经义
阴气盛于上，则下虚，下虚则胀满。○阴受之则入五脏，入五脏则 满闭塞。○脏寒生满病。○备化之
纪，其病痞。○卑监之纪，其病留满痞塞。○敦阜之化，其病胀满。（《素问》）
哲言
病者腹满，按之不痛为虚，痛者为实。（《金匮》）
痞与否同，不通泰也。由阴伏阳蓄气血不运而成，与胀满有别，惟内觉痞闷，而外无胀急之形也。有中
气久虚，不能运化精微而为痞者；有过服消克，不能输化饮食而为痞者；有湿热痰气，
上逆阳位而为痞者。（朱丹溪）
凡胸中满心下满者，皆气也。腹中满者，或燥矢，或宿食也。少腹满者，或溺；或血停蓄也。清阳出上窍，
故上满者为气而非物；浊阴出下窍，故下满者为物而非气也。（《医方集解》）
上焦如雾，雾不散则为喘满，此出而不纳也。中焦如沤，沤不利则为留饮，久为中满，此上不能纳而下不
能出也。下焦如渎，渎不利则为肿满，此上能纳而下不能出也。（王好古）
胃口之上为心下，居阳部而受气最清，所云上焦如雾者是也。清处何由凝浊而见痞满？知有所填也。冷则
生气，寒则冱血，为痰为食，所填不一。俱宜温以豁之，先使上焦开发，阳气得伸，然后导除其下。（程郊倩）
补编
腹满不减，减不足言，当下之。○腹满时减，复如故，此为寒，当与温药。（《金匮》）
按此篇无治虚寒腹满之方，当与温药之下，当有宜浓朴生姜甘草半夏人参汤主之十四字，必是脱简。阅
《伤寒·太阴篇》自知，当补之。（《医宗金鉴》）
虚痞不食，大便利；实痞能食，大便闭。虚痞以芍药、陈皮和之；实痞以浓朴、枳实消之。（《证治汇补》）
天地不交而成否，此脾之清气不升而下溜，胃之浊气不降而上逆，当用补中益气汤加苓、泽。盖升、柴从
九地之下而升其清气，苓、泽从九天之上而降其浊气，即所以交否而为泰矣。○邪气作痞，宜用疏剂。若气不
顺逆上为痞，此乃虚痞，愈疏而痞愈作，宜于补剂中微兼疏通，不可过用辛香。古人治泻后膈痞，用理中丸，
即此意也。○举世治中满痞胀，不问虚实，咸禁甘草。殊不知古人所谓中满勿食甘者，指实满而言。若自觉满
而外无腹胀之形者，当以甘治之。（朱丹溪）
时至秋初，阳气下坠，因夏间之湿热尚在胸中，致有痞满不
宽之证，用不换金正气散以去湿。湿去则金清，金清则降下之令复，譬如主人久不在家，家中为污秽所塞，扫
除污秽以俟主回之意。（《慎柔五书》）
古方治痞，用芩、连、枳实之苦以泄之；浓朴、姜、夏之辛以散之；参、术之甘以补之；苓、泻之淡以渗
之。痞同湿治，惟宜上下分消，果有内实，庶可略与消导。世治痞塞，喜行利药，以求速效，虽临时通快，痞
若再作，危殆滋甚。○痞满之病，人皆知气之不运也。独东垣以血病言之，谓下多亡阴而损其血，此前人所未
论及。世之用气药治痞不效者，盖不知此理耳。（刘宗浓）
有患下焦虚极，上焦痞满，若补其下焦之虚，则上焦痞满益甚，若攻其上焦痞满，则下焦之虚复剧，不若
以疏启其中而峻补其下，法于参、术、归、 药中，佐以陈皮、浓朴、香砂之类一、二味以制之。不可独攻，
不可单补，不可先攻后补，惟应攻补相兼，求功岁月，乃可万全。（罗赤诚）
丹参去瘀生新，乃治痞之要药。（《见闻录》）
凡治病伤其胸中正气，致令痞塞痹痛者，此为医咎。自昔通弊，限于不知，今特着为戒律，不可获罪于
冥冥矣。（《医门法律》）
脉候
胀满脉弦，脾制于肝。洪数热胀，迟弱阴寒，浮为虚满，紧则中实，浮则可治，虚则危急。（《脉诀举要》）
【经典论述】
阴气在上部过盛，则下部虚弱，下部虚弱就会发生胀满。○阴邪侵入人体则进入五脏，进入五脏就会导致痞满闭塞。○脏腑寒冷会产生胀满病。○在“备化”（土运太过）的年份，疾病表现为痞。○在“卑监”（土运不及）的年份，疾病表现为留滞、胀满和痞塞。○在“敦阜”（土运太过且偏盛）的气候变化下，疾病表现为胀满。（出自《素问》）
【哲人言论】
病人腹部胀满，按压时不痛的属于虚证，按之痛的属于实证。（出自《金匮要略》）
“痞”与“否”同义，指不通畅、不舒泰。这是由于阴气潜伏、阳气蓄积、气血运行不畅而形成的，与胀满不同，只是内部感觉痞闷，而外部没有胀急的形状。有的因为中气长久虚弱，不能运化精微物质而导致痞；有的因为过度服用消导克伐的药物，不能输化饮食而导致痞；有的因为湿热痰气上逆至阳位而导致痞。（朱丹溪）
凡是胸部中心窝处感到胀满的，都是气滞所致。腹部胀满的，可能是燥结的大便，也可能是宿食。小腹胀满的，可能是小便不利，也可能是瘀血停蓄。清阳之气出于上窍，所以上部胀满是气而非有形之物；浊阴之气出于下窍，所以下部胀满是有形之物而非气。（《医方集解》）
上焦的功能像雾露一样弥漫，如果雾露不散则为喘满，这是只出不纳。中焦的功能像沤泡一样腐熟水谷，如果沤泡不利则为留饮，日久导致中满，这是上不能纳而下不能出。下焦的功能像沟渠一样排泄废物，如果沟渠不利则为肿满，这是上能纳而下不能出。（王好古）
胃口之上称为心下，位于阳部而受气最清，所说的“上焦如雾”就是指的这个部位。清明的地方怎么会凝结成浊物而出现痞满呢？这是因为有东西填塞了。冷则生寒气，寒则凝滞血液，形成痰或食积，填塞的东西各不相同。都适宜用温通的方法来豁除它，先使上焦开发，阳气得以伸展，然后再引导清除下部的积滞。（程郊倩）
【补编】
腹部胀满持续不减，即使稍微减轻也不足以说明病情好转，应当使用攻下法。○腹部胀满有时减轻，过后又恢复原状，这属于寒证，应当给予温药。（《金匮要略》）
按：此篇中没有治疗虚寒腹满的方剂，在“当与温药”之下，应当有“宜浓朴生姜甘草半夏人参汤主之”这十四个字，必定是脱简。阅读《伤寒论·太阴篇》自然知晓，应当补入。（《医宗金鉴》）
虚性痞满而不思饮食，大便通畅；实性痞满而能进食，大便秘结。虚性痞满用芍药、陈皮来调和；实性痞满用浓朴、枳实来消除。（《证治汇补》）
天地之气不相交感而形成“否”卦之象，这就是脾的清气不升反而下溜，胃的浊气不降反而上逆，应当使用补中益气汤加茯苓、泽泻。因为升麻、柴胡从九地之下提升其清气，茯苓、泽泻从九天之上降泄其浊气，这就是使“否”转为“泰”的方法。○邪气导致的痞，适宜使用疏利剂。如果是气机不顺逆上导致的痞，这乃是虚痞，越疏利痞越发作，应当在补益剂中微微兼用疏通之法，不可过度使用辛香药物。古人治疗腹泻后膈间痞满，使用理中丸，就是这个意思。○举世治疗中满痞胀，不问虚实，都禁止使用甘草。殊不知古人所说的“中满勿食甘”，是指实满而言。如果自觉满闷而外部没有腹胀形状的，应当用甘味药治疗。（朱丹溪）
时间到了秋初，阳气下坠，因为夏季的湿热尚在胸中，导致有痞满不宽舒的症状，使用不换金正气散以去除湿气。湿气去除则肺金清肃，肺金清肃则下降的职能恢复，就像主人久不在家，家中被污秽堵塞，扫除污秽以等待主人回来的意思。（《慎柔五书》）
