〔镇逆〕旋复代赭汤 见本卷呕吐。
〔降气〕苏子降气汤 见二卷失音。
〔虚滞〕十味保和汤 参 术 苓 夏 陈 藿 草 香附 砂仁 木香
〔寒滞〕和胃煎 朴 陈 姜 草 或加苓、夏、丁香、木香、砂仁、藿香亦可。
〔驱痰〕和胃二陈汤 见本卷饮食。
〔虚饱〕养中煎 见本卷饮食。
〔温中〕理中丸 见一卷中风。
〔火衰〕理阴煎 见二卷咳嗽。
〔痰火〕星夏栀子汤 半夏 南星 香附 石膏 栀子
〔和中〕健脾散 人参 白术 丁香 藿香 砂仁 肉果 神曲 炙草 姜 枣
侄 左胁痞闷，上撑胸臆，频嗳不舒。按丹溪云∶凡上升之气，自肝而出。左胁肝部也，痞而上逆，必
犯胃。仿仲景旋复代赭汤，成氏所谓咸以软坚，重以镇逆也。代赭汤去甘草、姜、枣，加广皮、栝蒌皮、枳壳
（俱麸炒）。三服而愈。
心下满而硬痛，为结胸；满而不痛，为痞。痞则闭而不开，
满则闷而不舒。病在胸膈气分，而外不胀急，但不知饥，不欲食，脉缓弱，或虚弦。不宜过用消耗，重损元气。
经云∶太阴所至为痞满。《保命集》曰∶脾不能行气于肺胃，结而不散，则为痞。伤寒之痞，从外之内，故
宜苦泄。杂病之痞，从内之外，故宜辛散。治伤寒热痞，用苦寒药，大黄黄连泻心汤。治伤寒阴阳不和而痞，
兼用寒热药，三黄加附子汤。治伤寒阴盛阳虚而痞，则辛甘药多，而苦寒药少。半夏、甘草、生姜诸泻心汤。
二黄泻心汤治伤寒心下痞，关上脉浮。附子泻心汤治伤寒心下痞，复恶寒汗出。去附子名三黄泻心汤，治伤寒
热痞。半夏泻心汤治胸满而呕。甘草泻心汤治胃虚气逆。生姜泻心汤治胁有水气。痞虽虚邪，然表气入里，
热郁于心胸之分，必用苦寒为泻，辛甘为散，诸泻心汤所以寒热互用也。杂病痞满，亦有寒热虚实之不同，
如胃口寒滞停痰痞闷者，辛温泄浊。橘皮半夏汤，或二陈汤加丁香。饮食寒凉，伤胃致痞者，温中化滞。
和胃煎加楂肉、麦芽、砂仁、或浓朴温中汤，脾胃阳微，胸不清旷者，辛甘理阳。苓桂术甘汤。中气久虚，
精微不化者，升清降浊。补中益气汤加猪苓、泽泻。《医通》曰∶升、柴从九地之下而升其清，苓、泻从九天
之上而降其浊，所以交否而为泰也。脾虚失运，食少虚痞者，温补脾元。四君子汤，异功散。胃虚气滞而
痞者，行气散满。保和汤，或三因七气汤，食滞未除作痞者，专消导。大和中饮，或枳术丸、资生丸。食滞既
消，脾气受伤者，宜调补。异功散、养中煎。心脾郁结而成痞者，调其气。归脾汤、治中汤。暴怒伤肝，气
逆而痞者，舒其郁。解肝煎。肺失肃降。痰热阻痞者，清理上焦。清肺饮去五味、甘草，加豆豉、栝蒌、山栀、
竹茹、枇杷叶、枳壳。气闭化热，不食便秘者，辛润开降。蔻仁、杏仁、麻仁、栝蒌仁、贝母、竹茹、石斛、
郁金，或小陷胸汤。热邪里结，恶心中痞者，苦酸泄降。半夏泻心汤去参、甘、枣，加枳、芍、乌梅。暑邪阻
气，热渴满闷者，暑邪面垢脉虚，胸闷脘痞。辛凉清上。三物香薷饮、消暑丸加桔梗、竹茹、杏仁、茯苓、
滑石、郁金汁。湿邪阻气，呕恶胸痞者，湿邪头胀，舌白不饥，脘痞恶心，脉缓。甘淡渗湿。六一散加芦根、
茯苓、杏仁、薏仁、通草、藿梗、半夏、
蔻仁、或平胃散。寒热往来，胸胁痞满者，和解半表半里。小柴胡汤加枳、桔、栝蒌皮。噎膈痞塞，乃痰与气
搏，不得宣通。痰为气激而升，气为痰腻而滞，故痞塞而成噎膈也。连理汤、生姜泻心汤。痰挟瘀血，成窠囊，
作痞，脉沉涩，日久不愈，惟悲哀郁抑之人有之，宜从血郁治。桃仁、红花、丹皮、香附、降香、苏木、韭汁、
童便。
【镇逆法】旋复代赭汤（Renshen Xuanfuzi Hengshi Decoction），参见本卷呕吐章节。
【降气法】苏子降气汤（Suzi Jiangqi Decoction），参见二卷失音章节。
【虚滞证】十味保和汤（Shiwei Baohe Decoction）：人参、白术、茯苓、半夏、陈皮、藿香、甘草、香附、砂仁、木香。
【寒滞证】和胃煎（Hewei Jian）：厚朴、陈皮、生姜、甘草；也可加茯苓、半夏、丁香、木香、砂仁、藿香。
【驱痰法】和胃二陈汤（Hewei Erchen Decoction），参见本卷饮食章节。
【虚饱证】养中煎（Yangzhong Jian），参见本卷饮食章节。
【温中法】理中丸（Lizhong Wan），参见一卷中风章节。
