论
《内经》曰∶备化之纪，其病痞。又曰∶太阴所至，为积饮痞膈。夫痞满之证，东垣论之详矣。谓太阴湿土主壅塞，
乃土来心下为痞满也。伤寒下之太早，亦为痞满，乃寒伤荣血而然。心主血，邪入于本，故为心下痞。仲景以泻心汤，
用黄连泻心下之土邪，功效甚速。非止伤寒为然，至于酒积杂病，下之太过，亦作痞满，盖下多则亡阴也。亡阴者，谓
脾胃水谷之阴亡也。故胸中之气，因虚而下陷于心之分野，故心下痞。宜升胃气，以血药兼之。若全用利气之药导之，
则痞尤甚。痞甚而复下之，气愈下降，必变为中满鼓胀，皆非其治也。又有虚实之异，如实痞大便秘者，浓朴、枳实主
之。虚痞大便利者，芍药、陈皮主之。如饮食所伤而为痞满者，宜消导其胸中窒塞之气。上逆兀兀欲吐者，则宜吐之，
所谓在上者因而越之是也。学人宜详究焉。
脉法
《脉经》曰∶痞，脉浮紧而下之，紧反入里，因作痞。
脉濡而弱，弱反在关，濡反在颠，微反在上，涩反在下。微则阳气不足，涩则无血，阳气反微，中风汗出，而反躁
烦，涩则无血，厥而且寒，阳微不可下，下之则心下痞坚。
右关脉多弦，弦而迟者，必心下坚（此肝木克脾土，郁结涎闭于脏腑，气不舒则痞。）
方法
丹溪曰∶痞满与胀满不同，胀满内胀而外亦形，痞则内觉痞闷而外无胀急之形也。盖由阴伏阳蓄，气血不运而成，
位乎心下之中， 痞满塞，皆土邪之所为耳。有因误下，里气虚，邪乘虚而入于心之分野。有因食痰积，不能施化，郁
而作痞者。有湿热太甚，土来心下而为痞者。
用黄连、黄芩、枳实之苦以泄之，浓朴、生姜、半夏之辛以散之，人参、白术之甘温以补之，茯苓、泽泻之咸淡以
渗之，大概与湿同治，使上下分消可也。
（以上丹溪方法凡二条）
浓朴温中汤（东垣） 治脾胃虚弱，心腹胀满疼痛，时发时止。
浓朴（姜汁拌炒） 陈皮（去白，各一钱） 茯苓 草豆蔻 甘草 木香（各五分） 干生姜（一钱）
上细切，水煎服。
木香顺气汤（东垣） 治 胀，心腹满闷。
木香 益智 陈皮 苍术 草豆蔻（各五分） 浓朴（姜制） 青皮（各四分） 茯苓 泽泻 半夏（各六分） 干
生姜 茱萸（各三分） 当归 人参（各五分） 升麻 柴胡（各一钱）
上细切，作一服，水一盏半，煎至一盏，温服。
痞有痰挟血成窠囊者，用桃仁、红花、香附、大黄之类治之。
七气汤（局方） 治七情所伤，忧思郁结，腑脏气不和平，心腹痞闷。
半夏 茯苓（各二钱） 浓朴（姜制，一钱五分） 紫苏叶（一钱）
上细切，作一服，加生姜三片，水一盏半，煎至一盏，温服。
大消痞丸（东垣） 治一切心下痞，及年久不愈者。
干生姜 神曲（炒） 甘草（炙，各二钱） 猪苓（二钱五分） 泽泻 浓朴（姜汁拌炒） 砂仁（各三钱） 半
夏（汤泡七次，去皮脐） 陈皮（去白） 人参（各四钱） 黄连（陈壁土炒，去土） 黄芩（如连制，各六钱） 枳
实（五钱，去穣麸炒） 姜黄 白术（各一两）
上为细末，汤浸蒸饼为丸，如梧桐子大，每服五十丸至百丸，空心白汤下。
失 丸（一名枳实消痞丸，东垣） 治右关脉弦，心下虚痞，恶食懒倦。开胃进食。
干生姜（一钱） 甘草（炙） 麦 面（炒） 白茯苓 白术（各二钱） 半夏曲 人参（各三钱） 浓朴（姜制，
四钱） 枳实（麸炒黄色） 黄连（各五钱）
上为细末，蒸饼为丸，如梧桐子大，每服七、八十丸，白汤下。
消痞汤（一名木香化滞汤，东垣） 治因忧气郁结中脘，腹皮里微痛，心下痞满，不思饮食。
川归 枳实（炒，各四分） 陈皮 生姜 木香（各六分） 柴胡（七分） 甘草（炙） 草豆蔻（各一钱，面包
煨） 半夏（一钱五分） 红花（一分）
上细切，作一服，加生姜三片，水二盏，煎至一盏，温服。
黄连消痞丸（东垣） 治心下痞满，壅滞不散，烦热喘促不安。
泽泻 姜黄（各一钱） 干生姜（二钱） 甘草（炙） 茯苓 白术（各三钱） 陈皮（五钱） 猪苓（去黑皮，
五钱） 枳实（麸炒黄色，七钱） 半夏（汤泡七次，九钱） 黄连（一两） 黄芩（二两，炒）
上为细末，蒸饼为丸，如梧桐子大，每服五十丸，白汤下。
黄芩利膈丸（东垣） 除胸中热，利膈上痰。
生黄芩 炒黄芩（各一两） 半夏 黄连 泽泻 南星（各五钱） 枳壳（麸炒去穣） 陈皮（去白，各三钱） 白
