痞者有食积兼湿。东垣有法有方。心下痞，须用枳实、炒黄连。如禀受充实，面苍
骨露，气
，而心下痞者，宜白术、山楂、曲 、陈皮；如肥人心下痞者，乃是湿痰，宜苍术、半夏
砂仁、茯苓、滑石；如瘦人心下痞者，乃是郁热在中焦，宜枳实、黄连、葛根、升麻；如食
后感寒，饮食不化，心下痞，宜藿香、草豆蔻、吴茱萸、砂仁；痞挟血成窠囊，用桃仁、红
入方
吴茱萸（三两，汤浸煮少时） 黄连（八两）
粥糊为丸。每服五七十丸，白术陈皮汤下。
玉液丸
软石膏（不以多少，又云火焰红出火毒）
上为末，醋糊丸如绿豆大。服之专能泻胃火，并治食
〔附录〕痞者，与否同，不通泰也，由阴伏阳蓄，气与血不运而成。处心下，位中央，
满痞塞者，皆土之病也，与胀满有轻重之分。痞则内觉
闷，而外无胀急之形者，是痞也。有中气虚弱，不能运化精微为痞者；有饮食痰积，不能
化为痞者；有湿热太甚为痞者。古方，治痞用黄连、黄芩、枳实之苦以泄之；浓朴、生姜
之辛以散之；人参、白术之甘苦以补之；茯苓、泽泻之淡以渗之。既痞，同湿治，惟宜上下
分消其气。如果有内实之证，庶可略与疏导。世人苦于痞塞，喜行利药，以求其速效，暂
时快通，痞若再作，益以滋甚。
附方
加味补中益气汤 治内伤，心下痞。方见内伤。
脉缓有痰而痞，加半夏、黄连；脉弦，四肢满闷，便难，而心下痞，加柴胡、黄连、甘
草；大便秘燥，加黄连、桃仁，少加大黄、归身；心下痞，瞀闷者，加白芍药、黄连；心下
痞，中寒者，加附子、黄连；心下痞，腹胀，加五味子、白芍、砂仁；天寒，少加干姜，或
；心下痞，呕逆者，加黄连、生姜、陈皮如冬月，加黄连，少入丁香、藿香；心下痞，如腹中
气上逆者，是冲脉逆也，加黄柏三分，黄连一分半以泄之；如食已，心下痞，别服橘皮枳
枳实消痞丸 治右关脉浮弦，心下虚痞，恶食，懒倦。开胃进食。
枳实 黄连（各五钱） 干生姜（二钱） 半夏曲（三钱） 浓朴（四钱） 人参（三钱） 甘草（炙，二钱）
白术（三钱） 茯苓 麦芽（各二钱）
上为末，水浸蒸饼，丸如梧桐子大。服三五十丸，温水下。
橘皮枳术丸
橘皮 枳实 白术（等分）
上为末，荷叶裹烧饭为丸。每服五十丸，白汤下。
枳术丸 助胃消食，宽中，去痞满。
白术 枳实（各二两）
上为末，荷叶裹烧饭为丸。
痞证是由于食积兼夹湿邪所致。李东垣对此有治法和方剂。心下痞满，必须使用枳实、炒黄连。如果患者体质充实，面色苍老，骨骼显露，气机郁滞而心下痞满的，适宜用白术、山楂、神曲、陈皮；如果是肥胖之人出现心下痞满，这是湿痰所致，适宜用苍术、半夏、砂仁、茯苓、滑石；如果是瘦弱之人出现心下痞满，这是郁热在中焦，适宜用枳实、黄连、葛根、升麻；如果在进食后感冒寒邪，饮食不消化，导致心下痞满，适宜用藿香、草豆蔻、吴茱萸、砂仁；如果痞证夹杂瘀血形成窠囊，使用桃仁、红花加入方中。吴茱萸（三两，用水浸泡后煮片刻），黄连（八两），制成粥糊丸。每次服用五七十丸，用白术陈皮汤送服。
玉液丸：软石膏（用量不限，又说需煅烧至火焰红色以去火毒）。研为细末，用醋糊制成如绿豆大小的丸药。服用此药专门能清泻胃火，并治疗食积。
【附录】“痞”字与“否”字相同，意为不通畅。这是由于阴气潜伏、阳气蓄积，气与血运行不畅而形成的。病位在心下，处于人体中央，凡是感到胀满痞塞的，都是脾胃（土）的病证，与胀满相比有轻重的区别。痞证是内部感觉闷堵，但外部没有胀急形状的，这就是痞证。有中气虚弱，不能运化精微物质而导致痞证的；有因饮食痰积，不能消化而形成痞证的；有湿热过盛而导致痞证的。古方治疗痞证，用黄连、黄芩、枳实的苦味来泄降；用浓朴、生姜的辛味来发散；用人参、白术的甘苦味来补益；用茯苓、泽泻的淡味来渗利。既然已经形成痞证，应按湿证治疗，只宜上下分消其气。如果有里实证的证据，才可以稍微给予疏导。世人苦于痞塞不适，喜欢使用利尿药物，以求快速见效，暂时通畅，但痞证一旦复发，病情会更加严重。
附方：
加味补中益气汤：治疗内伤引起的心下痞满。方剂见内伤章节。脉象缓且有痰导致痞满的，加半夏、黄连；脉象弦，四肢胀满闷痛，大便困难，且心下痞满的，加柴胡、黄连、甘草；大便秘结干燥的，加黄连、桃仁，少量加大黄、当归身；心下痞满，头晕闷乱的，加白芍药、黄连；心下痞满，伴有中焦寒邪的，加附子、黄连；心下痞满，伴有腹胀的，加五味子、白芍、砂仁；天气寒冷时，少量加入干姜，或[原文缺字]；心下痞满，伴有呕吐逆气的，加黄连、生姜、陈皮；如果是冬季，加黄连，少量加入丁香、藿香；心下痞满，如果感觉腹中有气上逆的，这是冲脉之气上逆，加黄柏三分，黄连一分半以泄降之；如果进食后心下痞满，另外服用橘皮枳术丸。
枳实消痞丸：治疗右关脉浮弦，心下虚痞，厌恶饮食，懒倦乏力。开胃进食。
枳实、黄连（各五钱）、干生姜（二钱）、半夏曲（三钱）、浓朴（四钱）、人参（三钱）、甘草（炙，二钱）、白术（三钱）、茯苓、麦芽（各二钱）。
