【因】 误下阴虚。食积痰滞。湿土虚痞。
论曰∶太阴湿土为积饮痞膈，乃土来心下痞满也。
【证治】 误下多则亡阴，胸中之气，因虚而下陷于心之分野。宜升胃气，以血
药治之。亡阴谓脾胃水谷之阴亡也。
痰积痞膈，胸中窄塞，宜消导之，谓之实痞。
湿土虚痞有二。大便秘能食者，浓朴、枳实主之；大便利者，芍药、陈皮主之。
【治法】 以泻心汤。黄连为君，泻心下之土邪；浓朴降气。
《三因》论状 心下坚满，痞急痛如刺，不得俯仰，其胸前皮皆痛，短气，咳唾引痛，
咽塞不利，习习如痒，喉中干燥，呕吐烦闷，自汗时出，痛引彻背。
外有心热而痞之，痞则满硬。结胸则痛，属胸痹。
大消痞丸 治湿土痞、虚气痞。
黄连（炒） 黄芩（各三钱） 姜黄（一钱） 白术 半夏（各一两） 甘草（炙，一钱） 缩砂
（一钱） 枳实（炒） 生姜（各五钱） 陈皮（二钱） 神曲（一钱，炒） 浓朴（三钱） 泽泻 猪
苓（各一钱五分）
丸梧子大，白汤送下。木香，有忧气结中脘，心下痞满，肚皮底微痛加之，否则不用。
利膈丸 除痰利膈。
黄芩（生炒各一两） 黄连 南星 半夏（各五钱） 枳壳 陈皮（各三钱） 白术（二钱）
白矾（五分） 泽泻（五钱） 神曲（五钱，炒）
栝蒌丸 治胸痞，或胁下逆抢心。
栝蒌子 枳实 陈皮
取栝蒌皮，穣末熬丸。胸痞切痛，加栀子烧存性、附子炮，各二两。
【病因】 误用泻下法导致阴液亏损。饮食积滞，痰湿停滞。因脾土虚弱而导致的痞证。
论述说：太阴湿土之气积聚成饮邪，导致痞塞膈间，这是湿土之气上逆至心下部位，引起痞满的症状。
【证候与治疗】 如果误用泻下法过多，会导致阴液亡失，胸中的正气，因为虚弱而下陷到心经所主的区域。应当提升胃气，使用养血药物进行治疗。所谓“亡阴”，是指脾胃中水谷化生的阴液耗损。
痰食积滞引起的痞塞膈间，感觉胸中狭窄堵塞，应当采用消食导滞的方法治疗，这被称为“实痞”。
湿土虚弱引起的痞证有两种情况：大便干结且能进食的，以厚朴、枳实为主药；大便通畅的，以芍药、陈皮为主药。
【治法】 使用泻心汤。黄连作为君药，清泻心下部位的土邪（湿热）；厚朴降气。
《三因方》描述的病状：心下部位坚硬胀满，痞塞急痛如针刺感，不能俯身或仰背，胸前皮肤均疼痛，呼吸短促，咳嗽吐痰时牵引疼痛，咽喉堵塞不利，皮肤有瘙痒感，喉咙干燥，呕吐烦闷，自汗不时流出，疼痛放射至背部。
外部有心热症状并伴有痞证，痞证表现为胀满硬结。结胸证则表现为疼痛，属于胸痹范畴。
大消痞丸 治疗湿土痞证、虚气痞证。
黄连（炒制）三钱，黄芩（各三钱），姜黄一钱，白术一两，半夏一两，甘草（炙制）一钱，缩砂仁一钱，枳实（炒制），生姜五钱，陈皮二钱，神曲（炒制）一钱，厚朴三钱，泽泻一钱五分，猪苓一钱五分。
制成梧桐子大小的丸剂，用白开水送服。如果有忧思之气郁结在中脘部，心下痞满，肚皮底部轻微疼痛，可加木香，否则不使用。
利膈丸 祛除痰浊，利膈宽胸。
黄芩（生用与炒制各一两），黄连五钱，南星五钱，半夏五钱，枳壳三钱，陈皮三钱，白术二钱，白矾五分，泽泻五钱，神曲（炒制）五钱。
栝蒌丸 治疗胸中痞塞，或者胁下有气逆冲心胸。
栝蒌子，枳实，陈皮。
取栝蒌皮，去除瓤后研末熬制成丸。如果胸中痞塞疼痛剧烈，加入栀子（烧存性）二两、附子（炮制）二两。
[Pathogenesis] Misuse of purgatives leads to Yin deficiency. Food stagnation and phlegm-dampness obstruction. Pi syndrome (epigastric fullness) caused by deficient Spleen Earth.
