脉候 寸口脉双紧，即为入，其气不出，无表有里，心下痞坚。（《脉经》）
脉弦急而滑，骤然胸中痞闷，乃肝气与食滞而成，为实。脉弦或沉弦，或涩，或虚大无力，气口为甚，此日
久脾胃受伤，或过服克伐药所致，为虚。胸膈痞闷，而寸口脉沉滑或迟滑者，为有停滞。（《医通》）
源候 痞者与否同，不通泰也。（按∶此二句，据《丹溪心法附录》补。）痞之为病，由阴伏阳蓄，
气与血不运而成。处心下，位中央， 满痞塞，皆土之病也。与胀满有轻重之分，痞则内觉痞闷，而外无胀急之形，
胀满则外亦有形也。有中气虚弱，不能运化精微为痞者。有饮食痰积，不能施化为痞者。有湿热太甚，土乘心
下为痞者。（《微义》）（参《心法附录》。）
胀在腹中，痞在心下。胀有形，痞无形。（《准绳》）
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。（《景岳》）（虚痞更见
次条。）
治例 心下痞，宜升胃气，以血药治之。若全用气药导之，则其痞愈甚，甚而复下，气愈下降，必变为中
满鼓胀，皆非其治也。又有虚实之殊，如实痞大便秘，浓朴、枳实主之。虚痞大便利者，芍药、陈皮治之。如饮
食所伤而为痞满者，当内消导，其胸中窒塞上逆，兀兀欲吐者，则宜吐之，
所谓在上者因而越之也。凡治痞者，宜详审焉。（《试效》）
痞同湿治，惟宜上下分消其气，如果有内实之证，庶可略与疏导。世人苦于痞塞，喜行利药以求速效，临时
通快，痞若再作，益以滋甚。（《微义》）
中气虚弱，不能运化精微，心下痞者，以香砂六君子汤主之。有饮食痰积，不能施化为痞者，以枳缩二陈汤
加姜炒黄连主之，亦治心下夯闷，虚寒不散。心下痞，或宽或急，常喜热物，以枳实理中汤主之。（《原病集》）
邪气作痞，宜用疏剂。若气不顺，冲上而为痞，此乃虚痞，愈疏而痞愈作，宜于收补之中，微有疏通之意，
决不可十分用香剂，古方载泻后膈痞用理中，即此意也。痞塞服诸药不效，大便不甚通者，宜感应丸加巴豆。
（《要诀》）
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，则痞满开而饮食日进，元气自复矣。饮食偶伤，致为痞满者，当察其食滞之有无而治之。实滞之痞，当察
其所因而治之。（《景岳》）
痞气属脾气虚及气郁所致，忌破气、下、湿润、苦寒。宜健脾、兼散结滞、甘温、辛香。（《本草经疏》）
和中泻痞诸方 泻脾汤，治脾脏气实，胸中满，不能食方。
茯苓（四两） 浓朴（四两炙） 桂心（五两） 生姜（八两切） 半夏
（一升洗去滑） 人参 黄芩 甘草（炙各二两）
上八味 咀，以水一斗，煮取三升，分三服。又主冷气在脾脏，走在四肢，手足流肿，亦逐水气。（《千金
翼》）《医心》效验方，游气汤，治上气，于本方加枳实子。
治心下蓄积痞闷，或作痛，多噫败卵气，枳壳散。
枳壳（去瓤锉麸炒） 白术（各半两） 香附子（一两麸炒舂去皮） 槟榔（三钱）
上为细末，每服二钱，米饮调下，日三服，不拘时候。庞老方。（《本事》）
消痞汤，一名木香化滞汤，治因忧气（按∶《辨惑论》此有食湿面三字）郁结中脘，腹皮里微痛，心下痞满，
不思饮食。
枳实（炒） 当归梢（以上各二分） 陈皮 木香（以上各三分） 柴胡（四分） 草豆蔻 炙甘草（以上各五分）
半夏（一钱） 红花（少许）
上为粗末，作一服，水二盏，生姜三片，煎至一盏，食远服，忌酒湿面。（《兰室》）（按∶《医鉴》开怀
散，系此方之变，见《积聚》，宜参。）
枳实消痞丸，治心下虚痞，恶食懒倦，开胃进食。
枳实 黄连（各五钱） 干生姜（一钱） 半夏曲（三钱） 浓朴（炙四钱） 人参（三钱） 炙甘草（二钱）
白术（二钱） 白茯苓（二钱） 麦 面（二钱）
上件为细末，汤浸蒸饼为丸，如桐子大，每服三十丸，温水送下，不拘时候，量虚实加减。（《试效》）
枳实理中丸，治中脘痞滞，气不宣通，积寒停饮，饮入不化。（《宝鉴》）（即理中丸加枳实各等分。）
家弟曾余患呕逆不食者月余，服宽膈理气药二十余剂，几至绝粒，而痞胀异常。邀余诊之，脉得虚大而数。按仲景
脉法云∶大则为虚，数则为虚，此胃中阳气大虚，而浊阴填塞于膈上也。因取连理汤方，用人参三钱服之，四
剂而痞止食进，后与异功散，调理数月而安。（《医通》）
别驾吴蛟水公祖夫人，患痞眩呕逆，向因下体畏寒，肢肘麻木，久服八味、参附不彻，六脉弦滑而按之则
