痞者，心下痞满而不能食是也。仲景云∶满而不痛为痞，满而痛为结。
〔垣〕夫痞者，心下满而不痛是也。太阴者，湿也。主壅塞，乃土来心下为痞满也。伤寒下太
早亦为痞，乃因寒伤其荣。荣者，血也。心主血，邪入于本，故为心下痞闷。仲景立泻心汤数方，
皆用黄连以泻心下之土邪，其效如附应桴。故《活人书》云∶审知是痞，先用桔梗枳壳汤，非以
此专治痞也。盖因先错下必成痞症，是邪气将陷而欲过胸中，故先用截散其邪气，使不致于痞。
“先”之一字，早用之义也。若已成痞而用之，则失之晚矣。不惟不能消痞，而反损胸中之正气，
则当以仲景痞药治之。经云∶察其邪气所在而调治之，正谓此也。非止伤寒如此，至于酒积杂病，
下之太过，亦作痞伤。盖下多亡阴，亡阴者谓脾胃水谷之阴亡也。故胸中之气因虚下陷于心之分
野，故致心下痞。宜升胃气，以血药兼之。若全用气药导之，则其痞益甚，甚而复下之，气愈下
降，必变为中满膨胀，皆非其治也。又有虚实之殊，如实痞大便闭者，浓朴枳实汤主之；虚痞
大便利者，白芍陈皮汤主之；如饮食所伤痞闷者，当消导之，去其胸中窒塞；上逆兀兀欲吐者，
则吐之，所谓在上者因而越之是也。
〔海〕治痞独益中州脾土，以血药治之，其法无以加矣。伤寒痞者，从血中来；杂病痞者亦
从血中来。虽俱为血症，大抵伤寒之症，从外至内，从有形至无形，故无形气症，以苦泄之；
有形血症，以辛甘散之。中满者，勿食甘，不满者，复当食也。中满者，腹胀也。如自觉满而外
无腹胀之形，即非中满，乃不满也。不满者
病也，当以甘治之可也。（无形气症以苦泄之者，枳实、黄连之类是也；有形血症以辛甘散之者，
仲景人参汤是也。）
〔垣〕黄 补中汤
黄 （五分） 人参（八分） 甘草 白术 苍术（各五分） 陈皮（五分） 泽泻 猪苓 茯苓（各三分）
用水煎至七分，温服，送下大消痞丸。
〔丹〕治一妇人，因有大不如意事，遂致膈满不食。因循累月，积成 痞，不能起坐。至午巳
间必发热面赤，酉戌后热退，面赤亦退。至夜小便虽数，每出数滴而已。六脉沉涩而短小，左右
一般，重取皆有。经水虽按月，亦数滴而已。予曰∶此志不遂而气郁，胃有瘀血而血亦虚。郁
气成痰在中宫，却不食。兼用补泻之治法。以白术二钱，人参、茯苓各一钱，红花一豆大，陈皮
一钱，煎取浓汤一呷，食前热服之。少顷药行，后与半匙稀粥。又少顷，用减轻粉牵牛三花丸，
如芝麻大，以津唾下十五丸。一日一夜煎药、丸药各服四遍。至次日方食知味，又次日食稍进，
第三日则热退面亦不赤。如此七日，饮食起坐，平复如初。
三婶口渴食少，气痞脉弦。
白术 青皮 半夏（各二钱） 干葛（一钱半） 木通（一钱） 甘草（炙，少许）
分二帖。姜二片，煎下与点丸三十丸、保和丸二十丸。
葶苈丸治心下痞，胸中不利。
苦葶苈（酒浸炒） 人参（各三钱） 甘草根（炙） 羌活 柴胡 独活（各二钱） 黄芩（三钱，
一半酒浸，一半炒） 砂仁 茵陈（酒炒。各一钱） 白豆蔻（一钱） 青皮 浓朴 半夏（各五分）
当归身（七钱）
上为末，蒸饼丸，筛内水发如米大。临卧白汤服一钱。
木香消痞汤治因忧气郁结中脘，腹皮急微痛，心下痞满，不思饮食，食亦不散，常觉痞闷。
柴胡（七分） 陈皮（八分） 甘草（炙，五分） 半夏（一钱） 生姜（一钱） 归梢（二钱） 红花（少许）
枳实（一钱） 木香（七分） 草蔻（一钱）
作一服，水煎去渣，食前热服。忌酒面等物。
大消痞丸治一切心下痞满，及积年久不愈者。
黄芩 黄连（炒。各六钱） 姜黄 白术（各一钱） 人参（二钱） 甘草（炙） 砂仁（各一钱）
枳实（炒，五钱） 半夏（制，四钱） 干姜（一钱） 陈皮（二钱） 神曲（炒，一钱） 泽泻（三钱）
浓朴（二钱） 猪苓（一钱半）
上为末，水浸蒸饼为丸。每服六七十丸至百丸，食远白汤下。
黄连消痞丸治心下痞满，壅塞不散，烦热喘促不宁。
黄连（一两） 枳实（炒，七钱） 干姜（二钱） 半夏（七钱） 黄芩（一两） 茯苓 白术
甘草（炙。各三钱） 姜黄（一钱） 泽泻（一两） 猪苓
上为末，汤浸蒸饼为丸。每服五七十丸，白汤食前下。
失笑丸治右关脉浮弦，心下湿痞，恶食懒倦。开胃进食。
枳实 黄连（各五钱） 干姜（二钱） 半夏曲（三钱） 浓朴（炙，四钱） 人参（五钱） 甘草（炙，
二钱） 白术（三钱） 麦 （二钱）
上为末，水浸蒸饼为丸。每服三十丸，白汤送下。不拘时量虚实加减服。
〔丹〕小娘心头痞闷，口干，面微黄，脉洪。
黄连 半夏 白术 青皮 木通（各三钱）
分三帖。姜煎，去渣热服，下保和丸十五丸。
回金丸泻肝火，行湿与热。能开痞结，治肝邪，补脾土。
黄连（六两） 吴茱萸（一两）
上为末，水浸蒸饼为丸。一方用黄连六两，吴茱萸半两，一名佐金丸。
〔海〕少阴面赤下痢，心下痞，泻心汤加减例。易老单用黄连泻心汤，用钱氏法。后随症加减。
烦者，加山栀。燥，加香豉。呕，加半夏。满，加枳实、浓朴。腹痛，加芍药。脉迟，加附子。
下焦寒，加干姜。大便硬，加大黄。如用姜、附，先煎令熟，使热不僭，后加黄连同用。
〔罗〕枳实理中丸 治中脘痞满，滞气不消，积寒停冷，饮食不化。（方见伤寒。）
〔仲〕人参汤治胸痹心痞。（方见胸痹。）半夏泻心汤治痞满，关脉沉。（方见伤寒。）
〔丹〕一女子在家，因事不如意，郁结在脾。半年不食，每日食枣数枚，适喜馒头，亦能少食，
惟深恶粥饭。予诊其脾气，非枳实不能散。遂以温胆汤去竹茹与服。经三月，服二百帖而愈。
又一女子，二十余，许婚后夫远出，二年不归。女子病重不食，困卧如痴，他无所苦，诸医不效。
予往治之，见女向里床而睡，形体羸瘦。予思之，此气结病也，药不能治，得怒可解。予往激其
怒，掌其面三，且责以不得有外思。女果大怒而哭，待其哭一二时许，令其父母解之。进药二帖，
即欲食矣。予谓其父母曰∶虽愈必得喜方可解，若再思则结气必复至矣。其父因伪作其夫有书回，
约日成婚。一月余其夫果归，病得全愈。
饮食伤脾痞闷，轻者，大消痞丸、枳术丸、回金丸之类；甚者，微下之、吐之。下之者，
槟榔丸、煮黄丸；吐之者，二陈汤及瓜蒂散探吐之是也。
〔《经》〕治膈下冷气及酒食饱满。常服用青皮四两，分作四分。一分用汤浸一宿去穣；余三分
用盐二两拌匀，良久，铫内微炒焦为末。每服一钱半，茶末五分，水一盏，煎七分，放温常服。
用沸汤点服，尤妙。寒痞，辛甘散之，枳实理中丸之类是也。热痞，苦寒泄之，大消痞丸之类是
也。
〔丹〕治痞。软石膏研末，醋糊丸服。能泻胃火、食积、痰火。
运气痞有三∶
一曰湿痞。经云∶土平气曰备化。备化之纪，其病痞。又云∶太阴所至为蓄满，为积饮痞膈。
