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(Section 10)

Ren Zhai stated: "Pi" (epigastric fullness/stuffiness) refers to obstruction. "Jie" (knotting/mass) refers to solidity. When hot qi accumulates between the chest and diaphragm, and retained fluids gather within the waist and hypochondrium, Ying Qi (nutritive energy) and Wei Qi (defensive energy) cannot circulate smoothly, and the zang-fu organs cannot be unblocked. Abdominal distension leads to Pi-Jie (stuffiness and knotting), which is a natural consequence of the pathological situation. This is a syndrome of excess heat, which may manifest as high fever. "Pi" (mass in the hypochondrium) refers to water wrapped in blood membranes, located laterally in the hypochondrium, causing intermittent pain. Only Pi can cause tidal fever and alternating chills and fever; thus, in malaria, the pulse often indicates fluid retention in the upper abdomen, which over time forms masses, leading to chills and fever. In children, when the zang-fu organs are harmonious and Ying-Wei circulation is smooth, body fluids flow naturally. Even if they drink large amounts of water or milk, it will not cause disease. However, improper breastfeeding can obstruct the San Jiao (Triple Burner) and gateways, causing fluids to stagnate in the stomach and intestines without dispersing. The struggle between cold and heat leads to accumulation and the formation of Pi masses.

The Mai Jue (Pulse Classic) states: "In children, a deep and knotted pulse indicates the aggregation of pathogenic matter." Qian Yi stated: "A deep and fine pulse in children indicates Pi Ji (accumulation due to Pi)." The Mai Jing (Classic of Pulse Diagnosis) states: "A pulse that is thin and adheres closely to the bone indicates an accumulation."

Qian Yi said: "When there is a Pi mass in the abdomen, the child refuses food but only accepts breast milk." One should gradually administer Bai Bing Zi (White Pill) to purge it. Children develop Pi because undigested food from the mother's diet lingers in the infant's abdomen, causing alternating chills and heat resembling malaria. If not treated early, it will inevitably develop into Gan Syndrome (infantile malnutrition). Because the Pi mass prevents eating, the Spleen and Stomach become deficient and generate fever, leading to excessive drinking. This purges the intestines and stomach, depletes body fluids, and impairs the Spleen and Stomach's ability to transform and transport food and fluids. The pulse becomes deep and fine, appetite decreases further, Spleen-Stomach deficiency worsens, limbs become weak and immobile, various pathogens arise, and Gan Syndrome ensues. For mild cases, Ren Zhai's Muxiang Wan (Costus Pill) is used; for severe cases, heavy doses of Qu Pi Wan (Remove Pi Pill) are employed. For severe Pi-Jie, Shengsi Ganlu San (Holy Thought Sweet Dew Powder) is the primary treatment.

Luo Qianfu recorded: A child suffered from Pi accumulation under the left hypochondrium, hard like an inverted hand, with a distended abdomen and visible blue veins, fever, emaciation, cough, spontaneous sweating, worsening in the late afternoon, foul breath, rotting gums, bleeding loose teeth, limb fatigue, and reduced appetite. The condition was critical. Imperial Physician Liu Zhong'an treated him, predicting recovery in about 100 days. First, he administered one dose of Chenxiang Haijinsha Wan (Agarwood and Lygodium Spore Pill), resulting in the passage of two or three stools of foul matter. The next day, he prescribed Taqi Wan (Collapse Qi Pill). After ten days, he again used Chenxiang Haijinsha Wan to promote drainage, followed by Taqi Wan. This regimen was alternated five times over more than a month, reducing the mass by half. By the hundredth day, the child had fully recovered. This disease has been common in recent years, with many cures achieved. It is recorded here to aid future practitioners.