濡。此中焦素蕴痰湿，阳气不能周于四末之象，得桂、附辛热之力，有时虽可暂开，究非真阳之虚，且有地黄之
滞，所以痞晕漫无止期。遂疏《局方》七气汤，加沉香，一服豁然，再服神爽食进而安。（同上）
三脘痞气丸，治三焦痞滞，气不升降，水饮停积，不得流行，胁下虚满，或时刺痛，宜服。
沉香 大腹子 槟榔 缩砂（各半两） 青皮（去白） 陈皮（去白） 木香 白豆蔻 三棱（炮各一两）
半夏（汤泡七次二两）
上为末，糊丸如桐子大，每服三十丸，温水送下，陈皮汤亦得，食后。（《宝鉴》）（按∶此方先教谕去陈
皮，以大腹皮代子用。）
胜红丸，治心腹痞满，消食快气，美进饮食。
三棱（醋炙） 广术（醋炙） 青皮（去瓤炒） 陈皮（去白） 干姜（火炮） 良姜 枳实（去瓤炒）
白术（煨） 萝卜子（炒各一两别研） 香附子（二两炒去毛）
上为细末，醋糊为丸，如桐子大，每服五、七十丸，姜汤或木香同煎陈皮汤送下，不拘时候。（《瑞竹》）
（按∶此于《简易》胜红丸加枳实。白术、萝卜子者，宜参《积聚》门红丸子。）
养胃汤，治胸膈痞满。
香附 砂仁 木香 枳实（麸炒各七分） 白术（去芦） 茯苓 半夏（姜汁炒） 陈皮（各一钱）
白蔻（去壳七分） 藿香 浓朴（姜汁炒各七分） 甘草（炙二分）
上锉一剂，生姜三片，枣一枚，水煎，食后服。（《回春》）
解郁和中汤，治胸膈痞满，内热不安卧，卧则愈闷。
陈皮（一钱二分） 赤茯苓（一钱） 半夏（八分） 青皮（五分） 香附米（一钱） 枳壳（一钱）
栀子（一钱） 黄连（七分） 神曲（七分） 浓朴（七分） 前胡（八分） 苏子（七分） 生甘草（四分）
上锉一剂，姜五片，水煎热服。（同上）
回令丸，开痞结，治肝邪，补脾。（《丹溪》）（即左金丸）
中痞者，肠满，四肢倦，行立艰难，食已呕吐，冒昧，减食或渴者是也。宜用后方。
大黄（一两，湿纸十重包裹，煨令香熟，切作片子。） 槟榔（一枚） 木香（一分）
上为末，生蜜为丸，如桐子大，每服三十丸，生姜汤下，食后日午，日进二服，未减加之，效即勿再服。
附方∶
桂（五钱不见火） 槟榔（一个） 黑牵牛（四两生为末二两）
上为末，蜜酒调二钱，以利为度。（《中藏经》）（按∶原有上中下三痞方，今特存中痞。）
【脉象】寸口脉呈现双紧之象，表示邪气内入，正气郁结不得外达，表现为无表证而有里证，心下部位痞塞坚硬。（《脉经》）
脉象弦急而滑，突然感到胸中痞闷，这是肝气与食滞相结合所致，属于实证。脉象弦或沉弦，或涩，或虚大无力，且气口（右寸）尤为明显，这是由于日久脾胃受损，或过服攻伐药物所致，属于虚证。胸膈痞闷，而寸口脉沉滑或迟滑的，是有停滞（积滞）的表现。（《医宗金鉴·医学入门》简称《医通》）
【病因病机】“痞”字与“否”字相通，意为不通泰、不顺畅。（按：这两句是根据《丹溪心法附录》补入的。）痞这种病，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，处于人体中央，满闷痞塞，都是脾土系统的疾病。它与胀满有轻重的区别：痞证是内部感觉痞闷，但外部没有胀急的形状；胀满则是外部也有胀大的形状。有的因为中气虚弱，不能运化精微物质而形成痞证；有的因为饮食痰湿积聚，不能正常转化而形成痞证；有的因为湿热太盛，脾土之气上乘于心下而形成痞证。（《医宗必读》简称《微义》）（参考《丹溪心法附录》。）
胀在腹部，痞在心下。胀有外形，痞无形状。（《医学纲目》简称《准绳》）
痞是指痞塞不开的状态，满是指胀满不行的状态。大概满证接近于胀，而痞证不一定就是胀。所以痞满这一证候，最大的疑惑和辨别点在于“虚”和“实”两个字。凡是因邪气、积滞而导致痞的，是实痞；没有实物、没有积滞而导致痞的，是虚痞。有胀有痛而满的，是实满；没有胀没有痛而满的，是虚满。实痞实满，可以用消散的方法治疗；虚痞虚满，非大力温补不可。如果对此错误用药，大多会误人性命。（《景岳全书》）（虚痞详见下一条。）
【治疗原则】心下痞，应当提升胃气，用血分药来治疗。如果全用气药疏导，那么痞塞会更加严重，严重了反而下陷，气更加下降，必然变成中满鼓胀，这都不是正确的治法。又有虚实之分，如实痞伴有大便秘结，用厚朴、枳实为主药。虚痞伴有大便通畅的，用芍药、陈皮治疗。如果是饮食所伤导致的痞满，应当从内部消导；如果胸中窒塞感向上逆冲，恶心欲吐的，则应当采用催吐法，这就是所说的“病在上焦，因而越之（通过呕吐排出）”。凡是治疗痞证，应当详细审察。（《医学发明》作者李东垣著作简称《试效》）
