经曰∶病发于阴而反下之，因作痞。注云∶无热恶寒者，发于阴也。轻于结胸者，心下满而不
痛，按之则濡，是其虚邪留滞，故但满而不痛也，惟枳、桔最良。
欲攻之，只从表证解而后可。
痞者，关脉多沉，枳实理中丸、半夏泻心汤。关脉沉者，三黄汤泻其肝。若恶寒者，附子泻心
汤。服此汤痞不去，烦渴，小便不利，五苓散。
下后复汗，心下痞而恶寒，表不解，不可攻痞，先与桂枝汤；表解，乃攻痞，三黄汤。
表未解而心下妨闷，曰支结，柴胡桂枝汤；胸胁满而微结，小柴胡汤加干姜、牡蛎。表证未罢，
因攻之，协热而利，心下硬，为表里俱病，桂枝人参汤。
下利，心下痞硬，干噎食臭，腹鸣，甘草泻心汤、生姜泻心汤。治法通用桂枝人参汤。若下利
不止，则治下焦，赤石脂禹余粮汤。又不止，只利小便，五苓散。
发热不解，呕吐不利，心下痞硬，大柴胡汤。吐、汗、下后噎气痞硬，旋覆代赭汤。
若咳逆气虚，用四逆汤。胃寒，先宜理中丸，后用旋覆代赭汤。
脾为中央之土，所以腹满多属太阴也。常病者，为里实，从下之。时减者，
为里虚，当温之。若解表内不消，非大满，尤生寒热，未可下，是邪全未入腑。若大满大实，兼有
燥屎，虽得之四五日，亦为可下，谓邪已入腑也。大抵阳热为邪，则腹满而咽干，阴寒为邪，则腹
满而吐利，食不下。若虽经吐下后而腹满者，治法又各不同，是又不可不知也。
太阳误下，因时腹满而痛，桂枝加附子汤；痛甚，桂枝加大黄汤。
阳明发热，腹满微喘，口苦咽干，或不大便，谵语者，小柴胡汤；哕而小便难，加茯苓。
三阳合病，腹满，身重难以转侧，谵语，口中不仁，小柴胡汤；有汗，白虎汤。
太阴腹满，吐，食不下，枳桔理中丸。
少阴病六七日，腹胀满，不大便，急下之，大承气汤。
腹满痛者，脾不胜水，水与气搏皮肉之间，肠中漉漉有声，小半夏茯苓汤加桂枝。
下利腹满，身疼痛，先温其里，四逆汤；后攻其表，桂枝汤。
发汗后腹满，当温，浓朴半夏生姜人参汤。吐后腹满，当下，少与调胃承气汤。
下后腹满，宜栀子浓朴汤。腹胀满者，阴阳不和，桔梗半夏汤。
The *Neijing* states: When a disease originates from a Yin syndrome but is mistakenly treated with purgation, Pi syndrome (epigastric fullness and stuffiness) results. The annotation clarifies: Absence of fever and aversion to cold indicates origin from Yin. Its severity is less than Jie Xiong (chest binding), presenting as epigastric fullness without pain; palpation reveals softness. This is due to the stagnation of deficient pathogenic factors, resulting in fullness without pain. Zhi Shi (Immature Bitter Orange) and Jie Geng (Platycodon Root) are most suitable.
To attack the pathogen, one must first resolve the exterior syndrome before proceeding.
In Pi syndrome, the Guan pulse is often deep. Zhi Shi Li Zhong Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) or Ban Xia Xie Xin Tang (Pinellia Decoction for Draining the Epigastrium) may be used. If the Guan pulse is deep, indicating Liver constraint, San Huang Tang (Three Yellows Decoction) should be used to drain the Liver. If there is aversion to cold, Fu Zi Xie Xin Tang (Aconite Decoction for Draining the Epigastrium) is indicated. If the Pi syndrome persists after taking these decoctions, accompanied by irritability, thirst, and dysuria, Wu Ling San (Five-Ingredient Powder with Poria) is prescribed.
After purgation followed by sweating, if epigastric fullness and aversion to cold occur, indicating the exterior syndrome remains unresolved, one must not directly treat the Pi. First, administer Gui Zhi Tang (Cinnamon Twig Decoction); once the exterior is resolved, then treat the Pi with San Huang Tang.
If the exterior syndrome is unresolved while the epigastrium feels obstructed and stifling, it is called Zhi Jie (branching knot). Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is used. If there is fullness in the chest and hypochondrium with slight knotting, Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Gan Jiang (Dried Ginger) and Mu Li (Oyster Shell) is indicated. If the exterior syndrome has not ceased and purgation was mistakenly applied, leading to diarrhea with heat (Xie Re) and epigastric hardness, this represents simultaneous exterior and interior pathology. Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) is used.
