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Zhige stated: In the disease of Shanghan (Cold Damage), if the yin aspect within the interior has already been invaded by pathogenic heat, this is termed "disease originating from yin." If the heat is mild and the syndromes requiring purgation (symptoms indicating the need for downward-draining methods) are not fully formed, premature use of purgative methods will clear the interior heat. Consequently, exterior heat may enter the interior due to deficiency, resulting in Pi syndrome (a sensation of fullness and obstruction in the epigastrium). Therefore, Zhang Zhongjing often used cold-natured herbs such as Dahuang (Rhubarb Rhizome), Huanglian (Coptis Rhizome), and Huangqin (Scutellaria Root) to treat Pi syndrome. Later, some formulas added acrid-hot herbs like Fuzi (Aconite Lateral Root) and Ganjiang (Dried Ginger); these were used to assist the cold herbs with their acrid-hot nature, aiming to resolve the stagnation and constraint of heat within the Pi syndrome, rather than to attack cold.

Commentary: The previous work *Baoming Ji* discussed Xixin Tang (Gastrodia and Uncaria Decoction? No, Heart-Draining Decoction variants), prescribing medication based on the degrees of yin/yang and cold/heat, which can be considered detailed and appropriate. However, this discussion focuses exclusively on heat syndromes. Although they appear different, each has its specific application. Generally, Zhige discusses the root cause of the disease, while *Baoming Ji* discusses the symptomatic treatment. If one argues that Pi syndrome includes yin-cold types, why do all five Xixin Tang variants by Zhang Zhongjing use Huangqin and Huanglian? If one argues that Pi syndrome has no distinction between yin and yang, why do some Xixin Tang variants include Ganjiang, Fuzi, Banxia (Pinellia Tuber), and Shengjiang (Fresh Ginger)? This merely reflects one discussing the root and the other discussing the branch.

Respectfully noted: Pi syndrome arises from the latent yin and accumulated yang, causing dysfunction in the movement of Qi and Blood. The location is at the Xin Xia (epigastric region), situated in the center of the body; the symptoms of fullness and obstruction belong to disorders of the Earth element (Spleen/Stomach). There is a distinction in severity between Pi syndrome and Zhangman (distension and fullness): Pi syndrome involves an internal sensation of oppression without external signs of distension, whereas Zhangman presents with both internal and external distension. Previous discussions on Pi syndrome mostly refer to cases caused by erroneous purgation. Erroneous purgation leads to deficiency of interior Qi, allowing exterior pathogenic factors from Shanghan to invade the Xin Xia due to weakness; in miscellaneous diseases, pathogenic factors also accumulate in the Xin Xia, leading to Pi syndrome. There are also cases not caused by erroneous purgation, such as those arising from deficiency of Middle Qi failing to transform and transport essential nutrients; those caused by food retention and phlegm accumulation failing to be metabolized; and those where excessive damp-heat causes Earth qi to overact upon the Xin Xia. Therefore, ancient formulas for treating Pi syndrome employ bitter herbs like Huanglian, Huangqin, and Zhishi (Immature Bitter Orange) to drain downward; acrid herbs like Houpo (Magnolia Bark), Shengjiang, and Banxia to disperse stagnation; sweet, bitter, and warm herbs like Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) to tonify; and bland herbs like Fuling (Poria) and Zexie (Alisma Rhizome) to leach out dampness, adjusting according to the location of the pathology. Since Pi syndrome is treated similarly to dampness disorders, it is appropriate to dissipate Qi through upper and lower channels. If there are signs of interior excess (Fu organ excess), slight guidance/drainage may be applied. People suffering from Pi obstruction often prefer using diuretic or purgative drugs for quick relief. Although temporary relief occurs, recurrence worsens the condition. These individuals fail to examine the principle that excessive purgation leads to the loss of Yin fluids.

Treatment methods for Xin Xia Pi Man (Epigastric Fullness and Obstruction)