（一名伤寒夹痞结）
【因】素有痰结成痞。或有气聚为满。猝感风寒。引动宿疾而发。或先由气食相搏。或先由气血互结。
后感风寒而成。若由风寒犯太阳经。初治先当发汗。早用下药。每成痞满。
【证】初起头痛身热。恶寒无汗。胸膈痞满。满而不痛。气从上逆。甚则发厥。不语如喑。或胸满
而兼痛。或胁满痛。或腹胀疼。舌苔白滑。甚或白滑而浓。或前半无苔。中后白腻而浓。
【脉】左浮紧。右沉弦。或沉涩。或右寸关沉滑。或弦急而滑。皆伤寒夹痞结之候也。
【治】先用理气发汗。香苏葱豉汤加枳、桔。或用十味流气饮。（制香附、苏叶梗各钱半、枳壳、
橘红、姜半夏、川朴、赤苓各一钱、桔梗七分、广木香五分、炙甘草三分。）表散外邪。畅其气以宽痞。
若胸膈不宽。寒热似疟者。轻则柴胡枳桔汤。重则柴胡陷胸汤。气食相搏者。神术汤加减。气血互结者。
清肝达郁汤加减。怒郁不泄。昏厥不语者。先用通关取嚏。次用仁香汤去丁香、白蔻。烊冲紫金片。若邪
从火化。蒸痰壅气。轻则膈上如焚。心烦懊 。寒热便闭者。用柴芩清膈煎。攻其里以和解。甚则胸膈
痞闷。腹满便闭。喘胀躁乱。胸腹坚如铁石者。速用加味凉膈煎。下痰通便。以宽胸腹。若郁火伤中。
气逆痞满。腹痛便秘者。即用六磨饮子。下气通便。以畅胸腹。必俟里热清。痞满
解。始可用白术和中汤。温和脾胃以善后。若痞满虽解。而胃脘胀痛者。则用香砂理中汤加炒 皮、蜜炙延
胡、疏畅中气以除痛。终用木香理中汤（广木香六分、姜半夏、广皮、枳实拌炒白术各一钱、青皮、春砂仁
各五分、清炙草四分、烦热、加姜炒川连七分、便闭、加海南子、炒黑丑各钱半。）调和中气以除根。
若但误下成痞。满而不痛者。在胸膈。用柴胡陷胸汤。在心下。用半夏泻心汤加减。（姜半夏、姜炒条芩
各钱半、枳实一钱拌炒川连七分、炒干姜四分、清炙草二分、寒热加川柴胡八分、渴加花粉三钱、去半夏
干姜、呕加淡竹茹三钱、广皮钱半、姜汁四滴冲、腹痛自利者、加白术一钱、拌炒白芍一钱、浙茯苓三钱、
溺少加赤苓、泽泻各钱半。）如不因下早而为痞。乃表邪初传上焦。尚未入胃。证虽痞满。尚为在表。只
用柴胡枳桔汤。和解以宽痞气可也。
【秀按】痞者气不通泰也。内觉满闷。外无胀形。有湿热太甚。痰气上壅气机为痞者。有饮食过多。
滞气上逆胸膈为痞者。有过服消克。不能疏化饮食为痞者。有中气久虚。不能营运精微为痞者。有阳气素亏。
不能疏降浊阴为痞者。有大怒气盛。不能发泄成痞者。有痰与气搏。不得疏通成痞者。有痰挟血瘀。酿
成窠囊作痞者。因不一。治亦不同。而其所以痞满者。总由于气不通畅。方以香砂宽中散为君。（制香附、
广木香各五钱、春砂仁、白蔻仁各三钱、真川朴一两、炙黑甘草二钱、共研细末、每服二三钱。）因于湿
热挟痰者。必兼胃钝肢懈。痰多溺涩。用小陷胸合四苓汤调下。因于饮食阻滞者。必兼嗳腐吞酸。恶心腹
痛。用消导二陈汤调下。因于克削伤中者。必兼时胀时减。中空无物。用六君子汤去甘草调下。因于中气
久虚者。必兼或宽或急。喜手按摩。用补中益气汤调下。因于阳气素亏者。必兼朝宽暮急。 胀难忍。用
附子理中汤去草调下。因于大怒气盛者。口中多血腥气。甚则气逆血溢。更或痰中见血。宜从气郁血瘀治。
苏子降香汤调下。（蜜炙苏子、制
香附、广郁金、焦栀、丹皮、山楂各钱半、紫降香、醋炒红曲一钱、红花四分、童便一杯冲、甚则加
醋炒生锦纹钱半、光桃仁七粒。）因于痰与气搏者。气为痰腻而滞。痰为气激而上。必多喘满噫气。宜从
气逆痰郁治。增减旋复代赭汤调下。因于痰瘀成囊者。脘腹虽多满痛。按之呱呱有声。甚则肠间抽疼。
宜从痰凝血郁治。新加栝蒌薤白汤调下。（栝蒌仁炒香三钱、光桃仁七粒、干薤白酒洗捣二钱、杜苍术
八分、制香附、丹皮各钱半、控涎丹七分、藏红花五分、韭白汁两匙、姜汁两滴同冲。）此外调气宽痞
之药。如香附、紫苏、薄荷、葱白之疏泄卫气。杏仁、蔻仁、枳壳、桔梗之疏畅肺气。前胡、橘红、苏
子、郁金之疏化痰气。神曲、广皮、莱菔子、砂仁之疏消食气。他若藿香之上行胃气。浓朴之下泄胃气。
枳实能从上焦泻小肠之气。槟榔能从中焦泻大肠之气。青皮能伐肝气以疏胃。沉香能平肝气以纳肾。柴
胡、升麻能从下焦而升其清气。猪苓、泽泻能从上焦而降其浊气。气药虽多。然多服过服。恣行疏利以
求速效。反损真气。每致愈疏愈痞而成气虚中满之臌症。皆由不辨因证。笼统治痞。喜行疏剂。但求暂
时通快者阶之厉也。故凡辨症不精。莫如先用外治烫运法。（麸皮一两、拌炒生姜渣五钱、盐水炒枳壳
片一两、炒热布包、揉熨软快为度。）收效甚速。俞氏方法。但举其大要而言。尽美而未尽完善。特为
补缀数条。以弥其阙。另有一种先由郁怒伤肝，后感风寒的夹气伤寒。妇女最多。男子亦间有之。初
起香苏葱豉汤最为的对。若发自少阳经。寒热往来。胸胁串痛者。柴胡枳桔汤亦多取效。若发自阴经。
郁积伤中。形厥如尸者。用三合绛覆汤。（真新绛钱半、旋复花三钱、青葱管五寸冲、光桃仁七粒、东
白薇三钱、归须钱半、广郁金三钱、苏合丸一颗、磨汁冲。）若但郁闷不得发泄者。偶感风寒。但
略兼开郁理气。不可擅行破血消滞也。
【廉勘】夹气郁与夹食滞。初起时症多相同。而多右脉沉。手足冷。若呕逆胸满。颇类夹食。但
夹食为有物。为实邢。舌苔浓白而微黄。胸膈满痛不可按。而亦不移。夹气为无物。为虚邪。舌苔白
薄。胸膈满痛。半
软而可按。先宜宣通其郁。然后解表清里。自无不效。若不舒郁而徒发表。则里气不能外达。而难
于澈汗。遽用清下。则上气不宣。多致痞逆。惟于解表药中。加苏梗、青皮、郁金、香附之类。以宣其气。则
表易解。于清里药中。加栝蒌、川贝以舒其郁。则里易和。但川贝虽为舒郁要药。而力薄性缓。必
用至五钱一两。方能奏效。若加四磨饮子。（即六磨饮子去乌药、生军。）则尤捷。若气郁化火。阻碍中
