针经曰其脉大坚以涩者胀也
脉经曰关上脉虚即胀内 迟而滑者胀 脉盛而紧者胀
严氏曰胀脉浮者易治虚者为难
陈无择云脏气不平胜乘相因为病如怒伤肝肝克脾脾气不正必胀于胃名曰胜克怒乘肺肺气
不传
必胀于大肠名曰乘克忧思结聚本脏气郁皆内所因或冒寒暑风湿随经络传至阳明致胀者属外因
饮食饥饱生冷甜腻聚结不散或作胚块膨胀满闷属不内外因也
按此论肝木胜乘脾肺为胀满即东垣所谓脾胃之上不足火木大胜致胀也此不言火况怒伤肝
者
岂无火动耶所出大半夏汤以桂附中加参归以调血气言其脉弦迟恐非肝气克脾脏闭腑郁病也
内经云太阴所至为蓄满又云太阴所至为中满霍乱吐下又云诸湿肿满皆属脾土
按发明辨云脾为阴中之太阴又云脾为阴中之极阴乃为坤元亘古不迁之土天为阳也火也地
为阴
也水也在人则为脾同阴水之化脾有余则腹胀食不化故无阳则不能化五谷脾盛乃大寒为胀满
故脉经云胃中寒则胀满大抵此病皆水气寒湿为之也治宜大辛热之剂如土久于雨水中则为泥矣
岂能生化万物必待和风暖日湿去阳生自然长生矣脾湿有余无阳则不能化五谷所以宜辛热治之
必愈然亦有轻重
东垣曰经云诸腹胀大属热此乃八益之邪有余之证自天外而入感风寒之邪传入于里寒变为
热
作胃实日晡潮热大渴引饮谵语是太阳阳明并病大实大满者大承气汤下之少阳阳明微满实者小
承气汤下之五常正大论云下之则胀已是也假令 疟为胀满亦有寒胀热胀是天之邪气伤暑而
得之不实时发至秋暑气衰绝而疟病作矣知其寒已局方交加饮子是也岂不闻素问及灵枢经中说
内虚不足中寒湿令人中满及五脏六腑俱有胀满更以胀家寒热多少较之胃中寒则胀满阴阳应象
论云浊气在上则生 胀针经云胀取三阳三阳者足太阳膀胱寒水为胀与通评虚实论中说腹暴
满按之不下取太阳经络者胃之募正同五脏生成论云腹满 胀(云云见前)胃中寒湿菀遏故也脉
经所谓胃中寒则胀满也又厥论云太阴之厥则腹满 胀后不利不欲食食则呕不得卧按所说寒胀
多如此汤液醪醴论中说中满治法当开鬼门谓发汗也洁净府利小便也又云中满者泻之于内谓脾
胃有病当今上下分消其气下焦如渎气血自然分化不待泄滓秽如或大实大满大小便不利从权以
寒热药下之
《针经》说：脉象大、坚实且涩的，是胀病。
《脉经》说：关部脉虚弱的就会发生腹胀；脉迟而滑的是胀病；脉盛而紧的也是胀病。
陈无择说：脏腑之气不平和，相互克制乘袭，从而致病。例如发怒伤肝，肝木克脾土，脾气不正，必然导致胃胀，这叫做“胜”（相克太过）；怒伤肝后，肝气乘肺，肺气不能正常传变，必然导致大肠胀，这叫做“乘”（相乘）。忧思郁结，本脏之气郁滞，都属于内因；或者冒犯寒暑风湿之邪，随经络传入阳明经导致胀满的，属于外因；饮食饥饱不均，生冷甜腻之物聚结不散，或形成痞块，导致膨胀满闷的，属于不内外因。
按此论述，肝木胜乘脾肺导致胀满，即李东垣所说的脾胃之上不足火，木气大胜导致胀满。这里没有提及火，但既然说怒伤肝，难道就没有火动吗？所引用的大半夏汤中加入了桂枝、附子，并加入人参、当归以调和气血，这是考虑到脉象弦迟，恐怕不是单纯的肝气克伐脾脏，而是腑气闭塞、郁滞的病证。
《内经》说：太阴湿土之气至，会出现蓄积满闷；又说太阴之气至，会出现中满、霍乱、吐泻；还说诸般湿肿满闷，都归属于脾土。
按《医宗金鉴·伤寒心法要诀》（注：此处原文“发明辨”可能指代某部阐发医理的著作，结合上下文语境及后世引用习惯，此处暂译为相关医理辨析）辨析说：脾为阴中之太阴，又说脾为阴中之极阴，乃是坤元亘古不变的土。天为阳，为火；地为阴，为水。在人体中，脾对应于阴水的化生。脾有余则出现腹胀、食物不消化，所以如果没有阳气就不能运化五谷。脾盛则表现为大寒，导致胀满。所以《脉经》说胃中有寒就会胀满。大抵这类疾病都是水气、寒湿造成的。治疗应当使用大辛大热的药剂。就像土地久在雨水中就会变成泥沼，怎能生化万物呢？必须等待和风暖日，湿气去除，阳气生发，自然万物才能生长。脾湿有余，没有阳气就不能运化五谷，所以适宜用辛热的方法治疗，必定痊愈。然而病情也有轻重之分。
李东垣说：《内经》说诸般腹胀大都属于热证，这是八益之邪有余的证候，自天外而入，感受风寒之邪，传入体内，寒变为热，造成胃实，出现日晡潮热、大渴引饮、谵语，这是太阳阳明并病。大实大满的，用大承气汤攻下；少阳阳明微满实的，用小承气汤攻下。《五常政大论》说：“下之则胀已”，说的就是这个道理。假令疟疾导致胀满，也有寒胀和热胀之分，这是天之邪气伤暑所致，不即时发作，到了秋天暑气衰绝时疟病才发作。知道这是寒证，可以用《局方》中的交加饮子等治疗。难道没听说《素问》及《灵枢经》中说内虚不足、中寒湿令人中满，以及五脏六腑都有胀满吗？再根据胀家寒热的多少来比较。《阴阳应象大论》说浊气在上则生胀，《针经》说胀病取三阳经，三阳经中的足太阳膀胱寒水导致胀满，与《通评虚实论》中说腹暴满、按之不下，取太阳经络（胃之募穴），正相符合。《五脏生成论》说腹满胀（详见前文），是因为胃中寒湿郁遏的缘故。《脉经》所谓胃中寒则胀满。又《厥论》说太阴之厥则腹满、大便不利、不欲食、食则呕、不得卧。按照所说，寒胀大多如此。《汤液醪醴论》中说中满的治疗方法，应当“开鬼门”，即发汗；“洁净府”，即利小便。又说中满者“泻之于内”，是指脾胃有病，当今上下分消其气，下焦如渎，气血自然分化，不必像排泄糟粕那样泄下。如果大实大满，大小便不利，则权宜之计，用寒热药攻下。
