人有饮食之后,胸中倒饱,人以为多食而不能消,用香砂枳实等丸消导之,似
觉少快,已而又饱,又用前药,久久不已,遂成中满之症。腹渐高硕,脐渐突出,
肢体渐浮胀,又以为臌胀,用牵牛、甘遂之药,以逐其水。内原无水湿之邪,水未
见出,而正气益虚,胀满更急,又疑前药不胜,复加大黄、巴豆之类下之。仍然未
愈,又疑为风邪固结于经络,用龙胆、茵陈、防风、荆芥之类,纷然杂投,不至于
死不已。犹然开鬼门、泄净府,持论纷纭,各执己见,皆操刀下石之徒也。谁知中
满之症,实由于脾土之衰,而脾气之衰,又由于肾火之寒也。倘用温补之药,早健
其脾气,何至如此之极哉。方用温土汤∶
人参(一钱) 白术(三钱) 茯苓(三钱) 萝卜子(一钱) 薏仁(三钱) 芡实(五钱)
山药(五钱) 肉桂(三分) 谷芽(三钱) 水煎服。一剂而觉少饱,二剂而觉少宽矣,数剂之
后,中满自除。
此方但去补脾,绝不消导以耗其气。盖中满之病,未有不因气虚而成者。不补
脾胃之气,则胀从何消?况方中加入萝卜子最妙,助参、术以消胀,不辅参、术以
添邪;又有茯苓、薏仁、芡实、山药之类,益阴以利水,水流而正气不耗,自然下
泽疏通,而上游无阻滞之虞矣。第恐水寒冰冻,则溪涧断流,又益以肉桂,于水中
生火,则土气温和,雪消冰泮,尤无壅塞之苦也。奈何惟事于消导,遂成不可救药
之病哉。
此症用术苓加桂汤∶
白术(一两) 茯苓(五钱) 肉桂(一钱) 水煎服。
人有未见饮食则思,既见饮食则厌,乃勉强进用,饱塞于上脘之间,微微胀闷,
此不止胃气之虚。而心包之火正衰也。心包为胃土之母,母气既衰,何能生子,心
包之火不足,又何能生胃哉。故欲胃之能食。必须补胃土,而兼补心包之火也。方
用生胃进食汤∶
人参(三钱) 白术(三钱) 炒枣仁(五钱) 远志(八分) 山药(三钱) 茯苓(三钱) 神曲(五分)
良姜(五分) 萝卜子(一钱) 枳壳(五分) 干姜(炒黑,一钱) 水煎服。
此方治胃,无非治心包也。心包与胃,原是子母,何必分治之乎?不治中满而
中满自除,此补火之胜于补土也。
此症用调饥散亦妙。
人参(五分) 山药(一两) 白芍(三钱) 甘草(五分) 肉桂(一钱) 菖蒲(五分) 肉豆蔻(一枚)
炒枣仁(三钱) 水煎服。十剂愈。
人有中心郁郁不舒,久则两胁饱满,饮食下喉,即便填胀,不能消化,人以为
臌胀之渐也,而不知皆气滞之故。倘用逐水之药,必且更甚;用消食之药,亦止可
取一时之快,而不能去永久之胀也。法宜开郁为主。然而气郁既久,未有不气虚者
也,使仅解其郁,而不兼补其气,则气难化食,胀何以消?方用快膈汤∶
人参(一钱) 茯神(五钱) 白芍(三钱) 白芥子(二钱) 萝卜子(五分) 槟榔(三分) 神曲(五分)
枳壳
(三分) 柴胡(五分) 薏仁(三钱) 浓朴(三分) 水煎服。一、二剂轻,四剂全愈。
此方解郁而无刻削之忧,消胀而无壅塞之苦,攻补兼施,自易收功也。
此症用抒胀汤亦妙。
神曲(三钱) 柴胡(五分) 白芍(三钱) 茯苓 萝卜子(各一钱) 浓朴 人参(各五分)
白豆蔻(三枚) 苏叶(八分) 白芥子(二钱) 水煎服。十剂愈。
