脉∶痞满滑大，痰火作孽；弦伏中虚，微涩衰劣。
夫痞满者，非痞块之痞也，乃胸腹饱闷而不舒畅也。有气虚中满，有血虚中满，有食积中满，有脾泄中满，
有痰膈中满，皆是七情内伤、六淫外侵，或醉饱饥饿失节、房劳过度，则脾土虚而受伤，转输之官失职，胃虽受谷，
不能运化，
故阳自升而阴自降而成天地不交之痞不通泰也。盖阴伏阳蓄，治用香砂养胃汤、加减枳壳丸，调养脾胃，使心肺
之阳下降，肝肾之阴上升而成天地交泰，是无病也。
痞者，心下痞满而不能食也。（仲景云∶满而不痛为痞，满而痛为结）
养胃汤 治胸腹痞满。
香附 砂仁 木香 枳实（麸炒。各七分） 白术（去芦） 茯苓（去皮） 半夏（姜汁炒） 陈皮（各一钱）
白豆蔻（去壳，七分） 藿香 浓朴（姜汁炒。各七分） 甘草（炙，二分。）
上锉一剂，生姜三片、枣一枚，水煎，食后服。瘦人心下痞闷，加炒黄连，去半夏；血虚中满，加当归、白芍，
去半夏；食积中满加炒神曲、山楂、麦芽，去白术、半夏；肥人心下痞闷加苍术；气虚中满加人参，去半夏；痰膈
中满加栝蒌仁、贝母、桔梗、竹沥、姜汁少许，去白术、半夏；脾泄中满加炒苍术、炒白芍、去半夏。
内伤元气而痞满者，宜大补气也。加减补中益气汤，治内伤心下痞满。（方见内伤。）脉缓有痰而痞加半夏、
黄连，脉弦、四肢满闷、便难而心下痞加黄连、甘草、柴胡；大便闭燥加黄连、桃仁，少加大黄、当归身；心下痞饱
闷加白芍、黄连；心下痞腹胀加白芍、砂仁、五味子，如天寒少加干姜、官桂；心下痞或中寒者加附子、黄连；心下
痞呕逆者加陈皮、生姜、黄连，冬月加黄连，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，只根据本方；食以后心下痞者，则服橘皮枳实丸。
大消痞丸 治一切心下痞及年久不愈者。
黄连（去芦须，土炒） 黄芩（去朽，土炒。各六钱） 枳实（麸炒，五钱） 半夏（泡） 陈皮 浓朴
（姜汁炒。各四钱） 白术（去芦） 姜黄（各一两） 猪
苓泽泻 砂仁（各三钱） 干生姜（二钱） 人参（四钱） 神曲（炒） 甘草（炙。各二钱）
上为末蒸饼为丸，如梧桐子大。每服五十丸至百丸，空心白汤送下。
解郁和中汤 治胸膈痞满，内热夜不安卧，卧则愈闷。
陈皮（去白，一钱二分） 赤茯苓（一钱） 半夏（八分） 青皮（去瓤，醋炒，五分） 香附米（童便炒，
一钱） 枳壳（麸炒，一钱） 栀子（一钱） 黄连（姜汁炒，七分） 神曲（炒，七分） 浓朴（姜炒，七分）
前胡（八分） 苏子（研碎，七分） 生甘草（四分）
上锉一剂，姜五片，水煎热服。
脉象：痞满证见滑大脉，是痰火为患；见弦伏脉属中气虚弱，见微涩脉则正气衰败。
所谓痞满，并非指有形的痞块，而是指胸腹部胀闷、不舒畅的感觉。其中有因气虚导致的中满，有因血虚导致的中满，有因食积导致的中满，有因脾泄导致的中满，有因痰膈导致的中满。这些病症皆由七情内伤、六淫外侵，或因醉酒饱食、饥饿失节、房劳过度所致，致使脾土虚弱而受损。脾主运化（转输之官）失职，胃虽然受纳水谷，却无法运化，因此阳气自升、阴气自降，形成天地不交、痞塞不通的病理状态。大概阴气潜伏、阳气蓄积，治疗宜用香砂养胃汤或加减枳壳丸，以调养脾胃，使心肺之阳下降，肝肾之阴上升，从而恢复天地交泰的正常生理状态，疾病即可痊愈。
