钱仲阳云∶癖块者僻于两胁，痞结者否于中脘。此因乳哺失调，饮食停滞，邪气相搏而成；
或乳母六淫七情所致。古人多用克伐，痞癖既久，饮食减少，脾气必虚，久而不愈。必先以
固胃气为主，使养正则积自除。若欲直攻其结，不为不能善消，抑亦损其脾土，凡脾土亏损
，必变症百出矣。当参各类及随见症而主治之。
治验
一小儿患痞癖，服槟榔、蓬术、枳实、黄连之类，痞益甚。余曰∶此脾经血虚痞也，不可克
伐。遂用六君子加当归数剂，胃气渐复，诸症渐愈。乃朝用异功散加升麻、柴胡；夕用异
功散加当归、芍药而愈。
一小儿素嗜肉食腹痛，大便不调。半载后右胁结一块，三月后左胁又结一块，腹胀食少作渴
，小便赤涩，大便色秽。又半载后颔下亦结一核，妄服消块行滞等药，而元气益虚。用四味
肥儿丸、五味异功散之类，热渴渐止，腹胀渐可；佐以九味芦荟丸，结核渐消；后用四君子
为主，佐以四味肥儿丸之类，三月余而痊。
一小儿停食吐泻后饮食不节，作泻腹痛膨胀，腹中结块作渴，发热龈烂口臭，服消导克滞之
药而前症益甚，形体益瘦，视其面色，黄中隐青，乃脾土亏损而肝木所侮也。法当调补中气
，兼平肝木，遂用冲和汤及大芜荑汤之类，半载而愈。
一小儿患痞结，服克滞之药。余谓属形病俱虚，当补中气。彼不信，仍行克伐，遂致虚火上
炎，齿龈蚀烂，颔下结核。余用大芜荑汤及异功散加减用之而安。
一小儿患痞结，久而四肢消瘦，肚腹渐大，寒热嗜卧，作渴引饮，用白术散为主，佐以四味
肥儿丸，月余诸症渐愈。又以异功散加当归，并六味地黄丸，又月余而愈。
一小儿患痞结，身热如火，病状多端，不可尽述，朝用五味异功散，夕用四味肥儿丸，月余
诸症稍愈，佐以地黄丸，自能行立。遂朝用地黄丸，夕用异功散及虾蟆丸，数服而愈。
挨痞丸 治乳癖谷症，腹中块痛。
代赭石（火 ，醋淬，研细） 青皮 木香 蓬术（煨） 生地黄（各三钱） 巴豆（去油净，六钱）
上为末，醋糊丸，麻子大。每服二三丸，食后姜汤下。
甘遂破结散
甘遂（二钱五分，煨黄） 青皮（焙） 黄芩（炒） 大黄（炒。各半两）
上为末，每服一钱，水煎服。仍量儿加减，利后以粥补之。
进食丸 治乳食不消，心腹胀满，壮热喘粗，呕吐痰逆，肠鸣泄泻，或食症乳癖， 气痞结
，并皆治之。
巴豆霜
当归（米泔浸炒） 朱砂 代赭石（醋 七次） 枳壳（炒） 木香（各五钱） 麝香（一分）
上为末，糊丸，麻子大。每服一二丸，温米饮下，更量儿加减。
枳术丸
白术（四两） 枳实（二两）
上为末，荷叶包煨烂饭为丸，桐子大。每服四五十丸，空心白滚汤下。
阿魏膏 治一切癖块痞结，更服胡连丸。
羌活 独活 玄参 官桂 赤芍药 穿山甲 生地黄 两头尖 大黄 白芷 天麻（各五钱）
槐柳桃枝（各三钱） 红花（四钱） 木鳖（十枚去壳） 乱发（如鸡子大一团）
上用香油二斤四两，煎黑去渣，入发煎化，仍去渣，徐下黄丹，煎软硬得中，入芒硝、阿魏
、苏合香油、乳香、没药各五钱，麝香三钱，调匀即成膏矣。摊贴患处，内服丸药，黄丹须
用真正者效。凡贴膏药，先用朴硝随患处，铺半指浓，以纸覆上，用热熨斗熨良久，如硝耗
，再加熨之，二时许方贴膏药。若是疳积，加芦荟末同熨。
六味地黄丸（方见肾脏）
四君子汤
异功散
六君子汤（三方见内钓）
四味肥儿丸（方见呕吐）
大芜荑汤（一名冲和汤）
虾蟆丸
九味芦荟丸（三方见疳症）
白术散（方见积痛）
Qian Zhongyang stated: "Pi Ku" (masses in the hypochondrium) refers to pathogens gathering obliquely in the bilateral hypochondriac regions, while "Pi Jie" (epigastric fullness and obstruction) refers to Qi stagnation in the Zhongwan (CV12) area. These conditions arise from improper feeding and dietary stagnation, causing pathogenic factors to contend with each other; or they result from the mother's exposure to the Six Exogenous Pathogens (Wind, Cold, Summerheat, Dampness, Dryness, Fire) or emotional disturbances (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright). Ancients often used harsh purgatives to attack and reduce accumulation. However, if Pi Ku persists for a long time, food intake decreases, leading to inevitable deficiency of the Spleen Qi. If it remains uncured for a long time, one must first focus on consolidating Stomach Qi. By nourishing the righteous Qi, the accumulation will naturally dissipate. If one attempts to directly attack the knot, although it might not fail to eliminate the accumulation, it will damage the Spleen Earth. Once Spleen Earth is deficient, myriad complications will arise. One should refer to various categories and treat according to the presenting symptoms.
