枳实四枚 厚朴四两 薤白半筋 桂枝一两 栝蒌实（捣）一枚
右五味，以水五升，先煮枳实、厚朴，取三升，去滓，内诸药，煮数沸，分温三服。
人参 甘草 干姜 白术各三两
右四味，以水八升，煮取三升，温服一升，日三服。
@@@
心中痞，诸逆心悬痛，桂枝生姜枳实汤主之。
【注】
心中痞，即上条心中痞气也。诸逆，诸气上逆也。上条之逆，不过撞心而不痛；此条
之逆，则心悬而空痛，如空中悬物动摇而痛也。用桂枝生姜枳实汤，通阳气破逆气，
痛止痞开矣。
【集注】
程林曰：诸逆如□下逆抢心之类，邪气独留于上，则心悬痛。
尤怡曰：诸逆该痰饮客气而言。心悬痛，谓如悬物动摇而痛，逆气使然也。
桂枝三两 生姜三两 枳实五枚
右三味，以水六升，煮取三升，分温三服。
【集解】
赵良曰：枳实、生姜，原以治气塞，况于痞乎？故较前条稍减轻分两，使痞者下其气
以开之。悬痛属饮者，得生姜以散之，既足建功矣。乃去橘皮而用桂枝者，以所逆非
一，或通阳气，或破结气，或散寒气，皆能去痹也。
@@@
趺阳脉微弦，法当腹满，不满者必便难，两胠疼痛，此虚寒从下上也，当以温药服之
。
【注】
趺阳胃脉也，当缓而和，今见弦脉，是肝脉也。肝脉见于脾部，是木盛土虚也，法当
腹满。今不复满者，肝脉微弦不盛而脾不虚，故脾未受病也。肝自郁则失其条达之性
，必本经自病，故便难两胠痛也。然非肝火实病，此乃虚寒从下上也，当以温药服之
。
@@@
腹满时减，复如故，此为寒，当与温药。
【按】
此篇无治虚寒腹满之方，当与温药之下，当有「宜厚朴生姜甘草半夏人参汤主之」十
四字，必是脱简，阅『伤寒论·太阴篇』自知。
【注】
此承上条，互详其证，以明其治也。腹满便难，脾实病也，今腹满而不便难，脾虚病
也。且腹满有时而减，有时复如不满，乃虚寒也，当与温药主之。以厚朴生姜甘草半
夏人参汤，消满散寒，缓中降逆补虚，乃治虚满之法也。
【集注】
魏荔彤曰：腹满或服下药，或服补药，有时减退，未几旋腹满如故，则不可作实与热
治也。
仲景明此为寒，里寒从无下法，惟有温药与服，虚者以温中补气，实者亦以温中行气
为义，是治气寒腹满第一善法也。
枳实四枚，厚朴四两，薤白半筋，桂枝一两，栝蒌实（捣碎）一枚。
以上五味药，用水五升，先煎煮枳实、厚朴，取汁三升，滤去药渣，加入其余药物，煮沸数沸，分三次温服。
人参、甘草、干姜、白术各三两。
以上四味药，用水八升，煎煮取汁三升，每次温服一升，每日服用三次。
@@@
心中痞塞感，各种气逆引起的悬空样心痛，用桂枝生姜枳实汤主治。
【注】
“心中痞”，即上一条所述的心胸痞塞之气。“诸逆”，指各种气机上逆。上一条所述的逆气，仅仅是冲击心胸而不疼痛；这一条所述的逆气，则是心脏悬空且伴有空痛，如同空中悬挂之物摇动而引发的疼痛。使用桂枝生姜枳实汤，可以通阳散寒、破气降逆，疼痛停止，痞塞消散。
【集注】
程林说：各种气逆如气从少腹上冲心胸之类，邪气独留于上部，就会导致心悬痛。
尤怡说：“诸逆”包括痰饮和客气而言。心悬痛，是指像悬挂物体摇动一样的疼痛，这是由逆气造成的。
桂枝三两，生姜三两，枳实五枚。
以上三味药，用水六升，煎煮取汁三升，分三次温服。
【集解】
赵良说：枳实、生姜，原本是用来治疗气机堵塞的，何况是痞证呢？所以比前一条稍微减轻剂量，使痞证患者通过下气来开泄痞结。悬痛属于饮邪的，得到生姜以发散之，足以建功了。去掉橘皮而用桂枝的原因，是因为所逆之气不止一种，或通阳气，或破结气，或散寒气，都能去除痹阻。
@@@
趺阳脉微弦，按常理应当出现腹满，如果不腹满，必定是大便困难，两侧胁肋部疼痛，这是虚寒之气从下部向上侵犯，应当用温性药物治疗。
【注】
趺阳脉是胃脉，应当缓和柔和，现在见到弦脉，这是肝脉。肝脉出现在脾部（脾胃部位），说明木盛土虚，按常理应当腹满。现在不腹满的原因，是肝脉微弦而不旺盛，且脾不虚，所以脾未受病。肝气自郁则失去其条达的特性，必然导致本经自病，所以出现大便困难和两侧胁肋疼痛。然而这并非肝火实证，而是虚寒之气从下部向上侵犯，应当用温性药物治疗。
@@@
腹部胀满有时减轻，过后又恢复原状，这是寒证，应当给予温性药物。
【按】
本篇没有治疗虚寒腹满的方剂，在“当与温药”之下，应当有“宜厚朴生姜甘草半夏人参汤主之”这十四个字，必然是脱简（缺失的文字），阅读《伤寒论·太阴篇》即可知晓。
