薛己曰。痞结既久。饮食减少。脾气必虚。久而不愈。必先以固胃气为主。使养正则积自除。若欲直攻其结。不惟
不能善消。抑亦损其脾土。脾土既亏。必变症百出。当详参各类以治之。
陈藏器曰。痞者塞也。热气蕴于胸膈之间。留饮聚于腹胁之内。于是营卫不能流行。脏腑不能宣通。由胀满而致痞
结。势使然耳。此热实之症也。时或发为壮热。宜圣惠破结散。此方治小儿痞结。虽服汤药时。暂得利。而滞实不消。
心下坚胀。按之即哭。内有伏热并成。宜利大便。破结散气。
李仲南曰。积症有伤乳伤食而身体热者。惟肚热为甚耳。夜间有热者。伤积之明验也。
钱乙曰。小儿病癖。由乳食不消。伏在腹中。乍凉乍热。饮水不止。或喘而嗽。与潮食相类。若不早治。必成痨疳。
寒热饮水。胁下有形硬痛。法当用药渐消渐磨之。以其有症癖。故令儿不食。脾胃虚而发热。故
引饮也。
曾氏曰。婴孩积症。皆乳哺不节。过餐生冷坚硬之物。脾胃不能克化。积停中脘。外为风寒所袭。或夜卧失盖。致
头疼面黄身热。眼胞微肿。腹痛膨胀。足冷肚热。喜睡神昏。饮食不思。或呕或哕。口噫酸气。大便 臭。此为陈积所
伤。如觉一二日。先用百伤饮发表。次当归散荡动积滞。方下乌犀丸、六圣丸。重与宽利。后用匀气散调补。
陈无择曰。小儿五积。为脏气不行。蓄积一处不动。故曰积。如伏梁息贲奔豚痞气肥气是也。六聚。谓六腑之气留
聚也。腑属阳。阳气流转不停。故其聚不定一处。发而腹痛。积聚之候。皆面黄瘦劣。HT 不生肌肉。发立。或肌体
浮肿。腹急多困。多为水气。凡虚中有积者。因伤食而泻。又吐。如此渐处。其病未瘥。故曰虚积也。又虚中之积。有
积而频频取转。却取转不着。致其积尚伏。故亦曰虚中积。若惊积取下。则屎青。食积。屎成块子。凡疳中虚积者。因
疳病转泻。虚而疳不退。故虚中尔。所取下粪里白色也。
龚信曰。癖块者。僻于两胁。痞结者。痞于中脘。皆乳哺失节。饮食停滞。邪气相搏而成也。
Xue Ji stated: If the condition of Pi Jie (痞结, obstruction and accumulation) persists for a long time, it will lead to reduced food intake, and the Spleen Qi (脾气, functional activity of the Spleen) must be deficient. If it remains uncured for a long term, treatment must first focus on consolidating Stomach Qi (胃气, functional activity of the Stomach), so that when righteous Qi (正气, healthy energy) is nourished, the accumulation will naturally dissipate. If one attempts to directly attack the accumulation, not only will it fail to effectively eliminate the stagnation, but it will also damage the Spleen Earth (脾土, Spleen in Five Element theory). Once the Spleen Earth is deficient, myriad variable symptoms will emerge. One should carefully consult various categories of diseases to treat it.
Chen Cangqi stated: "Pi" (痞, obstruction/stuffiness) means blockage. Heat qi accumulates between the chest and diaphragm, while retained fluid gathers within the abdomen and hypochondrium. Consequently, Ying and Wei (营卫, Nutritive and Defensive Qi) cannot circulate smoothly, and Zang-Fu organs cannot communicate freely. Thus, distension and fullness lead to Pi Jie, which is an inevitable progression. This is a heat-excess syndrome. Occasionally, it manifests as high fever, and Shenghui Pojie San (圣惠破结散, Holy Benefit Powder to Break Accumulation) is suitable. This formula treats pediatric Pi Jie; although taking the decoction may temporarily provide relief (such as bowel movement), the stagnant excess pathogen is not eliminated. The epigastrium feels hard and distended, and crying occurs upon pressure, indicating the coexistence of latent heat inside. It is appropriate to promote bowel movements, break up the accumulation, and disperse Qi stagnation.
