大意
诸湿肿满。皆属于脾。（内经）专主土败木贼。湿留气滞为病。（正传）
内因
由七情内伤。六淫外侵。饮食失节。房劳致虚。脾土之阴受伤。转运之官失职。胃虽纳谷。脾不运化。故阳自
升而阴自降。乃成天地不交之否。清浊相混。隧道壅塞。郁而不行。气留血涩。湿气内停。遂成胀满。（丹溪）
外候
夫胀者。皆在于脏腑之外。排脏腑而攻胸胁。胀皮肤。故命曰胀。（内经）外虽坚满。中空无物。有似于鼓。（格致
余论）击之有声。按之有形。（绳墨）色苍黄。腹筋起。心腹胀满。旦食则不能暮食。（内经）
胀分新久
凡诸实症。或六淫外客。或饮食内伤。阳邪急速。其至必暴。每成于数日之间。若是虚症。或情志多劳。或酒
色过度。日积月累。其来有渐。每成于经月之后。（必读）
胀分虚实
腹胀坚硬。按之而痛者。为实。按之不坚不痛者。为虚。先胀于内。而后肿于外者。为实。先肿于外。而后胀于
内者。为虚。小便黄赤。大便闭结。为实。小便清白。大便溏泄。为虚。脉滑数有力为实。弦浮微细为虚。色红气
粗为实。色枯气短为虚。（微论）
胀分朝暮
朝宽暮急为血虚。朝急暮宽为气虚。朝暮皆急。气血俱虚。（入门）
胀分脏腑
心胀烦心。肝胀胁痛。脾胀呕哕。肺胀喘咳。肾胀腰痛。胆胀口苦。胃胀胃脘痛。大肠胀肠鸣飧泄。小肠胀小
腹引腰痛。膀胱胀小便癃闭。三焦胀气满皮肤。（入门）
胀分诸症
气胀者。七情郁结。胸腹满闷。四肢多瘦。食胀者。谷食不化。痞满醋心。不能暮食。虫胀者。腹痛能食。善吃茶
叶盐土等物。积胀者。痞块有形。心腹坚硬。水胀者。停饮肠鸣。怔忡喘息。瘀胀者。跌扑产后。大便黑色。虚胀
者。腹柔软而食入倒饱。更有单腹胀者。腹大而四肢极瘦。此由胀满既久。气血结聚。不能释散。俗名曰蛊。
其病更重。（汇补）
脉法
关上脉弦为胀。又迟而滑。盛而紧。大坚以涩者。皆胀也。又虚为虚胀。牢为实胀。浮而大者易治。细而微者
难治。（汇补）
治法
实者。下之消之。直清阳明。虚者。温之升之。调补脾肾。其有不大满不大虚者。先以清利疏导。继以补中调
摄。惟有标实而本虚者。泻之不可。补之无益。最难调治。宜却盐味。以防助邪。断妄想。以保母气。（必读）
寒胀宜温
脏寒生胀满。胃中寒则胀满。（经文）盖脾为阴中之至阴。同湿土之化。运精微而制水谷者也。脾湿有余。无
阳以化。聚而不散。因成胀满者。宜以辛热药治之。（东垣）
热胀宜清
诸腹胀大。皆属于热。（经文）因湿热之气。不得施化。壅滞于中而成胀满者。宜以苦寒药治之。若脾气不宣。
郁而成火。吞酸吐酸。渐成胀满者。用药宜刚中带柔。连理汤主之。（喻嘉言）
实胀宜下
腹坚惧按。舌黄脉牢者。此实邪有余。法宜推荡。所谓下之则胀已是也。（汇补）
虚胀宜补
脾虚之人。偶因气滞。误用克伐。致中气散乱不收。故水气横决而作胀。此脾虚不能统摄。法宜补土理中。
浊阴自化。
肝胀宜调
肝旺而胀者。虽当伐肝。然本性太过。肝亦自伤。不可过用克伐。宜扶脾疏肝。两法并用。使木性条达。不郁
土中。则胀自已。（准绳）
肾虚宜温
常见作劳好色之人。脾肾交虚。浊邪横溢。外为肿胀者。当收摄肾气。使水无泛滥之虞。此益火之源以消
阴翳。金匮肾气丸主之。（直斋）
治无速效
凡胀初起是气。久则成水。治比水肿更难。盖水肿饮食如常。鼓胀饮食减少。病根深固。三五年而后成。治
肿惟补中行气足矣。治胀必补中行湿。兼以消积。不责速效。乃可万全。（入门）
胀当大补
俗云。气无补法者。以痞闷壅塞。似难于补。不思正虚不运。邪着为病。不补其气。则气何由行。（凡溪）
治无峻攻
医者不察。病起于虚。急于取效。病者苦于胀急。喜行利药。以求一时之快。不知稍宽一日。胀愈甚。病愈增。
正愈伤。冀其再下。不可得矣。（丹溪）
死症
腹胀不食者死。腹胀身热者死。腹胀寒热如疟者死。腹大胀。四末清。脱形泄甚为逆。腹胀便血。脉大如绝
者死。腹胀时喘。汗出厥逆者死。胸膛胀满。脐关突出者死。（汇补）
用药
主以二陈汤。加浓朴、木香、苏梗、大腹皮。去甘草。肥人多湿。加苍术、木通、瘦人多火。加芩、连、山栀。食
积加山楂、神曲。蓄血加桃仁、莪术。郁气加香附、抚芎。怒气加柴胡、青皮。内寒凝滞者。加木香、炮姜。外寒郁
束者。加升、葛、苍术。便闭实热。加大黄。溺短湿结。加木香、泽泻。凡腹胀初起。宜行气疏导之剂。加木香、槟榔、
陈皮、青皮、枳壳、浓朴等。久而挟虚。宜补脾调气。如六君子加苏梗、砂仁等。虚而挟寒。宜温补。如理中汤加肉桂
等。若脾肾俱虚。少火不能扶脾者。宜补肾。然补肾有两法。能食而胸膈舒畅者。金匮肾气丸。不食而胸膈满
闷者。复元丹主之。惟大实大满坚硬而按之痛者。量其元气下之。三花神佑丸、导气丸等。下后仍宜调补脾胃。
【附虫蛊胀】
虫蛊由湿热既久。血化为虫。肚腹胀大。按之有块。形如稍瓜。四肢削瘦。腹虽痛而唇色红。能饮食。脉滑数
者。乃为蛊症。宜积块丸下之。（准绳）
胀满选方
六君子汤 治气虚中满。（方见中风）
连理汤 治脾虚肝郁。吞酸腹胀。（方见泄泻）
胃苓汤 治脾湿腹胀面黄。身浮溺涩。（方见暑症）
肾气丸（金匮） 治脾肾两虚。肿胀。腹濡而胸不硬者。（方见湿症）
补中益气汤（方见中风）
调中汤（方见斑疹）
复元丹（三因） 治脾肾俱虚。发为肿胀。心腹坚满。小便不通。两目下肿。
附子（炮二两） 南木香（煨） 茴香（炒） 川椒（炒出汗） 浓朴 独活
白术（炒） 陈皮 桂心 吴茱萸（炒各一两） 泽泻（一两半） 肉豆蔻（煨） 槟榔（各半两）
为末。糊丸。紫苏汤下。
导气丸 治诸腹胀大。痞塞不通。大便虚秘。形气病气俱实者。
青皮（水蛭炒） 莪术（虻虫炒） 三棱（干漆炒） 槟榔（斑蝥炒） 吴萸（牵牛炒） 赤芍（川
椒炒） 菖蒲（桃仁炒） 黄芩（大黄炒） 浓朴（干姜炒） 山楂肉（草果炒）
以上同炒药熟。去水蛭等不用。为末。酒糊丸。如梧子大。每服五丸至七丸。空心。紫苏汤下。