焦。上则胸闷。下则便闭者。用六磨饮子。最效。其满而不痛者为痞。属无形之气。满而兼痛者为结。
属有形之物。凡有感症。夹痞结者颇多。但痞轻而结重。有邪未结而但满者。有邪已结而满痛者。痞满以
宽气为主。轻则杏、蔻，橘、桔。重则蒌、薤、朴、枳。俞氏方法粗备。先祖详为申明。已大致楚楚矣。
若满而兼痛。邪早结实。每因夹食、夹痰、夹瘀之故。与新邪或伏邪互结。或结于胸胁。或结于脘腹。痛不
可按。甚则昏冒。虽因所夹不同。而其结痛拒按。闭塞不容喘息之状则同。倘不细察详问。鲜不认为本病
应得之候。不先行速去之。则所受之邪。每为其羁留伏匿。不得透达。以致凶变。宜先与一服飞马金丹。
（生川军、广郁金、五灵脂、上雄黄各一两、巴豆霜、广木香、赖橘红各三钱、明乳香、净没药、百草霜、
辰砂、山慈菇各二钱各秤另研净末分量、再合研一时许、令匀、米醋法丸、金箔为衣、如绿豆大、隔纸
晒干、瓷器紧贮、二十岁以上者、每服十二丸、禀强者加三丸、老年者七丸或九丸、二三岁者三丸或五丸、
温开水送下、半日或一二时许、非吐必泻、此丹治夹痰食血等、结于胸脘、高突痛胀、不可抑按、不得呼
吸、甚则欲吐不得吐、欲泻不得泻者、凡外感夹内伤、见有此状者、无论大小、均可用之。）自能随所结
之上下。而施其吐下之功。得夹邪一解。正气自伸。邪气自现。按法调治本症。为较易耳。若夹宿饮而气
郁成痞。甚则成窠囊者。许氏神术丸。每多不效。予仿薛生白先生法。用千金五香汤。（千金霜一钱煎汤、
磨沉香、木香、檀香、降香、丁香各一两匙。）效亦如神。若夹积水停饮。酿成痞气。绵延日久。腹胀如
鼓。按之呱呱有声者。仿危亦林先生法。用加味控涎丹。（炒黑丑二两、煨甘遂、红牙大
戟、白芥子、炒葶苈各一两、芫花、上沉香各五钱、巴霜一钱、研细、姜汁糊丸、金箔为衣、如梧桐子大、每
服五丸、淡姜汤送下。）继用六君子汤去甘草加香附。补而兼疏。往往三泻三补。厥疾顿瘳。总之因积成痞。
初为痞气。继为痞块。必审其何经受病。何物成积。认得分明。发直入之兵以讨之。血积如桃、红、穿甲、
虫、莪术、瓦楞子、干漆灰、醋炒生军等选用。痰积如风化硝、浮海石、海蛤粉、半夏曲、杜胆星、生枳
实、礞石、白芥子、萝卜子、海粉、竹沥、荆沥、姜汁、石菖蒲汁等选用。水积如大戟、甘遂、芫花、商陆、
千金霜、黑白丑等选用。酒积如酒曲、葛花、槟榔、橄榄、枳 子等选用。茶积如姜黄、茱萸、川椒、生干姜
等选用。肉积如山楂、萝卜子、阿魏、朴硝、毛栗壳灰等选用。虫积如雷丸、鹤虱、雄黄、锡灰、芜荑、巴
霜、使君子、枣儿槟榔等选用。瘀积如三棱、莪术、巴豆、大黄、鳖甲、 虫、虻虫、水蛭、夜明砂、地栗粉
等选用。各从其类。以直捣其巢穴。如经云、大积大聚。其可犯也。衰其大半而止。即调脾胃以养正。使积自
除。前哲周慎斋曰。凡痞积不可先用下药。徒损正气。病亦不去。当用消积药使之熔化。则除根矣。积去须大
补。诚治由积成痞之格言也。惟素有遗泄。气虚于下。痰结于上。饮食难化。而成郁结痞满之证。似隔非隔之
候。最为难治。（荣斋按∶以下详论痞积之上实下虚治法。）不但滋补阴虚药。于开膈进食。固有大碍。即用
香砂六君子汤。调补兼施。往往痞满益甚。食即停留不下。因下虚者不宜骤升。升则浊气在上。反生 胀。亦
不宜专用破气。愈破愈痞。总宜疏导郁滞。升降互用。合成疏通。使胸膈日宽一日。谷气日增一日。则津液从
上输下。阴气不补而自补矣。初用升降疏郁汤。（苏子、山楂各二钱、广皮红、半夏曲各钱半、茯苓、乌药、
制香附拌炒五谷虫各一钱、蜜炙升麻三分、柴胡四分、韭汁二匙、姜汁二滴、同冲。）次用和中畅卫汤。（制
香附、苏叶梗炒神曲、北沙参各一钱、杜苍术、川贝、抚芎、连翘各八分、苦桔梗六分、广木香四分、春砂
仁三分冲。）又次用八物顺气汤。（白芷、乌药、青皮、陈皮各一钱、茯苓、白术各钱半、米炒党参八分、清
炙草五分。）送下沉附都气丸。（熟地八两、山萸肉、山药各四两、茯苓、泽泻、丹皮各三两、沉香、淡附片
各一两、北五味五钱、蜜丸、如桐子大、每服二钱。）临卧口含陈氏噙化丸。（米炒西洋参六钱、醋制香附、
广皮红各四钱、川贝、桔梗各三钱、松萝茶二钱蒸烂、同竹沥梨膏为丸、每丸一钱。）使睡中常有药气。徐徐
沁入。以疏通其胸膈中脘之间。必使新结不增。旧结渐解。然后朝用二加龙蛎汤。（生白芍、化龙骨各二钱、
东白薇二钱、清炙草八分、 牡蛎四钱、蜜煨生姜一钱、大红枣三钱、淡附片五分。）滋阴潜阳。封固下焦以
收火。夜用运痰丸。（半夏曲四两、姜汁竹沥制、姜炒川连一两、广木香、沉香、清炙草五钱、党参、于术、
茯苓各三两、姜汁竹沥泛丸、每服二钱。）益气化痰。疏补中上以除根。此痞结之上实下虚。最为绵延难愈者
也。虽然。气虚中满症。亦属难治。每仿陆肖愚先生法。进退调补。酌用补气养荣汤。（党参、白术、归身、
白芍、川芎、茯苓木、香豆蔻、初用香蔻七八分至一钱。）调下宽膨散一钱。（顶大蛤蟆一只、破开、用春砂
仁萝卜子填满、黄泥封固、炭上 烧研、去渣。）参术但用六七分。而中满稍减。继则参术不减。香蔻宽膨。
增至钱半。而饮食渐加。中满较宽大半。后渐加参术至二三钱。减香蔻宽膨至三分。或进或退。约二三十剂。
始奏全功。
【荣斋按】痞与结胸，同为硬满之症，当以痛为辨。满而硬痛为结胸，为实热，宜陷胸法治之；满而不痛为
痞满，为虚热，宜用泻心法治之。文献告诉我∶治痞要药，在干姜，黄连二味，半夏、黄芩、甘草、大枣、四
味、则辅佐而已；偏于寒则多用干姜，亦可参以附子，偏于热则多用黄连，亦可参以大黄，偏于中虚则加人
参，或涉表邪一二则加生姜，并可与旋复代赭黄连等汤出入互用。此外为暑湿痰食，痧秽凝结成痞者，则参用
叶天士法，足以补本节所载之缺──如膈闷心烦痞满而喘急者，热痰内闭也；宜栀豉汤加川郁金、栝蒌仁、枳