人有患中满之病,饮食知味,但多食则饱闷不消,人以为脾气之虚,谁知是肾
气之虚乎。腹中饱闷,乃虚饱而非实饱,若作水肿治之,则丧亡指日矣。盖脾本属
土,土之能制水者,本在肾中之火气。土得火而坚,土坚而后能容物,能容物即能
容水也。惟肾火既虚,而土失其刚坚之气,土遂不能容物而容水,乃失其天度之流
转矣,故腹饱而作满,即水臌之渐也。人不知补肾火以生脾土,反用泻水之法以伤
脾,无异决水以护土,土有不崩者哉?是治肾虚之中满,可不急补其命门之火乎。
然而径补其火,则又不可,以肾火不能自生,生于肾水之中也。但补火而不补水,
则孤阳不长,无阴以生阳,即无水以生火也。或疑土亏无以制水,又补肾以生水,
不益增波以添胀哉?不知肾中之水,乃真水也,邪水欺火以侮土,真水助火以生土,
实有不同。故肾虚中满,必补火以生土;又必补水以生火耳。方用金匮肾气丸∶
茯苓(六两) 附子(一枚) 牛膝(一两) 肉桂(一两) 泽泻(二两) 车前子(一两五钱)
山茱萸(二两) 山药(四两) 牡丹皮(一两) 熟地(三两)各为末,蜜为丸。每日早晚白滚水送一
两。初服少胀,久服胀除而满亦尽消。
补火之圣药也。群药之内,利水健脾之味多于补阴补火者,虽意偏于补火,而
要实重于救脾,补火者正补脾也。故补阴不妨轻,而补脾不可不重耳。
此症用熏脾汤亦佳。
熟地 白术(各五钱) 山茱萸(四钱) 破故纸(一钱) 杜仲(三钱) 附子(五分)
水煎服。二剂而饱闷除,十剂全愈。
有人在进食之后,感到胸中胀满不适,人们认为是吃多了导致消化不良,于是使用香砂枳实丸等药物来消食导滞,虽然暂时觉得稍微舒服一些,但不久后又感到饱胀,再次服用之前的药物。这样长期反复下去,最终形成了中满症(以腹部胀满为主要表现的病证)。腹部逐渐高起膨大,肚脐逐渐突出,四肢身体逐渐浮肿发胀,人们又误以为是臌胀(腹部胀大如鼓的病证),于是使用牵牛子、甘遂等峻下逐水药来攻逐体内积水。然而体内原本并没有水湿之邪,水液未见排出,正气反而更加虚弱,胀满症状更加急迫。人们又怀疑之前的药力不足,再次加大黄、巴豆等泻下药来通便攻下。病情依然没有好转,又怀疑是风邪固结在经络中,于是杂乱地投用龙胆草、茵陈、防风、荆芥等药物,直到病人死亡才停止。这些医生还自诩运用了“开鬼门”(发汗法)、“洁净府”(利小便法)等治法,议论纷纷,各执己见,都是些拿着刀子落井下石的人。
谁知道中满症,实际上是由于脾土衰弱引起的,而脾气的衰弱,又是由于肾火(命门之火)寒冷造成的。如果及时使用温补类药物,早日强健脾气,怎么会发展到如此严重的地步呢?方剂使用温土汤:人参(一钱)、白术(三钱)、茯苓(三钱)、萝卜子(莱菔子,一钱)、薏苡仁(三钱)、芡实(五钱)、山药(五钱)、肉桂(三分)、谷芽(三钱),水煎服。服用一剂后感觉胀满稍减,服用两剂后感觉舒适宽畅,服用数剂之后,中满症状自然消除。
