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Jiawei Buzhong Yiqi Tang (Modified Decoction for Supplementing the Middle and Boosting Qi) treats epigastric fullness (a sensation of blockage or stuffiness in the epigastrium) caused by internal injury.
The formula is found in the section on Internal Injury.
If the pulse is slow with phlegm and epigastric fullness, add Banxia (Pinelliae Rhizoma) and Huanglian (Coptidis Rhizoma).
If the pulse is wiry, with fullness and obstruction in the four limbs, difficult urination/defecation, and epigastric fullness, add Chaihu (Bupleuri Radix), Huanglian (Coptidis Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma).
If stool is dry and constipated, add Huanglian (Coptidis Rhizoma) and Taoren (Persicae Semen), with a small amount of Dahuang (Rhei Radix et Rhizoma) and Dangguishen (Angelicae Sinensis Radix).
If there is a hard and stifling sensation of epigastric fullness, add Baishao (Paeoniae Radix Alba) and Huanglian (Coptidis Rhizoma).
If epigastric fullness is accompanied by abdominal distension, add Wuweizi (Schisandrae Chinensis Fructus), Baishao (Paeoniae Radix Alba), and Sharen (Amomi Fructus); if the weather is cold, add a small amount of Ganjiang (Zingiberis Rhizoma) or Rougui (Cinnamomi Cortex).
If epigastric fullness is due to cold in the middle jiao, add Fuzi (Aconiti Lateralis Radix Praeparata) and Huanglian (Coptidis Rhizoma).
If epigastric fullness is accompanied by vomiting and rebellious qi, add Huanglian (Coptidis Rhizoma), Shengjiang (Zingiberis Recens Rhizoma), and Chenpi (Citri Reticulatae Pericarpium); if it is winter, add Huanglian (Coptidis Rhizoma) and a small amount of Dingxiang (Caryophylli Flos) and Huoxiangye (Agastaches Herba).
If one can eat but has epigastric fullness, add half a qian of Huanglian (Coptidis Rhizoma) and three qian of Zhishi (Aurantii Fructus Immaturus); if one cannot eat and has epigastric fullness, do not add these; simply follow the original formula.
For epigastric fullness occurring after eating, separately take Jupi Zhizhu Wan (Tangerine Peel and Atractylodes Macrocephala Pill).

Commentary: Nan Zhi (referring to Li Dongyuan's academic lineage or specific text context) states: When there is abdominal fullness, avoid sweet substances; when there is no fullness, consume sweet substances. If one feels full internally but lacks external signs of tight distension, this is "Pi" (epigastric blockage), which is distinct from true "Man" (abdominal distension). In such cases, sweet substances should be used to support and tonify.

Furthermore, regarding Taiyang disease (Disease of the Taiyang Channel), if purgatives are incorrectly applied, resulting in abdominal fullness and occasional pain, it indicates splein meridian involvement, treated with Guizhi Jia Shaoyao Tang (Decoction of Cinnamon Twig with Added White Peony Root). If the fullness is severe like wood or stone, it is governed by the nature of sweetness (which tends to cause fullness); therefore, the sour property of Shaoyao (White Peony Root) is used to counteract the fullness. Sour-cool properties can relieve fullness and urgency, while sweet-warm properties can disperse and relieve, addressing the symptoms associated with sourness.

Carefully noted: Pi syndromes may arise from failure of qi transformation or yin deficiency with blood damage, as detailed in previous discussions, hence included here under "Tonifying Deficiency Formulas." However, laypeople often misunderstand this principle, routinely using harsh and rapid purgatives, which exacerbates the Pi condition and often leads to critical danger.

The Neijing (Inner Canon) states: "All vomiting and acid regurgitation belong to heat." It also states: "When Shaoyang (Lesser Yang) excess occurs, vomiting of acid ensues."

Yuanyan Shi (Treatise on Original Causes) states: "Sourness is the flavor of Liver Wood. When Fire excess suppresses Metal, failing to control Wood, Liver Wood becomes excessive, thus manifesting as sourness. For instance, hot food consumption easily leads to sourness. Therefore, Liver heat causes sour taste in the mouth." Some claim it belongs to cold, referring only to injury from hard, raw, or cold foods causing belching and acid regurgitation, leading folk doctors to advocate warming the spleen and stomach. They fail to realize that contracting cold pathogens often results in heat diseases. Cold damaging the skin and hair closes the pores, causing yang qi to stagnate and generate heat. Thus, for exterior heat in Shanghan (Cold Damage), Ma Huang Tang (Ephedra Decoction) is used to disperse with hot herbs, opening pores, inducing sweat, and resolving heat. Regarding internal injury from cold food: it may immediately cause yin excess and yang deficiency leading to cold pathology, or cold-heat struggle causing stomach-intestine yang qi stagnation and heat generation. There are also cases where internal cold food injury leads to heat pathology, resolved by sweating out heat and cooling the body. Mild cases presenting as acid vomiting, commonly called "vinegar heart," should be treated with warm herbs to dissipate, similar to releasing the exterior. However, chronic craving for sourness should not be treated with warmth; instead, cold herbs should be used to purge, followed by cooling herbs to regulate. Once stagnation clears and heat disperses, qi harmonizes. Therefore, those with "vinegar heart" should avoid sticky, slippery, and greasy foods, as these obstruct qi flow. Vegetables and greens should be consumed to promote smooth qi movement.