而疗之，实者涤之，虚者补之，寒者热之，热者清之，结者散之，留者行之，在血分则通其血，在气分则行其
气，始可万全，不致殆矣。（《奇效》）
夫风寒之邪，自外入里，寒变为热，胃实腹胀，谵语，大渴引饮，承气汤下之。伤暑潜伏，至秋 疟，病作
胀满，交加饮子（此方系肉果、草果、浓朴、甘草、生姜）。有内伤饮食停滞，嗳饱而胀者，木香槟榔丸，或
加味枳术汤。若伤酒食面及浓味之物，膏粱之人，或食已便卧，使湿热之气不化，致令腹胀，胃苓汤，或中满
分消丸。湿多小水不利，加木通、滑石，或大橘皮汤。热多者，加黄连、山栀。因于劳倦，伤损脾胃，不能运化
而胀，补中益气汤，加砂仁、神曲。或饮食所伤，脾胃虚弱，以致水谷聚而不化，此寒湿郁遏而胀，用香砂调
中汤。大怒而胀者，分心气饮。忧思过度者，紫苏子汤。有因积聚相攻，或疼或胀者，初作，七气消聚散；日
久，元气虚，脾胃弱而胀者，参术健脾汤，少佐消导药。瘀蓄死血而胀，腹皮上见青紫筋，小水反利，脉芤涩，
妇人多有此疾，先以桃仁承气汤；势重者，抵当汤；如虚人不可下者，且以当归活血散调治。浊气在上，干扰
清阳之气，菀而不伸，则生 胀，木香顺气汤，或沉香交泰丸。幽门不通，润燥丸。大病后饮食失调，脾胃受
伤，运化且难而生胀者，先以化滞调中汤，次以参苓白术散。泻痢后并过服通利药，以致脾胃太弱而胀，专以
补脾为主。若泻痢未止，或胃风汤兼用。（《统旨》）
腹胀诸证，虽属寒者多，属热者少，然世治胀，喜用辛温散气药，即使湿热作胀，亦必赖辛温之品以散气，
气散则胀满亦宽，但须以去湿热之药为主，而兼辛温为引导则可。然又有火盛阴虚，热乘血分者，其腹虽胀而
不甚大，按
之益坚，小便黄赤，大便秘涩，至夜则微热，其脉数实而细小，不可误作食积、湿热治，盖消导则阴愈伤，去
湿则津愈涸矣。宜用极苦极寒之药，如当归龙荟丸，或四物汤加宣胡二连、芦荟，俱用醋制，可一服而效也。有
气虚不能裹血，血散作胀，必其人大便不坚，或时结时溏，溏则稍减，结则渐加，小便清利，甚则浑白如泔，其
脉缓大而滞，气口益甚，慎不可用辛温耗气之药，宜四君子去白术，加木香、泽泻、当归、芍药，以固其气中
之血。有血虚不能敛气，气散作胀，必其人烦热便燥，小便黄数，其脉浮数而弦，人迎尤甚，慎不可用苦寒伤胃
之药，宜四物汤去地黄，加黄 、肉桂、甘草、煨姜，以和其血中之气。忧思过度，致伤脾胃，心腹膨胀，喘促
烦闷，肠鸣气走，漉漉有声，大小便不利，脉虚而涩，局方七气汤。浊气在上，则生 胀，生姜泻心汤，加木香、
浓朴。脾胃不温，不能腐熟水谷而胀，附子理中汤。肾脏虚寒，不能生化脾土而胀，济生肾气丸。中满，腹内坚
硬如盘，不能坐卧，大小便涩滞，上气喘促，面色痿黄，通身虚肿者，此寒热错杂胶固于中，营卫血气凝滞于内
也，分消汤、分消丸，详寒热多少，或加减用之，诸七气选用亦可。气口脉紧滑，恶心饱闷，口干内热者，是食
积，枳实导滞丸。饱食奔走，或跌扑凝血不散，或妇人血聚而成肿胀，腹上有青紫筋，腹中按之疼，脉来弦涩，
当作蓄血治之。怒甚气逆，腹胁胀满，两手脉弦，青皮、陈皮、木香、山栀、柴胡、枳壳、归尾、桃仁、芍药、
薄桂。嗜酒之人，病腹胀如斗，前后溲便俱有血，用利药转加，其脉数而涩，此得之湿热伤脾阴，不能统血，胃
虽受谷，脾不输运，故成痞胀，当理脾气，祛湿热，兼养血之剂，如枳实、黄连、炮姜、半夏、茯苓、当归、芍
药、阿胶、乌梅、砂仁之类，白
芍、乌梅收脾阴，黄连、枳实泻胀满，归、胶补营血，苓、半去涎饮，砂仁醒脾气也。倘触动平昔所蓄之湿热，
胀满逆上喘急者多死，下利不止者亦死。（《医通·腹满门》）
夫胀皆脾胃之气虚弱，不能运化精微，致水谷聚而不散，故成胀满。饮食不节，不能调养，则清气下降，浊
气填满胸腹，湿热相蒸，遂成此证。小便短涩，其病胶固，难以治疗，用半补半泻之法，健脾顺水宽中为主，不
可过用猛烈，反伤脾胃，病再复胀，不可治也，宜分消汤、分消丸，随寒热虚实加减治之。蓄血成胀，腹上青紫
筋见，或手足有红缕赤痕，小水利，大便黑，《金匮》下瘀血汤；不应，抵当丸去水蛭，加樗鸡，作丸，空腹日
进梧子大三丸，血下止后服，轻则散血消胀汤。妇人血肿烦躁，漱水不欲咽，神昏善忘，小便多，大便黑，散血
消胀汤。虚人血蛊，琥珀人参丸。或因产崩血虚，或瘀血不散，亦成肿胀，其人必脉涩面黑，不可作水湿治之。
如面色枯槁，肢体消瘦，单腹胀急而块垒不平者，皆属火胀，此非水肿，无虑助肾水之邪也。若脉弦细涩，虽能
饮食，终亦必亡。火肿误服《金匮》肾气等药，急投连、柏、金铃、白芍之类，仍用桂、附少许，为热因热用之
向导，庶可挽回。若喘泻肢枯，脉无胃气者，不救。（同上《鼓胀门》）
虫鼓 （互见蛔虫门）人有单腹胀满，四肢手足不浮肿，经数年不死者，非水鼓也。盖水鼓不能越两年，
未有不皮肤流水而死者。今经数年不死，皮肤又不流水，岂是水鼓之证，乃虫结于血之中，似鼓而非鼓也。夫此
证何因而得？饮食之内或食生菜，而有恶虫之子，入腹而生虫，或食难化之物，久变为虫，血即裹之不化，日
积月累，血块渐大，虫生遂多，所用食物止供虫食，即水谷入腹所化之血，亦为虫之
外郭，而不能灌注于各脏腑矣。或问∶此等之病既非水鼓，初起之时，何以知其是虫鼓与血鼓也？吾辨之于面焉
，凡面色淡黄之中，而有红点或红纹者是也；更验之于腹焉，凡未饮食而作疼，既饮食而不痛者是也。（《辨证
录》）
变证 久胀不已，则食不消而变下痢。所以然者，脾胃为表里，脾土消水谷，胃为水谷之海，脾虚，寒气
积久，脾气衰弱，故食不消也。而冷移入大肠，大肠为水谷糟粕之道路，虚而受冷，故变为痢也。（《病源论
》）（按∶《圣济》曰∶脾胃既虚，则难以腐熟水谷，故胀久不已，则令人变饮湿之疾。）
胀满不已，变证多端，或肠鸣气走漉漉有声，或两胁腰背痛连上下，或头痛呕逆，或胸满不食，或大小便为之
不利，未有不因胀满而枝蔓焉。（《济生》）
死证 其若久病羸乏，卒然胀满，喘息不得，与夫脐心突起，或下利频频，百药遍尝，未见一愈者耳。
（《直指》）
胀满得之未久，或胀或消，腹皮稍软，不泄不喘，随治随瘥。若脐心突起，利后复胀急，久病羸乏，喘息不
得安，名曰脾胃俱败，无有愈期。（《得效》）
前贤论蛊肿之证有五不治者，面黑如霉，肚大青筋，掌中无纹，脚肿无坑，脐中凸起。此五证亦能治之，间
有得生者。如败下黑水者不治，阳事不举者不治。（《寿世》）
至咳嗽失音，青筋横绊腹上，及爪甲青，卒肿，头面苍黑，呕吐头重，上喘下泄者，皆不治。腹胀误用攻药，
暂宽复胀者，皆不治。（《医通》）
治法概略 中满者泻之于内，谓脾胃有病，当令上下分消其湿，下焦如渎，气血自然分化，不待泄滓秽。
（《兰室秘藏》）（按∶此下文既录在辨证要领中，宜并参。）
胀满属寒，或内伤，或诸气，或因病数服通利药，脾胃虚而致者为甚多，属湿热者少，至积成者亦甚有之。
但古方多不分治，如禹余粮丸类，燥热气血之剂，于内郁之火，岂得不反有所助邪。夫治是疾，遇大实满燥实，
痞闭气滞，或始由内伤，脉洪实者，非下之不可。然有服下剂过多，或泻痢后所致，或素脾胃虚弱，不能运化
而成者，皆宜补脾行湿。盖此际正气已衰矣，况积而胀乎，故云平治之。又如血蓄血瘀致者，当从血药治之。
寒者热之，热者寒之，结者散之，清浊混者分消之，或升降其气，或消导，皆宜适事为故可也。（《玉机》）
胀满多因以渐而成，非一朝一夕之故，必须分其有余不足、新久浅深、寒热之异，然后或分消，或消导，
或升降，或散坚，或健脾胃，或扶正气，寒者热之，热者寒之，皆宜随证加减，切不可妄下。大抵寒胀多，热
胀少，脉浮实者易治，脉沉虚者难治。然因脾胃虚而致者为甚多，属湿热少，至积成者，亦甚有之。如初起大实
大满，气滞内伤，脉洪实者，非下不可，又不必拘泥。且先以疏利，利后便宜调养。若补之太早，邪气愈盛，
则胀满渐加，虽欲攻利，邪不能伏而反有所助也。治之者当识先后虚实，斟酌用药，量其脉证为的确也。（《统
旨》）
