Library

See details in respective categories.

*Mi Zang* cites *Nei Jing* stating: "In the era of Bei Hua (the harmonious phase of Earth), diseases manifest as Pi [Pi, a sensation of fullness and obstruction]." It also states: "Diseases caused by Tai Yin [Taiyin, one of the Six Channels characterized by dampness and earth] present as accumulated fluids, Pi, and diaphragmatic obstruction." Tai Yin belongs to damp Earth, primarily causing stagnation and blockage; this is Earth Qi overacting upon the epigastrium, resulting in Pi and fullness. If purgatives are administered too early in the course of Shang Han [Cold Damage], Pi may also result. This occurs because cold pathogenic factors damage Ying Blood [Nutritive Blood]. Since the Heart governs Blood, when pathogens invade the root organ, Pi in the epigastric region ensues. Several formulas of Xiexin Tang [Gallbladder-Draining Decoction, literally 'Heart-Draining'] from Zhang Zhongjing all contain Huanglian [Coptidis Rhizoma] to drain the Earth-pathogen in the epigastrium. Regarding Jiuzhi [Alcohol Accumulation] and other miscellaneous diseases, excessive purgation can also lead to Pi and fullness; these all belong to Blood syndromes. Excessive purgation leads to the loss of Yin [Yin fluids/substances]; losing Yin implies damaging the Spleen and Stomach, specifically referring to the depletion of the Yin derived from water and grain within the Spleen and Stomach. Consequently, Qi in the chest sinks due to Blood deficiency and descends into the domain of the Heart, causing epigastric Pi. Treatment should focus on regulating the Spleen and Stomach using Blood-invigorating or Blood-nourishing herbs. If only Qi-moving herbs are used for guidance, the Pi will worsen, and the descending Qi will fall further, inevitably transforming into abdominal distension and drum-like bloating. This is not the correct treatment. There are also distinctions between excess and deficiency: For Excess Pi with constipation, Houpo [Magnoliae Officinalis Cortex] and Zhishi [Aurantii Fructus Immaturus] are indicated. For Deficiency Pi with loose stools, Shaoyao [Paeoniae Radix Alba] and Chenpi [Citri Reticulatae Pericarpium] are indicated. For Pi and fullness caused by dietary injury, digestive and resolving herbs should be used. If there is severe oppression in the chest accompanied by the urge to vomit, emesis [inducing vomiting] is appropriate.

*Nan Zhi* states: Pi caused by Shang Han arises from Blood, moving from the exterior to the interior. Pi caused by miscellaneous diseases also arises from Blood, moving from the interior to the exterior. Because the former involves formless pathogens, bitter-draining methods are used; because the latter involves formed pathogens, acrid-dispersing methods are used.

Commentary: Regarding the stagnation and obstruction of Pi, it is commonly known that it results from the failure of Qi movement. Only Li Dongyuan pointed out that this is a Blood disease, arguing that excessive purgation leads to Yin loss and Blood damage—a point previously unaddressed by earlier physicians. The reason why some people fail to treat Pi with Qi-moving herbs is likely due to ignorance of this principle.

*Bao Ming Ji* states: The treatment of the root and branch of the Three Yin and Three Yang channels varies. Cold herbs may be used to treat Heat Pi, such as Dahuang [Rhei Radix et Rhizoma] and Huanglian [Coptidis Rhizoma]. Both cold and hot herbs may be used when Pi results from disharmony between Yin and Yang, such as Dahuang [Rhei Radix et Rhizoma] and Huanglian [Coptidis Rhizoma] combined with Fuzi [Aconiti Lateralis Radix Praeparata]. Acrid-hot herbs may predominate over cold herbs when Pi results from Yin excess and Yang deficiency, such as Banxia Xiexin Tang [Pinellia Decoction Draining the Epigastrium], Gancao Xiexin Tang [Licorice Decoction Draining the Epigastrium], and Shengjiang Xiexin Tang [Fresh Ginger Decoction Draining the Epigastrium]. The term "Xiexin Tang" does not refer to draining Heart Fire heat, but rather eliminating Pi in the epigastrium. Generally speaking, these formulas contain more Yang-tonifying/warming herbs than Yin-nourishing/cooling herbs. This is generally because the pathology originates from Yin. However, Dahuang Huanglian Xiexin Tang [Rhei and Coptis Decoction Draining the Epigastrium] is unique in treating a specific syndrome of Yin-origin Pi with rapid pulse. The variations occurring after the use of Guizhi Tang [Cinnamon Twig Decoction] stem from changes originating from the floating and weak pulse of the Taiyang [Greater Yang] channel. The remaining formulas utilize a mixture of Yin and Yang herbs.