胀病有二。属虚者多。实者少。东垣钱氏等从虚治。内经云。太阴从湿。谓寒湿也
热治者误矣。当以脉证辨之。实胀者。或因食积。或因癖块。先有物在胃肠中。而后胀形于
外也。按之则坚。宜消导以去之。不可攻之。攻之愈虚。不可治矣。宜胃苓丸主之。
虚胀者。或因吐泻疟痢之后。脾胃久伤而病。此虚气在于膜肓之外。其外虽胀。其中无
。按之则濡。扣之有声。不可用攻。攻之即死。宜用温补。钱氏加减异功散。作丸服之。
人参 白术 甘草（炙各一钱） 陈皮 青皮 枳实（炒） 浓朴（炒） 半夏曲 黄连（姜
汁炒
口干饮水。神识不清。无时谵妄。宜三黄丸。河间凉膈散。仍作胆导法。
河间凉膈散
连翘（一钱） 黄芩（二分五厘） 薄荷叶（二分） 栀子仁（三分） 甘草 大黄 朴硝（各
五分） 上用水一钟。竹叶五片。煎临熟入蜜一匙。去渣温服。
因于宿食者。必恶食吞酸。腹中时痛。宜三黄枳术丸。方见后。木香槟榔丸主之。
因于积者。腹中阵痛。丁香脾积丸主之。
小儿腹胀。与大人不同。多因伤食得之。宜胃苓丸合丹溪保和丸主之。
如果伤食。腹胀或痛。吞酸恶食。大便不利者。宜木香承气丸主之。
木香承气丸
枳实（炒） 浓朴（姜汁炒） 槟榔（酒浸各等分） 木香（减半） 大黄（酒浸分两同上三味）
上为末。酒糊丸麻子大。白汤下。
木香槟榔丸 治伤一切热积。兼治痢疾腹痛。
木香 槟榔 青皮（去白） 陈皮（去白） 莪术（煨） 黄连 黄柏 香附子 枳壳（麸炒
各一
为末。水杵为丸。麻子大。姜汤下。
加减塌气汤 治腹胀。
荜茇 砂仁 青皮 陈皮 丁香 全蝎（炒） 莱菔子（炒各等分） 上为末。神曲糊丸。
麻子大。浓朴汤送下。
予外甥女。有食积脾虚病。出痘后又伤食。腹胀不喜食。予用胃苓丸方。加枳实炒神曲
麦青皮作丸服之。
予孙。邦子也。先病疟。伤食成疳。又伤食。甚瘦。腹胀大而坚。见人则哭。予立一方
人参白术白茯苓甘草半夏曲枳实炒浓朴黄连木香莪术砂仁使君子神曲麦芽鳖甲夜明砂当归川
芎等药。
一小儿泻后腹胀。予用加减塌气丸服之愈。
一小儿疟久不退。腹大而坚。予用化癖丸服之愈。
一小儿五岁。腹大善食。予见之。谓其父母曰。乳多必损胃。食壅即伤脾。令郎腹大如
是。又不知节。纵其口腹。吾恐肠胃受伤，不成肠癖。必成疳也。后果成疳。肚大青筋。请予治
。以集圣丸调理而愈。
一儿善食腹大。予用保和丸胃苓丸二方。相间调理而愈。
一儿因伤食腹痛胀。医用药下之愈。又伤食腹胀。医再下之。予闻之曰。非其治也。误
杀此
脾虚不能消食。食饱则胀者。此宜补脾。以助其传化可也。岂可下乎。此儿初胀。食饱伤脾
也。不行消导。乃下之。误矣。后又腹胀。则脾虚之病也。再三下之。不大误乎。屡下屡胀
。故令腹大无纹。脐突背平而死。虽医之误。不听吾言。父母之过也。
腹中有癖。疟后多有之。儿有癖者。常作寒热似疟。不可作疟治也。癖去则寒热自止。
家传消癖丸甚效。
人参 陈皮 三棱 莪术 木香 黄连 砂仁 鳖甲 枳实 夜明砂 使君子 干蟾
半夏曲 麦芽 海昆布 上为末。酒糊丸。麻子大。米饮下。
先翁治癖只用香蟾丸。此家传十三方也。
木香 人参 黄 当归 桔梗 三棱 莪术 鳖甲 绿矾 枳实 使君子 楝根皮
诃子 干蟾（七钱五分） 黄连（一两） 上为末。丸如绿豆大。每服三四十丸。米饮下。
胀病有两种情况。属于虚证的居多，属于实证的较少。李东垣、钱乙等人主张从虚证治疗。《内经》说：“太阴经多受湿邪”，这里指的是寒湿。如果按照热证来治疗就错了。应当通过脉象和症状来辨别。实证胀满，可能是因为饮食积滞，或者有癖块（腹内结块），先有实物在胃肠中，然后才在体外表现出胀形。按压时感觉坚硬，适宜用消食导滞的方法去除积滞，不可使用攻下法。如果使用攻下法会使正气更虚，那就无法治愈了。适宜用胃苓丸主治。
虚证胀满，可能是因为呕吐、腹泻、疟疾或痢疾之后，脾胃长期受损而发病。这种虚气停留在膜原之外，虽然外表看起来胀满，但内部空虚。按压时感觉柔软，叩击时有空响声。不可使用攻下法，如果攻下会导致死亡。适宜采用温补法。钱乙的加减异功散，制成丸剂服用。药材包括：人参、白术、甘草（炙，各一钱）、陈皮、青皮、枳实（炒）、浓朴（炒）、半夏曲、黄连（姜汁炒）。如果出现口干想喝水、神识不清、不时胡言乱语的症状，适宜用三黄丸、河间凉膈散，并配合胆导法（一种通便疗法）。