【注】
此条承接上一条，详细辨析症状，以阐明治疗方法。腹满伴有大便困难，是脾实证；现在腹满但不伴有大便困难，是脾虚证。而且腹满有时减轻，有时又恢复得像没满一样，这是虚寒证，应当用温性药物主治。用厚朴生姜甘草半夏人参汤，可以消除胀满、驱散寒邪、缓中降逆、补益虚弱，这是治疗虚性胀满的方法。
【集注】
魏荔彤说：腹满如果服用下药或补药，有时减退，不久又恢复腹满，就不能当作实证和热证来治疗。
仲景明确这是寒证，里寒证从无攻下之法，只有用温药服用，虚证用温中补气，实证也用温中行气的意义，这是治疗气寒腹满的第一善法。
Zhi Shi (Fructus Aurantii Immaturus) 4 pieces, Hou Po (Cortex Magnoliae Officinalis) 4 liang, Xie Bai (Bulbus Allii Macrostemonis) half jin, Gui Zhi (Ramulus Cinnamomi) 1 liang, Gua Lou Shi (Fructus Trichosanthis) 1 piece (crushed).
The above five herbs are boiled with 5 sheng of water. First, decoct Zhi Shi and Hou Po to obtain 3 sheng of liquid, remove the dregs, add the remaining herbs, boil for a few more boils, and divide into three warm doses.
Ren Shen (Radix Ginseng), Gan Cao (Radix Glycyrrhizae Preparata), Gan Jiang (Rhizoma Zingiberis Secundi), and Bai Zhu (Rhizoma Atractylodis Macrocephalae) are each 3 liang.
The above four herbs are boiled with 8 sheng of water to obtain 3 sheng of liquid. Take 1 sheng warm per dose, three times daily.
@@@
For "Xin Zhong Pi" (chest oppression/stagnation) and various rebellious Qi causing "Xuan Tong" (suspended heart pain), Gui Zhi Sheng Jiang Zhi Shi Tang (Cinnamon Twig, Ginger, and Immature Bitter Orange Decoction) is the primary treatment.
[Annotation]
"Xin Zhong Pi" refers to the chest stagnation Qi described in the previous clause. "Zhu Ni" refers to various rebellious Qi movements. The rebellion in the previous clause merely struck the heart without pain; the rebellion in this clause causes the heart to feel suspended and hollow-painful, as if a suspended object were shaking and causing pain. Using Gui Zhi Sheng Jiang Zhi Shi Tang unblocks Yang Qi and breaks rebellious Qi, stopping the pain and resolving the stagnation.
