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。陈飞霞曰∶夫胀满者，腹胀
气满也。因于脾肺不能健运，所以作胀也。有虚胀、寒胀、实胀、热胀。大抵虚胀、寒胀十之八九，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。虚寒之证，由中气衰弱，脾气
不化而胀，所以难见而难医。若以虚寒之胀，而误为实热之胀治之，其变有不可胜言者矣。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，加桂附。实胀者，腹中原有食
积，或因饮食过饱，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，口闭不开，误以为慢风，而用宁神导痰之药，十中
十死，无一活者。不知大实有羸，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，大便闭结，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，复以异功散，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，不出者凶。经谓脏寒生胀满者，盖脾为阴中之至阴，如脾湿有余，阳火不能施化，如土之久于雨水，则为
泥矣，岂能生育万物。必待和风日暖，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，以成胀满者，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，
用从治之法耳。医者不察，惟执下之胀已，急于获效；病者喜以下药，以求痛快。不知暂快一时，则真气愈伤，
胀满愈甚，去死不远矣。
浓朴温中汤 治胃寒心腹胀。
川朴（七分） 陈皮（一钱） 黑姜炭（一钱） 茯苓（一钱） 草蔻仁（六分） 木香（五分） 炙甘草（一钱）
虚兼寒者，加熟附子、肉桂、生姜少许。
《集成》塌气丸 治寒郁结，肚腹虚胀。
胡椒仁 全蝎尾（去钩子，洗净炒干）
上以胡椒略去皮去净一两，炒过，和蝎尾碾末，面糊为丸，极小。每服一二钱，陈皮汤送下。
沆瀣丹（见前伤湿方内）
《集成》三仙丹
五灵脂（二两） 广木香（五钱） 巴豆仁（四十粒，去净油） 醋打曲糊为
丸绿豆大，朱砂为衣，量儿大小服之。
异功散
白术（一钱） 茯苓（一钱） 党参（一钱） 甘草（一钱） 陈皮（一钱）
荆防败毒散
芥穗（一钱） 防风（一钱） 连翘（一钱） 枳壳（七分） 升麻（五分） 薄荷（一钱） 羌活（七分）
独活（五分） 粉葛根（一钱） 川木通（一钱） 金银花（一钱） 黄芩（一钱） 川芎（五分） 栀子仁（一钱）
甘草（一钱）
上身肿，加葱三茎；下体肿，加灯草十茎，清水煎服。
涂蔚生曰∶陈飞霞谓虚胀，或因吐泻之后，或因攻伐太过，致成腹胀。然吐则伤阳，泻则伤阴，而攻伐之足以
伤阳伤阴，亦无异于吐泻。阴阳既形损伤，则滋阴补阳，即不容或已，岂容再施消导者哉？查浓朴温中汤原方，多系
破气之药，于此证未免失宜。余以为宜用六君子汤，稍加木香为佐，既无虚虚之患，又无实实之嫌。临时能因其
寒热，而加桂附归芍枳查芩连等味，而虚寒实热之胀，亦无不左宜右宜也。
《黄帝内经》说：足太阴脾经虚弱，就会出现鼓胀。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。陈飞霞说：所谓胀满，就是腹部胀大、气机壅滞。这是因为脾肺两脏不能正常运化水谷精微，所以导致胀满。胀满分为虚胀、寒胀、实胀、热胀四种类型。大体上，虚胀和寒胀占十分之八九，实胀和热胀占十分之二三。因为实热证候，人们容易察觉，多是由于饮食积滞或伤寒病邪入里化热所致，所以容易诊断也容易治疗。而虚寒证候，是由于中气衰弱，脾气无法运化水湿而导致胀满，所以容易被忽视且难以医治。如果把虚寒引起的胀满误认为是实热胀满来治疗，其产生的变证将不可胜数。
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，加入桂枝和附子。实胀，是因为腹中原有食积，或者因为饮食过饱，食物固结在肠胃之中。外在症状表现为胃口及胸前部位高起胀满，身体发热口渴，疲倦嗜卧不愿说话，腹痛伴有轻微气喘，眼睛闭合不睁，看起来像是极度虚弱的样子。小儿患此证最多且最难识别。庸医如果不仔细审察，见到患儿四肢不能抬举、口闭不开，就误以为是慢惊风（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，十个人中十个都会死亡，没有一个能活下来。他们不知道“大实有羸状”（真实的实证有时表现出虚弱的假象）的道理，指的就是这种情况。此时应当紧急使用泻下法，服用集成沆瀣丹和集成三仙丹。
热胀，可能是由于伤寒热邪入里，导致大便闭结不通，小便短少色赤，全身高热，面色红赤烦躁不安，可用集成沆瀣丹。寒胀，是由于中气素来虚寒，冷滞郁结在体内，没有身热口渴的症状，表现为面色和嘴唇青紫，手足厥冷，气喘且腹胀。先用塌气丸来消除寒凝，再用异功散调理脾胃。
