气者，因胸中气郁，痞结不舒，必得 出其气方快。经云∶浊气在上，则生 胀。此症日久，便
成痞满。治宜宣化无形之气为主。虽曰有火有痰，要皆气顺则愈。痞满者，因肺气不降，脾气不运，升
降之道乖则心下痞塞而满闷，与胀满之病不同。胀满内胀而外有形，痞满内觉痞闷，而外无胀急之形，
不可专用破气利下之剂，恐消克元气，变成鼓胀也。许学士云∶邪之所凑，其气必虚，留而不去，其病则
实。故治痞者，当一补一消。
旋复代赭汤〔见嗝。〕
原方〔姜、半酌用，甘、枣宜去。〕宜参用沉香降气散诸药。
此方心下痞满，噫气不除者，宜加减用之。
沉香降气散〔见喘。〕
宜加白芍 梨汁〔麦冬、苏子、梨汁清之润之，肺气自降，苓、芍、沉、砂、橘红，补之醒
之，则脾气自运。〕
此方心下痞满，不思饮食者，可加减用之。
枳术丸〔见泄泻。〕
此方心下痞满者，可随症加药用之，一补一消之法也。
一人患气上逆，每饭下一、二口。辄嗳气数十口，食顷三、四作焉。仲淳曰∶此气不归元，中
焦不运也。每剂须人参二钱。不信。服快气药，愈甚。越三月，仲淳云∶今须参四钱矣，不信。又三
月，仲淳云∶今须参六钱矣，不信。又逾月，饮食不下，每呕冷气如团而出，上下气不属，始求仲淳
治之。乃用人参〔六钱。〕佐沉香、砂仁、益智仁〔各一钱。〕以纳气归元，苏子、麦冬〔各三钱。〕
橘红〔一钱。〕枇杷叶〔三片。〕芦根汁〔一杯。〕降上逆之气，白芍、五味、萸肉〔各二钱。〕敛摄
耗散之气。服首煎不动，服再煎不动，然亦不如他汤药辄呕也。服三煎，忽心口下如爆一声，上则嗳
气，下则小遗无算，上下洞然，即索粥顿食三、四碗，不上逆也。服五、六剂，减参二钱，又以前药十
倍为末，山药糊丸，服半年而病始安。
气病，是由于胸中气机郁结，痞塞不通而感到不适，必须使气机通畅才能感到舒畅。《内经》说：“浊气在上，则生胀。”这种病症如果日久不愈，就会形成痞满证。治疗应当以宣通化解无形之气为主。虽然病因可能涉及火邪和痰饮，但关键在于气机调顺即可痊愈。
所谓痞满，是因为肺气不能肃降，脾气不能运化，导致升降功能失常，从而在心下（胃脘部）出现痞塞感和满闷感。这与胀满病是不同的。胀满病是内部胀满且外部可见形体膨隆；而痞满是内部自觉痞闷，但外部没有胀急的形态。因此，不可专门使用破气、利下的方剂，恐怕会损伤元气，进而演变成鼓胀病。许学士说：“邪气聚集的地方，正气必然虚弱；邪气停留不去，病势就会表现为实证。”所以治疗痞满，应当采用一补一消的方法。
旋复代赭汤（见噎膈章节）。原方中生姜、半夏酌情使用，甘草、大枣宜去掉。适宜参考使用沉香降气散等药物。此方适用于心下痞满、嗳气不止的患者，可加减后使用。
沉香降气散（见喘证章节）。适宜加入白芍、梨汁。（麦冬、苏子、梨汁用于清润，肺气自然下降；茯苓、白芍、沉香、砂仁、橘红用于补益和醒脾，脾气自然运化。）此方适用于心下痞满、不思饮食的患者，可加减后使用。
枳术丸（见泄泻章节）。此方适用于心下痞满的患者，可根据症状加味使用，这是一补一消的治疗方法。
有一人患气机上逆的病，每吃一两口饭，就打几十次嗝，一顿饭的时间要打三到四次。张遂辰（字仲淳）说：“这是气不归元，中焦脾胃不运化的缘故。”每剂药需要人参二钱。患者不信。服用行气快的药物，病情反而加重。过了三个月，张仲淳说：“现在需要人参四钱了。”患者仍不信。又过了三个月，张仲淳说：“现在需要人参六钱了。”患者还是不信。又过了一段时间，患者饮食难以下咽，每次呕吐出的冷气像一团一样出来，上下气机不相接续，这才请求张仲淳治疗。张仲淳用人参（六钱），佐以沉香、砂仁、益智仁（各一钱），以纳气归元；用苏子、麦冬（各三钱），橘红（一钱），枇杷叶（三片），芦根汁（一杯），以降上逆之气；用白芍、五味子、山茱萸（各二钱），以收敛摄持耗散之气。服用第一煎时症状未动，服用第二煎时症状也未动，但也没有像其他汤药那样引起呕吐。服用第三煎时，忽然感觉心口下方像爆炸了一声，上面打嗝，下面小便失禁无数，上下气机通畅无阻，随即索要粥喝，一顿吃了三四碗，气不再上逆。服用五到六剂后，减少人参二钱，又将前面的药物制成十倍量的粉末，用山药糊做成丸药，服用半年后病才痊愈。
Qi disorders arise from the stagnation of Qi in the chest, causing a sensation of fullness and discomfort; relief is achieved only when the Qi flows freely. The *Classic of Internal Medicine* states: "When turbid Qi remains above, distension occurs." If this condition persists for a long time, it develops into Pi-Man (epigastric fullness and stuffiness). Treatment should primarily focus on diffusing and resolving formless Qi. Although fire pathogens and phlegm may be involved, the key to recovery lies in the smooth flow of Qi.
