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Diseases originating from Yin syndromes, if mistakenly treated with purgation, result in Pi syndrome (a sensation of fullness and obstruction in the epigastrium). (Fever and aversion to cold indicate origin from Yang syndromes; mistaken purgation leads to Jie Xiong syndrome [chest binding]; absence of fever with aversion to cold indicates origin from Yin syndromes; mistaken purgation leads to Pi Qi [epigastric fullness].)

After purgation for Taiyang Cold Damage (Shanghan), if fever and sweating occur, it indicates the disease is about to resolve. If there is fullness and hardness with pain in the epigastrium, this is Jie Xiong syndrome. If there is only fullness without pain, this is Pi Qi, and Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) is indicated.

Ingredients: Gancao (Radix Glycyrrhizae Preparata), Huangqin (Radix Scutellariae), Ganjiang (Rhizoma Zingiberis Preparatum), Renshen (Radix Ginseng) (each 1.5 liang); Huanglian (Rhizoma Coptidis) (0.5 liang); Dazao (Fructus Jujubae) (6 pieces); Banxia (Rhizoma Pinelliae Preparatum) (1.1 liang).
Crush the herbs, add six sheng of water, boil to obtain three sheng, remove the dregs, and decoct again to obtain one and a half sheng. Drink one cup warm, three times during the day and twice at night. (If after purgation fluids enter the interior, causing stomach deficiency and rebellious qi, with cold knotting in the epigastrium, acrid-sweet dispersing methods are suitable. Banxia directs qi downward; bitter flavors eliminate dampness and unblock Heart qi; furthermore, Gancao has strong potency, so Ganjiang and Huanglian do not mutually antagonize each other.)

For epigastric Pi with softness upon palpation and a floating pulse at the Guan position, Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction to Drain the Epigastrium) is indicated.
Ingredients: Dahuang (Radix et Rhizoma Rhei) (1 liang); Huanglian, Huangqin (each 0.5 liang).
Crush the herbs, steep in one sheng of boiling water ("shrimp-eye" boiling point) for a moment, then strain and remove dregs. Drink warm, divided into four doses. Stop subsequent doses once bowel movement occurs. (Cold-dampness forces Heart qi to stagnate, intending to transform into heat.)

For epigastric Pi accompanied by aversion to cold and sweating, Fuzi (Radix Aconiti Lateralis Preparata) should be added to Dahuang Huanglian Xiexin Tang.
Fuzi (one piece, processed, skin and tips removed, cut into four pieces, decocted in three he of water to obtain one he. Remove the Fuzi, add the Fuzi juice to the herbal decoction, mix well, and take.)

If Pi does not resolve after taking Xiexin Tang, and the patient experiences thirst, dry mouth, and dysuria, Wuling San (Five-Ingredient Powder with Poria) is indicated. (The formula is recorded in the "Water-Accessible Syndromes" section.)

After Taiyang Cold Damage resolves via sweating, if there is disharmony in the Stomach, hard epigastric Pi, belching with food odor, fluid accumulation under the hypochondrium, borborygmus, and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Decoction to Drain the Epigastrium) is indicated.
Ingredients: Shengjiang (Rhizoma Zingiberis Recens) (2 liang); Renshen, Gancao, Huangqin (each 1.5 liang); Banxia (1.1 liang); Dazao (6 pieces); Huanglian, Ganjiang (each 0.5 liang).
Crush the herbs, add five sheng of water, boil to obtain three sheng, remove dregs, and decoct again to obtain one and a half sheng. Drink warm, divided into four doses. (Disharmony in the Stomach is constrained by Shaoyang Wood qi, hence the use of the acrid flavor of both types of ginger.)

In Taiyang Cold Damage or Wind Strike, if the physician mistakenly uses purgation, resulting in frequent diarrhea (dozens of times daily), undigested food, borborygmus, hard and full epigastric Pi, dry retching, irritability, and restlessness. Seeing the epigastric Pi, the physician assumes residual pathogenic factors and purges again, worsening the Pi. This is not excess heat knotting, but rather Stomach deficiency with rebellious guest qi, causing hardness. Gancao Xiexin Tang (Licorice Decoction to Drain the Epigastrium) is indicated.
Ingredients: Gancao (2 liang); Huangqin, Ganjiang, Renshen (each 0.5 liang); Banxia (1.1 liang); Dazao (6 pieces); Huanglian (0.5 liang).
Crush the herbs, add five sheng of water, boil to three sheng, remove dregs, and decoct again to obtain one and a half sheng. Drink warm, divided into four doses. (Because of Stomach deficiency, sweet flavors are increased.)

After severe purgation followed by sweating, if epigastric Pi and aversion to cold occur, the exterior syndrome remains unresolved. One must not attack the Pi directly; first resolve the exterior, then treat the Pi. To treat the Pi, Dahuang Huanglian Xiexin Tang is indicated. (The previous addition of Fuzi was for cases with excessive sweating and aversion to cold, where the exterior was resolving but interior knotting remained; this case involves no sweating and aversion to cold after sweating, so exterior resolution is required first.)

In Taiyang Cold Damage with fever, unresolved sweating, hard epigastric Pi, vomiting, and diarrhea, Da Chaihu Tang (Major Bupleurum Decoction) is indicated. (Sweating, vomiting, and diarrhea indicate dryness of Stomach fluids and interior excess knotting, not Stomach deficiency; thus, Da Chaihu Tang is used to purge.)

If a patient has a chronic Pi mass under the hypochondrium extending to the umbilicus, with pain radiating to the lower abdomen and genital tendons, this is Zang Jie (Visceral Binding), which is fatal.