术（二钱） 白矾（一钱） 今加萝卜子（五钱，炒） 小皂角（一钱）
上为细末，汤浸蒸饼为丸，如梧桐子大，每服五十丸，白汤下。忌酒、湿面、鱼腥。
（丹溪活套）云∶凡心下痞满，须用枳实、黄连。如肥人心下痞，内有湿饮，宜苍术、半夏、缩砂、茯苓、滑石之
类。如瘦人心下痞，乃郁热在上焦，宜枳实、黄连以导之，葛根、升麻以发之。如人饮食后，因冒风寒，饮食不消而作
痞满，宜吴茱萸、缩砂、藿香、草豆蔻之类，温以化之。如脾气虚弱，转运不调，饮食不化而作痞者，宜白术、山楂、
神曲、麦芽之类以消之。又曰∶痞满之证不一，有伤寒下早而作痞者，枳壳桔梗汤、小陷胸汤之类。有因饮食填塞胸
中而作痞者，保和丸、东垣枳实导滞丸、木香化滞汤之类。伤寒下多则亡阴而痞者，四物汤加参、苓、白术、升麻、柴
胡，少佐以陈皮、枳壳之类除之。或大病后，元气未夏而胸满气短者，宜补中益气汤、陈皮枳术丸、木香枳术丸之类。
夫痞满之证，不可执一，全在活法，详脉证虚实而调之可也。
（医案）
山头沈三十一丈，年三十余，身材肥盛，夏秋间因官差丈量田地辛苦，至冬间得痞满证，两胁气攻，胸中饱闷，
不能卧，欲成胀满证。历数医者，皆与疏气耗散之药，皆不效。十一月初旬，召予延医，两手关前皆浮洪而弦涩，两关
后脉皆沉伏。予曰∶此膈上有稠痰，脾土之气敦阜，肝木郁而不伸，当用吐法，木郁达之之理也。奈何值冬月降沉之令，
未可行此法，且先与豁痰疏肝气，泻脾胃敦阜之气。用平胃散加半夏、茯苓、青皮、川芎、草龙胆、香附、砂仁、柴
胡、黄连、栝蒌子等药，病退之十有三四。待次年二月初旬，为行倒仓法，平安。
论
《黄帝内经》说：具备化生万物特性的年份（土运太过之年），人们容易患痞病。又说：太阴湿土之气所至，会导致水饮停积、胸膈痞塞的病症。对于痞满这一证候，李东垣论述得非常详尽。他认为太阴湿土之气主司壅滞阻塞，是土邪侵扰心下部位导致痞满。伤寒病如果过早使用攻下法，也会形成痞满，这是因为寒邪损伤了营血所致。心主血脉，邪气侵入心脏的本位，所以出现心下痞塞的症状。张仲景使用泻心汤，用黄连来清泻心下部位的土邪，疗效非常迅速。这不仅仅在伤寒病中如此，即使是酒积等杂病，如果攻下太过，也会产生痞满，因为过度攻下会耗伤阴液。所谓亡阴，是指脾胃中水谷精微之阴液的耗损。因此，胸中的正气因虚弱而下陷到心部的分野，从而导致心下痞塞。治疗应当提升胃气，并配合养血药物一起使用。如果完全使用行气导滞的药物来疏导，那么痞满症状反而会加重。痞满严重后又再次使用攻下法，气机更加下降，必然转变为腹部胀大如鼓的鼓胀病，这些都不是正确的治疗方法。又有虚实之分，如果是实证痞满且伴有大便秘结的，以厚朴、枳实为主药。如果是虚证痞满且伴有大便通畅的，以芍药、陈皮为主药。如果是因饮食损伤而导致的痞满，应当消导胸中窒塞的气机。如果气机上逆，恶心欲吐，则适宜采用催吐法，这就是所说的“病位在上者，因而越之”的道理。学习中医的人应当详细探究这些内容。
脉法
《脉经》说：患痞病时，脉象浮紧却使用了攻下法，紧脉反而入里，因而形成痞病。
脉象濡软而弱，弱脉反见于关部，濡脉反见于寸部（颠指寸部），微脉反见于上部，涩脉反见于下部。脉微说明阳气不足，脉涩说明无血。阳气反而微弱，中风后出汗，反而出现躁动烦乱；脉涩说明无血，四肢厥冷而且发寒。阳气微弱不可攻下，攻下就会导致心下痞塞坚硬。
右关脉多呈弦象，弦而迟缓的，必定心下坚硬（这是肝木克制脾土，郁结痰涎闭塞于脏腑，气机不舒展而导致痞塞。）
方法
朱丹溪说：痞满与胀满不同，胀满是内部胀满且外部也显现出胀急的形状，痞满则是内部感觉痞闷堵塞而外部没有胀急的形状。这大概是由于阴气潜伏、阳气蓄积，气血运行不畅而形成的，病位在心下中部，痞满堵塞，都是土邪造成的。有因误用攻下法，导致里气虚弱，邪气乘虚侵入心之分野的。有因食积、痰积，不能消化，郁结而形成痞满的。有湿热过盛，土邪侵扰心下而形成痞满的。
使用黄连、黄芩的苦味来泄降，厚朴、生姜、半夏的辛味来散结，人参、白术的甘温来补益，茯苓、泽泻的咸淡来渗利，大抵与治湿的方法相同，使邪气从上、下分消即可。
（以上丹溪的治疗方法共两条）
