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[Appendix: Pi (Piecemeal Mass)]

Chen Ziming treated the wife of a high-ranking official in Kunling. The patient suffered from urinary retention, with unbearable distending pain in the umbilical and abdominal regions. All physicians treated it as Lin syndrome (dysuria), using formulas such as Bazheng San (Eight-Ingredient Powder for Rectifying Turbidity), but urination remained obstructed. Chen Ziming diagnosed, "This is Xue Jia (Blood Mass); only potent medicines inducing Mingxuan reactions (severe adverse reactions indicating effective treatment) can eliminate it." He prescribed Tao Ren Jian (Peach Kernel Decoction). Taken at the beginning of the first watch (approx. 7-9 PM), by noon the patient experienced severe pain and lay down. Shortly after, she passed several fist-sized blood clots, followed by one to two sheng (approx. 1-2 liters) of urine resembling black bean juice. The pain ceased, and she recovered. This medicine is effective but extremely potent; it should be used with caution in patients with Qi deficiency and Blood weakness. Formula: Tao Ren (Peach Seed, *Prunus persica* seed), Da Huang (Rhubarb Root, *Rhei Radix et Rhizoma*), and Po Xiao (Mirabilite, *Natrii Sulfas*) each 1 liang; Meng Chong (Dragonfly Larva, *Ephemeroptera larva*) half a liang, stir-fried until black. Grind into powder, refine with vinegar to make pills the size of paulownia seeds. At dawn on an empty stomach, swallow five pills with warm wine. (Original note: Do not use this formula casually. From *Liang Fang*.)

Du Ren treated a woman surnamed Ma, aged thirty-two, who had suffered from painful blood masses in the abdomen for five or six years. Her body was emaciated to the point of being skeletal. Everyone said it was incurable, yet she was not dead. Her family was very poor, and everyone pitied her. One day, he was summoned. He told Du Ren, "If you have compassion for saving lives, that is sufficient. Since a renowned physician has already been invited, no further words are needed." He offered some silk fabric to Du Ren. Du Ren refused, saying, "Just take my medicine, and you will surely be safe. Do not doubt this." He then presented the prescription. Ingredients: Mo Yao (Myrrh, *Commiphora myrrha*), Niu Xi (Achyranthes Root, *Achyranthis Bidentatae Radix*), Gan Qi (Dried Lacquer, *Rhus verniciflua resin*), and Dang Gui (Angelica Sinensis Root, *Angelicae Sinensis Radix*) each half a liang; Sha Ren (Amomum Fruit, *Amomi Fructus*), Mu Xiang (Vladimiria Root, *Vladimiriae Radix*), Shui Zhi (Leech, *Hirudo* species, stir-fried), Hong Niang Zi (Red Ladybug, *Mylabris phalerata*, stir-fried), Hong Hua (Safflower, *Carthami Flos*), Dan Pi (Moutan Bark, *Paeoniae Moutan Cortex*), and Zhu Sha (Cinnabar, *Cinnabaris) each one fen; one Hai Ma (Seahorse, *Hippocampus* species); fourteen Ban Mao (Mustard Beetle, *Meloides* species, wings and feet removed, stir-fried). Grind into powder, boil with half a sheng of wine and half a sheng of vinegar to form a paste. Each morning at dawn, take a piece the size of a soap pod, dissolve in wine and vinegar, and ingest. After one month, the disease receded; after sixty days, she gradually recovered. (This medicine is more potent than Tao Ren Tang; use with caution.)

Chen Cangqi stated: In the past, there was a patient with Pi disease who dreamed someone taught him to eat three cloves of garlic daily. Initially, eating them caused Mingxuan reactions, vomiting, and a burning sensation in the lower body. Later, someone taught him to take several cloves, keep the skin on, cut off both ends, and swallow them whole, called "Internal Roasting." It indeed yielded great efficacy. (*Ben Cao Gang Mu*: Zhang Jingyue's treatment of a mass at the right corner of the Small Intestine meridian on the face follows the same principle.)

Zi Hezi treated the daughter of Envoy Cao in Bianliang. She had just reached marriageable age and had suffered from Xue Jia (Blood Mass) for several years. Imperial Physician Yi Qixian treated her with blood-breaking medicines without success. Yi Qixian said, "Only Zhang Dairen from Chenzhou can cure her." One day, Dairen arrived in Bianjing, and the Cao family invited him for consultation. Dairen said, "Heat transferring from the Small Intestine to the Large Intestine forms Fu Jia (Hidden Mass), causing hard knots like lumps, yellow complexion, and loss of appetite." He employed Yong Xie Fa (Emetic and Purgative Method). The disease lasting several years was cured in less than ten days.

Chai Yuqing resided in the Shenyang Jingzhao Office during the Jiwei year of the Qianlong reign. Wang, a clerk in the Military Department, suffered from Zheng Ji (intermittent fever/mass disorder). Chai taught him the Umbilical Steaming method, combined with taking Modified Wuji San (Five Accumulations Powder), resulting in recovery. His mother-in-law suffered from the same condition; Wang gave her the same prescription, and she also recovered.

