脉
胸痞脉滑，为有痰结。弦伏亦痞，涩则气劣。
证
夫“痞”与“否”同，不通“泰”也。由阴伏阳蓄，气与血不运而成。处心下，位中央，填满痞塞，皆
土邪之为病也，与胀满有轻重之分。痞则内觉痞闷，而外无胀急之形；胀满则内胀而外亦有形也。前人
皆指误下而致之，盖误下则里气虚，故伤寒之表邪乘虚入于心下；杂病则所受之邪气，亦蓄心下，因而致
痞也。亦有不因误下而得之者，有中气虚弱，不能运化精微而为痞者；有饮食痰积，不能施化而为
痞者；有湿热太甚，土来心下为痞者。
治
古方治痞，用黄连、黄芩、枳实之苦以泄之，浓朴、半夏，生姜之辛以散之，人参、白术之甘苦以补之，
茯苓、泽泻之淡以渗之。大概与湿同治，使上下分消可也。又曰∶肥人多是湿痰，宜苍术、半夏、砂仁、茯
苓、滑石以燥之；瘦人多是中焦郁热，宜枳实、黄连以导之，葛根、升麻以发之。如饮食后因感风寒，以致
饮食不消而作痞者，宜藿香、砂仁、草豆蔻、吴茱萸以温化之，如脾气虚弱，转运不调，饮食不化为痞者，当
消导其胸中窒塞，宜陈皮、白术、神曲、麦芽、山楂以助化之，或以保和丸、枳实导滞丸，木香化滞
汤主之。有伤寒下早而作痞，桔梗汤、小陷胸汤主之；有伤寒下多则亡阳而痞者，四物汤加参、苓、白术、
柴胡、升麻，少佐陈皮、枳壳以疏之；有大病后元气未复，而胸满气短者，补中益气汤、橘皮枳术丸主之。又
有虚实之殊焉，实痞大便闭而能食者，浓朴枳实汤主之；虚痞大便利者，芍药、陈皮治之。上逆兀兀欲吐者，
则宜吐之，所谓在上者因而越之。世人苦于痞塞，喜行利药，以求速
效，虽临时通快，痞若再作，益以滋甚，是皆不察夫下多所谓亡阴之意也。
方
木香化滞汤 治因忧郁气结于中脘，腹中微痛，心下痞满，不思饮食。
当归梢（四两） 枳实（炒，四两） 陈皮（六分） 干姜（六分） 木香（六分） 柴胡
（七分） 草豆蔻（一钱） 半夏（一钱五分） 红花（少许） 甘草（炙，一钱）
上锉一剂，生姜煎，食远服。
黄连消痞丸〔批〕（按此方治气郁实痞专消之方） 治心下痞满，壅滞不散，喘促不安。
黄连（一两） 黄芩（二两，炒） 枳实（七钱，麸炒） 半夏（九钱，汤泡） 陈皮
（五钱） 茯苓（三钱） 白术（三钱） 猪苓（五钱） 泽泻（一钱） 姜黄（一钱） 干姜（二钱）
甘草（炙，三钱）
上为末，蒸饼为丸，如梧桐子大。每服五七十丸，白滚汤任下。
加减益气汤（即补中益气加减，方见内伤） 治内伤元气痞满。
脉缓有痰而痞，加半夏、黄连。脉弦，四肢乏力，便难而心下痞，加黄连、柴胡、甘草。大便闭燥，
加黄连、桃仁，少加大黄、当归。心下痞，劣闷，加白芍药、黄连。心下痞，腹胀，
加白芍药、砂仁、五味子，如天寒，少加干姜，或加中桂。心下痞，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、桔梗、黄连。
如不能食，心下痞者，勿加，但根据本方。食已，心下痞，则服橘皮枳术丸。
枳实消痞丸 治右关脉弦，心下虚痞，恶食，懒倦。
人参（三钱） 白术（三钱） 白茯苓（二钱） 黄连（五钱） 枳实（五钱） 半夏曲
（三钱） 浓朴（姜制，四钱） 麦芽（炒，二钱） 干姜（二钱） 甘草（炙，二钱）
上为末，汤浸蒸饼为丸，如梧桐子大。每服七十丸，食远白汤下。
大消痞丸〔批〕（按此方治内伤虚痞，消补兼施之剂） 治一切心下痞，及年久不愈者。
黄连（土炒，八钱） 黄芩（土炒，六钱） 枳实（麸炒，五钱） 半夏（泡，四钱） 陈
皮（四钱） 浓朴（姜制，四钱） 白术（土炒，二两） 猪苓（二钱五分） 泽泻（三钱） 姜
黄（一两） 干姜（二钱） 人参（四钱） 神曲（炒，二钱） 砂仁（二钱） 甘草（炙，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。
脉象
胸部痞闷的脉象若滑利，说明体内有痰浊凝结。脉象弦或伏也主痞证，脉象涩则表明气机衰弱。
证候
