丹溪云。痞与否同。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。痞则内觉痞闷而外无脉急之形也。有中气久虚。不能营运
精微为痞者。有过服消克。不能舒化饮食为痞者。有湿热太甚。痰气上逆阳位为痞者。古方治痞。
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。庶可略与消导。世人痞塞。
喜行利药以求速效。虽临时快通。痞若再作。危殆滋甚。天地不交而成痞。此脾之清气不升而下
溜。胃之浊气不降而上逆。当用补中益气加猪苓、泽泻。盖升麻、柴胡从九地之下而升其清气。
猪苓、泽泻从九天之上而降其浊气。即所以交痞而为泰矣。诸痞塞及噎膈。乃痰为气激而上。气
为痰腻而滞。痰与气搏。不得流通。并宜连理汤、干姜黄芩黄连人参汤、黄连汤、诸泻心汤选用。
气滞痞胀。用五膈宽中散。不应。丁沉透膈汤。应诸痞塞胀满。胸膈不利。或气上逆。或腹疼痛。
并宜指迷七气汤。胃虚。加参术。气滞。加木香。大便秘。加槟榔。面目浮。加苏叶。四肢肿。
加木瓜。虚痞。只用局方七气、局方乌沉二汤最妙。郁怒暴痞。面目浮肿。心腹胁满。二便秘涩。
四肢胀大。增损流气饮。膈上诸般冷气。呕逆不食。不问痞塞疼痛。且与姜汁探吐。然后用药。
痰饮尤宜。邪气作痞。宜用疏剂。若气不顺。逆上为痞。此乃虚痞。愈疏而痞愈作。宜于收补中
微兼疏通之意。不可过用香剂。古人治泻后膈痞。用理中丸。即此意也。痞塞诸药不效。大便不
通。脉数实者。小陷胸汤、三黄汤选用。
甚则宝鉴木香槟榔丸通利之。若肥人痰痞风 。大便不通者。御药院木香槟榔丸疏解之。肥人心
下痞闷。内有湿痰也。二陈汤加枳实、芩、连。然不若小陷胸汤尤捷。瘦人心下痞闷。乃郁热在
中焦。三黄加枳实以导之。心下痞而寒热不除者。小柴胡加枳、桔。如饮食后感冒风寒。饮食不
消。或食冷物而作痞闷。宜温中化滞。二陈加缩砂、紫苏、藿香。或平胃加藿香、草豆蔻之类。
虚人停滞不散。心下痞。或宽或急。常喜热物者。枳实理中汤。老人虚人。脾胃虚弱。转运不及。
饮食不化而作痞者。九味资生丸。饱闷常嚼一丸。或六君子加香、砂、山楂、曲、 之类。胸中
气塞短气。橘皮枳实生姜汤。有酒积杂病。过下伤脾。脾虚不运作痞。养胃兼和血。参、术、归、
芍兼升、柴。稍佐陈皮、枳壳之类。大怒之后成痞。或痰中见血。或口中作血腥气。是瘀血。用
丹皮、红曲、香附、桔梗、降香、红花、苏木、山楂、麦芽、童便。甚则加大黄、桃仁泥。有痰
挟瘀血成窠囊作痞。脉沉涩。日久不愈。多郁人悲哀过度有之。宜从血郁治。桃仁、红花、香附、
丹皮、韭汁之类。举世治中满痞胀。不问虚实。咸禁甘草。殊不知古人所谓中满勿食甘者。指实
满而言也。若自觉满而外无腹胀之形者。当以甘治之。
〔诊〕脉弦急而滑。骤然胸中痞闷。乃肝气与食滞而成。为实。脉弦。或沉弦。或涩。或虚大
无力。气口为甚。此日久脾胃受伤。或过服克伐药所致。为虚。胸膈痞闷而寸口脉沉滑。或迟滑
者。为有停滞。
罗谦甫治真定赵客。六月间乘凉伤湿面。心下痞满。躁热时作。坐卧不安。宿于寺中。僧以
丸药十数丸下之。下十余行。痞稍减。越日困睡。为盗劫其赀。心动。遂躁热而渴。饮酒一瓯。
是夜脐腹胀痛。僧再以前药复下十余行。病加困笃。四肢无力。躁热身不宁。喜冷水。米谷不化。
痢下如烂鱼肠脑。赤水相杂。全不思食。强食则呕。痞甚于前。噫气
不绝。足 冷。小腹不任其痛。诊之。脉浮数七八至。按之空虚。曰。予溯流寻源。盖暑热已伤
正气。以热毒之剂下之。一下之后。其所伤之物已去无余。遗巴豆之气。留毒于肠胃间。使呕逆
而不能食。胃气转伤而然。及下脓血无度。大肉脱下。皮毛枯槁。脾气弱而衰矣。舌上赤涩。口
燥咽干。下多亡阴之所致也。阴既已亡。火独旺。故心胸躁热。烦乱不宁。经曰。独阳不生。独
阴不长。夭之由也。遂辞去。易一医。不审脉究源。惟见痞满。以枳壳丸下之。病添喘满。利下
不禁而死。金匮云。不当下而强下之。令人开肠洞泄。便溺不禁而死。正此谓也。