胀满之疾，虽亦腹胀，却不至肿，不如鼓胀之生死相关。或因伤食，消导可已。或因气滞，行气即痊。有久
有暂，实者峻下之，上郁则夺之也。蓄血者，用破血药。病后气虚作胀，惟补益元气，使元气归元即愈。（《沈
氏》）
治宜理脾肺肾不宜利药 验之治法，理宜补脾，又须养肺金以制木，使脾无贼邪之虑，滋肾水以制火，
使肺得清化之令，却盐味以防助邪，断妄想以保母气，无有不安。医
不察病起于虚，急于作效， 能希赏。病者苦于胀急，喜行利药，以求一时之快。不知宽得一日半日，其肿愈
甚，病邪甚矣，真气伤矣，去死不远。古方惟禹余粮丸，又名石中黄丸，又名紫金丸，制肝补脾，殊为切当，亦
须随证，亦须顺时加减用之云云。此病之起，或三五年，或十余年，根深矣，势笃矣，欲求速效，自求祸耳。
知王道者，能治此病也。或曰∶胀病将终，不可与利药耶？予曰∶灼知其不因于虚，受病亦浅，脾胃尚壮，积滞
不痼，而又有可下之证，亦宜略与疏导。若援张子和浚川散、禹功丸为例，行迅攻之策，实所不敢。（《格致余
论》）
治宜温补下元 （治验）胀满之疾，谷食不消，小便不利，腹皮胀急而光，内空空然如鼓是矣。俗知谓之
鼓胀，不察其致之者有由也。《内经》曰∶胀取三阳。三阳者，足太阳寒水膀胱经也。《灵枢经》曰∶下焦溢而
为水。《灵兰秘典》曰∶膀胱者，州都之官，津液藏焉，气化则能出矣。历考三书，可见小便之不利，由下焦元
气虚寒，以致湿气壅遏于肤里膜外之间，不得发越，势必肿满，是肿满之疾，起于下元虚寒也。若非温补下元，
则小便何能独利。且夫人之胃，如釜甑然，釜底火旺，则热气熏蒸，甑炊易熟。若徒有水而无火，则无气上升，
物何由熟，即此可以例观矣。故治胀满者，先宜温补下元，使火气盛而温气蒸发，胃中温暖，谷食易化，则满可
宽矣。夫清气既升，则浊气自降，浊气降则为小便也，小便利，胀有不消乎。语谓地气上为云，天气下为雨，惟
此气流行，斯为云为雨也。今之医者，一遇此疾，则曰《内经》有言，诸湿肿满，皆属脾土。土虚则湿停，湿停
则渗透肌肤，遍身肿满，不可不通利也。辄用利小便及补中之剂，如五苓散、胃苓汤加木通、车前子、大腹皮、
滑石之
类，法未为爽，然乎谬乎？顾服之愈多而小便愈少，肿胀愈急，何故哉？不温补下元，而徒以通利之药施之也。
果若此，岂惟不效，则下元益虚，真气益弱，死期且至，安望其有瘳乎。余尝究心《灵·素》。参会易理，憬然
有得于中，且施之病者，随试辄效，故笔之于册，以公我之同志。（《赤水》）（按∶此论为壮原汤而发，其
方今录在《水气》中。）
石顽治文学顾若雨，鼓胀喘满，昼夜不得寝食者二十余日。吾吴名医，用大黄三下不除，技穷辞去。更一医，
先与发散，次用消克破气二十余剂，少腹至心下，遂坚满如石，腰胁与 中皆疼痛如折，亦无措手而退。彼戚
王墨公邀余往诊，脉得弦大而革，按之渐小，举指复大。询其二便，则大便八九日不通，小便虽少而清白如常。
此由克削太过，中气受伤，浊阴乘虚，僭据清阳之位而然。以其浊气上逆，不便行益气之剂，先与生料六味丸，
加肉桂三钱，沉香三分，下黑锡丹二钱，导其浊阴。是夜即胀减六七，胸中觉饥，清晨便进糜粥，但腰胯疼软，
如失两肾之状。再剂胸腹全宽，少腹反觉微硬，不时攻动。此大便欲行，津液耗竭，不能即去故也。诊其脉仅
存一丝，改用独参汤，加当归、枳壳，大便略去结块，腰痛稍可，少腹遂和。又与六味地黄，仍加肉桂、沉香，
调理而安。（《医通》）
温中消胀诸方 殿中丞郭中妹十岁，病腹色不变，按之而大，不陷，心腹下痞满，得之因取转数多，
病已月余。兆按《甲乙经》云∶三焦胀者，气满于皮肤中，壳然不坚。遂与仲景浓朴生姜半夏甘草人参汤，小
其服，凡经二十日，胀消而已。（《鸡峰》）
大半夏汤，主胃中虚冷，腹满塞下气方。
半夏（一升） 大枣（二十枚） 甘草 附子 当归 人参
浓朴（各二两） 桂心（五两） 生姜（八两） 茯苓 枳实（各二两） 蜀椒（二百粒）
治疗胀满病，实证用泻下法清除积滞，虚证用补益法扶助正气，寒证用温热药驱散寒气，热证用寒凉药清解热邪，气结者用消散法疏通郁结，水湿停留者用行气化湿法促进运行。病在血分则疏通血液，病在气分则调畅气机，这样才能万无一失，避免医疗危险。（《奇效良方》）
风寒之邪从体表侵入体内，寒邪转化为热邪，导致胃腑实热、腹部胀满、胡言乱语、极度口渴想喝水，此时应用承气汤类方剂攻下泄热。若因伤暑潜伏，至秋季发作疟疾，病情发作时出现胀满，可用交加饮子（此方由肉豆蔻、草果、厚朴、甘草、生姜组成）。若有内伤饮食停滞，嗳气饱胀而致腹胀，可用木香槟榔丸，或加味枳术汤。若是因饮酒、吃面食及肥甘厚味之物，多见于膏粱之人，或者饭后立即躺卧，致使湿热之气不能运化，导致腹胀，可用胃苓汤，或中满分消丸。若湿气偏重且小便不利，可加木通、滑石，或用大橘皮汤。若热邪偏重，可加黄连、山栀。因劳累过度，损伤脾胃，不能运化水谷而致腹胀，可用补中益气汤，加砂仁、神曲。或因饮食所伤，脾胃虚弱，导致水谷聚集而不能消化，这是寒湿郁遏所致腹胀，可用香砂调中汤。大怒后致腹胀，用分心气饮。忧思过度致腹胀，用紫苏子汤。有因积聚相互攻冲，或疼痛或腹胀的，初起时用七气消聚散；日久元气虚弱，脾胃软弱而腹胀的，用参术健脾汤，稍加消导药物。瘀血蓄积死血而致腹胀，腹皮上可见青紫色筋脉，小便反而通畅，脉象芤涩，妇人常有此疾，先用桃仁承气汤；病情严重的，用抵当汤；如果是体虚之人不可攻下的，暂且用当归活血散调理治疗。浊气停留在上部，干扰清阳之气，郁结而不伸展，则产生胀满，用木香顺气汤，或沉香交泰丸。幽门不通，用润燥丸。大病之后饮食失调，脾胃受伤，运化困难而生胀的，先用化滞调中汤，再用参苓白术散。泻痢之后并过服通利药物，致使脾胃太弱而腹胀，专门以补脾为主。如果泻痢未止，可将胃风汤兼用。（《医统正脉全书·统旨》）
腹胀的各种证候，虽然属寒的多，属热的少，然而世人治疗胀满，喜欢使用辛温理气药，即使是湿热引起的胀满，也必定依赖辛温之品来理气，气机疏散则胀满也会缓解，但必须以去除湿热的药物为主，兼用辛温药作为引导即可。然而又有火盛阴虚，热邪侵入血分的，其腹部虽然胀满但不甚大，按压时更加坚硬，小便黄赤，大便秘结涩滞，到了夜间则有轻微发热，脉象数实而细小，不可误认为是食积、湿热来治疗，因为消导会进一步损伤阴液，祛湿会使津液更加枯竭。适宜使用极苦极寒的药物，如当归龙荟丸，或四物汤加宣胡连、芦荟，均用醋制，可以一服药就见效。有因气虚不能固摄血液，血液散乱而致胀的，必定其人大便不坚硬，有时干结有时稀溏，稀溏时症状稍减，干结时逐渐加重，小便清长通畅，严重时浑浊如米泔水，脉象缓大而滞涩，气口脉尤为明显，千万不可用辛温耗气的药物，宜用四君子汤去白术，加木香、泽泻、当归、芍药，以巩固气中的血。有因血虚不能收敛气机，气机散乱而致胀的，必定其人烦热、大便干燥，小便黄而频数，脉象浮数而弦，人迎脉尤为明显，千万不可用苦寒伤胃的药物，宜用四物汤去地黄，加黄芪、肉桂、甘草、煨姜，以调和血中的气。忧思过度，损伤脾胃，心腹胀满，气喘急促烦闷，肠鸣气体走动，漉漉有声，大小便不利，脉虚而涩，用局方七气汤。浊气在上，则产生胀满，用生姜泻心汤，加木香、厚朴。脾胃不温暖，不能腐熟水谷而致腹胀，用附子理中汤。肾脏虚寒，不能生化脾土而致腹胀，用济生肾气丸。中满证，腹内坚硬如盘，不能坐卧，大小便涩滞，上气喘促，面色萎黄，全身虚肿的，这是寒热错杂胶固于中焦，营卫气血凝滞于体内的表现，用分消汤、分消丸，详细辨别寒热多少，加减使用，诸种七气汤选用亦可。气口脉紧滑，恶心饱闷，口干内热的，是食积，用枳实导滞丸。饱食后奔走，或跌打损伤凝血不散，或妇人血聚而成肿胀，腹上有青紫色筋脉，腹部按压疼痛，脉来弦涩，当作蓄血证治疗。大怒气逆，腹胁胀满，两手脉弦，药用青皮、陈皮、木香、山栀、柴胡、枳壳、归尾、桃仁、芍药、薄桂。嗜酒之人，患腹胀如斗，前后二便均有血，用利药后症状加重，脉数而涩，这是由于湿热损伤脾阴，不能统摄血液，胃虽受纳谷物，脾不输布运化，故成痞胀，应当调理脾气，祛除湿热，兼用养血药剂，如枳实、黄连、炮姜、半夏、茯苓、当归、芍药、阿胶、乌梅、砂仁之类，白芍、乌梅收敛脾阴，黄连、枳实泻除胀满，当归、阿胶补养营血，茯苓、半夏去除痰涎饮邪，砂仁醒脾开胃。倘若触动平日所蓄积的湿热，胀满逆上气喘急迫的多死亡，下利不止的也死亡。（《医学入门·腹满门》）