河间凉膈散的配方：连翘（一钱）、黄芩（二分五厘）、薄荷叶（二分）、栀子仁（三分）、甘草、大黄、朴硝（各五分）。以上药物用水一钟，竹叶五片，煎煮至快熟时加入蜂蜜一匙，去渣后温服。
因为宿食引起的，一定会有厌恶食物、吞酸、腹中时常疼痛的症状，适宜用三黄枳术丸（方剂见后文），或者木香槟榔丸主治。
因为有积滞引起的，腹中阵发性疼痛，适宜用丁香脾积丸主治。
小儿腹胀与成人不同，多因伤食引起，适宜用胃苓丸合丹溪保和丸主治。
如果是确实伤食，出现腹胀或腹痛、吞酸恶食、大便不通利的情况，适宜用木香承气丸主治。
木香承气丸的配方：枳实（炒）、浓朴（姜汁炒）、槟榔（酒浸，各等分）、木香（减半用量）、大黄（酒浸，分量同上三味药）。以上药物研为细末，用酒调糊做成如麻子大小的丸剂，用白开水送服。
木香槟榔丸：治疗各种热性积滞引起的损伤，兼治痢疾腹痛。配方：木香、槟榔、青皮（去白）、陈皮（去白）、莪术（煨）、黄连、黄柏、香附子、枳壳（麸炒，各一钱）。以上药物研为细末，用水杵捣做成如麻子大小的丸剂，用姜汤送服。
加减塌气汤：治疗腹胀。配方：荜茇、砂仁、青皮、陈皮、丁香、全蝎（炒）、莱菔子（炒，各等分）。以上药物研为细末，用神曲糊做成如麻子大小的丸剂，用浓朴汤送服。
我的外甥女，患有食积脾虚的病，出痘疹后又伤了食，导致腹胀不喜欢吃东西。我用胃苓丸的方子，加上炒枳实、炒神曲、麦曲、青皮做成丸剂给她服用。
我的孙子，名叫邦子。先前患疟疾，又因伤食形成疳积，再次伤食，身体非常消瘦，腹部胀大且坚硬，见到人就哭。我为他制定了一个方子：人参、白术、白茯苓、甘草、半夏曲、枳实（炒）、浓朴、黄连、木香、莪术、砂仁、使君子、神曲、麦芽、鳖甲、夜明砂、当归、川芎等药物。
有一个小孩疟疾久治不愈，腹部胀大且坚硬，我用化癖丸给他服用，痊愈了。
有一个五岁的小孩，肚子大但食欲好。我见到后对他的父母说：“乳汁过多必定损伤胃，食物壅滞就会伤害脾。令郎腹部如此肿大，又不懂得节制，放纵口腹之欲，我担心他的肠胃受伤，如果不变成肠癖，一定会发展成疳积。”后果然成了疳积，肚子大且有青筋暴露。请我治疗，我用集圣丸调理而痊愈。
有一个小孩爱吃东西但肚子大，我用保和丸和胃苓丸两个方子交替调理而痊愈。
有一个小孩因为伤食导致腹痛腹胀，医生用药攻下后痊愈。后来再次伤食腹胀，医生再次攻下。我听说后说：“这不是正确的治疗方法，会误杀这个孩子。”脾虚不能消化食物，吃饱了就胀，这种情况应该补脾，以助其传化功能，怎么可以攻下呢？这个孩子初次腹胀，是因为吃饱伤了脾，不进行消导治疗，反而攻下，这是错误的。后来再次腹胀，则是脾虚的病证，再三攻下，不是大错特错吗？屡次攻下屡次腹胀，所以导致腹部巨大无纹路，肚脐突出，背部平坦而死。虽然是医生的失误，但不听我的话，这也是父母的过错。
腹中有癖块，疟疾后多有此症。小孩有癖块的，常表现为像疟疾一样的寒热往来，不可当作疟疾治疗。癖块去除后，寒热自然停止。家传的消癖丸非常有效。配方：人参、陈皮、三棱、莪术、木香、黄连、砂仁、鳖甲、枳实、夜明砂、使君子、干蟾、半夏曲、麦芽、海昆布。以上药物研为细末，用酒调糊做成如麻子大小的丸剂，用米饮送服。
先父治疗癖块只用香蟾丸，这是家传十三方之一。配方：木香、人参、黄芪、当归、桔梗、三棱、莪术、鳖甲、绿矾、枳实、使君子、楝根皮、诃子、干蟾（七钱五分）、黄连（一两）。以上药物研为细末，做成如绿豆大小的丸剂，每次服用三四十丸，用米饮送服。
Distension disease has two types. Deficiency patterns are more common, while excess patterns are less frequent. Li Dongyuan and Qian Yi, among others, advocated treating from the perspective of deficiency. The *Neijing* states: "Taiyin is prone to dampness," referring here to