热聚于里，口干便闭。经云∶诸腹胀大，皆属于热是也。
枳壳锉散 治热症胀满。
浓朴 枳壳 桔梗（各半两） 炙草（一钱） 大黄（蒸，三钱）
锉，每服三钱，姜五片，枣二枚，乌梅一枚，煎服。
愚按∶热胀有二，假令外伤风寒有余之邪，自表入里，寒变为热，而作胃实腹满，仲景
以大
承气下之。亦有膏粱之人，湿热郁结于中，而成胀满者，宜清热导湿，东垣中满分消丸主之
。
中满分消丸 治中满热胀，有寒者勿用。
黄芩（一两二钱） 黄连（炒，五钱） 姜黄 白术 人参 炙草 猪苓（各一钱） 茯苓
干姜 砂
仁（各二钱） 枳实 半夏（各五钱） 浓朴（姜制，一两） 知母（炒，四钱） 泽泻 陈皮（各
为末，蒸饼为丸，如桐子大，每服百丸，热白汤下，食后，量病患虚实加减。
其症有二∶有寒气袭表而胀于外者，经云∶肤胀者，寒气客于皮肤， 然不坚，腹大
，身尽肿，皮浓，以手按其腹， 而不起，腹色不变，此其候也。有寒气入于里而胀于内者，盖
阴气凝聚，久而不散，内攻肠胃，则为寒中胀满泄利之症，经云∶脏寒生满病是也。在表者
温而散之，在里者温而行之。
温胃汤 治冷则气聚，胀满不下食。
熟附子 当归 浓朴 人参 半夏曲 橘红 生姜（各一两） 炙草（一两） 川椒（去合
锉散，每服三钱。
木香塌气丸（《元戎》）
丁香 胡椒（各三钱） 郁李仁（四钱） 白丑 枳实（各一两） 槟榔 木香 蝎尾（各半两）
为细末，饭丸绿豆大，每服十丸，加至十五丸，姜汤下。
此温行之剂，治单腹胀最妙。若胸胁胀满，一身面目尽浮，鼻塞咳逆，清涕出，当用
小青龙汤二三服，分利其经，却进消胀药。
热邪积聚于体内，导致口干、大便闭塞。《内经》说：“各种腹部胀大，都属于热证”，指的就是这种情况。
枳壳锉散：治疗热症引起的腹胀满。
药材组成：浓朴、枳壳、桔梗（各半两），炙甘草（一钱），大黄（蒸制，三钱）。
用法：切碎成散剂，每次服用三钱，加生姜五片、大枣二枚、乌梅一枚，煎汤服用。
我按语：热胀有两种情况。假如外感风寒等有余之邪，从体表传入体内，寒邪转化为热邪，从而造成胃实腹满，张仲景用大承气汤攻下治疗。也有的是饮食肥甘厚味之人，湿热郁结在中焦，形成胀满，适宜清热利湿，以东垣的中满分消丸为主方。
中满分消丸：治疗中焦胀满热胀，有寒证者禁用。
药材组成：黄芩（一两二钱），黄连（炒，五钱），姜黄、白术、人参、炙甘草、猪苓（各一钱），茯苓、干姜、砂仁（各二钱），枳实、半夏（各五钱），浓朴（姜汁制，一两），知母（炒，四钱），泽泻、陈皮（各一钱）。
用法：研为细末，用蒸饼糊制作药丸，如梧桐子大小，每次服用一百丸，用热白开水送服，饭后服用，根据病人的虚实情况加减用量。
寒胀的症状也有两种：一种是寒气侵袭体表而在外部引起胀满，《内经》说：“肤胀，是寒气客居在皮肤之间，鼓鼓然不坚硬，腹部肿大，全身浮肿，皮肤厚实，用手按压腹部，凹陷不起，腹部颜色不变，这就是它的征候。”另一种是寒气进入体内而在内部引起胀满，这是因为阴气凝聚，久而不散，向内攻冲肠胃，就会成为寒中胀满泄利的症状，《内经》说：“脏腑寒冷产生胀病”就是指这个。对于在体表的，用温法发散；对于在体内的，用温法通行。
温胃汤：治疗因冷导致气聚，腹胀满不能进食。
药材组成：熟附子、当归、浓朴、人参、半夏曲、橘红、生姜（各一两），炙甘草（一两），川椒（去目及闭合者，切碎成散剂）。
用法：每次服用三钱。
木香塌气丸（出自《元戎》）：
药材组成：丁香、胡椒（各三钱），郁李仁（四钱），白丑、枳实（各一两），槟榔、木香、蝎尾（各半两）。
用法：研为细末，用饭粒制作药丸，如绿豆大小，每次服用十丸，逐渐增加至十五丸，用姜汤送服。
这是温通运行的方剂，治疗单腹胀效果最好。如果出现胸胁胀满，全身面目全部浮肿，鼻塞咳嗽气逆，流出清鼻涕，应当先用小青龙汤二三服，分利其经络之气，然后再进用消除胀满的药物。
Heat accumulates in the interior, leading to dry mouth and constipation. The *Classic of Acupuncture and Moxibustion* (*Huangdi Neijing*) states: "All abdominal distensions and enlargements belong to heat," which refers to this condition.
