或问痞属何脏？邪属何气？曰尝考之《内经》，有阳明之复，心痛痞满者。注以
清甚于内，热郁于外。太阳之复，心胃生寒，心痛痞闷者。注以心气内燔。备化之
纪，病痞。卑监之纪，留满痞塞。太阴所至，为积饮否隔。注皆以阴胜阳也。由是
观之，则是受病之脏者，心与脾也。因而怫郁壅塞不通为痞者，火与湿也。其论致
病所由之邪，则不可一言而尽。天气之六淫外感，人气之五邪相乘，阴阳之偏负，
饮食七情之过节，皆足以乱其火土之气。盖心、阳火也，主血。脾、阴土也，主湿。
凡伤其阳则火怫郁而血凝，伤其阴则土壅塞而湿聚，二脏之病，相去不离方寸间，
至于阴阳之分，施治之法，便不可同也。何则？《金匮要略》水病篇谓∶心下坚大如
盘，边如旋杯，水饮所作者，二条同是语也。但一条之上有气分二字，用桂枝去芍
药，加麻黄附子细辛汤，治为水寒之邪闭结，气海之阳不布，荣卫不行。一条用枳
术汤，为中焦水停土壅故也。又胸痹篇云∶胸痹心下痞，留气结在胸，胸满，胁下
逆抢心，枳实薤白桂枝汤主之。人参汤亦主之。一证列二方，原其意盖是留气结在
胸为重者，便须补中。又心中痞，诸逆心悬痛，桂枝生姜枳实汤主之。《伤寒论》中，
有谓病患手足厥冷，脉作紧，邪结在胸中者，当吐之。脉浮大，心下反硬，有热属
脏者，下之。兹二者为不汗下而痞满，从其邪有高下，故吐下之不同。若经汗下而
心下痞，则以诸泻心汤。大抵痞与结胸，同是满硬，但结胸则涌治，岂非仲景治痞
亦在心脾二脏，从火土之阴阳者欤，各适其宜而治。高者越之，下者竭之，上气不
足推而扬之，下气不足温而行之。高者抑之，下者举之，郁者开之，结者解之，寒
者热之，热者寒之，虚则补，实则泻，随机应变以为治。东垣云∶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
为寒伤其荣，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。盖因先错下必成痞证，是邪气将陷而欲过胸中，故先用
截，散其邪气，使不至于痞。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，则致心
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，因而越之也。海藏云∶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，
虽俱为血证，然伤寒之证从外至内，从有形至无形，故无形气证，以苦泄之，有形
血证，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。主方，黄
补中汤加柴胡、升麻。缘天地不交为痞，今以猪苓、泽泻从九天之上而降，柴胡、
升麻从九地之下而升，则可以转否而为泰矣。无形气证，以苦泄之，枳实、黄连之
类，大消痞丸、黄连消痞丸、失笑丸。有形血证，以辛甘散之，枳实理中丸、人参
汤、半夏泻心汤。伤寒五六日，不论以下未下，心下痞满，泻心汤、小柴胡汤加枳、
桔主之。少阴面赤下利，心下痞，泻心汤加减例，易老单用泻心汤，用钱氏法。
后随症加减。烦者加山栀，躁加香豉，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。痞而头目不清者，以上清散主之。胸中不利者，悉利于表。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。若酒积杂病下之太过，亦作痞满，宜升
提胃气，以血药兼之。湿者，四肢困重，小便短，宜平胃和五苓以渗之。郁者，越
鞠丸。热则烦渴溺赤，以苦寒泄之，大消痞丸。（煎汤用黄连，及葛根、升麻发之。）便结即利
之。寒则中清，以辛甘散之，枳实理中丸，挝脾汤加丁香，或丁沉透膈汤。戴复庵
以诸痞塞及噎膈，乃是痰为气所激而上气，又为痰所隔而滞，痰与气搏不能流通，
并宜用二陈汤加枳实、砂仁、木香，或木香流气饮入竹沥、姜汁服。因七气所伤，
结滞成疾，痞塞满闷，宜四七汤或导痰汤加木香半钱，或下来复丹。脾胃弱而转运
不调为痞，宜四君子汤。伤于劳倦者，补中益气汤，大病后元气未复而痞者，亦宜
之。脉之右关多弦，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，木香顺气汤。挟死血者，多用牡丹皮、江西红曲、麦芽（炒研）、香附（童便制）、桔
梗、川通草、穿山甲、番降香、红花、山楂肉、苏木各钱许，酒、童便各一钟煎。
甚者加大黄，临服入韭汁、桃仁泥。此方一应大怒之后作痞者，皆可服。
【胸痹】心下满而不痛为痞，心下满而痛为胸痹。《金匮》方，胸痹，胸中气塞，短气，
茯苓杏仁甘草汤主之。橘枳姜汤主之。胸痹缓急者，薏苡仁附子散主之。（此二条不言痛）
支饮胸满者，枳朴大黄汤主之。（不言痹）胸痹之病，喘息咳唾，胸背痛，短气，寸口脉
沉而迟，关上小紧数者，以栝蒌薤白白酒汤主之。胸痹不得卧，心痛彻背，栝蒌薤
白半夏汤主之。胸痹心中痞，留气结在胸，胸满胁下逆抢心，枳实薤白桂枝汤主之。
人参汤亦主之。一味栝蒌，取子熟炒，连皮或煎或丸，最能荡涤胸中垢腻。
有人问：痞证属于哪一脏？邪气属于哪一气？回答说：我曾考证《黄帝内经》，其中有“阳明之复”（阳明燥金之气复旺），出现心痛、痞满的症状。注释解释为：内部清冷过甚，外部热邪郁结。“太阳之复”（太阳寒水之气复旺），心胃产生寒邪，出现心痛、痞闷的症状。注释解释为：心气在内燔灼。“备化之纪”（土运平和之年），疾病表现为痞。“卑监之纪”（土运不及之年），出现留滞、胀满、痞塞不通。“太阴所至”（太阴湿土司天或在泉之时），表现为积饮、否隔（气机闭塞不通）。这些注释都归结为阴胜阳衰。由此看来，受病的脏腑是心和脾。导致怫郁壅塞不通而形成痞证的邪气，是火与湿。论述致病的原因，不能一言以蔽之。天气的六淫（风、寒、暑、湿、燥、火）外感，人气的五邪（虚邪、实邪、贼邪、微邪、正邪）相乘，阴阳的偏盛偏衰，饮食不节和七情（喜、怒、忧、思、悲、恐、惊）过度，都足以扰乱火（心）土（脾）之气。大概心属阳火，主血；脾属阴土，主湿。凡是损伤其阳气，则火被郁遏而血液凝滞；损伤其阴气，则土被壅塞而湿气聚积。