【火衰证】理阴煎（Liyin Jian），参见二卷咳嗽章节。
【痰火证】星夏栀子汤（Xingxia Zhizi Decoction）：半夏、天南星、香附、石膏、栀子。
【和中法】健脾散（Jianpi San）：人参、白术、丁香、藿香、砂仁、肉豆蔻、神曲、炙甘草、生姜、大枣。
侄子左胁部痞闷，向上撑胀至胸臆，频繁嗳气且感觉不舒坦。根据丹溪的观点：“凡是上升的气，都从肝发出。”左胁是肝的部位，痞塞且气机上逆，必定侵犯胃腑。仿照仲景的旋复代赭汤，即成氏所说的“咸味以软坚，重剂以镇逆”。使用代赭石汤去掉甘草、生姜、大枣，加入广陈皮、瓜蒌皮、枳壳（均用麸炒）。服用三剂后痊愈。
心下部满硬且疼痛，称为结胸；满而不痛，称为痞。痞证表现为闭塞不通，满证表现为闷胀不舒。病位在胸膈气分，体表没有胀急感，只是不知道饥饿，不想吃东西，脉象缓弱或虚弦。不宜过度使用耗损正气的药物，以免严重损伤元气。《内经》说：“太阴湿土之气所致为痞满。”《保命集》说：“脾不能将气输送到肺和胃，气机郁结不散，就形成痞证。”伤寒引起的痞证，是从外传入内，所以适宜用苦寒泄降法。杂病引起的痞证，是从内达于外，所以适宜用辛温发散法。治疗伤寒热痞，使用苦寒药，如大黄黄连泻心汤。治疗伤寒阴阳不和而致的痞证，兼用寒热药，如三黄加附子汤。治疗伤寒阴盛阳虚而致的痞证，则辛甘药多，苦寒药少，如半夏、甘草、生姜等泻心汤。二黄泻心汤治疗伤寒心下痞，关脉浮。附子泻心汤治疗伤寒心下痞，伴有恶寒汗出。去掉附子的三黄泻心汤，治疗伤寒热痞。半夏泻心汤治疗胸满伴呕吐。甘草泻心汤治疗胃虚气逆。生姜泻心汤治疗胁下有水气。痞证虽属虚邪，但表气入里，热郁于心胸部位，必须用苦寒药来泻热，用辛甘药来散邪，各种泻心汤之所以寒热并用，就是这个道理。杂病的痞满，也有寒热虚实的不同，如胃口寒滞停痰导致的痞闷，用辛温泄浊法，如橘皮半夏汤，或二陈汤加丁香。因饮食寒凉伤胃导致痞证的，用温中化滞法，如和胃煎加山楂肉、麦芽、砂仁，或浓朴温中汤。脾胃阳气微弱，胸中不清旷的，用辛甘理阳法，如苓桂术甘汤。中气久虚，精微物质不能转化的，用升清降浊法，如补中益气汤加猪苓、泽泻。《医通》说：“升麻、柴胡从九地之下提升清气，茯苓、泽泻从九天之上下降浊气，从而使否卦变为泰卦。”脾虚失去运化功能，食少虚痞的，用温补脾元法，如四君子汤、异功散。胃虚气滞导致痞证的，用行气散满法，如保和汤，或三因七气汤。食滞未除导致痞证的，专攻消导法，如大和中饮，或枳术丸、资生丸。食滞已消除，但脾气受伤的，宜调补，如异功散、养中煎。心脾郁结而成痞证的，调理其气机，如归脾汤、治中汤。暴怒伤肝，气逆导致痞证的，疏解其郁结，如解肝煎。肺失肃降，痰热阻滞导致痞证的，清理上焦，如清肺饮去掉五味子、甘草，加豆豉、瓜蒌、栀子、竹茹、枇杷叶、枳壳。气闭化热，不进食且便秘的，用辛润开降法，如蔻仁、杏仁、麻仁、瓜蒌仁、贝母、竹茹、石斛、郁金，或小陷胸汤。热邪内结，恶心且心下痞的，用苦酸泄降法，如半夏泻心汤去掉人参、甘草、大枣，加枳实、白芍、乌梅。暑邪阻滞气机，热渴满闷的，若见暑邪面垢脉虚，胸闷脘痞，用辛凉清上法，如三物香薷饮、消暑丸加桔梗、竹茹、杏仁、茯苓、滑石、郁金汁。湿邪阻滞气机，呕吐恶心胸痞的，若见湿邪头胀，舌苔白不饥，脘痞恶心，脉缓，用甘淡渗湿法，如六一散加芦根、茯苓、杏仁、薏苡仁、通草、藿梗、半夏、蔻仁，或平胃散。寒热往来，胸胁痞满的，和解半表半里，如小柴胡汤加枳实、桔梗、瓜蒌皮。噎膈痞塞，是痰与气搏结，不得宣通。痰被气激而上升，气被痰腻而停滞，所以痞塞而成噎膈。用连理汤、生姜泻心汤。痰挟瘀血，结成窠囊，导致痞证，脉沉涩，日久不愈，只有悲哀抑郁的人才有此症，宜从血郁论治，如桃仁、红花、丹皮、香附、降香、苏木、韭汁、童便。
[Method of Subduing Rebellious Qi] Xuanfu Daizhe Tang (Inula and Hematite Decoction), see Vomiting in this volume.
[Method of Descending Qi] Suzi Jiangqi Tang (Perilla Seed Decoction for Descending Qi), see Aphonia in Volume II.