厚朴温中汤（李东垣方） 治疗脾胃虚弱，心腹胀满疼痛，时发时止。
厚朴（用姜汁拌炒） 陈皮（去白，各一钱） 茯苓 草豆蔻 甘草 木香（各五分） 干生姜（一钱）
以上药材切碎，加水煎服。
木香 益智仁 陈皮 苍术 草豆蔻（各五分） 厚朴（姜制） 青皮（各四分） 茯苓 泽泻 半夏（各六分） 干生姜 吴茱萸（各三分） 当归 人参（各五分） 升麻 柴胡（各一钱）
以上药材切碎，作为一剂服用，用水一盏半，煎至一盏，温服。
痞满有痰挟瘀血结成窠囊的，用桃仁、红花、香附、大黄之类的药物治疗。
七气汤（《太平惠民和剂局方》） 治疗七情所伤，忧思郁结，脏腑气机不和平，心腹痞闷。
半夏 茯苓（各二钱） 厚朴（姜制，一钱五分） 紫苏叶（一钱）
以上药材切碎，作为一剂服用，加生姜三片，用水一盏半，煎至一盏，温服。
大消痞丸（李东垣方） 治疗一切心下痞满，以及多年不愈的病例。
干生姜 神曲（炒） 甘草（炙，各二钱） 猪苓（二钱五分） 泽泻 厚朴（姜汁拌炒） 砂仁（各三钱） 半夏（汤泡七次，去皮脐） 陈皮（去白） 人参（各四钱） 黄连（陈壁土炒，去土） 黄芩（如连制，各六钱） 枳实（五钱，去瓤麸炒） 姜黄 白术（各一两）
以上研为细末，用米汤浸蒸饼制成丸药，如梧桐子大小，每次服用五十丸至一百丸，空腹时用白开水送服。
失笑丸（一名枳实消痞丸，李东垣方） 治疗右关脉弦，心下虚痞，厌恶食物，懒倦乏力。开胃进食。
干生姜（一钱） 甘草（炙） 麦面（炒） 白茯苓 白术（各二钱） 半夏曲 人参（各三钱） 厚朴（姜制，四钱） 枳实（麸炒黄色） 黄连（各五钱）
以上研为细末，用蒸饼制成丸药，如梧桐子大小，每次服用七八十丸，用白开水送服。
消痞汤（一名木香化滞汤，李东垣方） 治疗因忧怒气郁结在中脘，腹皮里微痛，心下痞满，不思饮食。
川当归 枳实（炒，各四分） 陈皮 生姜 木香（各六分） 柴胡（七分） 甘草（炙） 草豆蔻（各一钱，面包煨） 半夏（一钱五分） 红花（一分）
以上药材切碎，作为一剂服用，加生姜三片，用水二盏，煎至一盏，温服。
黄连消痞丸（李东垣方） 治疗心下痞满，壅滞不散，烦热喘促不安。
泽泻 姜黄（各一钱） 干生姜（二钱） 甘草（炙） 茯苓 白术（各三钱） 陈皮（五钱） 猪苓（去黑皮，五钱） 枳实（麸炒黄色，七钱） 半夏（汤泡七次，九钱） 黄连（一两） 黄芩（二两，炒）
以上研为细末，用蒸饼制成丸药，如梧桐子大小，每次服用五十丸，用白开水送服。
生黄芩 炒黄芩（各一两） 半夏 黄连 泽泻 天南星（各五钱） 枳壳（麸炒去瓤） 陈皮（去白，各三钱） 白术（二钱） 白矾（一钱） 现加萝卜子（五钱，炒） 小皂角（一钱）
以上研为细末，用米汤浸蒸饼制成丸药，如梧桐子大小，每次服用五十丸，用白开水送服。忌酒、湿面、鱼腥。
（丹溪活套）说：凡是心下痞满，必须使用枳实、黄连。如果是肥胖之人心中痞满，内有湿饮，适宜用苍术、半夏、缩砂、茯苓、滑石之类的药物。如果是瘦弱之人心中痞满，乃是郁热在上焦，适宜用枳实、黄连来引导，葛根、升麻来发散。如果是人在饮食之后，因冒受风寒，饮食不消化而产生痞满，适宜用吴茱萸、缩砂、藿香、草豆蔻之类的药物，用温法来化解。如果是脾气虚弱，转运不调，饮食不消化而产生痞满的，适宜用白术、山楂、神曲、麦芽之类的药物来消导。又说：痞满的证候不一，有因伤寒过早攻下而产生痞满的，可用枳壳桔梗汤、小陷胸汤之类的方剂。有因饮食填塞胸中而产生痞满的，可用保和丸、李东垣枳实导滞丸、木香化滞汤之类的方剂。伤寒攻下过多导致亡阴而痞满的，可用四物汤加人参、茯苓、白术、升麻、柴胡，少佐以陈皮、枳壳之类的药物来消除。或者大病之后，元气未复而胸满气短的，适宜用补中益气汤、陈皮枳术丸、木香枳术丸之类的方剂。
对于痞满这一证候，不可拘泥于一法，全在于灵活运用，详细辨别脉象、证候的虚实并进行调理即可。
（医案）