中满分消丸（东垣） 治中满热胀。
黄芩（炒） 黄连（炒各五钱） 姜黄 白术 人参 炙甘草
猪苓（各一钱） 白茯苓 干生姜 砂仁（各二钱） 枳实（炒） 半夏（各五钱）
浓朴（炒一两） 知母（炒四钱） 泽泻 陈皮（各三钱）
为末。汤浸蒸饼为丸。每服百丸。
中满分消汤（东垣） 治寒胀。
吴茱萸 浓朴 草豆蔻 黄柏（各五分） 益智仁 半夏
茯苓 木香 升麻（各三分） 人参 青皮 当归
黄连 泽泻 生姜 麻黄（不去节） 柴胡梢 干姜 川乌 荜澄茄（各二分）
水煎。热服。
广术溃坚汤（东垣） 治中满腹胀有积。
浓朴（姜炒五分） 升麻 红花 甘草 吴茱萸（汤泡各二分） 黄芩
益智 草豆蔻 当归（各五分） 黄连（三分） 半夏（七分） 广术（煨三分）
柴胡 泽泻 陈皮 神曲（炒） 青皮（各三分）
渴。加葛根四分。水煎。
保安丸 治症结内积。上抢心痛。脐腹痛。
大黄（三两） 附子（五钱） 干姜（一两） 鳖甲（一两五钱）
为末。先用醋一升。煮四五合。和药丸。空心服下。取积为度。
鸡矢醴（素问） 治湿热胀满。
羯鸡矢八合。炒微焦。无灰好酒二碗。煎至碗半，滤取汁。五更热饮。则鸡鸣辰巳时行二三次黑水。次日
足有绉纹。又饮一次。渐绉至膝上而愈。
积块丸
京三棱 莪术 自然铜 蛇含石 雄黄（各二钱） 蜈蚣（一钱一分）
木香（一钱半） 铁粉 辰砂 沉香（八分） 冰片（五分） 芦荟 天竺黄 阿魏 全蝎（各四钱）
炼猪胆汁为丸。每服八分。重者一钱。五更。酒送下。
肿满外治法
用水蓼花、皮硝、牙皂、大黄各五钱。生姜十片。葱、蒜各七枚。莱菔子三钱。栀子五钱。捣烂作一大膏药。贴
脐腹上。外用绵絮裹暖。
又法
方士用商陆根打烂。入麝香少许。贴脐中。外以绵絮裹暖。引水下行。
又有用蝼蛄捣碎服法，每称神奇。
又法。以田螺、大蒜、车前草。和研为膏。作大饼敷于脐上。使从便旋出。
又法。用大戟、牵牛各一两。大枣二升。入锅内煮。去药食枣。即愈。
铺脐药饼
真轻粉二钱、巴豆四两、生硫黄一钱。研匀成饼。先以新绵铺脐上。次铺药饼。外以帛紧束之。如人行十
里许。即下水。待行三五度。即去药。以温粥补之。一饼可治十人。
【大意】
各种湿邪导致的肿胀和胀满，都归属于脾脏病变。（出自《内经》）专门强调土气败坏、木气贼害，湿气留滞、气机阻滞而致病。（出自《正传》）
【内因】
由于七情内伤，六淫外侵，饮食不节制，房劳过度导致身体虚弱。脾阴受损，负责转运的脏腑功能失职。胃虽然能受纳食物，但脾不能运化，因此阳气自升、阴气自降，形成天地不交的“否”卦之象。清浊之气相混，经络隧道壅塞，气机郁结而不行，气滞血涩，湿气内停，于是形成胀满。（出自《丹溪心法》）
【外候】
所谓胀病，都在脏腑之外，排挤脏腑，攻冲胸胁，胀及皮肤，所以命名为胀。（出自《内经》）外表虽然坚硬胀满，内部却是空的，没有实物，类似鼓的样子。（出自《格致余论》）敲击有声音，按压有形状。（出自《医宗必读·绳墨》）面色苍黄，腹部青筋暴露，心胸腹胀满，早上吃了饭晚上就不能再吃。（出自《内经》）
【胀分新久】
凡是实证，或是六淫外感，或是饮食内伤，阳邪来势急速，发病必然突然，往往在几天内形成。如果是虚证，或是情志多忧思劳累，或是酒色过度，日积月累，发病缓慢，往往在几个月后才形成。（出自《医宗必读》）
【胀分虚实】
腹部胀硬，按压疼痛的，为实证；按压不硬不痛的，为虚证。先胀于体内，后肿于体外的，为实证；先肿于体外，后胀于体内的，为虚证。小便黄赤，大便闭结的，为实证；小便清白，大便溏泄的，为虚证。脉象滑数有力的，为实证；脉象弦浮微细的，为虚证。面色红、呼吸粗壮的，为实证；面色枯槁、气息短促的，为虚证。（出自《医学入门·微论》）
【胀分朝暮】
早晨宽舒、傍晚急重的，为血虚；早晨急重、傍晚宽舒的，为气虚；早晚都急重的，气血俱虚。（出自《医学入门》）
【胀分脏腑】
心胀表现为心烦；肝胀表现为胁痛；脾胀表现为呕吐呃逆；肺胀表现为气喘咳嗽；肾胀表现为腰痛；胆胀表现为口苦；胃胀表现为胃脘痛；大肠胀表现为肠鸣飧泄（完谷不化的腹泻）；小肠胀表现为小腹牵引腰痛；膀胱胀表现为小便癃闭（排尿困难或不通）；三焦胀表现为气满皮肤。（出自《医学入门》）
【胀分诸症】
气胀者，由七情郁结引起，胸腹满闷，四肢多消瘦。食胀者，谷物不消化，痞满反酸，晚上不能进食。虫胀者，腹痛但能进食，喜欢吃茶叶、盐、泥土等异物。积胀者，痞块有形，心腹坚硬。水胀者，停饮肠鸣，心悸喘息。瘀胀者，由跌打损伤或产后引起，大便黑色。虚胀者，腹部柔软但进食后容易饱胀。更有单腹胀者，腹部大但四肢极瘦，这是由于胀满日久，气血结聚，不能消散，俗称蛊胀，病情更重。（出自《证治汇补》）
【脉法】
关部脉弦主胀。又见迟而滑，盛而紧，大坚且涩的，都是胀病的脉象。又见虚脉主虚胀，牢脉主实胀。脉浮大的易治，脉细微的难治。（出自《证治汇补》）
【治法】
实证，用泻下、消导的方法，直接清泻阳明经热；虚证，用温补、升提的方法，调理补益脾肾。那些不大满也不大虚的，先用清利疏导的方法，继以补中调摄。只有标实本虚的，泻之不可，补之无益，最难调治。应当戒除咸味，以防助长邪气；断绝妄想，以保全母气（脾胃之气）。（出自《医宗必读》）
【寒胀宜温】
内脏寒冷产生胀满，胃中寒冷则胀满。（出自经文）因为脾是阴中之至阴，同湿土之气相应，负责运化精微、制约水谷。如果脾湿有余，没有阳气来化散，积聚不散，因而成胀满的，适宜用辛热药物治疗。（出自李东垣）
【热胀宜清】
各种腹部胀大，都归属于热。（出自经文）因为湿热之气，不得施化，壅滞在中焦而成胀满的，适宜用苦寒药物治疗。如果脾气不宣，郁结而成火，吞酸吐酸，逐渐形成胀满的，用药宜刚中带柔，主方连理汤。（出自喻嘉言）
【实胀宜下】