胀满皆因脾胃之气虚弱，不能运化精微物质，导致水谷聚集而不散，所以形成胀满。饮食不节制，不能调养身体，则清气下降，浊气填满胸腹，湿热相互蒸腾，遂成此证。小便短少涩滞，病情胶着顽固，难以治疗，用半补半泻的方法，以健脾、利水、宽中为主，不可过用猛烈药物，反而损伤脾胃，疾病再次复发胀满，就无法治愈了，宜用分消汤、分消丸，根据寒热虚实加减治疗。蓄血成胀，腹上青紫色筋脉显现，或手足有红缕赤痕，小便通畅，大便黑色，《金匮要略》的下瘀血汤；无效，用抵当丸去掉水蛭，加樗鸡，制成丸药，空腹每日进服三梧子大小的丸药，血下停止后服用，轻症用散血消胀汤。妇人血肿烦躁，漱水不欲咽，神志昏沉健忘，小便多，大便黑，用散血消胀汤。体虚人的血蛊，用琥珀人参丸。或因生产崩漏失血虚，或瘀血不散，也成肿胀，其人必定脉涩面黑，不可当作水湿证治疗。如果面色枯槁，肢体消瘦，单腹胀急且块垒不平的，都属于火胀，这不是水肿，不用担心助长肾水之邪。如果脉弦细涩，虽然能进食，最终也必亡。火肿误服《金匮》肾气丸等药，急投黄连、黄柏、金铃子、白芍之类，仍用少许桂枝、附子，作为热因热用的向导，或许可以挽回。如果喘息腹泻、肢体枯瘦，脉无胃气的，无法救治。（同上《鼓胀门》）
虫鼓 （互见蛔虫门）有人单侧腹部胀满，四肢手足不浮肿，经过数年不死，这不是水鼓。大概水鼓不能超过两年，没有不皮肤流水而死的人。现在经过数年不死，皮肤又不流水，怎么是水鼓的证候呢？乃是虫结于血中，似鼓而非鼓。这种证候是什么原因得的？饮食之中吃了生菜，而有恶虫的卵，入腹而生虫，或吃了难消化的东西，久变为虫，血液包裹它不消化，日积月累，血块渐大，虫生遂多，所用的食物只供给虫吃，即水谷入腹所化的血，也成为虫的外郭，而不能灌注到各脏腑了。有人问：这种病既然不是水鼓，初起的时候，怎么知道是虫鼓与血鼓呢？我从面色上辨别它，凡是面色淡黄之中，而有红点或红纹的就是；再验之于腹部，凡是未吃东西时疼痛，吃完东西后不痛的，就是。（《辨证录》）
变证 久胀不已，则食物不消化而变成下痢。之所以这样，是因为脾胃互为表里，脾土消化水谷，胃为水谷之海，脾虚，寒气积久，脾气衰弱，所以食物不消化。而冷气移入大肠，大肠为水谷糟粕的道路，虚而受冷，所以变成痢疾。（《诸病源候论》）（按：《圣济总录》说：脾胃既已虚弱，则难以腐熟水谷，所以胀久不已，就会让人变成饮湿之疾。）
胀满不已，变证多端，有的肠鸣气体走动漉漉有声，有的两胁腰背痛连上下，有的头痛呕逆，有的胸满不食，有的大小便为之不利，无不因胀满而蔓延开来。（《济生方》）
死证 如果是久病身体羸弱疲乏，突然胀满，喘息不得，以及脐心突起，或下利频频，百药遍尝，未见一个痊愈的，（此为不治之症）。（《直指方》）
胀满得病不久，或胀或消，腹皮稍软，不泄不喘，随治随愈。如果脐心突起，泻后复胀急，久病身体羸弱疲乏，喘息不得安，名叫脾胃俱败，没有痊愈的日期。（《经验广集·得效方》）
前贤论述蛊肿之证有五不治者，面黑如霉，肚大青筋，掌中无纹，脚肿无坑，脐中凸起。这五种证候也能治疗，间或有得生的。如泻下黑水的，不治；阳事不举的，不治。（《寿世保元》）
至于咳嗽失音，青筋横绊腹上，及爪甲青，卒肿，头面苍黑，呕吐头重，上喘下泄的，皆不治。腹胀误用攻下药，暂时宽舒又复胀的，皆不治。（《医学入门》）
治法概略 中满者泻之于内，谓脾胃有病，当令上下分消其湿，下焦如渎，气血自然分化，不待泄去滓秽。（《兰室秘藏》）（按：此下文既录在辨证要领中，宜一并参考。）
胀满属寒，或因内伤，或因诸气，或因因病多次服用通利药，脾胃虚而导致的为甚多，属湿热的较少，至于积结成块的也有。但古方大多不分治，如禹余粮丸类，燥热气血的药剂，对于内郁之火，岂能不反有所助长邪气。治疗此疾，遇到大实满燥实，痞闭气滞，或始由内伤，脉洪实的，非攻下不可。然而有服用下剂过多，或泻痢后所致，或素来脾胃虚弱，不能运化而成的，都宜补脾行湿。盖此时正气已衰矣，何况积而成胀乎，所以说平治。又如血蓄血瘀导致的，当从血药治疗。寒者热之，热者寒之，结者散之，清浊混杂者分消之，或升降其气，或消导，都适宜根据具体情况而定即可。（《玉机微义》）
胀满多因逐渐而成，非一朝一夕的缘故，必须分辨有余不足、新久浅深、寒热之异，然后或分消，或消导，或升降，或散坚，或健脾胃，或扶正气，寒者热之，热者寒之，都适宜随证加减，千万不可妄用攻下。大抵寒胀多，热胀少，脉浮实的易治，脉沉虚的难治。然而因脾胃虚而导致的为甚多，属湿热少，至于积成的，也有。如初起大实大满，气滞内伤，脉洪实的，非攻下不可，也不必拘泥。且先以疏利，利后便宜调养。如果补之太早，邪气愈盛，则胀满渐加，虽然想攻利，邪气不能伏反而有所助长。治疗者应当识别先后虚实，斟酌用药，衡量其脉证为确切。（《医统正脉全书·统旨》）
胀满之疾，虽然也是腹胀，却不至肿，不如鼓胀之生死相关。或因伤食，消导可愈。或因气滞，行气即痊。有久有暂，实证峻下之，上郁则夺之也。蓄血的，用破血药。病后气虚作胀，惟补益元气，使元气归元即愈。（《沈氏尊生书》）
治宜理脾肺肾不宜利药 验证治疗方法，理应补脾，又须养肺金以制木，使脾无贼邪之虑，滋肾水以制火，使肺得清化之令，忌盐味以防助邪，断妄想以保母气，没有不安稳的。医生不察病起于虚，急于求效，希望能获赏。病人苦于胀急，喜欢用利药，以求一时之快。不知道宽得一日半日，其肿更甚，病邪更盛，真气受伤，离死不远。古方只有禹余粮丸，又名石中黄丸，又名紫金丸，制肝补脾，殊为切当，也必须随证，也必须顺时加减使用云云。此病的起因，或三五年，或十余年，根深了，势笃了，欲求速效，是自求祸耳。懂王道治法的，能治此病。有人说：胀病将终，不可给利药吗？我说：确知不因于虚，受病亦浅，脾胃尚壮，积滞不痼，而又可有下之证，也宜略予疏导。如果援引张子和浚川散、禹功丸为例，行迅攻之策，实在不敢。（《格致余论》）
治宜温补下元 （治验）胀满之疾，谷食不消，小便不利，腹皮胀急而光，内空空然如鼓是了。俗人知道叫它鼓胀，不考察其致病的原因。《内经》说：胀取三阳。三阳者，足太阳寒水膀胱经也。《灵枢经》说：下焦溢而为水。《灵兰秘典》说：膀胱者，州都之官，津液藏焉，气化则能出矣。历考三书，可见小便的不利，由下焦元气虚寒，以致湿气壅遏于肤里膜外之间，不得发越，势必肿满，是肿满之疾，起于下元虚寒也。如果不是温补下元，那么小便怎么能单独通利。况且人的胃，如釜甑然，釜底火旺，则热气熏蒸，甑炊易熟。如果徒有水而无火，则无气上升，物何由熟，即此可以类推了。所以治胀满者，先宜温补下元，使火气盛而温气蒸发，胃中温暖，谷食易化，则满可宽矣。夫清气既升，则浊气自降，浊气降则为小便也，小便利，胀有不消乎。语谓地气上为云，天气下为雨，惟此气流行，斯为云为雨也。现在的医者，一遇此疾，就说《内经》有言，诸湿肿满，皆属脾土。土虚则湿停，湿停则渗透肌肤，遍身肿满，不可不通利也。辄用利小便及补中之剂，如五苓散、胃苓汤加木通、车前子、大腹皮、滑石之类，法未为爽，然乎谬乎？顾服之愈多而小便愈少，肿胀愈急，何故哉？不温补下元，而徒以通利之药施之也。果若此，岂惟不效，则下元益虚，真气益弱，死期且至，安望其有瘳乎。我曾经研究《灵枢》、《素问》，参会易理，憬然有得于中，且施之病者，随试辄效，故笔之于册，以公我之同志。（《赤水玄珠》）（按：此论为壮原汤而发，其方今录在《水气》中。）