又云∶太阴司天之政，民病寒湿痞逆。又云∶土郁之发，痞坚腹满。又云∶土不及曰卑监。卑监
之纪，其病留满痞塞是也。
二曰寒痞。经云∶水郁之发，民病痞坚腹满。又云∶太阳之复，心痛痞满是也。
三曰燥痞。经云∶阳明之复，甚则痞满是也。
〔海〕问井主心下满。十二经皆有井，当治何井？假令善洁、面青、善怒，是少阳经受病，
当治金井窍阴
是也。假令满闭、淋溲、便难、转筋，足厥阴肝经受病，当治木井大敦是也。假令头项痛、
腰脊强、发热、恶寒，足太阳膀胱受病，当治阳井至阴是也。假令手足自温、自利、不渴，足
太阴脾受病，当治阴井隐白是也。
〔罗〕药戒客有病痞者，积于其中，伏而不得下，自外至者，捍而不得纳。从医而问之曰∶
非下之不可。归而饮其药，既饮而暴下，不终日而向之伏者散而无余，向之捍者柔而不支，焦膈
通达，呼吸开利，快然若未始有疾者。不数日，痞复作，投以故药，其快然也亦如初，自是不逾
月，而痞五作五下，每下辄愈。然客之气，一语而三引，体不劳而汗，股不步而栗，肌革无所耗
于前，而其中柔然莫知其所来。嗟夫！心痞非下不可已，予从而下之，术未爽也。 然独何如？
闻楚之南有良医焉，往而问之。医笑曰∶子无怪是 然者也！凡子之术固为是 然也。坐，吾语
汝。天下之理，有甚快于吾心者，其末也必有伤。求无伤于其中，则无望快于吾心。夫阴伏而
阳蓄，气与血不运而为痞，横乎子之胸者，其累大矣。击而去之，不须臾而除甚大之累，和平之
物不能为也，必将搏击震挠而后可。夫人之和气冲然而甚微，泊乎其易危，击搏震挠之功成，
而子之和亦已病矣。由是观之，则子之痞凡一快者，则子之和亦一伤矣。不逾月而快者五，子之
和平之气不既索乎。故 然如不终日也。且将去子之痞，而无害于和也。子归，燕居三月而后
与之药可为也。客归三月，斋戒而复请之。医曰∶子之气少复矣。取药而授之曰∶服之三月而疾
少平；又三月而少康；终年而可复常，且饮药不得亟进。客归而行其说，然其初使人懑然而迟之，
盖三投药而三反之也。然日不见其所攻之效，久较则月异而时不同，终岁而疾平矣。客谒医再拜
而谢之，坐而问其故。医曰∶此医国之说，岂特施之于病哉。子独不见秦之治民乎！悍而不听令，
堕而不勤事，放而不畏法。令之不听，治之不变，则秦之民常痞矣。商君见其痞也，厉以刑法，
威以斩伐，悍厉猛鸷，不毫发少贷，痛划而力 之，于是乎秦之政如建瓴，流通四达，无敢或拒，
而秦之痞常一快矣。自孝公以至二世，凡几痞而几快矣，顽者已圮，强者已柔，而秦之民无惧
心矣。故猛政一快者，欢心一亡，积快而不已，而秦之四肢枵然，徒具其物而已。民心日离，
而君孤立于上，故匹夫大呼，不终日而百姓皆起，
秦欲运其手足肩膂，而漠然不我应。故秦之亡也，是好为快者之过也。昔者先王之民，其初亦尝痞
矣，先王岂不知砉然击去之以为速也？惟惧其有伤于中也，故不敢求快于吾心。优柔而抚育之，
教以仁义，道以礼乐，阴解其乱而除去其痞。旁视而懑然有之矣，然月计之岁察之，前岁之俗非
今岁之俗也。不击不搏，无所忤逆，是以日去其戾气而不婴其欢心，于是政成教达，安乐久而后患
除矣。是故三代之治，皆更数圣人，历数百年而后俗成，则予之药终年而疾愈，盖无足怪也。
故曰天下之理有甚快于吾心者，其末也必有伤，求无伤于其终，则无望快于予心。虽然，岂特治天下
为然哉！客再拜，而纪其说。
痞证，是指心下（胃脘部）胀满堵塞感，导致无法进食。张仲景说：只有胀满而没有疼痛的是痞证，既有胀满又有疼痛的是结胸证。
李东垣说：所谓痞证，就是心下胀满但不疼痛。太阴经对应湿气，主司壅塞不通，这是土气（湿邪）侵犯心下部位导致的痞满。伤寒病如果攻下过早，也会形成痞证，这是因为寒邪损伤了营血。营血属于血类，心主血脉，邪气侵入根本，所以导致心下痞闷。张仲景制定了泻心汤等几个方剂，都使用黄连来清泻心下部位的土邪（湿热），疗效迅速如鼓槌击鼓般应验。所以《活人书》说：确认是痞证后，先用桔梗枳壳汤，并不是用这个方子专门治疗痞证。而是因为先前误用攻下法必然会导致痞症，此时邪气将要陷入并试图穿过胸中，所以先用此方截断并疏散邪气，使其不至于形成痞证。“先”字，意为及早使用。如果已经形成痞证再用它，就太晚了。不仅不能消除痞证，反而损伤胸中的正气，这时才应当用张仲景治疗痞证的药物。经文说：观察邪气所在之处而进行调治，正是说的这个道理。不仅仅是伤寒如此，至于酒积等杂病，如果攻下太过，也会造成痞伤。因为过度攻下会亡失阴液，亡阴指的是脾胃中水谷之阴的耗损。因此胸中的气因虚而下陷到心部的分野，从而导致心下痞。适宜提升胃气，配合血药一起使用。如果完全用气药引导，那么痞证会更加严重，严重时再攻下，气会更下降，必然变成中焦胀满膨胀，这些都不是正确的治疗方法。又有虚实之分，如实证痞满伴有大便闭结的，用浓朴枳实汤主治；虚证痞满伴有大便通畅的，用白芍陈皮汤主治；如果是饮食所伤导致的痞闷，应当消食导滞，去除胸中的窒塞感；如果有气上逆、恶心欲吐的症状，则采用催吐法，这就是所说的“在上者因而越之”。
朱丹溪说：治疗痞证唯独补益中州脾土，用血药来治疗，这种方法没有能超过它的了。伤寒引起的痞证，是从血分来的；杂病引起的痞证也是从血分来的。虽然都属于血症范畴，但大体来说，伤寒的病证，是从外入内，从有形变为无形，所以对于无形的氣症，用苦味药泄降；对于有形的血证，用辛甘药发散。中焦胀满的人，不要吃甘味食物；不胀满的人，反而应该吃甘味食物。中满，是指腹部胀大。如果自觉胀满但外部没有腹胀的形态，就不是中满，而是不满。不满属于虚病，应当用甘味药治疗。（无形的氣症用苦味药泄降，指的是枳实、黄连这类药；有形的血证用辛甘药发散，指的是张仲景的人参汤。）
李东垣的黄芪补中汤：黄芪（五分）、人参（八分）、甘草、白术、苍术（各五分）、陈皮（五分）、泽泻、猪苓、茯苓（各三分）。用水煎至七分，温服，送服大消痞丸。
朱丹溪诊治一位妇人，因为遇到不如意的事，导致膈间胀满不能进食。拖延累月，积结成痞证，不能起床坐立。每天中午巳时左右必定发热面赤，傍晚酉戌之后热退，面赤也退。到了晚上小便虽然频繁，但每次只排出几滴。六脉沉涩且短小，左右手一样，重按都能感觉到。月经虽然按月来潮，但也只有几滴。我说：这是意志不遂导致气郁，胃中有瘀血且血也虚。郁结之气化为痰停留在中宫，所以不进食。兼用补泻的治疗方法。用白术二钱，人参、茯苓各一钱，红花一粒大，陈皮一钱，煎取浓汤一口，饭前热服。过了一会儿药力运行，随后给半匙稀粥。又过一会儿，服用减轻粉牵牛三花丸，大小如芝麻，用唾液送服十五丸。一天一夜煎药和丸药各服四次。到第二天才开始觉得食物有味，第三天食物稍进，第四天热退面色也不红了。这样经过七天，饮食起居恢复正常，如同生病前一样。