这两脏的病，相距不过方寸之间（指位置相近或关系密切），至于阴阳的区别，施治的方法，就不能相同了。为什么呢？《金匮要略》水病篇说：心下坚硬如盘，边缘像倒扣的杯子，这是水饮所致的病。两条条文虽然描述相似，但第一条上面有“气分”二字，用桂枝去芍药加麻黄附子细辛汤治疗，这是针对水寒之邪闭结，气海之阳不能布散，营卫运行不畅的情况。另一条用枳术汤治疗，是因为中焦水液停聚、土气壅塞的缘故。又在胸痹篇中说：胸痹伴有心下痞，留气结在胸中，胸部胀满，胁下有气逆冲心胸，用枳实薤白桂枝汤主治。人参汤也可以主治。一个病症列出两个方剂，推究其用意，大概是留气结在胸中较重的情况，就需要补益中气。又有心中痞，各种逆气上冲导致心部悬痛，用桂枝生姜枳实汤主治。《伤寒论》中，有说患者手足厥冷，脉象紧，邪气结在胸中的，应当用吐法。脉象浮大，心下反而硬，有热邪属于脏的，应当用下法。这二者是不通过汗法和下法就能解决的痞满，根据邪气的高下不同，所以吐法和下法也不同。如果是经过汗法或下法之后出现的心下痞，就用各种泻心汤。大致来说，痞证和结胸证，都是满硬的症状，但结胸证需要用涌吐法治之，这难道不是张仲景治疗痞证也是针对心脾两脏，依据火土的阴阳属性来治疗吗？各自适合其宜而治。高的病位用越法（吐法）祛除，低的病位用竭法（下法）清除，上气不足就推扬它，下气不足就温通它。高的病位用抑法降逆，低的病位用举法升提，郁结的就开泄它，凝结的就解散它，寒的用热药治，热的用寒药治，虚的就补益，实的就泻除，随机应变进行治疗。李东垣说：所谓痞，就是心下胀满但不疼痛。太阴属湿，主壅塞，是土气上乘于心下导致痞满。伤寒过早使用下法也会形成痞证，这是因为寒邪伤了营血，营即血，心主血，邪气侵入根本，所以导致心下痞闷。张仲景设立了几首泻心汤，都用黄连来泻心下的土邪，效果如附子反应鼓槌一样迅速。所以《活人书》说：确认是痞证后，先用桔梗枳壳汤，并不是专门用来治疗痞证的。而是因为先前误用下法必然形成痞证，此时邪气将要陷入且欲越过胸中，所以先用此方截断并疏散邪气，使其不至于形成痞证。“先”这个字，意思是早用。如果已经形成痞证再用它，那就晚了。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。经书说：观察邪气所在的位置而调治它，正是说的这个意思。不仅仅是伤寒如此，至于酒积等杂病因下法太过，也造成痞伤。因为下法多用会亡失阴液，亡阴是指脾胃水谷之阴亡失。所以胸中之气因虚而下陷到心的分野，导致心下痞，应当提升胃气，配合血药一起使用。如果全用气药引导，那么痞证会更加严重，严重时再下之，气会更下降，必定变为中满膨胀，都不是正确的治疗方法。又有虚实之分，如实证痞满伴大便闭结的，用浓朴枳实汤主治。虚证痞满伴大便通畅的，用白芍陈皮汤主治。如因饮食所伤导致的痞闷，应当消食导滞，去除胸中的窒塞。气机上逆、恶心欲吐的，就用吐法，这就是所说的“在上者，因而越之”。张元素（海藏）说：治疗痞证唯独要补益中州脾土，用血药治疗，这种方法无以复加了。伤寒引起的痞证从血中来，杂病引起的痞证也从血中来，虽然都属于血证，但伤寒的病证是从外入内，从有形到无形，所以对于无形的氣证，用苦味药泄之；对于有形的血证，用辛甘药散之。中满的人不要吃甘味食物，不满的人则可以食用。中满是指腹胀。如果自觉胀满但外表没有腹胀的形状，就不是中满，而是“不满”。不满是指病邪，可以用甘味药治疗。主方是黄耆补中汤加柴胡、升麻。因为天地不交泰导致痞证，现在用猪苓、泽泻从九天之上而降，柴胡、升麻从九地之下而升，就可以转否卦为泰卦了。无形的氣证，用苦味药泄之，如枳实、黄连之类，大消痞丸、黄连消痞丸、失笑丸。有形的血证，用辛甘药散之，枳实理中丸、人参汤、半夏泻心汤。伤寒五六天，不论是否用过下法，心下痞满，用泻心汤、小柴胡汤加枳实、桔梗主治。少阴病面赤下利，心下痞，用泻心汤加减，易老（张元素）单用泻心汤，采用钱氏（钱乙）的方法，随后随症加减。心烦的加山栀，躁动的加香豉，呕吐的加半夏，胀满的加枳实、浓朴，腹痛的加芍药，脉迟的加附子，下焦寒的加干姜，大便硬的加大黄。如果使用姜、附，先煎煮至熟，使热力不僭越，后加黄连同用。痞证伴有头目不清的，以上清散主治。胸中不利的，全部利于表散。饮食伤脾导致的痞闷，轻的用大消痞丸、枳术丸、回金丸之类。严重的轻微下之、吐之。下法的用槟榔丸、煮黄丸。吐法的用二陈汤及瓜蒂散探吐。如果是酒积杂病因下法太过，也造成痞满，应当提升胃气，配合血药使用。湿盛的，四肢困重，小便短少，用平胃散合五苓散以利渗之。郁结的，用越鞠丸。热的则烦渴尿赤，用苦寒药泄之，用大消痞丸。（煎汤时用黄连，以及葛根、升麻发之。）便秘的就通便。寒的则中焦清冷，用辛甘药散之，用枳实理中丸，挝脾汤加丁香，或丁沉透膈汤。戴复庵认为各种痞塞及噎膈，乃是痰被气激而上逆，又被痰阻隔而停滞，痰与气搏结不能流通，都适宜用二陈汤加枳实、砂仁、木香，或木香流气饮加入竹沥、姜汁服用。因七气所伤，结滞成疾，痞塞满闷，适宜用四七汤或导痰汤加半钱木香，或下来复丹。脾胃虚弱而转运不调导致痞证，适宜用四君子汤。因劳倦所伤的，用补中益气汤，大病后元气未恢复而痞的，也适宜用此方。脉象右关多弦，弦而迟的，必定心下坚硬，这是肝木克脾土，郁结涎液闭塞于脏腑，气不舒则痞，用木香顺气汤。挟死血的，多用牡丹皮、江西红曲、麦芽（炒研）、香附（童便制）、桔梗、川通草、穿山甲、番降香、红花、山楂肉、苏木各一钱左右，用酒、童便各一杯煎煮。严重的加大黄，临服时加入韭汁、桃仁泥。此方凡是大怒之后发生痞证的，都可以服用。
【胸痹】心下胀满但不疼痛叫痞，心下胀满且疼痛叫胸痹。《金匮要略》方剂中，胸痹，胸中气塞，短气，用茯苓杏仁甘草汤主治。橘枳姜汤主治。胸痹发作有时缓急的，用薏苡仁附子散主治。（这两条条文没说疼痛）支饮导致胸满的，用枳朴大黄汤主治。（没说痹痛）胸痹的病，喘息咳唾，胸背痛，短气，寸口脉沉而迟，关上脉小紧数，用栝蒌薤白白酒汤主治。胸痹不能平卧，心痛彻背，用栝蒌薤白半夏汤主治。胸痹心中痞，留气结在胸中，胸满胁下有气逆冲心胸，用枳实薤白桂枝汤主治。人参汤也可以主治。一味栝蒌，取种子熟炒，连皮煎煮或制成丸剂，最能荡涤胸中的垢腻。