石顽治疗文学顾若雨，鼓胀喘满，昼夜不得寝食者二十余日。我们吴地的名医，用大黄三次攻下不除，技穷辞去。换一医生，先用发散，次用消克破气二十余剂，少腹至心下，遂坚满如石，腰胁与 中皆疼痛如折，也无措手而退。他的亲戚王墨公邀我去诊，脉得弦大而革，按之渐小，举指复大。询问其二便，则大便八九日不通，小便虽少而清白如常。这是由克削太过，中气受伤，浊阴乘虚，僭据清阳之位而然。以其浊气上逆，不便行益气之剂，先用生料六味丸，加肉桂三钱，沉香三分，下黑锡丹二钱，导其浊阴。是夜即胀减六七，胸中觉饥，清晨便进糜粥，但腰胯疼软，如失两肾之状。再剂胸腹全宽，少腹反觉微硬，不时攻动。这是大便欲行，津液耗竭，不能即去故也。诊其脉仅存一丝，改用独参汤，加当归、枳壳，大便略去结块，腰痛稍可，少腹遂和。又与六味地黄，仍加肉桂、沉香，调理而安。（《医学入门》）
温中消胀诸方 殿中丞郭中妹十岁，病腹色不变，按之而大，不陷，心腹下痞满，得之因取转数多，病已月余。兆按《甲乙经》说：三焦胀者，气满于皮肤中，壳然不坚。遂与仲景浓朴生姜半夏甘草人参汤，减小其服量，凡经二十日，胀消而已。（《鸡峰普济方》）
大半夏汤，主治胃中虚冷，腹满塞下气方。
半夏（一升） 大枣（二十枚） 甘草 附子 当归 人参
浓朴（各二两） 桂心（五两） 生姜（八两） 茯苓 枳实（各二两） 蜀椒（二百粒）
Treatment of distension and fullness: For excess patterns, purge the accumulation; for deficiency patterns, tonify the body; for cold patterns, apply heat; for heat patterns, clear the heat; for stagnation patterns, disperse the blockage; for retention patterns, promote circulation. If the pathology is in the blood aspect, unblock the blood; if it is in the qi aspect, move the qi. Only then can treatment be comprehensive and avoid danger. (From *Qixiao Liangfang*)
When pathogenic wind-cold enters from the exterior to the interior, cold transforms into heat, leading to stomach excess, abdominal distension, delirium, and extreme thirst with a desire to drink. In such cases, use Chengqi Tang (Cassia Twig Decoction) to purge downward. If summerheat injury lies latent and manifests as malaria in autumn, accompanied by distension upon onset, use Jiaoyin Ziyin (Intersecting Drink). This formula consists of Myristicae Semen (Rougu), Tsaoko Fructus (Caoguo), Magnoliae Officinalis Cortex (Houpo), Glycyrrhizae Radix et Rhizoma (Gancao), and Zingiberis Rhizoma Recens (Shengjiang). If internal injury from dietary stagnation causes belching, fullness, and distension, use Muxiang Bingslang Wan (Aucklandia and Betel Nut Pill) or Jiawei Zhizhu Tang (Modified Immature Bitter Orange and Atractylodes Decoction). If caused by alcohol, wheat products, and rich/fatty foods, common among those accustomed to rich diets, or lying down immediately after eating, causing damp-heat to fail to transform and resulting in abdominal distension, use Weiling Tang (Stomach Cold Decoction) or Zhongman Fenxiao Wan (Middle Fullness Dispersion Pill). If dampness is predominant with difficult urination, add Akebia Caulis (Mutong) and Talcum (Huashi), or use Daju Pi Tang (Large Tangerina Peel Decoction). If heat is predominant, add Coptidis Rhizoma (Huanglian) and Gardeniae Fructus (Shanzhi). Due to overexertion damaging the spleen and stomach, impairing transformation and transportation, leading to distension, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Amomi Fructus (Sharen) and Massae Fermentatae Medicatedae (Shenqu). If injured by diet, with weak spleen and stomach causing food and water to accumulate without digestion, this is distension due to cold-dampness suppression; use Xiangsha Tiaozhong Tang (Costus and Amomum Regulating the Middle Decoction). Distension following severe anger is treated with Fenxin Qi Yin (Dividing Heart Qi Infusion). Distension from excessive worry and thought is treated with Zisuzi Tang (Perilla Seed Decoction). For distension or pain due to attacking accumulations, use Qiqi Xiaojusan (Seven Qi Accumulation Dispersing Powder) at onset; for long-standing cases with deficient yuan qi and weak spleen/stomach causing distension, use