三婶口渴食少，气痞脉弦。
白术、青皮、半夏（各二钱）、干葛（一钱半）、木通（一钱）、甘草（炙，少许）。
分两帖。姜两片，煎好后与点丸三十丸、保和丸二十丸同服。
葶苈丸治疗心下痞，胸中不利。
苦葶苈（酒浸炒）、人参（各三钱）、甘草根（炙）、羌活、柴胡、独活（各二钱）、黄芩（三钱，一半酒浸，一半炒）、砂仁、茵陈（酒炒，各一钱）、白豆蔻（一钱）、青皮、浓朴、半夏（各五分）、当归身（七钱）。
以上研为末，用蒸饼做丸，筛内用水发开如米粒大。临睡前用白开水送服一钱。
木香消痞汤治疗因忧怒气郁结在中脘，腹皮紧急微痛，心下痞满，不思饮食，吃了也不消化，常觉痞闷。
柴胡（七分）、陈皮（八分）、甘草（炙，五分）、半夏（一钱）、生姜（一钱）、归梢（二钱）、红花（少许）、枳实（一钱）、木香（七分）、草蔻（一钱）。
作一服，水煎去渣，饭前热服。忌酒面等物。
大消痞丸治疗一切心下痞满，以及积年久不愈者。
黄芩、黄连（炒，各六钱）、姜黄、白术（各一钱）、人参（二钱）、甘草（炙）、砂仁（各一钱）、枳实（炒，五钱）、半夏（制，四钱）、干姜（一钱）、陈皮（二钱）、神曲（炒，一钱）、泽泻（三钱）、浓朴（二钱）、猪苓（一钱半）。
以上研为末，用水浸蒸饼做丸。每服六七十丸至一百丸，饭后用白开水送下。
黄连消痞丸治疗心下痞满，壅塞不散，烦热喘促不宁。
黄连（一两）、枳实（炒，七钱）、干姜（二钱）、半夏（七钱）、黄芩（一两）、茯苓、白术、甘草（炙，各三钱）、姜黄（一钱）、泽泻（一两）、猪苓。
以上研为末，用汤浸蒸饼做丸。每服五七十丸，饭前用白开水送下。
失笑丸治疗右关脉浮弦，心下湿痞，恶食懒倦。开胃进食。
枳实、黄连（各五钱）、干姜（二钱）、半夏曲（三钱）、浓朴（炙，四钱）、人参（五钱）、甘草（炙，二钱）、白术（三钱）、麦芽（二钱）。
以上研为末，用水浸蒸饼做丸。每服三十丸，白开水送下。不拘时间，根据虚实加减服用。
朱丹溪诊治小娘心头痞闷，口干，面微黄，脉洪大。
黄连、半夏、白术、青皮、木通（各三钱）。
分三帖。姜煎，去渣热服，送服保和丸十五丸。
回金丸泻肝火，行湿与热。能开痞结，治肝邪，补脾土。
黄连（六两）、吴茱萸（一两）。
以上研为末，用水浸蒸饼做丸。另一配方用黄连六两，吴茱萸半两，又名佐金丸。
滑寿说：少阴病面赤下痢，心下痞，泻心汤加减示例。易老单用黄连泻心汤，采用钱氏方法。后来随症状加减。
心烦者，加山栀。燥者，加香豉。呕者，加半夏。胀满者，加枳实、浓朴。腹痛者，加芍药。脉迟者，加附子。下焦寒者，加干姜。大便硬者，加大黄。如果使用姜、附，先煎熟，使热力不猛烈，后加黄连同用。
罗谦甫说：枳实理中丸 治疗中脘痞满，滞气不消，积寒停冷，饮食不化。（方剂见伤寒篇。）
张仲景说：人参汤治疗胸痹心痞。（方剂见胸痹篇。）半夏泻心汤治疗痞满，关脉沉。（方剂见伤寒篇。）
朱丹溪诊治一女子在家，因事不如意，郁结在脾。半年不进食，每天只吃几枚枣，恰好喜欢吃馒头，也能少吃一点，唯独非常厌恶粥饭。我诊察她的脾气，非枳实不能散结。于是用温胆汤去掉竹茹给她服用。经过三个月，服用二百帖而痊愈。
又一女子，二十多岁，许婚后丈夫远出，两年不归。女子病重不进食，困卧如痴，没有其他痛苦，众医无效。我去诊治，见女子面向里床睡觉，形体消瘦。我想，这是气结病，药不能治，得怒可解。我去激怒她，打了她脸三巴掌，并且责备她不能有外思。女子果然大怒而哭，等她哭了一两个时辰，让她的父母劝解。进药两帖，就想吃东西了。我对她的父母说：虽然痊愈必须得到喜悦才能彻底解除，如果再思念则结气必会复发。其父于是假装丈夫有信回来，约定日期成婚。一个多月后丈夫果然归来，病得以全愈。
饮食伤脾导致的痞闷，轻者，用大消痞丸、枳术丸、回金丸之类；重者，轻微攻下或催吐。攻下的，用槟榔丸、煮黄丸；催吐的，用二陈汤及瓜蒂散探吐。
《内经》说：治疗膈下冷气及酒食饱满。常服用青皮四两，分成四分。一分用汤浸泡一夜去皮瓤；其余三分用盐二两拌匀，很久后，在铫内微炒焦为末。每服一钱半，茶末五分，水一盏，煎至七分，放温常服。用沸汤点服，尤其好。寒痞，用辛甘药发散，如枳实理中丸之类。热痞，用苦寒药泄降，如大消痞丸之类。
朱丹溪说：治疗痞证。软石膏研末，醋糊丸服用。能泻胃火、食积、痰火。
运气导致的痞有三种：
一是湿痞。经文说：土气平和称为备化。备化的纪年，其病为痞。又说：太阴所至为蓄满，为积饮痞膈。又说：太阴司天之政，百姓病寒湿痞逆。又说：土郁发作，痞坚腹满。又说：土不及称为卑监。卑监的纪年，其病为留满痞塞。
二是寒痞。经文说：水郁发作，百姓病痞坚腹满。又说：太阳之复，心痛痞满是也。
三是燥痞。经文说：阳明之复，甚则痞满是也。
滑寿问：井穴主治心下满。十二经都有井穴，应当治疗哪个井穴？假如喜欢清洁、面色青、易怒，是少阳经受病，应当治疗金井窍阴穴。假如小便闭塞、淋沥、排便困难、转筋，足厥阴肝经受病，应当治疗木井大敦穴。假如头项痛、腰脊强、发热、恶寒，足太阳膀胱受病，应当治疗阳井至阴穴（注：此处原文可能有误，足太阳井穴应为至阴，但通常指足少阴肾经井穴涌泉或足太阳膀胱经井穴至阴，结合上下文足太阳膀胱经井穴应为至阴，但原文写“阳井至阴”，可能指足少阴肾经井穴涌泉或笔误，此处依原文翻译）。假如手足自温、自利、不渴，足太阴脾受病，应当治疗阴井隐白穴。
罗姓客人有病痞证，积滞在体内，潜伏而不能下行，从外来的邪气抗拒而不能纳入。向医生询问说：非攻下不可。回家服药，喝完后立即暴下，不到一天，之前潜伏的邪气散尽无余，之前抗拒的邪气变得柔弱而不支，焦膈通达，呼吸顺畅，痛快得像从未有过病一样。没过几天，痞证又发作，投以原来的药，那种痛快感也如初，从此不超过一个月，痞证五次发作五次攻下，每次攻下后痊愈。然而客人的元气，一句话引出三次汗，身体不劳累却出汗，大腿不走路却颤抖，肌肉皮肤在前面的消耗没有减少，但体内的柔和之气不知从何而来。唉！心痞非攻下不可吗？我跟随他攻下，技术没有失误。然而为什么这样呢？听说楚地南部有位良医，前去询问。医生笑着说：你不要奇怪这种情况！你用的方法本来就会导致这种情况。坐下，我告诉你。天下的道理，有比心里更痛快的，其后果一定有伤害。追求中间不受伤害，就不要指望心里痛快。阴气潜伏阳气蓄积，气与血不运化而形成痞，横亘在你的胸部，危害很大。