Sun Wen Yuan treated a woman surnamed Wang. Her menstruation had lasted for a long time without stopping, containing dark purple-black blood clots. Her stomach, chest, and abdomen all hurt. Her vulva was swollen, hands and feet were cold, she felt no hunger, and there was a rock-hard lump under her abdomen. Her pulse was rapid on the left and deep-choppy on the right. This was Xue Jia (Blood Mass). He used Tang Qiu Zi (Sugar Ball Pill) 5 qian, Yuan Hu Suo (Corydalis Rhizome, *Corydzidis Rhizoma*), Wu Ling Zhi (Trogopterus Dung, *Tragopodi Excrement*), Xiang Fu (Cyperus Rhizome, *Cyperi Rhizoma*), Mai Ya (Barley Sprout, *Hordei Fructus Germinatus*), and Qing Pi (Green Tangerina Peel, *Citri Reticulatae Pericarpium Viride*) each 1 qian. Decoct in water and take. Pain reduced by half, hands and feet gradually warmed. Added Dang Gui (Angelica Sinensis Root, *Angelicae Sinensis Radix*), Dan Pi (Moutan Bark, *Paeoniae Moutan Cortex*), Pu Huang (Typha Pollen, *Typhae Pollen*), Yi Mu Cao (Motherwort Herb, *Leonuri Herba*), and Chuan Xiong (Ligusticum Rhizome, *Ligustici Chuanxiong Rhizoma*). After four doses, pain stopped, and vulvar swelling subsided. After another four doses, menstruation regulated. (The formula is very mild.)

Zi Hezi treated a young boy who entered bowing while walking. Zi Hezi said, "This is Zhu Qi (Neurotic Gas)." He asked him to undress and palpated, finding two tendons as thick as arms. The family sought treatment. Zi Hezi first needled the left side; it felt like piercing heavy paper, making a peeling sound, and instructed massage, which immediately softened it. The right side was treated similarly. Observers marveled. When asked, he said, "These are Shiguan Acupoints."

Ying Tongying of Yongkang suffered from abdominal disease, often unable to walk straight for a long time. Zhou Hanqing of Songyang undressed him and observed two qi rushes rising in the abdomen, as thick as arms. Zhou Hanqing needled one, producing a resonant sound, then needled the other similarly. After slight massage, the qi and blood dispersed completely, and he walked normally without hesitation. (*Xu Da Cui*.)

Wu Shuqing said: Zhu, Pi, and Jia are hard masses formed by congealed Qi and Blood, causing intermittent stabbing pain, sometimes so severe as to cause near-death experiences. Ultimately, they are all disorders of the Blood.

Chen Liangfu frequently treated a woman with stabbing pain from Qi and Blood stagnation, unbearable, even fainting for one or two days before regaining consciousness. Doctors and shamans treated her for years without success. I used Cong Bai San (Scallion White Powder) and Wu Ji Wan (Black Chicken Pill) to stabilize her.

Chen Liangfu treated a woman whose Qi and Blood caused suffering, feeling like a small plate moving around with stabbing pain. She needed someone to hold her still to find slight relief. Using one of these two medicines cured her. For ordinary minor Qi and Blood disorders, these two medicines also yield miraculous effects. (*Ji Yin Gang Mu*.)

Chen Liangfu treated a woman with Qi and Blood suffering, unbearable pain, unresponsive to various medicines. Upon diagnosis, he noted the Guan pulse was weak and deep, and the Liver pulse was deep and tight, indicating Qi and Blood were gradually forming a Pi (mass). He treated her with the aforementioned two formulas, and she recovered. Similarly, the wife of Ma Chaofeng in Siming suffered from this and was also cured by these two formulas. (Ibid.)

Empress Dowager Lu of Emperor Xiaowu of Song fell ill. Physicians could not identify it. Xu Wenbo diagnosed, "This is Shi Bo (Stone Mass) in the lower abdomen," and prescribed Shui Ji Xiao Shi Tang (Water-Ji Magnesium Sulfate Decoction). The illness healed immediately. (*History of Southern Dynasties*.)

Dong Hany's maternal relative developed a Pi mass in the abdomen, initially the size of a bullet, growing to the size of a goose egg after five or six years. It seemed to have a cavity inside, moved back and forth, causing intermittent pain. Hundreds of medicines failed. Eventually, her whole body swelled, with fluid sounds internally. She groaned day and night, died and revived twice. Physicians were helpless, stating, "This is Shui Gu (Water Drum/Ascites). The disease is advanced and incurable."