石顽治内兄顾九玉。颁诏假道归吴。大暑中患胸痞颅胀。脉得虚大而濡。气口独显滑象。此
湿热泛滥于膈上也。与清暑益气二剂。颅胀止而胸痞不除。与半夏泻心汤减炮姜。去大枣加枳实。
一服而愈。
家弟曾余。虽列贤书。最留心于医理。弟妇郑氏。乃世传女科中山之女。昆弟俱为时医。戊
申夏患呕逆。不食者月余。服宽膈理气药二十余剂。几至绝粒。而痞胀异常。邀余诊之。脉得虚
大而数。按仲景脉法云。大则为虚。数则为虚。此胃中阳气大虚。而浊阴填塞于膈上也。因取连
理汤方。用人参三钱服之。四剂而痞止食进。后与异功散调理数日而康。
别驾吴蛟水公祖夫人。患痞眩呕逆。向因下体畏寒。肢肘麻瞀。久服八味、参、附不彻。六
脉弦滑而按之则濡。此中焦素蕴痰湿。阳气不能周于四末之象。得桂、附辛热之力有时虽可暂开。
究非真阳之虚。且有地黄之滞。所以痞晕漫无止期。遂疏局方七气汤加沉香。一服豁然。再剂神
爽食进而安。
内翰缪钧间尊大人子长老先生。青年罢职。乐志林泉。偶因小愤。遂眩晕痞闷。三
月来服豁痰利气药不应。反觉
疲倦。饮食日减。下元乏力。至七月下浣。邀石顽诊之。六脉似觉有余。指下略无冲和之气。气
口独滞不调。时大时小。两尺俱濡大少力。此素多痰湿。渐渍于水土二经。复加剥削之剂屡犯中
气。疲倦少食。迨所必至。法当先调中气。输运水谷之精微。然后徐图温补下元。为疏六君子汤
加当归兼调营血。庶无阳无以化之虞。其如夫人久患崩淋。遍服诸血药罔效。以补中益气加制香
附、乌梅。升举其阳兼调其气。所谓病在下取之上。端不出古圣之成则耳。
朱丹溪说：痞与“否”字相通，意为不通畅。这是由于阴气潜伏、阳气蓄积，导致气与血运行不畅而形成的。病位在心下（胃脘部），处于人体中央。凡是感到痞塞满闷的，都是脾土系统的疾病。它与胀满病有轻重的区别：痞证是内部感觉痞闷，但外部没有腹部紧绷急迫的形态。有的因为中气长期虚弱，不能运化输布精微物质而形成痞证；有的因为过度服用消食攻伐的药物，不能舒展化解饮食而形成痞证；有的因为湿热太盛，痰气上逆侵犯阳位而形成痞证。古代方剂治疗痞证，用黄连、黄芩、枳实的苦味来泄降；用浓朴、生姜、半夏的辛味来散结；用人参、白术的甘味来补益；用茯苓、泽泻的淡味来渗湿。既然痞证同于湿邪治疗，只宜上下分消其气机。如果确实有内实之证，才可以稍微给予消导药物。世人遇到痞塞，喜欢使用利水通便药以求速效，虽然暂时痛快通畅，但痞证若再次发作，危险程度会更加严重。天地之气不交泰则形成痞证，这是脾的清气不升反而下溜，胃的浊气不降反而上逆造成的。应当使用补中益气汤加猪苓、泽泻。因为升麻、柴胡能从九地之下提升清气，猪苓、泽泻能从九天之上降下浊气，这就是使痞塞转为通泰的方法。各种痞塞及噎膈，是由于痰被气激而上行，气被痰腻而停滞，痰与气搏结，不得流通，都适宜选用连理汤、干姜黄芩黄连人参汤、黄连汤、各类泻心汤。气滞引起的痞胀，使用五膈宽中散，如果不奏效，改用丁沉透膈汤。应对各种痞塞胀满、胸膈不利，或者气机上逆，或者腹部疼痛的情况，都适宜使用指迷七气汤。胃虚的，加入人参、白术；气滞的，加入木香；大便秘结的，加入槟榔；面目浮肿的，加入苏叶；四肢肿的，加入木瓜。虚痞，只用《局方》七气汤、《局方》乌沉二汤最为巧妙。因郁怒突然导致的痞证，出现面目浮肿、心腹胁肋满闷、大小便涩滞、四肢胀大，使用增损流气饮。膈上的各种冷气，呕吐逆气、不能进食，不论是否有痞塞疼痛，先用姜汁探吐，然后再用药。痰饮引起的尤其适合这种方法。邪气导致的痞证，适宜使用疏利剂。如果气不顺，逆上形成痞证，这属于虚痞，越疏利痞证越发作，应当在收补之中微微兼用疏通之意，不可过度使用香燥理气药。古人治疗泻后膈痞，使用理中丸，就是这个道理。痞塞诸药无效，大便不通，脉象数而有力的，选用小陷胸汤、三黄汤。严重时使用宝鉴木香槟榔丸通利。如果是肥人痰痞风秘，大便不通的，使用御药院木香槟榔丸疏解。肥人心下痞闷，是因为内有湿痰，可用二陈汤加枳实、黄芩、黄连。然而不如小陷胸汤更为快捷。瘦人心下痞闷，是中焦有郁热，用三黄加枳实以导引。心下痞且寒热不退的，用小柴胡汤加枳实、桔梗。