Zhike Cuan San (Bitter Orange Powder): Treats abdominal distension and fullness caused by heat syndromes.
Ingredients: Houpo (Magnoliae Officinalis Cortex), Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix) (each 1.5 liang); Zhi Cao (Prepared Licorice Root) (1 qian); Dahuang (Rhubarb Root and Rhizome) (steamed, 3 qian).
Usage: Crush into a powder. Take 3 qian per dose, with 5 slices of Shengjiang (Fresh Ginger Rhizome), 2 dates, and 1 Wumei (Mume Fruit), decocted in water for oral administration.
Commentary: There are two types of heat distension. Suppose external pathogenic factors such as wind-cold, characterized by excess, enter from the exterior into the interior; cold transforms into heat, resulting in stomach excess and abdominal fullness. Zhang Zhongjing treats this with Dachengqi Tang (Major Order the Qi Decoction) to purge downward. Alternatively, individuals who consume rich and greasy foods may have damp-heat stagnating in the middle jiao, leading to distension and fullness. For these cases, clearing heat and guiding out dampness is appropriate, primarily using Dongyuan's Zhongman Fenxiao Wan (Middle Fullness Dispersing Pill).
Zhongman Fenxiao Wan (Middle Fullness Dispersing Pill): Treats middle-jiao distension and heat distension. Do not use if there is cold syndrome.
Ingredients: Huangqin (Scutellariae Radix) (1 liang 2 qian); Huanglian (Coptidis Rhizoma) (stir-fried, 5 qian); Jianghuang (Curcumae Longae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Renshen (Ginseng Radix et Rhizoma), Zhi Cao (Prepared Licorice Root), Zhuling (Polyporus) (each 1 qian); Fuling (Poria), Ganjiang (Zingiberis Rhizoma), Sharen (Amomi Fructus Rotundus) (each 2 qian); Zhishi (Aurantii Fructus Immaturus), Banxia (Pinelliae Rhizoma) (each 5 qian); Houpo (Magnoliae Officinalis Cortex) (processed with ginger juice, 1 liang); Zhimu (Anemarrhenae Rhizoma) (stir-fried, 4 qian); Zexie (Alismatis Rhizoma), Chenpi (Citri Reticulatae Pericarpium) (each 1 qian).
Usage: Grind into fine powder, mix with steamed cake paste to make pills the size of tung tree seeds. Take 100 pills per dose, administered with hot plain boiled water after meals. Adjust dosage according to the patient's deficiency or excess.
There are also two types of cold distension symptoms: One is where cold qi attacks the exterior, causing distension on the outside. The *Classic* states: "Skin distension occurs when cold qi lodges in the skin; it is bulging but not hard, the abdomen is large, the whole body swells, the skin is thick, and when pressed with hand, the depression does not rise immediately, while the abdominal color remains unchanged. This is its presentation." The other is where cold qi enters the interior, causing distension on the inside. This is due to the condensation of yin qi, which lingers and does not dissipate, attacking the stomach and intestines internally, leading to symptoms of cold-center distension, fullness, and diarrhea. The *Classic* states: "Cold of the zang organs generates distension diseases." For those at the exterior, warm and disperse them; for those in the interior, warm and promote circulation.
Weiwetang (Stomach-Warming Decoction): Treats qi accumulation due to cold, resulting in abdominal distension, fullness, and inability to eat.
Ingredients: Shufuzi (Prepared Aconiti Lateralis Radix), Danggui (Angelicae Sinensis Radix), Houpo (Magnoliae Officinalis Cortex), Renshen (Ginseng Radix et Rhizoma), Banxiaqu (Pinelliae Fermented Rhizoma), Juhong (Citri Reticulatae Pericarpium Rubrum), Shengjiang (Fresh Ginger Rhizoma) (each 1 liang); Zhi Cao (Prepared Licorice Root) (1 liang); Chuanjiao (Sichuan Pepper) (remove eyes and closed ones, crush into powder).
Usage: Take 3 qian per dose.
Muxiang Taqi Wan (Costus Settling Qi Pill) (from *Yuanrong*):
Ingredients: Dingxiang (Caryophylli Flos), Hujiao (Piperis Longi Fructus) (each 3 qian); Yuliren (Prunus Armeniacae Semen Amarum) (4 qian); BaiChou (Brayerae Semen), Zhishi (Aurantii Fructus Immaturus) (each 1 liang); Binglang (Arecae Semen), Muxiang (Aucklandiae Radix), Xiewei (Scorpion Tail) (each 0.5 liang).
Usage: Grind into fine powder, form pills with rice paste the size of mung beans. Take 10 pills per dose, increasing gradually to 15 pills, taken with ginger soup.
This is a warming and promoting formula, most excellent for treating isolated abdominal distension (monostasis). If there is chest and hypochondriac distension, complete swelling of the whole body including face and eyes, nasal congestion, coughing and reverse flow of qi, and discharge of clear nasal mucus, one should first administer Xia Qinglong Tang (Minor Green Dragon Decoction) two or three doses to differentiate and benefit the meridians, and then proceed with anti-distension medications.