夫伤寒太阳少阳并病。脉浮而下之。反入里。则作痞。痞者。心下满也。病发于阴者。
则不可下。下则心腹痞满。若按之自软。但气痞尔。不可复下也。若热毒瓦斯乘心。则心下痞
满。面赤目黄。狂言恍惚者。此为内实。宜吐下之也。伤寒病发于阴。而医误下之。邪气入
里。胃中虚。客气上逆。心下满不痛。按之不坚。此为痞也。法宜泻心。唯表未解者。未可
攻之。当先解表。然后攻痞。若表解而里未和。或泻心而痞不解。其人口燥烦渴背急。随证
处治。其眩冒而经脉动惕者。久则成痿。若表里俱虚之人。有气痞。阴阳气并竭。无阳则阴
独。复加火针。因而致烦。面青黄。肤 者。难治。其脉微浮。而气上冲咽喉。不能息者。
非痞。有寒在胸中故也。治属吐法。
活人书云。问心下满而不痛。此名痞也。伤寒本无痞。应其有身冷。医反下。遂成痞。
枳实理中丸最良。仲景治痞气诸汤中。有生姜泻心汤。半夏泻心汤。此方平和。宜常用。仲
景云。满而不痛为痞。柴胡不中与也。半夏泻心汤主之。此汤药味。盖本理中人参黄芩汤方
也。审知是痞。先用桔梗枳壳汤。尤妙。缘桔梗枳壳行气下膈。先用之。无论结胸与痞。关
脉须皆沉。若关脉浮者。大黄黄连黄芩泻心汤主之。关浮则结热。三黄以验也。泻肝。若复
恶寒汗出者。附子泻心汤主之。病患心下痞。与泻心汤痞不解。发渴。口热烦。小便不利者。
五苓散主之。汗出表解。而胃中不和。心下痞硬。干噫。食臭。胁下有水气。腹中雷鸣。下
利者。生姜泻心汤主之。下利日数十行。谷不化。腹中雷鸣。心下痞硬而满。此以医下之也。
若复下之。其痞益甚。甘草泻心汤主之。盖此非结热。以胃中虚。客气上逆。故使硬也。下
利而心下痞。生姜泻心汤。甘草泻心汤并主之。若下利不止者。当治其下焦。赤石脂禹余粮
汤主之。盖生姜泻心。甘草泻心汤。皆治中焦。此利在下焦。若只治中焦。则利益甚耳。服
赤石脂禹余粮汤。利复不止者。当利其小便。五苓散主之。凡痞胀泻心汤不愈。然后可与陷
胸丸下之。不可用陷胸汤。盖太猛。只用陷胸丸。大抵结胸与痞皆应。不然。表未解者。不
可攻也。仲景云。当先解表。表解乃可攻痞。解表。宜桂枝汤。攻痞。宜大黄黄连黄芩汤。
外证未解。心下妨闷者。非痞也。谓之支结。柴胡桂枝汤主之。胸胁满。微结。小柴胡加干
姜牡蛎汤主之。若太阳证未除。而数下之。遂KT 热而利。利不止。心下痞硬。表里不解
者。桂枝人参汤主之。十枣汤。大柴胡汤。皆治心下痞。此方尤难用。须是表证罢。不恶寒。
身凉。其人热汗出。发作有时。头疼。心下痞硬满。引胁下疼。干呕短气者。乃可行十枣汤。
表未解者。甚不可用也。大柴胡汤。治伤寒发热。汗出不解。心中痞硬。呕吐而下利者。非
大柴胡不可也。若发汗吐下后。心下痞硬。怒气不除者。旋复代赭汤主之。有旋复代赭汤证
之人。其或咳逆气虚者。先服四逆汤。其胃寒者。先服理中丸。次服旋复代赭汤。为良。旋
复代赭汤。是解心下痞硬证。宜详察之。
又云。伤寒心下满者。谓正当心下高起满硬者是也。不经下后而满者。则有吐下之殊。
若下后者。又有结胸痞气之别。经曰。病患手足厥冷。脉乍紧。邪结在胸中。心满而烦乱。
饥
属腑者不令攻之。兹二者。为不经汗下。而心下满者。或吐之。看其邪气之高下。高者。
则因而越之。下者。则因而竭之。其要在泄其邪也。至如阳明病。虽心下硬满。又未可攻。
经曰。阳明病。心下硬满。不可攻之。攻之。利遂不止者死。利止者愈。是气自表传里。至
于心下留结为实者。则不可下。乃吐之可也。若未全为实者。则不可下。故此戒也。又邪气
在表。未应下而强下之。邪气乘虚结于心下。实者硬满而痛。为结胸。虚者满而不痛。为虚
结。经曰。呕而热者。柴胡汤证具。而以他药下之。柴胡证仍在者。复与柴胡汤。此虽下之
。不为逆。必蒸蒸而振。却发热汗出而解。若下之。心满而硬痛者。此为结胸。但满而不痛
者。此为虚痞。盖实邪留结。则为硬痛。虚邪留滞。则但满而不硬痛也。结胸热实。脉沉而
紧。心下痛。按之若硬者。大陷胸汤主之。明其邪实可知矣。脉浮而紧。而反下之。紧反入
里。则作痞。按之自濡。但气痞耳。明其邪虚可知矣。病发于阳而反下之。热入因作结胸。
病发于阴。而发下之。因作痞。表邪未罢。医反下之。胃中空虚。客动于隔。阳气内陷。心
中因硬。则为结胸。须陷胸汤丸攻之可也。伤寒中风。医反下之。心下痞硬而满。医见心下