痞证，是指心下（胃脘部）痞塞满闷而不能进食。（张仲景说：胀满而不疼痛称为痞，胀满且疼痛称为结）
养胃汤：治疗胸腹痞满。
药物组成：香附、砂仁、木香、枳实（麸炒，各七分）、白术（去芦头）、茯苓（去皮）、半夏（姜汁炒）、陈皮（各一钱）、白豆蔻（去壳，七分）、藿香、浓朴（姜汁炒，各七分）、甘草（炙，二分）。
用法：以上药材锉碎为一剂，加生姜三片、大枣一枚，用水煎煮，饭后服用。若瘦人出现心下痞闷，加炒黄连，去掉半夏；若血虚致中满，加当归、白芍，去掉半夏；若食积致中满，加炒神曲、山楂、麦芽，去掉白术、半夏；若肥人出现心下痞闷，加苍术；若气虚致中满，加人参，去掉半夏；若痰膈致中满，加栝蒌仁、贝母、桔梗、竹沥及少许姜汁，去掉白术、半夏；若脾泄致中满，加炒苍术、炒白芍，去掉半夏。
因内伤元气而导致痞满者，宜大补元气。加减补中益气汤，治疗内伤引起的心下痞满。（方剂见“内伤”章节）。若脉缓且有痰而痞满，加半夏、黄连；若脉弦、四肢胀满闷痛、大便困难而心下痞满，加黄连、甘草、柴胡；若大便闭结干燥，加黄连、桃仁，稍加大黄、当归身；若心下痞满闷胀，加白芍、黄连；若心下痞满伴腹胀，加白芍、砂仁、五味子，如遇天寒可稍加干姜、官桂；若心下痞满或因中寒者，加附子、黄连；若心下痞满伴呕吐逆气者，加陈皮、生姜、黄连，冬季加黄连，稍加丁香、藿香；若能进食而心下痞满，加枳实三钱、黄连五分，如不能进食而心下痞满者，不要加入这两味药，只根据本方原方使用；若进食后出现心下痞满者，则服用橘皮枳实丸。
大消痞丸：治疗一切心下痞满及多年不愈者。
药物组成：黄连（去芦须，土炒）、黄芩（去朽坏部分，土炒，各六钱）、枳实（麸炒，五钱）、半夏（泡制）、陈皮、浓朴（姜汁炒，各四钱）、白术（去芦头）、姜黄（各一两）、猪苓、泽泻、砂仁（各三钱）、干生姜（二钱）、人参（四钱）、神曲（炒）、甘草（炙，各二钱）。
用法：以上药材研为细末，用蒸饼糊制成丸药，大小如梧桐子。每次服用五十丸至一百丸，空腹时用白开水送服。
解郁和中汤：治疗胸膈痞满，内有热邪夜间无法安卧，躺下则更加闷窒。
药物组成：陈皮（去白，一钱二分）、赤茯苓（一钱）、半夏（八分）、青皮（去瓤，醋炒，五分）、香附米（童便炒，一钱）、枳壳（麸炒，一钱）、栀子（一钱）、黄连（姜汁炒，七分）、神曲（炒，七分）、浓朴（姜炒，七分）、前胡（八分）、苏子（研碎，七分）、生甘草（四分）。
用法：以上药材锉碎为一剂，加生姜五片，用水煎煮，趁热服用。
Pulse: In the syndrome of Pi Man (epigastric fullness and stuffiness), a slippery and large pulse indicates pathogenic phlegm-fire; a wiry and deep-hidden pulse indicates deficiency in the middle jiao; a fine and choppy pulse indicates decline and deterioration of healthy qi.