这个方子只注重补益脾胃,绝不使用消导药物来耗损正气。因为中满这种病,没有不是因为气虚而形成的。如果不补益脾胃之气,胀满从何消除?况且方中加入萝卜子最为巧妙,它能辅助人参、白术来消除胀满,而不是辅助人参、白术去增添邪气;又有茯苓、薏苡仁、芡实、山药等药物,通过益阴来利水,水流则正气不耗损,自然下游疏通,上游也就没有阻滞的担忧了。只是担心如果水寒冰冻,溪流就会断流,所以加入肉桂,在水中生火,使土气温和,冰雪消融,尤其没有壅塞的痛苦。奈何那些医生只从事于消导攻伐,最终导致了不可救药的病症。
此症也可以使用术苓加桂汤:白术(一两)、茯苓(五钱)、肉桂(一钱),水煎服。
有的人还没看到食物就想着吃东西,一旦看到食物却厌恶它,勉强进食后,饱塞感停留在上脘之间,微微感到胀闷,这不仅仅是胃气虚弱,更是心包络之火正衰弱的表现。心包络是胃土的母脏,母脏之气既然衰弱,怎么能滋养子脏呢?心包络之火不足,又怎么能生助胃土呢?所以想要胃能正常进食,必须补益胃土,同时兼补心包络之火。方剂使用生胃进食汤:人参(三钱)、白术(三钱)、炒酸枣仁(五钱)、远志(八分)、山药(三钱)、茯苓(三钱)、神曲(五分)、良姜(五分)、萝卜子(一钱)、枳壳(五分)、干姜(炒黑,一钱),水煎服。
这个方子治疗胃,无非是在治疗心包络。心包络与胃,原本是母子关系,何必分开治疗呢?不直接治疗中满而中满自然消除,这是补火胜于补土的效果。
此症使用调饥散也非常奇妙。人参(五分)、山药(一两)、白芍(三钱)、甘草(五分)、肉桂(一钱)、石菖蒲(五分)、肉豆蔻(一枚)、炒酸枣仁(三钱),水煎服。服用十剂痊愈。
有的人心中郁郁不乐,时间久了导致两胁饱满,饮食咽下喉咙,立刻感到填塞胀满,不能消化,人们以为是臌胀的前兆,却不知道这都是气机滞涩的缘故。如果使用逐水药物,病情必定加重;使用消食药物,也只能取得一时的快感,而不能去除永久的胀满。治疗方法应当以开郁解结为主。然而气郁时间既久,没有不伴随气虚的,如果仅仅疏解其郁结,而不兼补气虚,那么气难以运化食物,胀满如何消除?方剂使用快膈汤:人参(一钱)、茯神(五钱)、白芍(三钱)、白芥子(二钱)、萝卜子(五分)、槟榔(三分)、神曲(五分)、枳壳(三分)、柴胡(五分)、薏苡仁(三钱)、厚朴(三分),水煎服。服用一、二剂症状减轻,四剂完全痊愈。
这个方子解郁而没有刻削正气之忧,消除胀满而没有壅塞之苦,攻补兼施,自然容易收到功效。
此症使用抒胀汤也非常奇妙。神曲(三钱)、柴胡(五分)、白芍(三钱)、茯苓(各一钱)、萝卜子(各一钱)、厚朴(各五分)、人参(各五分)、白豆蔻(三枚)、苏叶(八分)、白芥子(二钱),水煎服。服用十剂痊愈。
有的人患有中满病,饮食知道味道,但多吃就会饱闷不消化,人们认为是脾气虚弱,谁知道这是肾气虚弱呢?腹中饱闷,是虚性的饱闷而非实性的饱闷,如果按照水肿来治疗,死亡就在眼前了。因为脾本属土,土之所以能制约水,根本在于肾中的火气。土得到火的温煦而坚固,土坚固后才能容纳物体,能容纳物体就能容纳水。只有当肾火既已虚弱,土失去了刚坚之气,土就不能容纳物体而转而容纳水,于是失去了正常的流转规律,所以腹部饱闷而变成胀满,这就是水臌的前兆。人们不知道补肾火来生脾土,反而使用泻水的方法来损伤脾土,无异于决堤放水来保护堤岸,堤岸哪有不被崩塌的道理呢?因此治疗肾虚引起的中满,难道不应该急切地补益命门之火吗?