山头的沈三十一丈，三十多岁，身材肥壮，夏秋之间因官府差遣丈量田地辛苦劳作，到了冬天得了痞满证，两胁气机攻冲，胸中饱闷，不能卧倒，快要发展成胀满证。经过多位医生诊治，都给予疏气耗散的药物治疗，都没有效果。十一月初旬，请我前去诊治，两手关前脉象皆浮洪而弦涩，两关后脉象皆沉伏。我说：这是膈上有稠痰，脾土之气敦厚高阜，肝木郁结而不能伸展，应当使用吐法，这是顺应“木郁达之”的原理。奈何正值冬季气机沉降的时令，不可以施行此法，暂且先给予豁痰疏肝气，泻脾胃敦厚之气。使用平胃散加半夏、茯苓、青皮、川芎、草龙胆、香附、砂仁、柴胡、黄连、栝蒌子等药物，病情退去了十分之三四处。等到次年二月初旬，为他施行倒仓法（催吐疗法），平安无事。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: In years characterized by the "Baihua" phase (excessive Earth qi), the prevalent disease is Pi (痞, stuffiness/obstruction). It further states: When Taiyin (太阴, Great Yin) damp-earth qi arrives, it manifests as accumulation of drinking fluids and obstruction in the chest and diaphragm. Regarding the syndrome of Pi-Man (痞满, fullness and obstruction), Li Dongyuan (Li Gao) discussed it in detail. He asserted that Taiyin damp-earth qi governs stagnation and blockage; thus, Earth evil invading the epigastrium causes Pi-Man. If the Shaoyang disease (Shanghan, Cold Damage) is treated with purgatives too early, Pi-Man also results, caused by cold damaging the Ying (Nutritive) blood. The Heart governs blood; when pathogenic factors invade the Heart's domain, Pi at the epigastrium occurs. Zhang Zhongjing utilized Xiexin Tang (Coptis Decoction to Drain the Epigastrium), employing Huanglian (Rhizoma Coptidis) to clear the Earth evil in the epigastrium, achieving rapid efficacy. This is not limited to Shanghan; even in miscellaneous diseases such as alcohol accumulation, excessive purgation leads to Pi-Man because excessive purging destroys Yin. "Destruction of Yin" refers to the loss of the Yin essence derived from water and food in the Spleen and Stomach. Consequently, the Qi in the chest sinks due to deficiency into the Heart's territory, causing epigastric Pi. Treatment should involve raising Stomach Qi, combined with blood-nourishing herbs. If one uses only