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The *Mai Jue* (Pulse Classic) states: In children, a pulse that is deep and knotted indicates the accumulation of pathogenic factors or masses.

Qian Yi stated: A deep and fine pulse in children is indicative of Pi Ji (癖积, abdominal masses formed by fluid and blood stasis).

The *Mai Jing* (Classic of Pulse Diagnosis) states: A pulse that comes forth thin and adheres closely to the bone indicates the presence of an accumulation (Ji).

Yang Renzhai stated: "Pi" (痞, epigastric fullness/stuffiness) refers to obstruction; "Jie" (结, knotting/consolidation) refers to solidity. When heat qi accumulates between the chest and diaphragm, and retained fluids gather within the waist and hypochondrium, the Ying and Wei (Nutritive and Defensive Qi) fail to circulate smoothly, and the Zang-Fu organs fail to diffuse and unblock. This leads to abdominal distension and results in Pi Jie (痞结), which is the inevitable outcome. This constitutes a syndrome of excess-heat, which may occasionally manifest as high fever. "Pi" (癖, hidden mass) refers to water enclosed by blood membranes, located laterally in the hypochondrium, causing intermittent pain. Only Pi can cause tidal fever, and only Pi can generate alternating chills and fever. Therefore, in patients with malaria, the Zhongwan (CV12) area often retains yellowish fluids, which eventually consolidate into Pi over time. Persistent chills and fever are often due to this mechanism. In children, when the Zang-Fu organs are harmonious and Ying and Wei are balanced, body fluids flow naturally; even excessive water intake will not cause disease. However, if breastfeeding or dietary management is irregular, leading to obstruction in the Sanjiao (Triple Burner) and Guan Ge (diaphragmatic barriers), water and fluids stagnate, and the Qi of the intestines and stomach fails to diffuse. Cold Qi combats with these stagnations, resulting in consolidation and the formation of Pi.

Qian Yi stated: When there is Pi in the abdomen, the child refuses solid food and drinks only breast milk. One should gradually use Bai Bing Zi (White Pill) to purge the accumulation. Children develop Pi because undigested milk or maternal diet lingers in the abdomen, causing symptoms such as alternating cold and heat. If not treated early, it will inevitably develop into Gan Syndrome (疳积, infantile malnutrition syndrome). The presence of Pi causes anorexia, leading to Spleen-Stomach deficiency and fever, which induces excessive drinking. This purges the intestines and stomach, depletes body fluids, and impairs the Spleen-Stomach's ability to transform and transport water and grain. The pulse becomes deep and fine, appetite decreases further, Spleen-Stomach deficiency worsens, limbs become weak and immobile, various pathogens arise, and Gan Syndrome forms. Mild cases are treated with Renzhai Muxiang Wan (Aucklandia Pill); severe cases with Qu Pi Wan (Remove Pi Pill); and severe Pi Jie with Ganlu San (Sweet Dew Powder) from the *Shenghui Fang*.

Luo Qianfu stated: A child suffered from Pi accumulation in the left hypochondrium, hard as an inverted palm, with prominent abdominal veins, accompanied by fever, emaciation, cough, spontaneous sweating, worsening in the late afternoon, gum sores, foul breath, bleeding from lesions, limb fatigue, and reduced thirst. The condition was critical. Imperial Physician Liu Zhongan treated him, predicting recovery in about 100 days. First, he administered one dose of Chenxiang Haijinsha Wan (Agarwood and Calcitrite Pill), resulting in the passage of two or three stools of turbid matter. The next day, Hetanqi Wan (Harmonizing Collapsing Qi Pill) was given. On the tenth day, Chenxiang Haijinsha Wan was administered again for purgation, followed by Hetanqi Wan. This regimen was alternated five times. After more than a month of administration, the Pi reduced by half, and full recovery was achieved before 100 days. This disease has been common in recent years, with many successful cures. It is recorded here to aid future practitioners.