满而不痛谓之痞，满而痛者即是结。结者积聚有余因，痞者中气不足致。一消一补诚分
明，脾气素虚者自异。补则积滞邪愈深，消则土伤虚愈至。消补相兼养正宜，枳实之丸为主
治。不动为 动为瘕，瘕假 真有妙义。右胁食块菔曲草（草果），左胁血块芎桃桂。痰块在
中海石须，栝蒌白茯槟榔备，壮健亦用青棱蓬，瘦弱参 少许配。香砂青陈可共加，苏梗
当归姜枣类。妇人有块俱死血，莫将痰食为疑似。
痰热内闭
豆豉 山栀 枳壳 菖蒲 杏仁 半夏 郁金 栝蒌 川连 白金丸 白矾
热邪里结
枳实 白芍 橘皮 乌梅 杏仁 泻心汤有三∶生姜、干姜、半夏、人参、甘草、黄芩、
川连、大枣。人参、甘草、干姜、半夏、大枣。黄连、黄芩、人参、半夏、黄芩、黄连。人参、甘草、干姜、大枣
热邪入厥阴 吐蛔消温
泻心汤去人参 甘草 加枳实 白芍
气闭化热
栝蒌 钩藤 白蔻 郁金 橘皮 白蒺藜 山栀 苏梗 桑叶 杏仁 麻仁 绿豆壳
暑邪阻气
竹茹 黄芩 知母 桔梗 麻仁 郁金 半夏 滑石 枳壳 保和丸 神曲 山楂 半夏
连翘 广皮 卜子 茯苓
湿阻热分
半夏 茯苓 杏仁 橘皮 乌药 广藿 良姜 郁金 白蔻
中阳不运
桂枝 藿香 干姜 半夏 浓朴 茯苓 草果 附子 广皮
胃寒滞涎
吴萸 干姜 川楝子 半夏 茯苓 广陈皮
胸次清阳不运
宗仲景转旋胸次之阳，苓桂术甘汤。
寒热客邪互结
姜炒 川连 半夏 黄芩 淡干姜 枳实
陈曰∶古人治痞不外以苦为泄，辛甘为散二法。外感如仲景泻心汤，内伤如仲景苓桂甘
姜法。上焦不舒，枳桔杏蒌开降，栀豉除热化腐，疏畅清阳之气法。古人有形至无形，妙论也。
木犯土虚中挟滞
川朴 茯苓 白芍 广皮 益智 丁香 人参 半夏 川楝 吴萸 姜汁 牡蛎
湿热食滞
茅术 广皮 白芍 莱菔子 白术 黄芩 枳壳 鸡内金
痰凝脉络 右胁有形高突，按之不痛。
白芥子 栝蒌 蛤粉 山栀 广郁金 橘红 姜皮 半夏
血络凝痹
归须 木通 益母草 蜣螂 虫 香附 延胡 小青皮 韭白 郁金 川朴 枳
壳茺蔚子 川芎 橘核 单桃仁
陈曰∶积为血伤入络，必仗蠕动之物以搜逐病根。初为气结在经，久则血伤入络。经络
系于脏腑外廓，仲景于劳伤血痹通络方法每取虫蚁飞走诸灵，伏梁病亦在络也。
积为阴邪聚络，大旨当以辛温入血络治之。盖所以容此阴邪者，必无阳动之气以旋运
之，而必有阴静之血以倚仗之。故必仗体阴用阳之品，方能入阴出阳，以施其辛散温通之妙。
张景岳云∶心之积名伏梁，起脐上，大如臂，上至心下，令人烦闷。脾之积曰痞气，在胃
脘，覆大如盘，令人黄胆。肺之积曰息贲，在右胁下，覆大如杯，令人洒淅寒热，喘咳肺壅。肝
之积曰肥气，在左胁下，如覆杯，有头足，令人发咳。肾之积曰奔豚，发于少腹，上至心下，若
豚，或攻上攻下无时，令人喘逆，骨蒸少气。阴气所积曰积，阳气所聚曰聚。积者五脏所生，聚者是六腑所生也。
腹部胀满但不疼痛称为痞证，腹部胀满且疼痛则称为结证。结证是由于积聚邪气有余所致，痞证则是由于中焦脾胃之气不足引起。消法与补法确实界限分明，脾气素来虚弱者表现自然不同。若只使用消导攻伐之法，积滞的邪气会陷得更深；若只使用消法而忽视扶正，脾胃（土）受损，虚损会更加严重。因此，应当消补兼施，以扶助正气为宜，治疗主方选用枳实丸。
肿块固定不移称为“积”，聚散无常、时有时无称为“瘕”，这其中的真假虚实有着精妙的含义。右胁下的食积块，需用莱菔子、神曲和草果；左胁下的血瘀块，需用川芎、桃仁和桂枝。痰湿凝聚形成的块状物在胸膈中部，需用海浮石，并备齐瓜蒌、白茯苓和槟榔。身体壮健者也可加用青皮、莪术；身体瘦弱者则需配伍人参、附子少许。还可共同加入香附、砂仁、青皮、陈皮，以及苏梗、当归、生姜、大枣等药。妇女若有腹内肿块，多属死血（瘀血）阻滞，切勿将其误认为是痰或食积。
【痰热内闭】
用药：豆豉、山栀、枳壳、石菖蒲、杏仁、半夏、郁金、瓜蒌、黄连、白金丸（由白矾组成）。
【热邪里结】
用药：枳实、白芍、橘皮、乌梅、杏仁。
泻心汤有三种变方：
第一种：生姜、干姜、半夏、人参、甘草、黄芩、黄连、大枣。
第二种：人参、甘草、干姜、半夏、大枣。
第三种：黄连、黄芩、人参、半夏、黄芩、黄连。（注：原文此处重复列药，意指黄连黄芩人参半夏汤类）
第四种：人参、甘草、干姜、大枣。
【热邪入厥阴经，伴有吐蛔虫，需温中消痞】
用药：泻心汤去掉人参、甘草，加入枳实、白芍。
【气机闭塞化热】
用药：瓜蒌、钩藤、白蔻仁、郁金、橘皮、白蒺藜、山栀、苏梗、桑叶、杏仁、麻仁、绿豆壳。