痞证同湿证一起治疗，只宜上下分消其气，如果有内实的证候，才可以稍微给予疏导。世人苦于痞塞，喜欢使用利尿药以求速效，暂时虽然通快，但痞证再次发作时，会更加严重。（《医宗必读》简称《微义》）
中气虚弱，不能运化精微，导致心下痞的，用香砂六君子汤主治。有饮食痰积，不能转化形成痞证的，用枳缩二陈汤加姜炒黄连主治，也治疗心下硬闷，虚寒不散的情况。心下痞，有时宽舒有时拘急，常喜欢热物，用枳实理中汤主治。（《原病集》）
邪气导致的痞，适宜用疏利剂。如果气不顺，冲逆而上导致痞，这是虚痞，越疏利痞越发作，应当在收补之中，微微带有疏通的意思，决不可十分使用香燥行气药，古方记载泻后膈痞用理中汤，就是这个意思。痞塞服用各种药物无效，大便不太通的，宜用感应丸加巴豆。（《世医得效方》简称《要诀》）
虚寒性质的痞，凡是过于忧思，或过于劳倦，或饥饱失常，或病后脾气未醒，或脾胃素弱之人妄用寒凉攻伐药剂，以致重伤脾气的，都能产生此证。其症状是无胀无闷，只是不知道饿，也不想吃东西。问其胸腹胀痞，他说也觉得有些，但又说不怎么胀。本来就不是胀，只是因为不想吃东西而自己怀疑是胀罢了。观察他的脉象则缓弱无神，或弦多胃少，观察他的形体则面色平和但气息怯弱，这都是脾虚不运而痞塞不开。此证极多，不能因为他不吃东西，就妄用消耗正气的药物，否则会导致胃气日渐损耗，从而变证百出。治疗宜用温补，只要使脾肾之气强健，那么痞满就会开通，饮食日渐增加，元气自然恢复。饮食偶尔受伤，导致痞满的，应当考察是否有食滞而进行治疗。实滞导致的痞，应当考察其原因而治疗。（《景岳全书》）
痞气属于脾气虚及气郁所致，忌用破气、泻下、湿润、苦寒的药物。适宜健脾，兼散结滞，用甘温、辛香的药物。（《本草经疏》）
【和中泻痞诸方】
泻脾汤，治疗脾脏气实，胸中满闷，不能进食的方子。
茯苓（四两） 厚朴（四两炙） 桂心（五两） 生姜（八两切） 半夏（一升洗去滑） 人参 黄芩 甘草（炙各二两）
以上八味药切碎，用水一斗，煮取三升，分三次服用。又主治冷气在脾脏，游走于四肢，手足浮肿，也能驱逐水气。（《千金翼方》）《医心方》效验方，游气汤，治疗上气，在本方基础上加枳实子。
治疗心下蓄积痞闷，或作痛，多打嗝有腐败卵臭味，枳壳散。
枳壳（去瓤锉麸炒） 白术（各半两） 香附子（一两麸炒舂去皮） 槟榔（三钱）
以上研为细末，每次服用二钱，米饮调下，每日三次，不拘时候。庞安时老先生的方子。（《太平惠民和剂局方》简称《本事》）
消痞汤，一名木香化滞汤，治疗因忧气（按：《辨惑论》此处有“食湿面”三字）郁结在中脘，腹皮里微痛，心下痞满，不思饮食。
枳实（炒） 当归梢（以上各二分） 陈皮 木香（以上各三分） 柴胡（四分） 草豆蔻 炙甘草（以上各五分） 半夏（一钱） 红花（少许）
以上为粗末，作一服，水二盏，生姜三片，煎至一盏，饭后远服，忌酒湿面。（《兰室秘藏》简称《兰室》）（按：《医鉴》开怀散，是这个方的变方，见《积聚》篇，宜参考。）
枳实消痞丸，治疗心下虚痞，厌恶食物，懒倦，开胃进食。
枳实 黄连（各五钱） 干生姜（一钱） 半夏曲（三钱） 厚朴（炙四钱） 人参（三钱） 炙甘草（二钱） 白术（二钱） 白茯苓（二钱） 麦芽面（二钱）
以上为细末，汤浸蒸饼为丸，如梧桐子大，每次服用三十丸，温水送下，不拘时候，根据虚实加减。（《医学发明》简称《试效》）
枳实理中丸，治疗中脘痞滞，气不宣通，积寒停饮，饮水不化。（《卫生宝鉴》简称《宝鉴》）（即理中丸加枳实各等分。）
家弟曾患呕逆不食月余，服用宽膈理气药二十多剂，几乎绝食，而痞胀异常。邀请我诊治，脉象虚大而数。按照张仲景脉法说：大则为虚，数则为虚，这是胃中阳气大虚，而浊阴填塞于膈上。于是取连理汤方，用人参三钱服用，四剂后痞止食进，后来给异功散，调理数月而安。（《医宗金鉴·医学入门》简称《医通》）
别驾吴蛟水公祖夫人，患痞眩呕逆，先前因为下体畏寒，肢肘麻木，久服八味丸、参附汤未能痊愈，六脉弦滑而按之则濡。这是中焦素来蕴涵痰湿，阳气不能周流于四肢末端的征象，得到桂枝、附子辛热的力量，有时虽然可以暂时开通，终究不是真阳之虚，而且有地黄之滞腻，所以痞晕漫无止期。于是开具《局方》七气汤，加沉香，一服豁然开朗，再服神爽食进而安。（同上）
三脘痞气丸，治疗三焦痞滞，气不升降，水饮停积，不得流行，胁下虚满，或时常刺痛，适宜服用。
