痞者，痞塞不开之谓；满者，胀满不行之谓，盖满则近胀，而痞则不必胀也。所以痞满
一证，大有疑辨，则在虚实二字。凡有邪有滞而痞者，实痞也；无物无滞而痞者，虚痞也。
有胀有痛而满者，实满也；无胀无痛而满者，虚满也。实痞实满者，可散可消；虚痞虚满者
，非大加温补不可，此而错用，多致误人。
一、虚寒之痞，凡过于忧思，或过于劳倦，或饥饱失时，或病后脾气未醒，或脾胃素弱
之人，而妄用寒凉克伐之剂，以致重伤脾气者，皆能有之，其证则无胀无闷，但不知饥，亦
不欲食。问其胸腹胀痞，则曰亦觉有些，而又曰不甚胀。盖本非胀也，止因不欲食而自疑为
胀耳。察其脉则缓弱无神，或弦多胃少，察其形则色平气怯，是皆脾虚不运而痞塞不开也。
此证极多，不得因其不食，妄用消耗，将至胃气日损，则变证百出矣。治宜温补，但使脾肾
气强，则痞满开而饮食自进，元气自复矣。又凡脾胃虚者，多兼寒证，何也？盖脾胃属土，
土虚者多因无火，土寒则气化无权，故多痞满，此即寒生于中也。亦有为生冷外寒所侵，而
致中寒者，然胃强则寒不能侮，而寒能胜之，总由脾气之弱耳。此义详命门火候论中，当并
察之。凡脾胃微虚，而若满非满，食少不化者，宜四君子汤，或异功散。若心脾气虚，或气
有不顺者，归脾汤或治中汤。若三阴气血俱虚，治节不行，而不便于温者，宜五福饮。若中
焦不暖，或嗳腐，或吞酸而痞满者，非温补不可，宜温胃饮、五君子煎，或理中汤、圣术煎
，或参姜饮。若脾肾兼寒，命门不暖，则中焦不化，或腹溏，或胸腹喜暖畏寒，或上下腹俱
膨膨，而小水黄涩者，宜理阴煎，甚者宜六味回阳饮。此二药最妙，而实人所罕知也。予尝
治金孝廉，以劳倦思虑致伤脾气，别无他证，但绝口久不欲食，遂悉用参、术、归、熟附子
、姜、桂、甘草之属，半月始愈。后因病后复不食如此，自分必死，仍用前药，大加姜附各
至三钱而后愈。又一妇人，病后久不食，自言病前曾食牛肉，乞求去此，余佯应之，而培补
如前，方得全愈。故凡病如此者，只宜温补，不可行滞。（新按）
一、饮食偶伤，致为痞满者，当察其食滞之有无而治之。凡食滞未消而作痞满，或兼疼
痛者，宜大和中饮，或和胃饮加减治之，或枳术丸亦可，甚者神香散。此有治按在肿胀门。
若食滞既消，脾气受伤不能营运，而虚痞不开者，当专扶脾气，微者异功散、养中煎，甚者
五福饮、温胃饮、圣术煎。若命门母气不足者，治宜如前。若偶食寒凉伤胃，痞满不开，而
不可补者，宜和胃饮加山楂、麦芽之类，或用浓朴温中汤。
一、实滞之痞，当察其所因而治之。若湿胜气滞而痞者，宜平胃散，或《良方》浓朴汤
，或五苓散。若寒滞脾胃，或为痛为痞，而中气不虚者，浓朴温中汤。若脾寒气滞而痞者，
和胃饮。若怒气暴伤，肝气未平而痞者，解肝煎。若大便气秘，上下不通而痞者，河间浓朴
汤。若胃口停痰而痞者，二陈汤，或橘皮半夏汤。胃寒气滞停痰，痞而兼呕者，加减二陈汤
。胶痰不开，壅滞胃口者，药不易化，须先用吐法，而后随证治之。若大便秘结不通，而痞
满不开者，宜微利之。
一、外邪之痞∶凡寒邪感人者，必自表入里，若邪浅在经，未入于府，则饮食如故，稍
深则传入胸次，渐犯胃口，即不能饮食，是亦痞之类也。治此者，但解外邪，而或散或消，
或温或补，邪去则胃口自和，痞满自去。此当于伤寒门求法治之。又伤寒家曰∶阳证下之早
者，乃为结胸，阴证下之早者，因成痞气。此以邪在表而攻其里，邪在阳而攻其阴，不当下
而妄下之，以致邪气乘虚，陷结心下，是误治之害最危者也。实者硬满而痛，是为结胸；虚
者满而不痛，是为痞气，宜审别治之。治法详结胸腹满条中。
痞，是指气机痞塞不通；满，是指胀满而不行。一般来说，满证接近于胀，但痞证不一定伴有胀感。因此，对于痞满这一病证，关键在于辨别虚实。凡是因邪气或积滞导致的痞，属于实痞；没有实质病理产物且无积滞的痞，属于虚痞。伴有胀感和疼痛的满，属于实满；没有胀感和疼痛的满，属于虚满。实痞和实满，可以采用消散的方法治疗；虚痞和虚满，则必须采用温补的方法，如果错误使用其他治法，往往会导致误诊误治。
一、虚寒性质的痞证：凡是过度忧思，或者过度劳累，或者饮食饥饱无常，或者病后脾气尚未恢复，或者是脾胃素来虚弱的人，如果误用寒凉攻伐的药物，导致脾气严重受损，都可能出现这种情况。其症状表现为没有胀闷感，只是不知道饥饿，也不想吃东西。询问胸腹部是否有痞塞感时，患者会说觉得有些痞塞，但又说并不怎么胀。这本来不是胀，只是因为不想吃东西而自我怀疑是胀。观察其脉象，则缓弱无力，或者弦脉多而胃气少；观察其神色，则面色平淡、气息怯弱，这些都是脾气虚弱不能运化而导致的气机痞塞不开。这种证候非常多见，不能因为患者不吃饭，就妄用消导耗气的药物，否则会导致胃气日益亏损，从而变生各种证候。治疗应当采用温补法，只要脾肾之气强健，那么痞满就会消散，饮食自然增进，元气自然恢复。另外，凡是脾胃虚弱的人，多兼有寒证，为什么呢？因为脾胃属土，土虚往往是因为命门火衰（阳气不足），土寒则气化功能无权，所以多出现痞满，这就是所谓的“寒从中生”。也有因为生冷食物或外感寒邪侵袭，导致中焦受寒的，但是如果胃气强盛，寒邪就不能侵犯，反之寒邪却能胜之，归根结底还是因为脾气虚弱。这个道理在《命门火候论》中有详细论述，应当参考。凡是脾胃轻微虚弱，感觉像胀又不是胀，食量减少且不消化的，适宜用四君子汤，或者异功散。如果是心脾气虚，或者气机不畅的，适宜用归脾汤或者治中汤。如果是三阴经气血俱虚，治理调节功能不行，且不适合温补的，适宜用五福饮。如果是中焦不暖，或者有嗳腐吞酸且痞满的，非温补不可，适宜用温胃饮、五君子煎，或者理中汤、圣术煎，或者参姜饮。如果是脾肾兼寒，命门火衰不暖，导致中焦不能运化，或者大便溏泄，或者胸腹部喜欢温暖害怕寒冷，或者上下腹部都膨隆，且小便黄而涩滞的，适宜用理阴煎，严重的适宜用六味回阳饮。这两种药方非常妙，但实际上很少有人知道。我曾经治疗一位金姓孝廉，因为劳累思虑损伤了脾气，没有其他证候，只是长期绝口不想吃东西，于是全部使用人参、白术、当归、熟附子、干姜、肉桂、甘草这类药物，半个月才痊愈。后来因为病后再次出现这种情况，自己认为必死无疑，仍然使用前药，将干姜、附子各加到三钱后才痊愈。又有一位妇人，病后很久不想吃东西，自己说病前曾吃过牛肉，乞求去掉这个病因，我假装答应她，但培补方法如前，才得以完全痊愈。所以凡是这种病证，只宜温补，不可使用行气消滞的方法。（新按）
二、饮食偶然受伤，导致痞满的，应当检查是否有食滞而进行治疗。凡是食滞未消而出现痞满，或者兼有疼痛的，适宜用大和中饮，或者和胃饮加减治疗，或者枳术丸也可以，严重的用神香散。这方面的治疗案例记载在肿胀门中。如果食滞已经消除，脾气受伤不能营运，导致虚痞不开的，应当专门扶持脾气，轻的用异功散、养中煎，重的用五福饮、温胃饮、圣术煎。如果是命门母气不足的，治疗方法如前所述。如果是偶然食用寒凉伤胃，导致痞满不开，且不宜补益的，适宜在和胃饮中加入山楂、麦芽之类，或者用浓朴温中汤。
三、实滞性质的痞证，应当检查其原因而进行治疗。如果是湿气重导致气机阻滞而痞的，适宜用平胃散，或者《良方》中的浓朴汤，或者五苓散。如果是寒邪阻滞脾胃，或者引起疼痛或痞满，且中气不虚的，用浓朴温中汤。如果是脾寒气滞而痞的，用和胃饮。如果是怒气暴伤，肝气未平而痞的，用解肝煎。如果是大便气秘，上下不通而痞的，用河间浓朴汤。如果是胃口停痰而痞的，用二陈汤，或者橘皮半夏汤。胃寒气滞且停痰，痞满兼有呕吐的，用加减二陈汤。胶固之痰不开，壅滞在胃口的，药物难以化解，必须先使用吐法，然后随证治疗。如果是大便秘结不通，且痞满不开的，适宜轻微通利大便。