Shenju Jianpi Tang (Ginseng and Atractylodes Spleen-Strengthening Decoction) with a small amount of digestive aids. Distension due to retained dead blood, presenting with blue-purple veins on the abdominal skin, normal urination, and a knotted/choppy pulse, common in women, is first treated with Tao Ren Chengqi Tang (Peach Kernel Cassia Decoction); for severe cases, use Didang Tang (Definitely Invading Decoction); for deficient patients who cannot tolerate purgation, temporarily treat with Danggui Huoxue San (Angelica Blood-Moving Powder). When turbid qi stays in the upper jiao, interfering with clear yang, causing stagnation and distension, use Muxiang Shunqi Tang (Aucklandia Smoothing Qi Decoction) or Chenxiang Jiaotai Wan (Aquilaria Harmonizing Heaven and Earth Pill). For obstruction of the pylorus, use Runzao Wan (Moisten Dryness Pill). After serious illness, dietary irregularity damages the spleen/stomach, making transformation difficult and causing distension; first use Huazhi Tiaozhong Tang (Resolve Stagnation Regulating Middle Decoction), then Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). Post-dysentery distension from overuse of purgatives requires focusing solely on strengthening the spleen; if dysentery persists, combine with Weifeng Tang (Wind Protecting Decoction). (From *Yitong Zhengmai Tongzhi*)
Although most abdominal distension cases are cold-patterns and few are heat-patterns, physicians often prefer acrid-warm qi-moving herbs. Even for damp-heat distension, acrid-warm herbs are used to move qi; once qi moves, distension eases. However, clearing damp-heat should be primary, with acrid-warm herbs as guides. Conversely, in cases of fire excess and yin deficiency where heat invades the blood aspect, the abdomen may be distended but not significantly enlarged, feeling harder upon pressure, with yellow-red urine, constipation, slight night fever, and a rapid, solid yet fine pulse. Do not mistake this for food stagnation or damp-heat; resolving stagnation harms yin further, and drying dampness depletes fluids. Use extremely bitter and cold herbs like Danggui Longhui Wan (Angelica Dragon Gallbladder Pill) or Siwu Tang (Four Substances Decoction) plus Xuanhulian (Prepared Scutellaria and Coptis) and Lvhui (Aloe), all vinegar-processed, which can be effective in one dose. In cases of qi deficiency failing to contain blood, leading to blood dispersion and distension, stools are not hard, alternating between loose and formed; looseness brings slight relief, formation worsens it; urine is clear and profuse, sometimes turbid like rice water; the pulse is slow, large, and sluggish, especially at the Qi Kou position. Avoid acrid-warm qi-consuming herbs; use Sijunzi Tang (Four Gentlemen Decoction) minus Baizhu, plus Muxiang, ZeXie, Danggui, and Shaoyao to secure the blood within the qi. In cases of blood deficiency failing to gather qi, leading to qi dispersion and distension, there is irritability, heat, dry stools, yellow frequent urine, and a floating, rapid, wiry pulse, especially at the Ying Kou position. Avoid bitter-cold stomach-damaging herbs; use Siwu Tang minus Dihuang, plus Huangqi, Rougui, Gancao, and Wei Jiang (Baked Ginger) to harmonize the qi within the blood. Excessive