研为细末，用水浸泡蒸饼，制成如梧桐子大小的丸药。每次服用三五十丸，温水送服。
Pi syndrome (fullness and obstruction) is caused by food retention combined with dampness. Li Dongyuan has established methods and formulas for this. For epigastric fullness (heart-down pi), Zhi Shi (Immature Bitter Orange) and fried Huang Lian (Coptis Rhizome) must be used. If the patient has a robust constitution, a dark complexion, exposed bones, qi stagnation, and epigastric fullness, Bai Zhu (Atractylodes Macrocephala Rhizome), Shan Zha (Hawthorn Fruit), Shen Qu (Medicated Leaven), and Chen Pi (Tangerine Peel) are suitable. If an obese person presents with epigastric fullness, it is due to damp-phlegm; Cang Zhu (Atractylodes Rhizome), Ban Xia (Pinellia Tuber), Sha Ren (Amomum Fruit), Fu Ling (Poria), and Hua Shi (Talcum) are suitable. If a thin person presents with epigastric fullness, it is due to stagnant heat in the middle jiao; Zhi Shi (Immature Bitter Orange), Huang Lian (Coptis Rhizome), Ge Gen (Kudzu Root), and Sheng Ma (Cimicifuga Rhizome) are suitable. If cold is contracted after eating, leading to indigestion and epigastric fullness, Huo Xiang (Patchouli Herb), Cao Dou Kou (Black Cardamom Seed), Wu Zhu Yu (Evodia Fruit), and Sha Ren (Amomum Fruit) are suitable. If pi syndrome is complicated by blood stasis forming a nest-like structure, Tao Ren (Peach Kernel) and Hong Hua (Safflower) should be added to the formula. Wu Zhu Yu (Evodia Fruit, 3 liang, soaked in water and boiled briefly), Huang Lian (Coptis Rhizome, 8 liang) are made into pills using rice porridge paste. Take 50-70 pills per dose, administered with Bai Zhu Chen Pi Tang (White Atractylodes and Tangerine Peel Decoction).
Yu Ye Wan (Jade Fluid Pill): Ruan Shi Gao (Soft Gypsum, amount as needed, also stated as calcined until flame-red to remove fire toxicity). Pulverized into powder, formed into pills the size of mung beans using vinegar paste. This pill specifically clears stomach fire and treats food retention.
