按胃居心下。心下痞。即胃痞也。不曰泻胃。而曰泻心。恐人误认为传入阳明。而
以治阳明法治之也。伤寒误治成痞。五泻心法已尽。但此外尚有暑、湿、痰、食、痧秽、凝结成痞者。亦宜兼参。
如膈闷心烦。痞满而喘急者。热痰内闭也。宜栀豉汤。加川郁金、栝蒌仁、枳实、杏仁之类。开之宣之。
邵评∶此痰热内结于肺之正法。
如脘中痞闷。而兼头胀目黄。脉象濡涩者。此暑湿伏邪凝滞胸中也。宜清疏中宫。
川连、枳实、半夏、浓朴、郁金、草蔻、滑石粉、茯苓皮之类。
邵评∶此暑邪挟湿凝滞肺胃之正法。
如脘中痞闷。身热口渴。舌苔白燥者。此暑邪阻于气分也。宜滑石粉、川郁金、枳实、
橘红、黄芩、知母、桔梗、竹茹之类。以清气分之热。痞自开矣。
邵评∶此暑热入于肺卫之正法。
如脘痞满闷。舌苔白腻。脉濡缓。口不渴者。此湿邪阻于气分也。法宜开泄。用二陈
汤去甘草。加茅术、白蔻、郁金、枳实、浓朴、杏仁、通草之属。以开湿结。痞满自除。
若触秽暑。兼挟食滞。脘中痞满。饱闷呕恶。腹中板痛。亦宜清疏中宫。如广藿梗、川
郁金、川连、枳实、白蔻、浓朴、木香汁、生楂肉、莱菔子之类。
邵评∶此暑湿挟食。滞伏中宫。中上二焦。又吸秽浊。阻滞气机之正法。
若秽暑挟食。结于下焦。二便不通。胸腹胀满。痛楚难忍者。非枳实、大黄、承气辈不除。
邵评∶此暑秽食滞。结于下焦之正法。
若怒动肝火。或怒后加餐。而成痞满。或结于左胁之下。舌黄口渴。脉弦数。或兼胁
痛吞酸。左金、加川郁金、枳实之类主之。
邵评∶此肝火挟食。阻滞气机而成痞满之正法。
若暑湿之邪未清。误投补剂。以致胸膈胀满。脘中痞闷硬痛。几成结胸者。亦宜泻
心法治之。如二陈、枳实、浓朴、川连、楂肉、郁金、莱菔子、木香汁之类。
邵评∶此暑湿未清。误用补药。与邪相结。几成重病之正法。
胃位于心窝下方。所谓“心下痞”，实际上就是胃痞。这里不称为“泻胃”而称为“泻心”，是担心人们误以为病邪已传入阳明经，从而用治疗阳明病的方法来治疗它。伤寒因误治而形成痞证，五种泻心汤的治法已经涵盖了主要情况。但是，此外还有因暑、湿、痰、食积、痧秽等邪气凝结而成痞的情况，也应当兼参这些治法。
如果感到膈部闷塞、心烦意乱，痞满且伴有气喘急促，这是热痰内闭所致。适宜使用栀子豉汤，加入川郁金、瓜蒌仁、枳实、杏仁等药物。通过开宣肺气来治疗。
邵评：这是治疗痰热内结于肺的正法。
如果胃脘部痞闷，同时伴有头部胀痛、眼睛发黄，脉象表现为濡涩，这是暑湿伏邪凝滞于胸中。适宜清疏中焦脾胃。可用黄连、枳实、半夏、厚朴、郁金、草豆蔻、滑石粉、茯苓皮等药物。
邵评：这是治疗暑邪挟湿凝滞于肺胃的正法。
如果胃脘部痞闷，身体发热、口渴，舌苔白而干燥，这是暑邪阻滞在气分。适宜使用滑石粉、川郁金、枳实、橘红、黄芩、知母、桔梗、竹茹等药物，以清除气分之热，痞满自然消除。
邵评：这是治疗暑热入于肺卫的正法。
如果胃脘痞满闷塞，舌苔白腻，脉象濡缓，口不渴，这是湿邪阻滞在气分。治法宜开泄湿浊。可用二陈汤去掉甘草，加入苍术、白豆蔻、郁金、枳实、厚朴、杏仁、通草等药物，以开通湿邪结聚，痞满自然去除。
如果是触冒秽浊暑气，兼夹食积停滞，导致胃脘痞满，饱闷恶心呕吐，腹部僵硬疼痛，也适宜清疏中焦。可用广藿梗、川郁金、黄连、枳实、白豆蔻、厚朴、木香汁、生山楂肉、莱菔子等药物。
邵评：这是治疗暑湿挟食、滞伏中宫，以及中上二焦吸入秽浊、阻滞气机的正法。
如果是秽浊暑气挟带食积，结聚在下焦，导致大小便不通，胸部和腹部胀满，疼痛剧烈难以忍受，非用枳实、大黄、承气汤类方剂不能消除。
邵评：这是治疗暑秽食滞结于下焦的正法。
如果是因愤怒触动肝火，或者发怒后进食过多，而形成痞满，或者结聚在左侧胁下，舌苔黄、口渴，脉象弦数，或者兼有胁痛、吞酸，应以左金丸为主，加入川郁金、枳实等药物。
邵评：这是治疗肝火挟食、阻滞气机而成痞满的正法。
如果是暑湿之邪尚未清除，误用了补益药剂，导致胸膈胀满，胃脘部痞闷硬痛，几乎形成结胸证，也适宜用泻心法治之。可用二陈汤、枳实、厚朴、黄连、山楂肉、郁金、莱菔子、木香汁等药物。
邵评：这是治疗暑湿未清、误用补药，与邪气相结，几乎形成重病的正法。
The stomach is located below the heart. "Fullness below the heart" (Xin Xia Pi) refers to fullness of the stomach. It is not called "draining the stomach" but "draining the heart," to prevent people from mistakenly believing that the pathogen has transmitted to the Yangming channel and treating it with methods for Yangming disease. Fullness resulting from mismanagement in Cold Damage diseases is fully covered by the five methods of draining the heart (Xie Xin). However, there are other cases where fullness forms due to the condensation of summerheat, dampness, phlegm, food stagnation, or miasmic turbidity, which should also be considered concurrently.