腹部坚硬怕按，舌苔黄，脉象牢实的，这是实邪有余，治法宜推荡积滞，所谓“下之则胀已”（泻下后胀满即可消除）。（出自《证治汇补》）
【虚胀宜补】
脾虚的人，偶然因气滞，误用克伐药物，导致中气散乱不收，所以水气横决而作胀。这是脾虚不能统摄，治法宜补土理中，浊阴自然化解。
【肝胀宜调】
肝旺而致胀的，虽然应当伐肝，但本性太过，肝亦自伤，不可过用克伐。宜扶脾疏肝，两法并用，使肝木性条达，不郁结于土中，则胀满自止。（出自《医学准绳六要》）
【肾虚宜温】
常见作劳好色之人，脾肾交虚，浊邪横溢，外为肿胀的，当收摄肾气，使水无泛滥之虞。这是益火之源以消阴翳，主方金匮肾气丸。（出自直斋）
【治无速效】
凡胀初起是气，久则成水，治疗比水肿更难。因为水肿饮食如常，鼓胀饮食减少，病根深固，经过三五年才形成。治水肿只需补中行气足矣，治胀必须补中行湿，兼以消积，不追求速效，才可万全。（出自《医学入门》）
【胀当大补】
俗话常说“气无补法”，是因为痞闷壅塞，似乎难于补益。但不想正是正气虚弱不能运化，邪气附着致病，如果不补气，气如何能够运行。（出自凡溪）
【治无峻攻】
医者不察，病起于虚，急于取效，病者苦于胀急，喜欢用利药，以求一时之快。不知道稍宽一日，胀愈甚，病愈增，正气愈伤，希望再次泻下，也不可能了。（出自朱丹溪）
【死症】
腹胀且不食的，死。腹胀且身热的，死。腹胀且寒热如疟疾样的，死。腹大胀，四肢清冷，形体脱失，泄泻严重的，为逆证。腹胀且便血，脉大如绝的，死。腹胀且时喘，汗出厥逆的，死。胸膛胀满，脐关突出的，死。（出自《证治汇补》）
【用药】
主方二陈汤，加浓朴、木香、苏梗、大腹皮，去掉甘草。肥人多湿，加苍术、木通；瘦人多火，加黄芩、黄连、山栀。食积加山楂、神曲；蓄血加桃仁、莪术；郁气加香附、抚芎；怒气加柴胡、青皮。内寒凝滞者，加木香、炮姜；外寒郁束者，加升麻、葛根、苍术。便闭实热，加大黄；溺短湿结，加木香、泽泻。凡腹胀初起，宜行气疏导之剂，加木香、槟榔、陈皮、青皮、枳壳、浓朴等。久而挟虚，宜补脾调气，如六君子汤加苏梗、砂仁等。虚而挟寒，宜温补，如理中汤加肉桂等。若脾肾俱虚，少火不能扶脾者，宜补肾。然补肾有两法：能食而胸膈舒畅者，用金匮肾气丸；不食而胸膈满闷者，用复元丹主之。惟大实大满坚硬而按之痛者，量其元气下之，用三花神佑丸、导气丸等。下后仍宜调补脾胃。
【附虫蛊胀】
虫蛊由湿热既久，血化为虫，肚腹胀大，按之有块，形如稍瓜，四肢削瘦，腹虽痛而唇色红，能饮食，脉滑数的，乃为蛊症，宜积块丸下之。（出自《医学准绳六要》）
【胀满选方】
六君子汤：治气虚中满。（方见中风篇）
连理汤：治脾虚肝郁，吞酸腹胀。（方见泄泻篇）
胃苓汤：治脾湿腹胀面黄，身浮溺涩。（方见暑症篇）
肾气丸（金匮）：治脾肾两虚，肿胀，腹濡而胸不硬者。（方见湿症篇）
补中益气汤（方见中风篇）
调中汤（方见斑疹篇）
复元丹（三因方）：治脾肾俱虚，发为肿胀，心腹坚满，小便不通，两目下肿。
组成：附子（炮二两）、南木香（煨）、茴香（炒）、川椒（炒出汗）、浓朴、独活、白术（炒）、陈皮、桂心、吴茱萸（炒各一两）、泽泻（一两半）、肉豆蔻（煨）、槟榔（各半两）。
制法：为末，糊丸，紫苏汤送下。
导气丸：治诸腹胀大，痞塞不通，大便虚秘，形气病气俱实者。
组成：青皮（水蛭炒）、莪术（虻虫炒）、三棱（干漆炒）、槟榔（斑蝥炒）、吴萸（牵牛炒）、赤芍（川椒炒）、菖蒲（桃仁炒）、黄芩（大黄炒）、浓朴（干姜炒）、山楂肉（草果炒）。
制法：以上同炒药熟，去水蛭等不用，为末，酒糊丸，如梧子大。每服五丸至七丸，空心，紫苏汤送下。
中满分消丸（东垣）：治中满热胀。
组成：黄芩（炒）、黄连（炒各五钱）、姜黄、白术、人参、炙甘草、猪苓（各一钱）、白茯苓、干生姜、砂仁（各二钱）、枳实（炒）、半夏（各五钱）、浓朴（炒一两）、知母（炒四钱）、泽泻、陈皮（各三钱）。
制法：为末，汤浸蒸饼为丸。每服百丸。
中满分消汤（东垣）：治寒胀。
组成：吴茱萸、浓朴、草豆蔻、黄柏（各五分）、益智仁、半夏、茯苓、木香、升麻（各三分）、人参、青皮、当归、黄连、泽泻、生姜、麻黄（不去节）、柴胡梢、干姜、川乌、荜澄茄（各二分）。
用法：水煎，热服。
广术溃坚汤（东垣）：治中满腹胀有积。
组成：浓朴（姜炒五分）、升麻、红花、甘草、吴茱萸（汤泡各二分）、黄芩、益智、草豆蔻、当归（各五分）、黄连（三分）、半夏（七分）、广术（煨三分）、柴胡、泽泻、陈皮、神曲（炒）、青皮（各三分）。
加减：渴，加葛根四分。水煎。
保安丸：治症结内积，上抢心痛，脐腹痛。
组成：大黄（三两）、附子（五钱）、干姜（一两）、鳖甲（一两五钱）。
制法：为末。先用醋一升，煮四五合，和药丸。空心服下，取积为度。
鸡矢醴（素问）：治湿热胀满。
组成：羯鸡矢八合，炒微焦，无灰好酒二碗。
用法：煎至碗半，滤取汁。五更热饮，则鸡鸣辰巳时行二三次黑水。次日足有绉纹，又饮一次，渐绉至膝上而愈。
积块丸
组成：京三棱、莪术、自然铜、蛇含石、雄黄（各二钱）、蜈蚣（一钱一分）、木香（一钱半）、铁粉、辰砂、沉香（八分）、冰片（五分）、芦荟、天竺黄、阿魏、全蝎（各四钱）。
制法：炼猪胆汁为丸。每服八分，重者一钱。五更，酒送下。
【肿满外治法】
用水蓼花、皮硝、牙皂、大黄各五钱，生姜十片，葱、蒜各七枚，莱菔子三钱，栀子五钱，捣烂作一大膏药，贴脐腹上，外用绵絮裹暖。
又法：方士用商陆根打烂，入麝香少许，贴脐中，外以绵絮裹暖，引水下行。
又有用蝼蛄捣碎服法，每称神奇。
又法：以田螺、大蒜、车前草，和研为膏，作大饼敷于脐上，使从便旋出。
又法：用大戟、牵牛各一两，大枣二升，入锅内煮，去药食枣，即愈。
【铺脐药饼】
真轻粉二钱、巴豆四两、生硫黄一钱，研匀成饼。先以新绵铺脐上，次铺药饼，外以帛紧束之。如人行十里许，即下水。待行三五度，即去药，以温粥补之。一饼可治十人。
