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For infants suffering from **milk accumulation** (Ru Ji), the manifestations include restless sleep, frequent crying and calling, hot breath from the mouth, frequent vomiting of undigested milk curds, abdominal distension with heat in the abdomen, and sour, foul-smelling stools. Ancient methods primarily recommend *Xiaoru Wan* (Milk-Dissolving Pill) (see formula under "Vomiting due to Damaged Milk").

[Commentary by Chen Shouzhen] Infant milk accumulation arises from damaged milk causing stagnation and accumulation; this differs from cases where vomiting occurs immediately upon damage to the milk. Since children's **zang-fu organs** (Zang-Fu Organs) are delicate and tender, one should not recklessly use harsh purgative attacks. The prescription consists of stir-fried *Maiya* (Hordei Fructus Germinatus, 麦芽) 1 qian, *Liushen Qu* (Six-God Leaven, 六神曲) 8 fen, *Yun Fuling* (Poria, 茯苓) 2 qian, stir-fried *Laifuzi* (Radish Seed, 莱菔子) 5 fen, stir-fried *Zhike* (Aurantium Fructus, 枳壳) 8 fen, and honey-fried *Gancao* (Licorice Root, 甘草) 3 fen, using one slice of fresh ginger as a guiding agent.

If children indulge in rich, sweet, fatty, and raw/cold foods without restraint, leading to an inability of the spleen and stomach to transform and transport, **accumulation and stagnation** (Ji Zhi) will occur in the intestines and stomach. The symptoms present as warmth in the head, heat in the abdomen, sour and foul-smelling stools, belching with aversion to food, irritability and inability to sleep peacefully, dry mouth, and thirst. For mild accumulation, ancient methods recommend *Muxiang Da'an Wan* (Wood-Aromatic Great Peace Pill) to eliminate and guide out stagnation (ingredients include *Muxiang* (Aucklandiae Radix, 木香), *Huanglian* (Coptidis Rhizoma, 黄连), *Chenpi* (Citri Reticulatae Pericarpium, 陈皮), earth-stir-fried *Baizhu* (Atractylodis Macrocephalae Rhizoma, 白术), stir-fried *Zhishi* (Aurantii Fructus, 枳实), *Shanzha* (Crataegi Fructus, 山楂), *Lianqiao* (Forsythiae Fructum, 连翘), stir-fried *Shenqu* (Massa Medicata Fermentata, 神曲), stir-fried *Maiya* (Hordei Fructus Germinatus, 麦芽), *Sharen* (Amomi Fructus, 砂仁), and *Laifuzi* (Radish Seed, 莱菔子); these are ground into fine powder and formed into pills using a paste made from Shenqu). Each dose is 1 qian, taken down with rice water from stored grain.

For severe accumulation accompanied by constipation, ancient methods recommend *Xiao Chengqi Tang* (Minor Order the Qi Decoction) to purge downward (see formula mentioned previously).

[Commentary by Chen Shouzhen] For mild infant food accumulation, simply use bran-stir-fried *Zhishi* (Aurantii Fructus, 枳实) 1 qian and processed *Yezhu* (Atractylodis Rhizoma, 苍术) 1 qian, with *Suosharen* (Amomi Fructus, 缩砂仁) 3 fen as a guiding agent. For severe food accumulation, add to this base formula: stir-fried *Shenqu* (Massa Medicata Fermentata, 神曲) 8 fen, stir-fried *Maiya* (Hordei Fructus Germinatus, 麦芽) 8 fen, *Shanzha Rou* (Crataegi Fructus, 山楂肉) 1.5 qian, and baked *Laifuzi* (Radish Seed, 莱菔子) 5 fen, using ten pills of *Xianglian Wan* (Fragrant-Coptis Pill, 香连丸) as a guiding agent. If constipation is present, add five pills of *Gengyi Wan* (Change Toilet Pill, 更衣丸).

Any accumulation caused by diet initially results merely from occasional dietary injury and remains within the intestines and stomach; it can be treated by promoting qi movement or expelling pathogens, making treatment not difficult. However, only when there has been long-term lack of dietary moderation, gradually leaving behind stagnant filth, does it become *Pi Ji* (Pi Disease/Abdominal Mass). This accumulation lies between the left hypochondrium and the diaphragm, which is the pathway through which the **Yangming Zongqi** (Summing-up Qi of Yangming) emerges. The *Classic* states: "The great collateral of the Stomach is named Xuli, piercing through the diaphragm and connecting to the Lung, emerging below the left breast; its pulsation corresponds to the garment, reflecting the Zongqi." If qi knots and moves horizontally, accumulation forms. If a person usually suffers from irregular hunger and fullness, continuously consuming food, causing the Yangming Stomach qi to reverse once, yin-cold qi can take advantage of this weakness. If the Spleen fails to transform, the remaining stagnation combines with juices and foam outside the intestines, gathering and not dispersing, gradually forming a mass. Initially like a chicken egg, hard and lumpy, it gradually takes the shape of an inverted basin. If it crosses the umbilicus, the condition becomes critical. However, at its onset, it is very subtle, often unnoticed by people; after a long time, it becomes deeply rooted and firmly established, making medicinal power difficult to reach the disease site. Currently, many children in the northwest suffer from this disease, especially most frequently in rural areas where wheat noodles are the staple, because the accumulated stagnation resides between the skin and membranes, making it difficult to treat. Treatment should aim for slow resolution rather than urgent attack; careful observation is required. Therefore, I have composed this explanation on Pi Disease.