【歌】胸中满闷名为痞，外面殊无胀急形。食积结痰兼湿热，气虚不运病根深。
【论】痞者，否也，不通之意，由阴伏阳蓄，气血不运而成。处心下，位中央，填满痞塞，皆土之为病也，
然痞与胀有轻重之分。痞则内觉痞闷，而外无胀急之形也。有中气不足，不能运化者；有饮食痰结，不能施化
者；有湿热太甚而成者，当随证分消。虚者补中益气汤，不可峻剂攻之；实者略与疏导。昧者苟图一时通快，
喜行峻利，多致危殆也。
【脉】痞满滑大，痰火作孽。弦伏中虚，微涩衰劣。
中气不足
中气不足，不能运化精微而为痞闷，脉弱无力，不可用利药攻之，补中益气汤。久服中气充满，清道健运，
痞自除也。
补中益气汤（方见内伤。）
食积
饮食内伤，不能克化而痞者，枳术丸或保和丸，或枳桔二陈汤加神曲、麦芽、山楂。心下虚痞，按之痛者，
枳实消痞丸、黄连泻心汤。
枳术丸（方见脾胃。）
保和丸（方见伤食。）
枳桔二陈汤（方见脾胃。）
枳实消痞丸
枳实（一钱，炒） 山楂肉（一钱） 黄连（炒，一钱） 神曲（炒，一钱） 甘草（炙，一钱） 猪苓
（一钱） 泽泻（八分，去毛） 浓朴（姜汁拌炒，八分） 砂仁（八分，炒） 陈皮（一钱） 人参（一钱，
去芦） 黄芩（一钱，炒） 干姜（八分） 姜黄（八分） 白术（炒，一钱）
上未，蒸饼丸，梧子大，每服五十丸，食后白汤送下。
黄连泻心汤
黄连（一钱二分） 浓朴（一钱，制） 干姜（八分） 甘草（五分） 人参（八分） 白芍药（八分）
上锉，一剂，姜三片，水二钟，煎八分，空心热服。
湿热
湿热太甚而痞者，黄连泻心汤。有热，三黄泻心汤。火邪乘脾而痞者，二陈加黄连、黄芩、栝蒌。
黄连泻心汤（方见前。）
三黄泻心汤
大黄（三钱） 黄连（三钱） 黄芩（三钱）
上锉，一剂，水二盏，煎一盏，热服。
二陈汤（方见痰证。）
痰滞
痰气阻滞中州而为痞者，小陷胸汤，或枳桔二陈汤加黄
连、栝蒌、天花粉。痰气壅满，心胸痞满不宽，导痰汤。
小陷胸汤
半夏（六钱） 黄连（三钱） 栝蒌（小者一个，大者半个）
用水二钟，加生姜三片，先煎栝蒌，约钟半许，入半夏、黄连，煎至一钟，温服。
枳桔二陈汤（方见脾胃。）
导痰汤（方见痰证。）
【歌诀】胸部胀满憋闷称为“痞”，体表外部并没有肿胀急迫的形态。这是由饮食积滞、痰浊凝结兼夹湿热，以及气虚导致运化无力，使得病根深固所致。
【论述】“痞”字通“否”（pǐ），意为不通，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（胃脘部），处于人体中央，填满堵塞，都是脾土功能失常导致的病变。然而，“痞”与“胀”有轻重之分。“痞”只是内部感觉痞塞闷胀，而外部没有肿胀急迫的形态。其成因有中气不足、不能运化水谷精微的；有因饮食停滞、痰浊凝结、不能消化的；有因湿热过盛而形成的，应当根据证候分别消除。属于虚证的，用补中益气汤治疗，不可使用猛烈攻下的药剂；属于实证的，稍微给予疏导通利的方法。不明医理的人如果贪图一时的通畅舒适，喜欢使用峻猛利下的药物，往往会导致病情危重。
【脉象】痞满且脉象滑大，是痰火作祟的结果。脉象弦伏提示中气虚弱，脉象微涩则表明正气衰败恶劣。
中气不足
中气不足，无法运化精微物质而导致痞闷，脉象弱而无力，不可使用利尿或攻下的药物，应服用补中益气汤。长期服用使中气充盈，清气之道健运，痞闷自然消除。
补中益气汤（方剂见内伤篇。）
食积
饮食内伤，无法消化而导致痞闷的，可用枳术丸或保和丸，或者在枳桔二陈汤中加入神曲、麦芽、山楂。心下部位感觉虚痞，按压时疼痛的，可用枳实消痞丸、黄连泻心汤。
枳术丸（方剂见脾胃篇。）
保和丸（方剂见伤食篇。）
枳桔二陈汤（方剂见脾胃篇。）
枳实消痞丸
药材组成：枳实（一钱，炒制）、山楂肉（一钱）、黄连（炒制，一钱）、神曲（炒制，一钱）、甘草（炙制，一钱）、猪苓（一钱）、泽泻（八分，去毛）、浓朴（姜汁拌炒，八分）、砂仁（八分，炒制）、陈皮（一钱）、人参（一钱，去芦头）、黄芩（一钱，炒制）、干姜（八分）、姜黄（八分）、白术（炒制，一钱）。
将上述药材研为细末，用蒸饼糊制作成梧桐子大小的丸药，每次服用五十丸，饭后用白开水送服。
黄连泻心汤
药材组成：黄连（一钱二分）、浓朴（一钱，炮制）、干姜（八分）、甘草（五分）、人参（八分）、白芍药（八分）。
将上述药材切碎为一剂，加生姜三片，水两钟（约400-500毫升），煎煮至剩余八分（约300-400毫升），空腹时热服。
湿热
因湿热过盛而导致痞闷的，用黄连泻心汤。如果有热象明显的，用三黄泻心汤。火邪侵犯脾脏而导致痞闷的，在二陈汤基础上加入黄连、黄芩、栝蒌。
黄连泻心汤（方剂见前文。）
三黄泻心汤
药材组成：大黄（三钱）、黄连（三钱）、黄芩（三钱）。
将上述药材切碎为一剂，水两盏，煎煮至一盏，热服。
二陈汤（方剂见痰证篇。）
痰滞
痰气阻滞中焦（脾胃）而导致痞闷的，用小陷胸汤，或者在枳桔二陈汤中加入黄连、栝蒌、天花粉。痰气壅盛满闷，心胸痞满不舒展的，用导痰汤。
小陷胸汤
药材组成：半夏（六钱）、黄连（三钱）、栝蒌（小的一个，大的半个）。
用水两钟，加生姜三片，先煎栝蒌，煎至约钟半（约300毫升左右），再加入半夏、黄连，煎煮至一钟（约200-250毫升），温服。
枳桔二陈汤（方剂见脾胃篇。）
导痰汤（方剂见痰证篇。）
[Verse]
Fullness and stifling sensation in the chest are termed "Pi" (Pì, obstruction). There is no external appearance of distension or urgency. This condition arises from food stagnation, phlegm accumulation, combined with damp-heat, and deep-rooted disease due to Qi deficiency failing to transport and transform.
