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(This type of Pi [abdominal fullness and obstruction] is located within the abdomen, differing from Pi at the epigastrium.)

Yang states: "Pi" refers to blockage; "Jie" refers to solidity. Heat qi accumulates between the chest and diaphragm, while retained fluid gathers within the abdomen and hypochondrium. Consequently, Ying [Nutritive] and Wei [Defensive] Qi cannot circulate freely, and the Zang-Fu organs cannot communicate smoothly. Thus, distension and fullness progress into Pi-Jie [accumulation and obstruction], which is the natural progression of the disease pattern. This belongs to a Heat-Excess syndrome. Occasionally, it manifests as high fever (Zhuang Re), for which Gan Sui San (Kansui Powder) from *Taiping Shenghui Fang* (The Holy惠民 Formulary of the Taiping Era) is indicated. This medicine treats pediatric Pi-Jie; although temporary relief may occur after taking the decoction, the stagnation and excess pathogens remain. The epigastrium feels hard and distended, and crying ensues upon palpation due to latent heat within, with various symptoms presenting simultaneously. For this disease, one should unblock and purge the bowels, break up accumulations, and dissipate Qi stagnation. Subsequently, Jin Shi Wan (Appetizing Pills) is suitable for regular use.

Commentary: Jin Shi Wan contains Ba Dou (Croton Seed Frost), which is unsuitable for long-term administration. Gan Sui (Kansui Root) possesses great toxicity; its water-draining power is like bursting a river dyke. It should not be used lightly unless three conditions are met simultaneously: the patient must be extremely robust, the condition extremely critical, and the pathogenic water-dampness extremely severe. Using it now as the primary formula for Pi-Jie is erroneous.

Xue states: When Pi-Pi [lumps or masses in the abdomen] persists for a long time, dietary intake decreases, leading inevitably to Spleen Qi deficiency. If it remains uncured for a long period, the primary treatment must focus on consolidating Stomach Qi. Nourishing the righteous Qi will cause the accumulation to resolve spontaneously. If one attempts to directly attack the accumulation, not only will it fail to dissolve effectively, but it will also damage the Spleen Earth. Once the Spleen Earth is deficient, myriad complications will arise. One should refer to various categories and treat according to the specific manifestations.

Case 1: A child suffered from Pi-Pi and took medicines such as Bing Lang (Areca Seed), Peng Zhu (Turmeric Tuber), Zhi Shi (Immature Bitter Orange), and Huang Lian (Coptis Rhizome), yet the Pi worsened. I stated that this was Pi caused by Blood deficiency in the Spleen Meridian and should not be treated with harsh purgatives. I prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) added with Dang Gui (Angelica Sinensis Root). After several doses, Stomach Qi gradually recovered, and symptoms improved. Then, Yi Gong San (Benefit the Work Powder) added to Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root) was administered in the morning, and Yi Gong San added with Dang Gui and Shao Yao (Peony Root) in the evening, resulting in recovery.

Case 2: Another child suffered from Pi-Jie and took medicines that clear stagnation. I considered this a case of both Form and Qi being deficient, requiring tonification of Middle Qi. The family did not believe me and continued with attacking treatments, leading to deficient Fire flaming upward, erosion and ulceration of the gums, and tubercles under the jaw. I used Da Wu Yi Tang (Great Wormwood Decoction) and modified Yi Gong San, which stabilized the condition.

Case 3: A child suffered from Pi-Jie for a long time, resulting in emaciated limbs and a gradually enlarging abdomen, alternating chills and fever, lethargy, thirst, and desire to drink. Bai Zhu San (Atractylodes Macrocephala Powder) was used as the main formula, assisted by Si Wei Fei Er Wan (Four-Ingredient Child-Nourishing Pills). After more than a month, symptoms gradually improved. Then, Yi Gong San added with Dang Gui, along with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), were used, leading to recovery after another month.