古方治疗痞，用黄芩、黄连、枳实的苦味来泄降；用浓朴、生姜、半夏的辛味来发散；用人参、白术的甘味来补益；用茯苓、猪苓的淡味来渗湿。痞同湿邪一起治疗，适宜上下分消，如果确实有内实，才可以略微给予消导。世人治疗痞塞，喜欢使用利尿药以求速效，虽然临时通快，但痞若再发作，危险程度更加严重。○关于痞满的病，人们都知道是气机不运。唯独李东垣从血病角度论述，认为下利多亡阴而损伤其血，这是前人所未曾论及的。世上用理气药治疗痞无效的人，大概是不懂这个道理罢了。（刘宗浓）
有患者下焦极度虚弱，上焦痞满，如果补其下焦之虚，则上焦痞满会更加严重；如果攻其上焦痞满，则下焦之虚会更剧烈，不如疏通其中焦而峻补其下焦，法子在人参、白术、当归、白芍药中加入陈皮、浓朴、香附、砂仁等一两种药来制约它。不可单独攻邪，不可单纯补益，不可先攻后补，只有攻补兼施，经过一段时间求取功效，才能万全。（罗赤诚）
丹参能去瘀生新，是治疗痞的要药。（《见闻录》）
凡是治病损伤了胸中的正气，导致痞塞痹痛的，这是医生的过错。自古以来的通病，限于不知晓，现在特别著为此戒律，不可获罪于冥冥之中了。（《医门法律》）
【脉候】
胀满的脉象弦，是因为脾受到肝的克制。脉洪数表示热胀，脉迟弱表示阴寒，脉浮表示虚满，脉紧表示中实，脉浮则可治，脉虚则危急。（《脉诀举要》）
[Classic Discourse]
When Yin Qi is excessive in the upper part, the lower part becomes deficient; deficiency in the lower part leads to distension and fullness. ○ When Yin pathogens enter the body, they penetrate the Five Zang Organs; entering the Five Zang Organs results in stuffiness, fullness, and obstruction. ○ Cold of the Zang Organs generates diseases of fullness. ○ In years of "Bei Hua" (excessive Earth operation), the disease manifests as Pi (stuffiness). ○ In years of "Bei Jian" (deficient Earth operation), the disease manifests as retention, fullness, and Pi obstruction. ○ Under climatic changes of "Dun Fu" (excessive and flourishing Earth operation), the disease manifests as distension and fullness. (From *Su Wen*)
[Philosophical Remarks]
When a patient presents with abdominal fullness, if it is painless upon palpation, it is a Deficiency pattern; if painful, it is an Excess pattern. (From *Jin Gui Yao Lue*)
"Pi" is synonymous with "Pi" (obstruction), meaning lack of smooth flow and comfort. It arises from the latent accumulation of Yin, the stagnation of Yang, and the failure of Qi and Blood to circulate. It differs from distension in that there is only internal sensation of stuffiness without external signs of tension or swelling. Some cases arise from long-term deficiency of Middle Qi, failing to transform and transport subtle nutrients; some result from overuse of digestive and reducing herbs, failing to process food and drink; others are caused by Damp-Heat, Phlegm, and Qi rebelling upwards to the Yang regions. (Zhu Danxi)
Wherever there is fullness in the chest or epigastrium, it is due to Qi. Fullness in the abdomen may be due to dry feces or retained food. Fullness in the lower abdomen may be due to urinary difficulty or blood stasis. Clear Yang emerges through the upper orifices, so upper fullness is due to Qi rather than tangible matter; Turbid Yin emerges through the lower orifices, so lower fullness is due to tangible matter rather than Qi. (*Yi Fang Ji Jie*)
The Upper Jiao is like mist; if the mist does not disperse, it causes panting and fullness, indicating output without intake. The Middle Jiao is like fermentation; if fermentation is ineffective, it leads to retained fluids, eventually causing central fullness, indicating inability to receive above and eliminate below. The Lower Jiao is like a ditch; if the ditch is obstructed, it causes edema and fullness, indicating ability to receive above but inability to eliminate below. (Wang Haogu)