Clinical Cases:
A child suffered from Pi Ku and took medicines such as Areca Seed (Binglang), Curcuma Zedoaria (Pengzhu), Immature Bitter Orange (Zhishi), and Coptis Rhizome (Huanglian), resulting in aggravated epigastric fullness. I said: This is Pi caused by Blood deficiency in the Spleen Meridian; harsh purgatives are contraindicated. Thus, I prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) with added Angelica Sinensis (Danggui). After several doses, Stomach Qi gradually recovered, and all symptoms improved. Subsequently, Yi Gong San (Extraordinary Efficacy Powder) with added Cimicifuga Rhizome (Shengma) and Bupleurum Root (Chaihu) was administered in the morning; Yi Gong San with added Danggui and White Peony Root (Shaoyao) was administered in the evening, leading to recovery.
Another child had a habit of eating meat, abdominal pain, and irregular bowel movements. Half a year later, a mass formed in the right hypochondrium; three months later, another mass formed in the left hypochondrium. The child experienced abdominal distension, poor appetite, thirst, red and scanty urine, and foul-smelling stools. Another half year later, a nodule appeared under the chin. Blindly taking medicines to dissipate masses and promote Qi movement further depleted Yuan Qi (Original Qi). Si Wei Fei Er Wan (Four-Ingredient Child-Nourishing Pill) and Wu Wei Yi Gong San (Five-Ingredient Extraordinary Efficacy Powder) were used; heat and thirst gradually ceased, and abdominal distension alleviated. Ji Wei Lu Hui Wan (Nine-Ingredient Aloe Vera Pill) was added as an adjuvant, causing the nodules to gradually subside. Later, Si Jun Zi Tang (Four Gentlemen Decoction) was used as the main formula with Si Wei Fei Er Wan as an adjuvant. After more than three months, the child recovered.
Yet another child developed diarrhea, vomiting, and dyspepsia after stopping food intake and subsequent dietary indiscretion. Symptoms included diarrhea, abdominal pain, distension, intra-abdominal masses, thirst, fever, gingival ulceration, and halitosis. Taking digestive and purgative medicines worsened these symptoms and emaciation. Observation revealed a yellowish complexion with a hint of green, indicating Spleen Earth deficiency being overcontrolled by Liver Wood. The treatment principle was to regulate and tonify Middle Qi while soothing the Liver Wood. Chong He Tang (Harmonizing Decoction) and Da Wu Yi Tang (Large Wormwood Decoction) were used, resulting in recovery after half a year.
Another child suffering from Pi Jie took purgative medicines. I considered this a case of both Form and Disease deficiency, requiring tonification of Middle Qi. The patient did not believe this and continued with purgatives, leading to defluxion of Deficient Fire upward, erosion of gums, and cervical lymphadenopathy. Da Wu Yi Tang and modified Yi Gong San were used, stabilizing the condition.
Another child with chronic Pi Jie exhibited emaciated limbs, progressively enlarged abdomen, alternating chills and fever, lethargy, and excessive thirst. Bai Zhu San (Atractylodes Macrocephala Powder) was used as the main formula with Si Wei Fei Er Wan as an adjuvant. After one month, symptoms gradually improved. Yi Gong San with added Danggui and Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) were then used. After another month, the child recovered.
Another child with Pi Jie presented with high fever resembling fire and numerous complex symptoms. Wu Wei Yi Gong San was administered in the morning, and Si Wei Fei Er Wan in the evening. After one month, symptoms slightly improved. Di Huang Wan (Rehmannia Pill) was added as an adjuvant, enabling the child to walk and stand independently. Subsequently, Di Huang Wan was used in the morning, and Yi Gong San combined with Xia Ma Wan (Toad Pill) in the evening. After several doses, the child recovered.
Ai Pi Wan (Mass-Dissipating Pill): Treats nursing masses and grain stagnation with abdominal mass pain.
