痞者有食积兼湿。东垣有法有方。心下痞，须用枳实、炒黄连。如禀受充实，面苍
骨露，气
，而心下痞者，宜白术、山楂、曲 、陈皮；如肥人心下痞者，乃是湿痰，宜苍术、半夏
砂仁、茯苓、滑石；如瘦人心下痞者，乃是郁热在中焦，宜枳实、黄连、葛根、升麻；如食
后感寒，饮食不化，心下痞，宜藿香、草豆蔻、吴茱萸、砂仁；痞挟血成窠囊，用桃仁、红
入方
吴茱萸（三两，汤浸煮少时） 黄连（八两）
粥糊为丸。每服五七十丸，白术陈皮汤下。
玉液丸
软石膏（不以多少，又云火焰红出火毒）
上为末，醋糊丸如绿豆大。服之专能泻胃火，并治食
〔附录〕痞者，与否同，不通泰也，由阴伏阳蓄，气与血不运而成。处心下，位中央，
满痞塞者，皆土之病也，与胀满有轻重之分。痞则内觉
闷，而外无胀急之形者，是痞也。有中气虚弱，不能运化精微为痞者；有饮食痰积，不能
化为痞者；有湿热太甚为痞者。古方，治痞用黄连、黄芩、枳实之苦以泄之；浓朴、生姜
之辛以散之；人参、白术之甘苦以补之；茯苓、泽泻之淡以渗之。既痞，同湿治，惟宜上下
分消其气。如果有内实之证，庶可略与疏导。世人苦于痞塞，喜行利药，以求其速效，暂
时快通，痞若再作，益以滋甚。
附方
加味补中益气汤 治内伤，心下痞。方见内伤。
脉缓有痰而痞，加半夏、黄连；脉弦，四肢满闷，便难，而心下痞，加柴胡、黄连、甘
草；大便秘燥，加黄连、桃仁，少加大黄、归身；心下痞，瞀闷者，加白芍药、黄连；心下
痞，中寒者，加附子、黄连；心下痞，腹胀，加五味子、白芍、砂仁；天寒，少加干姜，或
；心下痞，呕逆者，加黄连、生姜、陈皮如冬月，加黄连，少入丁香、藿香；心下痞，如腹中
气上逆者，是冲脉逆也，加黄柏三分，黄连一分半以泄之；如食已，心下痞，别服橘皮枳
枳实消痞丸 治右关脉浮弦，心下虚痞，恶食，懒倦。开胃进食。
枳实 黄连（各五钱） 干生姜（二钱） 半夏曲（三钱） 浓朴（四钱） 人参（三钱） 甘草（炙，二钱）
白术（三钱） 茯苓 麦芽（各二钱）
上为末，水浸蒸饼，丸如梧桐子大。服三五十丸，温水下。
橘皮枳术丸
橘皮 枳实 白术（等分）
上为末，荷叶裹烧饭为丸。每服五十丸，白汤下。
枳术丸 助胃消食，宽中，去痞满。
白术 枳实（各二两）
上为末，荷叶裹烧饭为丸。
Pi syndrome (fullness and obstruction) is caused by food retention combined with dampness. Li Dongyuan has established methods and formulas for this. For epigastric fullness (heart-down pi), Zhi Shi (Immature Bitter Orange) and fried Huang Lian (Coptis Rhizome) must be used. If the patient has a robust constitution, a dark complexion, exposed bones, qi stagnation, and epigastric fullness, Bai Zhu (Atractylodes Macrocephala Rhizome), Shan Zha (Hawthorn Fruit), Shen Qu (Medicated Leaven), and Chen Pi (Tangerine Peel) are suitable. If an obese person presents with epigastric fullness, it is due to damp-phlegm; Cang Zhu (Atractylodes Rhizome), Ban Xia (Pinellia Tuber), Sha Ren (Amomum Fruit), Fu Ling (Poria), and Hua Shi (Talcum) are suitable. If a thin person presents with epigastric fullness, it is due to stagnant heat in the middle jiao; Zhi Shi (Immature Bitter Orange), Huang Lian (Coptis Rhizome), Ge Gen (Kudzu Root), and Sheng Ma (Cimicifuga Rhizome) are suitable. If cold is contracted after eating, leading to indigestion and epigastric fullness, Huo Xiang (Patchouli Herb), Cao Dou Kou (Black Cardamom Seed), Wu Zhu Yu (Evodia Fruit), and Sha Ren (Amomum Fruit) are suitable. If pi syndrome is complicated by blood stasis forming a nest-like structure, Tao Ren (Peach Kernel) and Hong Hua (Safflower) should be added to the formula. Wu Zhu Yu (Evodia Fruit, 3 liang, soaked in water and boiled briefly), Huang Lian (Coptis Rhizome, 8 liang) are made into pills using rice porridge paste. Take 50-70 pills per dose, administered with Bai Zhu Chen Pi Tang (White Atractylodes and Tangerine Peel Decoction).
Yu Ye Wan (Jade Fluid Pill): Ruan Shi Gao (Soft Gypsum, amount as needed, also stated as calcined until flame-red to remove fire toxicity). Pulverized into powder, formed into pills the size of mung beans using vinegar paste. This pill specifically clears stomach fire and treats food retention.