沉香 大腹子 槟榔 缩砂仁（各半两） 青皮（去白） 陈皮（去白） 木香 白豆蔻 三棱（炮各一两） 半夏（汤泡七次二两）
以上为末，糊丸如梧桐子大，每次服用三十丸，温水送下，陈皮汤也可以，饭后服用。（《卫生宝鉴》简称《宝鉴》）（按：此方先教谕去掉陈皮，以大腹皮代子用。）
胜红丸，治疗心腹痞满，消食快气，促进饮食。
三棱（醋炙） 莪术（醋炙） 青皮（去瓤炒） 陈皮（去白） 干姜（火炮） 良姜 枳实（去瓤炒） 白术（煨） 萝卜子（炒各一两别研） 香附子（二两炒去毛）
以上为细末，醋糊为丸，如梧桐子大，每次服用五、七十丸，姜汤或木香同煎陈皮汤送下，不拘时候。（《瑞竹堂经验方》简称《瑞竹》）（按：此方是在《简易》胜红丸基础上加枳实、白术、萝卜子者，宜参考《积聚》门红丸子。）
养胃汤，治疗胸膈痞满。
香附 砂仁 木香 枳实（麸炒各七分） 白术（去芦） 茯苓 半夏（姜汁炒） 陈皮（各一钱） 白蔻（去壳七分） 藿香 厚朴（姜汁炒各七分） 甘草（炙二分）
以上锉一剂，生姜三片，枣一枚，水煎，饭后服用。（《内科摘要》简称《回春》）
解郁和中汤，治疗胸膈痞满，内热不安卧，卧则更闷。
陈皮（一钱二分） 赤茯苓（一钱） 半夏（八分） 青皮（五分） 香附米（一钱） 枳壳（一钱） 栀子（一钱） 黄连（七分） 神曲（七分） 厚朴（七分） 前胡（八分） 苏子（七分） 生甘草（四分）
以上锉一剂，姜五片，水煎热服。（同上）
回令丸，开痞结，治肝邪，补脾。（《丹溪心法》简称《丹溪》）（即左金丸）
中痞者，肠满，四肢倦怠，行立艰难，食已呕吐，头目昏花，减食或渴的是。适宜用后方。
大黄（一两，湿纸十重包裹，煨令香熟，切作片子。） 槟榔（一枚） 木香（一分）
以上为末，生蜜为丸，如梧桐子大，每次服用三十丸，生姜汤下，食后日午，每日进二服，未减加之，效即勿再服。
附方：
桂枝（五钱不见火） 槟榔（一个） 黑牵牛（四两生为末二两）
以上为末，蜜酒调二钱，以利为度。（《中藏经》）（按：原有上中下三痞方，今特存中痞。）
[Pulse Diagnosis] The cunkou (radial artery at the wrist) pulse presents as double-tight, indicating that pathogenic factors have entered inward. Qi is stagnant and unable to reach the exterior, manifesting as no exterior syndrome but an interior syndrome, with hardness and stuffiness in the epigastrium (upper abdomen). (*Mai Jing* / Pulse Classic)
A pulse that is wiry, rapid, and slippery, accompanied by sudden chest stuffiness, indicates Liver Qi combined with food stagnation; this is an Excess pattern. A pulse that is wiry or deep-wiry, or choppy, or deficient and large without force, especially prominent at the Qikou (right radial artery), results from long-term damage to the Spleen and Stomach, or from excessive use of purgative drugs; this is a Deficiency pattern. Chest and diaphragm stuffiness with a cunkou pulse that is deep-slippery or slow-slippery indicates the presence of stagnation. (*Yi Tong*)