痞。为病不尽而复下之。其痞益甚。此非结热。但以胃中空虚。客气上逆。故使硬也。须诸
泻心汤散可也。二者。俱是心下满硬。一为虚。一为实。凡投汤者。大须详审。结胸虽为实
邪。众皆共知。当用陷胸汤丸下之。或脉浮大者。则不可。下之则死。即是犹带表邪。未全
结实。下之重虚其里。邪深结则死。设其结胸形证悉具。而加之烦躁者。又为不治之疾。药
之所以能胜邪者。必待胃气施布。药力始能温汗吐下以逐之。其邪气胜。胃气绝者。汤药纵
下。胃气不能施布。虽神丹难为效也。又云。伤寒腹满者。俗谓之肚胀是也。华佗曰。伤寒
一日在皮。二日在肤。三日在肌。四日在胸。五日在腹。六日入胃。谓入腑也。是在腑也。
犹未全入里者。虽腹满为里证。故亦有浅深之别。经曰。表已解而内不消。非大满。犹生寒
热。则病不除。是其未全入腑。若大满大实。坚有燥屎自可除下之。虽四五日不能为祸。谓
之邪气已入腑也。伤寒邪入腑。是里证已深。故腹满。乃可下之。多矣。如经曰。其热不潮
。未可与承气汤。若腹大满不通者。可与小承气汤。发汗不解。腹满痛者。急下之。本太阳
病。医反下之。因而腹满时痛者。属太阴也。桂枝芍药汤主之。大实痛者。桂枝加大黄汤主
之。少阴病。腹胀不大便者。急下之。诸如此者。皆里证也。虽曰腹中满痛者。此为实也。
当下之。然腹满不减者。则为实也。若腹满时减者。又为虚也。则不可下。经曰。腹不减。
减不足言。当下之。金匮略曰。腹满时减。复如故。此虚寒从下上也。当以温药和之。盖虚
留滞。亦为之胀。但比之实者。不至坚痛也。大抵腹属太阴证也。阳热为邪者。则腹满而
咽干。阴寒为邪者。则腹满而吐食不下。自利益甚。时腹痛。自太阴者。属脾土也。治中央
。故专主腹满之候。又发汗吐下之后。因而腹成满者。皆邪气乘虚内客而为之。而所生又各
不同。经曰。发汗后。腹胀满者。浓朴生姜甘草半夏人参汤主之。伤寒吐后。腹胀者。调胃
承气汤主之。伤寒下后。心烦腹胀满。卧起不安者。栀子浓朴汤主之。有当温者。有当下者
。有当吐者何。邪气不一也。但发汗后腹满。当温之。邪气在表。因发散则邪去。胃为津液
之主。发汗亡阳。则胃所虚而不能敷布。诸气壅滞而为胀满。是当温散可也。吐后腹满。可
下之。邪气在胸者。则可吐之。则邪去人安。若吐后。邪气不去。加之腹胀者。是胸中之邪。
下传入胃。拥而实。故主胀满。当须下之可也。下后腹满可吐者。邪气在表。未传入腑。而
妄下之也。自表乘虚而入。郁于胸中而为虚烦。气上下不得通利者。腹为之满。故当吐之可
也。凡为医者。要识邪气所起所在。审其所起。知邪气之由来。观其所在。知邪气之虚实。
发汗吐下之不瘥。温补针艾之适。则十全之功。自可得也。
圣济总录论曰。伤寒心腹胀满者。以脏气不调。邪气入乘。正邪相搏。故令人心腹胀闷
而满。然脏有虚实。邪有冷热。若吐下以后。病不除。内外有热。心腹胀闷而痛者。此为实
也。若其素有冷癖。因病发热。服冷药。及饮水过度。水结心下动于痼滞。心腹胀满者。此
为虚也。
活人歌括云。问君腹胀是如何。只谓阴阳气不和。若是曾经汗吐下。根据方调治莫蹉跎。
腹胀者。何也。阴阳不和也。桔梗半夏汤最良。仲景太阳证。发汗后。腹胀满者。浓朴
半夏甘草人参汤。太阳证。下后。心烦腹胀满。卧起不安者。栀子浓朴汤。吐后。腹胀满者。
调
又歌曰。胀满脾家及胃家。三阳合病心烦麻。入邪吐汗下之后。肾证便坚承气瘥。
如腹胀多属太阴。盖脾为中央土。所以主腹满之候。腹中常满者。里实而可下。时满时
减者。里虚不可下。当以温和药和之。其有吐汗下后。因成腹满者。此则邪乘气虚而入。或
疏利。或温散。或涌吐。条例又不同焉。审其邪气之所起。知其邪气之所在。可知矣。虽然。
太
不可以无别。若大腹满而涸。难以有瘳。太阴腹满。吐食。不可下。枳实理中丸主之。误下
太阳。因而腹满时痛。为太阴病。桂枝大黄汤。重者。桂枝加大黄汤。阳明发热。腹满微喘
。口苦咽干。或不大便。言语太迫者。亦有此证并小柴胡汤。哕而小便难。加茯苓。又阳明
复大满。不大便。小承气汤微下之。阳明脉迟。腹满时喘。潮热。亦用小承气汤。发黄证。
有本条。三阳合病。腹满身重。难以转侧。谵言。口中不仁。少与白虎汤。吐后腹满胀不减
者。胸中之邪。下传入胃。拥而为实也。少与调胃承气汤。汗后腹胀满者。胃气虚而不能敷