【暑邪阻滞气机】
用药：竹茹、黄芩、知母、桔梗、麻仁、郁金、半夏、滑石、枳壳、保和丸（含神曲、山楂）、连翘、广陈皮、萝卜子、茯苓。
【湿阻导致热势分争】
用药：半夏、茯苓、杏仁、橘皮、乌药、广藿香、良姜、郁金、白蔻仁。
【中阳不运】
用药：桂枝、藿香、干姜、半夏、厚朴、茯苓、草果、附子、广陈皮。
【胃寒停滞涎沫】
用药：吴茱萸、干姜、川楝子、半夏、茯苓、广陈皮。
【胸中清阳之气不运】
遵循张仲景旋转胸中阳气的方法，使用苓桂术甘汤。
【寒热客邪互相结聚】
用药：姜炒黄连、川连、半夏、黄芩、淡干姜、枳实。
陈氏说：古人治疗痞证，不外乎运用“苦味泄降”和“辛甘发散”两种方法。外感病如张仲景的泻心汤，内伤病如张仲景的苓桂甘姜法。上焦气机不舒畅，可用枳桔杏蒌开降肺气，用栀豉除热化腐，这是疏畅清阳之气的治法。古人认为从有形的病理产物转化为无形的功能失调，是精妙的论述。
【肝木犯脾土，中焦夹杂滞气】
用药：厚朴、茯苓、白芍、广陈皮、益智仁、丁香、人参、半夏、川楝子、吴茱萸、姜汁、牡蛎。
【湿热与食积停滞】
用药：苍术、广陈皮、白芍、莱菔子、白术、黄芩、枳壳、鸡内金。
【痰凝脉络】
症状：右胁下有有形肿块高突，按压时不痛。
用药：白芥子、瓜蒌、蛤粉、山栀、广郁金、橘红、姜皮、半夏。
【血络凝涩痹阻】
用药：当归须、木通、益母草、蜣螂、䗪虫（原文缺字，依语境补）、香附、延胡索、小青皮、韭白、郁金、川朴、枳壳、茺蔚子、川芎、橘核、单桃仁。
陈氏说：积证是血液受伤深入络脉，必须依靠蠕动之物来搜逐病根。初起多为气结在经脉，日久则血伤进入络脉。经络联络脏腑的外廓，张仲景在治疗劳伤血痹通络的方法中，常取虫蚁飞走等灵动之品。伏梁病也是在络脉。
积证属于阴邪聚集于络脉，大旨应当用辛温药物入血络治疗。因为容纳这些阴邪的地方，必然没有阳动之气来旋转运行，而必须有阴静之血来依附。所以必须依靠体阴用阳的药物，才能进入阴分出于阳分，从而施展其辛散温通的妙用。
张景岳说：心脏的积证名叫伏梁，起于脐上，大如手臂，向上延伸至心下，使人烦闷。脾脏的积证名叫痞气，在胃脘部，覆盖面积大如盘子，使人发黄胆。肺脏的积证名叫息贲，在右胁下，覆盖面积大如杯子，使人洒淅恶寒发热，喘咳肺壅。肝脏的积证名叫肥气，在左胁下，如倒扣的杯子，有头足形状，使人发生咳嗽。肾脏的积证名叫奔豚，发于少腹，向上至心下，像小猪奔跑一样，有时攻冲向上有时向下，使人喘逆，骨蒸少气。阴气所积聚的叫作“积”，阳气所聚散的叫作“聚”。积证是由五脏产生的，聚证是由六腑产生的。
Abdominal fullness without pain is termed Pi (Pih, 痞), whereas abdominal fullness with pain is termed Jie (Jie, 结). Jie arises from an excess of accumulated pathogenic factors, while Pi results from a deficiency of Middle Qi (Zhongqi, 中气). The distinction between reducing (Xiao, 消) and tonifying (Bu, 补) methods is indeed clear; those with inherent Spleen Qi (Piqi, 脾气) deficiency present differently. If only reduction is used, the stagnation and pathogens sink deeper; if only reduction is used without supporting the healthy Qi, the Earth element (Spleen/Stomach) is damaged, and deficiency worsens. Therefore, reduction and tonification should be combined to nourish the upright Qi (Zhengqi, 正气); the primary treatment formula is Zhishi Wan (Bitter Orange Pill).