Above the stomach opening lies the epigastrium ("Xia Xin"), situated in the Yang region and receiving the clearest Qi, which corresponds to "The Upper Jiao is like mist." How can clear areas condense into turbidity causing Pi and fullness? This is due to blockage. Cold generates Qi stagnation, and cold coagulates Blood, forming Phlegm or Food Retention, with various types of blockage. All should be treated with warming methods to resolve them: first, open the Upper Jiao so that Yang Qi can extend, then guide and remove the obstructions below. (Cheng Jiaoqian)
[Supplement]
Abdominal fullness that persists without relief, even if slightly reduced, indicates a condition requiring purgation. ○ Abdominal fullness that decreases intermittently and then returns indicates Cold, requiring warming herbs. (*Jin Gui Yao Lue*)
Note: This chapter lacks formulas for treating Deficiency-Cold abdominal fullness. Below the phrase "should be given warming herbs," the fourteen characters "Yi Niu Pi Sheng Jiang Gan Cao Ban Xia Ren Shen Tang Zhu Zhi" (Niu Pi Sheng Jiang Gan Cao Ban Xia Ren Shen Decoction should be used) must have been lost. Reading the *Tai Yin* chapter of *Shang Han Lun* will clarify this; it should be supplemented. (*Yi Zong Jin Jian*)
Deficiency Pi with loss of appetite is accompanied by free stool; Excess Pi with preserved appetite is accompanied by constipation. Deficiency Pi is harmonized with Bai Shao and Chen Pi; Excess Pi is resolved with Hou Po and Zhi Shi. (*Zheng Zhi Hui Bu*)
When Heaven and Earth do not interact, the "Pi" hexagram forms; this signifies Spleen Clear Qi failing to ascend and sinking downward, while Stomach Turbid Qi fails to descend and rebels upward. One should use Bu Zhong Yi Qi Tang plus Fu Ling and Ze Xie. Because Sheng Ma and Chai Hu lift the Clear Qi from the depths of the earth, while Fu Ling and Ze Xie drain the Turbid Qi from the heights of heaven, thereby transforming "Pi" (obstruction) into "Tai" (peace). ○ Pi caused by pathogenic factors should be treated with dispersing agents. If Pi is caused by rebellious Qi, it is Deficiency Pi; further dispersing will worsen the Pi. One should incorporate mild dispersing methods within tonifying formulas, avoiding excessive use of acrid-aromatic drugs. Ancients treated post-diarrhea diaphragmatic Pi with Li Zhong Wan, illustrating this principle. ○ The world treats central fullness and Pi distension without distinguishing Deficiency or Excess, universally prohibiting Gan Cao (Licorice Root). However, what ancients meant by "do not eat sweet substances for central fullness" referred to Excess Fullness. If one feels full internally but has no external abdominal distension, sweet herbs should be used. (Zhu Danxi)