[General Principle]
All swellings and distensions caused by dampness belong to the Spleen. (From *Neijing*) It specifically emphasizes that when Earth Qi fails and Wood Qi attacks, with dampness remaining and Qi stagnation causing disease. (From *Zhengchuan*)
[Internal Causes]
Due to internal injury from the Seven Emotions, external invasion by the Six Excesses, irregular diet, or excessive sexual activity leading to deficiency. The Yin of the Spleen Earth is injured, and the official responsible for transportation and transformation loses its function. Although the Stomach receives food, the Spleen cannot transform and transport it. Thus, Yang rises spontaneously and Yin descends spontaneously, forming the state of "Pi" (Stagnation) where Heaven and Earth do not interact. Clear and turbid Qi mix, meridians and collaterals become obstructed, Qi stagnates and does not move, Qi stasis leads to blood sluggishness, dampness stops internally, and thus distension and fullness are formed. (From *Danxi Xinfa*)
[External Manifestations]
The so-called distension disease lies outside the Zang-Fu organs, pushing against the organs and attacking the chest and hypochondrium, swelling the skin, hence named Distension. (From *Neijing*) Although the exterior appears hard and full, the interior is empty without solid matter, resembling a drum. (From *Gezhi Yulun*) Striking produces sound, pressing yields shape. (From *Yizong Bidu* / *Shengmo*) The complexion is pale yellow, abdominal veins are prominent, chest and abdominal fullness, unable to eat in the evening if food was consumed in the morning. (From *Neijing*)
[New vs. Old Distension]
For all excess syndromes, whether due to external invasion of the Six Excesses or internal injury from diet, Yang pathogens arrive rapidly, onset is sudden, often forming within a few days. If it is a deficiency syndrome, whether due to emotional labor or excessive wine and sex, accumulating day by day, the onset is gradual, often forming after several months. (From *Yizong Bidu*)
[Distinguishing Excess and Deficiency]