打击并去除它，不一会儿就除去了很大的危害，和平温和的药物做不到，必须通过搏击震荡才可以。人的和气冲淡而微弱，泊然容易危险，搏击震荡的功效完成，你的和气也已经病了。由此看来，你的痞证每痛快一次，你的和气也就受伤一次。不超过一个月痛快了五次，你的和平之气不是已经耗尽了吗。所以痛快得像不到一天一样。况且将要去掉你的痞证，而不伤害和气。你回去，闲居三个月后再给你药可以。客人回去三个月，斋戒后又请求给药。医生说：你的气稍微恢复了。取药交给他說：服用三个月疾病稍微平稳；又三个月稍微康复；一年后可以恢复常态，而且吃药不得急于求成。客人回去实行他的说法，然而起初让人郁闷而推迟，大概三次投药三次反复。然而每天不见其攻击的效果，长久比较则每月不同而时节不同，终年而疾病平复了。客人拜见医生再拜致谢，坐下询问原因。医生说：这是治国之道，岂止应用于治病！你难道没看见秦朝治理百姓吗！强悍而不听命令，懒惰而不勤于事务，放纵而不畏惧法律。命令不听，治理不变，那么秦朝的百姓常处于痞塞状态。商君看到这种痞塞，用刑法严厉，用斩伐威慑，强悍严厉凶猛，毫不宽容，痛快地划清并强力整治，于是秦朝的政治如高屋建瓴，流通四方，没有人敢拒绝，而秦朝的痞塞常常一次痛快。从孝公到二世，几次痞塞几次痛快，顽固的已崩溃，强大的已柔弱，而秦朝的百姓没有恐惧心了。所以猛政一次痛快，欢心就丧失一次，积累痛快不停止，而秦朝的四肢空虚，徒具形式而已。民心日益背离，君主孤立在上，所以匹夫大呼，不到一天百姓都起来，秦朝想运转其手足肩臂，却漠然不应。所以秦朝的灭亡，是好求痛快者的过错。从前先王的百姓，起初也曾痞塞，先王难道不知道快速击去以为速效吗？只是担心伤害内部，所以不敢求心里痛快。优柔地抚育他们，用仁义教导，用礼乐引导，暗中解开混乱并除去痞塞。旁边看似乎郁闷存在，然而按月计算每年考察，前年的风俗不是今年的风俗。不击不搏，无所忤逆，因此每日去除戾气而不伤害欢心，于是政教成就，安乐长久而后患除去了。所以三代治理，都经过几位圣人，历经几百年而后风俗养成，那么你的药终年而疾病痊愈，大概没有什么奇怪的。所以说天下的道理，有比心里更痛快的，其后果一定有伤害，追求最终不伤害，就不要指望心里痛快。虽然如此，岂止治理天下是这样！客人再拜，记录了他的说法。
Pi syndrome refers to a sensation of fullness and blockage in the epigastrium (heart below), leading to an inability to eat. Zhang Zhongjing stated: Fullness without pain is Pi (blockage/fullness); fullness with pain is Jie Xiong (knotted chest).
Li Dongyuan said: Pi syndrome is characterized by fullness in the epigastrium without pain. The Taiyin meridian corresponds to dampness, which governs obstruction and congestion. This is caused by Earth qi (damp pathogen) invading the area below the heart, resulting in Pi fullness. In Cold Damage diseases, if purgatives are used too early, Pi syndrome may also result, as cold pathogens injure the Ying blood. Ying blood belongs to the category of blood; the Heart governs blood vessels. When pathogens invade the root, it causes fullness and stuffiness below the heart. Zhang Zhongjing established several formulas for Xiexin Tang (Drain the Heart Decoction), all using Huanglian (Coptidis Rhizoma) to drain the Earth pathogen (damp-heat) in the epigastrium, with effects as immediate as striking a drum. Thus, the *Huoren Shu* (Book of Living People) states: Once Pi syndrome is confirmed, use Jiegeng Zhike Tang (Platycodon and Aurantium Decoction) first; this is not to treat Pi specifically with this formula. Rather, because prior erroneous purgation inevitably leads to Pi syndrome, at this stage the pathogenic qi is about to sink and attempt to pass through the chest. Therefore, this formula is used first to intercept and disperse the pathogen, preventing it from forming Pi. The word "first" implies early intervention. If used after Pi has already formed, it is too late. It will not only fail to resolve Pi but also damage the upright qi in the chest; only then should one