如饮食后感冒风寒，饮食不消化，或吃冷物而作痞闷，适宜温中化滞，用二陈汤加缩砂仁、紫苏、藿香，或者平胃散加藿香、草豆蔻之类。虚人停滞不散，心下痞，有时宽缓有时紧急，常喜热物的，使用枳实理中汤。老人虚人，脾胃虚弱，转运不及，饮食不化而作痞的，使用九味资生丸。饱闷时常嚼服一丸，或者六君子汤加木香、砂仁、山楂、神曲之类。胸中气塞短气的，使用橘皮枳实生姜汤。有酒积杂病，过度攻下损伤脾气，脾虚不运作痞的，养胃兼和血，用人参、白术、当归、芍药兼升麻、柴胡，稍佐陈皮、枳壳之类。大怒之后成痞，或者痰中带血，或者口中作血腥气，这是瘀血，使用丹皮、红曲、香附、桔梗、降香、红花、苏木、山楂、麦芽、童便。严重时加大黄、桃仁泥。有痰挟瘀血成窠囊作痞，脉沉涩，日久不愈，多发生在忧郁悲哀过度的人身上，适宜从血郁治疗，用桃仁、红花、香附、丹皮、韭汁之类。举世治疗中满痞胀，不问虚实，都禁忌甘草。殊不知古人所说的中满勿食甘者，是指实满而言。如果自觉满闷而外部没有腹胀形态的，应当用甘味药治疗。
【诊法】脉弦急而滑，骤然胸中痞闷，是肝气与食滞而成，属实证。脉弦，或沉弦，或涩，或虚大无力，气口脉象尤为明显，这是日久脾胃受伤，或过服克伐药物所致，属虚证。胸膈痞闷而寸口脉沉滑，或迟滑的，是有停滞。
罗谦甫治疗真定赵客，六月间乘凉伤湿，心下痞满，躁热时作，坐卧不安，寄宿在寺中。僧人以丸药十数丸让他泻下，泻下十余次，痞稍减。第二天困倦嗜睡，又被盗贼抢劫财物，心神动荡，于是躁热而渴，饮酒一杯。当晚脐腹胀痛，僧人再用前药让他泻下十余次，病情加重困笃，四肢无力，躁热身不宁，喜喝冷水，米谷不化，痢下如烂鱼肠脑，赤水相杂，全不思食，强食则呕，痞甚于前，噫气不绝，足冷，小腹不能忍受疼痛。诊察发现，脉浮数七八至，按之空虚。罗谦甫说：我溯流寻源，大概是暑热已伤正气，又以热毒之剂攻下，一下之后，所伤之物已去无余，遗留巴豆之气，留毒于肠胃间，导致呕逆而不能食，胃气转伤而然。及至下脓血无度，大肉脱下，皮毛枯槁，脾气弱而衰矣。舌上赤涩，口燥咽干，这是下利多亡阴所致。阴既已亡，火独旺，故心胸躁热，烦乱不宁。《内经》说：独阳不生，独阴不长，这是夭折的原因。于是辞别离去。换了一位医生，不审脉究源，只见痞满，用枳壳丸攻下，病情添喘满，利下不禁而死。《金匮要略》说：不当下而强下之，令人开肠洞泄，便溺不禁而死。正是这个意思。
石顽治疗内兄顾九玉，颁诏假道归吴，大暑中患胸痞颅胀，脉得虚大而濡，气口独显滑象，这是湿热泛滥于膈上也。给予清暑益气汤两剂，颅胀止而胸痞不除。给予半夏泻心汤减炮姜，去大枣加枳实，一服而愈。
家弟曾余，虽列贤书，最留心于医理。弟妇郑氏，乃世传女科中山之女，昆弟俱为时医。戊申夏患呕逆，不食者月余，服宽膈理气药二十余剂，几至绝粒，而痞胀异常。邀余诊之，脉得虚大而数。按仲景脉法云：大则为虚，数则为虚。此胃中阳气大虚，而浊阴填塞于膈上也。因取连理汤方，用人参三钱服之，四剂而痞止食进。后与异功散调理数日而康。
别驾吴蛟水公祖夫人，患痞眩呕逆，向因下体畏寒，肢肘麻瞀，久服八味丸、人参、附子不彻，六脉弦滑而按之则濡，这是中焦素蕴痰湿，阳气不能周于四末之象。得桂、附辛热之力有时虽可暂开，究非真阳之虚，且有地黄之滞，所以痞晕漫无止期。遂疏局方七气汤加沉香，一服豁然，再剂神爽食进而安。
内翰缪钧间尊大人子长老先生，青年罢职，乐志林泉，偶因小愤，遂眩晕痞闷，三月来服豁痰利气药不应，反觉疲倦，饮食日减，下元乏力，至七月下浣，邀石顽诊之。六脉似觉有余，指下略无冲和之气，气口独滞不调，时大时小，两尺俱濡大少力，这是素多痰湿，渐渍于水土二经，复加剥削之剂屡犯中气，疲倦少食，迨所必至。法当先调中气，输运水谷之精微，然后徐图温补下元。为疏六君子汤加当归兼调营血，庶无阳无以化之虞。其如夫人久患崩淋，遍服诸血药罔效，以补中益气汤加制香附、乌梅，升举其阳兼调其气。所谓病在下取之上，端不出古圣之成则耳。