Abdominal distension that is hard and painful upon pressure is Excess; non-hard and non-painful upon pressure is Deficiency. Distending internally first, then swelling externally is Excess; swelling externally first, then distending internally is Deficiency. Yellow-red urine and constipation indicate Excess; clear-white urine and loose stools indicate Deficiency. Slippery, rapid, and forceful pulse indicates Excess; wiry, floating, minute, and fine pulse indicates Deficiency. Red complexion and coarse breathing indicate Excess; withered complexion and short breath indicate Deficiency. (From *Yixue Rumen* / *Weilun*)
[Morning vs. Evening Distension]
Loose in the morning and urgent/tight in the evening indicates Blood Deficiency; urgent/tight in the morning and loose in the evening indicates Qi Deficiency; urgent/tight both morning and evening indicates combined Qi and Blood Deficiency. (From *Yixue Rumen*)
[Zang-Fu Specific Distension]
Heart Distension presents with mental restlessness; Liver Distension with hypochondriac pain; Spleen Distension with vomiting and hiccups; Lung Distension with wheezing and cough; Kidney Distension with lower back pain; Gallbladder Distension with bitter taste; Stomach Distension with epigastric pain; Large Intestine Distension with borborygmus and undigested stool diarrhea; Small Intestine Distension with lower abdomen pulling to lower back pain; Bladder Distension with stranguria (difficulty or inability to urinate); Sanjiao Distension with Qi fullness in the skin. (From *Yixue Rumen*)
[Various Types of Distension]
Qi Distension: Caused by emotional depression, chest and abdominal fullness, limbs often emaciated. Food Distension: Undigested grains, epigastric stuffiness, acid regurgitation, inability to eat at night. Parasite Distension: Abdominal pain but able to eat, craving tea leaves, salt, soil, etc. Accumulation Distension: Visible masses, hard heart and abdomen. Water Distension: Retained fluids with borborygmus, palpitations, and wheezing. Blood Stasis Distension: Due to trauma or postpartum, black stools. Deficiency Distension: Soft abdomen but early satiety after eating. There is also Single Abdominal Distension, where the abdomen is large but limbs are extremely thin. This occurs because distension has persisted for a long time, causing Qi and Blood to aggregate and fail to disperse, commonly known as Gu Distension, which is more severe. (From *Zhengzhi Huibu*)
[Pulse Diagnosis]
Wiry pulse at the Guan position indicates distension. Also, slow and slippery, vigorous and tight, large, firm, and choppy pulses all indicate distension. A deficient pulse indicates Deficiency Distension; a deep and firm pulse indicates Excess Distension. Floating and large pulses are easy to treat; minute and faint pulses are difficult to treat. (From *Zhengzhi Huibu*)