Qi-moving and guiding herbs, the Pi will worsen. If Pi is severe and purgatives are used again, the Qi descends further, inevitably transforming into Zhongman Guzhang (中满鼓胀, abdominal distension like a drum). These are all incorrect treatments. There are distinctions between Excess and Deficiency. For Excess Pi accompanied by constipation, Houpo (Cortex Magnoliae Officinalis) and Zhishi (Fructus Aurantii Immaturus) are indicated. For Deficient Pi accompanied by normal bowel movements, Shaoyao (Radix Paeoniae Alba) and Chenpi (Pericarpium Citri Reticulatae) are indicated. If Pi-Man is caused by dietary injury, one should resolve the obstructed Qi in the chest. If Qi rebels upward causing nausea and a desire to vomit, emesis (vomiting therapy) is appropriate, following the principle: "For pathogens located above, induce vomiting." Students should investigate this thoroughly.
Pulse Diagnosis
The *Mai Jing* (Pulse Classic) states: In Pi, if the pulse is floating and tight but purgatives are administered, the tightness enters the interior, resulting in Pi.
If the pulse is Ru (Ruo, soft and weak) and Ruo, with the Ruo position reversed at the Guan (middle) position, and the Ru position reversed at the Cun (superficial/distal) position; if the Wei (fine) pulse appears at the upper position and the Se (choppy) pulse at the lower position. A Wei pulse indicates insufficient Yang Qi; a Se pulse indicates lack of Blood. If Yang Qi becomes faint, wind-stroke occurs with sweating, yet restlessness and irritability appear instead; a Se pulse indicates lack of Blood, leading to Jue (cold extremities) and cold. Faint Yang Qi contraindicates purgation; purging will result in hard Pi at the epigastrium.