worry damaging the spleen/stomach causes heart/abdominal distension, panting, irritability, borborygmus, and difficulty with urination/defecation; use Ju Fang Qiqi Tang (Standard Formula Seven Qi Decoction). Turbid qi in the upper jiao causes distension; use Shengjiang Xiexin Tang (Fresh Ginger Draining Heart Decoction) with Muxiang and Houpo. Cold spleen/stomach failing to ripen food causes distension; use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). Kidney deficiency-cold failing to generate spleen earth causes distension; use Jisheng Shenqi Wan (Living Generation Kidney Qi Pill). Middle fullness with hardness like a plate, inability to sit/lie, difficult urination/defecation, panting, sallow complexion, and generalized edema indicates mixed cold-heat congealing in the middle and stagnant nutritive/blood qi; use Fenxiao Tang/Wan (Dispersion Decoctions/Pills), adjusting for cold/heat ratio, or select from Seven Qi formulas. Tight/slippery Qi Kou pulse with nausea, fullness, dry mouth, and internal heat indicates food stagnation; use Zhishi Daozhi Wan (Immature Bitter Orange Directing Stagnation Pill). Running after full meals, trauma causing blood stasis, or gynecological blood accumulation causing swelling with blue-purple abdominal veins, tenderness, and wiry/choppy pulse should be treated as blood stasis. Severe anger causing qi reversal, hypochondriac distension, and wiry pulses uses Qingpi, Chenpi, Muxiang, Shanzhi, Chaihu, Zhike, Guiwei, Taoren, Shaoyao, and Bo Gui. Alcoholics with bucket-like distension and hematuria/hematochezia worsening with diuretics, showing rapid/choppy pulses, suffer from damp-heat injuring spleen yin and failing to control blood; treat by regulating spleen qi, dispelling damp-heat, and nourishing blood using Zhishi, Huanglian, Pao Jiang, Banxia, Fuling, Danggui, Shaoyao, Ejiao, Wumei, and Sharen. Shaoyao/Wumei astringe spleen yin; Huanglian/Zhishi drain distension; Danggui/Ejiao nourish blood; Fuling/Banxia resolve phlegm-fluids; Sharen awakens spleen qi. If accumulated damp-heat is triggered causing upward rebellious distension and panting, death is likely; similarly for persistent diarrhea. (From *Yitong* - Abdominal Fullness Section)
Distension arises from spleen/stomach qi deficiency failing to transform subtle essences, causing food/water to accumulate. Irregular diet fails to nourish, causing clear qi to descend and turbid qi to fill the chest/abdomen; steaming damp-heat creates this syndrome. Short/scanty urine indicates stubborn disease hard to treat; use half-tonifying half-purging methods, focusing on strengthening spleen, moving water, and relaxing the middle. Avoid harsh drugs that damage the spleen/stomach and cause relapse; use Fenxiao Tang/Wan adjusted for cold/heat/deficiency/excess. Blood stasis distension shows blue-purple abdominal veins or red streaks on limbs, normal urine, black stool; use *Jinkui* Xiayuxue Tang (Lower Blood Stasis Decoction); if ineffective, use Didang Wan minus Leech, add Chuiji, taken fasting; mild cases use Sanxue Xiaozhang Tang (Dispel Blood Relieve Distension Decoction). Gynecological blood swelling with irritability, rinsing mouth without swallowing, confusion, polyuria, and black stool uses Sanxue Xiaozhang