Library

Whenever food stagnates and accumulates to form a *pi* mass (a sensation of fullness or obstruction, often without a palpable lump), it may be due to consuming raw or cold foods, contracting wind-cold pathogens, experiencing anger leading to rebellious Qi, or suffering from overexertion and hunger. These factors cause continuous intake of food that cannot be digested, resulting in accumulation. However, individuals with strong Stomach Qi will not typically experience such food retention; the inability to digest food is necessarily due to weak Spleen and Kidney Qi. Therefore, treatment should be adjusted according to deficiency or excess to apply purgative or tonifying methods, thereby achieving efficacy. Detailed treatment methods are described in the chapter on Accumulation and Gathering (*Ji Ju*), which should be consulted.

Xue Lizhai stated: For the aforementioned conditions, if the physical constitution and Zheng Qi (Upright Qi) are deficient, one must first focus on regulating and tonifying the Spleen and Stem, assisting with digestive-promoting herbs. If the constitution and Zheng Qi are robust, one should first focus on unblocking and guiding, assisting with Spleen and Stomach tonification. If there is Qi congestion and blood stasis preventing flow, Wuyao San (Lindera Powder) should be used to disperse and promote movement. If Spleen Qi deficiency prevents blood circulation, Sijunzi Tang (Four Gentlemen Decoction) combined with Chuanxiong Rhizoma (Chuanxiong) and Angelicae Sinensis Radix (Danggui) should be used to tonify and promote movement. If Spleen Qi depression prevents blood circulation, Guipi Tang (Restore the Spleen Decoction) should be used to resolve depression and promote movement. If Liver and Kidney Yin-blood dryness prevents circulation, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) should be used to clear heat and promote movement. Generally, syndromes of food accumulation and pi masses involve excess due to pathogenic abundance or deficiency due to Zheng Qi depletion. The principle is to nourish the righteous Qi and repel pathogens, after which the accumulation will naturally dissipate. Although ancient texts state "firm masses should be pared away, and invading pathogens should be eliminated," these harsh methods may only be used in small doses if the Stomach Qi has not yet weakened. If the disease has been prolonged and the body is depleted, they should not be used lightly.

"Jia" means false. A "false" condition refers to a shape that appears like a mass but originally lacks a fixed root, unlike "Pi" masses which are hard, stubborn, and have a tangible form. Tangible masses arise from blood accumulation or food accumulation; the accumulation has a fixed shape and cannot be moved. Intangible diseases reside in the Qi level; symptoms worsen when Qi rebels and ease when Qi disperses, gathering and scattering without a root. Because they lack a root, they can change size and location. If located near the hypochondrium and resembling an arm or finger, it is called "Pi" (specifically referring to a type of abdominal mass distinct from the general pi sensation). If located below the umbilicus causing distension and urgency, it is called "Shan Jia" (Hernia/Jia). The *Nan Jing* states: How to distinguish between Accumulation (*Ji*) and Gathering (*Ju*)? The answer is: Accumulation belongs to Yin Qi, which is dark and latent; Gathering belongs to Yang Qi, which is floating and active. Thus, Accumulation arises from the Five Zang Organs, while Gathering is formed by the Six Fu Organs. Therefore, Pi (here referring to tangible accumulation) stems from *Ji*; since *Ji* resides in the Yin aspect with deep roots, attacking it is difficult. Jia stems from *Ju*; since *Ju* resides in the Yang aspect like a hasty coalition, dispersing it is not difficult. This is the distinction between Pi and Jia. Among dispersal methods, the subtle application of "treating obstruction with unblocking agents" (Tong Yin Yong Tong) is most effective, though few understand this.

First, for any disease residing in the Qi level without stagnant tangible accumulation, purgative methods must not be used. Purgatives remove tangible forms but cannot remove intangible Qi stagnation. If Qi is obstructed by tangible forms, removing the accumulation allows Qi to flow smoothly. If the issue is entirely in the intangible Qi level, purgatives will fail to remove it and will instead damage Zheng Qi; this must be clearly understood.

Second, the method to dissipate Qi stagnation lies in moving Qi, as moving Qi leads to dispersion. However, the method of moving Qi requires flexibility. If Qi is excessive and congested, breaking Qi is appropriate; if Qi is closed and retained, promoting drainage is appropriate; if Qi is hot and drying, cooling is appropriate; if Qi is cold and coagulated, warming is appropriate. These are the general principles for dissipating Qi to treat Jia. However, if Qi strength and vitality were robust, circulation would be uninterrupted, and no Jia would exist. Only when Zheng Qi fails do pathogens gather. The Classics state: "Where pathogens gather, Qi must be deficient." Therefore, those suffering from this disease are mostly Qi-deficient. If deficiency is not addressed, Zheng Qi does not move; if Zheng Qi does not move, pathogens do not disperse, and recovery is impossible. Excess syndromes have evident signs, while deficiency syndromes often mimic excess, making them hidden and difficult to identify; thus, distinguishing true from false is crucial.