布。诸气壅滞也。浓朴生姜半夏人参甘草汤。若满而痛。则小承气汤微下之。妄下后。腹胀
满。心烦。而卧起不安者。表邪乘虚而入。郁于胸中也。栀子浓朴汤。少阴病。六七日。腹
胀满。不大便。承气汤急下之。腹胀逆。用桔梗半夏汤。腹皮痛者。脾不胜水。故水与气博
于皮肤之间。观其肠鸣漉漉可知矣。半夏茯苓汤加官桂。腹胀满而短气者。邪在里而为实也
。腹濡满而短气者。邪在里而为虚也。见气短而腹满。用药皆去白术。以术温燥而闭气也。
方
前胡散（出圣惠方）治伤寒心腹痞满。头痛。四肢烦疼。
前胡（去芦头一两） 赤茯苓 赤芍药 桂心 白术（各三分） 柴胡（去苗） 枳壳
（麸炒
微黄去瓤） 诃黎勒（煨用皮各一两） 甘草（半两炙赤微锉） 上粗捣为散。每服四钱。
水一
中
旋复花散（出圣惠方）治伤寒头痛。心腹痞满。痰壅。不下饮食。
旋复花（半两） 半夏（汤洗七次去滑） 桂心（各三两） 前胡（去芦头） 石膏 赤
茯苓
陈橘皮（汤浸去白瓤焙各一两） 甘草（一分炙微赤锉） 上粗捣筛为散。每服三钱。水一
中盏。
入
诃黎勒散（出圣惠方）治伤寒心腹痞满。咽喉噎塞。四肢不和。背膊壅闷。不
欲饮食。
诃黎勒（煨用皮） 大腹皮（锉） 前胡（去芦头） 陈橘皮（汤浸去白瓤焙） 川大
黄（锉碎
微炒各一两） 半夏（汤浸七次去滑） 枳实（麸炒微黄） 桂心（各三分） 木香（半两）
上粗
捣筛为散。每服三钱。水一中盏。入生姜半分。煎六分。去滓。不计时候。稍热服。
附子泻心汤（出圣惠方）治伤寒心腹痞满。恶寒汗出者。宜服。
附子（炮裂去皮脐） 黄连（去须） 黄芩 川大黄（锉碎微炒各一两） 上粗捣筛为
散。每
服三钱。水一中盏。煎六分。去滓。不计时候。温服。
陈橘皮散（出圣惠方）治伤寒心腹痞满。下之后。心腹转胀。宜服。
陈橘皮（汤浸去白瓤焙） 诃黎勒皮 赤茯苓 人参（去芦头） 白术（各一两） 浓
朴（去
粗皮涂生姜汁炙令香熟） 桂心（各三分） 木香 高良姜（各一两） 上粗捣筛为散。每
服四
钱。水一中盏。入枣三枚。煎六分。去滓。稍热。不计时候服。
白术散（出圣惠方）治伤寒冷气结在心腹。痞满妨闷。宜服。
白术 桂心 赤芍药 当归（锉微炒） 半夏（汤洗七次去滑） 干姜（炮） 木香（各
三分）
陈橘皮（汤浸去白瓤焙） 浓朴（去粗皮涂生姜汁炙令香熟各二两） 上粗捣筛为散。每服
四
钱。水一中盏。入生姜半分。枣三枚。煎六分。去滓。稍热。不计时候。
治伤寒头项急闷。心腹痞满。气逆。不思饮食。宜服。（出圣惠方）
附子（炮裂去皮脐） 人参（去芦头） 陈橘皮（汤浸去白瓤焙） 白术 紫苏茎叶（各
一两）
桂心 木香 大腹皮（锉） 杏仁（汤浸去皮尖双仁麸炒微黄各半两） 上粗捣筛为散。每
服四
钱。水一中盏。生姜半分。煎六分。去滓。稍热。不计时候服。
赤茯苓散（出圣惠方）治伤寒心腹痞满。两胁下急。不能饮食。宜服。
赤茯苓 枳壳（麸炒微黄去瓤） 白术 陈橘皮（各一两汤浸去白瓤焙） 泽泻 桔梗
（去
芦头） 人参（各三分去芦头） 甘草（一分炙微赤锉） 杏仁（三分汤浸去皮尖麸炒黄去
双仁）
上捣
治伤寒气逆。心腹痞满。不下饮食。宜服此方。（出圣惠方）
人参（去芦头） 白术 枳壳（麸炒微黄去瓤） 赤茯苓（各一两） 桔梗（三分去芦
头） 桂
In Shaoyang and Taiyang concurrent disease (Taiyang-Shaoyang Bing, a condition where pathogenic factors affect both the Taiyang and Shaoyang meridians simultaneously), if the pulse is floating and purgation is mistakenly applied, the pathogen retreats into the interior, resulting in Pi syndrome (Pien, characterized by fullness and obstruction in the epigastrium without pain). Pi refers to fullness below the heart. If the disease