【歌】胸中满闷名为痞，外面殊无胀急形。食积结痰兼湿热，气虚不运病根深。
【论】痞者，否也，不通之意，由阴伏阳蓄，气血不运而成。处心下，位中央，填满痞塞，皆土之为病也，
然痞与胀有轻重之分。痞则内觉痞闷，而外无胀急之形也。有中气不足，不能运化者；有饮食痰结，不能施化
者；有湿热太甚而成者，当随证分消。虚者补中益气汤，不可峻剂攻之；实者略与疏导。昧者苟图一时通快，
喜行峻利，多致危殆也。
【脉】痞满滑大，痰火作孽。弦伏中虚，微涩衰劣。
中气不足
中气不足，不能运化精微而为痞闷，脉弱无力，不可用利药攻之，补中益气汤。久服中气充满，清道健运，
痞自除也。
补中益气汤（方见内伤。）
食积
饮食内伤，不能克化而痞者，枳术丸或保和丸，或枳桔二陈汤加神曲、麦芽、山楂。心下虚痞，按之痛者，
枳实消痞丸、黄连泻心汤。
枳术丸（方见脾胃。）
保和丸（方见伤食。）
枳桔二陈汤（方见脾胃。）
枳实消痞丸
枳实（一钱，炒） 山楂肉（一钱） 黄连（炒，一钱） 神曲（炒，一钱） 甘草（炙，一钱） 猪苓
（一钱） 泽泻（八分，去毛） 浓朴（姜汁拌炒，八分） 砂仁（八分，炒） 陈皮（一钱） 人参（一钱，
去芦） 黄芩（一钱，炒） 干姜（八分） 姜黄（八分） 白术（炒，一钱）
上未，蒸饼丸，梧子大，每服五十丸，食后白汤送下。
黄连泻心汤
黄连（一钱二分） 浓朴（一钱，制） 干姜（八分） 甘草（五分） 人参（八分） 白芍药（八分）
上锉，一剂，姜三片，水二钟，煎八分，空心热服。
湿热
湿热太甚而痞者，黄连泻心汤。有热，三黄泻心汤。火邪乘脾而痞者，二陈加黄连、黄芩、栝蒌。
黄连泻心汤（方见前。）
三黄泻心汤
大黄（三钱） 黄连（三钱） 黄芩（三钱）
上锉，一剂，水二盏，煎一盏，热服。
二陈汤（方见痰证。）
痰滞
痰气阻滞中州而为痞者，小陷胸汤，或枳桔二陈汤加黄
连、栝蒌、天花粉。痰气壅满，心胸痞满不宽，导痰汤。
小陷胸汤
半夏（六钱） 黄连（三钱） 栝蒌（小者一个，大者半个）
用水二钟，加生姜三片，先煎栝蒌，约钟半许，入半夏、黄连，煎至一钟，温服。
枳桔二陈汤（方见脾胃。）
导痰汤（方见痰证。）
[Verse]
Fullness and stifling sensation in the chest are termed "Pi" (Pì, obstruction). There is no external appearance of distension or urgency. This condition arises from food stagnation, phlegm accumulation, combined with damp-heat, and deep-rooted disease due to Qi deficiency failing to transport and transform.
[Dissertation]
"Pì" shares its meaning with "Pǐ" (obstruction), signifying blockage. It is formed by the lurking of Yin and the accumulation of Yang, resulting in the failure of Qi and Blood to circulate. The location is at the epigastrium (Xin Xia), situated in the center of the body. Fullness and blockage here are diseases attributed to the Earth element (Spleen/Stomach). However, there is a distinction in severity between Pi (obstruction) and Zhang (distension). Pi involves an internal sensation of fullness and stifling without external signs of distension or urgency. Etiologies include: insufficiency of Middle Qi failing to transport and transform; retention of food and phlegm failing to digest; and excess damp-heat. Treatment should be based on differentiating the syndrome for resolution. For deficiency patterns, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); do not use harsh purgatives. For excess patterns, provide mild guiding and draining methods. Unskilled practitioners who seek temporary relief through harsh, draining medicines often lead to critical danger.
[Pulse]
Pi-fullness with slippery and large pulses indicates Phlegm-Fire causing mischief. Wiry and hidden pulses suggest Middle Qi deficiency; fine and choppy pulses indicate decline and deterioration.
Insufficiency of Middle Qi
Insufficiency of Middle Qi fails to transport and transform essential substances, leading to Pi-stifling. The pulse is weak and powerless. Do not use draining or purgative medicines. Administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Long-term use fills the Middle Qi, strengthens the clear pathways, and eliminates Pi naturally.
Buzhong Yiqi Tang (See Internal Injury section.)