“痞”字与“否”字相通，意指不通达、不泰和。这是由于阴气潜伏、阳气蓄积，导致气与血运行不畅而形成的。病位在心下（胃脘部），处于人体中央，表现为内部填满、痞塞不通，这都是土邪（脾胃病变）所致，与胀满病在轻重程度上有所区别。痞证的感觉是内部自觉痞闷堵塞，但外部没有胀急的形态；胀满病则是内部感到胀满，外部也能看到胀大的形状。前人大多认为这是误用泻下法导致的，因为误下损伤了里气，使伤寒的表邪乘虚侵入心下；杂病中，所受的邪气也会蓄积在心下，从而形成痞证。也有并非因误下而得病的，有中气虚弱，不能运化精微物质而形成痞证的；有饮食停滞、痰湿积聚，不能消化而形成痞证的；有湿热过盛，土邪侵犯心下形成痞证的。
治法
古方治疗痞证，使用黄连、黄芩、枳实的苦味来泄降痞结，使用浓朴、半夏、生姜的辛味来散结，使用人参、白术的甘苦味来补益正气，使用茯苓、泽泻的淡味来渗湿利水。大抵是与湿邪一同治疗，使邪气从上、下分消即可。又说：肥胖的人多患湿痰，适宜用苍术、半夏、砂仁、茯苓、滑石来燥湿化痰；消瘦的人多患中焦郁热，适宜用枳实、黄连来导滞清热，用葛根、升麻来升发清阳。如果在饮食后因感受风寒，导致饮食不消化而形成痞证，适宜用藿香、砂仁、草豆蔻、吴茱萸来温中化湿；如果是脾气虚弱，转运失调，饮食不消化而形成痞证，应当消除胸中的窒塞感，适宜用陈皮、白术、神曲、麦芽、山楂来助消化，或者以保和丸、枳实导滞丸、木香化滞汤为主治方剂。有因伤寒过早使用泻下法而形成痞证的，以桔梗汤、小陷胸汤主治；有因伤寒泻下过多导致亡阳而出现痞证的，用四物汤加人参、茯苓、白术、柴胡、升麻，少量佐以陈皮、枳壳来疏理气机；有大病之后元气尚未恢复，出现胸满、气短症状的，以补中益气汤、橘皮枳术丸主治。又有虚实之分，实证痞满且大便闭结、能进食的，以浓朴枳实汤主治；虚证痞满且大便通畅的，以芍药、陈皮治疗。气机上逆、恶心欲吐的，则适宜采用催吐法，即所谓“病位在上者，因而越之”。世人苦于痞塞，喜欢使用通利药物以求速效，虽然暂时通畅爽快，但痞证一旦复发，病情会更加严重，这都是没有洞察过度泻下会导致亡阴的道理。
方剂
木香化滞汤 治疗因忧郁导致气结在中脘，腹中轻微疼痛，心下痞满，不思饮食。
当归梢（四两） 枳实（炒，四两） 陈皮（六分） 干姜（六分） 木香（六分） 柴胡（七分） 草豆蔻（一钱） 半夏（一钱五分） 红花（少许） 甘草（炙，一钱）
以上药材锉碎为一剂，加生姜煎煮，饭后服用。
黄连消痞丸〔批注〕（按：此方是专门用于消除气郁实证痞满的方剂） 治疗心下痞满，壅滞不散，气喘急促不安。
黄连（一两） 黄芩（二两，炒） 枳实（七钱，麸炒） 半夏（九钱，开水泡） 陈皮（五钱） 茯苓（三钱） 白术（三钱） 猪苓（五钱） 泽泻（一钱） 姜黄（一钱） 干姜（二钱） 甘草（炙，三钱）
以上研为细末，用蒸饼糊制成丸药，如梧桐子大小。每次服用五七十丸，用白开水送服。
加减益气汤（即补中益气汤的加减方，原方见内伤章节） 治疗内伤元气导致的痞满。
脉缓且有痰导致痞满的，加半夏、黄连。脉弦，四肢乏力，排便困难且心下痞满的，加黄连、柴胡、甘草。大便闭结干燥的，加黄连、桃仁，少量加大黄、当归。心下痞满、劣闷不适的，加白芍药、黄连。心下痞满、腹胀的，加白芍药、砂仁、五味子，如果天气寒冷，少量加干姜，或者加肉桂。心下痞满、中寒的，加附子、黄连。心下痞满、呕吐逆气的，加陈皮、生姜、黄连，冬季加黄连，少量加丁香、藿香。能进食但心下痞满的，加枳实、桔梗、黄连。如果不能进食且心下痞满的，不要加这些药，只根据本方基础用药。进食后心下痞满的，则服用橘皮枳术丸。
枳实消痞丸 治疗右关脉弦，心下虚痞，厌恶食物，懒惰疲倦。
人参（三钱） 白术（三钱） 白茯苓（二钱） 黄连（五钱） 枳实（五钱） 半夏曲（三钱） 浓朴（姜制，四钱） 麦芽（炒，二钱） 干姜（二钱） 甘草（炙，二钱）
以上研为细末，用汤浸泡蒸饼制成丸药，如梧桐子大小。每次服用七十丸，饭后用白开水送服。
大消痞丸〔批注〕（按：此方治疗内伤虚痞，是消导与补益兼施的药剂） 治疗一切心下痞满，以及多年不愈者。