实、杏仁之类，开之宣之。如脘中痞闷而兼头胀目黄，脉象濡涩者，此暑湿伏邪凝滞胸中也；宜清疏中焦，川
【病因】患者平素体内有痰浊凝结成痞。或者因气机郁滞导致腹部胀满。突然感受风寒之邪，引动宿疾而发作。或者是先由气滞与食积相互搏结，或者先由气血相互郁结，之后又感受风寒而形成的。如果是由风寒侵犯太阳经所致，初期治疗应当先采用发汗法。若过早使用泻下药，往往会导致痞满证的形成。
【症状】疾病初起时出现头痛、身体发热、怕冷、无汗。胸膈部位感觉痞塞胀满，胀满但不疼痛。气机上逆冲犯，严重时会出现四肢厥冷、神志不清、沉默不语如同失音一样。或者胸部胀满且伴有疼痛，或者胁肋部胀满疼痛，或者腹部胀满疼痛。舌苔白滑，严重时白滑且厚腻，或者前半部分没有舌苔，中后部白腻且厚。
【脉象】左手脉浮紧，右手脉沉弦，或者沉涩，或者右寸关部脉沉滑，或者弦急而滑，这些都是伤寒夹痞结的征候。
【治法】首先采用理气发汗的方法，使用香苏葱豉汤加枳壳、桔梗。或者使用十味流气饮。（制香附、苏叶梗各一钱半、枳壳、橘红、姜半夏、川朴、赤茯苓各一钱、桔梗七分、广木香五分、炙甘草三分。）以疏散外邪，通畅气机以缓解痞满。如果胸膈依然不宽畅，寒热往来像疟疾一样的，轻症用柴胡枳桔汤，重症用柴胡陷胸汤。如果是气食相搏结的，用神术汤加减。如果是气血互结的，用清肝达郁汤加减。如果是因愤怒抑郁导致气机不畅，出现昏厥、不语的，先用通关散取嚏开窍，其次用仁香汤去掉丁香、白蔻，将紫金片烊化后冲服。如果病邪从火化，蒸腾痰浊壅滞气机，轻症则感到胸膈如火烧，心烦意乱，懊恼不安，寒热交作且大便闭结的，用柴芩清膈煎，攻逐里热以和解表里。严重时胸膈痞闷，腹部胀满，大便闭结，气喘腹胀，烦躁混乱，胸腹部坚硬如铁石的，迅速使用加味凉膈煎，下痰通便，以宽舒胸腹。如果是郁火损伤中焦，气机上逆导致痞满，腹痛便秘的，立即使用六磨饮子，下气通便，以畅通胸腹。必须等到里热清除，痞满解除后，才可以使用白术和中汤，温和脾胃以善后调理。如果痞满虽然解除了，但胃脘部仍然胀痛，则使用香砂理中汤加炒陈皮、蜜炙延胡索，疏畅中焦气机以消除疼痛。最后使用木香理中汤（广木香六分、姜半夏、广陈皮、枳实拌炒白术各一钱、青皮、春砂仁各五分、清炙甘草四分、烦热者加姜炒川黄连七分、便闭者加海南子、炒黑牵牛子各一钱半。）调和中和气机以除根。如果是单纯误用泻下法导致成痞，胀满但不疼痛的，病位在胸膈的，用柴胡陷胸汤；病位在心下的，用半夏泻心汤加减。（姜半夏、姜炒黄芩各一钱半、枳实一钱拌炒川黄连七分、炒干姜四分、清炙甘草二分、寒热往来者加川柴胡八分、口渴者加天花粉三钱、去半夏干姜、呕吐者加淡竹茹三钱、广陈皮一钱半、姜汁四滴冲服、腹痛自利者加白术一钱、拌炒白芍一钱、浙茯苓三钱、尿少者加赤茯苓、泽泻各一钱半。）如果不是因为过早泻下而成痞，而是表邪刚刚传入上焦，尚未入胃，证候虽然是痞满，但病邪仍在表，只需用柴胡枳桔汤，和解表里以宽舒痞气即可。
【秀按】痞证是指气机不通畅。内部感觉满闷，外部没有肿胀的形状。有的因湿热太盛，痰气上壅，气机阻滞而成痞；有的因饮食过多，滞气上逆胸膈而成痞；有的因过服消导克伐药物，不能疏化解化饮食而成痞；有的因中气久虚，不能运化精微而成痞；有的因阳气素来亏虚，不能疏降浊阴而成痞；有的因大怒气盛，不能发泄而成痞；有的因痰与气搏结，不得疏通而成痞；有的因痰挟血瘀，酿成窠囊而成痞。原因不一，治疗方法也不同，但其所以形成痞满的原因，总归是由于气机不通畅。方剂以香砂宽中散为君药。（制香附、广木香各五钱、春砂仁、白蔻仁各三钱、真川朴一两、炙黑甘草二钱，共研细末，每次服用二三钱。）如果是因湿热挟痰引起的，必然兼见胃纳呆钝、肢体倦怠、痰多、小便涩滞，用小陷胸汤合四苓汤调服。如果是因饮食阻滞引起的，必然兼见嗳腐吞酸、恶心腹痛，用消导二陈汤调服。如果是因克伐伤中引起的，必然兼见时而胀满时而减轻、中空无物感，用六君子汤去甘草调服。如果是因中气久虚引起的，必然兼见有时宽舒有时拘急、喜欢用手按摩，用补中益气汤调服。如果是因阳气素亏引起的，必然兼见早晨宽舒傍晚拘急、胀满难以忍受，用附子理中汤去甘草调服。如果是因大怒气盛引起的，口中多有血腥气味，严重时气逆血溢，或者痰中带血，宜从气郁血瘀论治，用苏子降香汤调服。（蜜炙苏子、制香附、广郁金、焦栀子、丹皮、山楂各一钱半、紫降香、醋炒红曲一钱、红花四分、童便一杯冲服，严重时加醋炒生大黄一钱半、光桃仁七粒。）如果是因痰与气搏结引起的，气被痰腻所滞，痰被气激而上逆，必然多伴有喘满、噫气，宜从气逆痰郁论治，用增减旋复代赭汤调服。如果是因痰瘀成囊引起的，脘腹部虽然多满痛，按压时发出呱呱有声，严重时肠间抽痛，宜从痰凝血郁论治，用新加栝蒌薤白汤调服。（栝蒌仁炒香三钱、光桃仁七粒、干薤白酒洗捣二钱、杜苍术八分、制香附、丹皮各一钱半、控涎丹七分、藏红花五分、韭白汁两匙、姜汁两滴同冲。）此外调气宽痞的药物，如香附、紫苏、薄荷、葱白能疏泄卫气；杏仁、蔻仁、枳壳、桔梗能疏畅肺气；前胡、橘红、苏子、郁金能疏化痰气；神曲、广陈皮、莱菔子、砂仁能疏消食气。其他如藿香能上行胃气，浓朴能下泄胃气，枳实能从上焦泻小肠之气，槟榔能从中焦泻大肠之气，青皮能伐肝气以疏胃，沉香能平肝气以纳肾，柴胡、升麻能从下焦升提清气，猪苓、泽泻能从上焦降泄浊气。气药虽然很多，但是多服、过服，肆意使用疏利药物以求速效，反而损伤真气，往往导致愈疏愈痞，形成气虚中满的鼓胀症。这都是因为不辨别病因证候，笼统地治疗痞满，喜欢使用疏利剂，只求暂时通快的缘故。所以凡是辨证不精细的，不如先用外治烫熨法。（麸皮一两、拌炒生姜渣五钱、盐水炒枳壳片一两，炒热用布包好，揉熨至软快为止。）收效很快。俞氏的方法，只是列举了大要，尽美但未完全完善，特意补充几条，以弥补其缺失。另外有一种先由郁怒伤肝，后感风寒的夹气伤寒，妇女最多见，男子也有偶尔发生的。初起时香苏葱豉汤最为对症。如果发自少阳经，寒热往来，胸胁串痛的，柴胡枳桔汤也多能取效。如果发自阴经，郁积伤中，形体厥冷如尸的，用三合绛覆汤。（真新绛一钱半、旋复花三钱、青葱管五寸冲服、光桃仁七粒、东白薇三钱、归须一钱半、广郁金三钱、苏合丸一颗，磨汁冲服。）如果只是郁闷不得发泄，偶然感受风寒，只需略微兼用开郁理气的药物，不可擅自使用破血消滞的药物。
