【因】 误下阴虚。食积痰滞。湿土虚痞。
论曰∶太阴湿土为积饮痞膈，乃土来心下痞满也。
【证治】 误下多则亡阴，胸中之气，因虚而下陷于心之分野。宜升胃气，以血
药治之。亡阴谓脾胃水谷之阴亡也。
痰积痞膈，胸中窄塞，宜消导之，谓之实痞。
湿土虚痞有二。大便秘能食者，浓朴、枳实主之；大便利者，芍药、陈皮主之。
【治法】 以泻心汤。黄连为君，泻心下之土邪；浓朴降气。
《三因》论状 心下坚满，痞急痛如刺，不得俯仰，其胸前皮皆痛，短气，咳唾引痛，
咽塞不利，习习如痒，喉中干燥，呕吐烦闷，自汗时出，痛引彻背。
外有心热而痞之，痞则满硬。结胸则痛，属胸痹。
大消痞丸 治湿土痞、虚气痞。
黄连（炒） 黄芩（各三钱） 姜黄（一钱） 白术 半夏（各一两） 甘草（炙，一钱） 缩砂
（一钱） 枳实（炒） 生姜（各五钱） 陈皮（二钱） 神曲（一钱，炒） 浓朴（三钱） 泽泻 猪
苓（各一钱五分）
丸梧子大，白汤送下。木香，有忧气结中脘，心下痞满，肚皮底微痛加之，否则不用。
利膈丸 除痰利膈。
黄芩（生炒各一两） 黄连 南星 半夏（各五钱） 枳壳 陈皮（各三钱） 白术（二钱）
白矾（五分） 泽泻（五钱） 神曲（五钱，炒）
栝蒌丸 治胸痞，或胁下逆抢心。
栝蒌子 枳实 陈皮
取栝蒌皮，穣末熬丸。胸痞切痛，加栀子烧存性、附子炮，各二两。
[Pathogenesis] Misuse of purgatives leads to Yin deficiency. Food stagnation and phlegm-dampness obstruction. Pi syndrome (epigastric fullness) caused by deficient Spleen Earth.
It is stated that: The accumulation of dampness in the Taiyin Spleen Earth transforms into fluid retention, causing Pi syndrome and diaphragmatic obstruction. This refers to the Qi of Earth rising to the epigastrium, resulting in fullness and blockage.
[Syndrome Differentiation and Treatment] Excessive misuse of purgatives causes the loss of Yin. The Qi in the chest, due to deficiency, sinks downward into the region governed by the Heart. It is appropriate to raise Stomach Qi and treat with blood-invigorating/nourishing herbs. "Loss of Yin" refers to the depletion of the Yin fluids derived from food and water in the Spleen and Stomach.
Pi syndrome and diaphragmatic obstruction caused by phlegm and food stagnation, characterized by a narrow and blocked sensation in the chest, should be treated with methods that resolve stagnation and promote digestion; this is called "Excess Pi".
There are two types of Pi caused by deficient Spleen Earth: If constipation is present but appetite remains good, Magnoliae Officinalis Cortex (Houpo) and Immature Bitter Orange (Zhishi) are the primary herbs; if bowel movements are normal or loose, White Peony Root (Shaoyao) and Tangerine Peel (Chenpi) are the primary herbs.
[Therapeutic Method] Use Xiexin Tang (Drain the Epigastrium Decoction). Coptis Rhizome (Huanglian) serves as the Sovereign herb to drain the Earth-pathogenic factors (damp-heat) in the epigastrium; Magnoliae Officinalis Cortex (Houpo) descends Qi.
The *San Yin Fang* describes the symptoms as: Hardness and fullness in the epigastrium, urgent pain in the Pi area like stabbing, inability to bend forward or extend backward, pain over the entire skin of the chest, shortness of breath, pain radiating during coughing and expectoration, throat obstruction and discomfort, a tickling sensation like itching, dryness in the throat, vomiting with restlessness, spontaneous sweating occurring intermittently, and pain radiating through to the back.
Externally, there may be Heart heat accompanying Pi; Pi manifests as fullness and hardness. Jie Xiong (Chest Binding) manifests as pain and belongs to the category of Xiong Bi (Obstruction of the Chest).
Da Xiao Pi Wan (Great Elimination of Pi Pill) treats Pi due to Damp-Earth and Deficient Qi.
Coptis Rhizome (Huanglian, stir-fried), Scutellaria Root (Huangqin) [3 qian each], Turmeric Tuber (Jianghuang) [1 qian], Atractylodes Macrocephala Rhizome (Baizhu) [1 liang], Pinellia Tuber (Banxia) [1 liang], Licorice Root (Gancao, honey-fried) [1 qian], Amomum Fruit (Suosha) [1 qian], Immature Bitter Orange (Zhishi, stir-fried), Fresh Ginger (Shengjiang) [5 qian each], Tangerine Peel (Chenpi) [2 qian], Medicated Leaven (Shenqu, stir-fried) [1 qian], Magnoliae Officinalis Cortex (Houpo) [3 qian], Alisma Rhizome (Zexie) [1.5 qian], Polyporus (Zuling) [1.5 qian].
Form into pills the size of wu zi (wu berry seeds), take with warm water. Add Costus Root (Muxiang) if there is Qi stagnation from worry in the Zhongwan region, with epigastric fullness and slight pain at the base of the abdomen; otherwise, do not use.
Li Ge Wan (Diaphragm-Opening Pill) eliminates phlegm and opens the diaphragm.
Scutellaria Root (Huangqin, raw and stir-fried) [1 liang each], Coptis Rhizome (Huanglian) [5 qian], Arisaema Rhizome (Nanxing) [5 qian], Pinellia Tuber (Banxia) [5 qian], Aurantium Fructus Immaturus (Zhike) [3 qian], Tangerine Peel (Chenpi) [3 qian], Atractylodes Macrocephala Rhizome (Baizhu) [2 qian], Alum (Baifan) [0.5 qian], Alisma Rhizome (Zexie) [5 qian], Medicated Leaven (Shenqu, stir-fried) [5 qian].
Gualou Wan (Trichosanthes Pill) treats chest Pi or rebellious Qi rushing from the hypochondrium to the heart.
Trichosanthes Seed (Gualouzi), Immature Bitter Orange (Zhishi), Tangerine Peel (Chenpi).
Take Trichosanthes Peel (Gualoupi), remove the pulp, powder it, and decoct to form pills. If chest Pi involves severe pain, add Gardenia Fruit (Zhizi, charred to retain its nature) [2 liang] and Prepared Aconite Root (Fuzi, processed) [2 liang].