[Deficiency with Stagnation] Shiwei Baohe Tang (Ten-Ingredient Harmonizing the Middle Decoction): Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Banxia (Pinelliae Tuber), Chenpi (Citri Reticulatae Pericarpium), Huoxiang (Agastaches Herba), Gancao (Glycyrrhizae Radix et Rhizoma), Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus), Muxiang (Aucklandiae Radix).
[Cold with Stagnation] Hewei Jian (Stomach-Harmonizing Decoction): Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Shengjiang (Zingiberis Rhizoma Recens), Gancao (Glycyrrhizae Radix et Rhizoma); alternatively, add Fuling (Poria), Banxia (Pinelliae Tuber), Dingxiang (Caryophylli Flos), Muxiang (Aucklandiae Radix), Sharen (Amomi Fructus), Huoxiang (Agastaches Herba).
[Method of Expelling Phlegm] Hewei Erchen Tang (Stomach-Harmonizing Two-Aged Decoction), see Diet in this volume.
[Fullness due to Deficiency] Yangzhong Jian (Nourishing the Middle Decoction), see Diet in this volume.
[Method of Warming the Middle] Lizhong Wan (Regulate the Middle Pill), see Stroke in Volume I.
[Decline of Fire] Liyin Jian (Nourishing Yin Decoction), see Cough in Volume II.
[Phlegm-Fire] Xingxia Zhizi Tang (Arisaema, Pinellia, and Gardenia Decoction): Banxia (Pinelliae Tuber), Nanxing (Arisaematis Rhizoma), Xiangfu (Cyperi Rhizoma), Shigao (Gypsum Fibrosum), Zhizi (Gardeniae Fructus).
[Method of Harmonizing the Middle] Jianpi San (Spleen-Strengthening Powder): Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Dingxiang (Caryophylli Flos), Huoxiang (Agastaches Herba), Sharen (Amomi Fructus), Rougu (Myristicae Semen), Shenqu (Massa Medicata Fermentata), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Dazao (Jujubae Fructus).