[Collected Notes]
Cheng Lin stated: Various rebellious Qi, such as Qi rushing up from the lower abdomen to the heart, when pathogenic factors remain exclusively in the upper part, lead to suspended heart pain.
You Yi stated: "Zhu Ni" encompasses phlegm-fluids and hostile Qi. "Xuan Tong" means pain like that caused by a suspended object shaking, which is due to rebellious Qi.
Gui Zhi (Ramulus Cinnamomi) 3 liang, Sheng Jiang (Rhizoma Zingiberis Recens) 3 liang, Zhi Shi (Fructus Aurantii Immaturus) 5 pieces.
The above three herbs are boiled with 6 sheng of water to obtain 3 sheng of liquid. Divide into three warm doses.
[Collected Explanations]
Zhao Liang said: Zhi Shi and Sheng Jiang are originally used to treat Qi blockage, let alone Pi syndrome. Therefore, the dosage is slightly reduced compared to the previous clause, allowing patients with Pi syndrome to descend Qi to open the obstruction. Suspended pain caused by fluid retention is dispersed by Sheng Jiang, which is sufficient to achieve efficacy. The reason for removing Ju Pi (Pericarpium Citri Reticulatae) and using Gui Zhi is that the rebellious Qi is not of a single type; whether unblocking Yang Qi, breaking condensed Qi, or dispersing Cold Qi, all can remove Bi obstruction.
@@@
If the Fu Yang pulse is slightly wiry (Xian), according to standard principles, abdominal fullness should occur. If there is no abdominal fullness, there will certainly be difficult defecation and pain in both hypochondriac regions. This is deficiency-Cold ascending from below, and it should be treated with warming medicines.
[Annotation]
Fu Yang is the Stomach pulse, which should be slow and harmonious. Now seeing a wiry pulse indicates Liver involvement. When the Liver pulse appears in the Spleen/Stomach region, it indicates Wood excess and Earth deficiency, so abdominal fullness should theoretically occur. The reason for the absence of fullness now is that the Liver pulse is only slightly wiry and not excessive, and the Spleen is not deficient, so the Spleen has not been diseased. When Liver Qi stagnates internally, it loses its free-flowing nature, inevitably affecting its own meridian, thus causing difficult defecation and hypochondriac pain. However, this is not a Liver Fire excess condition, but rather deficiency-Cold ascending from below, so it should be treated with warming medicines.
@@@
Abdominal fullness that decreases intermittently and then returns to normal indicates Cold; warming medicines should be administered.
[Commentary]
This section lacks a formula for treating deficiency-Cold abdominal fullness. Below the phrase "should be given warming medicines," the fourteen characters "Yi Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang Zhu Zhi" (Hou Po, Ginger, Licorice, Pinellia, and Ginseng Decoction should be used as the main treatment) should likely exist, indicating a missing text (tuo jian). This can be verified by reading the *Tai Yin* chapter of the *Shang Han Lun*.
[Annotation]
This clause follows the previous one, detailing the symptoms to clarify the treatment. Abdominal fullness accompanied by difficult defecation is a Spleen Excess condition; current abdominal fullness without difficult defecation is a Spleen Deficiency condition. Moreover, since abdominal fullness sometimes decreases and sometimes returns as if nothing were wrong, it is a deficiency-Cold condition, and warming medicines should be used as the main treatment. Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) eliminates fullness, scatters Cold, moderates the middle, directs rebellious Qi downward, and tonifies deficiency, representing the method for treating deficiency-type fullness.
[Collected Notes]
Wei Litong said: If abdominal fullness decreases after taking purgatives or tonics, but soon returns to fullness, it cannot be treated as an Excess or Heat condition.
Zhong Jing clearly identifies this as Cold. Interior Cold never uses purgation methods; only warming medicines should be taken. For deficiency, warming the middle and tonifying Qi is used; for excess, warming the middle and moving Qi is the principle. This is the best method for treating Qi-cold abdominal fullness.