Zhu Danxi stated: "Pi" (epigastric fullness/oppression) is synonymous with "Pǐ" (blockage), meaning lack of smooth flow. It arises from the latent retention of Yin and the accumulation of Yang, resulting in impaired circulation of Qi and Blood. The lesion is located at the "Xin Xia" (epigastrium/sub-xiphoid region), situated in the center of the body. Any condition characterized by a sensation of blockage and fullness belongs to disorders of the Earth element (Spleen/Stomach). There is a distinction in severity between Pi and Zhang Man (distension/fullness): Pi presents as an internal sensation of oppression without external signs of abdominal tension or rigidity.
Some cases result from chronic deficiency of Middle Qi, which fails to transport and transform essential nutrients; others arise from excessive use of digestive and purgative drugs that fail to relax and resolve food stagnation; still others are caused by excessive Damp-Heat, where Phlegm-Qi rebels upward into the Yang regions. Ancient formulas for treating Pi employ the bitter flavor of Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), and Zhi Shi (Aurantii Fructus Immaturus) to drain downward; the acrid flavor of Hou Po (Magnoliae Officinalis Cortex), Sheng Jiang (Zingiberis Rhizoma Recens), and Ban Xia (Pinelliae Rhizoma) to disperse; the sweet flavor of Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) to tonify; and the bland flavor of Fu Ling (Poria) and Ze Xie (Alismatis Rhizoma) to leach out dampness. Since Pi is treated similarly to Dampness, the Qi mechanism should be resolved through simultaneous upper and lower dispersion. If there are indeed signs of interior excess, mild resolving and guiding agents may be used.