The Right Guan pulse is often Xian (string-taut); if Xian and Chi (slow), there will certainly be hardness at the epigastrium (This is Liver Wood overcoming Spleen Earth, with phlegm-fluids binding in the Zang-Fu organs; Qi fails to flow freely, causing Pi.)
Methods
Zhu Danxi stated: Pi-Man differs from Zhang-Man (distension). Zhang-Man involves internal distension and external manifestation of swelling/tightness, whereas Pi-Man involves internal sensation of stuffiness and obstruction without external signs of distension. This is generally caused by latent Yin and stored Yang, with impaired circulation of Qi and Blood. The location is in the middle of the epigastrium. Pi-Man obstruction is all due to Earth evil. Causes include: erroneous purgation leading to interior deficiency, allowing pathogens to enter the Heart's territory; food and phlegm accumulation failing to transform, leading to stagnation and Pi; or excessive Damp-Heat, where Earth evil invades the epigastrium causing Pi.
Use the bitter properties of Huanglian (Rhizoma Coptidis) and Huangqin (Radix Scutellariae) to drain; the acrid properties of Houpo (Cortex Magnoliae Officinalis), Shengjiang (Rhizoma Zingiberis Recens), and Banxia (Rhizoma Pinelliae) to disperse; the sweet-warm properties of Renshen (Radix Ginseng) and Baizhu (Rhizoma Atractylodis Macrocephalae) to tonify; and the salty-light properties of Fuling (Poria) and Zexie (Rhizoma Alismatis) to leach out moisture. Generally, treat it similarly to Dampness, allowing the pathogen to be eliminated from above and below.
(Above are two methods from Danxi.)
Houpo Wenzhong Tang (Magnolia Decoction to Warm the Middle) [Dongyuan]: Treats Spleen-Stomach deficiency, abdominal distension and pain, occurring intermittently.
Houpo (stir-fried with ginger juice) 1 qian, Chenpi (de-white) 1 qian, Fuling 5 fen, Caodoukou (Cardamomi Fructus) 5 fen, Gancao (Licorice Root) 5 fen, Muxiang (Aucklandiae Radix) 5 fen, Gan Jiang (Dried Ginger) 1 qian.
Cut finely, decoct in water, and take warm.
Muxiang Shunqi Tang (Costus Decoction to Smooth Qi) [Dongyuan]: Treats distension, epigastric and abdominal fullness.
Muxiang 5 fen, Yizhi (Alpiniae Oxymatary Fructus) 5 fen, Chenpi 5 fen, Cangzhu (Rhizoma Atractylodis Lanceae) 5 fen, Caodoukou 5 fen, Houpo (processed with ginger) 4 fen, Qingpi (Green Tangerine Peel) 4 fen, Fuling 6 fen, Zexie 6 fen, Banxia 6 fen, Gan Jiang 3 fen, Zhuyu (Evodiae Fructus) 3 fen, Danggui (Angelicae Sinensis Radix) 5 fen, Renshen 5 fen, Shengma (Cimicifugae Rhizoma) 1 qian, Chaihu (Bupleuri Radix) 1 qian.
Cut finely, take as one dose, decoct 1.5 cups of water to 1 cup, and take warm.
For Pi formed by Phlegm entangling Blood into nests/cysts, use Taoren (Persicae Semen), Honghua (Carthami Flos), Xiangfu (Cyperi Rhizoma), Dahuang (Rhei Radix et Rhizoma), etc.
Qi Qi Tang (Seven Qi Decoction) [Jufang]: Treats damage from Seven Emotions, worry and thought leading to stagnation, disharmony of Zang-Fu Qi, and epigastric fullness.
Banxia 2 qian, Fuling 2 qian, Houpo (processed with ginger) 1.5 qian, Zisu Ye (Perillae Folium) 1 qian.
Cut finely, take as one dose, add 3 slices of fresh ginger, decoct 1.5 cups of water to 1 cup, and take warm.