originates from a Yin pattern, purgation must not be used; if mistakenly purged, it leads to abdominal Pi fullness. If palpation reveals softness, it is merely Qi Pi (Qi stagnation causing fullness), and further purgation is contraindicated. If toxic heat invades the Heart, causing epigastric fullness, red face, yellow eyes, delirium, and mental confusion, this indicates internal excess, and emesis and purgation are indicated.
If Shaoyin disease (Yin pattern) occurs and the physician mistakenly applies purgation, the pathogen enters the interior, stomach Qi becomes deficient, and rebellious Qi ascends, causing epigastric fullness without pain and hardness upon palpation; this is Pi syndrome. The treatment method should focus on draining the Heart (Xie Xin). However, if the exterior syndrome has not resolved, direct attack on the Pi is contraindicated; one must first resolve the exterior, then treat the Pi. If the exterior resolves but the interior remains unharmonized, or if Pi persists after using Xie Xin Decoctions, and the patient presents with dry mouth, irritability, thirst, and back stiffness, treatment should be adjusted according to the specific syndrome. If dizziness, vertigo, and twitching of the meridians occur, prolonged duration may lead to Wei syndrome (flaccidity syndrome). In patients with both exterior and interior deficiency who have Qi Pi, with exhaustion of both Yin and Yang Qi, where the absence of Yang leaves Yin isolated, the additional use of fire needles can cause irritability, cyanotic-yellow complexion, and xerotic skin (skin resembling fish scales); this is difficult to treat. If the pulse is slightly floating and Qi rushes to the throat causing dyspnea, this is not Pi but cold in the chest, treated by emesis.