四、外邪引起的痞证：凡是寒邪伤人，必定从表入里。如果邪气浅在经络，未传入脏腑，则饮食如常；稍微深一点则传入胸膈，逐渐侵犯胃口，就不能饮食，这也属于痞的一类。治疗这种情况，只要解除外邪，或者发散，或者消导，或者温补，邪气去除则胃口自然调和，痞满自然消失。这应当在伤寒门中寻求治疗方法。另外，伤寒家说：阳证过早使用下法的，会形成结胸；阴证过早使用下法的，会形成痞气。这是因为邪气在表却攻里，邪气在阳却攻阴，不该下而妄用下法，导致邪气乘虚陷入并结聚于心下，这是误治中最危险的害处。实证表现为硬满且疼痛，这叫结胸；虚证表现为满但不痛，这叫痞气，应当仔细辨别并治疗。治疗方法详见结胸腹满条中。
Pi (Pih, a sensation of fullness and obstruction) refers to the blockage and lack of free flow; Man (Man, distension/fullness) refers to distension with stagnation. Generally speaking, Man is close to Zhang (Zhang, abdominal distension), but Pi does not necessarily involve distension. Therefore, in distinguishing the syndrome of Pi-Man, the key lies in the differentiation between Deficiency (Xu) and Excess (Shi). Pi caused by pathogenic factors or stagnation is Excess Pi; Pi without substantial pathological products or stagnation is Deficiency Pi. Fullness accompanied by distension and pain is Excess Man; fullness without distension or pain is Deficiency Man. Excess Pi and Excess Man can be treated with dispersing and resolving methods; Deficiency Pi and Deficiency Man must be treated with warming and tonifying methods. Misapplication of other treatments often leads to medical errors.
1. Deficiency-Cold Pi: This condition can occur in individuals who have overthought, overworked, had irregular eating habits, suffered from spleen Qi deficiency after illness, or have inherently weak spleen and stomach. If such individuals mistakenly use cold and purgative medicines, causing severe damage to spleen Qi, they may develop this condition. The symptoms include no distension or oppression, only a lack of hunger and loss of appetite. When asked about chest or abdominal fullness, patients may report a slight sensation of Pi but deny significant distension. This is not true distension but rather self-doubt due to anorexia. The pulse is typically slow and weak, lacking spirit, or string-like with insufficient Stomach Qi. The complexion is pale, and the breath is timid. These signs indicate that spleen deficiency fails to transport, leading to Qi blockage. This syndrome is common. One must not recklessly use draining and consuming herbs simply because the patient refuses food, as this will further damage Stomach Qi and lead to various complications. Treatment should employ warming and tonifying methods. Once Spleen and Kidney Qi are strengthened, Pi and Man will resolve, appetite will return, and Yuan Qi (Original Qi) will recover. Furthermore, Spleen and Stomach deficiency often accompanies Cold syndromes. Why? Because Spleen and Stomach belong to Earth. Earth deficiency often stems from a lack of Fire (Mingmen Fire/Ministerial Fire). When Earth is cold, Qi transformation lacks authority, resulting in Pi and Man; this is known as "Cold generated within." It can also result from invasion by raw/cold foods or external Cold, causing Middle Jiao Cold. However, if Stomach Qi is strong, Cold cannot invade; conversely, Cold