[Etiology and Pathogenesis] "Pi" (stuffiness) is synonymous with "Pi" (obstruction/blockage), meaning lack of smooth flow. (Note: These two sentences are supplemented according to *Danxi Xinfa Fulu*). Pi disease arises from Yin lurking and Yang accumulating, causing Qi and Blood to fail to circulate. It is located in the epigastrium, at the center of the body. Fullness and stuffiness are diseases of the Earth element (Spleen/Stomach system). There is a distinction in severity between Pi and Zhangman (distension): Pi involves internal sensation of stuffiness without external signs of distension, whereas Zhangman presents with external physical distension. Some cases arise from deficiency of Middle Qi, failing to transform and transport essential nutrients; some from accumulation of food and phlegm-dampness, failing to be metabolized; some from excessive Damp-Heat, where Earth Qi overacts upon the epigastrium. (*Wei Yi*) (Refer to *Xinfa Fulu*).
Distension is in the abdomen, while Pi is in the epigastrium. Distension has a visible form, while Pi does not. (*Zhun Sheng*)
Pi refers to a state of blockage and inability to open; Man (fullness) refers to distension and inability to move. Generally, Man is close to distension, while Pi need not necessarily involve distension. Therefore, the key to distinguishing Pi-Man lies in the concepts of Deficiency and Excess. Pi caused by pathogens and stagnation is Excess Pi; Pi without material accumulation is Deficiency Pi. Fullness accompanied by distension and pain is Excess Fullness; fullness without distension or pain is Deficiency Fullness. Excess Pi and Fullness can be treated with dispersing and resolving methods; Deficiency Pi and Fullness require strong warming and tonifying. Misapplication of treatment often leads to harm. (*Jing Yue Quan Shu*) (See next section for Deficiency Pi.)