Case 4: A child suffered from Pi-Jie with body heat intense as fire and numerous complex symptoms. Morning administration of Wu Wei Yi Gong San (Five-Ingredient Benefit the Work Powder) and evening administration of Si Wei Fei Er Wan led to slight improvement after a month. Assisted by Di Huang Wan (Rehmannia Pill), the child could walk and stand independently. Subsequently, Di Huang Wan was taken in the morning, and Yi Gong San combined with Xia Wa Wan (Toad Pill) in the evening, resulting in recovery after several doses.

Qian Hu San (Peucedanum Powder) from *Taiping Shenghui Fang*: Treats pediatric abdominal Pi-Jie, high fever, emaciation, and excessive crying.
Ingredients: Qian Hu (Peucedani Radix), Chuan Da Huang (Rhei Radix et Rhizoma) (each 3 fen, slightly stir-fried), Zhi Ke (Aurantii Fructus Immaturus) (stir-fried until slightly yellow), Chi Fu Ling (Poria with Hostwood), Xi Jiao (Rhino Horn) (crushed), Yu Li Ren (Prunus Armeniaca Seed) (soaked in hot water, skin removed, slightly stir-fried), Bie Jia (Trionycis Carapax) (coated with vinegar, roasted until yellow, skirt removed) (each 0.5 liang).
Process: Crush the ingredients and sieve coarsely. Take 1 qian per dose, boil in one small cup of water until reduced to 0.5 cup, strain, and administer warm in adjusted doses according to the child's age. Stop when mild diarrhea occurs.

Gan Sui Po Jie San (Kansui Breaking Accumulation Powder) from *Taiping Shenghui Fang*:
Ingredients: Gan Sui (Kansui Radix) (roasted to 2.5 qian, yellow), Qing Pi (Citri Reticulatae Pericarpium Viride) (soaked, white pith removed, dried), Huang Qin (Scutellariae Radix), Chuan Da Huang (Rhei Radix et Rhizoma) (cut finely, roasted) (each 0.5 liang).
Process: Make into coarse powder. Take 1 qian per dose, boil in one small cup of water until reduced to 0.6 cup, strain, and take warm. Adjust dosage based on age/size. Stop when bowel movement is achieved, then replenish with cold congee.

Jin Shi Wan (Appetizing Pills): Treats indigestion of milk and food, epigastric and abdominal fullness, high fever, coarse breathing, vomiting with phlegm reversal, borborygmus with diarrhea, undigested food particles. Also treats dysentery with red and white discharge, abdominal pain with tenesmus. Additionally treats Food Accumulation Syndrome, Milk Lump, Zhi Qi [masses], and Pi-Jie. For children with Heat-Excess in the chest/diaphragm and retained fluid in the abdomen causing blockage of Ying/Wei Qi and inability of Zang-Fu Qi to circulate, manifesting as abdominal Qi knotting/distension or high fever, these pills unblock the bowels, break accumulations, and dissipate Qi.
Ingredients: Ba Dou Shuang (Crotonis Fructus Frost) (1.2 qian), Dang Gui (Angelicae Sinensis Radix) (soaked in rice wash overnight, stir-fried), Zhu Sha (Cinnabar), Dai Zhe Shi (Hematitum) (calcined, quenched in vinegar seven times), Zhi Ke (Aurantii Fructus Immaturus) (stir-fried), Mu Xiang (Aucklandiae Radix) (each 0.5 liang), She Xiang (Moschus) (a little).
Process: Grind into fine powder, bind with wheat paste into pills the size of hemp seeds. One-year-old infants take one pill, washed down with warm rice water. Adjust based on deficiency/excess. Take after meals. Treats food-stagnation fever, emaciation with large belly, Green Vein Malnutrition, abdominal pain with protruding ribs.