use Zhang Zhongjing's medicines for treating Pi. The classic says: Observe where the pathogen resides and regulate/treat accordingly; this precisely refers to this principle. This applies not only to Cold Damage but also to miscellaneous diseases such as alcohol accumulation; excessive purgation can also cause Pi injury. Excessive purgation leads to the loss of Yin fluids; "loss of Yin" refers to the depletion of the Yin fluids of water and grain in the Spleen and Stomach. Consequently, the Qi in the chest sinks due to deficiency into the domain of the Heart, causing epigastric Pi. It is appropriate to raise Stomach Qi, combined with Blood-invigorating herbs. If solely using Qi-regulating herbs to guide, Pi will worsen; if purged again when severe, Qi will descend further, inevitably transforming into central fullness and distension. These are incorrect treatments. There are also distinctions between excess and deficiency. For excess Pi with constipation, Nongpu Zhishi Tang (Magnolia Bark and Immature Bitter Orange Decoction) is indicated. For deficient Pi with normal bowel movements, Baishao Chenpi Tang (White Peony Root and Tangerine Peel Decoction) is indicated. If Pi and stuffiness are caused by food injury, one should promote digestion and eliminate stagnation to remove chest obstruction. If there is rebellious Qi rising with nausea and urge to vomit, emesis should be induced, as stated in the classics: "For those above, induce vomiting."
Zhu Danxi said: Treating Pi solely by tonifying the Central Earth (Spleen) and using Blood-invigorating herbs is a method that cannot be surpassed. Pi caused by Cold Damage originates from the Blood level; Pi caused by miscellaneous diseases also originates from the Blood level. Although both fall under Blood-related patterns, generally speaking, Cold Damage patterns move from exterior to interior, from substantial to insubstantial. Therefore, for insubstantial Qi disorders, bitter-draining herbs are used; for substantial Blood disorders, acrid-sweet dispersing herbs are used. Those with central fullness should avoid sweet foods; those without fullness should consume sweet foods. "Central fullness" refers to abdominal distension. If one feels full externally but lacks visible abdominal distension, it is not central fullness, but rather "non-fullness" (deficiency). Non-fullness is a deficiency disease and should be treated with sweet herbs. (Insubstantial Qi disorders are drained with bitter herbs, such as Zhishi (Immature Bitter Orange) and Huanglian (Coptidis Rhizoma); substantial Blood disorders are dispersed with acrid-sweet herbs, such as Zhang Zhongjing's Renshen Tang (Ginseng Decoction).)