凡是遍身生疮疥，因为淋洗涂搽药物，迫使毒邪内陷归入脏腑而导致腹胀的，病情轻的用荆防败毒散升散透邪，病情重的用集成沆瀣丹轻微通利。如果疮毒发出后胀满消退的预后良好，如果疮毒发不出来的预后凶险。经文说“脏寒生胀满”，大概是因为脾为阴中之至阴，如果脾湿过重，阳气火气不能施化运湿，就像土地长期浸泡在雨水中变成淤泥一样，怎么能生育万物呢？必须等待和风日暖，湿气去除阳气生发，才能自然生长。凡此情况适宜运用辛热的药物。经文说“下之则胀已”（通过泻下法胀满即可消除），这是针对湿热饮食有余、脾胃素来强盛、形体气质壮实的人而言的。如果是脾虚内寒，气机不能运化精微物质而形成胀满的，只适宜以甘温补脾为主，稍微佐以辛热药物，以行散壅滞的气机。这样能使脾土健旺，胀满得以营运，才可以痊愈。这就是经文所说的“塞因塞用”（用补益的方法治疗闭塞不通的病证），属于从治（顺从疾病假象而治）的方法。医生如果不加考察，只执着于“下之则胀已”的说法，急于求效；病人也喜欢用泻下药，以求一时的痛快。却不知道暂时痛快一时，真气却更加受伤，胀满反而更严重，离死不远了。
浓朴温中汤：治疗胃寒引起的心腹胀痛。
川朴（七分） 陈皮（一钱） 黑姜炭（一钱） 茯苓（一钱） 草蔻仁（六分） 木香（五分） 炙甘草（一钱）
如果是虚证兼有寒象的，加入熟附子、肉桂、生姜少许。
《集成》塌气丸：治疗寒郁结聚，肚腹虚胀。
胡椒仁 全蝎尾（去掉钩子，洗净炒干）
以上取略去皮去净的一两胡椒，炒过后，与蝎尾一起碾成粉末，用面糊做成丸子，极小。每次服用一二钱，用陈皮汤送服。
沆瀣丹（见前文伤湿方剂内）
《集成》三仙丹
五灵脂（二两） 广木香（五钱） 巴豆仁（四十粒，去净油） 醋打曲糊为丸如绿豆大，朱砂为衣，根据儿童大小服用。
异功散
白术（一钱） 茯苓（一钱） 党参（一钱） 甘草（一钱） 陈皮（一钱）
荆防败毒散
芥穗（一钱） 防风（一钱） 连翘（一钱） 枳壳（七分） 升麻（五分） 薄荷（一钱） 羌活（七分） 独活（五分） 粉葛根（一钱） 川木通（一钱） 金银花（一钱） 黄芩（一钱） 川芎（五分） 栀子仁（一钱） 甘草（一钱）
上身肿胀，加葱三茎；下体肿胀，加灯心草十茎，清水煎服。
涂蔚生说：陈飞霞认为虚胀，可能是因为呕吐腹泻之后，或者因为攻伐太过，导致形成腹胀。然而呕吐会损伤阳气，腹泻会损伤阴液，而攻伐之法足以损伤阳气和阴液，这与吐泻没有区别。既然阴阳已经受到损伤，那么滋阴补阳就不容片刻停止，怎么还能再施用消导破气的药物呢？查阅浓朴温中汤原方，大多属于破气类药物，对于这种证候未免失宜。我认为应该使用六君子汤，稍加木香作为辅助，既没有使虚者更虚的祸患，也没有使实者更实的嫌疑。临时若能根据其寒热属性，加入桂枝、附子、当归、白芍、枳实、柴胡、黄芩、黄连等药物，那么虚寒和实热引起的胀满，就没有不适宜治疗的了。
The *Yellow Emperor's Inner Canon* states: When the Foot-Taiyin Spleen Meridian is deficient, drum-like distension occurs. It also states: Cold in the Stomach leads to fullness and distension. Furthermore: When turbid Qi stagnates in the upper jiao, distension arises. Chen Feixia stated: "Distension and fullness refer to abdominal enlargement and Qi stagnation. This occurs because the Spleen and Lungs fail to transport and transform effectively." Distension is categorized into deficiency distension, cold distension, excess distension, and heat distension. Generally, deficiency and cold distensions account for eight or nine-tenths of cases, while excess and heat distensions 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 weakened Middle Qi and the Spleen's inability to transform dampness, making them difficult to detect and treat. If deficiency-cold distension is mistakenly treated as excess-heat distension, the resulting complications will be countless.