It is stated that: The accumulation of dampness in the Taiyin Spleen Earth transforms into fluid retention, causing Pi syndrome and diaphragmatic obstruction. This refers to the Qi of Earth rising to the epigastrium, resulting in fullness and blockage.
[Syndrome Differentiation and Treatment] Excessive misuse of purgatives causes the loss of Yin. The Qi in the chest, due to deficiency, sinks downward into the region governed by the Heart. It is appropriate to raise Stomach Qi and treat with blood-invigorating/nourishing herbs. "Loss of Yin" refers to the depletion of the Yin fluids derived from food and water in the Spleen and Stomach.
Pi syndrome and diaphragmatic obstruction caused by phlegm and food stagnation, characterized by a narrow and blocked sensation in the chest, should be treated with methods that resolve stagnation and promote digestion; this is called "Excess Pi".
There are two types of Pi caused by deficient Spleen Earth: If constipation is present but appetite remains good, Magnoliae Officinalis Cortex (Houpo) and Immature Bitter Orange (Zhishi) are the primary herbs; if bowel movements are normal or loose, White Peony Root (Shaoyao) and Tangerine Peel (Chenpi) are the primary herbs.
[Therapeutic Method] Use Xiexin Tang (Drain the Epigastrium Decoction). Coptis Rhizome (Huanglian) serves as the Sovereign herb to drain the Earth-pathogenic factors (damp-heat) in the epigastrium; Magnoliae Officinalis Cortex (Houpo) descends Qi.
The *San Yin Fang* describes the symptoms as: Hardness and fullness in the epigastrium, urgent pain in the Pi area like stabbing, inability to bend forward or extend backward, pain over the entire skin of the chest, shortness of breath, pain radiating during coughing and expectoration, throat obstruction and discomfort, a tickling sensation like itching, dryness in the throat, vomiting with restlessness, spontaneous sweating occurring intermittently, and pain radiating through to the back.
Externally, there may be Heart heat accompanying Pi; Pi manifests as fullness and hardness. Jie Xiong (Chest Binding) manifests as pain and belongs to the category of Xiong Bi (Obstruction of the Chest).
Da Xiao Pi Wan (Great Elimination of Pi Pill) treats Pi due to Damp-Earth and Deficient Qi.
Coptis Rhizome (Huanglian, stir-fried), Scutellaria Root (Huangqin) [3 qian each], Turmeric Tuber (Jianghuang) [1 qian], Atractylodes Macrocephala Rhizome (Baizhu) [1 liang], Pinellia Tuber (Banxia) [1 liang], Licorice Root (Gancao, honey-fried) [1 qian], Amomum Fruit (Suosha) [1 qian], Immature Bitter Orange (Zhishi, stir-fried), Fresh Ginger (Shengjiang) [5 qian each], Tangerine Peel (Chenpi) [2 qian], Medicated Leaven (Shenqu, stir-fried) [1 qian], Magnoliae Officinalis Cortex (Houpo) [3 qian], Alisma Rhizome (Zexie) [1.5 qian], Polyporus (Zuling) [1.5 qian].
Form into pills the size of wu zi (wu berry seeds), take with warm water. Add Costus Root (Muxiang) if there is Qi stagnation from worry in the Zhongwan region, with epigastric fullness and slight pain at the base of the abdomen; otherwise, do not use.
Li Ge Wan (Diaphragm-Opening Pill) eliminates phlegm and opens the diaphragm.
Scutellaria Root (Huangqin, raw and stir-fried) [1 liang each], Coptis Rhizome (Huanglian) [5 qian], Arisaema Rhizome (Nanxing) [5 qian], Pinellia Tuber (Banxia) [5 qian], Aurantium Fructus Immaturus (Zhike) [3 qian], Tangerine Peel (Chenpi) [3 qian], Atractylodes Macrocephala Rhizome (Baizhu) [2 qian], Alum (Baifan) [0.5 qian], Alisma Rhizome (Zexie) [5 qian], Medicated Leaven (Shenqu, stir-fried) [5 qian].
Gualou Wan (Trichosanthes Pill) treats chest Pi or rebellious Qi rushing from the hypochondrium to the heart.
Trichosanthes Seed (Gualouzi), Immature Bitter Orange (Zhishi), Tangerine Peel (Chenpi).
Take Trichosanthes Peel (Gualoupi), remove the pulp, powder it, and decoct to form pills. If chest Pi involves severe pain, add Gardenia Fruit (Zhizi, charred to retain its nature) [2 liang] and Prepared Aconite Root (Fuzi, processed) [2 liang].