Fixed masses are termed Ji (Ji, 积), while fluctuating masses that appear and disappear are termed Jia (Jia, 瘕); this distinction between apparent and real holds profound meaning. For food accumulation masses in the right hypochondrium, use Radish Seed (Laifuzi, 莱菔子), Medicated Leaven (Shenqu, 神曲), and Cardamom Fruit (Caoguo, 草果). For blood stasis masses in the left hypochondrium, use Ligusticum Chuanxiong Rhizome (Chuanxiong, 川芎), Peach Kernel (Taoren, 桃仁), and Cinnamon Twig (Guizhi, 桂枝). For phlegm masses in the central chest/diaphragm area, use Floating Lithostes (Haifushi, 海浮石), along with Trichosanthes Fruit (Gualou, 栝蒌), Poria (Fuling, 茯苓), and Areca Seed (Binglang, 槟榔). For robust individuals, add Green Bitter Orange (Qingpi, 青皮) and Curcuma Zedoary Rhizome (Ezhu, 蓬莪术); for frail individuals, pair with Ginseng (Renshen, 人参) and Aconite Root (Fuzi, 附子) in small doses. One may also add Cyperus Rhizome (Xiangfu, 香附), Amomum Fruit (Sharen, 砂仁), Green Bitter Orange (Qingpi, 青皮), Tangerine Peel (Chenpi, 陈皮), Perilla Stem (Sugeng, 苏梗), Angelica Sinensis Root (Danggui, 当归), Ginger (Shengjiang, 生姜), and Jujube (Dazao, 大枣). In women, abdominal masses are invariably due to dead blood (stasis); do not mistake them for phlegm or food retention.
[Phlegm-Heat Internal Closure]
Herbs: Fermented Soybean (Douchi, 豆豉), Gardenia Fruit (Shanzhi, 山栀), Aurantium Fruit (Zhike, 枳壳), Acorus Rhizome (Changpu, 菖蒲), Apricot Seed (Xingren, 杏仁), Pinellia Tuber (Banxia, 半夏), Curcuma Aromatica Rhizome (Yujin, 郁金), Trichosanthes Fruit (Gualou, 栝蒌), Coptis Rhizome (Chuanlian, 川连), Baijin Wan (White Gold Pill, composed of Alum/Baifan, 白矾).
[Heat Pathogen Interior Binding]
Herbs: Immature Bitter Orange (Zhishi, 枳实), White Peony Root (Baishao, 白芍), Tangerine Peel (Jupi, 橘皮), Chinese Plum Fruit (Wumei, 乌梅), Apricot Seed (Xingren, 杏仁).