Tang Case: The young daughter of Vice Minister Zhang of the Ministry of Revenue suffered from accumulated stagnation and mass formation for over a year. Symptoms included abdominal fullness, high fever, closure of stool and urine, and anorexia. Various physicians treated it as Deficient Heat or tidal fever, or as Cold-Stomach anorexia. Since she could not eat, stool and urine naturally decreased. Others tried treating it as Malnutrition Fever. All medicines failed, and the condition became critical. I was summoned. I asked what medication she should take. I answered: She should take Gan Sui and Da Huang. Mr. Zhang was horrified, saying previous doctors used tonics, and since the girl hadn't eaten for long, purging agents should not disturb the intestines. I replied: Trust me and live; defy me and die. He asked if there was a substitute without Gan Sui. I ordered immediate administration of Da Cheng Qi Tang (Major Order the Qi Decoction). After two doses, she recovered. On the next day's pulse diagnosis, residual stagnation remained. I predicted abdominal closure would recur in a few days, requiring the previous strong medicine to eradicate the root. Days later, indeed, closure recurred with abdominal fullness and Pi-Jie. Administering the strong medicine again cured her in one dose.
Above is the example of unblocking the bowels. Suitable for cases where both Form and Qi are Excess.

Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill):
Ingredients: Bai Zhu (Atractodis Macrocephalae Rhizoma) (4 liang), Zhi Shi (Aurantii Fructus Immaturus) (2 liang).
Process: Grind into powder. Bind with steamed rice wrapped in Lotus Leaf into pills the size of tung tree seeds. Take 40-50 pills per dose, empty stomach, with plain boiling water.

Zhi Shi Li Zhong Wan (Immature Bitter Orange Regulate the Middle Pill):
Ingredients: Zhi Shi (16 slices, bran-stir-fried), Fu Ling (Poria), Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractodis Macrocephalae Rhizoma), Gan Jiang (Zingiberis Rhizoma) (processed), Zhi Gan Cao (Prepared Licorice Root) (each 2 liang).
Process: Grind into powder, bind with refined honey into pills the size of longan fruits. Take one pill per dose, dissolved in hot water. Continue for 2-3 doses. If chest feels open but thirst persists, add Gua Lou Gen (Trichosanthis Radix) 1 liang. If spontaneous sweating occurs, add Mu Li (Ostrea Shell) 2 liang. Add for diarrhea as well.

Kuai Ge Tang (Quick Diaphragm Decoction): Regulates chest/diaphragm discomfort, poor appetite. Also promotes Qi flow, harmonizes the middle, and digests old stagnation.
Ingredients: Ren Shen (Ginseng Radix et Rhizoma) (rhizome removed), Qing Pi (Citri Reticulatae Pericarpium Viride) (white pith removed), Suo Sha Ren (Amomi Fructus), Wu Yao (Linderae Radix), Liang Jiang (Alpiniae Officinarum Rhizoma) (processed), Xiang Fu (Cyperi Rhizoma), Zhi Gan Cao (Prepared Licorice Root) (each 1 liang).
Process: Grind into fine powder. Take 1 qian per dose, mix with warm salted water, take empty stomach.

Shen Zhu Xian Xiong Tang (Ginseng and Atractylodes Trap-the-Chest Decoction):
Ingredients: Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractodis Macrocephalae Rhizoma), Fu Ling (Poria), Ju Hong (Citri Reticulatae Pericarpium), Ban Xia (Pinelliae Rhizoma) (each 1 qian), Gua Lou (Trichosanthis Fructus) (whole, cut finely, damp weight 3 qian), Huang Lian (Coptidis Rhizoma), Zhi Gan Cao (Prepared Licorice Root) (each 0.5 qian).
Process: Use 1.5 zhong of water, 3 slices of Sheng Jiang (Zingiberis Rhizoma Recens), 1 Jujube. Decoct to 0.7 portion, take warm.

Jie Gu states: For loss of appetite, use Si Jun Zi Tang (Four Gentlemen Decoction) with Sheng Jiang and Jujube boiled together.