The *Zhen Jing* (Needle Classic) states: A pulse that is large, firm, and choppy indicates distension disease.
The *Mai Jing* (Pulse Classic) states: A deficient pulse at the Guan position indicates abdominal distension; a slow and slippery pulse indicates distension; a full and tight pulse also indicates distension.
Yan Shi states: For distension diseases, if the pulse is floating, it is easy to treat; if the pulse is deficient, it is difficult to treat.
Chen Wuze states: When the Qi of the Zang organs is not harmonious, they mutually overcome and attack each other, causing disease. For example, anger injures the Liver (Gan), Wood overcomes Earth, Spleen Qi becomes abnormal, and inevitably causes stomach distension; this is called "Sheng" (excessive overcoming). Anger injures the Liver, Liver Qi attacks the Lung, Lung Qi fails to transmit normally, and inevitably causes Large Intestine distension; this is called "Cheng" (over-acting). Worry and thought cause accumulation, and the Qi of the affected organ becomes stagnant; these are all internal causes. Alternatively, exposure to cold, heat, wind, or dampness transmits through the meridians to the Yangming channel, causing distension; this is an external cause. Irregular eating habits, consumption of raw, cold, sweet, or greasy foods that accumulate and do not disperse, or form masses, leading to bloating and fullness; this is neither purely internal nor purely external.
According to this discussion, Liver Wood overacting on Spleen and Lung causing distension is what Li Dongyuan referred to as insufficient Fire in the upper part of the Spleen and Stomach, with excessive Wood Qi causing distension. This text does not mention Fire, but since anger injures the Liver, could there not be Fire stirring? The Banxia Tang (Pinellia Decoction) mentioned adds Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root), along with Renshen (Ginseng Root) and Danggui (Angelica Sinensis Root) to regulate Blood and Qi. This suggests considering the string-tight and slow pulse, implying it may not be merely Liver Qi attacking the Spleen, but rather a condition of Fu organ closure and stagnation.