The nephew suffered from stuffiness and oppression in the left hypochondrium, distending upward to the chest and epigastrium, accompanied by frequent belching and discomfort. According to Danxi: "All ascending qi originates from the Liver." The left hypochondrium is the region of the Liver; stuffiness with rebellious qi must invade the Stomach. Following Zhongjing's Xuanfu Daizhe Tang, which Chengshi describes as "salty to soften hardness, heavy to subdue rebellion," we used Daizhe Tang removing Gancao (Glycyrrhizae Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), and Dazao (Jujubae Fructus), adding Guangpi (Citri Reticulatae Pericarpium), Gualoupi (Trichosanthis Pericarpium), and Zhike (Aurantii Fructus Immaturus) (all stir-fried with bran). After three doses, he recovered.
Fullness, hardness, and pain in the epigastrium constitute Jie Xiong (Chest Binding); fullness without pain constitutes Pi (Stagnant Fullness). Pi is characterized by blockage and lack of openness, while Man (Fullness) is characterized by oppression and discomfort. The pathology lies in the Qi level of the chest and diaphragm, with no external tension or swelling, but rather a lack of hunger and anorexia. The pulse may be slow and weak, or deficient and wiry. One should not overuse draining drugs that severely damage Yuan Qi (Original Qi). The Classics state: "What arrives from Taiyin manifests as Pi Man (Stagnant Fullness)." *Baoming Ji* states: "When the Spleen cannot transport Qi to the Lung and Stomach, and it knots without dispersing, Pi results." Pi caused by Shanghan (Cold Damage) arises from the exterior moving inward, thus requiring bitter-draining methods. Pi caused by miscellaneous diseases arises from the interior reaching outward, thus requiring acrid-dispersing methods. For Shanghan Heat Pi, use bitter-cold herbs, such as Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction). For Pi due to Yin-Yang disharmony in Shanghan, combine cold and hot herbs, such as Sanhuang Jia Fuzi Tang (Three Yellows plus Aconite Decoction). For Pi due to excess Yin and deficiency of Yang in Shanghan, use more acrid-sweet herbs and fewer bitter-cold ones, such as Banxia, Gancao, and Shengjiang Xiexin Tangs. Erhuang Xiexin Tang treats Shanghan Epigastric Pi with a floating Guan pulse. Fuzi Xiexin Tang treats Shanghan Epigastric Pi accompanied by aversion to cold and sweating. Sanhuang Xiexin Tang (without Fuzi) treats Shanghan Heat Pi. Banxia Xiexin Tang treats chest fullness with vomiting. Gancao Xiexin Tang treats Stomach deficiency with rebellious Qi. Shengjiang Xiexin Tang treats water-Qi in the hypochondrium. Although Pi is a deficiency-pathogen, when exterior Qi enters the interior and heat stagnates in the heart-chest region, bitter-cold herbs are necessary to drain, and acrid-sweet herbs to disperse; hence, the various Xiexin Tangs use cold and hot herbs mutually. Miscellaneous disease Pi Man also varies by cold, heat, deficiency, and excess. For stomach cold-stagnation with retained phlegm causing stuffiness, use acrid-warm turbidity-draining methods, such as JuPi Banxia Tang (Tangerine Peel and Pinellia Decoction) or Erchen Tang (Two-Aged Decoction) added with Dingxiang (Caryophylli Flos). For Pi caused by dietary cold damaging the Stomach, use warming-middle and stagnation-resolving methods, such as Hewei Jian (Stomach-Harmonizing Decoction) added with Zhari Rou (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), and Sharen (Amomi Fructus), or Nongpu Wenzhong Tang (Magnolia Bark Decoction for Warming the Middle). For slight Spleen-Stomach Yang deficiency with unclear chest cavity, use acrid-sweet Yang-regulating methods, such as Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction). For long-term Middle Qi deficiency with failure to transform essence, use ascending-clear and descending-turbid methods, such as Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) added with Zhuling (Polyporus) and Zexie (Alismatis Rhizoma). *Yitong* states: "Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) ascend clear Qi from below, while Fuling (Poria) and Zexie (Alismatis Rhizoma) descend turbid Qi from above, transforming obstruction into harmony." For Spleen deficiency with failed transportation, leading to food intake reduction and deficient Pi, use warming-tonifying