Da Xiao Pi Wan (Great Pill to Eliminate Pi) [Dongyuan]: Treats all types of epigastric Pi, especially chronic cases lasting years.
Gan Jiang 2 qian, Shenqu (Massa Medicata Fermentata) stir-fried 2 qian, Gancao (roasted) 2 qian, Zhuling (Polyporus) 2.5 qian, Zexie 3 qian, Houpo (mixed with ginger juice and fried) 3 qian, Sharen (Amomi Fructus) 3 qian, Banxia (soaked in boiling water seven times, skin removed) 4 qian, Chenpi (de-white) 4 qian, Renshen 4 qian, Huanglian (fried with old wall soil, remove soil) 6 qian, Huangqin (prepared like Huanglian) 6 qian, Zhishi (5 qian, bran-fried, remove pith), Jianghuang (Curcumae Longae Rhizoma) 1 liang, Baizhu 1 liang.
Grind into fine powder, mix with steamed dough soaked in water to form pills the size of paulownia seeds. Take 50-100 pills per dose on an empty stomach with plain boiled water.
Shi Wan (One Name: Zhishi Xiaopi Wan, Acupunctured Pi-Eliminating Pill) [Dongyuan]: Treats Xian pulse at Right Guan, deficient Pi at epigastrium, aversion to food, and lassitude. Opens the stomach and promotes appetite.
Gan Jiang 1 qian, Gancao (roasted), Mai Mian (Wheat Flour) stir-fried, Baifuling, Baizhu (each 2 qian), Banxia Qu (Pinelliae Fermentatum) 3 qian, Renshen 3 qian, Houpo (ginger-processed) 4 qian, Zhishi (bran-fried yellow), Huanglian (each 5 qian).
Grind into fine powder, make into pills with steamed dough, size of paulownia seeds. Take 70-80 pills per dose with plain boiled water.
Xiao Pi Tang (Pi-Eliminating Decoction) [Dongyuan], also known as Muxiang Huazhi Tang: Treats Qi stagnation in the Zhongwan region due to sorrow and anger, slight pain under the abdominal skin, epigastric Pi-Man, and loss of appetite.
Chuan Gui (Angelicae Sinensis Radix) stir-fried 4 fen, Zhishi stir-fried 4 fen, Chenpi 6 fen, Shengjiang 6 fen, Muxiang 6 fen, Chaihu 7 fen, Gancao (roasted), Caodoukou (wrapped in bread and baked) (each 1 qian), Banxia 1.5 qian, Honghua 1 fen.
Cut finely, take as one dose, add 3 slices of fresh ginger, decoct 2 cups of water to 1 cup, and take warm.
Huanglian Xiao Pi Wan (Coptis Pi-Eliminating Pill) [Dongyuan]: Treats epigastric Pi-Man, stagnation not dispersing, irritability, heat, panting, and restlessness.
Zexie 1 qian, Jianghuang 1 qian, Gan Jiang 2 qian, Gancao (roasted), Fuling, Baizhu (each 3 qian), Chenpi 5 qian, Zhuling (remove black skin) 5 qian, Zhishi (bran-fried yellow) 7 qian, Banxia (soaked in boiling water seven times) 9 qian, Huanglian 1 liang, Huangqin (fried) 2 liang.
Grind into fine powder, make into pills with steamed dough, size of paulownia seeds. Take 50 pills per dose with plain boiled water.
Huangqin Lige Wan (Scutellaria Diaphragm-Relieving Pill) [Dongyuan]: Clears heat in the chest, relieves phlegm in the diaphragm.
Sheng Huangqin (Raw Scutellaria) 1 liang, Chao Huangqin (Fried Scutellaria) 1 liang, Banxia 5 qian, Huanglian 5 qian, Zexie 5 qian, Nanting (Arisaematis Rhizoma) 5 qian, Zhike (Aurantii Fructus) (bran-fried, remove pith), Chenpi (de-white) (each 3 qian), Baizhu 2 qian, Baijian (Alumen) 1 qian. Now add Luobozi (Brassicae Semens) 5 qian (fried), Xiao Zaojiao (Gleditsiae Spina) 1 qian.
