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Abdominal fullness without pain is termed Pi (Pih, 痞), whereas abdominal fullness with pain is termed Jie (Jie, 结). Jie arises from an excess of accumulated pathogenic factors, while Pi results from a deficiency of Middle Qi (Zhongqi, 中气). The distinction between reducing (Xiao, 消) and tonifying (Bu, 补) methods is indeed clear; those with inherent Spleen Qi (Piqi, 脾气) deficiency present differently. If only reduction is used, the stagnation and pathogens sink deeper; if only reduction is used without supporting the healthy Qi, the Earth element (Spleen/Stomach) is damaged, and deficiency worsens. Therefore, reduction and tonification should be combined to nourish the upright Qi (Zhengqi, 正气); the primary treatment formula is Zhishi Wan (Bitter Orange Pill).

Fixed masses are termed Ji (Ji, 积), while fluctuating masses that appear and disappear are termed Jia (Jia, 瘕); this distinction between apparent and real holds profound meaning. For food accumulation masses in the right hypochondrium, use Radish Seed (Laifuzi, 莱菔子), Medicated Leaven (Shenqu, 神曲), and Cardamom Fruit (Caoguo, 草果). For blood stasis masses in the left hypochondrium, use Ligusticum Chuanxiong Rhizome (Chuanxiong, 川芎), Peach Kernel (Taoren, 桃仁), and Cinnamon Twig (Guizhi, 桂枝). For phlegm masses in the central chest/diaphragm area, use Floating Lithostes (Haifushi, 海浮石), along with Trichosanthes Fruit (Gualou, 栝蒌), Poria (Fuling, 茯苓), and Areca Seed (Binglang, 槟榔). For robust individuals, add Green Bitter Orange (Qingpi, 青皮) and Curcuma Zedoary Rhizome (Ezhu, 蓬莪术); for frail individuals, pair with Ginseng (Renshen, 人参) and Aconite Root (Fuzi, 附子) in small doses. One may also add Cyperus Rhizome (Xiangfu, 香附), Amomum Fruit (Sharen, 砂仁), Green Bitter Orange (Qingpi, 青皮), Tangerine Peel (Chenpi, 陈皮), Perilla Stem (Sugeng, 苏梗), Angelica Sinensis Root (Danggui, 当归), Ginger (Shengjiang, 生姜), and Jujube (Dazao, 大枣). In women, abdominal masses are invariably due to dead blood (stasis); do not mistake them for phlegm or food retention.

[Phlegm-Heat Internal Closure]
Herbs: Fermented Soybean (Douchi, 豆豉), Gardenia Fruit (Shanzhi, 山栀), Aurantium Fruit (Zhike, 枳壳), Acorus Rhizome (Changpu, 菖蒲), Apricot Seed (Xingren, 杏仁), Pinellia Tuber (Banxia, 半夏), Curcuma Aromatica Rhizome (Yujin, 郁金), Trichosanthes Fruit (Gualou, 栝蒌), Coptis Rhizome (Chuanlian, 川连), Baijin Wan (White Gold Pill, composed of Alum/Baifan, 白矾).

[Heat Pathogen Interior Binding]
Herbs: Immature Bitter Orange (Zhishi, 枳实), White Peony Root (Baishao, 白芍), Tangerine Peel (Jupi, 橘皮), Chinese Plum Fruit (Wumei, 乌梅), Apricot Seed (Xingren, 杏仁).
There are three variations of Xiexin Tang (Drain the Epigastrium Decoction):
1. Fresh Ginger, Dried Ginger, Pinellia Tuber, Ginseng, Licorice Root, Scutellaria Root, Coptis Rhizome, Jujube.
2. Ginseng, Licorice Root, Dried Ginger, Pinellia Tuber, Jujube.
3. Coptis Rhizome, Scutellaria Root, Ginseng, Pinellia Tuber, Scutellaria Root, Coptis Rhizome. (Note: Original text repeats herbs, implying a variation of Coptis/Scutellaria/Ginseng/Pinellia formulas).
4. Ginseng, Licorice Root, Dried Ginger, Jujube.