黄连（土炒，八钱） 黄芩（土炒，六钱） 枳实（麸炒，五钱） 半夏（泡，四钱） 陈皮（四钱） 浓朴（姜制，四钱） 白术（土炒，二两） 猪苓（二钱五分） 泽泻（三钱） 姜黄（一两） 干姜（二钱） 人参（四钱） 神曲（炒，二钱） 砂仁（二钱） 甘草（炙，二钱）
以上研为细末，用蒸饼糊制成丸药，如梧桐子大小。每次服用五十丸至一百丸，空腹时用白开水送服。
Pulse
A slippery pulse in the chest indicates phlegm accumulation. A wiry or deep-hidden pulse also indicates epigastric fullness (Pi Zheng), while a choppy pulse suggests Qi deficiency.
Syndrome
"Pi" (epigastric fullness) is synonymous with "Pi" (obstruction), meaning lack of smooth flow and harmony. It arises from Yin stagnation and Yang retention, resulting in impaired circulation of Qi and Blood. Located at the epigastrium (Xin Xia), which is central to the body, it presents as internal fullness and obstruction. This is caused by Earth pathogen (Spleen/Stomach dysfunction) and differs from distension (Zhang Man) in severity. In Pi syndrome, there is a subjective sensation of stifling fullness internally, but no external sign of swelling or tension. In distension, there is both internal fullness and external visible swelling. Previous physicians generally attributed this condition to improper use of purgatives; improper purgation damages interior Qi, allowing exterior pathogens from Cold Damage (Shang Han) to invade the epigastrium due to deficiency. In miscellaneous diseases, pathogenic factors accumulate in the epigastrium, leading to Pi. There are also cases not caused by improper purgation: those caused by deficiency of Middle Qi failing to transform and transport fine nutrients; those caused by food stagnation and phlegm accumulation failing to digest; and those caused by excessive Damp-Heat where Earth pathogen invades the epigastrium.