There are three variations of Xiexin Tang (Drain the Epigastrium Decoction):
1. Fresh Ginger, Dried Ginger, Pinellia Tuber, Ginseng, Licorice Root, Scutellaria Root, Coptis Rhizome, Jujube.
2. Ginseng, Licorice Root, Dried Ginger, Pinellia Tuber, Jujube.
3. Coptis Rhizome, Scutellaria Root, Ginseng, Pinellia Tuber, Scutellaria Root, Coptis Rhizome. (Note: Original text repeats herbs, implying a variation of Coptis/Scutellaria/Ginseng/Pinellia formulas).
4. Ginseng, Licorice Root, Dried Ginger, Jujube.
[Heat Pathogen entering Jueyin Meridian, with vomiting of roundworms, requiring warming and dissipating]
Formula: Xiexin Tang (Drain the Epigastrium Decoction) minus Ginseng and Licorice Root, plus Immature Bitter Orange and White Peony Root.
[Qi Stagnation transforming into Heat]
Herbs: Trichosanthes Fruit, Uncaria Ramulus cum Uncis (Gouteng, 钩藤), White Cardamom Seed (Baokou, 白蔻), Curcuma Aromatica Rhizome (Yujin, 郁金), Tangerine Peel, Tribulus Fruit (Bajili, 白蒺藜), Gardenia Fruit, Perilla Stem, Mulberry Leaf, Apricot Seed, Hemp Seed (Maren, 麻仁), Mung Bean Husk (Lvdouke, 绿豆壳).
[Summerheat Pathogen obstructing Qi]
Herbs: Bamboo Sap (Zhurou, 竹茹), Scutellaria Root, Anemarrhena Rhizome (Zhimu, 知母), Platycodon Root (Jiegeng, 桔梗), Hemp Seed, Curcuma Aromatica Rhizome, Pinellia Tuber, Talcum (Huashi, 滑石), Aurantium Fruit, Baohe Wan (Harmonize the Stomach Pill, containing Medicated Leaven, Hawthorn Fruit), Forsythia Fruit (Lianqiao, 连翘), Broad-leaved Citrus Peel (Guangpi, 广皮), Radish Seed (Buzi, 卜子), Poria.
[Obstruction by Dampness with divided Heat]
Herbs: Pinellia Tuber, Poria, Apricot Seed, Tangerine Peel, Black Cardamom Fruit (Wuyao, 乌药), Guanghuoxiang (Patchouli Herb, 广藿), Galangal Rhizome (Liangjiang, 良姜), Curcuma Aromatica Rhizome, White Cardamom Seed.
[Failure of Middle Yang to transport]
Herbs: Cinnamon Twig, Pogostemon Herba (Huoxiang, 藿香), Dried Ginger, Pinellia Tuber, Magnolia Bark (Nongpo, 浓朴), Poria, Cardamom Fruit, Aconite Root, Broad-leaved Citrus Peel.
[Stomach Cold with stagnant saliva/phlegm]
Herbs: Evodia Fruit (Wuyu, 吴萸), Dried Ginger, Toosendan Fruit (Chuanlianzi, 川楝子), Pinellia Tuber, Poria, Broad-leaved Citrus Peel.
[Clear Yang of the Chest fails to circulate]
Follow Zhang Zhongjing’s method of rotating Yang Qi in the chest using Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala Rhizome, and Licorice Decoction).
[Mixed Cold and Heat Exogenous Pathogens binding together]
Herbs: Ginger-fried Coptis Rhizome, Coptis Rhizome, Pinellia Tuber, Scutellaria Root, Light Dried Ginger, Immature Bitter Orange.
Mr. Chen stated: Ancient treatments for Pi (Pih) primarily utilized two methods: "Bitter taste to drain" and "Acrid-Sweet to disperse." For exogenous conditions, Zhang Zhongjing’s Xiexin Tang is used; for endogenous injury, his Linggui Gan Jiang method is applied. For upper jiao discomfort, use Immature Bitter Orange, Platycodon, Apricot Seed, and Trichosanthes to open and descend; use Gardenia and Fermented Soybean to clear heat and transform rot. This is the method of unblocking Clear Yang Qi. The ancient theory that "from tangible [pathology] to intangible [function]" is a profound insight.