[Heat Pathogen entering Jueyin Meridian, with vomiting of roundworms, requiring warming and dissipating]
Formula: Xiexin Tang (Drain the Epigastrium Decoction) minus Ginseng and Licorice Root, plus Immature Bitter Orange and White Peony Root.

[Qi Stagnation transforming into Heat]
Herbs: Trichosanthes Fruit, Uncaria Ramulus cum Uncis (Gouteng, 钩藤), White Cardamom Seed (Baokou, 白蔻), Curcuma Aromatica Rhizome (Yujin, 郁金), Tangerine Peel, Tribulus Fruit (Bajili, 白蒺藜), Gardenia Fruit, Perilla Stem, Mulberry Leaf, Apricot Seed, Hemp Seed (Maren, 麻仁), Mung Bean Husk (Lvdouke, 绿豆壳).

[Summerheat Pathogen obstructing Qi]
Herbs: Bamboo Sap (Zhurou, 竹茹), Scutellaria Root, Anemarrhena Rhizome (Zhimu, 知母), Platycodon Root (Jiegeng, 桔梗), Hemp Seed, Curcuma Aromatica Rhizome, Pinellia Tuber, Talcum (Huashi, 滑石), Aurantium Fruit, Baohe Wan (Harmonize the Stomach Pill, containing Medicated Leaven, Hawthorn Fruit), Forsythia Fruit (Lianqiao, 连翘), Broad-leaved Citrus Peel (Guangpi, 广皮), Radish Seed (Buzi, 卜子), Poria.

[Obstruction by Dampness with divided Heat]
Herbs: Pinellia Tuber, Poria, Apricot Seed, Tangerine Peel, Black Cardamom Fruit (Wuyao, 乌药), Guanghuoxiang (Patchouli Herb, 广藿), Galangal Rhizome (Liangjiang, 良姜), Curcuma Aromatica Rhizome, White Cardamom Seed.

[Failure of Middle Yang to transport]
Herbs: Cinnamon Twig, Pogostemon Herba (Huoxiang, 藿香), Dried Ginger, Pinellia Tuber, Magnolia Bark (Nongpo, 浓朴), Poria, Cardamom Fruit, Aconite Root, Broad-leaved Citrus Peel.

[Stomach Cold with stagnant saliva/phlegm]
Herbs: Evodia Fruit (Wuyu, 吴萸), Dried Ginger, Toosendan Fruit (Chuanlianzi, 川楝子), Pinellia Tuber, Poria, Broad-leaved Citrus Peel.

[Clear Yang of the Chest fails to circulate]
Follow Zhang Zhongjing’s method of rotating Yang Qi in the chest using Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala Rhizome, and Licorice Decoction).

[Mixed Cold and Heat Exogenous Pathogens binding together]
Herbs: Ginger-fried Coptis Rhizome, Coptis Rhizome, Pinellia Tuber, Scutellaria Root, Light Dried Ginger, Immature Bitter Orange.

Mr. Chen stated: Ancient treatments for Pi (Pih) primarily utilized two methods: "Bitter taste to drain" and "Acrid-Sweet to disperse." For exogenous conditions, Zhang Zhongjing’s Xiexin Tang is used; for endogenous injury, his Linggui Gan Jiang method is applied. For upper jiao discomfort, use Immature Bitter Orange, Platycodon, Apricot Seed, and Trichosanthes to open and descend; use Gardenia and Fermented Soybean to clear heat and transform rot. This is the method of unblocking Clear Yang Qi. The ancient theory that "from tangible [pathology] to intangible [function]" is a profound insight.

[Liver Wood invading Spleen Earth deficiency with middle jiao stagnation]
Herbs: Magnolia Bark, Poria, White Peony Root, Broad-leaved Citrus Peel, Alpinia Oxyphylla Fruit (Yizhi, 益智), Clove Flower (Dingxiang, 丁香), Ginseng, Pinellia Tuber, Toosendan Fruit, Evodia Fruit, Ginger Juice, Oyster Shell (Muli, 牡蛎).