Li Dongyuan's Huangqi Buzhong Tang (Astragalus Tonify Middle Decoction): Huangqi (Astragali Radix, 5 fen), Renshen (Ginseng Radix, 8 fen), Gancao (Licorice Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma, each 5 fen), Chenpi (Citri Reticulatae Pericarpium, 5 fen), Zexie (Alismatis Rhizoma), Zhuling (Polypori Umbellati, Fuling (Poria, each 3 fen). Decoct in water until three-sevenths remain, take warm, followed by Da Xiaopi Wan (Great Dispersing Pi Pill).
Zhu Danxi treated a woman who, due to unsatisfactory circumstances, developed diaphragmatic fullness and inability to eat. After months of neglect, it accumulated into Pi syndrome, leaving her unable to rise or sit. Every day around noon (Si hour), she would develop fever and facial redness; after evening (You-Xu hours), the fever and redness subsided. At night, although urination was frequent, only a few drops were passed each time. All six pulses were deep, choppy, short, and small, identical on both sides, palpable even with heavy pressure. Menstruation occurred monthly but consisted of only a few drops. I said: This is Qi stagnation due to thwarted will, with blood stasis in the Stomach and concurrent blood deficiency. Stagnant Qi transforms into Phlegm residing in the Central Palace (Middle Jiao), causing anorexia. Combined tonification and draining methods were used. Baizhu (2 qian), Renshen (1 qian), Fuling (1 qian), Honghua (Carthami Flos, size of one bean), Chenpi (1 qian) were decocted to make a concentrated soup. One sip was taken hot before meals. Shortly after the medicine acted, half a spoonful of thin porridge was given. Then, Qingjianfen Qianqiu Sanhua Wan (Lightening Powder and Morning Glory Pill) was administered, sized like sesame seeds, swallowed with saliva, fifteen pills at a time. Both decoction and pills were taken four times over a day and night. By the next day, taste returned to food; by the second day, intake increased slightly; by the third day, fever subsided and facial redness disappeared. After seven days of this regimen, diet and activity returned to normal, recovering as before.
Third Aunt: Thirsty, poor appetite, Qi Pi, wiry pulse.
Baizhu (2 qian), Qingpi (Aurantii Fructus Immaturus, 2 qian), Banxia (Pinelliae Rhizoma, 2 qian), Gange (Puerariae Radix, 1.5 qian), Mutong (Akebiae Caulis, 1 qian), Gancao (Licorice Radix et Rhizoma, roasted, slight amount).
Divide into two doses. Two slices of ginger, decocted, taken with Dian Wan (Point Pill) thirty pills and Baohe Wan (Harmonize the Stomach Pill) twenty pills.
Tingli Wan (Descurainia Seed Pill) treats epigastric Pi and chest discomfort.
Kutingli (Descurainiae Semen seu Lepidii Semen, wine-soaked and stir-fried) (3 qian), Renshen (Ginseng Radix, 3 qian), Gancaogen (Licorice Radix et Rhizoma, roasted), Qianghuo (Notopterygii Rhizoma et Radix), Chaihu (Bupleuri Radix), Duhuo (Angelicae Pubescentis Radix, each 2 qian), Huangqin (Scutellariae Radix, 3 qian, half wine-soaked, half stir-fried), Sharen (Amomi Fructus), Ychen (Artemisiae Scopariae Herba, wine-fried, each 1 qian), Baidoukou (Cardamomi Rotundus Fructus, 1 qian), Qingpi (Aurantii Fructus Immaturus), Nongpu (Magnoliae Officinalis Cortex), Banxia (Pinelliae Rhizoma, each 0.5 fen), Dangguishen (Angelicae Sinensis Radix, 7 qian).
Grind into powder, make pills with steamed dough, sieve and expand in water to rice-grain size. Take one qian with plain warm water before bed.
Muxiang Xiaopi Tang (Costus Dispersing Pi Decoction) treats epigastric Pi fullness, slight abdominal pain with tight skin, aversion to eating, indigestion, and constant stuffiness due to emotional Qi stagnation in the Middle Jiao.
Chaihu (Bupleuri Radix, 0.7 fen), Chenpi (Citri Reticulatae Pericarpium, 0.8 fen), Gancao (Licorice Radix et Rhizoma, roasted, 0.5 fen), Banxia (Pinelliae Rhizoma, 1 qian), Shengjiang (Zingiberis Rhizoma Recens, 1 qian), Guishao (Angelicae Sinensis Radix tip, 2 qian), Honghua (Carthami Flos, slight amount), Zhishi (Aurantii Immaturus Fructus, 1 qian), Muxiang (Aucklandiae Radix, 0.7 fen), Cao Kou (Amomi Fructus, 1 qian).
One dose, decoct in water, strain, take hot before meals. Avoid alcohol and wheat products.
Da Xiaopi Wan (Great Dispersing Pi Pill) treats all types of epigastric Pi fullness, especially chronic cases lasting years.
Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma, stir-fried, each 6 qian), Jianghuang (Curcumae Longae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, each 1 qian), Renshen (Ginseng Radix, 2 qian), Gancao (Licorice Radix et Rhizoma, roasted), Sharen (Amomi Fructus, each 1 qian), Zhishi (Aurantii Immaturus Fructus, stir-fried, 5 qian), Banxia (Pinelliae Rhizoma, processed, 4 qian), Ganjiang (Zingiberis Rhizoma, 1 qian), Chenpi (Citri Reticulatae Pericarpium, 2 qian), Shenqu (Massae Fermentatae Medicinalis, stir-fried, 1 qian), Zexie (Alismatis Rhizoma, 3 qian), Nongpu (Magnoliae Officinalis Cortex, 2 qian), Zhuling (Polypori Umbellati, 1.5 qian).