Spleen-origin methods, such as Sijunzi Tang (Four Gentlemen Decoction) or Yigong San (Extraordinary Skill Powder). For Stomach deficiency with Qi stagnation causing Pi, use Qi-moving and distension-resolving methods, such as Baohe Tang (Harmonizing the Middle Decoction) or Sanyin Qi Qi Tang (Three Causes Seven Qi Decoction). For Pi caused by unremoved food stagnation, focus on digestion-promoting methods, such da Hezhong Yin (Great Harmonizing the Middle Infusion), or Zhizhu Wan (Aurantium and Atractylodes Pill), or Zisheng Wan (Nourishing Life Pill). After food stagnation is resolved but Spleen Qi is injured, use regulation and tonification, such as Yigong San (Extraordinary Skill Powder) or Yangzhong Jian (Nourishing the Middle Decoction). For Pi formed by Heart-Spleen depression, regulate Qi, such as Guipi Tang (Restore the Spleen Decoction) or Zhizhong Tang (Regulate the Middle Decoction). For Pi caused by sudden anger injuring the Liver and rebellious Qi, soothe depression, such as Jiegan Jian (Relieve Liver Decoction). For Lung failing in descending function with phlegm-heat obstructing Pi, clear the Upper Jiao, such as Qingfei Yin (Lung-Clearing Infusion) removing Wuweizi (Schisandrae Fructus) and Gancao (Glycyrrhizae Radix et Rhizoma), adding Douchi (Sojae Semen Preparatum), Gualou (Trichosanthis Fructus), Zhizi (Gardeniae Fructus), Zhuru (Bambusae Caulis in Taenia), Pipaye (Loquat Leaf), and Zhike (Aurantii Fructus Immaturus). For Qi closure transforming into heat, with anorexia and constipation, use acrid-moistening opening and descending methods, such as Keren (Amomi Semen), Xingren (Armeniacae Semen Amarum), Maren (Cannabis Semen), Gualou Ren (Trichosanthis Semen), Beimu (Fritillariae Bulbus), Zhuru (Bambusae Caulis in Taenia), Shihu (Dendrobii Caulis), and Yujin (Curcumae Radix), or Xiaoxianxiong Tang (Small Chest-Thrashing Decoction). For internal binding of heat pathogen with nausea and epigastric Pi, use bitter-acid draining and descending methods, such as Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) removing Renshen (Ginseng Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), and Dazao (Jujubae Fructus), adding Zhishi (Aurantii Fructus Immaturus), Shaoyao (Paeoniae Radix Alba), and Wumei (Mume Fructus). For Summerheat pathogen obstructing Qi with heat-thirst and fullness, if presenting with summerheat facial greasiness, deficient pulse, chest fullness, and epigastric Pi, use acrid-cool clearing-upper methods, such as Sanwu Xiangru Yin (Three-Ingredient Elsholtzia Infusion) or Xiaoshu Wan (Summerheat-Dispelling Pill) added with Jiegeng (Platycodon Radix), Zhuru (Bambusae Caulis in Taenia), Xingren (Armeniacae Semen Amarum), Fuling (Poria), Huashi (Humphilitis), and Yujin juice. For Dampness pathogen obstructing Qi with vomiting, nausea, and chest Pi, if presenting with dampness-induced head heaviness, white tongue coating, anorexia, epigastric Pi, nausea, and slow pulse, use sweet-bland damp-draining methods, such as Liuyi San (Six-to-One Powder) added with Lugen (Reed Rhizome), Fuling (Poria), Xingren (Armeniacae Semen Amarum), Yiren (Coicis Semen), Tongcao (Tetrapanacis Medulla), Huogeng (Agastache Stem), Banxia (Pinelliae Tuber), and Keren (Amomi Semen), or Pingwei San (Level the Stomach Powder). For alternating chills and fever with chest-hypochondriac Pi Man, harmonize half-exterior half-interior, such as Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhishi (Aurantii Fructus Immaturus), Jiegeng (Platycodon Radix), and Gualoupi (Trichosanthis Pericarpium). Yige (Dysphagia) and Pi Se (Obstruction) result from the struggle between Phlegm and Qi, preventing free circulation. Phlegm rises due to Qi agitation, and Qi stagnates due to Phlegm viscosity, thus forming obstruction leading to Yige. Use Lianli Tang (Connected Decoction) or Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction). When Phlegm carries Blood Stasis forming nests causing Pi, with deep-choppy pulse and chronic non-resolution, occurring only in those who are sorrowful and depressed, treat from Blood Depression, such as Tao Ren (Persicae Semen), Honghua (Carthami Flos), Danpi (Moutan Cortex), Xiangfu (Cyperi Rhizoma), Jiangxiang (Dalbergiae Odoriferae Lignum), Sumu (Pterocarpi Santalinus), Jiuzhi (Allii Tuberosi Juice), and Tongbian (Human Urine).