[Liver Wood invading Spleen Earth deficiency with middle jiao stagnation]
Herbs: Magnolia Bark, Poria, White Peony Root, Broad-leaved Citrus Peel, Alpinia Oxyphylla Fruit (Yizhi, 益智), Clove Flower (Dingxiang, 丁香), Ginseng, Pinellia Tuber, Toosendan Fruit, Evodia Fruit, Ginger Juice, Oyster Shell (Muli, 牡蛎).
[Damp-Heat and Food Stagnation]
Herbs: Atractylodes Lancea Rhizome (Maozhu, 茅术), Broad-leaved Citrus Peel, White Peony Root, Radish Seed, Atractylodes Macrocephala Rhizome (Baizhu, 白术), Scutellaria Root, Aurantium Fruit, Chicken Gizzard Lining (Jineijin, 鸡内金).
[Phlegm coagulating in collaterals]
Symptoms: Tangible mass protruding in the right hypochondrium, non-tender upon pressure.
Herbs: White Mustard Seed (Baijiezi, 白芥子), Trichosanthes Fruit, Clam Shell Powder (Gafen, 蛤粉), Gardenia Fruit, Broad-leaved Curcuma Aromatica Rhizome (Guangyujin, 广郁金), Tangerine Red Peel (Hongpi, 橘红), Ginger Peel (Jiangpi, 姜皮), Pinellia Tuber.
[Blood collaterals coagulated and bi-syndrome]
Herbs: Angelica Sinensis Root Tip (Guixu, 归须), Tetrapanax Pith (Mutong, 木通), Motherwort Herba (Yimucao, 益母草), Dung Beetle (Bianglang, 蜣螂), Ground Beetle (Chong, 虫 - likely Diechong/Scarabaeus), Cyperus Rhizome (Xiangfu, 香附), Corydalis Rhizome (Yanhu, 延胡), Small Green Bitter Orange (Xiaoqingpi, 小青皮), Garlic Sprout (Jiu bai, 韭白), Curcuma Aromatica Rhizome, Magnolia Bark, Immature Bitter Orange, Leonurus Fructus (Chongweizi, 茺蔚子), Ligusticum Chuanxiong Rhizome, Tangerine Seed (Juhe, 橘核), Single Peach Kernel (Dan Taoren, 单桃仁).
Mr. Chen stated: Ji (accumulation) involves blood injury penetrating the collaterals; one must rely on creeping creatures to search out and expel the root cause. Initially, it is Qi knotting in the meridians; over time, blood injury enters the collaterals. The collaterals connect to the outer shell of the zang-fu organs. Zhang Zhongjing, in treating labor injury and blood bi syndrome to unblock collaterals, often employs flying insects and crawling spirits. Fuliang disease (Voliere Beam) also resides in the collaterals.
Ji (accumulation) is Yin pathogen gathering in the collaterals; the general principle is to treat with Acrid-Warm substances entering the blood collaterals. Because the place accommodating these Yin pathogens lacks Yang-moving Qi to rotate and transport, there must be Yin-still Blood to rely upon. Therefore, one must rely on substances that are Yin in substance but Yang in function, to enter the Yin and emerge to the Yang, thereby exerting their acrid-dispersing and warm-unblocking efficacy.
Zhang Jingyue stated: The accumulation of the Heart is named Fuliang (Voliere Beam), arising above the navel, large as an arm, extending up to below the heart, causing restlessness and oppression. The accumulation of the Spleen is named Piqi (Pi Qi), located in the epigastrium, covering an area large as a plate, causing jaundice. The accumulation of the Lung is named Xiben (Breath Burden), located under the right hypochondrium, covering an area large as a cup, causing chills and fever, wheezing cough, and lung congestion. The accumulation of the Liver is named Feiqi (Fat Qi), located under the left hypochondrium, like an inverted cup with heads and feet, causing cough. The accumulation of the Kidney is named Bentun (Running Piglet), originating in the lower abdomen, ascending to below the heart, resembling a running piglet, attacking up or down intermittently, causing wheezing, bone-steaming fever, and shortness of breath. What accumulates is Yin Qi, termed "Ji" (Accumulation); what gathers is Yang Qi, termed "Ju" (Gathering). Ji originates from the Five Zang organs; Ju originates from the Six Fu organs.