Treatment
Ancient formulas for treating Pi use the bitter properties of Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root), and Zhi Shi (Immature Bitter Orange) to drain and descend; the acrid properties of Hou Po (Magnolia Bark), Ban Xia (Pinellia Tuber), and Sheng Jiang (Fresh Ginger) to disperse; the sweet-bitter properties of Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome) to tonify; and the bland properties of Fu Ling (Poria) and Ze Xie (Alisma Rhizome) to leach out dampness. Generally, it is treated similarly to Dampness, allowing the pathogen to be eliminated from above and below. Furthermore, obese individuals often suffer from Damp-Phlegm, suitable for Cang Zhu (Atractylodes Lancea Rhizome), Ban Xia, Sha Ren (Amomum Fruit), Fu Ling, and Hua Shi (Talcum) to dry dampness; thin individuals often suffer from Middle Jiao stagnant heat, suitable for Zhi Shi and Huang Lian to guide out heat, and Ge Gen (Kudzu Root) and Sheng Ma (Cimicifuga Rhizome) to raise clear Yang. If Pi results from food indigestion after contracting Wind-Cold, Huo Xiang (Patchouli Herb), Sha Ren, Cao Dou Kou (Nutmeg-like Seed), and Wu Zhu Yu (Evodia Fruit) should be used to warm and transform. If Pi results from Spleen Qi deficiency causing poor transportation and food indigestion, one should eliminate the stifling sensation in the chest using Chen Pi (Tangerine Peel), Bai Zhu, Shen Qu (Medicated Leaven), Mai Ya (Barley Sprout), and Shan Zha (Hawthorn Fruit) to aid digestion, or primarily use Bao He Wan, Zhi Shi Dao Zhi Wan, or Mu Xiang Hua Zhi Tang. For Pi caused by premature purgation in Cold Damage, Jie Geng Tang or Xiao Xian Xiong Tang are indicated. For Pi caused by Yang collapse due to excessive purgation in Cold Damage, Si Wu Tang added with Ren Shen, Fu Ling, Bai Zhu, Chai Hu (Bupleurum Root), and Sheng Ma, with a small amount of Chen Pi and Zhi Qiao (Bitter Orange) to regulate Qi, is used. For post-major illness cases where Yuan Qi has not recovered, presenting with chest fullness and shortness of breath, Bu Zhong Yi Qi Tang or Ju Pi Zhi Zhu Wan are indicated. There is also a distinction between excess and deficiency: Excess Pi with constipation and ability to eat is treated with Hou Po Zhi Shi Tang; Deficiency Pi with loose stools is treated with Shao Yao (Peony Root) and Chen Pi. If Qi rebels upward causing nausea and desire to vomit, emesis is appropriate, following the principle "For pathogens located above, induce vomiting." People suffering from Pi often prefer laxatives for quick relief; although temporary relief occurs, recurrence leads to worsening conditions, failing to understand that excessive purgation can lead to Yin collapse.
Formulas
Mu Xiang Hua Zhi Tang (Costus Regulating Stagnation Decoction) treats Qi knotting in the middle Jiao due to depression, slight abdominal pain, epigastric fullness, and loss of appetite.
Dang Gui Shao (Tail of Angelica Sinensis Root) (4 liang), Zhi Shi (Immature Bitter Orange, stir-fried, 4 liang), Chen Pi (6 fen), Gan Jiang (Dried Ginger, 6 fen), Mu Xiang (Costus Root, 6 fen), Chai Hu (7 fen), Cao Dou Kou (Cardamom Seed, 1 qian), Ban Xia (Pinellia Tuber, 1.5 qian), Hong Hua (Carthamus Flower, a little), Gan Cao (Licorice Root, honey-fried, 1 qian).
Decoct these ingredients as one dose with fresh ginger, take after meals.
Huang Lian Xiao Pi Wan (Coptis Eliminating Fullness Pill) [Commentary: This formula specifically eliminates Qi-stagnation excess Pi] treats epigastric fullness, blockage that does not dissipate, and restless panting.