People suffering from obstruction often prefer diuretic or purgative drugs for rapid effect. Although this provides temporary relief, if Pi recurs, the danger increases significantly. When Heaven and Earth Qi do not interact, Pi forms; this occurs when the Spleen's clear Qi fails to ascend and instead sinks, while the Stomach's turbid Qi fails to descend and instead rebels upward. One should use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Zhu Ling (Poria) and Ze Xie (Alismatis Rhizoma). This is because Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix) lift the clear Qi from below, while Zhu Ling and Ze Xie descend the turbid Qi from above, thereby transforming obstruction into smooth flow (Tai).
For various types of Pi obstruction and Ye Ge (dysphagia/pharyngeal obstruction), where Phlegm is stirred upward by Qi, and Qi is stagnant due to Phlegm coating, causing Phlegm and Qi to knot and preventing free flow, one should select from Lian Li Tang (Connected Spleen Decoction), Gan Jiang Huang Qin Huang Lian Ren Shen Tang (Ginger, Scutellaria, Coptis, and Ginseng Decoction), Huang Lian Tang (Coptis Decoction), or various Xie Xin Tangs (Drain the Epigastrium Decoctions). For Qi stagnation causing Pi distension, use Wu Ge Kuan Zhong San (Five Diaphragms Midsection-Widening Powder); if ineffective, switch to Ding Chen Tou Ge Tang (Cloves and Amber Throat-Penetrating Decoction). To address various Pi obstructions, distensions, chest-diaphragm discomfort, Qi rebellion, or abdominal pain, Zhi Mi Qi Qi Tang (Point-Mist Seven Qi Decoction) is suitable. Add Ren Shen and Bai Zhu for Stomach deficiency; Mu Xiang (Aucklandiae Radix) for Qi stagnation; Bing Lang (Arecae Semen) for constipation; Su Ye (Perillae Folium) for facial edema; and Mu Gua (Chaenomelis Fructus) for limb swelling. For Deficiency Pi, Ju Fang Qi Qi Tang (Formulary Seven Qi Decoction) and Ju Fang Wu Chen Er Tang (Formulary Black Pepper and Cypress Decoctions) are most effective.
For sudden Pi caused by anger, accompanied by facial edema, fullness of heart/abdomen/hypochondrium, difficult urination and defecation, and limb distension, use Zeng Sun Liu Qi Yin (Modified Flow-Qi Decoction). For cold Qi in the diaphragm, vomiting, inability to eat, regardless of Pi pain, first induce vomiting with fresh ginger juice, then administer medication. This method is especially suitable for Phlegm-Fluid retention. For Pi caused by pathogenic factors, dispersing agents are appropriate. However, if Qi fails to move smoothly and rebels upward causing Pi, this is Deficiency Pi; further dispersing will worsen the condition. Tonification should be primary, with only slight inclusion of dispersing intent, avoiding excessive use of aromatic Qi-regulating herbs. Ancients treated post-dysentery epigastric Pi using Li Zhong Wan (Regulate the Middle Pill), illustrating this principle.
If various Pi medications fail, bowel movements are blocked, and the pulse is rapid and forceful, select Xiao Xian Xiong Tang (Minor Chest-Trap Decoction) or San Huang Tang (Three Yellows Decoction). In severe cases, Bao Jian Mu Xiang Bing Lang Wan (Precious Mirror Aucklandia and Areca Pill) may be used for purgation. For obese patients with Phlegm-Pi and wind-constipation, Yu Yao Yuan Mu Xiang Bing Lang Wan (Imperial Pharmacy Aucklandia and Areca Pill) is used for dispersal. Obese patients with epigastric oppression have internal Damp-Phlegm; Er Chen Tang (Two-Cured Decoction) plus Zhi Shi, Huang Qin, and Huang Lian can be used, though Xiao Xian Xiong Tang is often more expedient. Thin patients with epigastric oppression have constrained Heat in the Middle Jiao; San Huang plus Zhi Shi guides it out. For epigastric Pi with unrelenting chills and fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Zhi Shi and Jie Geng (Platycodonis Radix) is indicated. If Pi results from catching wind-cold after eating, or from consuming cold foods, warm the middle and resolve stagnation using Er Chen Tang plus Sha Ren (Amomi Fructus), Zi Su (Perillae Folium), and Huo Xiang (Agastaches Herba), or Ping Wei San (Calm the Stomach Powder) plus Huo Xiang and Dou Kou (Tsaoko Fructus).