【廉勘】夹气郁与夹食滞，在初起时的症状大多相同，且多见右脉沉，手足冰冷。如果出现呕逆、胸满，颇类似夹食滞。但夹食滞是有形之物，属于实证，舌苔浓白而微黄，胸膈满痛且不可按压，且疼痛位置固定不移；夹气滞是无形之物，属于虚邪，舌苔白薄，胸膈满痛，半软而可以按压。先宜宣通其郁结，然后解表清里，自然没有不有效的。如果不舒展郁结而仅仅发表，则里气不能外达，而难以透彻出汗；急于使用清下法，则上气不宣，多导致痞逆。只有在解表药中加入苏梗、青皮、郁金、香附之类，以宣通气机，则表邪易解；在清里药中加入栝蒌、川贝以舒展郁结，则里气易和。虽然川贝是舒展郁结的要药，但药力薄弱、性质缓和，必须用到五钱甚至一两，才能奏效。如果加入四磨饮子（即六磨饮子去掉乌药、生大黄），则更为快捷。如果气郁化火，阻碍中焦，上则胸闷，下则便秘的，用六磨饮子，效果最好。胀满而不疼痛的叫痞，属于无形之气；胀满且伴有疼痛的叫结，属于有形之物。凡是感受外邪，夹带痞结的很多。但痞轻而结重，有邪气未结而仅胀满的，有邪气已结而胀满疼痛的。痞满以宽气为主，轻症用杏、蔻、橘、桔，重症用蒌、薤、朴、枳。俞氏的方法粗略具备，先祖详细阐明，已经大致清楚明白。如果胀满且伴有疼痛，邪气早已结实，往往因为夹食、夹痰、夹瘀的缘故，与新邪或伏邪互相结聚，或者结于胸胁，或者结于脘腹，疼痛不可按压，严重时昏迷头眩，虽然因夹杂的不同，但其结痛拒按、闭塞不容喘息的状态是相同的。倘若不仔细察问，很少不认为是本病应有的证候。不先行迅速去除它，那么所受的外邪，往往被其羁留伏匿，不得透达，以致发生凶险变化。宜先给予一服飞马金丹。（生大黄、广郁金、五灵脂、上雄黄各一两、巴豆霜、广木香、赖橘红各三钱、明乳香、净没药、百草霜、辰砂、山慈菇各二钱，各秤另研净末分量，再合研约一时许，令均匀，米醋泛丸，金箔为衣，如绿豆大，隔纸晒干，瓷器密封贮存，二十岁以上者，每次服用十二丸，体质强者加三丸，老年者七丸或九丸，二三岁者三丸或五丸，温开水送下，半日或一二时许，非吐即泻，此丹治疗夹痰食血等，结于胸脘，高突痛胀，不可按压，呼吸困难，严重时欲吐不得吐，欲泻不得泻的情况，凡外感夹内伤，见到有此状况的，无论大小，均可使用。）自然能根据结聚的上下位置，施行吐下之功。得到夹邪一解，正气自然伸展，邪气自然显露，按照方法调治本症，就比较容易了。如果夹宿饮而气郁成痞，严重时成窠囊的，许氏神术丸，往往多不生效，我仿照薛生白先生的方法，用千金五香汤。（千金霜一钱煎汤，磨沉香、木香、檀香、降香、丁香各一两匙。）效果也如神一般。如果夹积水停饮，酿成痞气，绵延日久，腹胀如鼓，按压时发出呱呱有声的，仿照危亦林先生的方法，用加味控涎丹。（炒黑牵牛子二两，煨甘遂、红牙大戟、白芥子、炒葶苈各一两，芫花、上沉香各五钱，巴霜一钱，研细，姜汁糊丸，金箔为衣，如梧桐子大，每次服用五丸，淡姜汤送下。）继用六君子汤去甘草加香附，补而兼疏，往往经过三次泻三次补，陈旧疾病顿时痊愈。总之因积成痞，初为痞气，继为痞块，必须审察是哪一经受病，是什么物质形成积聚，认识分明，发直入之兵以讨伐之。血积如桃仁、红花、穿山甲、虫类、莪术、瓦楞子、干漆灰、醋炒生大黄等选用。痰积如风化硝、浮海石、海蛤粉、半夏曲、杜胆星、生枳实、礞石、白芥子、萝卜子、海粉、竹沥、荆沥、姜汁、石菖蒲汁等选用。水积如大戟、甘遂、芫花、商陆、千金霜、黑白丑等选用。酒积如酒曲、葛花、槟榔、橄榄、枳椇子等选用。茶积如姜黄、茱萸、川椒、生干姜等选用。肉积如山楂、萝卜子、阿魏、朴硝、毛栗壳灰等选用。虫积如雷丸、鹤虱、雄黄、锡灰、芜荑、巴霜、使君子、枣儿槟榔等选用。瘀积如三棱、莪术、巴豆、大黄、鳖甲、虻虫、水蛭、夜明砂、地栗粉等选用。各从其类，以直捣其巢穴。如《内经》所说：大积大聚，其可犯也，衰其大半而止。即调脾胃以养正，使积自除。前哲周慎斋说：凡痞积不可先用下药，徒损正气，病亦不去，当用消积药使之熔化，则除根矣。积去须大补，这确实是治疗由积成痞的格言。只有素来有遗泄，气虚于下，痰结于上，饮食难化，而成郁结痞满之证，似膈非膈的证候，最为难治。（荣斋按：以下详论痞积之上实下虚治法。）不但滋补阴虚药，对于开膈进食，固然大有影响，即使使用香砂六君子汤，调补兼施，往往痞满更加严重，食物停留不下。因为下虚者不宜骤升，升则浊气在上，反而产生胀满。也不宜专用破气药，愈破愈痞。总宜疏导郁滞，升降互用，合成疏通，使胸膈日宽一日，谷气日增一日，则津液从上输下，阴气不补而自补矣。初用升降疏郁汤。（苏子、山楂各二钱、广陈皮红、半夏曲各一钱半、茯苓、乌药、制香附拌炒五谷虫各一钱、蜜炙升麻三分、柴胡四分、韭汁二匙、姜汁二滴，同冲。）次用和中畅卫汤。（制香附、苏叶梗炒神曲、北沙参各一钱、杜苍术、川贝、抚芎、连翘各八分、苦桔梗六分、广木香四分、春砂仁三分冲。）又次用八物顺气汤。（白芷、乌药、青皮、陈皮各一钱、茯苓、白术各一钱半、米炒党参八分、清炙甘草五分。）送下沉附都气丸。（熟地八两、山萸肉、山药各四两、茯苓、泽泻、丹皮各三两、沉香、淡附片各一两、北五味五钱，蜜丸，如桐子大，每次服用二钱。）