[Therapeutic Principles]
For Excess, use purgation and reduction, directly clearing the Yangming channel. For Deficiency, use warming and ascending, regulating and tonifying the Spleen and Kidney. For those who are neither significantly full nor significantly deficient, first use clearing, draining, and guiding methods, followed by middle-tonifying regulation. Only in cases of superficial Excess and root Deficiency is it difficult to treat; purging is contraindicated, and tonifying is ineffective. One should avoid salty flavors to prevent aiding pathogenic factors, and eliminate delusions to preserve Mother Qi (Spleen/Stomach Qi). (From *Yizong Bidu*)
[Cold Distension Should Be Warmed]
Cold in the viscera generates distension; cold in the Stomach causes distension. (From Classics) Because the Spleen is the extreme Yin within Yin, corresponding to Damp Earth, responsible for transforming nutrients and controlling food and water. If Spleen Dampness is excessive and lacks Yang to transform it, accumulation occurs without dispersion, leading to distension. Such cases should be treated with acrid-hot herbs. (From Li Dongyuan)
[Heat Distension Should Be Cleared]
All abdominal distensions and enlargements belong to Heat. (From Classics) When Damp-Heat Qi cannot be transformed and diffused, stagnating in the middle Jiao causing distension, bitter-cold herbs should be used. If Spleen Qi is not dispersed, stagnating into Fire, causing acid regurgitation and gradually forming distension, medication should be rigid yet gentle, primarily using Lianli Tang. (From Yu Jiayan)
[Excess Distension Should Be Purged]
Hard abdomen fearing pressure, yellow tongue coating, and firm pulse indicate Excess pathogen surplus. The method should be to push away stagnation, meaning "purging will resolve the distension." (From *Zhengzhi Huibu*)
[Deficiency Distension Should Be Tonified]
In people with Spleen Deficiency, accidental Qi stagnation treated incorrectly with harsh reducing drugs scatters Middle Qi, causing Water Qi to overflow and cause distension. This is Spleen Deficiency failing to control. The method should be to tonify Earth and regulate the center, allowing Turbid Yin to transform naturally.