If there is oppression in the diaphragm, irritability, fullness accompanied by panting and urgency, this is caused by internal closure of heat-phlegm. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) should be used, added with Chuan Yujin (Curcuma Aromatica Rhizome), Gualou Ren (Trichosanthis Semen), Zhishi (Immature Bitter Orange), and Xingren (Apricot Seed), to open and diffuse.
Shao's Commentary: This is the standard method for treating internal knotting of phlegm-heat in the Lung.
If there is epigastric fullness and oppression, accompanied by head distension, yellow eyes, and a soggy-choppy pulse, this is due to latent summerheat-dampness stagnating in the chest. The middle jiao should be cleared and dispersed. Coptis Rhizome (Chuanlian), Zhishi, Pinellia Tuber (Banxia), Magnolia Bark (Houpo), Curcuma Aromatica Rhizome (Yujin), Cardamom Seed (Caokou), Talcum Powder (Huashi), and Poria Peel (Fulingpi) may be used.
Shao's Commentary: This is the standard method for treating summerheat pathogen combined with dampness stagnating in the Lung and Stomach.
If there is epigastric fullness, fever, thirst, and a white-dry tongue coating, this is due to summerheat obstructing the Qi level. Talcum Powder (Huashi), Curcuma Aromatica Rhizome (Yujin), Zhishi, Tangerine Peel (Juhong), Scutellaria Root (Huangqin), Anemarrhena Rhizome (Zhimu), Platycodon Root (Jiegeng), and Bamboo Shavings (Zhuru) should be used to clear heat from the Qi level; the fullness will resolve spontaneously.
Shao's Commentary: This is the standard method for treating summerheat entering the Lung and Wei levels.
If there is epigastric fullness and oppression, a white-greasy tongue coating, a soggy-slow pulse, and no thirst, this is due to dampness obstructing the Qi level. The treatment method should be to open and drain. Erchen Tang (Two-Cured Decoction) without Gancao (Licorice Root), added with Atractylodes Rhizome (Maozhu), White Cardamom Seed (Baikou), Curcuma Aromatica Rhizome (Yujin), Zhishi, Magnolia Bark (Houpo), Apricot Seed (Xingren), and Tongcao, should be used to open dampness knots; the fullness will resolve spontaneously.
If one contracts miasmic summerheat combined with food stagnation, leading to epigastric fullness, bloating, nausea, vomiting, and rigid abdominal pain, clearing and dispersing the middle jiao is appropriate. Pogostemon Cablin Stem (Guanghuogeng), Curcuma Aromatica Rhizome (Yujin), Coptis Rhizome (Chuanlian), Zhishi, White Cardamom Seed (Baikou), Magnolia Bark (Houpo), Aucklandia Juice (Muxiangzhi), Raw Hawthorn Fruit (Shengzharou), and Radish Seed (Laifuzi) may be used.
Shao's Commentary: This is the standard method for treating summerheat-dampness combined with food stagnation lodging in the middle jiao, and the inhalation of miasmic turbidity obstructing Qi mechanism in the Upper and Middle Jiao.
If miasmic summerheat combined with food stagnation knots in the Lower Jiao, causing obstruction of urination and defecation, chest and abdominal distension, and unbearable pain, only Zhishe (Immature Bitter Orange), Dahuang (Rhubarb Root), and Chengqi Decoctions can remove it.
Shao's Commentary: This is the standard method for treating summerheat-miasma and food stagnation knotting in the Lower Jiao.
If anger stirs Liver Fire, or if one eats heavily after anger, resulting in fullness, or knotting under the left hypochondrium, with a yellow tongue coating, thirst, wiry-rapid pulse, or accompanied by hypochondriac pain and acid regurgitation, Zuojin Wan (Left Metal Pill) should be used as the main formula, added with Curcuma Aromatica Rhizome (Yujin) and Zhishi.
Shao's Commentary: This is the standard method for treating fullness caused by Liver Fire combined with food stagnation obstructing the Qi mechanism.
If summerheat-dampness pathogens have not been cleared, and tonifying agents are mistakenly administered, leading to chest and diaphragm distension, epigastric fullness, hardness, and pain, nearly forming a Chest Binding (Jie Xiong), the methods of draining the heart should also be employed. Erchen Tang, Zhishi, Magnolia Bark (Houpo), Coptis Rhizome (Chuanlian), Hawthorn Fruit (Zhrou), Curcuma Aromatica Rhizome (Yujin), Radish Seed (Laifuzi), and Aucklandia Juice (Muxiangzhi) may be used.
Shao's Commentary: This is the standard method for treating severe conditions where uncleared summerheat-dampness combines with pathogens due to the mistaken use of tonics.