cold-dampness. Treating it as a heat pattern would be an error. One must distinguish based on pulse and symptoms. In excess distension, it may be due to food stagnation or masses (abdominal lumps). There is first a physical object in the intestines and stomach, followed by distension manifesting externally. Palpation reveals hardness. It is appropriate to use methods to resolve and guide out stagnation; one must not use purgatives. Using purgatives will further deplete healthy qi, making it incurable. Wei Ling Wan (Stomach-Calm Pill) is indicated.
In deficiency distension, it may occur after prolonged vomiting, diarrhea, malaria, or dysentery, where the Spleen and Stomach have been damaged over time. This deficient qi resides outside the membrane source (a region between the interior and exterior). Although the exterior appears distended, the interior is empty. Palpation feels soft, and percussion yields a hollow sound. Purgatives must not be used; using them can lead to death. Warm tonification is appropriate. Qian's Modified Yigong San (Modified Benefit-Working Powder), prepared as pills, should be taken. Ingredients include: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Licorice Root, honey-fried, 1 qian each), Chenpi (Citrus Reticulata Pericarpium), Qingpi (Citrus Aurantium Pericarpium), Zhishi (Immature Bitter Orange, stir-baked), Nongpu (Magnolia Bark, stir-baked), Banxiaqu (Pinellia Fermented Paste), Huanglian (Coptis Rhizome, stir-fried with ginger juice). If dry mouth with desire to drink, unclear consciousness, and occasional delirious speech occur, Sanhuang Wan (Three-Yellow Pill) and Hejian Liangge San (He Jian's Cooling Chest Powder) are indicated, along with the Dan Dao method (a bowel-cleansing technique).