For deficient individuals with unresolved stagnation, epigastric Pi that varies in tightness, and a preference for hot substances, use Zhi Shi Li Zhong Tang (Immature Bitter Orange Regulate-Middle Decoction). For elderly or deficient persons with weak Spleen/Stomach, poor transportation, and food stagnation causing Pi, use Jiu Wei Zi Sheng Wan (Nine-Ingredient Nourishing-Life Pill); chew one pill when feeling full/distended, or use Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Mu Xiang, Sha Ren, Shan Zha (Crataegi Fructus), and Shen Qu (Massa Medicata Fermentata). For chest Qi blockage and shortness of breath, use Ju Pi Zhi Shi Sheng Jiang Tang (Tangerine Peel, Immature Bitter Orange, and Ginger Decoction). For alcohol accumulation and miscellaneous diseases where excessive purging damaged the Spleen, leading to Spleen deficiency and Pi, nourish the Stomach and harmonize Blood using Ren Shen, Bai Zhu, Dang Gui (Angelicae Sinensis Radix), and Bai Shao (Paeoniae Radix Alba) combined with Sheng Ma and Chai Hu, slightly assisted by Chen Pi (Tangerine Peel) and Zhi Ke (Aurantii Fructus).
Pi following intense anger, blood in phlegm, or a bloody taste in the mouth indicates Blood stasis. Use Mu Dan Pi (Moutan Cortex), Hong Qu (Red Yeast Rice), Xiang Fu (Cyperi Rhizoma), Jie Geng, Jiang Xiang (Dalbergiae Odoriferae Lignum), Hong Hua (Carthami Flos), Su Mu (Sappan Lignum), Shan Zha, Mai Ya (Hordei Fructus Germinatus), and Tong Bian (Human Urine). In severe cases, add Da Huang (Rhei Radix et Rhizoma) and Tao Ren (Persicae Semen). If Phlegm and Blood stasis form a "nest" causing Pi with a deep, choppy pulse and chronic duration, often seen in those with excessive grief and depression, treat as Blood Depression using Tao Ren, Hong Hua, Xiang Fu, Mu Dan Pi, and Jiu Zhi (Leek Juice).
The world universally prohibits Gan Cao (Licorice Root) for mid-fullness Pi, regardless of deficiency or excess. However, the ancient saying "do not consume sweet flavors for mid-fullness" refers specifically to Excess Fullness. If one feels full internally but lacks external abdominal distension, sweet-flavored tonics should be used.
[Diagnosis] A string-taut, rapid, and slippery pulse with sudden epigastric oppression indicates Liver Qi combined with Food Stagnation, representing an Excess pattern. A string-taut, deep-string-taut, choppy, or empty-large and powerless pulse, particularly prominent at the Qi Kou (Radial Artery at the wrist), indicates chronic Spleen/Stomach injury or overuse of harsh purgatives, representing a Deficiency pattern. Chest-diaphragm oppression with a deep-slippery or slow-slippy Cun Kou (Inch Position) pulse indicates stagnation.
Luo Qianfu treated a guest named Zhao from Zhending. In June, he suffered dampness injury from cooling off, presenting with epigastric fullness, intermittent irritability and heat, and restlessness. Lodging in a temple, a monk administered ten-plus pills of a purgative. After more than ten loose stools, the Pi slightly improved. The next day, exhausted and sleeping, he was robbed. His Heart spirit agitated, leading to irritability, heat, and thirst. He drank a cup of wine. That night, his umbilical and abdominal areas became painful. The monk administered the same purgative again, causing another ten-plus stools. The illness worsened severely: limbs were weak, irritability and heat persisted with restlessness, he craved cold water, rice and grains were undigested, dysentery resembled rotten fish intestines mixed with red water, he had no appetite, forced eating caused vomiting, Pi was worse than before, continuous belching occurred, feet were cold, and lower abdominal pain was unbearable. Pulse was floating and rapid (7-8 beats per breath), empty upon pressure. Luo said: Tracing the source, summer-heat had already injured healthy Qi. Using hot-toxic purgatives drained away all pathological material, leaving residual properties of E Ba Dou (Crotonis Fructus) and toxins in the intestines, causing vomiting and inability to eat, further injuring Stomach Qi. Subsequent profuse pus and blood discharge depleted flesh, dried skin and hair, and weakened Spleen Qi. Red and dry tongue, dry mouth and throat resulted from excessive loss of Yin fluids. With Yin exhausted, Fire flared alone, causing chest-heat and mental agitation. The Classic states: "Exclusive Yang does not generate, exclusive Yin does not grow; this is the cause of premature death." Luo declined further treatment. Another physician, failing to examine the pulse and trace the origin, saw only Pi and used Zhi Ke (Aurantii Fructus) pills to purge. The patient developed wheezing and fullness, uncontrollable diarrhea, and died. The *Jin Gui Yao Lue* states: "Purging when not indicated causes intestinal perforation and uncontrollable excretion," which applies here.
