turbid Qi remains in the upper part, distension arises.
Distension and fullness refer to abdominal enlargement and Qi stagnation. This occurs due to deficiency of Spleen and Lung Qi, which fails to perform normal transportation and transformation, thereby generating distension. Distension is categorized into deficiency distension, excess distension, heat distension, and cold distension. Generally, deficiency distension and cold distension account for seven or eight tenths, while excess distension and heat distension account for two or three tenths. Excess-heat patterns are easily observed by people, often caused by food retention or Shaoyang disease pathogens entering the interior; thus, they are easy to diagnose and treat. In contrast, deficiency-cold patterns result from decline of Middle Qi (Spleen-Stomach Qi) and failure of Spleen Qi to transform, leading to distension; therefore, they are difficult to detect and treat. If deficiency-cold distension is mistakenly treated as excess-heat distension, the resulting complications would be countless.
Deficiency distension may arise after vomiting and diarrhea, or due to excessive purgative medication, resulting in abdominal distension. The appropriate treatment is to warm the middle and regulate Qi using Nongpu Wenzhong Tang (Thick Magnolia Bark Decoction to Warm the Middle). If deficiency is accompanied by cold, add Fuzi (Aconite Lateral Root) and Guizhi (Cinnamon Twig).
Excess distension occurs when there is pre-existing food accumulation in the abdomen, or due to overeating, causing food to consolidate in the center. External manifestations include high swelling at the epigastrium and chest, fever, thirst, lethargy with unwillingness to speak, abdominal pain with slight panting, eyes closed and unopenable, presenting an appearance of extreme deficiency. This pattern is most common in children and difficult to recognize. Unskilled practitioners who fail to examine carefully may mistake the immobility of limbs and closed eyes for Slow Convulsion (a pediatric condition characterized by chronic convulsions), and administer calming spirit and resolving phlegm medications. Such treatments lead to death in nearly all cases, with no survivors. One must understand that "great excess presents with deficient signs," which refers precisely to this situation. Urgent purgation is required; Chengji Hangxie Dan (Chengji Hengxie Pill) should be administered together with Chengji Sanxian Dan (Chengji Three Immortals Pill).
Heat distension may result from heat pathogens of Wind-Cold disease entering the interior, causing constipation, scanty dark urine, high fever throughout the body, red face, and irritability. Chengji Hangxie Dan is indicated.
Cold distension results from inherent cold in the Middle Qi, with cold stagnation and consolidation. There is no fever or thirst; instead, there is a blueish complexion of the face and lips, cold hands and feet, panting, and abdominal distension. First, use Taqi Wan (Collapse Qi Pill) to eliminate the distension, followed by Yigong San (Yigong Powder) to regulate the Spleen and Stomach.
In cases where sores and scabies cover the whole body, distension arises because bathing and topical applications force toxins inward. For mild cases, Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Overcome Toxins) is used to raise and disperse; for severe cases, Chengji Hangxie Dan is used to mildly promote drainage. If sores erupt and distension subsides, it is auspicious; if sores do not erupt, it is ominous.
The *Classic* states that cold in the Zang organs generates distension. The Spleen is the ultimate Yin within Yin. Due to excess Spleen dampness, without Yang Qi, transformation cannot occur. Just as soil subjected to prolonged rain becomes mud and cannot nurture all things, it requires gentle winds and warm suns to remove dampness and generate Yang before natural growth can occur. For such cases, it is appropriate to employ acrid-hot herbs.
The *Classic* states that "purging will resolve distension." This statement applies to those with excess damp-heat and food retention, robust Spleen and Stomach constitution, and strong physical temperament. However, for those with Spleen deficiency and internal cold, where Qi fails to transport refined essences leading to distension, the primary treatment should be sweet-warm tonification of the Spleen, slightly assisted by acrid-hot herbs to move stagnant Qi. This allows the Spleen Earth to become vigorous and distension to resolve. This is what the *Classic* refers to as "treating obstruction with obstruction" (using tonification for blockage symptoms), a method of following the disease's apparent nature. Physicians who do not comprehend this, but cling to "purging resolves distension" and seek quick effects, often prescribe diuretics and purgatives to satisfy patients' desire for relief. They fail to realize that temporary relief injures True Qi further and exacerbates distension, bringing death near.
Various schools treating distension and edema only know how to move Qi and promote urination, combining attack and reduction, often resorting to harsh purgatives. This is a path to rapid death. They do not realize that when extreme Spleen Qi deficiency causes swelling and distension, further purging increases deficiency. Seeking only immediate relief damages Yin and True Yuan, with disaster ensuing immediately. Future physicians should pay close attention to this.