[Liver Distension Should Be Regulated]
For distension due to Hyperactive Liver, although Liver should be subdued, excessive nature harms the Liver itself; harsh reduction should not be overused. Support the Spleen and soothe the Liver, using both methods, allowing Wood nature to be smooth and not stagnate in Earth, then distension will stop. (From *Zhuncheng*)
[Kidney Deficiency Should Be Warmed]
Commonly seen in those who work hard and indulge in sex, with concurrent Spleen and Kidney Deficiency, Turbid Pathogens overflowing, causing external swelling. One should gather Kidney Qi to prevent water flooding. This is benefiting the source of Fire to eliminate Yin shadows, primarily using Jin Gui Shen Qi Wan. (From Zhizhai)
[Treatment Has No Rapid Effect]
Distension begins as Qi, becoming Water over time; treatment is harder than for edema. Edema patients eat normally, while Drum Distension patients have reduced appetite. The disease root is deep, forming over 3-5 years. Treating edema only requires tonifying the center and moving Qi. Treating distension must involve tonifying the center, resolving dampness, and eliminating accumulations. Do not seek rapid effects to ensure complete safety. (From *Yixue Rumen*)
[Distension Requires Major Tonification]
Common saying "Qi has no tonification method" arises because stuffiness and obstruction seem hard to tonify. But consider that true deficiency fails to transport, allowing pathogens to attach. Without tonifying Qi, how can Qi move? (From Fanxi)
[Treatment Avoids Harsh Attack]
Physicians fail to observe that disease originates from deficiency but rush for effect. Patients suffer from distension urgency and prefer laxatives for temporary relief. Not knowing that slight relief leads to worse distension, increased disease, and damaged Zheng Qi, making further purging impossible. (From Zhu Danxi)
[Death Syndromes]
Distension with anorexia: Death. Distension with fever: Death. Distension with chills and fever like malaria: Death. Large abdominal distension, cold extremities, emaciation, severe diarrhea: Adverse/Death. Distension with hematochezia, pulse large as if absent: Death. Distension with intermittent wheezing, sweating, and cold reversal: Death. Chest and throat fullness, umbilical protrusion: Death. (From *Zhengzhi Huibu*)
[Medication]
Primary formula: Er Chen Tang, add Hou Po, Mu Xiang, Su Geng, Da Fu Pi, remove Gan Cao. Obese people have much Dampness, add Cang Zhu, Mu Tong. Thin people have much Fire, add Huang Qin, Huang Lian, Shan Zhi. Food accumulation adds Shan Zha, Shen Qu. Blood stasis adds Tao Ren, E Zhu. Qi depression adds Xiang Fu, Fu Xiong. Anger adds Chai Hu, Qing Pi. Internal Cold stagnation adds Mu Xiang, Pao Jiang. External Cold constraint adds Sheng Ma, Ge Gen, Cang Zhu. Constipation with Excess Heat adds Da Huang. Short urine with Dampness binding adds Mu Xiang, Ze Xie. For initial distension, use Qi-moving and guiding agents, adding Mu Xiang, Bing Lang, Chen Pi, Qing Pi, Zhi Qiao, Hou Po, etc. For long-term with deficiency, tonify Spleen and regulate Qi, such as Liu Jun Zi Tang plus Su Geng, Sha Ren. For deficiency with Cold, warm and tonify, such as Li Zhong Tang plus Rou Gui. If Spleen and Kidney are both deficient, and Ming Men Fire cannot support Spleen, tonify Kidney. There are two methods for Kidney tonification: If able to eat and chest/diaphragm is comfortable, use Jin Gui Shen Qi Wan. If unable to eat and chest/diaphragm is full/stuffy, use Fu Yuan Dan. Only for severe Excess, large fullness, hardness, and pain on pressure, measure Zheng Qi and purge, using San Hua Shen You Wan, Dao Qi Wan, etc. After purging, still regulate and tonify Spleen and Stomach.
[Attached: Parasite Gu Distension]
Parasite Gu results from long-standing Damp-Heat, blood transforming into parasites. Abdomen distended and large, masses palpable, shape like a melon, limbs emaciated, abdominal pain but red lips, able to eat, slippery-rapid pulse. This is Gu Syndrome, treat with Ji Kuai Wan to purge. (From *Zhuncheng*)
[Selected Formulas for Distension]
Liu Jun Zi Tang: Treats Qi Deficiency central fullness. (Formula see Stroke chapter)
Lianli Tang: Treats Spleen Deficiency with Liver Depression, acid regurgitation, abdominal distension. (Formula see Diarrhea chapter)
Wei Ling Tang: Treats Spleen Dampness abdominal distension with yellow face, body edema, scanty urine. (Formula see Summerheat chapter)
Shen Qi Wan (*Jin Gui*): Treats Spleen-Kidney dual deficiency, swelling, soft abdomen but non-hard chest. (Formula see Dampness chapter)
Bu Zhong Yi Qi Tang (Formula see Stroke chapter)
Tiao Zhong Tang (Formula see Macules/Rashes chapter)
Fu Yuan Dan (*San Yin Fang*): Treats Spleen-Kidney dual deficiency causing swelling, hard/full heart and abdomen, urinary retention, swelling under eyes.
Ingredients: Fu Zi (prepared 2 liang), Nan Mu Xiang (roasted), Hui Xiang (stir-fried), Chuan Jiao (stir-fried until sweat comes out), Hou Po, Du Huo, Bai Zhu (stir-fried), Chen Pi, Gui Xin, Wu Zhu Yu (stir-fried, each 1 liang), Ze Xie (1.5 liang), Rou Dou Kou (roasted), Bing Lang (each 0.5 liang).
Preparation: Powder, paste pills, taken with Perilla decoction.
Dao Qi Wan: Treats various abdominal distensions, blockage, false constipation, where form, Qi, and disease Qi are all Excess.
