脉来坚实者顺。虚弱者逆。
痞满与胀满不同。胀满是内胀而外亦形。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。位心下之中。腹满痞塞。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。不能施行而作痞者。有湿热太甚。上来心下而为痞者。治之用
黄连、黄芩、枳实之苦以泄之。生姜、半夏、浓朴之辛以散之。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。
一论按之坚而软。无块为痞。多是痰气郁结。或饮食停滞者。
加味二陈汤
陈皮（二钱） 半夏（姜炒二钱） 枳实（麸炒一钱） 黄连（姜炒六分） 山楂（去子二钱）
木香
（八分） 青皮（去穣二钱） 白茯苓（去皮三钱） 砂仁（八分） 甘草（八分）
上锉。生姜煎服。
一论痞满。宜调中补气血。清痞清热。攻补兼施。简而当也。
平补枳术丸
白术（去芦土炒三两） 白芍（酒炒一两） 陈皮 枳实（麸炒） 黄连（酒炒各一两） 人参
木香（各五钱）
上为细末。荷叶煎汤。打米糊为丸。如梧子大。每服五十丸。食远。米汤下。渐加至六
七十
丸。一论内伤元气脾胃。而作心下痞者。宜大补元气也。服加减补中益气汤。（方见内伤
）
如脉缓有痰而痞。加半夏、黄连。
脉弦。四肢满闭。便难而心下痞。加黄连、柴胡、甘草。大便闭燥。黄连桃仁。少加大黄、
归身。心下痞腌闷。加白芍。黄连。
心下痞腹胀。加白芍、砂仁、五味子。天寒少加干姜
或官桂。心下痞。中寒者。加附子、黄连。心下痞。
呕逆者。加陈皮、生姜、黄连。夏月加黄连。少加丁香、藿香。能食而心下痞。加枳实
三钱。黄连五分。如不能食。心下痞者。勿加之。根据本方。食已心下痞。服前枳术丸而愈
一论一切心下痞。及年久不愈者。宜用
大消痞丸
黄连（土炒六钱） 黄芩（土炒六钱） 枳实（麸炒五钱） 半夏（泡四钱） 陈皮（四钱） 浓
朴（
姜炒四钱） 猪苓（四钱） 泽泻（四钱） 姜黄（二两） 干生姜（三钱） 人参（四钱） 神曲（五
钱炒） 砂仁（三钱） 甘草（三钱炙） 白术（去芦土炒一两）
上为细末。蒸饼为丸。如梧子大。每服五十丸。渐加至百丸。空心。白滚汤送下。
一男子胸膈作痞。饮食难化。服枳术丸。久而形体消瘦。发热口干。脉浮大而微。用补
中益
气加姜、桂。诸症悉退。唯见脾胃虚寒。遂用八味丸。补命门相火。不月而饮食进。三月而
形体充。此症若不用前丸。多变腹胀喘促。腿足浮肿。小便淋涩等症。急用加减肾气丸。亦
有得生者。
一治痞闷气结食积。宜服
内消丸
青皮 陈皮 三棱（煨） 莪术（煨） 神曲（炒） 麦芽 香附（炒各等分）
上为细末。醋糊为丸。如梧子大。每服三五十丸。清茶送下。
一腹中窄狭。须用苍术。若肥人自觉腹中窄狭。乃是湿痰流注脏腑。气不升降。燥饮。
用苍术、香附行气。如瘦人自觉腹中窄狭。乃是热气熏蒸脏腑。宜黄连、苍术。
一论心下坚如盘者。
枳实（麸炒一钱） 白术（去芦三钱）
上锉一剂。水煎。温服。
补中益气汤（方见内伤） 八味丸（方见补益）
脉象来势坚实者，预后良好（顺）；脉象虚弱者，预后不良（逆）。