Shi Wan treated his brother-in-law Gu Jiuyu, who returned to Wu during an imperial decree. Suffering from chest Pi and cranial distension during extreme heat, his pulse was empty-large and soggy, with a slippery image exclusively at the Qi Kou. This indicated Damp-Heat flooding the Upper Jiao. Two doses of Qing Shu Yi Qi Tang (Clear Summerheat and Augment Qi Decoction) stopped the cranial distension but not the chest Pi. Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) was prescribed, reducing Pao Jiang (Prepared Ginger), removing Da Zao (Jujubae Fructus), and adding Zhi Shi. One dose cured him.
My younger brother, Zeng Yu, though literate, was deeply interested in medical theory. His wife, Ms. Zheng, came from a family of renowned gynecologists. Both brothers were contemporary physicians. In the summer of Wushen year, she suffered from vomiting and rebellion, unable to eat for over a month. After twenty-plus doses of broad-diaphragm Qi-regulating medicines, nearly starving, her Pi and distension became abnormal. I examined her pulse: empty, large, and rapid. According to Zhang Zhongjing's pulse methods: "Large indicates Deficiency; Rapid indicates Deficiency." This showed severe deficiency of Stomach Yang and filling of the Upper Jiao with turbid Yin. I prescribed Lian Li Tang using three qian of Ren Shen. After four doses, Pi ceased and appetite returned. She recovered after several days of regulation with Yi Gong San (Extraordinary Merit Powder).
Madam, wife of Vice Prefect Wu Jiaoshui, suffered from Pi, vertigo, vomiting, and rebellion. Previously, fearing cold in the lower body and numbness/confusion in limbs and elbows, she had long taken Ba Wei Wan (Eight-Ingredient Pill), Ren Shen, and Fu Zi (Aconiti Lateralis Radix Preparata) without complete resolution. Six pulses were string-taut and slippery, becoming soggy upon pressure. This indicated inherent Phlegm-Dampness in the Middle Jiao and Yang Qi failing to circulate to the extremities. While the acrid-hot power of Gui Zhi (Cinnamomi Ramulus) and Fu Zi could temporarily open blockages, it did not address true Yang deficiency, and the cloying nature of Di Huang (Rehmanniae Radix) meant Pi and vertigo would never cease. I prescribed Ju Fang Qi Qi Tang plus Chen Xiang (Aquilariae Lignum), which brought immediate relief. After two doses, spirit brightened, appetite returned, and she was calm.
Mr. Zi Lao, father of Honorary Hanlin Scholar Miao Junjian, retired young, enjoying forest and spring life. Due to minor anger, he suffered vertigo and Pi oppression. For three months, expectorant and Qi-moving medicines failed, causing fatigue and reduced diet, with weakness in the Lower Yuan. In late July, I examined him. Six pulses seemed sufficient but lacked harmonious energy at the fingertips. Qi Kou was stagnant and irregular, varying in size. Both Chi positions were soggy-large and weak. This indicated inherent Phlegm-Dampness infiltrating Water and Earth meridians, compounded by repeated purgative attacks on Middle Qi, inevitably leading to fatigue and poor intake. The method required first regulating Middle Qi to transport essence of grain and water, then gradually warming and tonifying the Lower Yuan. I prescribed Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Dang Gui to regulate Ying and Blood, avoiding the risk of "no Yang to transform." His wife suffered from prolonged metrorrhagia, unresponsive to various blood medicines. I used Bu Zhong Yi Qi Tang plus processed Xiang Fu and Wu Mei (Mume Fructus) to raise Yang and regulate Qi. This exemplifies "treating lower disease by taking from above," adhering strictly to ancient sage principles.