[Appendix] "Pi" (痞) is synonymous with "Pi" (否), meaning lack of smooth flow. It arises from the latent yin and accumulated yang, resulting in impaired circulation of qi and blood. The lesion is located at the epigastrium (heart-down), situated in the center. Any condition characterized by internal fullness and obstruction belongs to disorders of the Earth element (Spleen/Stomach), differing from Zhang Man (distension and fullness) in severity. Pi syndrome is defined by a sensation of internal stuffiness without external signs of distension or urgency. Causes include: deficiency of Middle Qi failing to transform and transport essence; food and phlegm retention failing to digest; and excessive damp-heat. Ancient formulas treat Pi syndrome using the bitter nature of Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root), and Zhi Shi (Immature Bitter Orange) to drain; the pungent nature of Hou Po (Magnolia Bark) and Sheng Jiang (Fresh Ginger) to disperse; the sweet-bitter nature of Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome) to tonify; and the bland nature of Fu Ling (Poria) and Ze Xie (Alisma Rhizome) to leach out dampness. Once Pi syndrome is established, it should be treated like dampness, focusing on dispersing qi from above and below. Only if there are signs of interior excess can mild guiding and draining be applied. People suffering from obstruction often prefer diuretic drugs for quick relief, achieving temporary patency, but upon recurrence, the condition worsens.
Attached Formulas:
Jia Wei Bu Zhong Yi Qi Tang (Modified Tonify the Middle and Augment the Qi Decoction): Treats epigastric fullness due to internal injury. See Internal Injury chapter for the formula.
If the pulse is slow with phlegm causing pi, add Ban Xia (Pinellia Tuber) and Huang Lian (Coptis Rhizome); if the pulse is wiry, limbs are full and stifled, defecation is difficult, and there is epigastric fullness, add Chai Hu (Bupleurum Root), Huang Lian (Coptis Rhizome), and Gan Cao (Licorice Root); if stool is dry and constipated, add Huang Lian (Coptis Rhizome), Tao Ren (Peach Kernel), and small amounts of Da Huang (Rhubarb Root) and Dang Gui Shen (Angelica Sinensis Root Body); if there is epigastric fullness with dizziness and mental clouding, add Bai Shao Yao (White Peony Root) and Huang Lian (Coptis Rhizome); if there is epigastric fullness with middle-jiao cold, add Fu Zi (Prepared Aconite Lateral Root) and Huang Lian (Coptis Rhizome); if there is epigastric fullness with abdominal distension, add Wu Wei Zi (Schisandra Berry), Bai Shao Yao (White Peony Root), and Sha Ren (Amomum Fruit); in cold weather, add small amounts of Gan Jiang (Dried Ginger), or [text missing]; if there is epigastric fullness with vomiting and rebellious qi, add Huang Lian (Coptis Rhizome), Sheng Jiang (Fresh Ginger), and Chen Pi (Tangerine Peel); in winter, add Huang Lian (Coptis Rhizome) and small amounts of Ding Xiang (Clove) and Huo Xiang (Patchouli Herb); if there is epigastric fullness with a sensation of qi rushing upward in the abdomen, this is rebellion of the Chong Mai (Penetrating Vessel); add Huang Bo (Phellodendron Bark, 3 fen) and Huang Lian (Coptis Rhizome, 1.5 fen) to drain it; if epigastric fullness occurs after eating, separately take Ju Pi Zhi Zhu Wan (Tangerine Peel and Immature Bitter Orange Pill).
Zhi Shi Xiao Pi Wan (Immature Bitter Orange Pill to Reduce Fullness): Treats floating-wiry pulse at the right Guan position, empty epigastric fullness, aversion to food, and lethargy. Opens the stomach and promotes appetite.
Zhi Shi (Immature Bitter Orange), Huang Lian (Coptis Rhizome) (each 5 qian), Gan Sheng Jiang (Dried Fresh Ginger, 2 qian), Ban Xia Qu (Pinellia Medicated Leaven, 3 qian), Hou Po (Magnolia Bark, 4 qian), Ren Shen (Ginseng Root, 3 qian), Zhi Gan Cao (Honey-fried Licorice Root, 2 qian), Bai Zhu (Atractylodes Macrocephala Rhizome, 3 qian), Fu Ling (Poria), Mai Ya (Sprouted Hordeum Grain) (each 2 qian).
Pulverized into powder, mixed with steamed dough cakes soaked in water, formed into pills the size of sophora seeds. Take 30-50 pills per dose, administered with warm water.
Ju Pi Zhi Zhu Wan (Tangerine Peel and Immature Bitter Orange Pill):
Ju Pi (Tangerine Peel), Zhi Shi (Immature Bitter Orange), Bai Zhu (Atractylodes Macrocephala Rhizome) (equal parts).
Pulverized into powder, formed into pills using rice wrapped in lotus leaves and roasted. Take 50 pills per dose, administered with plain hot water.
Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill): Assists stomach digestion, expands the middle, and removes fullness and obstruction.
Bai Zhu (Atractylodes Macrocephala Rhizome), Zhi Shi (Immature Bitter Orange) (each 2 liang).
Pulverized into powder, formed into pills using rice wrapped in lotus leaves and roasted.