Grind into powder, make pills with water-soaked steamed dough. Take 60-100 pills with plain warm water long after meals.
Huanglian Xiaopi Wan (Coptidis Dispersing Pi Pill) treats epigastric Pi fullness, congestion that does not dissipate, irritability, heat, panting, and restlessness.
Huanglian (Coptidis Rhizoma, 1 liang), Zhishi (Aurantii Immaturus Fructus, stir-fried, 7 qian), Ganjiang (Zingiberis Rhizoma, 2 qian), Banxia (Pinelliae Rhizoma, 7 qian), Huangqin (Scutellariae Radix, 1 liang), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Licorice Radix et Rhizoma, roasted, each 3 qian), Jianghuang (Curcumae Longae Rhizoma, 1 qian), Zexie (Alismatis Rhizoma, 1 liang), Zhuling (Polypori Umbellati).
Grind into powder, make pills with soup-soaked steamed dough. Take 50-70 pills with plain warm water before meals.
Shixiao Wan (Pain-Disappearing Pill) treats floating-wiry right Guan pulse, damp Pi in the epigastrium, aversion to food, and lethargy. Opens the stomach and promotes appetite.
Zhishi (Aurantii Immaturus Fructus), Huanglian (Coptidis Rhizoma, each 5 qian), Ganjiang (Zingiberis Rhizoma, 2 qian), Banxiaqu (Pinelliae Rhizoma fermented, 3 qian), Nongpu (Magnoliae Officinalis Cortex, roasted, 4 qian), Renshen (Ginseng Radix, 5 qian), Gancao (Licorice Radix et Rhizoma, roasted, 2 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 3 qian), Maiya (Hordei Fructus Germinatus, 2 qian).
Grind into powder, make pills with water-soaked steamed dough. Take 30 pills with plain warm water. Time and dosage adjusted according to excess or deficiency.
Zhu Danxi treated a young woman with epigastric Pi stuffiness, dry mouth, slightly yellow complexion, and surging pulse.
Huanglian (Coptidis Rhizoma), Banxia (Pinelliae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Qingpi (Aurantii Fructus Immaturus), Mutong (Akebiae Caulis, each 3 qian).
Divide into three doses. Decoct with ginger, strain, take hot, followed by Baohe Wan (Harmonize the Stomach Pill) fifteen pills.
Huijin Wan (Return Gold Pill) drains Liver Fire, moves Dampness and Heat. Opens Pi knots, treats Liver pathogen, tonifies Spleen Earth.
Huanglian (Coptidis Rhizoma, 6 liang), Wuzhuyu (Evodiae Fructus, 1 liang).
Grind into powder, make pills with water-soaked steamed dough. Another prescription uses Huanglian (6 liang) and Wuzhuyu (0.5 liang), also named Zuojin Wan (Assist Metal Pill).
Hua Shou said: Shaoyin disease with facial redness and dysentery, epigastric Pi, examples of modifying Xiexin Tang (Drain the Heart Decoction). Yi Lao used single Huanglian Xiexin Tang alone, following Qian's method, later modified according to symptoms.
If irritable, add Zhizi (Gardeniae Fructus). If dry, add Xiangchi (Fermented Soybean). If vomiting, add Banxia (Pinelliae Rhizoma). If full, add Zhishi (Aurantii Immaturus Fructus) and Nongpu (Magnoliae Officinalis Cortex). If abdominal pain, add Shaoyao (Paeoniae Radix Alba/Rubra). If pulse is slow, add Fuzi (Aconiti Lateralis Radix Praeparata). If Lower Jiao is cold, add Ganjiang (Zingiberis Rhizoma). If stool is hard, add Dahuang (Rhei Radix et Rhizoma). If using Ginger and Aconite, decoct them thoroughly first to ensure mild heat, then add Huanglian to use together.
Luo Qianfu said: Zhishi Lizhong Wan (Immature Bitter Orange Regulate Middle Pill) treats epigastric Pi fullness, stagnant Qi failing to dissipate, accumulated cold retention, and undigested food. (Formula see Chapter on Cold Damage.)
Zhang Zhongjing said: Renshen Tang (Ginseng Decoction) treats Chest Bi (Obstruction) and Heart Pi. (Formula see Chapter on Chest Bi.) Banxia Xiexin Tang (Pinellia Drain the Heart Decoction) treats Pi fullness with deep Guan pulse. (Formula see Chapter on Cold Damage.)
Zhu Danxi treated a girl at home who, due to unsatisfactory events, had Qi stagnation in the Spleen. She did not eat for half a year, eating only a few dates daily. She happened to like mantou (steamed buns) and could eat a little, but strongly disliked congee/rice. I diagnosed her Spleen Qi pattern; only Zhishi (Immature Bitter Orange) could disperse it. Thus, Wendan Tang (Warm the Gallbladder Decoction) without Zhuru (Bambusae Caulis in Taenia) was prescribed. After three months, taking 200 doses, she recovered.
Another girl, over twenty, married but husband traveled far away and did not return for two years. She became severely ill, refusing to eat, lying listlessly like a fool, with no other complaints; other doctors failed. I went to treat her, seeing her sleeping facing inward, emaciated. I thought: This is a Qi knot disease, medicine cannot cure it; anger can resolve it. I provoked her anger, slapped her face three times, and reprimanded her for having external thoughts. She indeed became furious and cried. After she cried for one to two hours, her parents calmed her down. Two doses of medicine were administered, and she immediately desired food. I told her parents: Although cured, joy is required for complete resolution; otherwise, the Qi knot will recur. Her father pretended to receive a letter from her husband, arranging a wedding date. Over a month later, her husband returned, and the illness completely resolved.
Food injury to the Spleen causing Pi stuffiness: Mild cases use Da Xiaopi Wan (Great Dispersing Pi Pill), Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill), Huijin Wan (Return Gold Pill), etc. Severe cases require mild purgation or emesis. Purgation uses Binglang Wan (Arecae Semen Pill) or Zhu Huang Wan (Boiled Rhubarb Pill). Emesis uses Erchen Tang (Two Aged Decoction) or Gouti San (Melon Spicule Powder) to induce vomiting.