At the beginning of autumn, Yang Qi descends. Since Damp-Heat from summer remains in the chest, symptoms of Pi and fullness with discomfort occur. Use Bu Huan Jin Zheng Qi San to eliminate Dampness. Once Dampness is gone, Metal (Lung) becomes clear; once Metal is clear, its descending function restores. This is like a master being away for a long time, with the house blocked by filth; sweeping the filth awaits the master's return. (*Shen Rou Wu Shu*)
Ancient formulas for treating Pi used the bitterness of Huang Qin, Huang Lian, and Zhi Shi to drain; the acridity of Hou Po, Sheng Jiang, and Ban Xia to disperse; the sweetness of Ren Shen and Bai Zhu to tonify; and the blandness of Fu Ling and Zhu Ling to leach out Dampness. Pi is treated similarly to Dampness, favoring simultaneous elimination from above and below. Only if there is definite interior Excess should slight guiding and resolving methods be applied. People today treat Pi obstruction by favoring diuretics for quick effects; although temporarily relieving, if Pi recurs, the danger increases. ○ Regarding Pi and fullness, everyone knows it is due to stagnant Qi. Only Li Dongyuan discussed it from the perspective of Blood disease, stating that excessive purging loses Yin and damages Blood, a point not previously discussed by predecessors. Those who fail to treat Pi with Qi-regulating herbs likely do not understand this principle. (Liu Zongnong)
In cases where the Lower Jiao is extremely deficient while the Upper Jiao suffers from Pi and fullness, tonifying the Lower Jiao exacerbates the Upper Jiao Pi, while attacking the Upper Jiao Pi worsens the Lower Jiao deficiency. It is better to unblock the Middle Jiao while vigorously tonifying the Lower Jiao. In formulas containing Ren Shen, Bai Zhu, Dang Gui, and Bai Shao, add one or two herbs such as Chen Pi, Hou Po, Xiang Fu, or Sha Ren to regulate. Do not attack alone, do not tonify alone, do not attack then tonify; only by combining attack and tonification over time can safety be ensured. (Luo Chicheng)
Dan Shen (Salvia Miltiorrhiza) removes stasis and generates new blood; it is a key herb for treating Pi. (*Jian Wen Lu*)
Any treatment that damages the upright Qi in the chest, leading to Pi obstruction and bi-pain, is the physician's fault. This has been a common flaw since ancient times due to ignorance; now it is specifically recorded as a prohibition, lest one incur guilt in the unseen realm. (*Yi Men Fa Lv*)
[Pulse Diagnosis]
A wiry pulse in distension and fullness indicates the Spleen is controlled by the Liver. A洪数 (Hong-Shu / Surging-Rapid) pulse indicates Heat-type distension; a 迟弱 (Chi-Ruo / Slow-Weak) pulse indicates Yin-Cold; a 浮 (Fu / Floating) pulse indicates Deficiency-fullness; a 紧 (Jin / Tight) pulse indicates Interior Excess. A Floating pulse is treatable; a Weak/Empty pulse indicates critical danger. (*Mai Jue Ju Yao*)