临睡前口含陈氏噙化丸。（米炒西洋参六钱、醋制香附、广陈皮红各四钱、川贝、桔梗各三钱、松萝茶二钱蒸烂，同竹沥梨膏为丸，每丸一钱。）使睡中常有药气，徐徐沁入，以疏通其胸膈中脘之间。必使新结不增，旧结渐解，然后早上用二加龙蛎汤。（生白芍、化龙骨各二钱、东白薇二钱、清炙甘草八分、牡蛎四钱、蜜煨生姜一钱、大红枣三钱、淡附片五分。）滋阴潜阳，封固下焦以收火，晚上用运痰丸。（半夏曲四两、姜汁竹沥制，姜炒川黄连一两、广木香、沉香、清炙甘草五钱、党参、于术、茯苓各三两，姜汁竹沥泛丸，每次服用二钱。）益气化痰，疏补中上以除根。这是痞结之上实下虚，最为绵延难愈的证候。虽然如此，气虚中满症，也属难治，每每仿照陆肖愚先生的方法，进退调补，酌用补气养荣汤。（党参、白术、当归身、白芍、川芎、茯苓木、香豆蔻，初用香蔻七八分至一钱。）调下宽膨散一钱。（顶大蛤蟆一只，破开，用春砂仁萝卜子填满，黄泥封固，炭上烧研，去渣。）参术但用六七分，而中满稍减。继则参术不减，香蔻宽膨增至一钱半，而饮食渐加，中满较宽大半。后渐加参术至二三钱，减香蔻宽膨至三分，或进或退，约二三十剂，始奏全功。
【荣斋按】痞与结胸，同为硬满之症，应当以疼痛来辨别。胀满且硬痛的是结胸，属于实热，宜用陷胸法治之；胀满而不痛的是痞满，属于虚热，宜用泻心法治之。文献告诉我：治疗痞的要药，在于干姜、黄连二味，半夏、黄芩、甘草、大枣四味，则是辅佐而已；偏于寒则多用干姜，亦可参以附子，偏于热则多用黄连，亦可参以大黄，偏于中虚则加人参，或者涉及表邪一二分则加生姜，并可与旋复代赭黄连等汤出入互用。此外如果是暑湿痰食，痧秽凝结成痞的，则参考叶天士的方法，足以补本节所载之缺——如膈闷心烦痞满而喘急的，是热痰内闭；宜栀豉汤加川郁金、栝蒌仁、枳实、杏仁之类，开之宣之。如脘中痞闷而兼头胀目黄，脉象濡涩的，这是暑湿伏邪凝滞胸中；宜清疏中焦，川……
(Also known as Taiyang Disease with Clumped Stagnation)
**Etiology:** The patient habitually has phlegm turbidity condensing into clumped stagnation (Pi). Or, due to Qi stagnation causing abdominal fullness. Suddenly contracting Wind-Cold pathogenic factors, triggering the latent disease and causing an outbreak. Or, initially due to the mutual struggle of Qi stagnation and food retention, or initially due to the mutual knotting of Blood and Qi, followed by contracting Wind-Cold to form the condition. If caused by Wind-Cold invading the Taiyang Meridian, initial treatment should prioritize sweating methods. Premature use of purgatives often leads to the formation of Pi (clumped stagnation).
**Symptoms:** At the onset, headache, feverish body sensation, aversion to cold, and absence of sweating occur. A sensation of clumped fullness in the chest and diaphragm, characterized by fullness without pain. Qi rebels upwards; in severe cases, limb coldness (Jue), unconsciousness, muteness, resembling aphonia. Or chest fullness accompanied by pain, or hypochondriac fullness and pain, or abdominal distension and pain. Tongue coating is white and slippery; severely, it is white, slippery, and thick/greasy, or absent on the anterior half, while the middle and posterior parts are white, greasy, and thick.
**Pulse:** Left side floating and tight; right side deep and wiry, or deep and choppy, or right Cun and Guan positions deep and slippery, or wiry, rapid, and slippery. These are all signs of Taiyang Disease with Clumped Stagnation.
