痞块，肝积也，肝经湿热之气聚而成也。外以大蒜、皂角、阿魏胶敷之，内以地黄汤加
验案
一妇因丧子忧虑，饮食不思，有块在软肚内。用四君子加陈皮、肉桂、归身、沉香、半
夏；丸用茯苓、白术四、五两，藏猪肚内，煮烂，沉香为衣，久服全愈。
一妇素善怒，左胁下有块，身肥大，经将行，先一二日且吐且下。此肝木乘脾，脾虚生
痰，不生血也。善怒胁块，肝气亢也；吐下者，脾气虚也；身肥则多痰，痰盛则中焦多湿；每经
行时气血流通，冲动脾湿，且吐且下也。久而不治，必变中满。宜理脾燥湿。白术一两，半
夏五钱，生姜七钱，沉香二钱，共末。白糖和服。
一人左胁有块，右关脉豁大。用乌药一两，附子五钱制之。将乌药日磨二三分，酒送下
，俟积行动，乃以补中益气汤加附子服之，丸用六味丸。
一人左乳下有一块，此肾虚水不上升，肝火无制，郁而为块也。宜滋肾丸治之，知母、
一人小腹左边有块，宜戊己丸治之。白术补脾，白芍、肉桂以平肝。服之全愈。
一人当胸有一块，遇心有所用，即火动上燎其面，时吐痰，脉缓而有力，右手浮大。盖
胸为肺室，面属阳明。有块不宽，肺火郁也；火燎其面，大肠火炽也；脉浮大，火脉也。实则泻
之，宜养血以制之。四物汤各一钱，肉桂三分煎服。
一人因忧虑发寒热，三月后呕吐，食仓边有一块，痛直冲心，胸膈饱，便闭，背胀胁痛
。盖
不下也。脾不转运，故诸病生焉。方用二陈汤加苏梗、炮姜、吴萸，一服便通。
一人右脐旁有块作痛，移动不定，大便不通，诸药不效。左寸缓而有力，右寸微大，关
脉沉细无力。此肝气虚，脾土衰，土不受克，木无生发之气，肾元可纳矣。不可攻痞，宜益肝、
扶脾、安肾，使脾气输则痞运散。人参、熟地、小茴各五分，归身一钱，山药、茯苓各七分
Pi Mass (Subcutaneous or Intraperitoneal Mass) is a type of Liver Accumulation (Liver Ji), formed by the aggregation of damp-heat qi in the Liver Meridian. Externally, it can be treated with applications of Garlic, Gleditsia Sinensis Fruit (Zaojiao), and Ferula Resin (Awei Jiao); internally, Dihuang Tang (Rehmannia Decoction) is used.
Clinical Cases:
A woman, distressed by the loss of her child, lost her appetite and had a mass in the soft part of her abdomen. She was treated with Sijunzi Tang (Four Gentlemen Decoction) added with Chenpi (Tangerine Peel), Rougui (Cinnamon Bark), Dangguishen (Radix Angelicae Sinensis Stem), and Chenxiang (Aquilaria Wood). For pills, Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome), four to five liang each, were stewed inside a pig's stomach until soft, coated with Chenxiang powder, and taken over a long period for complete recovery.
Another woman, prone to anger, had a mass under her left hypochondrium, was obese, and experienced vomiting and diarrhea one or two days before her menstruation. This indicates Liver Wood overacting on Spleen Earth (Liver Qi invading the Spleen), causing Spleen deficiency to generate phlegm and fail to produce blood. Frequent anger and hypochondriac masses indicate hyperactive Liver Qi; vomiting and diarrhea indicate Spleen Qi deficiency; obesity suggests excessive phlegm, and excessive phlegm leads to dampness in the Middle Jiao. During menstruation, the flow of Qi and Blood stirs up Spleen dampness, causing vomiting and diarrhea. If untreated for a long time, it will inevitably transform into Zhongman (Abdominal Fullness). The treatment should focus on regulating the Spleen and drying dampness. Baizhu 1 liang, Banxia (Pinellia Tuber) 5 qian, Shengjiang (Fresh Ginger) 7 qian, Chenxiang 2 qian, all ground into powder and taken mixed with white sugar.
A man had a mass under his left hypochondrium, and his Right Guan pulse was hollow and large. He was treated with Wuyao (Lindera Root) 1 liang and prepared Fuzi (Prepared Aconite Lateralis Radix) 5 qian. The Wuyao was ground finely (2-3 fen daily) and taken with wine. Once the accumulated pathogen began to move, Buzhong Yiqi Tang (Decoction for Boosting the Middle and Augmenting Qi) with added Fuzi was administered, along with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) as pills.
A person had a mass below the left breast. This is due to Kidney deficiency failing to ascend water, allowing Liver Fire to go unchecked, leading to stagnation and mass formation. It should be treated with Zishen Wan (Kidney-Nourishing Pill), containing Zhimu (Anemarrhenae Rhizoma)... [text incomplete].
A person had a mass on the left side of the lower abdomen. It should be treated with Wuji Wan (Wuji Pill), which uses Baizhu to tonify the Spleen, and Baishao (White Peony Root) and Rougui to calm the Liver. Complete recovery was achieved.
A person had a mass in the center of the chest. Whenever mental exertion occurred, fire flared up, scorching the face, accompanied by frequent expectoration of phlegm. The pulse was slow yet forceful, and the Right hand pulse was floating and large. The chest is the residence of the Lung, and the face belongs to the Yangming channel. The presence of a mass obstructs free flow, indicating stagnant Lung Fire; the scorching of the face indicates blazing Large Intestine Fire; the floating and large pulse indicates Fire excess. For excess patterns, purging is indicated. Nourishing Blood to subdue the fire is appropriate. Siwu Tang (Four Substances Decoction), 1 qian of each ingredient, with Rougui 3 fen, decocted and taken.
A person developed alternating chills and fever due to worry. Three months later, vomiting occurred, with a mass at the edge of the stomach, pain shooting straight to the heart, chest and diaphragm fullness, constipation, back distension, and hypochondriac pain. This arises because worry injures the Spleen, impairing its transportation and transformation, giving rise to various diseases. The formula used was Erchen Tang (Two-Aged Decoction) added with Sugen (Perilla Stem), Paojiang (Prepared Ginger), and Wuyu (Evodia Fruit). One dose resulted in bowel movement.
A person had a painful mass beside the right umbilicus, moving unpredictably, with constipation, unresponsive to various medications. The Left Cun pulse was slow and forceful, the Right Cun pulse slightly large, and the Guan pulse deep, fine, and weak. This indicates Liver Qi deficiency and Spleen Earth decline. Since Earth is not controlled (or fails to control Wood appropriately), Wood lacks generating vitality, and Kidney Yuan can be secured. Attacking the Pi mass is contraindicated; instead, tonifying the Liver, supporting the Spleen, and calming the Kidney are required to allow Spleen Qi to distribute, thereby dispersing the mass. Renshen (Ginseng Radix), Shudi (Prepared Rehmanniae Radix), and Xiaohui (Fennel Fruit) each 5 fen, Dangguishen 1 qian, Shanyao (Dioscorea Rhizome) and Fuling each 7 fen... [text ends].