The *Huoren Shu* states: Epigastric fullness without pain is called Pi. Shaoyin disease does not originally present with Pi; it should present with cold limbs. If the physician mistakenly purges, Pi forms. Zhishi Lizhong Wan is the best formula. Among Zhang Zhongjing's formulas for Pi, Shengjiang Xiexin Tang and Banxia Xiexin Tang are mild and suitable for regular use. Zhang Zhongjing stated: Fullness without pain is Pi; Chaihu Tang is not appropriate; Banxia Xiexin Tang is indicated. This decoction is derived from the principles of Lizhong Ren Shen Huang Qin Tang. Once Pi is confirmed, Jiegeng Zhike Tang is excellent initially because Jiegeng and Zhike promote Qi movement in the diaphragm. Regardless of Jie Xiong or Pi, the Guan pulse is typically deep. If the Guan pulse is floating, Dahuang Huanglian Huangqin Xiexin Tang is indicated, signifying constrained heat verified by the three yellow herbs. For Liver heat, if accompanied by aversion to cold and sweating, Fuzi Xiexin Tang is indicated.
If a patient has epigastric Pi unrelieved by Xiexin Tang, with thirst, oral heat, irritability, and dysuria, Wuling San is indicated. If sweating occurs and the exterior resolves, but Stomach disharmony persists with hard epigastric Pi, belching, fetid eructation, fluid retention in the hypochondrium, borborygmus, and diarrhea, Shengjiang Xiexin Tang is indicated. If diarrhea occurs dozens of times daily with undigested food, borborygmus, and hard/full epigastric Pi due to mistaken purgation, further purgation worsens the condition; Gancao Xiexin Tang is indicated. This is not heat constraint but deficiency of Stomach Qi with rebellious Qi. For diarrhea with epigastric Pi, both Shengjiang Xiexin Tang and Gancao Xiexin Tang are applicable. If diarrhea is intractable, treat the Lower Jiao with Chishizhi Yuyuliang Tang, as the previous formulas treat the Middle Jiao. Treating only the Middle Jiao would worsen the Lower Jiao diarrhea. If Chishizhi Yuyuliang Tang fails, promote urination with Wuling San. For Pi distension unresponsive to Xiexin Tang, Xianxiong Wan may be used cautiously, as Xianxiong Tang is too harsh. Generally, Jie Xiong and Pi require differentiation; if the exterior is unresolved, do not purge. Zhang Zhongjing said: Resolve the exterior first, then attack the Pi. Guizhi Tang resolves the exterior; Dahuang Huanglian Huangqin Tang attacks the Pi.
If exterior signs persist with epigastric oppression, it is not Pi but Zhi Jie (branch knotting), treated with Chaihu Guizhi Tang. Hypochondriac fullness with slight constraint is treated with Xiaochaihu Tang plus Ganjiang and Muli. If Taiyang signs remain despite multiple purgations leading to協熱利 (diarrhea with heat), intractable diarrhea, hard epigastric Pi, and simultaneous exterior-interior pathology, Guizhi Renshen Tang is indicated. Shizao Tang and Da Chaihu Tang also treat epigastric Pi but are difficult to apply. Shizao Tang is only suitable when exterior signs have ceased, no aversion to cold, body cool, periodic fever/sweating, headache, hard/distended epigastric Pi radiating to the hypochondrium, dry retching, and shortness of breath. It is strictly contraindicated if the exterior is unresolved. Da Chaihu Tang treats Shaoyang-Yangming combined disease with fever, unremitting sweating, hard epigastric Pi, vomiting, and diarrhea; it is indispensable in such cases. After sweating, emesis, or purgation, if hard epigastric Pi and irritability persist, Xuanshu Daizhe Tang is indicated. For patients with Xuanshu Daizhe Tang indications accompanied by cough, rebellious Qi, and deficiency, Sini Tang should be taken first; for Cold Stomach, Lizhong Wan first, then Xuanshu Daizhe Tang. Xuanshu Daizhe Tang resolves hard epigastric Pi and requires careful examination.