Pi Man (epigastric fullness and stuffiness) refers not to a palpable mass, but to a sensation of fullness and stuffiness in the chest and abdomen without comfort. It includes middle-fullness due to Qi deficiency, middle-fullness due to Blood deficiency, middle-fullness due to food stagnation, middle-fullness due to Spleen diarrhea, and middle-fullness due to phlegm obstruction. These conditions are all caused by internal injury from the seven emotions, external invasion by the six climatic pathogens, or irregularities in diet such as overeating, drinking, hunger, and excessive sexual activity. These factors damage the Earth element of the Spleen, causing the official responsible for transportation and transformation (Spleen) to fail in its duties. Although the Stomach receives grain, it cannot transform and transport it. Consequently, Yang qi ascends naturally while Yin qi descends, resulting in a state where Heaven and Earth do not interact, leading to blockage and lack of smooth flow. Generally, when Yin is latent and Yang is stored, treatment should employ Xiangsha Yangwei Tang (Amomum and Cyperus Decoction to Nourish the Stomach) or Jiajian Zhike Wan (Modified Aurantium Pill) to regulate and nourish the Spleen and Stomach. This allows the Yang of the Heart and Lungs to descend and the Yin of the Liver and Kidneys to ascend, restoring the harmonious interaction of Heaven and Earth, thereby curing the disease.
Pi (blockage) refers to stuffiness and fullness below the heart (epigastrium) accompanied by an inability to eat. (Zhang Zhongjing stated: Fullness without pain is called Pi; fullness with pain is called Jie [knot].)
Yangwei Tang: Treats chest and abdominal Pi Man (epigastric fullness and stuffiness).
Ingredients: Xiangfu (Cyperus Rhizome), Sharen (Amomum Fruit), Muxiang (Aucklandiae Radix), Zhishi (Immature Bitter Orange, bran-fried, each 0.7 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, radix removed), Fuling (Poria, peel removed), Banxia (Pinelliae Rhizoma, ginger juice fried), Chenpi (Citri Reticulatae Pericarpium, each 1 qian), Baidoukou (Cardamomi Fructus, shell removed, 0.7 qian), Huoxiang (Agastaches Herba), Nongpo (Magnoliae Officinalis Cortex, ginger juice fried, each 0.7 qian), Gancao (Licorice Root, honey-fried, 0.2 qian).
Preparation: Coarsely crush the above herbs into one dose. Add three slices of fresh ginger and one jujube. Decoct in water and take after meals. For thin individuals with epigastric stuffiness, add fried Huanglian (Coptidis Rhizoma) and remove Banxia. For middle-fullness due to Blood deficiency, add Danggui (Angelicae Sinensis Radix) and Baishao (Paeoniae Radix Alba) and remove Banxia. For middle-fullness due to food stagnation, add fried Shenqu (Massa Medicata Fermentata), Shanzha (Crataegi Fructus), and Maiya (Hordei Fructus Germinatus), and remove Baizhu and Banxia. For fat individuals with epigastric stuffiness, add Cangzhu (Atractylodis Rhizoma). For middle-fullness due to Qi deficiency, add Renshen (Ginseng Radix et Rhizoma) and remove Banxia. For middle-fullness due to phlegm obstruction, add Gualouren (Trichosanthis Semen), Beimu (Fritillariae Bulbus), Jiegeng (Platycodonis Radix), Zhuli (Bambusa Textilis Caulis Juice), and a small amount of Jiangzhi (Fresh Ginger Juice), and remove Baizhu and Banxia. For middle-fullness due to Spleen diarrhea, add fried Cangzhu and fried Baishao, and remove Banxia.