Tang. Deficient patients with blood gu use Hupo Renshen Wan (Amber Ginseng Pill). Postpartum hemorrhage deficiency or unresolved blood stasis causing swelling presents with choppy pulse and dark face; do not treat as water-dampness. Withered complexion, emaciation, isolated abdominal distension with lumps indicates fire distension, not edema; fear no kidney-water pathogen. Wiry/thin/choppy pulse despite appetite indicates eventual demise. Fire distension misdiagnosed and treated with *Jinkui* Shenqi Wan requires immediate Liu, Bai, Jinling, Shaoyao with small amounts of Gui/Fu as "heat treating heat" guides to salvage. Panting/diarrhea with emaciated limbs and pulse lacking stomach qi is incurable. (Same - Drum Distension Section)
Insect Gu: Patients with isolated abdominal distension, non-edematous limbs, surviving years, do not have water-gu. Water-gu kills within two years via skin leakage. Survival for years without skin leakage indicates insect-gu, where insects bind in blood, resembling drum distension. Cause: ingesting raw vegetables with insect eggs or indigestible matter transforming into worms; blood encapsulates them, forming masses over time. Food intake feeds worms rather than nourishing organs. Differentiate from blood-gu by pale yellow face with red spots/lines, and abdominal pain before eating but not after. (From *Bianzheng Lu*)
Transformation Syndromes: Chronic distension leads to indigestion and dysentery. Spleen/stomach are exterior-interior pairs; spleen digests food, stomach is the sea of food. Spleen deficiency and chronic cold weaken spleen qi, causing indigestion. Cold moves to the large intestine, the pathway for waste; deficiency and cold cause dysentery. (From *Bingyuan Lun*) Note: *Shengji Zonglu* states spleen/stomach weakness prevents food ripening, so chronic distension turns into fluid-damp diseases.
Chronic distension has varied transformations: borborygmus, radiating pain to flanks/lower back, headache/vomiting, chest fullness/anorexia, or urinary/defecatory difficulty. All branch from distension. (From *Jisheng*)
Death Syndromes: Chronic wasting with sudden distension, panting, umbilical protrusion, frequent diarrhea, unresponsive to all medicines. (From *Zhizhi Fang*)
Recent distension with soft abdomen, no diarrhea/panting, responds quickly to treatment. Umbilical protrusion, post-diarrhea urgency, chronic wasting, panting indicate spleen/stomach collapse with no hope of cure. (From *Dexiao*)
Former experts listed five untreatable Gu-swelling signs: face black as mold, large belly with prominent veins, palm lines absent, foot swelling without pits, umbilical protrusion. These can sometimes be cured. Black water discharge and impotence are untreatable. (From *Shoushi Baoyuan*)
Cough/aphonia, abdominal veins, cyanotic nails, acute swelling, dark head/face, vomiting/heavy head, upper panting/lower diarrhea are untreatable. Distension temporarily relieved by purgatives then recurring is untreatable. (From *Yitong*)
General Treatment Principles: Middle fullness is treated internally by dispersing dampness up and down. The lower jiao is like a ditch; qi/blood differentiate naturally without needing to purge filth. (From *Lanshi Micang*) Note: Refer to differentiation principles.
