经曰∶太阴所至，为积饮痞膈。痞，不通之谓。精神荣卫，气血津液，出入流行之纹理，闷
密而为痞也。有伤寒下早，邪气攻上而痞者；有杂病下多亡阴，血虚而痞者；有中气虚弱，不能
运化精微而痞者；有饮食、痰积窒塞而痞者；有湿热太甚而痞者。盖痞与胀不同，胀满则内空虚
而外有形，痞满则内
闷实而外无状，脉宜浮滑，忌短涩。治宜察其虚实而行攻补，实人略与疏通，随宜调补，不可专
于通利，暂得宽舒，再作益甚。
主方 陈皮 半夏 茯苓 枳实 黄连（姜炒） 浓朴（姜炒。各八分） 草豆蔻 木香
益智 青皮 柴胡（各五分） 干姜 吴茱萸（各三分）上水煎服。
脾虚无血加当归、芍药、川芎、白术；郁加香附、神曲；中气虚痞加人参、白术、苍术；痰
积加贝母、山楂、麦芽；湿热加酒炒黄芩、栀子、苍术；肥人湿痰，半夏、茯苓、苍术、滑石；
瘦人，枳实、黄连、芍药、升麻；痰挟血成窠囊，桃仁、红花、香附、大黄、郁金。
黄连消痞丸 治心下痞满，小便不利有热者。
黄连（炒，两半） 黄芩（炒） 干姜（各三钱） 茯苓 白术（炒） 甘草（炙） 浓朴
（制） 猪苓（各五钱） 枳实（一两） 陈皮（七钱五分） 泽泻 姜黄（各三钱半） 砂仁（
三钱五分） 半夏（制，一两三钱）
上为末，蒸饼，丸桐子大，每服百丸，白汤送下。
开结枳实丸 （一名木香利膈丸） 治湿痰留滞，胸膈痞闷，时作鸣声。
枳实（炒） 白术 半夏（制） 南星（泡） 枯矾 大黄 青皮 木香（各五钱） 牵牛
（头末，二两） 皂角（炙，去皮弦子） 旋复花（各一两）
上为末，面糊丸，如桐子大，每服三十五丸，米饮下。
香砂枳实丸 治痞。
保和丸 （并见饮食。）
简便方 痰食积痞。
半夏为末，姜汁和作饼子，用湿纸包，慢火煨香，熟水二钟，饼一个，盐五分，煎至一钟服
。
又 凉物过饱，不消，遂成痞。用马牙硝一两，以陈年吴茱萸半升，煮浓汁入硝，乘热服。
良久未转更服。
又 用枳实麸炒为末，每服二钱，清粥汤送下。
又 卒得胸痛，薤根捣自然汁饮。姜、葱熨（法见伤寒。）
The medical classics state: When the Qi of Taiyin (Great Yin) prevails, it leads to the accumulation of fluids and obstruction in the chest and diaphragm. "Pi" (Pien/Plugged sensation) refers to the blockage of flow. The spirit, Ying-Wei (Nutritive and Defensive Qi), Qi and Blood, and Body Fluids circulate through the meridians and collaterals; if this circulation becomes stagnant and dense, a Pi syndrome occurs.
Causes of Pi include:
1. In Cold Damage diseases, premature use of purgatives allows pathogenic factors to attack upwards, causing Pi.
2. In miscellaneous diseases, excessive purging depletes Yin and Blood, leading to Pi due to Blood deficiency.
3. Weakness of Middle Qi (Spleen/Stomach Qi) failing to transform and transport essence and micro-nutrients causes Pi.
4. Obstruction by food retention or phlegm accumulation causes Pi.
5. Excessive Damp-Heat causes Pi.
Generally, Pi differs from Zhang (Distension). Distension is characterized by internal emptiness but external visible swelling, whereas Pi is characterized by a sensation of internal fullness and stuffiness without external morphological changes. The pulse should be Floating-Slippery; Short-Rough pulses are contraindicated. Treatment requires assessing Deficiency and Excess to apply attacking or tonifying methods. For Excess patterns, mild unblocking agents are used, followed by appropriate tonification. One must not rely solely on draining methods; although temporary relief may occur, recurrence will be more severe.