Hematitum (Dai Zhe Shi) (calcined, quenched in vinegar, ground fine), Green Tangerine Peel (Qingpi), Aucklandia Root (Muxiang), Curcuma Zedoaria (Pengzhu) (roasted), Rehmannia Root (Sheng Dihuang) (each 3 qian), Croton Seed (Badou) (de-oiled, 6 qian).
Grind into powder, make pills with vinegar paste, size of hemp seeds. Take 2-3 pills after meals, washed down with ginger decoction.
Gan Suan Po Jie San (Kansui Knot-Breaking Powder):
Kansui Root (Gansui) (2.5 qian, roasted yellow), Green Tangerine Peel (Qingpi) (roasted), Scutellaria Root (Huangqin) (stir-fried), Rhubarb (Dahuang) (stir-fried. Each 0.5 liang).
Grind into powder. Take 1 qian per dose, decocted in water. Adjust dosage according to the child. Supplement with congee after purgation.
Jin Shi Wan (Appetite-Stimulating Pill): Treats indigestion of milk and food, epigastric and abdominal fullness, severe fever, coarse breathing, vomiting with phlegm reflux, borborygmus and diarrhea, or food stagnation and nursing masses, Qi stagnation and obstruction.
Croton Frost (Badou Shuang), Angelica Sinensis (Danggui) (soaked in rice wash water and stir-fried), Cinnabar (Zhusha), Hematitum (Dai Zhe Shi) (quenched in vinegar seven times), Immature Bitter Orange (Zhike) (stir-fried), Aucklandia Root (Muxiang) (each 5 qian), Musk (Shexiang) (1 fen).
Grind into powder, make pills with paste, size of hemp seeds. Take 1-2 pills, washed down with warm rice drink. Adjust dosage according to the child.
Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill):
Atractylodes Macrocephala Rhizome (Baizhu) (4 liang), Immature Bitter Orange (Zhishi) (2 liang).
Grind into powder. Wrap in lotus leaf, roast until soft, mix with cooked rice to make pills, size of paulownia seeds. Take 40-50 pills on an empty stomach with plain boiled water.
A Wei Gao (Asafoetida Plaster): Treats all types of masses and epigastric obstruction; also take Hu Lian Wan.
Notopterygium Rhizome (Qianghuo), Angelica Dahurica Root (Duhuo), Scrophularia Root (Xuanshen), Cinnamon Twig (Guangui), Red Peony Root (Chishaoyao), Pangolin Scales (Chuanshanjia), Rehmannia Root (Sheng Dihuang), Acronychia Pedunculata Stem (Liangtoujian), Rhubarb (Dahuang), Angelica Dahurica Root (Baizhi), Gastrodia Rhizome (Tianma) (each 5 qian), Branches of Sophora, Willow, and Peach (Huai Liutao Zhi) (each 3 qian), Safflower (Honghua) (4 qian), Momordica Charantia Seed (Mubiezi) (10 pieces, shelled), Human Hair (Luankuafa) (one ball the size of a chicken egg).
Fry the above ingredients in 2 jin 4 liang of sesame oil until black, remove dregs. Add hair and fry until dissolved, then remove dregs again. Slowly add Lead Oxide (Huangdan), frying until the consistency is appropriate. Add Niter (Mangxiao), Asafoetida (Awei), Benzoin Resin Oil (Suhe Xiang You), Frankincense (Ruxiang), and Myrrh (Moyao) (each 5 qian), and Musk (Shexiang) (3 qian). Mix well to form the plaster. Apply to the affected area. Internal use of pills is required. True Lead Oxide must be used for efficacy. Before applying the plaster, spread Pungent Salt (Puxiao) half a finger thick over the affected area, cover with paper, and apply heat with a hot iron for a long time. If the salt depletes, reapply heat. After about two hours (4 hours), apply the plaster. For malnutrition due to parasites, add Aloe Vera powder and apply heat together.
Liu Wei Di Huang Wan (See Kidney section for formula)
Si Jun Zi Tang (Four Gentlemen Decoction)
Yi Gong San (Extraordinary Efficacy Powder)
Liu Jun Zi Tang (Six Gentlemen Decoction) (See Neidiao section for formulas)
Si Wei Fei Er Wan (Four-Ingredient Child-Nourishing Pill) (See Vomiting section for formula)
Da Wu Yi Tang (Large Wormwood Decoction) (Also known as Chong He Tang)
Xia Ma Wan (Toad Pill)
Jiu Wei Lu Hui Wan (Nine-Ingredient Aloe Vera Pill) (See Gan Zheng section for formulas)
Bai Zhu San (Atractylodes Macrocephala Powder) (See Ji Tong section for formula)