Huang Lian (1 liang), Huang Qin (2 liang, stir-fried), Zhi Shi (7 qian, bran-fried), Ban Xia (9 qian, soaked in water), Chen Pi (5 qian), Fu Ling (3 qian), Bai Zhu (3 qian), Zhu Ling (Polyporus, 5 qian), Ze Xie (1 qian), Jiang Huang (Turmeric Rhizome, 1 qian), Gan Jiang (2 qian), Gan Cao (Licorice Root, honey-fried, 3 qian).
Grind into powder, make pills with steamed wheat cake dough, size of Sophora seeds. Take 50-70 pills per dose with plain boiled water.
Jia Jian Yi Qi Tang (Modified Tonifying Qi Decoction) (Modification of Bu Zhong Yi Qi Tang, see Internal Injury section) treats Pi fullness due to internal injury of Yuan Qi.
If pulse is slow with phlegm causing Pi, add Ban Xia and Huang Lian. If pulse is wiry with limb weakness, difficult defecation, and epigastric Pi, add Huang Lian, Chai Hu, and Gan Cao. If stool is closed and dry, add Huang Lian, Tao Ren (Peach Kernel), and a small amount of Da Huang (Rhubarb Root) and Dang Gui (Angelica Sinensis Root). If epigastric Pi with stifling discomfort, add Bai Shao Yao (White Peony Root) and Huang Lian. If epigastric Pi with abdominal distension, add Bai Shao Yao, Sha Ren, and Wu Wei Zi (Schisandra Berry); if cold weather, add a small amount of Gan Jiang or Rou Gui (Cinnamon Bark). If epigastric Pi with Cold in the Middle, add Fu Zi (Aconite Root) and Huang Lian. If epigastric Pi with vomiting/reversal, add Chen Pi, Sheng Jiang, and Huang Lian; in winter, add Huang Lian and a small amount of Ding Xiang (Clove) and Huo Xiang (Patchouli Herb). If able to eat but with epigastric Pi, add Zhi Shi, Jie Geng (Platycodon Root), and Huang Lian. If unable to eat with epigastric Pi, do not add these, stick to the base formula. If epigastric Pi occurs after eating, take Ju Pi Zhi Zhu Wan instead.
Zhi Shi Xiao Pi Wan (Immature Bitter Orange Eliminating Fullness Pill) treats wiry pulse at the right Guan position, empty epigastric Pi, aversion to food, and lethargy.
Ren Shen (3 qian), Bai Zhu (3 qian), Bai Fu Ling (White Poria, 2 qian), Huang Lian (5 qian), Zhi Shi (5 qian), Ban Xia Qu (Pinellia Medicated Leaven, 3 qian), Hou Po (Magnolia Bark, ginger-processed, 4 qian), Mai Ya (Barley Sprout, stir-fried, 2 qian), Gan Jiang (2 qian), Gan Cao (Licorice Root, honey-fried, 2 qian).
Grind into powder, make pills with steamed wheat cake dough soaked in decoction, size of Sophora seeds. Take 70 pills per dose after meals with plain water.
Da Xiao Pi Wan (Great Eliminating Fullness Pill) [Commentary: This formula treats internal injury deficiency Pi, combining elimination and tonification] treats all types of epigastric Pi, including chronic cases lasting years.
Huang Lian (Earth-fried, 8 qian), Huang Qin (Earth-fried, 6 qian), Zhi Shi (Bran-fried, 5 qian), Ban Xia (Soaked, 4 qian), Chen Pi (4 qian), Hou Po (Ginger-processed, 4 qian), Bai Zhu (Earth-fried, 2 liang), Zhu Ling (2.5 qian), Ze Xie (3 qian), Jiang Huang (1 liang), Gan Jiang (2 qian), Ren Shen (4 qian), Shen Qu (Stir-fried, 2 qian), Sha Ren (2 qian), Gan Cao (Honey-fried, 2 qian).
Grind into powder, make pills with steamed wheat cake dough, size of Sophora seeds. Take 50-100 pills per dose on an empty stomach with plain water.