Someone asked: Which Zang organ does the Pi syndrome (epigastric fullness and stuffiness) belong to? Which Qi does the pathogen belong to? The answer is: I have examined the *Huangdi Neijing* (Yellow Emperor's Inner Canon), which mentions "Yangming Fui" (rebound of Yangming dryness-metal Qi), presenting with heart pain and Pi. The commentary explains this as internal excessive cold and external heat stagnation. It also mentions "Taiyang Fui" (rebound of Taiyang cold-water Qi), presenting with cold in the heart and stomach, heart pain, and Pi. The commentary explains this as heart Qi burning internally. In the "Bihua Ji" (year of balanced earth Qi), the disease is Pi. In the "Beijian Ji" (year of deficient earth Qi), there is retention, fullness, and Pi obstruction. When "Taiyin" (Taiyin damp-earth Qi) arrives, it manifests as fluid accumulation and obstruction. All these commentaries attribute it to Yin prevailing over Yang. From this, we can see that the affected organs are the Heart and Spleen. The pathogens causing Fu Yu (depression and obstruction) leading to Pi are Fire and Dampness. Discussing the causes of disease cannot be summarized in one sentence. External contraction of the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) from Heaven, mutual overcoming of the Five Pathogens (Deficiency, Excess, Thief, Minor, Proper) from Humanity, imbalance of Yin and Yang, excess in diet and Seven Emotions (Joy, Anger, Worry, Thought, Grief, Fear, Fright) all suffice to disturb the Fire (Heart) and Earth (Spleen) Qi. Generally, the Heart belongs to Yang Fire and governs Blood; the Spleen belongs to Yin Earth and governs Dampness. Any injury to Yang leads to Fire depression and Blood coagulation; any injury to Yin leads to Earth obstruction and Dampness accumulation. The diseases of these two organs are close to each other (within a square inch), but regarding the distinction of Yin and Yang, the treatment methods cannot be the same. Why? The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) chapter on Water Disease states: Hardness below the heart like a plate, with edges like an inverted cup, is caused by fluid retention. Although the descriptions in two clauses are similar, the first clause has the term "Qi Fen" (Qi division) above it, treated with Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Aconite, and Cinnabar Root Decoction). This treats water-cold pathogen closure, where the Yang of the Qi Sea cannot distribute, and Ying and Wei (Nutritive and Defensive Qi) do not circulate. The second clause uses Zhizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction) because of water retention and Earth obstruction in the Middle Jiao. Also, in the Chest Bi chapter: Chest Bi accompanied by Pi below the heart, retained Qi knotting in the chest, chest fullness, and Qi counterflow rushing to the heart, is primarily treated with Zhishi Yebai Guizhi Tang (Immature Bitter Orange, White Melon Seed, and Cinnamon Twig Decoction). Renshen Tang (Ginseng Decoction) is also indicated. One syndrome lists two formulas; inferring the intent, when retained Qi knotting in the chest is severe, tonifying the Middle Jiao is necessary. There is also Pi in the heart, various counterflows causing hanging pain in the heart, primarily treated with Guizhi Shengjiang Zhishi Tang (Cinnamon Twig, Ginger, and Immature Bitter Orange Decoction). In the *Shanghan Lun* (Treatise on Cold Damage), it is said that if patients have cold hands and feet, a tight pulse, and pathogen knotting in the chest, vomiting should be induced. If the pulse is floating and large, and the area below the heart is hard with heat belonging to the Zang, purging should be used. These two cases involve Pi and fullness without sweating or purging initially; depending on the high or low position of the pathogen, vomiting or purging is chosen differently. If Pi below the heart occurs after sweating or purging, various Xiexin Tangs (Drain the Epigastrium Decoctions) are used. Generally, Pi and Jie Xiong (Knotting in the Chest) both present with fullness and hardness, but Jie Xiong requires Yong Zhi (surge treatment/vomiting). Is it not that Zhang Zhongjing's treatment of Pi also focuses on the Heart and Spleen, treating according to the Yin-Yang of Fire and Earth, adapting to each situation? High positions are cleared by Yue (vomiting), low positions by Jie (purging); insufficient Upper Qi is pushed up, insufficient Lower Qi is warmed and circulated. High positions are suppressed, low positions are lifted, depression is opened, knots are resolved, cold is treated with heat, heat is treated with cold, deficiency is tonified, excess is drained, and treatment varies with circumstances. Li Dongyuan said: Pi refers to fullness below the heart without pain. Taiyin is Dampness, governing obstruction; it is Earth Qi rising to the heart causing Pi. Early purging in Shanghan can also cause Pi, as cold damages Ying (Blood); the Heart governs Blood, so pathogen entering the root causes Pi below the heart. Zhang Zhongjing established several Xiexin Tangs, all using Huanglian (Coptis Rhizome) to drain Earth pathogen in the heart, effective as