Food Stagnation
For Pi caused by internal injury from diet and inability to digest, use Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) or Baohe Wan (Preserve Harmony Pill), or Zhijie Erchen Tang (Immature Bitter Orange, Tangerine Peel, and Two-Aged Decoction) added with Shenqu (Medicated Leaven), Maiya (Germinated Hordeum Fructus), and Shanzha (Crataegi Fructus). For empty Pi at the epigastrium that is painful upon pressure, use Zhishi Xiaopi Wan (Immature Bitter Orange Decrementing Pi Pill) or Huanglian Xiexin Tang (Coptis Decoction Draining the Heart).
Zhizhu Wan (See Spleen and Stomach section.)
Baohe Wan (See Food Injury section.)
Zhijie Erchen Tang (See Spleen and Stomach section.)
Zhishi Xiaopi Wan (Immature Bitter Orange Decrementing Pi Pill)
Ingredients: Zhishi (Fructus Aurantii Immaturus, 1 qian, stir-fried), Shanzha Rou (Sarcocarpus Crataegi, 1 qian), Huanglian (Rhizoma Coptidis, 1 qian, stir-fried), Shenqu (Massa Medicata Fermentata, 1 qian, stir-fried), Gancao (Radix Glycyrrhizae, 1 qian, honey-fried), Zhuling (Polyporus, 1 qian), Zexie (Rhizoma Alismatis, 8 fen, dehusked), Houpo (Cortex Magnoliae Officinalis, 8 fen, stir-fried with ginger juice), Sharen (Fructus Amomi Rotundus, 8 fen, stir-fried), Chenpi (Pericarpium Citri Reticulatae, 1 qian), Renshen (Radix Ginseng, 1 qian, radix removed), Huangqin (Scutellariae Radix, 1 qian, stir-fried), Ganjiang (Rhizoma Zingiberis Recens, 8 fen), Jianghuang (Rhizoma Curcumae Longae, 8 fen), Baizhu (Rhizoma Atractylodis Macrocephalae, 1 qian, stir-fried).
Grind the above into powder, make pills using steamed bread paste, size of Sophora japonica seeds. Take 50 pills per dose, administered after meals with warm water.
Huanglian Xiexin Tang (Coptis Decoction Draining the Heart)
Ingredients: Huanglian (Rhizoma Coptidis, 1.2 qian), Houpo (Cortex Magnoliae Officinalis, 1 qian, processed), Ganjiang (Rhizoma Zingiberis Recens, 8 fen), Gancao (Radix Glycyrrhizae, 5 fen), Renshen (Radix Ginseng, 8 fen), Baishao (Radix Paeoniae Rubra, 8 fen).
Cut into pieces for one dose. Add 3 slices of fresh ginger, 2 zhong (approx. 400-500 ml) of water, decoct to 0.8 zhong. Take hot on an empty stomach.
Damp-Heat
For Pi caused by excessive damp-heat, use Huanglian Xiexin Tang (Coptis Decoction Draining the Heart). If heat is prominent, use Sanhuang Xiexin Tang (Three Yellows Decoction Draining the Heart). For Pi caused by Fire Evil invading the Spleen, use Erchen Tang (Two-Aged Decoction) added with Huanglian, Huangqin, and Gualou.
Huanglian Xiexin Tang (See previous section.)
Sanhuang Xiexin Tang (Three Yellows Decoction Draining the Heart)
Ingredients: Dahuang (Rhei Radix et Rhizoma, 3 qian), Huanglian (Rhizoma Coptidis, 3 qian), Huangqin (Scutellariae Radix, 3 qian).
Cut into pieces for one dose. Add 2 zhan (approx. 400 ml) of water, decoct to 1 zhan. Take hot.
Erchen Tang (See Phlegm Syndrome section.)
Phlegm Stasis
For Pi caused by Phlegm-Qi blocking the Middle Jiao, use Xiao Xianxiong Tang (Minor Intrapleural Decoction), or Zhijie Erchen Tang (Immature Bitter Orange, Tangerine Peel, and Two-Aged Decoction) added with Huanglian, Gualou, and Tianhuafen. For Phlegm-Qi congestion and fullness causing stifling and lack of expansion in the chest and heart, use Daotan Tang (Great Phlegm Decoction).
Xiao Xianxiong Tang (Minor Intrapleural Decoction)
Ingredients: Banxia (Rhizoma Pinelliae Ternatae, 6 qian), Huanglian (Rhizoma Coptidis, 3 qian), Gualou (Fructus Trichosanthis, one small or half a large).
Add 2 zhong of water and 3 slices of fresh ginger. First decoct Gualou until approximately 1.5 zhong remains. Then add Banxia and Huanglian, decoct to 1 zhong. Take warm.
Zhijie Erchen Tang (See Spleen and Stomach section.)
Daotan Tang (See Phlegm Syndrome section.)