Ingredients: Qing Pi (fried with leech), E Zhu (fried with drone fly), San Leng (fried with dry lacquer), Bing Lang (fried with blister beetle), Wu Yu (fried with qian Niu), Chi Shao (fried with Chuan Jiao), Chang Pu (fried with Tao Ren), Huang Qin (fried with Da Huang), Hou Po (fried with Gan Jiang), Shan Zha Rou (fried with Cao Guo).
Preparation: Stir-fry together until cooked, remove leeches etc., powder, wine paste pills, size of wu zi. Take 5-7 pills, empty stomach, with Perilla decoction.
Zhong Man Fen Xiao Wan (Dongyuan): Treats central fullness heat distension.
Ingredients: Huang Qin (stir-fried), Huang Lian (stir-fried, each 5 qian), Jiang Huang, Bai Zhu, Ren Shen, Zhi Gan Cao, Zhu Ling (each 1 qian), Bai Fu Ling, Gan Sheng Jiang, Sha Ren (each 2 qian), Zhi Shi (stir-fried), Ban Xia (each 5 qian), Hou Po (stir-fried 1 liang), Zhi Mu (stir-fried 4 qian), Ze Xie, Chen Pi (each 3 qian).
Preparation: Powder, steamed biscuit pill soaked in decoction. Take 100 pills.
Zhong Man Fen Xiao Tang (Dongyuan): Treats Cold Distension.
Ingredients: Wu Zhu Yu, Hou Po, Cao Dou Kou, Huang Bo (each 5 fen), Yi Zhi Ren, Ban Xia, Fu Ling, Mu Xiang, Sheng Ma (each 3 fen), Ren Shen, Qing Pi, Dang Gui, Huang Lian, Ze Xie, Sheng Jiang, Ma Huang (uncut joints), Chai Hu Shao, Gan Jiang, Chuan Wu, Bi Cheng Qie (each 2 fen).
Usage: Decoct in water, take hot.
Guang Shu Kui Jian Tang (Dongyuan): Treats central fullness abdominal distension with accumulation.
Ingredients: Hou Po (Ginger stir-fried 5 fen), Sheng Ma, Hong Hua, Gan Cao, Wu Zhu Yu (soaked in soup, each 2 fen), Huang Qin, Yi Zhi, Cao Dou Kou, Dang Gui (each 5 fen), Huang Lian (3 fen), Ban Xia (7 fen), Guang Shu (roasted 3 fen), Chai Hu, Ze Xie, Chen Pi, Shen Qu (stir-fried), Qing Pi (each 3 fen).
Modification: Thirst, add Ge Gen 4 fen. Decoct in water.
Bao An Wan: Treats internal nodules, upward rushing heart pain, umbilical abdominal pain.
Ingredients: Da Huang (3 liang), Fu Zi (5 qian), Gan Jiang (1 liang), Bie Jia (1.5 liang).
Preparation: Powder. First boil vinegar 1 sheng to 4-5 he, mix with medicine to make pills. Take empty stomach, until accumulation is expelled.
Ji Shi Li (*Suwen*): Treats Damp-Heat distension.
Ingredients: Ram chicken feces 8 he, stir-fried slightly charred, good wine without ash 2 bowls.
Usage: Decoct to half bowl, filter juice. Drink hot at dawn, then pass black water 2-3 times during chicken crowing to Si hour. Next day feet show wrinkles. Drink once more, wrinkles extend to knees, then cured.
Ji Kuai Wan
Ingredients: Jing San Leng, E Zhu, Zi Ran Tong, She Han Shi, Xiong Huang (each 2 qian), Wu Gong (1.1 qian), Mu Xiang (1.5 qian), Tie Fen, Chen Sha, Chen Xiang (8 fen), Bing Pian (5 fen), Lu Hui, Tian Zhu Huang, A Wei, Quan Xie (each 4 qian).
Preparation: Pig bile pills. Take 8 fen, severe cases 1 qian. At dawn, send down with wine.
[External Treatment for Swelling and Fullness]
Use Shui Liao Hua, Pi Xiao, Ya Zao, Da Huang each 5 qian, Sheng Jiang 10 slices, Cong, Suan each 7 pieces, Lai Fu Zi 3 qian, Zhi Zi 5 qian. Pound into a large plaster, apply to umbilicus and abdomen, wrap with cotton wool to keep warm.
Another method: Alchemist uses Phytolacca radix pounded, add a little Moschus, apply to umbilicus, wrap with cotton wool to guide water downward.
Another method: Using Toad crushed and taken orally, often called miraculous.
Another method: Use Snail, Garlic, Plantago herb, grind into paste, make large cake apply to umbilicus, let exit via urination/defecation.
Another method: Use Da Ji, Qian Niu each 1 liang, Da Zao 2 sheng. Boil in pot, remove medicine, eat dates, then cured.
[Umbilical Paste Pill]
Zhen Qing Fen 2 qian, Ba Dou 4 liang, Sheng Liu Huang 1 qian. Grind evenly into a cake. First place new cotton on umbilicus, then place medicine cake, bind tightly with cloth. After walking about 10 li, water will flow. After 3-5 times, remove medicine, supplement with warm porridge. One cake treats ten people.