按胃居心下。心下痞。即胃痞也。不曰泻胃。而曰泻心。恐人误认为传入阳明。而
以治阳明法治之也。伤寒误治成痞。五泻心法已尽。但此外尚有暑、湿、痰、食、痧秽、凝结成痞者。亦宜兼参。
如膈闷心烦。痞满而喘急者。热痰内闭也。宜栀豉汤。加川郁金、栝蒌仁、枳实、杏仁之类。开之宣之。
邵评∶此痰热内结于肺之正法。
如脘中痞闷。而兼头胀目黄。脉象濡涩者。此暑湿伏邪凝滞胸中也。宜清疏中宫。
川连、枳实、半夏、浓朴、郁金、草蔻、滑石粉、茯苓皮之类。
邵评∶此暑邪挟湿凝滞肺胃之正法。
如脘中痞闷。身热口渴。舌苔白燥者。此暑邪阻于气分也。宜滑石粉、川郁金、枳实、
橘红、黄芩、知母、桔梗、竹茹之类。以清气分之热。痞自开矣。
邵评∶此暑热入于肺卫之正法。
如脘痞满闷。舌苔白腻。脉濡缓。口不渴者。此湿邪阻于气分也。法宜开泄。用二陈
汤去甘草。加茅术、白蔻、郁金、枳实、浓朴、杏仁、通草之属。以开湿结。痞满自除。
若触秽暑。兼挟食滞。脘中痞满。饱闷呕恶。腹中板痛。亦宜清疏中宫。如广藿梗、川
郁金、川连、枳实、白蔻、浓朴、木香汁、生楂肉、莱菔子之类。
邵评∶此暑湿挟食。滞伏中宫。中上二焦。又吸秽浊。阻滞气机之正法。
若秽暑挟食。结于下焦。二便不通。胸腹胀满。痛楚难忍者。非枳实、大黄、承气辈不除。
邵评∶此暑秽食滞。结于下焦之正法。
若怒动肝火。或怒后加餐。而成痞满。或结于左胁之下。舌黄口渴。脉弦数。或兼胁
痛吞酸。左金、加川郁金、枳实之类主之。
邵评∶此肝火挟食。阻滞气机而成痞满之正法。
若暑湿之邪未清。误投补剂。以致胸膈胀满。脘中痞闷硬痛。几成结胸者。亦宜泻
心法治之。如二陈、枳实、浓朴、川连、楂肉、郁金、莱菔子、木香汁之类。
邵评∶此暑湿未清。误用补药。与邪相结。几成重病之正法。
The stomach is located below the heart. "Fullness below the heart" (Xin Xia Pi) refers to fullness of the stomach. It is not called "draining the stomach" but "draining the heart," to prevent people from mistakenly believing that the pathogen has transmitted to the Yangming channel and treating it with methods for Yangming disease. Fullness resulting from mismanagement in Cold Damage diseases is fully covered by the five methods of draining the heart (Xie Xin). However, there are other cases where fullness forms due to the condensation of summerheat, dampness, phlegm, food stagnation, or miasmic turbidity, which should also be considered concurrently.
If there is oppression in the diaphragm, irritability, fullness accompanied by panting and urgency, this is caused by internal closure of heat-phlegm. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) should be used, added with Chuan Yujin (Curcuma Aromatica Rhizome), Gualou Ren (Trichosanthis Semen), Zhishi (Immature Bitter Orange), and Xingren (Apricot Seed), to open and diffuse.
Shao's Commentary: This is the standard method for treating internal knotting of phlegm-heat in the Lung.
If there is epigastric fullness and oppression, accompanied by head distension, yellow eyes, and a soggy-choppy pulse, this is due to latent summerheat-dampness stagnating in the chest. The middle jiao should be cleared and dispersed. Coptis Rhizome (Chuanlian), Zhishi, Pinellia Tuber (Banxia), Magnolia Bark (Houpo), Curcuma Aromatica Rhizome (Yujin), Cardamom Seed (Caokou), Talcum Powder (Huashi), and Poria Peel (Fulingpi) may be used.