prevails when it wins out, which ultimately boils down to Spleen Qi weakness. This principle is detailed in the *Treatise on Mingmen Fire Heat*, which should be consulted. For mild Spleen and Stomach deficiency, where there is a sensation of fullness without actual distension, reduced intake, and indigestion, Si Jun Zi Tang (Four Gentlemen Decoction) or Yi Gong San (Yi Gong Powder) are appropriate. For Heart-Spleen Qi deficiency or stagnant Qi, Gui Pi Tang (Restore the Spleen Decoction) or Zhi Zhong Tang (Regulate the Middle Decoction) are suitable. For deficiency of Qi and Blood in all three Yin meridians, with impaired regulatory function and unsuitability for warming, Wu Fu Yin (Five Blessings Drink) is indicated. For Middle Jiao cold, belching of rotten food, acid regurgitation, and Pi-Man requiring warming and tonification, Wen Wei Yin (Warm the Stomach Drink), Wu Jun Zi Jian (Five Gentlemen Decoction), Li Zhong Tang (Regulate the Middle Decoction), Sheng Zhu Jian (Holy Atractylodes Decoction), or Shen Jiang Yin (Ginseng and Ginger Drink) are appropriate. For combined Spleen-Kidney Cold with Mingmen deficiency failing to warm, leading to Middle Jiao failure to transform, loose stools, preference for warmth and aversion to cold in the chest/abdomen, distension of upper and lower abdomen, and yellow, scanty urine, Li Yin Jian (Nourish Yin Decoction) is indicated; for severe cases, Liu Wei Hui Yang Yin (Six-Ingredient Decoction to Restore Yang) is used. These two formulas are excellent yet rarely known. I once treated a scholar named Jin, whose spleen Qi was damaged by fatigue and overthinking, presenting only with prolonged anorexia. I prescribed a formula containing Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), Dang Gui (Angelica Sinensis), Shu Fu Zi (Prepared Aconite Root), Gan Jiang (Dried Ginger), Rou Gui (Cinnamon Bark), and Gan Cao (Licorice Root). He recovered in half a month. Later, he relapsed after illness, believing he would die, but again recovered after increasing Gan Jiang and Shu Fu Zi to 3 qian each. Another woman, suffering from prolonged anorexia post-illness, claimed she ate beef before falling ill and begged me to remove it. I feigned agreement but continued the same tonic treatment, leading to her full recovery. Thus, for such conditions, only warming and tonifying are suitable; moving Qi and resolving stagnation should be avoided. (New Note)
2. Pi-Man caused by accidental dietary injury should be treated based on the presence or absence of food stagnation. If Pi-Man arises from un-digested food, possibly with pain, Da He Zhong Yin (Great Harmonize the Middle Drink) or He Wei Yin (Harmonize the Stomach Drink) with modifications are indicated; Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill) is also suitable; for severe cases, Shen Xiang San (Divine Fragrance Powder) is used. Clinical notes on this are found in the Distension chapter. If food stagnation has resolved but Spleen Qi is injured and unable to circulate, leading to Deficiency Pi, one