Grind into fine powder, make into pills with steamed dough soaked in water, size of paulownia seeds. Take 50 pills per dose with plain boiled water. Avoid alcohol, wet wheat noodles, and fishy foods.
(Danxi Huotao / Flexible Patterns of Danxi) states: For any epigastric Pi-Man, Zhishi and Huanglian must be used. For obese individuals with epigastric Pi due to internal damp-drinking, use Cangzhu, Banxia, Suosha (Amomi Fructus Rotundus), Fuling, Huashi (Talcum), etc. For thin individuals with epigastric Pi due to stagnant heat in the Upper Jiao, use Zhishi and Huanglian to guide, and Gegen (Puerariae Radix) and Shengma to release. If Pi-Man arises after eating due to exposure to wind-cold and indigestion, use Wuzhuyu (Evodiae Fructus), Suosha, Huoxiang (Agastaches Herba), Caodoukou, etc., to resolve with warmth. If Pi-Man arises from Spleen Qi deficiency, poor transportation, and indigestion, use Baizhu, Shanzha (Crataegi Fructus), Shenqu, Maiya (Hordei Fructus Germinatus), etc., to digest. Furthermore: Pi-Man syndromes vary. Those caused by premature purgation in Shanghan can be treated with Zhike Jiegeng Tang (Aurantii Fructus and Platycodon Decoction) or Xiao Xiantong Tang (Minor Trap-the-Thorax Decoction). Those caused by food blocking the chest can be treated with Baohe Wan (Preserve Harmony Pill), Dongyuan Zhishi Daozhi Wan (Acupunctured Pi Guiding Stasis Pill), or Muxiang Huazhi Tang. Those caused by excessive purgation in Shanghan leading to Yin destruction and Pi can be treated with Siwu Tang (Four Substances Decoction) plus Renshen, Fuling, Baizhu, Shengma, Chaihu, with small amounts of Chenpi and Zhike to eliminate. Or, for post-major illness cases with unrecovered Yuan Qi, chest fullness, and shortness of breath, use Buzhong Yiqi Tang (Middle-Warming Qi-Supporting Decoction), Chenpi Zhizhu Wan (Tangerine Peel and Atractylodes Pill), or Muxiang Zhizhu Wan (Costus and Atractylodes Pill).
Regarding Pi-Man, one must not adhere rigidly to a single method; flexibility is key. One must carefully examine the pulse and symptoms to determine excess or deficiency and regulate accordingly.
Medical Case
Mr. Shen San-shiyi-zhang from Shantou, over thirty years old, was of robust build. During summer and autumn, he suffered hardship while surveying land for official duties. By winter, he developed Pi-Man, with Qi attacking both hypochondria, chest fullness and oppression, inability to lie down, and impending transformation into Zhang-Man (distension). Several physicians treated him with Qi-moving and dissipating drugs, all without effect. In early November, I was summoned. The pulses at the front of both Guan positions were floating, surging, string-taut, and choppy; the pulses behind both Guan positions were deep and hidden. I said: "There is thick phlegm in the diaphragm; the Spleen Earth Qi is overly abundant and elevated; Liver Wood is stagnant and unable to extend. Vomiting therapy should be used, following the principle 'When Wood is stagnant, unblock it.'" However, since it was winter, the season of descending Qi, this method could not be applied immediately. Instead, I first prescribed herbs to resolve phlegm, soothe Liver Qi, and drain the excessive Qi of the Spleen Earth. I used Pingwei San (Peaceful Stomach Powder) added with Banxia, Fuling, Qingpi, Chuanxiong (Ligustici Chuanxiong Rhizoma), Cao Longdan (Gentianae Radix), Xiangfu, Sharen, Chaihu, Huanglian, and Gualouzi (Trichosanthis Semen). The condition improved by three or four tenths. By early February of the following year, I performed Daocang Fa (Inversion Granary Method, a drastic purging/emetic therapy), and he recovered safely.