[Appendix] "Pi" (痞) is synonymous with "Pi" (否), meaning lack of smooth flow. It arises from the latent yin and accumulated yang, resulting in impaired circulation of qi and blood. The lesion is located at the epigastrium (heart-down), situated in the center. Any condition characterized by internal fullness and obstruction belongs to disorders of the Earth element (Spleen/Stomach), differing from Zhang Man (distension and fullness) in severity. Pi syndrome is defined by a sensation of internal stuffiness without external signs of distension or urgency. Causes include: deficiency of Middle Qi failing to transform and transport essence; food and phlegm retention failing to digest; and excessive damp-heat. Ancient formulas treat Pi syndrome using the bitter nature of Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root), and Zhi Shi (Immature Bitter Orange) to drain; the pungent nature of Hou Po (Magnolia Bark) and Sheng Jiang (Fresh Ginger) to disperse; the sweet-bitter nature of Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome) to tonify; and the bland nature of Fu Ling (Poria) and Ze Xie (Alisma Rhizome) to leach out dampness. Once Pi syndrome is established, it should be treated like dampness, focusing on dispersing qi from above and below. Only if there are signs of interior excess can mild guiding and draining be applied. People suffering from obstruction often prefer diuretic drugs for quick relief, achieving temporary patency, but upon recurrence, the condition worsens.
Attached Formulas:
Jia Wei Bu Zhong Yi Qi Tang (Modified Tonify the Middle and Augment the Qi Decoction): Treats epigastric fullness due to internal injury. See Internal Injury chapter for the formula.
If the pulse is slow with phlegm causing pi, add Ban Xia (Pinellia Tuber) and Huang Lian (Coptis Rhizome); if the pulse is wiry, limbs are full and stifled, defecation is difficult, and there is epigastric fullness, add Chai Hu (Bupleurum Root), Huang Lian (Coptis Rhizome), and Gan Cao (Licorice Root); if stool is dry and constipated, add Huang Lian (Coptis Rhizome), Tao Ren (Peach Kernel), and small amounts of Da Huang (Rhubarb Root) and Dang Gui Shen (Angelica Sinensis Root Body); if there is epigastric fullness with dizziness and mental clouding, add Bai Shao Yao (White Peony Root) and Huang Lian (Coptis Rhizome); if there is epigastric fullness with middle-jiao cold, add Fu Zi (Prepared Aconite Lateral Root) and Huang Lian (Coptis Rhizome); if there is epigastric fullness with abdominal distension, add Wu Wei Zi (Schisandra Berry), Bai Shao Yao (White Peony Root), and Sha Ren (Amomum Fruit); in cold weather, add small amounts of Gan Jiang (Dried Ginger), or [text missing]; if there is epigastric fullness with vomiting and rebellious qi, add Huang Lian (Coptis Rhizome), Sheng Jiang (Fresh Ginger), and Chen Pi (Tangerine Peel); in winter, add Huang Lian (Coptis Rhizome) and small amounts of Ding Xiang (Clove) and Huo Xiang (Patchouli Herb); if there is epigastric fullness with a sensation of qi rushing upward in the abdomen, this is rebellion of the Chong Mai (Penetrating Vessel); add Huang Bo (Phellodendron Bark, 3 fen) and Huang Lian (Coptis Rhizome, 1.5 fen) to drain it; if epigastric fullness occurs after eating, separately take Ju Pi Zhi Zhu Wan (Tangerine Peel and Immature Bitter Orange Pill).
Zhi Shi Xiao Pi Wan (Immature Bitter Orange Pill to Reduce Fullness): Treats floating-wiry pulse at the right Guan position, empty epigastric fullness, aversion to food, and lethargy. Opens the stomach and promotes appetite.
Zhi Shi (Immature Bitter Orange), Huang Lian (Coptis Rhizome) (each 5 qian), Gan Sheng Jiang (Dried Fresh Ginger, 2 qian), Ban Xia Qu (Pinellia Medicated Leaven, 3 qian), Hou Po (Magnolia Bark, 4 qian), Ren Shen (Ginseng Root, 3 qian), Zhi Gan Cao (Honey-fried Licorice Root, 2 qian), Bai Zhu (Atractylodes Macrocephala Rhizome, 3 qian), Fu Ling (Poria), Mai Ya (Sprouted Hordeum Grain) (each 2 qian).
Pulverized into powder, mixed with steamed dough cakes soaked in water, formed into pills the size of sophora seeds. Take 30-50 pills per dose, administered with warm water.
Ju Pi Zhi Zhu Wan (Tangerine Peel and Immature Bitter Orange Pill):
Ju Pi (Tangerine Peel), Zhi Shi (Immature Bitter Orange), Bai Zhu (Atractylodes Macrocephala Rhizome) (equal parts).
Pulverized into powder, formed into pills using rice wrapped in lotus leaves and roasted. Take 50 pills per dose, administered with plain hot water.
Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill): Assists stomach digestion, expands the middle, and removes fullness and obstruction.
Bai Zhu (Atractylodes Macrocephala Rhizome), Zhi Shi (Immature Bitter Orange) (each 2 liang).
Pulverized into powder, formed into pills using rice wrapped in lotus leaves and roasted.