Pi-Man (epigastric fullness and stuffiness) results from the failure of Lung Qi to descend and Spleen Qi to transform, leading to dysfunction in the ascending and descending mechanisms. This causes a sensation of blockage and fullness in the epigastrium ("heart below"). It differs from Zhang-Man (distension). In Zhang-Man, there is internal distension accompanied by visible external swelling; in Pi-Man, there is an internal sensation of stuffiness without external signs of acute distension. Therefore, one should not exclusively use formulas that break Qi or promote downward purging, as this may damage Yuan Qi (Original Qi) and potentially transform into Gu-Zhang (drum-like distension). Scholar Xu stated: "Where pathogenic factors gather, Qi must be deficient; if they remain and do not depart, the disease manifests as excess." Thus, treating Pi-Man requires a method of tonification and reduction combined.
Xuanfu Daizhe Tang (Inula and Hematite Decoction) [See Ye Ge (Regurgitation)]. In the original formula, Sheng Jiang (Fresh Ginger Rhizome) and Ban Xia (Pinellia Tuber) should be used with discretion, while Gan Cao (Licorice Root) and Da Zao (Jujube Fruit) should be removed. It is advisable to refer to Chenxiang Jiangqi San (Agarwood Descending Qi Powder) and other herbs. This formula is suitable for patients with epigastric fullness and persistent belching; it can be used with modifications.
Chenxiang Jiangqi San (Agarwood Descending Qi Powder) [See Chuan (Asthma/Wheezing)]. Bai Shao (White Peony Root) and Li Zhi (Pear Juice) should be added. [Mai Dong (Ophiopogon Tuber), Su Zi (Perilla Seed), and Li Zhi clear and moisten, allowing Lung Qi to descend naturally; Fu Ling (Poria), Bai Shao, Chen Xiang (Agarwood), Sha Ren (Amomum Fruit), and Ju Hong (Tangerine Peel) tonify and awaken, allowing Spleen Qi to transform naturally.] This formula is suitable for patients with epigastric fullness and loss of appetite; it can be used with modifications.
Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) [See Xie Xie (Diarrhea)]. This formula is suitable for patients with epigastric fullness and can be modified according to symptoms; it embodies the method of simultaneous tonification and reduction.
A patient suffered from rebellious Qi rising, belching dozens of times after every one or two bites of food, occurring three or four times per meal. Zhang Zhunchun said: "This is due to Qi failing to return to its origin and the failure of the Middle Jiao to transform." Each dose required 2 qian of Ren Shen (Ginseng Root). The patient did not believe him. After taking Qi-moving drugs, the condition worsened. Three months later, Zhang Zhunchun said: "Now 4 qian of Ren Shen are needed." The patient still did not believe him. Another three months passed, and Zhang Zhunchun said: "Now 6 qian of Ren Shen are needed." The patient remained skeptical. Eventually, the patient could not swallow food, vomiting cold Qi in clumps, with upper and lower Qi failing to connect. Only then did he seek treatment from Zhang Zhunchun.
Zhang Zhunchun prescribed Ren Shen (6 qian) assisted by Chen Xiang (Agarwood), Sha Ren (Amomum Fruit), and Yi Zhi Ren (Alpinia Oxyphylla Fruit) (each 1 qian) to guide Qi back to its origin; Su Zi (Perilla Seed) and Mai Dong (Ophiopogon Tuber) (each 3 qian), Ju Hong (Tangerine Peel) (1 qian), Pi Pa Ye (Loquat Leaf) (3 slices), and Lu Gen Zhi (Reed Rhizome Juice) (1 cup) to descend rebellious Qi; and Bai Shao (White Peony Root), Wu Wei Zi (Schisandra Berry), and Yu Rou (Cornus Fruit) (each 2 qian) to astringe and consolidate dissipating Qi. The first decoction produced no effect; the second also produced no effect, though it did not cause vomiting like other decoctions. Upon taking the third decoction, there was suddenly a sound like an explosion below the heart, followed by belching upwards and uncontrollable urination downwards. The upper and lower pathways became clear, and the patient immediately requested porridge, eating three or four bowls without further rebellion of Qi. After five or six doses, the amount of Ren Shen was reduced by 2 qian. The remaining herbs were ground into powder ten times the original quantity, formed into pills using Shan Yao Paste (Chinese Yam Paste), and taken for half a year until the illness was cured.