quickly as a drumstick striking a gong. Thus, the *Renwu Shu* says: Once Pi is confirmed, use Jiegeng Zhike Tang (Platycodon and Aurantium Decoction) first, not specifically to treat Pi, but because premature purging inevitably leads to Pi, where pathogen is about to sink and pass through the chest. Using it first intercepts and disperses the pathogen, preventing Pi. "First" implies early use. If used after Pi is formed, it is too late, damaging Zheng Qi (Upright Qi) in the chest without resolving Pi; then Zhongjing's Pi medicines should be used. The classics say: Observe the location of the pathogen and regulate treatment accordingly. This applies not only to Shanghan but also to Jiuzhi (wine accumulation) and miscellaneous diseases where excessive purging causes Pi injury. Purging often destroys Yin, meaning the Yin of Spleen-Stomach food and fluids is lost. Thus, Qi in the chest sinks due to deficiency into the Heart's territory, causing Pi. One should raise Stomach Qi combined with Blood medicines. Using only Qi-moving drugs worsens Pi; further purging lowers Qi more, leading to Zhongman (middle fullness/bloating), which is incorrect treatment. There are also differences between excess and deficiency. Excess Pi with constipation is treated with Nongpu Zhishi Tang (Magnolia Bark and Immature Bitter Orange Decoction). Deficiency Pi with loose stools is treated with Baishao Chenpi Tang (White Peony Root and Tangerine Peel Decoction). Pi due to food injury requires digestion and guiding out, removing chest obstruction. If Qi rebels with nausea, induce vomiting ("Above, therefore vomit"). Zhang Yuansu (Haizang) said: Treating Pi solely benefits the Central Earth (Spleen), using Blood medicines; no method surpasses this. Shanghan Pi comes from Blood; miscellaneous disease Pi also comes from Blood. Both are Blood syndromes, but Shanghan moves from exterior to interior, from substantial to insubstantial. Therefore, insubstantial Qi syndromes are drained with bitter drugs; substantial Blood syndromes are dispersed with acrid-sweet drugs. Those with Zhongman should avoid sweet foods; those without can eat them. Zhongman means abdominal distension. Self-perceived fullness without external distension is not Zhongman, but "Bu Man" (not full). Bu Man refers to pathology, treatable with sweet drugs. Main formula: Huangqi Buzhong Tang (Astragalus Tonify the Middle Decoction) plus Chaihu (Bupleurum Root) and Shengma (Cimicifuga Rhizome). Since Pi results from Heaven and Earth not interacting, using Zhu Ling (Polyporus) and Zexie (Alisma Rhizome) descending