should focus on supporting Spleen Qi. For mild cases, Yi Gong San or Yang Zhong Jian (Nourish the Center Decoction); for severe cases, Wu Fu Yin, Wen Wei Yin, or Sheng Zhu Jian. If Mingmother Qi (Kidney Essence/Qi) is insufficient, treat as previously described. If Cold damages the Stomach due to accidental ingestion of cold substances, causing Pi-Man that cannot be tonified, add Shan Zha (Hawthorn Fruit) and Mai Ya (Sprouted Barley Seed) to He Wei Yin, or use Hou Po Wen Zhong Tang (Magnolia Bark to Warm the Middle Decoction).
3. Excess Stagnation Pi should be treated according to its cause. If dampness predominates causing Qi stagnation and Pi, Ping Wei San (Peace the Stomach Powder) or Hou Po Tang (Magnolia Bark Decoction) from *Liang Fang*, or Wu Ling San (Five Ingredient Powder with Poria) are indicated. If Cold stagnates the Spleen and Stomach, causing pain or Pi, without Middle Qi deficiency, Hou Po Wen Zhong Tang is used. If Spleen Cold and Qi stagnation cause Pi, He Wei Yin is indicated. If sudden anger injures the Liver, causing unresolved Liver Qi stagnation and Pi, Jie Gan Jian (Resolve the Liver Decoction) is used. If Qi constipation causes blockage and Pi, He Jian's Hou Po Tang is indicated. If Phlegm stagnates at the Stomach entrance causing Pi, Er Chen Tang (Two-Chen Decoction) or Ju Pi Ban Xia Tang (Tangerine Peel and Pinellia Decoction) are used. If Stomach Cold, Qi stagnation, and retained Phlegm cause Pi with vomiting, Jia Jian Er Chen Tang (Modified Two-Chen Decoction) is indicated. If sticky Phlegm blocks the Stomach entrance and resists medication, emesis must be induced first, followed by syndrome-specific treatment. If fecal impaction causes Pi-Man, mild purgation is appropriate.
4. Pi caused by External Pathogens: When Cold pathogens invade, they move from the exterior to the interior. If the pathogen is shallow in the channels and has not entered the fu organs, diet remains normal. If slightly deeper, it enters the chest and gradually invades the Stomach entrance, causing inability to eat; this is also a form of Pi. Treatment involves resolving the external pathogen through dispersing, resolving, warming, or tonifying as needed. Once the pathogen is eliminated, the Stomach harmonizes, and Pi-Man resolves. Refer to the Shang Han (Cold Damage) chapter for methods. Additionally, Shang Han scholars state: premature purgation in Yang syndromes leads to Jie Xiong (Chest Binding); premature purgation in Yin syndromes leads to Pi Qi (Pi Syndrome). This occurs because treating the interior while the pathogen is in the exterior, or attacking Yin while the pathogen is in Yang, constitutes inappropriate purgation. This allows the pathogen to sink into the deficiency and knot at the epigastrium, representing the most dangerous harm of misdiagnosis. Excess presents as hard, full, and painful Jie Xiong; Deficiency presents as full but painless Pi Qi. Careful differentiation and treatment are required. See the section on Jie Xiong and Abdominal Fullness for detailed methods.