痞满与胀满不同。胀满是内部胀满，外部也显现出肿胀的形态；痞满则是内部感觉痞塞闷胀，而外部没有肿胀紧急的形态。这大多是由于阴气潜伏、阳气蓄积，导致气血运行不畅而形成的。病位在心下中部，腹部胀满痞塞，都是土邪（脾胃病变）所致。有的因为误用泻下法，导致里气虚弱，邪气乘虚侵入心之分野；有的因为饮食停滞、痰湿积聚，不能运化而形成痞满；有的因为湿热太盛，上扰心下而形成痞满。治疗时，使用黄连、黄芩、枳实的苦味药以泄降之；生姜、半夏、厚朴的辛味药以散结之；人参、白术的甘温药以补益之；茯苓、泽泻的咸淡味药以渗利之。大概应与湿证同治，使邪气从上、下分消即可。
一种论述认为：按之坚硬但无肿块者为痞。多是痰气郁结，或饮食停滞所致。
加味二陈汤
陈皮（二钱） 半夏（姜炒二钱） 枳实（麸炒一钱） 黄连（姜炒六分） 山楂（去核二钱）
木香（八分） 青皮（去瓤二钱） 白茯苓（去皮三钱） 砂仁（八分） 甘草（八分）
以上药材切碎，用生姜煎服。
另一种论述认为：痞满，适宜调理中焦，补益气血，清除痞热。攻邪与补正兼施，简要而得当。
平补枳术丸
白术（去芦头，土炒三两） 白芍（酒炒一两） 陈皮 枳实（麸炒） 黄连（酒炒各一两） 人参 木香（各五钱）
以上研为细末，用荷叶煎汤，调和米糊制成丸药，如梧桐子大。每次服用五十丸，饭后较远时间，用米汤送服。逐渐增加至六七十丸。
另一种论述认为：内伤元气脾胃，导致心下痞满的，宜大补元气。服用加减补中益气汤。（方剂见“内伤”篇）
如果脉缓且有痰导致痞满，加半夏、黄连。
如果脉弦，四肢胀满闭塞，大便困难且心下痞满，加黄连、柴胡、甘草。如果大便闭结干燥，用黄连、桃仁，稍加大黄、当归身。如果心下痞闷不适，加白芍、黄连。
如果心下痞满伴腹胀，加白芍、砂仁、五味子。天气寒冷时，稍加干姜或官桂。如果心下痞满属中寒者，加附子、黄连。如果心下痞满伴呕吐逆气，加陈皮、生姜、黄连。夏季加黄连，稍加丁香、藿香。如果能进食而心下痞满，加枳实三钱、黄连五分。如果不能进食而心下痞满，不要加入这些药。根据本方，如果食后心下痞满，服用前面的枳术丸可愈。
另一种论述认为：一切心下痞满，以及多年不愈的，宜用
大消痞丸
黄连（土炒六钱） 黄芩（土炒六钱） 枳实（麸炒五钱） 半夏（泡制四钱） 陈皮（四钱） 厚朴（姜炒四钱） 猪苓（四钱） 泽泻（四钱） 姜黄（二两） 干生姜（三钱） 人参（四钱） 神曲（炒五钱） 砂仁（三钱） 甘草（炙三钱） 白术（去芦头，土炒一两）
以上研为细末，用蒸饼制成丸药，如梧桐子大。每次服用五十丸，逐渐增加至一百丸。空腹时，用白开水送服。
一个男子胸膈部痞满，饮食难以消化，服用枳术丸，日久形体消瘦，发热口干，脉浮大而微弱。使用补中益气汤加干姜、肉桂，各种症状全部消退。唯独见到脾胃虚寒，于是用八味丸，补益命门相火，不到一个月饮食增进，三个月后形体充实。此症如果不使用前面的丸药，容易转变为腹胀喘促、腿足浮肿、小便淋涩等症状。急用加减肾气丸，也有得以生存的。
一种治疗痞闷气结、食积的方法，适宜服用
内消丸
青皮 陈皮 三棱（煨） 莪术（煨） 神曲（炒） 麦芽 香附（炒，各等分）
以上研为细末，用醋糊制成丸药，如梧桐子大。每次服用三五十丸，用清茶送服。
一种腹中狭窄的感觉，必须用苍术。如果肥胖的人自觉腹中狭窄，乃是湿痰流注脏腑，气机不升降所致，燥湿化痰，用苍术、香附行气。如果瘦人自觉腹中狭窄，乃是热气熏蒸脏腑所致，宜用黄连、苍术。
When the pulse is firm and solid, it indicates a favorable prognosis (Shun); when the pulse is weak and deficient, it indicates an unfavorable prognosis (Ni).
