本以下之故心下痞与泻心汤痞不解。其人渴而口燥烦。小便不利者。五苓散主之。
泻心诸方。开结荡热益虚可谓具备。乃服之而痞不解更加渴而口燥烦小便不利者。五苓两解之法正当主用。盖其功
擅润津滋燥导饮荡热。所以亦得为消痞满之良法也。
太阳病外证未除而数下之。遂协热而利。利下不止。心下痞硬。表里不解者。桂枝人参汤主之。
误下而致里虚则外热乘之变为利下不止者。里虚不守也。痞硬者。正虚邪实中成滞碍痞塞而坚满也。以表未除。故
用桂枝以解之。以里适虚。故用理中以和之即理中加桂枝而易其名为治虚痞下利之圣法也。
伤寒发热汗出不解。心中痞硬。呕吐而下利者。大柴胡汤主之。
外邪不解。转入于里心中痞硬呕吐下利攻之则碍表。不攻。则里证已迫。计惟有大柴胡一汤。合表里而两解之也。
太阳病医发汗。遂发热恶寒。因复下之。心下痞。表里俱虚。阴阳气并竭无阳则阴独复加烧针因胸烦面色青黄肤
者。难治。今色微黄。手足温者易愈。
凡表里错误证变危笃有阴已亡而阳邪尚不尽者。有阳邪尽而阳气亦随亡者。有外邪将尽未尽而阴阳未至全亏者。此
可患不可愈。所由分也。大率心下痞与胸间结。虽有上下之分。究竟皆是阳邪所聚之位。观无阳则阴独一语正见所以成
痞之故。虽曰阴阳并竭实。由心下无阳。故阴独痞塞也。无阳阴独早已括尽。误下成痞。大义无阳亦与亡阳有别。无阳
不过阳气不治。复加烧针。以逼劫其阴。乃成危候其用药差误。即可同推。
以上痞证例。
Because of the erroneous use of purgation, epigastric fullness and stuffiness (Xin Xia Pi) occurred. After administering Xixin Tang (Heart-Draining Decoction), the fullness did not resolve. If the patient presents with thirst, dryness in the mouth, irritability, and difficulty in urination, Wuling San (Five-Ingredient Poria Pill) is indicated.
The various formulas of the Heart-Draining group (Xixin Fangs) are comprehensive in their ability to open accumulations, purge heat, and tonify deficiency. However, if after administration the fullness does not resolve, but instead worsens with symptoms of thirst, dry mouth, irritability, and dysuria, the method of simultaneous resolution of exterior and interior by Wuling San becomes the primary treatment. This is because Wuling San excels at moistening fluids, nourishing dryness, guiding out fluid retention, and clearing heat; thus, it can also serve as an excellent method for dissipating epigastric fullness.
In Taiyang disease (Taiyang Syndrome), if the exterior syndrome has not resolved and multiple purgations have been performed, this leads to diarrhea accompanied by fever (Xie Re Li). With unceasing diarrhea, hardness and fullness in the epigastrium, and both exterior and interior syndromes unresolved, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is indicated.
Erroneous purgation causes interior deficiency, allowing external heat to invade and transform into unceasing diarrhea, indicating that the interior cannot maintain its integrity. The term "hardness and fullness" refers to a state where righteous Qi is deficient while pathogenic factors are excess, causing obstruction, stuffiness, and firm distension in the middle jiao. Since the exterior remains unresolved, Guizhi is used to release the exterior. Since the interior is newly deficient, Lizhong Tang is used to harmonize (specifically, Lizhong Tang modified with Guizhi and renamed); this is a sage method for treating deficiency-type epigastric fullness with diarrhea.
In Shanghan (Cold Damage) presenting with fever and sweating that does not resolve, along with epigastric fullness and hardness, vomiting, and diarrhea, Da Chaihu Tang (Major Bupleurum Decoction) is indicated.
When external pathogens do not resolve and penetrate inward, causing epigastric fullness and hardness, vomiting, and diarrhea, attacking the interior would hinder the resolution of the exterior, while failing to attack allows the interior condition to become urgent. The only strategy is to use Da Chaihu Tang to simultaneously resolve both the exterior and interior.
In Taiyang disease, if the physician first employs sweating therapy, leading to fever and aversion to cold, and subsequently erroneously uses purgation, resulting in epigastric fullness, both exterior and interior Qi become deficient. When Yin and Yang Qi are exhausted, and there is no Yang leaving only Yin alone, the addition of burning needle therapy causes chest irritability. If the complexion is greenish-yellow and the skin is dull/lusterless, the prognosis is difficult. If the complexion is slightly yellow and the hands and feet are warm, recovery is easy.
Whenever errors in diagnosing exterior and interior lead to critical changes in syndrome, some cases involve the exhaustion of Yin while Yang pathogens remain; others involve the exhaustion of Yang pathogens along with Yang Qi; others involve external pathogens that are nearly but not fully exhausted, with Yin and Yang not yet completely depleted. These represent conditions that may be suffered from but are not curable, due to these distinctions. Generally speaking, epigastric fullness (Pi) and chest binding (Jie Xiong), despite having upper and lower positional differences, are ultimately sites where Yang pathogens gather. Observing the phrase "no Yang, therefore Yin stands alone" reveals the cause of forming Pi. Although it is said that Yin and Yang are both exhausted, the reality is that without Yang in the epigastrium, Yin stands alone in obstruction. The concept of "no Yang, Yin stands alone" encompasses this principle. Epigastric fullness caused by erroneous purgation differs in essence from the loss of Yang (Wang Yang). "No Yang" merely implies the failure of Yang Qi to function properly. If burning needles are then mistakenly applied to coerce and deplete Yin, a critical condition ensues. By analogy, medication errors can lead to similar consequences.
The above are examples of Pi syndromes.