Shao's Commentary: This is the standard method for treating summerheat pathogen combined with dampness stagnating in the Lung and Stomach.
If there is epigastric fullness, fever, thirst, and a white-dry tongue coating, this is due to summerheat obstructing the Qi level. Talcum Powder (Huashi), Curcuma Aromatica Rhizome (Yujin), Zhishi, Tangerine Peel (Juhong), Scutellaria Root (Huangqin), Anemarrhena Rhizome (Zhimu), Platycodon Root (Jiegeng), and Bamboo Shavings (Zhuru) should be used to clear heat from the Qi level; the fullness will resolve spontaneously.
Shao's Commentary: This is the standard method for treating summerheat entering the Lung and Wei levels.
If there is epigastric fullness and oppression, a white-greasy tongue coating, a soggy-slow pulse, and no thirst, this is due to dampness obstructing the Qi level. The treatment method should be to open and drain. Erchen Tang (Two-Cured Decoction) without Gancao (Licorice Root), added with Atractylodes Rhizome (Maozhu), White Cardamom Seed (Baikou), Curcuma Aromatica Rhizome (Yujin), Zhishi, Magnolia Bark (Houpo), Apricot Seed (Xingren), and Tongcao, should be used to open dampness knots; the fullness will resolve spontaneously.
If one contracts miasmic summerheat combined with food stagnation, leading to epigastric fullness, bloating, nausea, vomiting, and rigid abdominal pain, clearing and dispersing the middle jiao is appropriate. Pogostemon Cablin Stem (Guanghuogeng), Curcuma Aromatica Rhizome (Yujin), Coptis Rhizome (Chuanlian), Zhishi, White Cardamom Seed (Baikou), Magnolia Bark (Houpo), Aucklandia Juice (Muxiangzhi), Raw Hawthorn Fruit (Shengzharou), and Radish Seed (Laifuzi) may be used.
Shao's Commentary: This is the standard method for treating summerheat-dampness combined with food stagnation lodging in the middle jiao, and the inhalation of miasmic turbidity obstructing Qi mechanism in the Upper and Middle Jiao.
If miasmic summerheat combined with food stagnation knots in the Lower Jiao, causing obstruction of urination and defecation, chest and abdominal distension, and unbearable pain, only Zhishe (Immature Bitter Orange), Dahuang (Rhubarb Root), and Chengqi Decoctions can remove it.
Shao's Commentary: This is the standard method for treating summerheat-miasma and food stagnation knotting in the Lower Jiao.
If anger stirs Liver Fire, or if one eats heavily after anger, resulting in fullness, or knotting under the left hypochondrium, with a yellow tongue coating, thirst, wiry-rapid pulse, or accompanied by hypochondriac pain and acid regurgitation, Zuojin Wan (Left Metal Pill) should be used as the main formula, added with Curcuma Aromatica Rhizome (Yujin) and Zhishi.
Shao's Commentary: This is the standard method for treating fullness caused by Liver Fire combined with food stagnation obstructing the Qi mechanism.
If summerheat-dampness pathogens have not been cleared, and tonifying agents are mistakenly administered, leading to chest and diaphragm distension, epigastric fullness, hardness, and pain, nearly forming a Chest Binding (Jie Xiong), the methods of draining the heart should also be employed. Erchen Tang, Zhishi, Magnolia Bark (Houpo), Coptis Rhizome (Chuanlian), Hawthorn Fruit (Zhrou), Curcuma Aromatica Rhizome (Yujin), Radish Seed (Laifuzi), and Aucklandia Juice (Muxiangzhi) may be used.
Shao's Commentary: This is the standard method for treating severe conditions where uncleared summerheat-dampness combines with pathogens due to the mistaken use of tonics.