from heaven, and Chaihu, Shengma ascending from earth, transforms Pi (obstruction) into Tai (peace). Insubstantial Qi syndromes are drained with bitter drugs, e.g., Zhishi (Immature Bitter Orange), Huanglian; formulas include Da Xiao Pi Wan (Great Eliminate Pi Pill), Huanglian Xiao Pi Wan, Shixiao Wan. Substantial Blood syndromes are dispersed with acrid-sweet drugs, e.g., Zhishi Lizhong Wan, Renshen Tang, Banxia Xiexin Tang. After 5-6 days of Shanghan, regardless of prior purging, for Pi below the heart, use Xiexin Tang or Xiaochaihu Tang (Minor Bupleurum Decoction) plus Zhishi and Jiegeng. Shaoyin syndrome with red face and diarrhea, Pi below the heart, use Xiexin Tang modifications; Yi Lao (Zhang Yuansu) uses Xiexin Tang alone, following Qian Shi's (Qian Yi) method, modifying based on symptoms. Add Zhizi (Gardenia Fruit) for vexation, Douchi (Fermented Soybean) for restlessness, Banxia (Pinellia Tuber) for vomiting, Zhishi and Nongpu for fullness, Shaoyao for abdominal pain, Fuzi (Aconite Lateral Root) for slow pulse, Ganjiang (Dried Ginger) for lower Jiao cold, Dahuang (Rhubarb Root) for hard stool. If using Jiang (Ginger) and Fuzi, boil thoroughly first to prevent excessive heat, then add Huanglian. For Pi with unclear head and eyes, use Shangqing San (Upper Clearing Powder). For chest obstruction, benefit the exterior. For food-injury Pi, mild cases use Da Xiao Pi Wan, Zhizhu Wan, Huijin Wan. Severe cases require mild purging or vomiting. Purging uses Binglang Wan (Areca Seed Pill), Zhu Huang Wan. Vomiting uses Erchen Tang (Two-Cured Decoction) and Gouti San (Melon Spicule Powder) to induce vomiting. For wine-accumulation/miscellaneous disease Pi from excessive purging, raise Stomach Qi with Blood medicines. For Dampness with heavy limbs and scanty urine, use Pingwei San (Regulate the Stomach Powder) combined with Wuling San (Five-Ling Powder) to leach. For Depression, use Yueju Wan (Resolve Depression Pill). For Heat with vexation, thirst, and dark urine, drain with bitter-cold drugs, e.g., Da Xiao Pi Wan (boil with Huanglian, Gegen (Pueraria Root), and Shengma to release). For constipation, purge. For Cold with clear middle, disperse with acrid-sweet drugs, e.g., Zhishi Lizhong Wan, Zhuopi Tang plus Dingxiang (Caryophylli Flos), or Dingchen Touge Tang. Dai Funan stated that various Pi obstructions and Yige (dysphagia) are caused by Phlegm agitated by Qi rising, blocked by Phlegm stagnation, with Phlegm and Qi clashing. Treat all with Erchen Tang plus Zhishi, Sharen (Amomi Fructus), Muxiang (Aucklandiae Radix), or Muxiang