然而直接补火也是不可以的,因为肾火不能独自产生,它是生于肾水中的。只补火而不补水,那么孤阳不能生长,没有阴来生阳,也就是没有水来生火。有人或许怀疑土亏无法制水,又补肾来生水,不是增加波澜来增添胀满吗?不知道肾中的水是先天真水,邪水欺侮火气进而侮犯脾土,而真水帮助火气进而生助脾土,确实是有区别的。所以肾虚中满,必须补火来生土;又必须补水来生火。方剂使用金匮肾气丸:茯苓(六两)、附子(一枚)、牛膝(一两)、肉桂(一两)、泽泻(二两)、车前子(一两五钱)、山茱萸(二两)、山药(四两)、牡丹皮(一两)、熟地黄(三两),各研为末,蜂蜜制成丸药。每日早晚用白开水送服一两。初服时感觉轻微胀满,久服后胀满消除,痞满也全部消散。
这是补火的圣药。在这群药物之中,利水健脾的成分多于补阴补火的成分,虽然意图偏向于补火,但实际上重在挽救脾土,补火正是为了补脾。所以补阴不妨轻淡,而补脾不可不厚重。
此症使用熏脾汤也很好。熟地黄(五钱)、白术(五钱)、山茱萸(四钱)、破故纸(补骨脂,一钱)、杜仲(三钱)、附子(五分),水煎服。服用两剂后饱闷消除,服用十剂完全痊愈。
A person, after eating, feels fullness and discomfort in the chest. People assume it is due to overeating and indigestion, so they use pills such as Xiangsha Zhishi Wan (Fragrant Sand and Immature Bitter Orange Pill) to promote digestion. Although there seems to be slight relief, fullness returns shortly after. The same medication is used again. This cycle continues for a long time, eventually resulting in the syndrome of Middle Fullness (a disease characterized by abdominal distension). The abdomen gradually becomes high and swollen, the umbilicus protrudes, and the limbs and body become edematous. People then mistakenly diagnose it as Drum Distension (abdominal distension resembling a drum) and use harsh water-draining herbs like Qian Niu Zi (Pharbitis Seed) and Gan Sui (Kansui Root) to purge fluid retention. However, there was originally no pathogenic damp-fluid in the interior. Before any fluid is expelled, the healthy Qi becomes even more deficient, and the distension becomes more urgent. Suspecting that the previous medications were ineffective, doctors further administer purgatives such as Da Huang (Rhubarb Rhizome) and Ba Dou (Croton Seed). The condition remains unimproved. They then suspect that wind pathogens are firmly bound in the meridians and indiscriminately prescribe drugs like Long Dan Cao (Gentian Root), Yin Chen Hao (Artemisia Capillaris Herb), Fang Feng (Saposhnikovia Root), and Jing Jie (Schizonepeta Spike), continuing until the patient dies. These practitioners still claim to have employed methods such as "opening the ghost gate" (diaphoresis/sweating) and "purifying the clean mansion" (diuresis), arguing纷纭ly and sticking to their own views. They are all people who wield knives to stab those already down. Who knows that the syndrome of Middle Fullness actually stems from the decline of Spleen Earth, and the decline of Spleen Qi is caused by the coldness of Kidney Fire (Mingmen Fire). If warm-tonic medicines had been used early to strengthen Spleen Qi, how could it have reached such an extreme? The prescription used is Wendu Tang (Warm Earth Decoction): Ren Shen (Ginseng Radix et Rhizoma, 1 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 qian), Fu Ling (Poria, 3 qian), Luo Bo Zi (Radish Seed, 1 qian), Yi Yi Ren (Coicis Semen, 3 qian), Qian Shi (Euryales Semen, 5 qian), Shan Yao (Dioscoreae Rhizoma, 5 qian), Rou Gui (Cinnamon Twig, 3 fen), Gu Ya (Sprouted Grain, 3 qian). Decoct in water and take orally. After one dose, slight fullness is felt; after two doses, a sense of ease is experienced; after several doses, Middle Fullness naturally resolves.
This formula focuses solely on tonifying the Spleen and Stomach, absolutely avoiding digestive-promoting drugs that would consume Qi. The disease of Middle Fullness invariably arises from Qi deficiency. Without tonifying Spleen and Stomach Qi, how can distension dissipate? Moreover, adding Luo Bo Zi (Radish Seed) to the formula is exquisite; it assists Ren Shen and Bai Zhu in resolving distension without assisting them in generating pathogenic factors. Additionally, herbs such as Fu Ling, Yi Yi Ren, Qian Shi, and Shan Yao nourish Yin to facilitate fluid metabolism. As fluids flow, healthy Qi is not consumed, ensuring smooth drainage downstream without obstruction upstream. The only concern is that if water is cold and frozen, streams may dry up. Therefore, Rou Gui (Cinnamon Twig) is added to generate fire within the water, warming the Earth element. With melting snow and ice, there is no suffering from blockage. Alas, why do physicians insist on digestive purgation, leading to incurable conditions?