Pi-man (fullness and stuffiness) differs from Zhang-man (distension). Zhang-man involves internal distension with external swelling visible; Pi-man involves internal sensation of stuffiness and oppression, but without external signs of swelling or tightness. This is generally caused by the latent retention of Yin and the accumulation of Yang, leading to impaired circulation of Qi and Blood. The location is in the middle of the epigastrium (Xin-xia). Abdominal fullness and blockage are all due to pathogenic factors affecting the Earth element (Spleen and Stomach disorders). Some cases arise from improper use of purgatives, causing deficiency of interior Qi, allowing pathogens to enter the region of the Heart due to this deficiency. Some cases result from food stagnation and phlegm accumulation that fail to transform, leading to Pi. Some cases are caused by excessive Damp-Heat rising to the epigastrium. Treatment employs the bitter properties of Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), and Zhishi (Aurantii Fructus Immaturus) to drain and descend; the acrid properties of Shengjiang (Zingiberis Rhizoma Recens), Banxia (Pinelliae Rhizoma), and Houpo (Magnoliae Officinalis Cortex) to disperse and resolve; the sweet-warm properties of Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) to tonify; and the salty-bland properties of Fuling (Poria) and Zexie (Alismatis Rhizoma) to leach out dampness. Generally, it should be treated similarly to Dampness patterns, allowing the pathogen to be dispersed from above and below.
One discussion states: If palpation reveals hardness without distinct masses, it is Pi. This is mostly due to the constraint of Phlegm-Qi or food stagnation.
Jiawei Erchen Tang (Modified Two-Aged Decoction)
Chenpi (Tangerine Peel, 2 qian) Banxia (Pinellia, stir-fried with ginger, 2 qian) Zhishi (Immature Bitter Orange, bran-fried, 1 qian) Huanglian (Coptis, stir-fried with ginger, 6 fen) Shanzha (Crataegus, seeds removed, 2 qian)
Muxiang (Costus Root, 8 fen) Qingpi (Green Tangerine Peel, albedo removed, 2 qian) Bai Fuling (Poria, peel removed, 3 qian) Sharen (Amomum Fruit, 8 fen) Gancao (Licorice Root, 8 fen)
Crush the herbs and decoct with fresh ginger for administration.
Another discussion states: For Pi-man, it is appropriate to regulate the Middle Jiao, tonify Qi and Blood, clear Pi-heat, and combine purging with tonification. This approach is concise and appropriate.
Pingbu Zhizhu Wan (Balanced Tonifying Atractylodes and Aurantium Pill)
Baizhu (Atractylodes Macrocephala, rhizome removed, earth-fried, 3 liang) Baishao (White Peony Root, wine-fried, 1 liang) Chenpi (Tangerine Peel) Zhishi (Immature Bitter Orange, bran-fried) Huanglian (Coptis, wine-fried, each 1 liang) Renshen (Ginseng) Muxiang (Costus Root, each 5 qian)
Grind into fine powder. Use decoction of lotus leaves to mix with rice paste to form pills the size of wu zi (wu tree seeds). Take 50 pills per dose, well after meals, with rice gruel. Gradually increase to 60–70 pills.
Another discussion states: When internal injury to Yuan Qi and the Spleen-Stomach causes epigastric Pi, it is appropriate to greatly tonify Yuan Qi. Administer Jiabuzhong Yiqi Tang (Modified Tonify the Middle and Augment Qi Decoction). (Formula see "Internal Injury" chapter.)
If the pulse is slow with Phlegm causing Pi, add Banxia and Huanglian.
If the pulse is wiry, with fullness and closure of the four limbs, difficult defecation, and epigastric Pi, add Huanglian, Chaihu, and Gancao. If stool is closed and dry, use Huanglian and Taoren (Peach Kernel), adding a small amount of Dahuang (Rhubarb) and Guishen (Angelica Sinensis Root). If there is oppressive stuffiness in the epigastrium, add Baishao and Huanglian.