For diarrhea with epigastric fullness and hardness, dry heaving with the smell of undigested food, and borborygmus, Gan Cao Xie Xin Tang (Licorice Decoction for Draining the Epigastrium) or Sheng Jiang Xie Xin Tang (Fresh Ginger Decoction for Draining the Epigastrium) are used. The treatment method generally applies Gui Zhi Ren Shen Tang. If diarrhea persists uncontrollably, treat the Lower Jiao (Lower Burner) with Chi Shi Zhi Yu Liang Tang (Red Halloysite and Hematite Decoction). If it still does not stop, promote urination only with Wu Ling San.
If fever persists, accompanied by vomiting and diarrhea, and epigastric fullness and hardness, Da Chai Hu Tang (Major Bupleurum Decoction) is used. After vomiting, sweating, and purgation, if belching and epigastric hardness occur, Xuan Fu Dai Zhe Tang (Inula and Magnetite Decoction) is indicated.
If there is cough, qi rebellion, and qi deficiency, Si Ni Tang (Frigid Extremities Decoction) is used. For Stomach cold, Li Zhong Wan (Regulate the Middle Pill) is first appropriate, followed by Xuan Fu Dai Zhe Tang.
The Spleen belongs to the Earth of the Center; therefore, abdominal fullness mostly belongs to Tai Yin (Greater Yin) syndrome. Chronic cases indicate Interior Excess (Li Shi) and should be treated with purgation. Cases where fullness decreases intermittently indicate Interior Deficiency (Li Xu) and should be treated with warming methods. If the exterior is not resolved and internal stagnation persists, but it is not a major fullness, and chills and fever arise, purgation is contraindicated because the pathogen has not entered the Fu organs. However, if there is major fullness and excess, combined with dry feces, even if only four or five days have passed, purgation is permissible, as the pathogen has entered the Fu organs. Generally, when Yang-Heat acts as the pathogen, abdominal fullness is accompanied by a dry throat; when Yin-Cold acts as the pathogen, abdominal fullness is accompanied by vomiting, diarrhea, and inability to eat. Even if abdominal fullness persists after emesis or purgation, the treatment methods differ, which must not be overlooked.
In Tai Yang syndrome, mistaken purgation leads to intermittent abdominal fullness and pain. Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction plus Aconite) is used; if pain is severe, Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction plus Rhubarb) is indicated.
In Yang Ming syndrome, with fever, abdominal fullness, slight wheezing, bitter taste, dry throat, constipation, or delirium, Xiao Chai Hu Tang is used; if there is hiccups and difficult urination, add Fu Ling (Poria).
In Three-Yang combined syndrome, with abdominal fullness, heavy body difficult to turn, delirium, and numbness/insensitivity in the mouth, Xiao Chai Hu Tang is used; if there is sweating, Bai Hu Tang (White Tiger Decoction) is indicated.
In Tai Yin syndrome, with abdominal fullness, vomiting, and inability to eat, Zhi Jue Li Zhong Wan (Immature Bitter Orange, Platycodon, and Regulate-the-Middle Pill) is used.
In Shao Yin syndrome, on the sixth or seventh day, with abdominal distension and fullness and constipation, urgent purgation is required using Da Cheng Qi Tang (Major Order the Qi Decoction).
For abdominal fullness and pain, caused by the Spleen failing to control Water, with water and Qi battling between the skin and flesh, and gurgling sounds in the intestines, Xiao Ban Xia Fu Ling Tang (Minor Pinellium and Poria Decoction) plus Gui Zhi is used.
For diarrhea with abdominal fullness and body pain, first warm the Interior with Si Ni Tang; then attack the Exterior with Gui Zhi Tang.
After sweating, if abdominal fullness occurs, warming is indicated using Nong Po Ban Xia Sheng Jiang Ren Shen Tang (Thick Bark, Pinellia, Fresh Ginger, and Ginseng Decoction). After vomiting, if abdominal fullness occurs, purgation is indicated; give a small amount of Tiao Wei Cheng Qi Tang (Regulate the Wall Order the Qi Decoction).
After purgation, if abdominal fullness occurs, Zhi Zi Nong Po Tang (Gardenia and Thick Bark Decoction) is suitable. Abdominal distension and fullness result from disharmony of Yin and Yang; Jie Geng Ban Xia Tang (Platycodon and Pinellia Decoction) is used.