For Pi Man caused by internal injury to Yuan Qi (Original Qi), major tonification of Qi is appropriate. Jiajian Buzhong Yiqi Tang (Modified Tonify the Middle and Augment the Qi Decoction) treats epigastric Pi Man caused by internal injury. (Formula see "Internal Injury" chapter). If the pulse is slow with phlegm and Pi, add Banxia and Huanglian. If the pulse is wiry with fullness and stuffiness in the four limbs, difficult defecation, and epigastric Pi, add Huanglian, Gancao, and Chaihu (Bupleuri Radix). If there is constipation with dry stool, add Huanglian and Taoren (Prunus Persica Seed), with a small amount of Dahuang (Rhei Radix et Rhizoma) and Dangguishen (Danggui root body). If there is epigastric fullness and stuffiness, add Baishao and Huanglian. If there is epigastric Pi with abdominal distension, add Baishao, Sharen, and Wuweizi (Schisandrae Chinensis Fructus); if cold weather prevails, add a small amount of Ganjiang (Zingiberis Rhizoma) and Guangui (Cinnamomi Cortex). If there is epigastric Pi due to middle-cold, add Fuzi (Aconiti Lateralis Radix Preparata) and Huanglian. If there is epigastric Pi with vomiting and counterflow, add Chenpi, Shengjiang (Fresh Ginger), and Huanglian; in winter, add Huanglian with a small amount of Dingxiang (Caryophylli Flos) and Huoxiang. If appetite is present with epigastric Pi, add 3 qian of Zhishi and 0.5 qian of Huanglian; if appetite is absent with epigastric Pi, do not add these, but follow the base formula strictly. If epigastric Pi occurs after eating, then administer Jupi Zhishi Wan (Tangerine Peel and Immature Bitter Orange Pill).
Da Xiao Pi Wan (Great Elimination of Pi Pill): Treats all types of epigastric Pi and chronic cases that have not healed for years.
Ingredients: Huanglian (Coptidis Rhizoma, rhizome tip removed, earth-fried), Huangqin (Scutellariae Radix, rotten parts removed, earth-fried, each 6 qian), Zhishi (Immature Bitter Orange, bran-fried, 5 qian), Banxia (Pinelliae Rhizoma, soaked), Chenpi, Nongpo (Magnoliae Officinalis Cortex, ginger juice fried, each 4 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, radix removed), Jianghuang (Curcumae Longae Rhizoma, each 1 liang), Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Sharen (Amomum Fruit, each 3 qian), Ganjiang (Dried Ginger, 2 qian), Renshen (Ginseng Radix et Rhizoma, 4 qian), Shenqu (Massa Medicata Fermentata, fried), Gancao (Licorice Root, honey-fried, each 2 qian).
Preparation: Grind the above ingredients into powder. Use steamed cake paste to form pills the size of paulownia seeds. Take 50 to 100 pills per dose, swallowed with plain warm water on an empty stomach.
Jieyu Hezhong Tang (Relieve Depression and Harmonize the Middle Decoction): Treats chest and diaphragm Pi Man, internal heat preventing sleep at night, and worsening stuffiness when lying down.
Ingredients: Chenpi (Citri Reticulatae Pericarpium, white pith removed, 1.2 qian), Chi Fuling (Poria with red wood, 1 qian), Banxia (Pinelliae Rhizoma, 0.8 qian), Qingpi (Green Tangerine Peel, pulp removed, vinegar-fried, 0.5 qian), Xiangfumii (Cyperus Rhizome, child's urine fried, 1 qian), Zhike (Aurantium Fructus, bran-fried, 1 qian), Zhizi (Gardeniae Fructus, 1 qian), Huanglian (Coptidis Rhizoma, ginger juice fried, 0.7 qian), Shenqu (Massa Medicata Fermentata, fried, 0.7 qian), Nongpo (Magnoliae Officinalis Cortex, ginger-fried, 0.7 qian), Qianhu (Peucedani Radix, 0.8 qian), Suzi (Perillae Fructus, crushed, 0.7 qian), Sheng Gancao (Raw Licorice Root, 0.4 qian).
Preparation: Coarsely crush the above herbs into one dose. Add five slices of ginger. Decoct in water and take hot.