For this syndrome, Shuling Jiagui Tang (Atractylodes and Poria with Cinnamon Decoction) can also be used: Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 liang), Fu Ling (Poria, 5 qian), Rou Gui (Cinnamon Twig, 1 qian). Decoct in water and take orally.
There are individuals who crave food before seeing it but feel aversion upon seeing it. Forcing themselves to eat results in fullness lodged in the Upper Jiao (Upper Burner), accompanied by slight distension and oppression. This indicates not only Stomach Qi deficiency but also the decline of Pericardium Fire. The Pericardium is the mother organ of Stomach Earth. If the mother's Qi declines, how can it generate the child? If Pericardium Fire is insufficient, how can it generate Stomach Earth? Thus, to enable the Stomach to digest food, one must tonify Stomach Earth while simultaneously supplementing Pericardium Fire. The prescription used is Shengwei Jinshi Tang (Generate Stomach and Promote Appetite Decoction): Ren Shen (Ginseng Radix et Rhizoma, 3 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 qian), Chao Zao Ren (Fried Ziziphus Seed, 5 qian), Yuan Zhi (Polygalae Radix, 8 fen), Shan Yao (Dioscoreae Rhizoma, 3 qian), Fu Ling (Poria, 3 qian), Shen Qu (Medicated Leaven, 5 fen), Liang Jiang (Galangal Rhizome, 5 fen), Luo Bo Zi (Radish Seed, 1 qian), Zhi Ke (Aurantii Fructus, 5 fen), Gan Jiang (Zingiberis Rhizoma, fried black, 1 qian). Decoct in water and take orally.
Treating the Stomach in this formula is essentially treating the Pericardium. The Pericardium and Stomach share a mother-child relationship; why treat them separately? By not directly treating Middle Fullness, it resolves spontaneously. This demonstrates that tonifying Fire is superior to tonifying Earth.
For this syndrome, Tiaoji San (Regulate Hunger Powder) is also excellent: Ren Shen (Ginseng Radix et Rhizoma, 5 fen), Shan Yao (Dioscoreae Rhizoma, 1 liang), Bai Shao (Paeoniae Radix Alba, 3 qian), Gan Cao (Licorice Root, 5 fen), Rou Gui (Cinnamon Twig, 1 qian), Chang Pu (Acori Tatarinowii Rhizoma, 5 fen), Rou Dou Kou (Myristica Seed, 1 piece), Chao Zao Ren (Fried Ziziphus Seed, 3 qian). Decoct in water and take orally. Ten doses result in cure.
Some individuals feel depressed and stifled in the heart. Over time, this leads to fullness in both hypochondriac regions. When food enters the throat, immediate bloating occurs, preventing digestion. People mistake this for the onset of Drum Distension, unaware that it is caused by Qi stagnation. Using water-draining drugs will worsen the condition; using digestive-promoting drugs only provides temporary relief and cannot eliminate chronic distension. The treatment method should primarily focus on relieving depression (stagnation). However, prolonged Qi stagnation inevitably leads to Qi deficiency. If one only resolves stagnation without tonifying Qi, Qi will fail to transform food, and distension will not resolve. The prescription used is Kuai Ge Tang (Quick Diaphragm Decoction): Ren Shen (Ginseng Radix et Rhizoma, 1 qian), Fu Shen (Poria with Hostwood, 5 qian), Bai Shao (Paeoniae Radix Alba, 3 qian), Bai Jie Zi (Mustard Seed, 2 qian), Luo Bo Zi (Radish Seed, 5 fen), Bing Lang (Areca Seed, 3 fen), Shen Qu (Medicated Leaven, 5 fen), Zhi Ke (Aurantii Frizctus, 3 fen), Chai Hu (Bupleuri Radix, 5 fen), Yi Yi Ren (Coicis Semen, 3 qian), Hou Po (Magnolia Bark, 3 fen). Decoct in water and take orally. Symptoms lighten after one or two doses; complete recovery occurs after four doses.
This formula relieves stagnation without damaging righteous Qi and reduces distension without causing blockage. Combining attacking and tonifying methods facilitates success.