Liuqi Yin plus Zhuli (Bamboo Juice) and Jiangzhi (Ginger Juice). For injuries from Seven Qi causing stagnation and Pi fullness, use Siqi Tang or Daotan Tang plus half a qian of Muxiang, or Xiailai Dan. For Pi due to weak Spleen-Stomach and poor transport, use Sijunzi Tang (Four Gentlemen Decoction). For Pi due to fatigue, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for Pi after major illness with unrecovered Yuan Qi, use the same. Right Guan pulse often wiry; wiry and slow indicates hardness below the heart, Liver Wood overcoming Spleen Earth, stagnation blocking viscera, Qi not smoothing causing Pi; use Muxiang Shunqi Tang. For attached dead blood, use much Mudanpi (Moutan Cortex), Jiangxi Hongqu (Red Yeast Rice), Maiya (Hordei Fructus Germinatus, fried and ground), Xiangfu (Cyperi Rhizoma, processed with child's urine), Jiegeng, Chuantongcao (Tetrapanacis Medulla), Chuanshanjia (Manis Squama), Fanjiangxiang (Dalbergiae Odoriferae Lignum), Honghua (Carthami Flos), Shanzha Rou (Crataegi Fructus), Sumu (Pterocarpus Indicus Lignum), each approx. 1 qian, decocted with wine and child's urine. Severe cases add Dahuang; add Leizhi juice and Taoren paste before administration. This formula is suitable for Pi arising after great anger.
[Chest Bi] Fullness below the heart without pain is Pi; fullness with pain is Chest Bi. In *Jingui*, for Chest Bi with chest Qi obstruction and shortness of breath, use Fuling Xingren Gancao Tang (Poria, Apricot Seed, and Licorice Decoction). Juqi Jiang Tang (Citrus, Immature Bitter Orange, and Ginger Decoction) is also indicated. For Chest Bi with alternating severity, use Yiyiren Fuzi San (Coix Seed and Aconite Powder). (These two clauses do not mention pain.) For Zhī Yin (branching fluid) causing chest fullness, use Zhipo Dahuang Tang (Immature Bitter Orange, Magnolia Bark, and Rhubarb Decoction). (Does not mention Bi pain.) For Chest Bi with wheezing, coughing, spitting, chest and back pain, shortness of breath, Cun Kou pulse sinking and slow, Guan pulse small, tight, and rapid, use Gualou Xiebai Baijiu Tang (Melon Seed, Macrostemon Stem, and White Wine Decoction). For Chest Bi unable to lie down, heart pain penetrating to the back, use Gualou Xiebai Banxia Tang (Melon Seed, Macrostemon Stem, and Pinellia Decoction). For Chest Bi with Pi in the heart, retained Qi knotting in the chest, chest fullness, and Qi counterflow rushing to the heart, use Zhishi Yebai Guizhi Tang. Renshen Tang is also indicated. Gualou seed, roasted熟, used with peel, decocted or made into pills, best at cleansing chest turbidity.