[Dissertation]
"Pì" shares its meaning with "Pǐ" (obstruction), signifying blockage. It is formed by the lurking of Yin and the accumulation of Yang, resulting in the failure of Qi and Blood to circulate. The location is at the epigastrium (Xin Xia), situated in the center of the body. Fullness and blockage here are diseases attributed to the Earth element (Spleen/Stomach). However, there is a distinction in severity between Pi (obstruction) and Zhang (distension). Pi involves an internal sensation of fullness and stifling without external signs of distension or urgency. Etiologies include: insufficiency of Middle Qi failing to transport and transform; retention of food and phlegm failing to digest; and excess damp-heat. Treatment should be based on differentiating the syndrome for resolution. For deficiency patterns, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); do not use harsh purgatives. For excess patterns, provide mild guiding and draining methods. Unskilled practitioners who seek temporary relief through harsh, draining medicines often lead to critical danger.
[Pulse]
Pi-fullness with slippery and large pulses indicates Phlegm-Fire causing mischief. Wiry and hidden pulses suggest Middle Qi deficiency; fine and choppy pulses indicate decline and deterioration.
Insufficiency of Middle Qi
Insufficiency of Middle Qi fails to transport and transform essential substances, leading to Pi-stifling. The pulse is weak and powerless. Do not use draining or purgative medicines. Administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Long-term use fills the Middle Qi, strengthens the clear pathways, and eliminates Pi naturally.
Buzhong Yiqi Tang (See Internal Injury section.)
Food Stagnation
For Pi caused by internal injury from diet and inability to digest, use Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) or Baohe Wan (Preserve Harmony Pill), or Zhijie Erchen Tang (Immature Bitter Orange, Tangerine Peel, and Two-Aged Decoction) added with Shenqu (Medicated Leaven), Maiya (Germinated Hordeum Fructus), and Shanzha (Crataegi Fructus). For empty Pi at the epigastrium that is painful upon pressure, use Zhishi Xiaopi Wan (Immature Bitter Orange Decrementing Pi Pill) or Huanglian Xiexin Tang (Coptis Decoction Draining the Heart).