**Treatment:** Initially employ Qi-regulating and sweating methods, using Xiangsu Congchi Decoction added with Zhi Qiao (Aurantium Fructus) and Jie Geng (Platycodon Radix). Or use Shiwei Liuqi Yin (Ten-Ingredient Flowing-Qi Decoction). (Zhi Xiangfu (Prepared Cyperi Rhizoma), Su Ye Geng (Perilla Caulis et Folium) each 1.5 qian; Zhi Qiao (Aurantium Fructus), Ju Hong (Citri Reticulatae Pericarpium Rubrum), Jiang Banxia (Pinelliae Rhizoma Preparatum), Chuan Po (Magnoliae Officinalis Cortex), Chi Ling (Poria Cocos with Red Mycelium) each 1 qian; Jie Geng (Platycodon Radix) 7 fen; Guang Mu Xiang (Aucklandiae Radix) 5 fen; Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 3 fen.) To disperse external pathogens and smooth Qi to relieve stagnation. If the chest and diaphragm remain unrelaxed, with chills and fever resembling malaria: for mild cases, Chaihu Zhijie Tang; for severe cases, Chaihu Xianxiong Tang. For Qi and Food struggling together, modify Shenzhu Tang. For Blood and Qi mutually knotted, modify Qinggan Dayu Tang. For anger-induced depression with failure to vent, leading to syncope and muteness: first induce sneezing via Tongguan powder to open orifices; subsequently use Renxiang Tang removing Dingxiang (Caryophylli Flos) and Baokouren (Amomi Fructus Rotundus), dissolving Zijian (Calamina) and taking orally. If pathogenic factors transform into Fire, steaming Phlegm and obstructing Qi: for mild cases, a burning sensation in the chest/diaphragm, vexation, restlessness, alternating chills/fever, and constipation: use Chaiqin Qingge Jian to attack the interior and harmonize. In severe cases, chest/diaphragm clumped fullness, abdominal distension, constipation, wheezing, abdominal distension, irritability, and chest/abdomen hard as ironstone: rapidly use Jiawei Liangge Jian to purge Phlegm and unblock bowels to relax the chest/abdomen. If depressed Fire damages the Middle Jiao, with rebellious Qi, clumped fullness, abdominal pain, and constipation: immediately use Limo Yinzi to move Qi and unblock bowels to smooth the chest/abdomen. Only after interior heat clears and clumped fullness resolves, may Baizhu Hezhong Tang be used to gently warm the Spleen and Stomach for convalescence. If clumped fullness resolves but epigastric distension/pain persists: use Xiangsha Lizhong Tang added with Chao Chenpi (Citri Reticulatae Pericarpium) and Mi Zhi Yanhusuo (Corydalis Rhizoma Preparatum) to smooth Middle Qi and remove pain. Finally, use Muxiang Lizhong Tang (Guang Muxiang 6 fen, Jiang Banxia, Guang Chenpi, Zhi Shi stir-fried with Baizhu each 1 qian, Qingpi, Chun Sharen each 5 fen, Qing Zhi Gancao 4 fen; add Jiang Chao Chuan Lian 7 fen for vexation/heat; add Hainanzi, Chao Heishuang each 1.5 qian for constipation) to harmonize Middle Qi and eradicate the root. If Pi results solely from premature purging, with fullness but no pain: if located in the chest/diaphragm, use Chaihu Xianxiong Tang; if located below the heart, use Banxia Xiexin Tang modified. (Jiang Banxia, Jiang Chao Tiaohuangqin each 1.5 qian; Zhi Shi 1 qian stir-fried with Chuan Lianfen 7 fen; Chao Ganjiang 4 fen; Qing Zhi Gancao 2 fen; add Chuan Chaihu 8 fen for chills/fever; add Huafen 3 qian for thirst; remove Banxia/Ganjiang; add Dan Zhuru 3 qian, Guang Chenpi 1.5 qian, Jiangzhi 4 drops for vomiting; add Baizhu 1 qian, Chao Baishao 1 qian, Zhe Fuling 3 qian for abdominal pain/spontaneous diarrhea; add Chi Ling, Zexie each 1.5 qian for scanty urination.) If not caused by premature purging, but by exterior pathogens just transmitting to the Upper Jiao, not yet entering the Stomach: although presenting as Pi/fullness, the pathogen remains at the Exterior. Use only Chaihu Zhijie Tang to harmonize and relax the Qi stagnation.
**Xiu's Commentary:** Pi refers to the obstruction of Qi flow. Internally, one feels fullness/stuffiness; externally, there is no swelling shape. Causes include: excessive Damp-Heat and Phlegm-Qi rebelling upward obstructing Qi mechanism; excessive food intake causing stagnant Qi to rebel to chest/diaphragm; overuse of digestive/clearing drugs failing to resolve food; chronic deficiency of Middle Qi failing to transport essences; constitutional Yang deficiency failing to descend turbid Yin; excessive anger failing to vent; Phlegm and Qi struggling preventing unblocking; Phlegm mixed with Blood stasis forming nests/cysts. Causes vary, treatments differ, but the root of Pi/fullness is always Qi obstruction. Formula: Xiangsha Kuanzhong San as Sovereign herb. (Zhi Xiangfu, Guang Muxiang each 5 qian; Chun Sharen, Baikouren each 3 qian; Zhen Chuanpo 1 liang; Zhihei Gancao 2 qian, finely powdered, 2-3 qian per dose.) For Damp-Heat with Phlegm: accompanied by dull stomach, limp limbs, profuse phlegm,涩 urine. Use Xiaoxianxiong Tang combined with Siling Tang. For Food obstruction: accompanied by belching with rotten smell, acid regurgitation, nausea, abdominal pain. Use Xiaodao Erchen Tang. For damage from clearing/draining drugs: accompanied by intermittent distension/reduction, hollow feeling. Use Liujunzi Tang removing Gancao. For chronic Middle Qi deficiency: accompanied by alternating relaxation/tightness, preference for massage. Use Buzhong Yiqi Tang. For constitutional Yang deficiency: accompanied by morning relief/evening tightness, unbearable distension. Use Fuzi Lizhong Tang removing Gancao. For excessive anger: bloody taste in mouth, severe Qi rebellion/blood overflow, or blood in phlegm. Treat as Qi depression/Blood stasis. Use Suzi Jiangxiang Tang. (Mi Zhi Suzi, Zhi Xiangfu, Guang Yujin, Jiao Zhizi, Danpi, Shanzha each 1.5 qian; Zi Jiangxiang, Cu Chao Hongqu 1 qian; Honghua 4 fen; Tongbian 1 cup; add Cu Chao Sheng Dajun 1.5 qian, Guang Taoren 7 grains if severe.) For Phlegm-Qi struggle: Qi stagnated by Phlegm, Phlegm agitated upward by Qi. Accompanied by wheezing/fullness, belching. Treat as Qi