Li Zhongnan stated: In accumulation syndromes where body heat arises from damaged milk or food, heat in the abdomen is particularly severe. Nighttime fever is a clear sign of food accumulation injury.
Qian Yi stated: Pediatric Pi disease (癖病, mass/accumulation disorder) results from undigested milk and food lying dormant in the abdomen, presenting with alternating cold and heat, incessant thirst, or wheezing and coughing. It resembles tidal fever and food stagnation. If not treated early, it will inevitably develop into Lao Gan (痨疳, consumptive malnutrition syndrome). With alternating cold and heat, excessive drinking, and hard, painful masses under the hypochondrium, the method should be to use medicine to gradually dissolve and grind down the accumulation. Due to the presence of Pi masses, the child loses appetite; due to Spleen deficiency causing heat, the child seeks water.
Zeng Shi stated: Infantile accumulation syndromes are all caused by irregular breastfeeding and feeding, overconsumption of raw, cold, hard, and solid foods, leading to the Spleen and Stomach's inability to transform and transport. Accumulation stops in the Zhongwan (中脘, CV12) region. Externally, the body is attacked by wind-cold, or covering is lost during night sleep, resulting in headache, sallow complexion, body heat, slightly swollen eyelids, abdominal pain and distension, cold feet but hot belly, drowsiness and confusion, lack of desire for food, vomiting or hiccups, sour belching, and foul-smelling stool. This is injury caused by old accumulation. If detected within one or two days, first use Baishang Yin (百伤饮, Hundred Injuries Decoction) to release the exterior, then use Danggui San (当归散, Angelica Powder) to stir and move the stagnation, followed by administering Wuxi Wan (乌犀丸, Black Rhinoceros Horn Pill) and Liusheng Wan (六圣丸, Six Sages Pill) with heavy doses to strongly promote laxation. Finally, use Yunqi San (匀气散, Qi-Regulating Powder) to regulate and tonify.
Chen Wuzhe stated: The "Five Acculations" (五积, Five Types of Accumulation) in children occur because Zang Qi fails to circulate, accumulating in one place without moving, hence called "Ji" (积, fixed accumulation). Examples include Fuliang (伏梁, Hidden Beam), Xiben (息贲, Resting Tyrant), Bentun (奔豚, Running Piglet), Piqi (痞气, Obstruction Qi), and Feiqi (肥气, Fat Qi). The "Six Gatherings" (六聚, Six Types of Gathering) refer to Qi remaining and gathering in the Fu organs. Fu organs belong to Yang, and Yang Qi flows continuously, so their gatherings do not stay in one fixed place, manifesting as abdominal pain upon onset. Signs of accumulation and gathering include sallow complexion, emaciation, failure of hair to grow muscle, erect hair, or bodily edema, tight abdomen with fatigue, often due to water qi. For cases of deficiency with internal accumulation, if diarrhea follows food injury and is accompanied by vomiting, and the condition persists despite gradual management, it is called "Xu Ji" (虚积, Deficient Accumulation). Furthermore, "Xu Zhong Ji" (虚中积, Accumulation within Deficiency) refers to having accumulation that is frequently attempted to be expelled but fails, leaving the accumulation latent. If it is a Jing Ji (惊积, Shock Accumulation), the stool is green; if it is Shi Ji (食积, Food Accumulation), the stool forms clumps. For Xu Zhong in Gan disease (疳病, Malnutrition Syndrome), it occurs because Gan disease turns into diarrhea, the body becomes weak, and the Gan condition does not resolve, thus termed Xu Zhong. The excreted feces contain white matter.
Gong Xin stated: Pi Ku (癖块, Masses/Lumps) are located obliquely in the hypochondrium, while Pi Jie (痞结, Obstruction/Accumulation) is obstructed in the Zhongwan. Both result from irregular breastfeeding and feeding, food stagnation, and the struggle between pathogenic factors.