If epigastric Pi is accompanied by abdominal distension, add Baishao, Sharen, and Wuweizi (Schisandra Berry). In cold weather, add a small amount of Ganjiang (Dried Ginger) or Guangui (Cinnamon Bark). If epigastric Pi is due to Cold in the Middle, add Fuzi (Prepared Aconite) and Huanglian. If epigastric Pi is accompanied by vomiting and reflux, add Chenpi, Shengjiang, and Huanglian. In summer, add Huanglian and a small amount of Dingxiang (Clove) and Huoxiang (Patchouli). If one can eat but has epigastric Pi, add 3 qian of Zhishi and 5 fen of Huanglian. If one cannot eat and has epigastric Pi, do not add these. Based on this formula, if epigastric Pi occurs after eating, taking the previous Zhizhu Wan will cure it.
Another discussion states: For all cases of epigastric Pi, especially those persisting for years, use
Da Xiao Pi Wan (Great Eliminating Pi Pill)
Huanglian (Coptis, earth-fried, 6 qian) Huangqin (Scutellaria, earth-fried, 6 qian) Zhishi (Immature Bitter Orange, bran-fried, 5 qian) Banxia (Pinellia, soaked, 4 qian) Chenpi (Tangerine Peel, 4 qian) Houpo (Magnolia Bark, ginger-fried, 4 qian) Zhuling (Polyporus, 4 qian) Zexie (Alisma, 4 qian) Jianghuang (Curcuma Longa Rhizome, 2 liang) Ganshengjiang (Dried Fresh Ginger, 3 qian) Renshen (Ginseng, 4 qian) Shenqu (Medicated Leaven, fried, 5 qian) Sharen (Amomum, 3 qian) Gancao (Licorice, honey-fried, 3 qian) Baizhu (Atractylodes Macrocephala, rhizome removed, earth-fried, 1 liang)
Grind into fine powder. Use steamed bread dough to form pills the size of wu zi. Take 50 pills per dose, gradually increasing to 100 pills. Take on an empty stomach with plain boiled water.
A male patient suffered from chest and diaphragm Pi, difficulty digesting food. After taking Zhizhu Wan for a long time, he became emaciated, with fever, dry mouth, and a floating, large, yet slightly weak pulse. He was treated with Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) plus Ganjiang and Rougui (Cinnamon Twig). All symptoms subsided. However, signs of Spleen-Stomach Deficiency-Cold remained, so Bawei Wan (Eight-Ingredient Pill) was used to tonify Mingmen Fire (Gate of Life Yang). Within less than a month, appetite improved; within three months, his physique was restored. If this case had not been treated with the aforementioned pills, it might have progressed to abdominal distension, panting, edema of the legs and feet, and dysuria. Urgent treatment with Jiashenqi Wan (Modified Kidney Qi Pill) could also lead to survival.
For treating Pi-stuffiness, Qi constraint, and food stagnation, it is appropriate to take
Neixiao Wan (Internal Eliminating Pill)
Qingpi (Green Tangerine Peel) Chenpi (Tangerine Peel) Sanleng (Sparganium Rhizome, roasted) Ezhu (Curcuma Zedoaria Rhizome, roasted) Shenqu (Medicated Leaven, fried) Maiya (Barley Sprout) Xiangfu (Cyperus Rhizome, fried, equal parts)
Grind into fine powder. Use vinegar paste to form pills the size of wu zi. Take 30–50 pills per dose with clear tea.
For a sensation of narrowness in the abdomen, Cangzhu (Atractylodes Lancea Rhizoma) is essential. If obese individuals feel narrowness in their abdomen, it is due to Damp-Phlegm flowing into the Zang-Fu organs, causing failure of Qi ascent and descent. To dry dampness and move Qi, use Cangzhu and Xiangfu. If thin individuals feel narrowness in their abdomen, it is due to Heat steaming the Zang-Fu organs. It is appropriate to use Huanglian and Cangzhu.
Regarding the condition where the epigastrium feels hard as a plate:
Zhishi (Immature Bitter Orange, bran-fried, 1 qian) Baizhu (Atractylodes Macrocephala, rhizome removed, 3 qian)
Crush one dose, decoct in water, and take warm.
Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) (See "Internal Injury" chapter) Bawei Wan (Eight-Ingredient Pill) (See "Tonification" chapter)