Shaoyin disease epigastric fullness refers to high, hard, and full sensation at the epigastrium. If fullness occurs without prior purgation, emesis or purgation may differ. Post-purgation fullness distinguishes between Jie Xiong and Pi. The Classic states: Cold extremities, sudden tight pulse, pathogen constrained in the chest, epigastric fullness with irritability, and hunger indicate pathogen in the chest. Fu-patterns should not be purged. These two scenarios describe post-Han-Xia epigastric fullness requiring emesis based on pathogen height: high pathogens are expelled via emesis ("increase"), low pathogens via elimination. The key is expelling the pathogen. In Yangming disease, even with hard epigastric fullness, purgation is contraindicated. The Classic warns: Yangming with hard epigastric fullness cannot be purged; purging leads to intractable diarrhea and death, or recovery if diarrhea stops. This indicates Qi transmission from exterior to interior, forming real constraint at the epigastrium, which requires emesis, not purgation, unless fully realized as excess.
Pathogen in the exterior improperly purged leads to pathogen entering the empty interior. Excess results in painful hard Jie Xiong; deficiency results in non-painful full Pi. The Classic states: Vomiting with heat indicates Chaihu syndrome. If wrongly purged but Chaihu signs remain, re-administer Chaihu Tang; this causes shaking chills followed by fever and sweating for resolution. If purging leads to painful hard epigastric fullness, it is Jie Xiong; non-painful fullness is Xu Pi. Real constraint causes pain/hardness; deficient constraint causes fullness only. Jie Xiong Re Shi (Heat-Excess) presents with deep-tight pulse, painful epigastrium, and hardness, treated with Da Xianxiong Tang, indicating excess pathogen. Floating-tight pulse wrongly purged leads to Pi with soft palpation, indicating deficient pathogen. Disease originating in Yang wrongly purged leads to Heat-Jie Xiong; disease originating in Yin wrongly purged leads to Pi. Unresolved exterior pathogen wrongly purged empties the Stomach, allowing guest Qi to move in the diaphragm, Yang Qi sinks inward, causing hard epigastric fullness (Jie Xiong), treated with Xianxiong formulas. Shaoyang-Taiyang disease wrongly purged leads to hard epigastric Pi; repeated purgation worsens it due to Stomach emptiness and rebellious Qi, treated with Xiexin formulas. Both involve hard epigastric fullness, one deficient, one excess; careful differentiation is vital. Jie Xiong is excess, treated with Xianxiong formulas, except if pulse is floating-large (contraindicated, purging kills due to residual exterior pathogen and interior depletion). If Jie Xiong signs are complete with irritability, it is incurable. Drugs require Stomach Qi distribution to work; if Stomach Qi is exhausted, even divine medicine fails.