Main Formula: Chenpi (Tangerine Peel), Banxia (Pinellia Rhizome), Fuling (Poria), Zhishi (Immature Bitter Orange), Huanglian (Coptis Rhizome, stir-fried with ginger juice), Houpo (Magnolia Bark, stir-fried with ginger juice), each 8 fen; Caodoukou (Grass Cardamom Seed), Muxiang (Aucklandiae Root), Yizhi (Alpinia Oxyphylla Fruit), Qingpi (Green Tangerine Peel), Chaihu (Bupleurum Root), each 5 fen; Ganjiang (Dried Ginger), Wuzhuyu (Evodia Fruit), each 3 fen. Decoct in water and take orally.
Modifications:
- Spleen Deficiency with Blood Deficiency: Add Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Chuanxiong (Ligusticum Rhizome), Baizhu (Atractylodes Macrocephala Rhizome).
- Qi Stagnation: Add Xiangfu (Cyperi Rhizome), Shenqu (Massa Medicata Fermentata).
- Middle Qi Deficiency Pi: Add Renshen (Ginseng Radix), Baizhu, Cangzhu (Atractylodes Lancea Rhizome).
- Phlegm Accumulation: Add Beimu (Fritillaria Bulb), Shanzha (Crataegus Fruit), Maiya (Hordeum Germinatum).
- Damp-Heat: Add Huangqin (Scutellaria Root, wine-fried), Zhizi (Gardenia Fruit), Cangzhu.
- Obesity (Damp-Phlegm): Banxia, Fuling, Cangzhu, Huashi (Talcum).
- Emaciation: Zhishi, Huanglian, Shaoyao, Shengma (Cimicifugae Rhizome).
- Phlegm binding with Blood stasis forming "Nest Bags" (stubborn masses): Taoren (Peach Kernel), Honghua (Carthamus Flower), Xiangfu, Dahuang (Rhubarb Root), Yujin (Curcuma Longa Rhizome).
Huanglian Xiaopi Wan (Coptis Dispel Pien Pill): Treats epigastric Pi with fullness, difficult urination, and Heat signs.
Ingredients: Huanglian (stir-fried, 1.5 liang), Huangqin (stir-fried), Ganjiang (each 3 qian); Fuling, Baizhu (stir-fried), Gancao (roasted), Houpo (processed), Zhuling (Polyporus), each 5 qian; Zhishi (1 liang); Chenpi (7.5 qian); Zexie (Alisma Rhizome), Jianghuang (Turmeric Rhizome), each 3.5 qian; Sharen (Amomum Fruit, 3.5 qian); Banxia (processed, 1 liang 3 qian).
Preparation: Powder the ingredients, mix with steamed dough paste, form pills the size of tung tree seeds. Take 100 pills per dose with warm water.
Kaijie Zhishi Wan (Unbind Immature Bitter Orange Pill, also known as Muxiang Lige Wan): Treats stagnation of Damp-Phlegm, chest/diaphragm Pi with stuffiness, and occasional borborygmus.
Ingredients: Zhishi (stir-fried), Baizhu, Banxia (processed), Nanxing (Arisaema Rhizome, soaked), Kufan (Alum), Dahuang, Qingpi, Muxiang (each 5 qian); Qianniu (Morning Glory Seed, first powder, 2 liang); Zaorao (Gleditsia Sinensis Fruit, roasted, skin and strings removed), Xuanjinhua (Inula Flower, each 1 liang).
Preparation: Powder the ingredients, mix with flour paste, form pills the size of tung tree seeds. Take 35 pills per dose with rice drink.
Xiangsha Zhishi Wan: Treats Pi.
Baohe Wan (See Food Retention section).
Simple Prescription for Phlegm-Food Retention Pi:
Powder Banxia, mix with ginger juice to make cakes. Wrap in wet paper and slow-roast until fragrant. Take one cake, two cups of cooked water, and 5 fen of salt. Decoct until one cup remains and take orally.
Another prescription for Pi caused by overeating cold/raw foods leading to indigestion:
Take 1 liang of Mayaxiao (Mirabilite) and half sheng of aged Wuzhuyu. Boil Wuzhuyu to make a concentrated decoction, add Mirabilite, and take while hot. If no bowel movement occurs after some time, take another dose.
Another prescription:
Powder Zhishi stir-fried with bran. Take 2 qian per dose with clear porridge soup.
Another prescription for sudden chest pain:
Drink the natural juice extracted from crushed Xiegen (Allium Macrostemon Root). Apply warming compresses with Ginger and Scallion (see Cold Damage chapter for method).