[Treatment Principles] For epigastric Pi, one should raise Stomach Qi and treat using blood-invigorating herbs. If only Qi-moving herbs are used for guidance, the Pi will worsen, potentially sinking further, causing Qi to descend excessively, inevitably transforming into central fullness and drum-like distension. This is incorrect treatment. Differentiation between Excess and Deficiency is crucial: Excess Pi with constipation is treated primarily with Houpo (Magnolia Bark) and Zhishi (Immature Bitter Orange); Deficiency Pi with loose stools is treated with Shaoyao (Peony Root) and Chenpi (Tangerine Peel). If Pi-Man results from dietary injury, internal resolution and guiding out are appropriate. If there is chest obstruction with upward rebellion and nausea/vomiting, emesis should be induced, following the principle "What is above should be expelled upwards." Treatment of Pi requires careful examination. (*Shi Xiao*)
Pi is treated similarly to Dampness; the Qi should be drained from both upper and lower aspects. Only if there are signs of interior excess may slight draining and guiding be used. People suffering from Pi often prefer diuretics for quick relief; while temporary relief occurs, recurrence is more severe. (*Wei Yi*)
For Pi due to Middle Qi deficiency failing to transform nutrients, Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction) is indicated. For Pi due to food-phlegm accumulation, Zhisuo Erchen Tang (Immature Bitter Orange and Alder Catkin Two-Aged Decoction) added with ginger-fried Huanglian (Coptis Rhizome) is indicated; this also treats hard/stuffy epigastrium with unresolved cold-deficiency. For epigastric Pi that alternates between relaxation and tension, preferring warm substances, Zhishi Lizhong Tang (Immature Bitter Orange and Middle-Warming Decoction) is indicated. (*Yuan Bing Ji*)
For Pi caused by pathogenic factors, dispersing formulas are suitable. However, if Qi fails to flow smoothly and rebels upward causing Pi, this is Deficiency Pi; further dispersing will exacerbate it. One should employ tonification with mild dispersing intent, avoiding heavy use of aromatic Qi-moving herbs. Ancient texts note the use of Lizhong Tang after purgation for diaphragmatic Pi, illustrating this principle. For refractory Pi with incomplete bowel movements, Yinggan Wan (Miraculous Response Pill) added with Radix Euphorbiae Pekingensis (Baidu Dou) is indicated. (*Yao Jue*)
Deficient-Cold Pi arises from excessive worry, overwork, irregular eating, post-illness Spleen Qi weakness, or improper use of cold/purgative drugs by those with weak Spleen/Stomach, severely damaging Spleen Qi. Symptoms include no distension or stuffiness, lack of hunger, and loss of appetite. Patients may deny significant distension despite feeling some discomfort, often mistaking anorexia for distension. Pulses are slow, weak, and spiritless, or wiry with little Stomach Qi. Physical signs show normal complexion but timid Qi. This is Spleen deficiency failing to transport, leading to blockage. Many such cases exist; do not mistakenly use draining herbs due to anorexia, as this damages Stomach Qi and causes myriad complications. Treatment requires warming and tonifying; strengthening Spleen and Kidney Qi resolves Pi-Man, improves diet, and restores Yuan Qi. For Pi-Man due to accidental dietary injury, examine for food stagnation. Treat Excess stagnation based on its cause. (*Jing Yue Quan Shu*)
Pi-Qi is caused by Spleen Qi deficiency and Qi stagnation. Avoid breaking Qi, purging, moistening, and bitter-cold herbs. Favor Spleen-strengthening, knot-resolving, sweet-warm, and pungent-aromatic herbs. (*Ben Cao Jing Shu*)
[Formulas for Harmonizing Middle and Draining Pi]
Xie Pi Tang (Drain Spleen Decoction), for Spleen organ Excess Qi, chest fullness, and inability to eat.
Fuling (Poria, 4 liang), Houpo (Magnolia Bark, 4 liang, processed), Guixin (Cinnamon Twig Heart, 5 liang), Shengjiang (Fresh Ginger, 8 liang, sliced), Banxia (Pinellia Tuber, 1 sheng, washed), Renshen (Ginseng Root), Huangqin (Scutellaria Root), Gancao (Licorice Root, 2 liang each, processed).
Chop the eight ingredients, boil in 10 dou of water to obtain 3 sheng, divide into three doses. Also treats Cold Qi in the Spleen migrating to limbs, causing edema in hands/feet, and expels Water Qi. (*Qianjin Yifang*)
*Yi Xin Fang* effective formula, Youqi Tang (Wandering Qi Decoction), for Upper Qi, adds Zhishi (Immature Bitter Orange) to the base formula.
Zhike San (Citrus Aurantium Powder), for epigastric accumulation/stuffiness, pain, and belching with rotten egg odor.
Zhike (Exocarpium Citri Grandis, de-seeded, bran-fried), Baizhu (Atractylodes Macrocephala Rhizome, 0.5 liang each), Xiangfu (Cyperus Rotundus Rhizome, 1 liang, bran-fried, pounded, skin removed), Binglang (Areca Seed, 3 qian).