Deficiency distension may arise after vomiting or diarrhea, or due to excessive purgative medication, leading to abdominal distension. The appropriate treatment is to warm the middle and regulate Qi using Nongpo Wenzhong Tang (Magnolia Bark Decoction to Warm the Middle); if deficiency is accompanied by cold, add Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root). Excess distension occurs when there is pre-existing food accumulation in the abdomen, or due to overeating causing food to consolidate in the middle jiao. External signs include high swelling at the epigastrium and chest, fever, thirst, lethargy with a desire to lie down and silence, abdominal pain with slight wheezing, eyes closed and unopen, resembling an extreme state of deficiency. This condition is most common in children and difficult to identify. Unskilled physicians, failing to examine carefully, may mistake the inability to move limbs and closed mouth for Man Feng (Slow Wind/Chronic Convulsion), and administer calming and phlegm-resolving drugs. In ten cases, all ten die, with none surviving. They fail to understand the principle that "great excess can manifest as weakness," which refers precisely to this situation. Urgent purgation is required, administering Jicheng Hangxie Dan (Jicheng Cang Lake Pill) and Jicheng Sanxian Dan (Jicheng Three Immortals Pill).
Heat distension may result from heat pathogens of Shanghan (Cold Damage) entering the interior, causing constipation, scanty dark urine, high fever, red face, and irritability; Jicheng Hangxie Dan is indicated. Cold distension results from inherent Middle Qi coldness, with cold stagnation and knotting internally. There is no fever or thirst; instead, there is cyanosis of the face and lips, cold extremities, wheezing, and abdominal distension. First, use Taqi Wan (Collapse Qi Pill) to resolve cold stagnation, followed by Yigong San (Benefit Labor Powder) to regulate the Spleen and Stomach.
For generalized sores and scabies, where bathing and topical applications force toxins inward, causing abdominal distension: for mild cases, use Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Defeat Toxins) to raise and disperse; for severe cases, use Jicheng Hangxie Dan to mildly purge. If distension resolves after sores erupt, the prognosis is auspicious; if sores do not erupt, it is ominous. The Classic states "Cold in the Zang organs generates distension," implying that the Spleen is the ultimate Yin within the Yin. If Spleen dampness is excessive and Yang fire cannot transform it, it is like soil soaked in rain turning to mud, unable to nourish all things. One must wait for gentle winds and warm sun to remove dampness and generate Yang for natural growth. Such cases are suitable for treatment with acrid-hot herbs. The statement "Purgation resolves distension" applies only to those with excess damp-heat and food retention, robust Spleen-Stomach constitution, and strong physical temperament. For those with Spleen deficiency and internal cold, where Qi fails to transport fine essences, causing distension, one should primarily use sweet-warm herbs to tonify the Spleen, slightly assisting with acrid-hot herbs to move stagnant Qi. This allows the Spleen Earth to become robust and distension to circulate, leading to recovery. This is what the Classic calls "treating obstruction with obstruction" (using tonification for blockage symptoms), a method of following the disease's false presentation. Physicians who fail to investigate and cling to "purgation resolves distension," seeking quick results, and patients who prefer purgatives for immediate relief, do not realize that temporary relief injures True Qi further and worsens distension, bringing death near.