Zhizhu Wan (See Spleen and Stomach section.)
Baohe Wan (See Food Injury section.)
Zhijie Erchen Tang (See Spleen and Stomach section.)
Zhishi Xiaopi Wan (Immature Bitter Orange Decrementing Pi Pill)
Ingredients: Zhishi (Fructus Aurantii Immaturus, 1 qian, stir-fried), Shanzha Rou (Sarcocarpus Crataegi, 1 qian), Huanglian (Rhizoma Coptidis, 1 qian, stir-fried), Shenqu (Massa Medicata Fermentata, 1 qian, stir-fried), Gancao (Radix Glycyrrhizae, 1 qian, honey-fried), Zhuling (Polyporus, 1 qian), Zexie (Rhizoma Alismatis, 8 fen, dehusked), Houpo (Cortex Magnoliae Officinalis, 8 fen, stir-fried with ginger juice), Sharen (Fructus Amomi Rotundus, 8 fen, stir-fried), Chenpi (Pericarpium Citri Reticulatae, 1 qian), Renshen (Radix Ginseng, 1 qian, radix removed), Huangqin (Scutellariae Radix, 1 qian, stir-fried), Ganjiang (Rhizoma Zingiberis Recens, 8 fen), Jianghuang (Rhizoma Curcumae Longae, 8 fen), Baizhu (Rhizoma Atractylodis Macrocephalae, 1 qian, stir-fried).
Grind the above into powder, make pills using steamed bread paste, size of Sophora japonica seeds. Take 50 pills per dose, administered after meals with warm water.
Huanglian Xiexin Tang (Coptis Decoction Draining the Heart)
Ingredients: Huanglian (Rhizoma Coptidis, 1.2 qian), Houpo (Cortex Magnoliae Officinalis, 1 qian, processed), Ganjiang (Rhizoma Zingiberis Recens, 8 fen), Gancao (Radix Glycyrrhizae, 5 fen), Renshen (Radix Ginseng, 8 fen), Baishao (Radix Paeoniae Rubra, 8 fen).
Cut into pieces for one dose. Add 3 slices of fresh ginger, 2 zhong (approx. 400-500 ml) of water, decoct to 0.8 zhong. Take hot on an empty stomach.
Damp-Heat
For Pi caused by excessive damp-heat, use Huanglian Xiexin Tang (Coptis Decoction Draining the Heart). If heat is prominent, use Sanhuang Xiexin Tang (Three Yellows Decoction Draining the Heart). For Pi caused by Fire Evil invading the Spleen, use Erchen Tang (Two-Aged Decoction) added with Huanglian, Huangqin, and Gualou.
Huanglian Xiexin Tang (See previous section.)
Sanhuang Xiexin Tang (Three Yellows Decoction Draining the Heart)
Ingredients: Dahuang (Rhei Radix et Rhizoma, 3 qian), Huanglian (Rhizoma Coptidis, 3 qian), Huangqin (Scutellariae Radix, 3 qian).
Cut into pieces for one dose. Add 2 zhan (approx. 400 ml) of water, decoct to 1 zhan. Take hot.
Erchen Tang (See Phlegm Syndrome section.)
Phlegm Stasis
For Pi caused by Phlegm-Qi blocking the Middle Jiao, use Xiao Xianxiong Tang (Minor Intrapleural Decoction), or Zhijie Erchen Tang (Immature Bitter Orange, Tangerine Peel, and Two-Aged Decoction) added with Huanglian, Gualou, and Tianhuafen. For Phlegm-Qi congestion and fullness causing stifling and lack of expansion in the chest and heart, use Daotan Tang (Great Phlegm Decoction).
Xiao Xianxiong Tang (Minor Intrapleural Decoction)
Ingredients: Banxia (Rhizoma Pinelliae Ternatae, 6 qian), Huanglian (Rhizoma Coptidis, 3 qian), Gualou (Fructus Trichosanthis, one small or half a large).
Add 2 zhong of water and 3 slices of fresh ginger. First decoct Gualou until approximately 1.5 zhong remains. Then add Banxia and Huanglian, decoct to 1 zhong. Take warm.
Zhijie Erchen Tang (See Spleen and Stomach section.)
Daotan Tang (See Phlegm Syndrome section.)