Liangge San (Cooling Chest Powder) formula: Lianqiao (Forsythiae Fructum, 1 qian), Huangqin (Scutellariae Radix, 2.5 fen), Boheye (Menthae Haplocalycis Folium, 2 fen), Zhiziren (Gardeniae Semen, 3 fen), Gancao (Licorice Root), Dahuang (Rhei Radix et Rhizoma), Puxiao (Natrii Sulfas, 5 fen each). Take one zhong of water and five leaves of Zhu Ye (Bambusae Folium), decoct until nearly ready, add one spoonful of honey, remove dregs, and take warm.
If caused by retained food, there will necessarily be aversion to food, acid regurgitation, and intermittent abdominal pain. Sanhuang Zhizhu Wan (Three-Yellow Immature Orange-Atractylodes Pill) is indicated (formula see below), or Muxiang Binglang Wan (Costus and Areca Nut Pill) may be used.
If caused by accumulations, there is paroxysmal abdominal pain. Dingxiang Pi Ji Wan (Clove Spleen-Accumulation Pill) is indicated.
Pediatric abdominal distension differs from adults; it is mostly due to food injury. Weiling Wan combined with Baohe Wan (Preserve Harmony Pill) from Danxi is indicated.
If indeed food-injured, with abdominal distension or pain, acid regurgitation, aversion to food, and difficult defecation, Muxiang Chengqi Wan (Costus Bowel-Regulating Pill) is indicated.
Muxiang Chengqi Wan formula: Zhishi (Immature Bitter Orange, stir-baked), Nongpu (Magnolia Bark, stir-fried with ginger juice), Binglang (Areca Seed, wine-soaked, equal parts), Muxiang (Costus Root, half dose), Dahuang (Rhei Radix et Rhizoma, wine-soaked, same dosage as the above three ingredients). Grind into powder, make pills with wine paste, size of hemp seeds, take with clear water.
Muxiang Binglang Wan: Treats all heat accumulations from injury, and also dysentery with abdominal pain. Ingredients: Muxiang (Costus Root), Binglang (Areca Seed), Qingpi (Citrus Aurantium Pericarpium, white pith removed), Chenpi (Citrus Reticulata Pericarpium, white pith removed), Ezhu (Curcumae Rhizoma, baked), Huanglian (Coptis Rhizoma), Huangbai (Phellodendri Cortex), Xiangfuzi (Cyperi Rhizoma), Zhike (Aurantii Fructus, bran-stir-fried, 1 qian each). Grind into powder, pound with water to make pills, size of hemp seeds, take with ginger soup.
Jiajian Taqi Tang (Modified Collapse-Qi Decoction): Treats abdominal distension. Ingredients: Bibai (Piperis Longi Fructus), Sharen (Amomi Fructus Rotundus), Qingpi (Citrus Aurantium Pericarpium), Chenpi (Citrus Reticulata Pericarpium), Dingxiang (Eugeniae Flos), Quanxie (Scorpio, stir-fried), Laifuzi (Raphani Semen, stir-fried, equal parts). Grind into powder, make pills with Shenqu (Medicated Leaven) paste, size of hemp seeds, take with Nongpu Tang (Magnolia Bark Decoction).
My niece suffered from food stagnation and Spleen deficiency. After smallpox, she injured her food again, resulting in abdominal distension and loss of appetite. I used the Weiling Wan formula, adding stir-baked Zhishi (Immature Bitter Orange), stir-baked Shenqu (Medicated Leaven), Maiqu (Wheat Medicated Leaven), and Qingpi (Citrus Aurantium Pericarpium), made into pills for her to take.