Abdominal fullness (Du Zhang) is discussed. Hua Tuo described pathogen progression: Day 1 Skin, Day 2 Flesh, Day 3 Muscle, Day 4 Chest, Day 5 Abdomen, Day 6 Stomach (Fu). Abdominal fullness is an interior sign but varies in depth. The Classic states: Exterior resolved but interior not cleared, with alternating chills/fever, indicates incomplete Fu involvement. Large excess with dry stool requires purgation. Shaoyang-Yangming pathogen entering Fu causes deep interior signs and abdominal fullness, amenable to purgation. Examples: Non-tidal fever precludes Chengqi Tang; large abdominal fullness/blockage allows Xiao Chengqi Tang. Sweating failure with abdominal fullness/pain requires urgent purgation. Taiyang disease wrongly purged causing intermittent abdominal fullness/pain belongs to Taiyin, treated with Guizhi Shaoyao Tang. Severe excess pain uses Guizhi Jiada Huang Tang. Shaoyin disease with abdominal fullness and constipation requires urgent purgation. These are interior signs. Constant abdominal fullness/pain is excess, requiring purgation. Variable fullness (reducing temporarily) is deficiency, contraindicated for purgation. The Classic states: "Fullness does not reduce" indicates excess requiring purgation. *Jingui Yaolue* states: "Fullness reduces then returns" indicates deficiency-cold ascending, treated with warming harmonizing agents. Deficient stagnation causes bloating but less hardness/pain than excess. Abdominal fullness generally belongs to Taiyin. Yang-heat pathogen causes fullness with dry throat; Yin-cold pathogen causes fullness with vomiting/inability to eat, worsening diarrhea, and intermittent pain. Taiyin governs the Spleen/Earth and Central Jiao, specializing in abdominal fullness. Post-sweating/emesis/purgation abdominal fullness results from pathogen invading deficiency. Causes vary: Post-sweating fullness uses Houpo Shengjiang Gancao Banxia Renshen Tang; post-emesis fullness uses Tiaowei Chengqi Tang; post-purgation irritability/fullness/restlessness uses Zhizi Houpo Tang. Treatment depends on pathogen location: Sweating-induced fullness requires warming (Stomach Qi deficiency failing to distribute fluids); Emesis-induced fullness may require purgation (pathogen descending from chest to Stomach); Purgation-induced fullness may require emesis (pathogen trapped in chest causing deficiency irritability and Qi blockage). Physicians must identify pathogen origin, location, and excess/deficiency status to achieve perfect outcomes.
*Shengji Zonglu* discusses Shaoyin abdominal fullness as organ dysfunction with pathogen invasion, Zheng-pathogen conflict. Post-emesis/purgation heat causing painful fullness is excess. Pre-existing cold癖 (masses) exacerbated by cold meds/water causing fluid constraint and fullness is deficiency.
*Huoren Ge Kuo* asks: What is abdominal fullness? It is Yin-Yang disharmony. Post-Han-Xia-Fa cases require precise formula selection. Jiegeng Banxia Tang is excellent. Zhang Zhongjing's Taiyang post-sweating fullness uses Houpo Banxia Gancao Renshen Tang; post-purgation irritability/fullness uses Zhizi Houpo Tang; post-emesis fullness uses Tiaowei Chengqi Tang.
Another song states: Fullness involves Spleen/Stomach; Three Yang combined disease causes irritability/dizziness. Post-pathogen/Han-Xia-Fa, Kidney signs/stool hardness respond to Chengqi. Abdominal fullness often belongs to Taiyin (Spleen Earth). Constant fullness is interior excess (purge); variable fullness is interior deficiency (warm/harmonize). Post-Han-Xia-Fa fullness requires differentiation: soothing, warming, or emetic methods based on pathogen entry via deficiency. Differentiation of pathogen origin/location is key. Taiyin differentiation is crucial: Large abdominal fullness with dehydration is hard to cure. Taiyin fullness with vomiting precludes purgation; Zhishi Lizhong Wan is indicated. Mistaken purgation of Taiyang causing intermittent abdominal fullness/pain is Taiyin disease, treated with Guizhi Dahuang Tang (heavy cases: Guizhi Jiada Huang Tang). Yangming fever, abdominal fullness, slight wheezing, bitter taste, dry throat, constipation, or rapid speech may use Xiaochaihu Tang. Hiccups with dysuria add Fuling. Yangming severe fullness/constipation uses Xiao Chengqi Tang mildly. Yangming slow pulse, abdominal fullness, wheezing, tidal fever also use Xiao Chengqi Tang. Jaundice has its own section. Three Yang combined disease with abdominal fullness, heaviness, difficulty turning, delirium, insensate mouth uses Baihu Tang. Post-emesis persistent fullness indicates chest pathogen descending to Stomach (excess), treated mildly with Tiaowei Chengqi Tang. Post-sweating fullness indicates Stomach Qi deficiency/Qi stagnation, treated with Houpo Shengjiang Banxia Renshen Gancao Tang. Fullness with pain uses Xiao Chengqi Tang mildly. Mistaken purgation causing fullness/irritability/restlessness indicates exterior pathogen trapping in chest, treated with Zhizi Houpo Tang. Shaoyin disease day 6-7 fullness/constipation requires urgent Chengqi Tang. Abdominal distension/reversal uses Jiegeng Banxia Tang. Abdominal wall pain indicates Spleen unable to control water, water-Qi interaction in skin, audible borborygmus, treated with Banxia Fuling Tang plus Guixin. Fullness with shortness of breath indicates interior excess; soft fullness with shortness of breath indicates interior deficiency. Shortness of breath with fullness requires removing Baizhu (too drying/closing).
