张元素曰。凡久病吐泻后。虚则脉微细。若色淡黄。目胞腮虚肿。手足冷。先塌气丸。后异功散、和中丸、益黄散、
四君之类。用诸温药养其气。实则脉洪实。不因吐泻痢下后。腹胀而喘急闷乱。更有热有痰有食而腹胀者。白饼子、大
黄丸、解毒丸下之。兼须认二便。如都不通。先利小便。
李杲曰。大约寒胀多。热胀少。皆主于脾。
庞安常曰。东垣治胀。不犯上下二焦。用素问中满者泻之于内之法。实者分气消积。虚者升阳滋血。治者当师其意
而活用之。不可排击。宜中满分消丸、消痞丸、丹腹胀方、升阳滋血汤。
痞义为闭。结则实哉。始由痰饮。热蕴如煨。专留腹胁。似盆似杯。营卫气塞。不能往来。非心下痞。易于宣开。
故时胀满。按则哭哀。饮食减少。寒热相催。原其所由。脾脏虚羸。久必土败。变难预推。当须养正。勿但结摧。然痞
虽结。未成硬胚。积且致癖。坚实难锤。积因乳哺。节度多乖。腻滞
生冷。停聚难裁。风寒外袭。湿热中怀。老痰坚结。或系血 。皆能成积。腹内为灾。始同鸡卵。逐渐如胎。腹胀且痛。
足冷面灰。亦由脾病。虚实兼该。实则宜攻。虚则宜培。未可概论。未可狐猜。汉东王氏。论积最佳。可治不治。分辨
无差。虚中
之积。症更难谐。因惊伤食。吐泻与偕。其脾愈弱。其病难排。取转不着。积反隐埋。惊疳之候。最易根 。婴儿乳积。
面色莓苔。口疮吐 。腹中块 。皆由乳后。偏卧不回。乳滞胁下。结块而 。 癖一症。更属奇
。蕴结在腹。成块如梅。时常叫痛。骨瘦如柴。左胁下痛。 气为媒。右胁下痛。癖气相偎。俗名龟痨。左右胁叉。
此亦脾病。冷气沉霾。致成是疾。寒热侵骸。至于伤暑。秋必病 。寒热来往。脾胃气衰。血膜包水。疟癖如蛙。古人
成法。可摩可楷。详核方治。慎保婴孩。
张元素说：凡是久病呕吐腹泻之后，如果是虚证，脉象微细。如果面色淡黄，眼睑和脸颊浮肿，手脚冰冷，先用先塌气丸，再用异功散、和中丸、益黄散、四君子汤之类的方剂。使用各种温性药物来养护正气。如果是实证，脉象洪大有力。不是因为呕吐腹泻痢疾之后，而是出现腹胀且呼吸急促、胸闷烦乱。更有因热邪、痰饮、食积导致腹胀的，用白饼子、大黄丸、解毒丸等攻下。同时也必须辨别大小便情况。如果大小便都不通，先通利小便。
庞安常说：东垣（李杲）治疗胀满，不侵犯上焦和下焦，采用《素问》中“中满者泻之于内”的方法。实证分消气滞、消除积滞；虚证升发阳气、滋养血液。治疗者应当效法其意并灵活运用，不可强行攻伐。适宜使用中满分消丸、消痞丸、丹溪治腹胀方、升阳滋血汤。
“痞”的意思是闭塞，“结”则是坚实。起初由痰饮引起，热邪蕴结如同煨烤，专门停留在腹部和胁部，形状像盆又像杯子。营卫之气阻塞，不能正常往来流通。这不是心下的痞证，容易宣通开散。所以时常感到胀满，按压时哭闹哀痛。饮食减少，寒热交替催促。追溯其根源，是脾脏虚弱羸弱，时间久了必然导致脾气败坏，变化难以预先推测。应当需要养护正气，不要仅仅着眼于攻破结聚。然而痞虽然结聚，尚未形成坚硬的肿块；积滞进而导致癖块，坚实难破。积滞因为乳食喂养不当，节度多有乖违。腻滞、生冷食物停聚难以裁断。风寒外袭，湿热内怀，老痰坚结，或者是瘀血阻滞，都能形成积滞，在腹内造成灾害。开始像鸡蛋大小，逐渐像胎儿一样大。腹胀且疼痛，脚冷面色灰暗。这也是由于脾病，虚实兼有。实证适宜攻伐，虚证适宜培补。不可以一概而论，不可以犹豫猜疑。汉东王氏论述积滞最佳，可以治疗而不治疗，分辨没有差错。虚中的积滞，症状更难调和。因为受惊伤食，呕吐腹泻伴随而来。脾脏更加虚弱，病情难以排除。取转（推拿手法）不着，积滞反而隐藏埋没。惊疳的症状，最容易根除。婴儿乳积，面色如莓苔般斑驳。口疮吐奶，腹中有块状物。都是因为哺乳后，偏卧不回头。乳汁停滞在胁下，结块而痛。癖这一病症，更属于奇特之症。蕴结在腹部，成块像梅子。时常叫喊疼痛，骨瘦如柴。左胁下痛，气机作为媒介。右胁下痛，癖气相偎依。俗名龟痨，左右胁肋交叉处疼痛。这也是脾病，冷气沉郁阴霾，导致成为这种疾病。寒热侵袭骨骼形体。至于伤暑，秋天必定生病。寒热往来，脾胃气衰。血膜包裹水液，疟疾癖块像青蛙一样。古人成法，可以按摩可以楷式（效法）。详细核查方剂治疗，谨慎保护婴孩。
Zhang Yuansu stated: In cases of prolonged illness following vomiting and diarrhea, if it is a deficiency pattern, the pulse will be faint and fine. If the complexion is pale yellow, with edema in the eyelids and cheeks, and cold hands and feet, first administer Xianta Qi Wan (First Collapse Qi Pill), followed by Yigong San (Benefit Power Powder), Hezhong Wan (Harmonize Middle Pill), Yihuang San (Benefit Yellow Powder), or formulas similar to Sijunzi Tang (Four Gentlemen Decoction). Use various warming medicines to nourish the healthy qi. If it is an excess pattern, the pulse will be surging and solid. This occurs not after vomiting, diarrhea, or dysentery, but presents with abdominal distension accompanied by panting, chest tightness, and restlessness. Furthermore, there are cases of abdominal distension caused by heat, phlegm, or food retention; these should be purged using Baibing Zi (White Cake Pill), Dahuang Wan (Rhubarb Pill), or Jiedu Wan (Detoxification Pill). One must also examine the bowel movements and urination. If both are obstructed, first promote diuresis.