Grind to fine powder. Take 2 qian per dose, mixed with rice drink, three times daily, anytime. Formula of Pang Laoshi. (*Ben Shi*)
Xiao Pi Tang (Resolve Pi Decoction), also known as Muxiang Huazhi Tang (Costus Regulating Stagnation Decoction), for忧气 (Worry Qi) combined with food/damp/flour stagnation knotting in the Middle Jiao, causing slight abdominal pain, epigastric Pi-Man, and anorexia.
Zhishi (Immature Bitter Orange, fried), Danggui Shao (Angelica Sinensis Root Tip, 2 fen each), Chenpi (Tangerine Peel, 3 fen), Muxiang (Costus Root, 3 fen), Chaihu (Bupleurum Root, 4 fen), Caodoukou (Black Cardamom, 5 fen), Zhigancao (Honey-fried Licorice, 5 fen), Banxia (Pinellia Tuber, 1 qian), Honghua (Carthamus Flower, small amount).
Grind to coarse powder. One dose boiled in 2 zhan of water with 3 slices of fresh ginger until 1 zhan remains. Take far after meals. Avoid alcohol, dampness, and wheat products. (*Lan Shi*) (Note: *Kai Huai San* in *Yi Jian* is a variation of this formula, see *Ji Ju* section.)
Zhishi Xiaopi Wan (Immature Bitter Orange Resolving Pi Pill), for epigastric Deficient Pi, aversion to food, lethargy, opening stomach and promoting intake.
Zhishi (Immature Bitter Orange), Huanglian (Coptis Rhizome, 5 qian each), Ganshengjiang (Dried Ginger, 1 qian), Banxiaqu (Pinellia Fermented Curd, 3 qian), Houpo (Magnolia Bark, 4 qian, processed), Renshen (Ginseng Root, 3 qian), Zhigancao (Honey-fried Licorice, 2 qian), Baizhu (Atractylodes Macrocephala Rhizome, 2 qian), Baifuling (White Poria, 2 qian), Maibianmian (Malt Flour, 2 qian).
Grind to fine powder. Mix with dough made from steamed buns soaked in decoction. Form pills like wisteria seeds. Take 30 pills per dose with warm water, anytime, adjusting for Deficiency/Excess. (*Shi Xiao*)
Zhishi Lizhong Wan (Immature Bitter Orange Middle-Warming Pill), for Middle Jiao Pi stagnation, blocked Qi, accumulated cold, retained fluids, and indigestion of drinks. (*Bao Jian*) (Equivalent to Lizhong Wan plus equal parts Zhishi.)
My younger brother suffered from vomiting and inability to eat for over a month. After taking 20+ doses of broad-chest Qi-regulating herbs, he nearly stopped eating entirely, yet experienced severe Pi-distension. I diagnosed a pulse that was deficient-large and rapid. According to Zhang Zhongjing's pulse theory: "Large indicates Deficiency, Rapid indicates Deficiency." This indicates severe deficiency of Stomach Yang with turbid Yin filling the diaphragm. I prescribed Lianli Tang (Coptis and Gastrodia Decoction) with 3 qian of Renshen. After four doses, Pi ceased and appetite returned. Subsequently, Yigong San (Extraordinary Power Powder) was given for months until recovery. (*Yi Tong*)
Madam of Governor Wu Jiaoshui suffered from Pi, vertigo, vomiting, and rebellion. Previously, due to cold intolerance in the lower body and numbness in limbs/elbows, she had taken Bawei Wan (Eight-Ingredient Pill) and Shenfu Tang (Ginseng and Aconite Decoction) without complete cure. Her six pulses were wiry-slippery but soft upon pressure. This indicated chronic Phlegm-Damp in the Middle Jiao and Yang Qi failing to circulate to the extremities. While Gui/Zhi (Cinnamon Twig/Aconite) warmth provided temporary relief, it did not address true Yang deficiency, and Dihuang (Rehmannia Root) caused stagnation, leading to endless Pi/vertigo. I prescribed Qi Qi Tang (Seven Qi Decoction) from *Ju Fang* with Chenxiang (Agarwood). One dose brought immediate relief; subsequent doses restored clarity, appetite, and health. (Same source)
Sanwan Piqi Wan (Three-Furnace Pi Qi Pill), for Triple Burner Pi stagnation, failed Qi ascent/descent, retained fluids, hypochondriac fullness, or stabbing pain.
Chenxiang (Agarwood), Dafuzi (Areca Petiole), Binglang (Areca Seed), Suosha (Cardamom), Qingpi (Green Tangerine Peel, white removed), Chenpi (Tangerine Peel, white removed), Muxiang (Costus Root), Baidoukou (White Cardamom), Sanleng (Sparganium Rhizome, processed, 1 liang each), Banxia (Pinellia Tuber, 2 liang, boiled seven times).