rebellion/Phlegm depression. Use modified Xuanfudaihzhe Tang. For Phlegm-Stasis cysts: epigastric/abdominal fullness/pain, gurgling sound on pressure, intestinal cramping pain. Treat as Phlegm coagulation/Stasis depression. Use Xinjia Gualou Xiebai Tang. (Chao Xiang Gualouren 3 qian, Guang Taoren 7 grains, Gan Xieji washes with Baijiu and crushes 2 qian, Du Cangzhu 8 fen, Zhi Xiangfu, Danpi each 1.5 qian, Kongxian Dan 7 fen, Zang Honghua 5 fen, Jiu Baiju 2 spoons, Jiangzhi 2 drops.) Other Qi-smoothing herbs: Xiangfu, Zisu, Bohe, Congbai diffuse Wei Qi; Xingren, Kouren, Zhiqiao, Jiegeng smooth Lung Qi; Qianhu, Juhong, Suzi, Yujin diffuse Phlegm Qi; Shenqu, Guangpi, Laifuzi, Sharen digest Food Qi. Others: Huoxiang ascends Stomach Qi; Houpo descends Stomach Qi; Zhishi drains Small Intestine Qi from Upper Jiao; Binglang drains Large Intestine Qi from Middle Jiao; Qingpi attacks Liver Qi to smooth Stomach; Chenxiang calms Liver Qi to grasp Kidney; Chaihu, Shengma raise Clear Qi from Lower Jiao; Zhuling, Zexie drain Turbid Qi from Upper Jiao. Although many Qi herbs exist, overuse indiscriminately seeking quick effects damages True Qi, leading to worsening Pi and Qi-deficiency abdominal distension (Gu Zheng). This stems from failing to differentiate causes and treating generically with draining agents. Therefore, if differentiation is imprecise, use external hot compress therapy first. (Fupi 1 liang, stir-fried with Shengjiangzha 5 qian; Shuiyan Chao Zhike pian 1 liang, heat well, wrap in cloth, rub/knead until soft/warm.) Rapid effect. Yu’s method lists general principles, beautiful but incomplete. I supplement here. Another type: Clamped Qi Taiyang Disease, starting with Liver injury from depression, then Wind-Cold. Common in women, rare in men. Initial: Xiangsu Congchi Tang is most appropriate. If originating from Shaoyang, with alternating chills/fever, hypochondriac wandering pain: Chaihu Zhijie Tang is effective. If originating from Yin meridians, depression damaging Middle, body cold like a corpse: use Sanhe Jiangfu Tang. (Zhen Xinjiang 1.5 qian, Xuanfuhua 3 qian, Qingcongguan 5 cun; Guang Taoren 7 grains, Dong Baiwei 3 qian, Guixu 1.5 qian, Guang Yujin 3 qian, Suhewan 1 pill ground/juice). If merely depressed/unvented, slight Wind-Cold: slightly add opening depression/smoothing Qi herbs, do not arbitrarily use breaking-blood/resolving-stasis herbs.
**Lian’s Verification:** Clamped Qi Depression and Clamped Food Stagnation have similar initial symptoms, often with deep Right pulse and cold hands/feet. Vomiting/rebellion/chest fullness resembles Food Stagnation. But Food Stagnation is有形 (有形之物/Substantial), Excess pattern, thick white/yellow tongue coating, chest/diaphragm fullness/pain unpressable and fixed. Qi Depression is 无形 (无形之气/Ethereal), Deficient pathogen, thin white tongue coating, chest/diaphragm fullness/pain semi-soft and pressable. First soothe depression, then release exterior/clear interior. Without soothing depression, merely releasing exterior prevents interior Qi from reaching surface, hindering thorough sweating. Premature clearing/purging prevents upper Qi from diffusing, causing Pi/rebellion. Add Sugeng, Qingpi, Yujin, Xiangfu to exterior-releasing formulas to diffuse Qi, facilitating exterior resolution. Add Gualou, Chuanbei to interior-clearing formulas to soothe depression, facilitating interior harmony. Chuanbei is key for soothing depression but weak/slow; requires 5 qian to 1 liang for effect. Adding Simo Yinzi (Limo Yinzi minus Wuyao, Shengjun) is faster. If Qi depression transforms to Fire, obstructing Middle Jiao, causing chest oppression and constipation: Limoyinzi is most effective. Fullness without pain is Pi (Ethereal Qi); fullness with pain is Jie (Substantial Object). Many exogenous diseases involve Pi/Jie. Pi is light, Jie is heavy. Some have pathogen unknotted but full; some knotted and painful. Pi/fullness focuses on smoothing Qi: light uses Xing/Kou/Ju/Jie; heavy uses Lou/Xie/Po/Zhi. Yu’s method is rough; my ancestor clarified it thoroughly. If fullness+pain, pathogen firmly knotted, often due to clamped Food/Phlegm/Stasis interacting with new/latent pathogens, knotting in chest/hypochondrium/epigastrium/abdomen, unpressable pain, severe dizziness/coma: although causes differ, the state of rejection/pain/blockage preventing breathing is same. Without careful inquiry, mistaken for natural progression. Failure to quickly remove leads to pathogen entrapment/latency, causing凶变 (ominous changes). First give Feima Jindan. (Sheng Chuanjun, Guang Yujin, Wulingzhi, Shang Xionghuang each 1 liang; Badoushuang, Guang Muxiang, Lai Juhong each 3 qian; Ming Rushi, Jing Moyao, Baicaoshuang, Chensha, Shancigu each 2 qian. Grind separately, mix 1 hour, rice vinegar pills, gold foil coating, mung bean size. >20 yrs: 12 pills; strong: +3; elderly: 7-9; 2-3 yrs: 3-5. Warm water. Half day or 1-2 hrs, vomit or diarrhea. Treats clamped Phlegm/Food/Blood knotting in chest/epigastrium, high/protruding/painful/distended, unpressable, breathless, unable to vomit/purge. External/Internal mixed, this presentation: usable for all ages.) Naturally acts according to knot location (vomit/purge). Once clamped pathogen resolves, Righteous Qi extends, Pathogenic Qi reveals, making treatment easier. If clamped old Fluid/Dampness causes Qi depression into Pi, forming cysts: Xu’s Shenzhu Wan often fails. I emulate Xue Shengbai, using Qianjin Wuxiang Tang. (Qianjinshuang 1 qian decocted, grind Chenxiang, Muxiang, Tanxiang, Jiangxiang, Dingxiang each 1 liang spoon.) Effect miraculous. If clamped accumulated Water/Fluid酿成 (ferments into) Pi, lingering long, drum-like abdomen, gurgling on pressure: emulate Wei Yilin, use Jiawei Kongxian Dan. (Chao Heishuang 2 liang, Wei Gansui, Hongya Daji, Baijiezi, Chao Tingli each 1 liang; Yuanhua, Shang Chenxiang each 5 qian; Bashuang 1 qian. Fine