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Zhang Yuansu stated: In cases of prolonged illness following vomiting and diarrhea, if it is a deficiency pattern, the pulse will be faint and fine. If the complexion is pale yellow, with edema in the eyelids and cheeks, and cold hands and feet, first administer Xianta Qi Wan (First Collapse Qi Pill), followed by Yigong San (Benefit Power Powder), Hezhong Wan (Harmonize Middle Pill), Yihuang San (Benefit Yellow Powder), or formulas similar to Sijunzi Tang (Four Gentlemen Decoction). Use various warming medicines to nourish the healthy qi. If it is an excess pattern, the pulse will be surging and solid. This occurs not after vomiting, diarrhea, or dysentery, but presents with abdominal distension accompanied by panting, chest tightness, and restlessness. Furthermore, there are cases of abdominal distension caused by heat, phlegm, or food retention; these should be purged using Baibing Zi (White Cake Pill), Dahuang Wan (Rhubarb Pill), or Jiedu Wan (Detoxification Pill). One must also examine the bowel movements and urination. If both are obstructed, first promote diuresis.

Li Dongyuan said: Generally, cold distension is more common than heat distension. Both primarily involve the Spleen.

Pang Anchang stated: Dongyuan’s treatment of distension does not violate the Upper and Lower Jiao (Upper and Lower Burners). It employs the principle from *Suwen* (Basic Questions): "For fullness in the center, drain it from within." For excess patterns, differentiate qi stagnation and eliminate accumulations; for deficiency patterns, raise yang and nourish blood. Practitioners should learn from this intent and apply it flexibly, avoiding forceful attacking methods. Suitable formulas include Zhongman Fenxiao Wan (Middle Fullness Differentiation and Dissipation Pill), Xiaopi Wan (Eliminate Pi Pill), Danxi's Abdominal Distension Formula, and Shengyang Zixue Tang (Raise Yang and Nourish Blood Decoction).

"Pi" (Pi Syndrome) implies obstruction or closure, while "Jie" (Knotting) implies solidity. Initially caused by fluid retention (Phlegm-Fluids), heat accumulates like simmering, staying specifically in the abdomen and hypochondrium, resembling a basin or cup. Ying and Wei (Nutritive and Defensive) qi become blocked and cannot circulate freely. This is not Heart-level Pi, which is easier to disperse and open. Therefore, there is frequent distension, and crying in pain upon pressure. Food intake decreases, with alternating cold and heat sensations. Tracing the origin, it stems from Spleen deficiency and emaciation; over time, Earth (Spleen) function fails, making changes difficult to predict. One must nourish the upright qi rather than merely attempting to break up the knot. Although Pi involves knotting, it has not yet formed a hard mass. Accumulation leads to Xi (Parasitic Masses), which are solid and hard to break. Accumulations arise from improper infant feeding, where dietary regulations are often violated. Greasy, stagnant, and raw/cold foods accumulate and are difficult to manage. External invasion by wind-cold and internal accumulation of damp-heat, along with old stubborn phlegm or blood stasis, can all form accumulations causing disaster within the abdomen. Starting the size of a chicken egg, they gradually grow as large as a fetus. Abdominal distension and pain occur, with cold feet and a grayish complexion. This is also due to Spleen disease, encompassing both excess and deficiency. Excess patterns require purgation, while deficiency patterns require tonification. One cannot generalize or hesitate. Wang Shi of Handong discussed accumulations best; failing to treat when treatable leads to no error in differentiation. Accumulations in deficiency patterns present even more complex symptoms. Due to fright and food injury, vomiting and diarrhea accompany each other. The Spleen becomes weaker, making the disease harder to expel. If massage techniques fail, the accumulation may hide deeper. Fright and malnutrition syndromes are easiest to root out. Infant milk accumulation presents with a moss-like mottled complexion, mouth ulcers, spitting up milk, and abdominal masses. All result from post-feeding behaviors, such as lying on one side without turning back. Milk stagnates under the hypochondrium, forming painful knots. Xi (Parasitic Masses) is a peculiar condition. Accumulated in the abdomen, it forms lumps like plums. Frequent crying in pain leads to emaciation. Pain in the left hypochondrium is mediated by Qi; pain in the right hypochondrium involves Xi-Qi clinging together. Commonly known as "Tortoise Consumption," it affects the crossing points of the left and right hypochondria. This too is a Spleen disease, caused by sinking and gloomy cold qi. Invasion by cold and heat damages the bones and body. Regarding summerheat injury, autumn brings illness with alternating chills and fever, leading to Spleen-Stomach qi decline. Blood membranes wrap water, creating malaria-like parasitic masses resembling frogs. Ancient established methods allow for massage and emulation. Carefully verify prescriptions and treatments to prudently protect infants.