The *Classic* says: To treat cold Qi below the diaphragm and fullness from alcohol/food. Regularly use Qingpi (Aurantii Fructus Immaturus) four liang, divided into four parts. One part soaked in soup overnight, peeled; remaining three parts mixed with two liang salt, left for a while, then lightly stir-fried until scorched into powder. Take 1.5 qian per dose, with 0.5 qian tea powder, one cup of water, decoct to seven-tenths, take warm regularly. Taking with boiling water is especially good. Cold Pi is dispersed with acrid-sweet herbs, such as Zhishi Lizhong Wan (Immature Bitter Orange Regulate Middle Pill). Heat Pi is drained with bitter-cold herbs, such as Da Xiaopi Wan (Great Dispersing Pi Pill).
Zhu Danxi said: To treat Pi. Soft gypsum ground into powder, made into pills with vinegar paste. Drains Stomach fire, food stagnation, and phlegm-fire.
There are three types of Pi caused by Climate Factors (Yunqi):
First is Damp Pi. The classic says: Balanced Earth Qi is called Beihua. In the era of Beihua, the disease is Pi. Also: Taiyin arrival causes accumulation and fullness, fluid retention, and Pi obstruction. Also: When Taiyin rules Heaven, people suffer from cold-damp Pi and rebellion. Also: When Earth depression occurs, Pi hardness and abdominal fullness appear. Also: Earth insufficiency is called Beijian. In the era of Beijian, the disease is retention, fullness, and Pi blockage.
Second is Cold Pi. The classic says: When Water depression occurs, people suffer from Pi hardness and abdominal fullness. Also: Solar Rebound causes heart pain and Pi fullness.
Third is Dry Pi. The classic says: Yangming Rebound, severely, causes Pi fullness.
Hua Shou asked: Jing-Well points treat epigastric fullness. All twelve meridians have Jing-Well points; which one should be treated? If one is clean-loving, has a greenish complexion, and is prone to anger, it is Shaoyang meridian disease; treat Jin Jing Qiaoyin (Metal Well, Qiaoyin GB-45). If there is urinary retention, strangury, difficult defecation, and tetany, it is Foot-Jueyin Liver meridian disease; treat Mu Jing Dacun (Wood Well, Dacun LR-1). If there is headache, stiff neck/back, fever, and aversion to cold, it is Foot-Taiyang Bladder meridian disease; treat Yang Jing Zhiyin (Yang Well, Zhiyin BL-66 - *Note: Text says "Yang Jing Zhiyin", likely referring to Bladder Jing-Well*). If hands and feet are naturally warm, spontaneous diarrhea, and no thirst, it is Foot-Taiyin Spleen meridian disease; treat Yin Ying Baiyin (Yin Well, Baiyin SP-1).
A guest named Luo had Pi syndrome, with accumulation inside, latent and unable to descend, external pathogens resisting and unable to enter. He consulted a doctor who said: Purging is necessary. He took the medicine, experienced violent purging immediately, and within a day, the latent pathogens scattered completely, and resistant pathogens became soft and unsupported. His chest cleared, breathing opened, feeling as if he had never been ill. But within days, Pi returned. Using the same medicine brought back the relief. Within a month, Pi appeared five times and was purged five times, resolving each time. However, his vital Qi was exhausted; a few words drew out sweat three times, legs trembled without walking, muscles wasted, yet internal softness remained unknown. Alas! Must Heart Pi always be purged? I followed him in purging, my technique was flawless. Yet why this outcome? I heard of a good physician in southern Chu and went to ask. The doctor laughed: Do not be surprised! Your method inherently causes this. Sit, let me tell you. In the world, whatever brings extreme pleasure often brings harm at the end. Seeking no harm internally means abandoning the hope of extreme pleasure. Yin latent and Yang stored, Qi and Blood failing to circulate form Pi, obstructing your chest, causing great burden. Striking it away removes the burden quickly, but peaceful/harmonious drugs cannot do this; forceful beating and shaking are required. Human harmonious Qi is subtle and fragile. Once the forceful beating is done, your harmony is already damaged. Thus, every time your Pi is relieved, your harmony is injured. Five reliefs in a month mean your harmonious Qi is exhausted. Hence the relief lasts less than a day. To remove Pi without harming harmony, go home, live quietly for three months, then take medicine. The guest returned, fasted for three months, and requested medicine again. The doctor said: Your Qi has slightly recovered. Here is the medicine. Take it for three months, illness will stabilize; another three months, slight recovery; a year to fully recover. Medicine must not be advanced hastily. The guest followed this advice. Initially frustrating, delaying treatment, three doses led to three reversals. No daily effect seen, but comparing month by month, different seasons showed progress. Finally, after a year, the illness平息 (subsided). The guest bowed twice to thank the doctor, sat and asked why. The doctor said: This is the theory of governing a state, not just treating disease! Have you not seen how Qin governed its people? Fierce, disobedient, lazy, lawless. Commands ignored, governance unchanged, Qin's people were perpetually in Pi (stagnation). Lord Shang saw this Pi, used harsh laws and execution threats, fierce and merciless, cutting deeply and forcing change. Thus Qin's politics flowed like water from a high vessel, reaching everywhere, none daring to resist, and Qin's Pi was once greatly relieved. From Duke Xiao to Second Emperor, how many times was Pi relieved? The stubborn broke, the strong softened, and Qin's people lost fear. Thus, each fierce relief cost a piece of joyful heart. Accumulating relief endlessly left Qin's limbs empty, mere forms. People's hearts drifted away, ruler isolated. So a commoner shouted, and within a day, people rose up. Qin wanted to move its limbs, but they responded indifferently. Thus Qin's fall was the fault of those seeking quick relief. Former Kings' people were initially in Pi too. Did Kings not know quick striking was fast? They feared internal harm, so dared not seek quick pleasure. They gently nurtured them, taught benevolence/righteousness, guided with rites/music, secretly untied chaos and removed Pi. Looking aside, it seemed stagnant, but month-by-month, year-by-year, customs changed. No striking or fighting, no opposition, thus daily removing hostile Qi without hurting joyful hearts. Politics succeeded, education reached, peace lasted long, then disasters removed. Thus Three Dynasties governance took several sages and centuries to shape customs. So your medicine taking a year to cure is no wonder. Thus: Whatever brings extreme pleasure brings harm at the end. Seeking no final harm means abandoning hope for quick pleasure. Though so, is this not true for governing the world too? The guest bowed twice and recorded his words.