Nongpo Wenzhong Tang (Magnolia Bark Decoction to Warm the Middle): Treats epigastric and abdominal distension due to Stomach cold.
Chuan Po (Magnoliae Officinalis Cortex, 0.7 qian) Chenpi (Citri Reticulatae Pericarpium, 1 qian) Heijiangtan (Zingiberis Rhizoma Carbonized, 1 qian) Fuling (Poria, 1 qian) Cao Kouren (Amomi Fructus Rotundus Seed, 0.6 qian) Muxiang (Aucklandiae Radix, 0.5 qian) Zhigancao (Glycyrrhizae Radix et Rhizoma Prepared with Honey, 1 qian).
For deficiency with cold, add Shu Fuzi (Aconiti Lateralis Radix Praeparata), Rougui (Cinnamomi Cortex), and fresh Ginger in small amounts.
Jicheng Taqi Wan (Jicheng Collapse Qi Pill): Treats cold stagnation and knotting, abdominal deficiency distension.
Hujiaoren (Piperis Longi Fructus) Quanxieweii (Scorpio Tail, hooks removed, washed and stir-fried dry).
Take approximately 1 liang of Hujiaoren with skin removed, stir-fry, mix with powdered Scorpion tails, form pills with wheat paste, very small. Take 1-2 qian per dose, delivered with Chenpi decoction.
Hangxie Dan (See previous formula for Dampness Injury).
Jicheng Sanxian Dan (Jicheng Three Immortals Pill)
Wulingzhi (Trogopterori Faeces, 2 liang) Guangmuxiang (Aucklandiae Radix, 5 qian) Badouren (Crotonis Fructus Kernel, 40 grains, oil completely removed). Form pills with vinegar-treated Qu paste, size of mung beans, coated with Cinnabar. Dosage according to child's age.
Yigong San (Benefit Labor Powder)
Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian) Fuling (Poria, 1 qian) Dangshen (Codonopsis Radix, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian) Chenpi (Citri Reticulatae Pericarpium, 1 qian).
Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Defeat Toxins)
Jiesui (Schizonepetae Spica, 1 qian) Fangfeng (Saposhnikoviae Radix, 1 qian) Lianqiao (Forsythiae Fructum, 1 qian) Zhiqiao (Aurantii Fructus Immaturus, 0.7 qian) Shengma (Cimicifugae Rhizoma, 0.5 qian) Bohe (Menthae Haplocalycis Herba, 1 qian) Qianghuo (Notopterygii Rhizoma et Radix, 0.7 qian) Duohuo (Angelicae Pubescentis Radix, 0.5 qian) Fengegen (Puerariae Lobatae Radix, 1 qian) Chuantong (Lini Semen, 1 qian) Jinyinhua (Lonicerae Japonicae Flos, 1 qian) Huangqin (Scutellariae Radix, 1 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma, 0.5 qian) Zhiziren (Gardeniae Fructus Seed, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian).
For upper body edema, add 3 stalks of Congbai (Allii Fistulosi Bulbus); for lower body edema, add 10 stalks of Dengcao (Junci Medulla). Decoct in clear water.
Tu Weisheng commented: Chen Feixia stated that deficiency distension may arise after vomiting/diarrhea or excessive purging. However, vomiting injures Yang, and diarrhea injures Yin; purging also injures both Yang and Yin, similar to vomiting and diarrhea. Once Yin and Yang are damaged, tonifying Yin and Yang is imperative; how can one continue to use resolving and draining methods? Examining the original Nongpo Wenzhong Tang, it consists mainly of Qi-breaking herbs, which is inappropriate for this condition. I believe Liu Junzi Tang (Six Gentlemen Decoction) should be used, with slight addition of Muxiang as an assistant. This avoids worsening deficiency or exacerbating excess. Temporarily, based on cold or heat, one can add Guizhi, Fuzi, Danggui, Baishao, Zhishi, Chaihu, Huangqin, Huanglian, etc., making the treatment suitable for both deficiency-cold and excess-heat distensions.