powder, ginger juice paste pills, gold foil, wutong seed size. 5 pills, light ginger soup.) Follow with Liujunzi Tang removing Gancao adding Xiangfu, tonifying and smoothing. Often 3 purges/3 tonics cure old disease. Summary: Accumulation becomes Pi, then Pi Mass. Must identify meridian/pathogen. Attack directly. Blood accumulation: Taoren, Honghua, Chuannanjia, insects, Ezhu, Walengzi, Ganqihui, Cu Chao Shengjun. Phlegm accumulation: Fenghuaxiao, Fuhaisshi, Haigefen, Banxiaqu, Du Dansheng, Sheng Zhishi, Mengshi, Baijiezi, Luobozhi, Haifen, Zhuli, Jingli, Jiangzhi, Shichangpu zhi. Water accumulation: Daji, Gansui, Yuanhua, Shanglu, Qianjinshuang, Heibai Chou. Wine accumulation: Jiuqu, Gehua, Binglang, Ganlan, Zhizu. Tea accumulation: Jianghuang, Zhuyu, Chuanjiao, Sheng Ganjiang. Meat accumulation: Shanzha, Luobozhi, Awei, Poxiao, Maolikehui. Parasite accumulation: Leiwan, Heshi, Xionghuang, Xihui, Wuyi, Bashuang, Shijunzi, Zaor Binglang. Stasis accumulation: Sanleng, Ezhu, Badou, Dahuang, Biejia, insect, Mengchong, Shuizhi, Yemingcha, Dilifen. Each targets its nest. As Classic says: Great accumulation/depression can be attacked, stop when half resolved. Then tonify Spleen/Stomach to nourish Righteous Qi, allowing accumulation to self-resolve. Zhou Shenzhen said: Do not use purgatives first for Pi/Accumulation, only damages Righteous Qi, disease remains. Use resolving accumulation herbs to melt them, eradicating root. After accumulation removal, major tonification is essential. This is the maxim for Pi from Accumulation. However, chronic emission/leakage, Lower Qi deficiency, Upper Phlegm knot, difficult digestion, forming depression/clumped Pi, resembling Ge syndrome but not quite, is hardest to treat. (Rongzhai Note: Below details Upper Excess/Lower Deficiency Pi/Accumulation treatment.) Not only Yin-tonics hinder opening diaphragm/appetite; even Xiangsha Liujunzi Tang, tonifying/smoothing, often worsens Pi/fullness, food retention. Lower deficiency should not be raised abruptly; rising causes Turbid Qi in Upper, generating distension. Should not exclusively use Qi-breaking herbs; more breaking means more Pi. Total approach: guide/dredge stagnation, combine ascending/descending, create unblocking. Chest/diaphragm widens daily, Grain Qi increases daily, Jin-Ye transports down, Yin Tonifies itself spontaneously. Initial: Shengjiang Shuyu Tang. (Suzi, Shanzha each 2 qian; Guangpi Hong, Banxiaqu each 1.5 qian; Fuling, Wuyao, Zhi Xiangfu stir-fried with Wu Gu Chong each 1 qian; Mi Zhi Shengma 3 fen, Chaihu 4 fen; Jiuji 2 spoons, Jiangzhi 2 drops, mix.) Next: Hezhong Changwei Tang. (Zhi Xiangfu, Su Ye Geng stir-fried with Shenqu, Beishashen each 1 qian; Du Cangzhu, Chuanbei, Fuxiong, Lianqiao each 8 fen; Ku Jiegeng 6 fen; Guang Muxiang 4 fen; Chun Sharen 3 fen mix.) Again: Bawu Shunqi Tang. (Baizhi, Wuyao, Qingpi, Chenpi each 1 qian; Fuling, Baizhu each 1.5 qian; Mi Chao Dangshen 8 fen; Qing Zhi Gancao 5 fen.) Take Chenfu Duqi Wan. (Shudi 8 liang, Shanyurou, Shanyao each 4 liang; Fuling, Zexie, Danpi each 3 liang; Chenxiang, Dan Fupian each 1 liang; Bei Wuwei 5 qian. Honey pills, wutong seed size. 2 qian per dose.) Before sleep, hold Chenshi Qinhua Wan in mouth. (Mi Chao Xiyangshen 6 qian, Cu Zhi Xiangfu, Guangpi Hong each 4 qian; Chuanbei, Jiegeng each 3 qian; Songluocha 2 qian steamed/mashed, with Zhuli Ligan pills. 1 qian per pill.) Ensures medicinal vapor enters slowly during sleep, dredging chest/diaphragm/Middle Jiao. Ensure new knots don't increase, old knots dissolve. Then morning: Erjia Longli Tang. (Sheng Baishao, Hualonggu each 2 qian; Dong Baiwei 2 qian; Qing Zhi Gancao 8 fen; Muli 4 qian; Mi Wei Shengjiang 1 qian; Da Hongzao 3 pieces; Dan Fupian 5 fen.) Nourish Yin, submerge Yang, seal Lower Jiao to secure Fire. Evening: Yuntan Wan. (Banxiaqu 4 liang, Jiangzhi Zhuli processed; Jiang Chao Chuanlian 1 liang; Guang Muxiang, Chenxiang, Qing Zhi Gancao 5 qian; Dangshen, Yuzhu, Fuling each 3 liang. Jiangzhi Zhuli pellet pills. 2 qian per dose.) Tonify Qi, resolve Phlegm, smooth/tonify Middle/Upper to eradicate root. This Upper Excess/Lower Deficiency Pi-Jie is most lingering/hard to cure. Although, Qi-deficiency abdominal distension is also hard to treat. Emulate Lu Xiaoyu: advance/retreat tonification. Use Buqi Yangrong Tang. (Dangshen, Baizhu, Guishen, Baishao, Chuanxiong, Fulingmu, Xiang Doukou. Initial Xiangdou 7-8 fen to 1 qian.) Take Kuanpeng San 1 qian. (Large toad split, filled with Chun Sharen/Luobozhi, sealed with yellow mud, charcoal roasted/powdered, filtered.) Ginseng/Atractylodes use 6-7 fen, distension reduces slightly. Then maintain Ginseng/Atractylodes, increase Xiangdou/Kuanpeng to 1.5 qian, diet improves, distension halves. Gradually increase Ginseng/Atractylodes to 2-3 qian, decrease Xiangdou/Kuanpeng to 3 fen. Advance/retreat, approx 20-30 doses, complete success.
**Rongzhai Note:** Pi and Jie Xiong (Clumped Chest) both present with hardness/fullness, distinguished by pain. Fullness+Hardness+Pain = Jie Xiong (Excess Heat), treat with Xianxiong method. Fullness+No Pain = Pi Man (Deficient Heat), treat with Xiexin method. Literature states: Key herbs for Pi are Ganjiang, Huanglian. Banxia, Huangqin, Gancao, Dazao are assistants. Cold bias: more Ganjiang, add Fuzi. Heat bias: more Huanglian, add Dahuang. Middle deficiency: add Renshen. Exterior involvement: add Shengjiang. Can interchange with Xuanfudaihzhe Huanglian Tang etc. For Summerheat-Dampness/Phlegm-Food/Shahui condensing into Pi: refer to Ye Tianshi’s methods to supplement this section—e.g., chest stuffiness/vexation/Pi/fullness+wheezing: Heat-Phlegm internal closure. Use Zhichi Tang plus Yujin, Gualouren, Zhishi, Xingren to open/vent. Epigastric Pi/fullness+head distension/yellow eyes, soggy-choppy pulse: Summerheat-Damp latent pathogen stagnating in Chest/Middle. Clear/smooth Middle Jiao...