Third, for formulas that break and move Qi, suitable for severe Qi excess and congestion causing distension and pain, include Paiqi Yin, Muxiang Shunqi San, Muxiang Tiaoqi San, Simo Tang, and various Qi Qi Tangs. For Qi stagnation within Blood causing stasis and pain, Shixiao San, Tongyu Jian, and Tiaojing Yin are suitable; for severe cases, Qiming Dan from *Liang Fang*. For Qi gathering in Shan Jia, Lixiang San is used; for severe cases, Tiantai Wuyao San. For Qi knotting in the Bladder causing difficult urination, Xiao Li Qing Yin, Siling San, and Wuling San are used. For Qi knotting in the Large Intestine causing dry constipation, Soufeng Shunqi Wan and Mahuang Wan are used. For constipation due to Water and Blood deficiency, Jichuan Jian is used. For Liver Qi rebellion causing gathering, Jiegan Jian is used; if accompanied by Fire, Huagan Jian is used. For Qi gathering with Heat and suppressed Fire, Chouxin Yin and Da Li Qing Yin are used. For Cold stagnation preventing movement and Qi knotting causing distension, Yifu Jian, Hewei Yin, and Dingxiang Fuling Tang are used. For Triple Burner congestion, unclear Qi pathways, and middle-jiao distension/swelling, Kuqing Yin is used. For Phlegm-fluid and Water-Qi stagnation in the chest and hypochondrium causing acid regurgitation and vomiting, Lingzhu Erchen Jian, Liu'an Jian, Hewei Yin, and Kutan Wan are used. All the above methods are suitable only for Qi-excess Jia gathering; they must not be used for those with insufficient Yuan Qi.

Fourth, for formulas that tonify Qi to move Qi, such as Shengyu Tang, Shen Gui Tang, and Qifu Yin, they regulate Heart Qi deficiency and stagnation. Wuwei Yigong San and Shen Zhu Tang regulate Heart-Spleen Qi deficiency and non-movement. Dushen Tang and Shenfu Tang assist Lung Qi to govern the regulation of the Five Zang Organs. For Spleen-Stomach Qi deficiency with stagnation, Liujunzi Tang and Guipi Tang are suitable. For Spleen-Stomach deficiency-cold with stagnation, Wenwei Yin, Lizhong Tang, and Wu Junzi Jian are best. For deficiency in the Yin aspect of Spleen-Kidney, where Qi non-movement leads to phlegm-fluid, distension, vomiting, or abdominal pain, Liyin Jian is indispensable. For deficiency in Qi within Blood causing stagnation and pain, mild cases use Siwu Tang; severe cases require Wuwu Jian,iejing Jian, or Daying Jian. For Liver-Kidney cold stagnation with rebellious Qi and pain in the lower abdomen, Nuangan Jian is required for warming. For Spleen-Kidney Qi deficiency leading to loss of control and stagnation/pain, Weiguan Jian is required for securing. For Yuan Qi sinking with stagnation and failure to ascend, Buzhong Yiqi Tang and Juyuan Jian are used to lift. For severe Yuan Qi deficiency with failed Qi transformation and stagnation, Wufu Yin, Shiquan Dabu Tang, Dabu Wan Jian, or Liuwei Huiyang Yin are required for tonification. All the above are methods of tonifying Qi to move Qi. They are merely tools to achieve the goal; their subtleties cannot be fully expressed in words. However, common sentiment holds that for Qi stagnation, breaking and dispersing is best; claiming tonification is met with disbelief. They do not know that pathogenic strength stems from host weakness; pathogenic victory stems from Zheng Qi deficiency. Most modern illnesses are deficiency-based, yet tonification is rarely used. Treatment contradicts the disease, making successful healing rare. I repeatedly emphasize that most diseases are deficiency with little excess, but people do not believe me. Let me use a human analogy to clarify. Human deficiency/excess is like wealth/poverty. Qi-excess is like a rich man; Qi-deficiency is like a poor scholar. How many rich men are there among thousands? Aside from the rich, all are poor. This ratio applies similarly. There are also those who appear wealthy but are internally bankrupt, hard to discern, fitting this category. But the nature of the poor is that they can be increased but not diminished; adding a bit is still insufficient, subtracting a bit makes their distress unbearable. Applying subtle draining techniques to the poor and destitute secretly transfers their fortune without their knowledge, which is pitiful. Medicine uses benevolence as its technique; how can one not hold this heart? Alas! Life depends on Qi; gaining Qi brings life, losing Qi brings death. The wise know how to preserve life; the unwise only treat disease. To pretend to know what one does not know, merely for convenience, using human lives as experiments—such people's outcomes are predictable.