[Damp-Heat and Food Stagnation]
Herbs: Atractylodes Lancea Rhizome (Maozhu, 茅术), Broad-leaved Citrus Peel, White Peony Root, Radish Seed, Atractylodes Macrocephala Rhizome (Baizhu, 白术), Scutellaria Root, Aurantium Fruit, Chicken Gizzard Lining (Jineijin, 鸡内金).

[Phlegm coagulating in collaterals]
Symptoms: Tangible mass protruding in the right hypochondrium, non-tender upon pressure.
Herbs: White Mustard Seed (Baijiezi, 白芥子), Trichosanthes Fruit, Clam Shell Powder (Gafen, 蛤粉), Gardenia Fruit, Broad-leaved Curcuma Aromatica Rhizome (Guangyujin, 广郁金), Tangerine Red Peel (Hongpi, 橘红), Ginger Peel (Jiangpi, 姜皮), Pinellia Tuber.

[Blood collaterals coagulated and bi-syndrome]
Herbs: Angelica Sinensis Root Tip (Guixu, 归须), Tetrapanax Pith (Mutong, 木通), Motherwort Herba (Yimucao, 益母草), Dung Beetle (Bianglang, 蜣螂), Ground Beetle (Chong, 虫 - likely Diechong/Scarabaeus), Cyperus Rhizome (Xiangfu, 香附), Corydalis Rhizome (Yanhu, 延胡), Small Green Bitter Orange (Xiaoqingpi, 小青皮), Garlic Sprout (Jiu bai, 韭白), Curcuma Aromatica Rhizome, Magnolia Bark, Immature Bitter Orange, Leonurus Fructus (Chongweizi, 茺蔚子), Ligusticum Chuanxiong Rhizome, Tangerine Seed (Juhe, 橘核), Single Peach Kernel (Dan Taoren, 单桃仁).

Mr. Chen stated: Ji (accumulation) involves blood injury penetrating the collaterals; one must rely on creeping creatures to search out and expel the root cause. Initially, it is Qi knotting in the meridians; over time, blood injury enters the collaterals. The collaterals connect to the outer shell of the zang-fu organs. Zhang Zhongjing, in treating labor injury and blood bi syndrome to unblock collaterals, often employs flying insects and crawling spirits. Fuliang disease (Voliere Beam) also resides in the collaterals.

Ji (accumulation) is Yin pathogen gathering in the collaterals; the general principle is to treat with Acrid-Warm substances entering the blood collaterals. Because the place accommodating these Yin pathogens lacks Yang-moving Qi to rotate and transport, there must be Yin-still Blood to rely upon. Therefore, one must rely on substances that are Yin in substance but Yang in function, to enter the Yin and emerge to the Yang, thereby exerting their acrid-dispersing and warm-unblocking efficacy.

Zhang Jingyue stated: The accumulation of the Heart is named Fuliang (Voliere Beam), arising above the navel, large as an arm, extending up to below the heart, causing restlessness and oppression. The accumulation of the Spleen is named Piqi (Pi Qi), located in the epigastrium, covering an area large as a plate, causing jaundice. The accumulation of the Lung is named Xiben (Breath Burden), located under the right hypochondrium, covering an area large as a cup, causing chills and fever, wheezing cough, and lung congestion. The accumulation of the Liver is named Feiqi (Fat Qi), located under the left hypochondrium, like an inverted cup with heads and feet, causing cough. The accumulation of the Kidney is named Bentun (Running Piglet), originating in the lower abdomen, ascending to below the heart, resembling a running piglet, attacking up or down intermittently, causing wheezing, bone-steaming fever, and shortness of breath. What accumulates is Yin Qi, termed "Ji" (Accumulation); what gathers is Yang Qi, termed "Ju" (Gathering). Ji originates from the Five Zang organs; Ju originates from the Six Fu organs.