For this syndrome, Shuzhang Tang (Relieve Distension Decoction) is also effective: Shen Qu (Medicated Leaven, 3 qian), Chai Hu (Bupleuri Radix, 5 fen), Bai Shao (Paeoniae Radix Alba, 3 qian), Fu Ling (Poria, 1 qian), Luo Bo Zi (Radish Seed, 1 qian), Hou Po (Magnolia Bark, 5 fen), Ren Shen (Ginseng Radix et Rhizoma, 5 fen), Bai Dou Kou (Cardamomi Fructus, 3 pieces), Su Ye (Perillae Leaf, 8 fen), Bai Jie Zi (Mustard Seed, 2 qian). Decoct in water and take orally. Ten doses result in cure.
Some patients suffer from Middle Fullness. They retain taste sensation for food, but overeating leads to bloating and indigestion. People attribute this to Spleen Qi deficiency, not realizing it is actually Kidney Qi deficiency. The abdominal fullness is false fullness (deficiency-type) rather than true fullness (excess-type). Treating it as edema would lead to imminent death. The Spleen belongs to Earth. Earth controls Water, but this control fundamentally relies on the Fire within the Kidneys. Earth becomes firm when warmed by Fire; once firm, it can contain objects, and thus contain water. When Kidney Fire is deficient, Earth loses its firmness and cannot contain objects, instead accumulating water. This disrupts normal physiological flow, leading to abdominal fullness and progressing to Water Drum Distension. Ignoring the need to tonify Kidney Fire to generate Spleen Earth, and instead using water-draining methods to injure the Spleen, is akin to breaching a dam to protect the soil—the soil will inevitably collapse. Therefore, treating Middle Fullness caused by Kidney deficiency requires urgently tonifying the Fire of the Gate of Vitality (Mingmen).
However, directly tonifying Fire is inadvisable because Kidney Fire does not arise independently; it is generated within Kidney Water. Tonifying Fire without tonifying Water results in solitary Yang failing to grow, lacking Yin to generate Yang, and thus lacking Water to generate Fire. Some may doubt: if Earth is deficient and cannot control Water, tonifying the Kidney to generate Water might increase waves and exacerbate distension. This is incorrect. The Water in the Kidneys is True Water. Pathogenic Water bullies Fire to insult Earth, whereas True Water aids Fire to generate Earth. There is a distinct difference. Therefore, for Middle Fullness due to Kidney deficiency, one must tonify Fire to generate Earth, and also tonify Water to generate Fire. The prescription used is Jin Kui Shen Qi Wan (Golden Cabinet Kidney Qi Pill): Fu Ling (Poria, 6 liang), Fu Zi (Aconiti Lateralis Radix Praeparata, 1 piece), Niu Xi (Achyranthis Bidentatae Radix, 1 liang), Rou Gui (Cinnamon Twig, 1 liang), Ze Xie (Alismatis Rhizoma, 2 liang), Che Qian Zi (Plantaginis Semen, 1.5 liang), Shan Zhu Yu (Corni Fructus, 2 liang), Shan Yao (Dioscoreae Rhizoma, 4 liang), Mu Dan Pi (Moutan Cortex, 1 liang), Shu Di Huang (Rehmanniae Radix Praeparata, 3 liang). Grind each into powder and form pills with honey. Take 1 liang daily morning and evening with plain boiled water. Initial intake may cause slight distension; long-term use eliminates distension and fullness completely.
This is the supreme medicine for tonifying Fire. Among these ingredients, those promoting diuresis and strengthening the Spleen outnumber those tonifying Yin and Fire. Although the intent leans toward tonifying Fire, the practical emphasis is on saving the Spleen; tonifying Fire is precisely tonifying the Spleen. Thus, tonifying Yin can be light, but tonifying the Spleen must be heavy.
For this syndrome, Xunpi Tang (Smoke-Spleen Decoction) is also good: Shu Di Huang (Rehmanniae Radix Praeparata, 5 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 5 qian), Shan Zhu Yu (Corni Fructus, 4 qian), Po Gu Zhi (Psoraleae Fructus, 1 qian), Du Zhong (Eucommiae Cortex, 3 qian), Fu Zi (Aconiti Lateralis Radix Praeparata, 5 fen). Decoct in water and take orally. Fullness and oppression resolve after two doses; complete recovery occurs after ten doses.