Li Dongyuan said: Generally, cold distension is more common than heat distension. Both primarily involve the Spleen.
Pang Anchang stated: Dongyuan’s treatment of distension does not violate the Upper and Lower Jiao (Upper and Lower Burners). It employs the principle from *Suwen* (Basic Questions): "For fullness in the center, drain it from within." For excess patterns, differentiate qi stagnation and eliminate accumulations; for deficiency patterns, raise yang and nourish blood. Practitioners should learn from this intent and apply it flexibly, avoiding forceful attacking methods. Suitable formulas include Zhongman Fenxiao Wan (Middle Fullness Differentiation and Dissipation Pill), Xiaopi Wan (Eliminate Pi Pill), Danxi's Abdominal Distension Formula, and Shengyang Zixue Tang (Raise Yang and Nourish Blood Decoction).
"Pi" (Pi Syndrome) implies obstruction or closure, while "Jie" (Knotting) implies solidity. Initially caused by fluid retention (Phlegm-Fluids), heat accumulates like simmering, staying specifically in the abdomen and hypochondrium, resembling a basin or cup. Ying and Wei (Nutritive and Defensive) qi become blocked and cannot circulate freely. This is not Heart-level Pi, which is easier to disperse and open. Therefore, there is frequent distension, and crying in pain upon pressure. Food intake decreases, with alternating cold and heat sensations. Tracing the origin, it stems from Spleen deficiency and emaciation; over time, Earth (Spleen) function fails, making changes difficult to predict. One must nourish the upright qi rather than merely attempting to break up the knot. Although Pi involves knotting, it has not yet formed a hard mass. Accumulation leads to Xi (Parasitic Masses), which are solid and hard to break. Accumulations arise from improper infant feeding, where dietary regulations are often violated. Greasy, stagnant, and raw/cold foods accumulate and are difficult to manage. External invasion by wind-cold and internal accumulation of damp-heat, along with old stubborn phlegm or blood stasis, can all form accumulations causing disaster within the abdomen. Starting the size of a chicken egg, they gradually grow as large as a fetus. Abdominal distension and pain occur, with cold feet and a grayish complexion. This is also due to Spleen disease, encompassing both excess and deficiency. Excess patterns require purgation, while deficiency patterns require tonification. One cannot generalize or hesitate. Wang Shi of Handong discussed accumulations best; failing to treat when treatable leads to no error in differentiation. Accumulations in deficiency patterns present even more complex symptoms. Due to fright and food injury, vomiting and diarrhea accompany each other. The Spleen becomes weaker, making the disease harder to expel. If massage techniques fail, the accumulation may hide deeper. Fright and malnutrition syndromes are easiest to root out. Infant milk accumulation presents with a moss-like mottled complexion, mouth ulcers, spitting up milk, and abdominal masses. All result from post-feeding behaviors, such as lying on one side without turning back. Milk stagnates under the hypochondrium, forming painful knots. Xi (Parasitic Masses) is a peculiar condition. Accumulated in the abdomen, it forms lumps like plums. Frequent crying in pain leads to emaciation. Pain in the left hypochondrium is mediated by Qi; pain in the right hypochondrium involves Xi-Qi clinging together. Commonly known as "Tortoise Consumption," it affects the crossing points of the left and right hypochondria. This too is a Spleen disease, caused by sinking and gloomy cold qi. Invasion by cold and heat damages the bones and body. Regarding summerheat injury, autumn brings illness with alternating chills and fever, leading to Spleen-Stomach qi decline. Blood membranes wrap water, creating malaria-like parasitic masses resembling frogs. Ancient established methods allow for massage and emulation. Carefully verify prescriptions and treatments to prudently protect infants.