My grandson, Bangzi, first suffered from malaria, then developed malnutrition (Gan syndrome) from food injury, and suffered another food injury. He was very thin, with a large, hard, distended abdomen, and cried when seeing people. I prescribed a formula containing: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Baifuling (Poria), Gancao (Licorice Root), Banxiaqu (Pinellia Fermented Paste), Zhishi (Immature Bitter Orange, stir-baked), Nongpu (Magnolia Bark), Huanglian (Coptis Rhizoma), Muxiang (Costus Root), Ezhu (Curcumae Rhizoma), Sharen (Amomi Fructus Rotundus), Shijunzi (Quisqualis Fructus), Shenqu (Medicated Leaven), Maiya (Hordei Fructus Germinatus), Biejia (Testudinis Carapax et Plastrum), Yemingsha (Chiropterae Os), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), etc.
A child had abdominal distension after diarrhea. I treated him with Jiajian Taqi Wan (Modified Collapse-Qi Pill), and he recovered.
A child had persistent malaria with a large, hard abdomen. I treated him with Huapi Wan (Resolve-Mass Pill), and he recovered.
A five-year-old child had a large abdomen but good appetite. Upon seeing him, I told his parents: "Excessive milk damages the Stomach; food accumulation injures the Spleen. Your son's abdomen is so enlarged, and without self-restraint, indulging his appetite, I fear his intestines and stomach will be injured. It will either become intestinal dysentery or develop into Gan syndrome." Indeed, he later developed Gan syndrome, with a large abdomen and visible blue veins. I treated him with Jisheng Wan (Collect-Sage Pill) for regulation, and he recovered.
A child who ate well had a large abdomen. I alternated between Baohe Wan (Preserve Harmony Pill) and Weiling Wan (Stomach-Calm Pill) for regulation, and he recovered.
A child had abdominal pain and distension due to food injury. A doctor treated him with purgatives, and he recovered. Later, he injured his food again, causing abdominal distension, and the doctor purged him again. I heard this and said, "This is not the correct treatment; it will mistakenly kill this child." When Spleen deficiency cannot digest food, fullness leads to distension. This situation requires tonifying the Spleen to assist transportation and transformation. How can purgatives be used? Initially, the distension was due to overeating injuring the Spleen. Not using resolving and guiding methods, but instead purging, was an error. Subsequent distension was due to Spleen deficiency. Purging repeatedly is a grave mistake. Repeated purging led to repeated distension, resulting in a huge abdomen without skin markings, protruding umbilicus, flat back, and death. Although it was the doctor's error, the parents' failure to listen to my advice was also at fault.
Masses in the abdomen are common after malaria. Children with masses often present with chills and fever resembling malaria; this should not be treated as malaria. Once the mass is resolved, the chills and fever will stop naturally. Our family's Xiaopi Wan (Resolve-Mass Pill) is very effective. Ingredients: Renshen (Ginseng Radix et Rhizoma), Chenpi (Citrus Reticulata Pericarpium), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Muxiang (Costus Root), Huanglian (Coptis Rhizoma), Sharen (Amomi Fructus Rotundus), Biejia (Testudinis Carapax et Plastrum), Zhishi (Immature Bitter Orange), Yemingsha (Chiropterae Os), Shijunzi (Quisqualis Fructus), Ganchan (Bufo Skin), Banxiaqu (Pinellia Fermented Paste), Maiya (Hordei Fructus Germinatus), Haikunbu (Sargassum). Grind into powder, make pills with wine paste, size of hemp seeds, take with rice drink.
My late father treated masses using only Xiangchan Wan (Costus-Bufo Pill). This is one of our thirteen family formulas. Ingredients: Muxiang (Costus Root), Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Jiegeng (Platycodonis Radix), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Biejia (Testudinis Carapax et Plastrum), Lvfan (Green Vitriol), Zhishi (Immature Bitter Orange), Shijunzi (Quisqualis Fructum), Lian Gen Pi (Meliae Radicis Cortex), Hezi (Terminaliae Chebulae Fructus), Ganchan (Bufo Skin, 7.5 qian), Huanglian (Coptis Rhizome, 1 liang). Grind into powder, make pills the size of mung beans. Take 30-40 pills per dose with rice drink.