The *Nei Jing* (Inner Canon) states: When Taiyin arrives, there is accumulation and fullness. It also states: When Taiyin arrives, there is central fullness, Huoluan (cholera-like syndrome with vomiting and diarrhea), vomiting, and purging. It further states: All dampness, swelling, and fullness belong to Spleen Earth.
According to medical analysis: The Spleen is the Taiyin within Yin, and also the extreme Yin within Yin; it is the Earth of Kun Yuan, unchanging since antiquity. Heaven is Yang and Fire; Earth is Yin and Water. In humans, the Spleen corresponds to the transformation of Yin Water. If Spleen Qi is excessive, abdominal distension occurs, and food is not digested; thus, without Yang, one cannot transform the five grains. Excess Spleen manifests as severe cold, causing distension. Therefore, the *Mai Jing* states that cold in the Stomach causes distension. Generally, this disease is caused by Water Qi and Cold-Dampness. Treatment should employ strongly pungent and hot agents. Just as soil soaked in rainwater becomes mud and cannot generate all things, one must wait for gentle winds and warm suns to remove dampness and generate Yang, so that life can naturally flourish. With excess Spleen dampness and insufficient Yang, the five grains cannot be transformed; therefore, treatment with pungent and hot methods is suitable, and recovery will surely occur. However, there are degrees of severity.
Li Dongyuan states: The *Classic* says that most abdominal distensions and enlargements belong to Heat. This is a syndrome of excess from the Eight Benefits pathogenic factors, entering from outside heaven. Feeling Wind-Cold pathogens transmitting inward, Cold transforms into Heat, creating Stomach Excess, with afternoon tidal fever, intense thirst with desire to drink, and delirious speech. This is a concurrent disease of Taiyang and Yangming. For severe excess and fullness, Da Chengqi Tang (Major Order the Qi Decoction) is used to purge downward. For mild excess and fullness in Shaoyang-Yangming, Xiao Chengqi Tang (Minor Order the Qi Decoction) is used to purge downward. The *Wu Chang Zheng Da Lun* states: "Purging downward resolves the distension," which refers to this. Suppose malaria causes distension; there are Cold distension and Heat distension. This results from Heavenly pathogenic factors injuring Summerheat, not manifesting immediately, but occurring in autumn when Summerheat wanes. Knowing it is Cold, one might use Jiaojia Yinzi (Interlaced Drink) from the *Ju Fang*. Have we not heard that the *Su Wen* and *Ling Shu* state that internal deficiency and insufficiency, combined with Cold-Dampness invading, lead to central fullness, and that all Zang and Fu organs can have distension? Furthermore, compare the amount of Cold and Heat in distension patients. The *Yin Yang Ying Xiang Lun* states: "Turbid Qi residing above generates distension." The *Zhen Jing* states: For distension, treat the Three Yang channels. Among the Three Yang, Foot-Taiyang Bladder Cold Water causes distension. This aligns with the *Tong Ping Xu Shi Lun*, which states: Sudden abdominal fullness, unyielding to pressure, should be treated by taking the Foot-Taiyang meridian (the Front-Mu point of the Stomach). The *Wu Zang Sheng Cheng Lun* states: Abdominal fullness and distension (see previous text) are due to Stomach Cold-Dampness stagnation and obstruction. The *Mai Jing* states: Cold in the Stomach causes distension. Also, the *Jue Lun* states: Jue of Taiyin leads to abdominal fullness, difficulty in defecation, aversion to food, vomiting after eating, and inability to sleep. As described, Cold distension is mostly like this. The *Tang Ye Lao Li Lun* states that the treatment for central fullness should involve "opening the ghost gate" (inducing sweating) and "cleaning the pure residence" (promoting urination). It also states: For central fullness, "purge from within," referring to pathological conditions of the Spleen and Stomach where Qi is distributed upward and downward simultaneously. The Lower Jiao is like a drain, and Qi and Blood naturally differentiate; there is no need to purge waste matter like excrement. However, in cases of severe excess and fullness with dysfunction of bowel and bladder movements, one may resort to using Cold or Hot purgative agents as a temporary measure.