Grind to powder. Make pills with paste like wisteria seeds. Take 30 pills with warm water or Chenpi decoction after meals. (*Bao Jian*) (Note: Instructor originally replaced Chenpi with Dafupi [Areca Peel].)
Shenghong Wan (Victory Red Pill), for heart/abdominal Pi-Man, digesting food, moving Qi, and improving appetite.
Sanleng (Sparganium Rhizome, vinegar-processed), Ezhu (Curcuma Rhizome, vinegar-processed), Qingpi (Green Tangerine Peel, fried), Chenpi (Tangerine Peel, white removed), Ganjiang (Dried Ginger, fire-roasted), Liangjiang (Galangal Rhizome), Zhishi (Immature Bitter Orange, fried), Baizhu (Atractylodes Macrocephala Rhizome, baked), Luobozizi (Radish Seed, fried, 1 liang each, separately ground), Xiangfu (Cyperus Rotundus Rhizome, 2 liang, fried, hairs removed).
Grind to fine powder. Make pills with vinegar paste like wisteria seeds. Take 50-70 pills with Ginger Decoction or Chenpi Decoction boiled with Muxiang, anytime. (*Rui Zhu*) (Note: Added Zhishi, Baizhu, Luobozizi to *Jian Yi* Shenghong Wan. Refer to *Hong Wan Zi* in *Ji Ju* section.)
Yangwei Tang (Nourish Stomach Decoction), for chest/diaphragm Pi-Man.
Xiangfu (Cyperus Rotundus Rhizome), Sharen (Amomum Fruit), Muxiang (Costus Root), Zhishi (Immature Bitter Orange, bran-fried, 7 fen each), Baizhu (Atractylodes Macrocephala Rhizome, radicle removed), Fuling (Poria), Banxia (Pinellia Tuber, ginger juice-fried), Chenpi (Tangerine Peel, 1 qian each), Baiko (White Cardamom, de-shelled, 7 fen), Huoxiang (Patchouli Herb), Houpo (Magnolia Bark, ginger juice-fried, 7 fen each), Zhigancao (Honey-fried Licorice, 2 fen).
Cut one dose. Boil with 3 slices of fresh ginger and one jujube in water. Take after meals. (*Hui Chun*)
Jieyu Hezhong Tang (Resolve Depression and Harmonize Middle Decoction), for chest/diaphragm Pi-Man, internal heat, restlessness when lying down, worsening when supine.
Chenpi (Tangerine Peel, 1.2 qian), Chi Fuling (Red Poria, 1 qian), Banxia (Pinellia Tuber, 8 fen), Qingpi (Green Tangerine Peel, 5 fen), Xiangfum (Cyperus Rotundus Rhizome, 1 qian), Zhike (Citrus Aurantium Exocarp, 1 qian), Zhizi (Gardenia Fruit, 1 qian), Huanglian (Coptis Rhizome, 7 fen), Shenqu (Medicated Leaven, 7 fen), Houpo (Magnolia Bark, 7 fen), Qianhu (Peucedanum Root, 8 fen), Suzi (Perilla Fruit, 7 fen), Sheng Gancao (Raw Licorice, 4 fen).
Cut one dose. Boil with 5 slices of ginger in water. Take hot. (Same source)
Huiling Wan (Return Command Pill), opens Pi knots, treats Liver pathogen, tonifies Spleen. (*Danxi*) (Equivalent to Zuojin Wan).
Middle Pi involves intestinal fullness, limb fatigue, difficulty walking/standing, vomiting after eating, dizziness, reduced appetite, or thirst. Use the following formula.
Dahuang (Rhubarb Root, 1 liang, wrapped in ten layers of wet paper, roasted until fragrant and ripe, sliced), Binglang (Areca Seed, 1 piece), Muxiang (Costus Root, 1 fen).
Grind to powder. Make pills with raw honey like wisteria seeds. Take 30 pills with Ginger Decoction after meals at noon. Two doses daily. Increase if no effect; stop if effective.
Attached Formula:
Guizhi (Cinnamon Twig, 5 qian, avoid direct fire), Binglang (Areca Seed, 1 piece), Heiqianniu (Black Morning Glory Seed, 4 liang, raw powder, use 2 liang).
Grind to powder. Mix 2 qian with honey and wine. Take until purgation occurs. (*Zhong Zang Jing*) (Note: Originally had Upper/Middle/Lower Pi formulas; only Middle Pi is preserved here.)