Distension is mostly cold, from internal injury, qi disorders, or overuse of purgatives weakening spleen/stomach; damp-heat is rare, though accumulation exists. Ancient formulas like Yuyuliang Wan are too hot/dry for internal fire. For excess/fullness/blockage with surging pulse, purgation is necessary. However, for cases from over-purgation, post-dysentery, or inherent spleen weakness, strengthen spleen and move dampness as righteous qi is depleted. For blood stasis, treat with blood-invigorating herbs. Cold treated with heat, heat with cold, stagnation dispersed, mixed clear/turbid separated, qi regulated or directed downward—all must suit the condition. (From *Yuji Weiyi*)
Distension develops gradually. Differentiate excess/deficiency, new/old, shallow/deep, cold/heat. Treat by dispersing, directing, regulating, softening, strengthening spleen, or supporting qi. Adjust for symptoms; never blindly purge. Cold distension is common, heat is rare; floating/solid pulse is easy, sinking/deficient pulse is hard. Spleen deficiency is common; damp-heat rare. Initial excess/blockage with surging pulse needs purgation but start with gentle regulation then nourish. Early tonification strengthens pathogen. Identify priority of deficiency/excess and adjust meds based on pulse/symptoms. (From *Tongzhi*)
Distension differs from edema and is less critical than drum distension. Food stagnation resolves with digestion-promoting herbs; qi stagnation resolves with qi-moving herbs. Acute excess requires strong purgation; upper depression requires draining. Blood stasis requires blood-breaking herbs. Post-illness qi-deficiency distension resolves by tonifying yuan qi. (From *Shen Shi*)
Treatment should regulate spleen/lung/kidney, avoiding diuretics. Strengthen spleen, nourish lung metal to control liver wood, nourish kidney water to control heart fire, avoid salt, eliminate desires. Physicians ignoring deficiency for quick results harm patients. Patients preferring diuretics for temporary relief suffer worse swelling and qi depletion later. Yuyuliang Wan (Stone Yellow Pill/Vermilion Pill) regulates liver/stomach effectively but requires seasonal/symptomatic adjustment. Deep-rooted diseases require patience; seeking speed invites disaster. Kings' Way practitioners can cure this. Some ask if diuretics are forbidden in terminal distension; I say if not deficient, shallow disease, strong spleen/stomach, and no stagnation, mild guidance is okay. But aggressive purgation like Zhang Hezi's methods is unacceptable. (From *Gezhi Yulun*)
Treatment Should Warm and Tonify Lower Yuan (Case Study): Distension with indigestion, difficult urination, tight/shiny abdomen empty inside resembles drum distension. *Neijing* says treat distension via Three Yang (Bladder Meridian). *Lingshu* says lower jiao overflow becomes water. *Lanlin Midian* says bladder stores fluids, qi transformation enables excretion. Thus, difficult urination stems from lower yuan deficiency-cold trapping dampness outside skin/membranes, causing swelling. Without warming lower yuan, urination won't improve. The stomach is like a steamer; fire below cooks food. No fire means no steam/cooking. Therefore, treat distension by warming lower yuan to boost fire/qi, warming stomach, aiding digestion, and relieving fullness. Clear qi rises, turbid qi descends as urine; if urine flows, distension resolves. Like earth vapor rising as clouds, heaven rain falling. Modern doctors cite "all damp/swelling belongs to spleen earth," using diuretics/strengtheners like Wuling San or Weiling Tang plus Mutong, Cheqianzi, Fupipi, Huashi. This often fails, reducing urine and increasing swelling because lower yuan isn't warmed. This worsens deficiency and hastens death. Studying *Lingsu* and Yi principles, I found efficacy in this approach and record it for colleagues. (From *Chuishui Xuanzhu*) Note: This discusses Zhuangyuan Tang, recorded in Water-Qi section.
Shiwen treated scholar Gu Ruoyu with drum distension/panting for 20+ days. Local doctors failed with three doses of Dahuang. Another doctor used dispersants and qi-breaking herbs for 20+ doses, causing rock-hard lower abdomen/chest and severe flank/back pain. Relative Wang Mogu invited me. Pulse was wiry-large/reed-like, small on pressure, large on lift. Bowels blocked 8-9 days; urine scant but clear. Caused by excessive depletion damaging middle qi, allowing turbid yin to usurp clear yang. Due to rebellious turbid qi, avoided qi-tonics initially. Used Shengliao Liuwei Wan + Rougui (3 qian), Chenxiang (3 fen), Heixi Dan (2 qian) to guide turbid yin down. Distension reduced 60-70% that night; hunger felt; ate porridge next morning. Waist/hips sore as if kidneys lost. Second dose relaxed chest/abdomen; lower abdomen slightly hard with movement, indicating impending bowel movement due to fluid depletion. Pulse thread-like; switched to Dushen Tang + Danggui, Zhike. Stool passed clots; waist pain eased; lower abdomen harmonized. Continued Liuwei Dihuang + Rougui, Chenxiang for recovery. (From *Yitong*)
Warm Middle Relieve Distension Formulas: Gu Zhongmei, age 10, had unchanged abdominal color, enlarged on palpation without depression, epigastric fullness, caused by excessive turning/movement for over a month. Based on *Jiayi Jing*, Sanjiao distension involves qi filling skin without hardness. Prescribed Zhongjing Houpo Shengjiang Banxia Gancao Renshen Tang, reduced dosage. Distension resolved in 20 days. (From *Jifeng*)
Banxia Banxia Tang: For stomach deficiency-cold, abdominal fullness/blockage, descending qi.
Banxia (1 sheng), Dazao (20 pieces), Gancao, Fuzi, Danggui, Renshen, Houpo (2 liang each), Guixin (5 liang), Shengjiang (8 liang), Fuling, Zhishi (2 liang each), Shujiao (200 grains).