Qianhu San (*Shenghui Fang*) treats Shaoyin epigastric Pi fullness, headache, limb pain.
Qian Hu (1 liang), Chi Fu Ling, Chi Shao Yao, Gui Xin, Bai Zhu (3 fen each), Chai Hu, Zhi Ke (bran-fried), He Li Le (roasted), Gan Cao (0.5 liang). Coarse powder. 4 qian per dose, water 1 zhan, boil to 0.6 zhan, strain, warm.
Xuanfu Hua San (*Shenghui Fang*) treats Shaoyin headache, epigastric Pi fullness, phlegm obstruction, anorexia.
Xuan Fu Hua (0.5 liang), Ban Xia (washed 7 times), Gui Xin (3 liang each), Qian Hu, Shi Gao, Chi Fu Ling, Chen Ju Pi (1 liang each), Gan Cao (1 fen). Coarse powder. 3 qian per dose, water 1 zhan, boil to 0.6 zhan, strain, warm.
He Li Le San (*Shenghui Fang*) treats Shaoyin epigastric Pi fullness, throat obstruction, limb discomfort, back oppression, anorexia.
He Li Le, Da Fu Pi, Qian Hu, Chen Ju Pi, Chuan Da Huang (1 liang each), Ban Xia, Zhi Shi, Gui Xin (3 fen each), Mu Xiang (0.5 liang). Coarse powder. 3 qian per dose, water 1 zhan, add Ginger (0.5 part), boil to 0.6 zhan, strain, warm.
Fuzi Xiexin Tang (*Shenghui Fang*) treats Shaoyin epigastric Pi fullness with aversion to cold and sweating.
Fu Zi (processed), Huang Lian, Huang Qin, Chuan Da Huang (1 liang each). Coarse powder. 3 qian per dose, water 1 zhan, boil to 0.6 zhan, strain, warm.
Chen Ju Pi San (*Shenghui Fang*) treats Shaoyin epigastric Pi fullness, worsening distension after purgation.
Chen Ju Pi, He Li Le Pi, Chi Fu Ling, Ren Shen, Bai Zhu (1 liang each), Hou Po, Gui Xin (3 fen each), Mu Xiang, Gao Liang Jiang (1 liang each). Coarse powder. 4 qian per dose, water 1 zhan, add 3 dates, boil to 0.6 zhan, strain, warm.
Bai Zhu San (*Shenghui Fang*) treats Cold-Qi constraint in epigastrium/abdomen causing Pi fullness/oppression.
Bai Zhu, Gui Xin, Chi Shao Yao, Dang Gui, Ban Xia, Gan Jiang, Mu Xiang (3 fen each), Chen Ju Pi, Hou Po (2 liang each). Coarse powder. 4 qian per dose, water 1 zhan, add Ginger (0.5 part), 3 dates, boil to 0.6 zhan, strain, warm.
Formula for Shaoyin neck/head tension, epigastric Pi fullness, rebellious Qi, anorexia (*Shenghui Fang*).
Fu Zi, Ren Shen, Chen Ju Pi, Bai Zhu, Zi Su Jing Ye (1 liang each), Gui Xin, Mu Xiang, Da Fu Pi, Xing Ren (0.5 liang each). Coarse powder. 4 qian per dose, water 1 zhan, add Ginger (0.5 part), boil to 0.6 zhan, strain, warm.
Chi Fu Ling San (*Shenghui Fang*) treats Shaoyin epigastric Pi fullness, hypochondriac urgency, anorexia.
Chi Fu Ling, Zhi Ke, Bai Zhu, Chen Ju Pi (1 liang each), Ze Xie, Jie Geng, Ren Shen (3 fen each), Gan Cao (1 fen), Xing Ren (3 fen). ...
Formula for Shaoyin rebellious Qi, epigastric Pi fullness, anorexia (*Shenghui Fang*).
Ren Shen, Bai Zhu, Zhi Ke, Chi Fu Ling (1 liang each), Jie Geng (3 fen), Gui...