Zhang Wenxue Xu, courtesy name Dongsheng, was a famous physician skilled in treating rare diseases. Invited, he said, "This is not Water Syndrome, but caused by Accumulation and Gathering. It can be cured in half a day. However, the medicine used is potent, driving water downward rapidly. Ask if the patient is willing to take it." The patient said, "I am on the verge of death. If a coin's worth of medicine can save me, I die without regret." Thus, ten Red Pills, sized like mung beans, were taken with a decoction of Bing Lang (Areca Nut, *Arecae Semen*), Zhi Shi (Immature Bitter Orange, *Aurantii Fructus Immaturus*), and five or six other herbs. Initially, terrifying noises were heard in the throat, and the patient felt unable to endure. Soon, stabbing pain like knife blades occurred in the chest and diaphragm, with wailing and rolling in agony. Then, about one dou (approx. 10 liters) of water was discharged. Head and facial swelling subsided. Within an hour, several more sheng were discharged, and abdominal/back swelling receded. The patient said, "I feel my chest and back are suddenly relaxed," and slept deeply. Mr. Zhang, still present, said, "Not only has the water gone, but the Pi mass should also gradually dissipate." Two days of tonic agents were prescribed for continued use, and he departed. That evening, four or five more sheng of water were discharged. Hand and foot swelling completely resolved. Within three days, the disease was fully cured. Suddenly, the Pi mass shifted, and red-black dysentery lasted for three days and nights, after which the Pi mass disappeared. Physicians were amazed and asked for the reason. Mr. Zhang said, "This is Chang Qin (Intestinal Polyp/Mass), described in the Water Swelling chapter of the *Nei Jing*. You simply sit here without reading books." They withdrew in shame. According to Qibo: "Cold pathogen lodges outside the intestines, combats with Stomach Qi, adheres internally, and flesh grows. Initially like a chicken egg, eventually like pregnancy. Hard to touch, movable when pushed. Menstruation occurs on time. Chang Qin arises outside the intestines." Another type is named Shi Jia (Stone Mass). Symptoms are identical, but menstruation is irregular. Shi Jia arises in the Uterus. Both are women's diseases caused by accumulation, treatable by guiding downward. It resembles Water Swelling but is not Water Swelling. (Clinicians must distinguish carefully.) If not for Mr. Zhang, this person would long have been a ghost beneath the springs. (Few people today are grateful like this. *San Gang Shi Lue*.)

A man suffered from borborygmus (intestinal rumbling) and poor appetite. A mass churned below the navel, resolving only after passing much gas, only to recur. Repeated use of Qi-dispersing and Fire-descending medicines for half a year failed. He used Lizhong Tang (Regulate the Middle Decoction) as the principal formula, assisted by Huang Qin (Scutellaria Root, *Scutellariae Radix*), Huang Lian (Coptis Rhizome, *Coptidis Rhizoma*), and Zhi Shi (Immature Bitter Orange, *Aurantii Fructus Immaturus*). After one dose, borborygmus stopped. Additionally, swallowing Nong Po Hong Dou Kou Wan (Thick Magnolia and Cardamom Pill) with each dose calmed the churning Qi.

Xue Lizhai treated a woman with irregular menstruation, swelling in both flanks, difficult urination, and a painful mass in the abdomen. Sometimes attacking the hypochondrium and abdomen upwards, sometimes the lower abdomen downwards. Fever, afternoon heat with aversion to cold, emaciation, loss of taste, resembling Phthisis (consumption), persisting for a long time. This was Liver and Spleen Qi and Blood deficiency. He used Bazhen Tang (Eight-Treasure Decoction), Xiaoyao San (Free and Easy Wanderer Powder), and Guipi Tang (Restore the Spleen Decoction), alternating according to symptoms, resulting in recovery.

A woman prone to depression and anger, diligent in needlework, developed a mass in the lower abdomen, causing pain or fullness, with irregular menstruation. She strictly took Spleen-attacking agents (many suffer this harm today). Internal heat, alternating chills and fever, chest/diaphragm discomfort, poor appetite, progressive emaciation, rotting gums. This was Spleen Earth failing to generate Lung Metal, Lung Metal failing to generate Kidney Water, Kidney Water failing to nourish Liver Wood. One must nourish the source of transformation. He used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). She recovered by mid-spring. (Mid-spring is mentioned because Liver Wood governs this season.)

He Gongren, Prefect of Songjiang, prone to anger, developed an abdominal mass. Over a year, it eroded through the upper body, leaving extreme Qi and Blood deficiency. In late winter, the Liver pulse was surging and rapid, wiry and tight upon pressure, while other pulses were faint. Some used Liver-attacking and Stomach-Fire-clearing medicines. Xue said, "True Qi is deficient, Evil Qi is excess. Attacking Liver Wood may prevent Spring generation." He used Bazhen Tang to generate Qi and Blood, and Dihuang Wan (Rehmannia Pill) to nourish Kidney Water. The Liver pulse instantly retreated. Due to great anger, bleeding occurred from the ear, and the Liver pulse remained large, with irritability, heat, and thirst. This was Rootless Fire. He added Rou Gui (Cinnamon Bark, *Cinnamomi Cortex*) to the previous medicine. After two doses, the pulse contained, and heat receded. Angering again, she indeed died on the Xin Si day of late winter, due to Metal overcoming Wood.

A woman had swelling and redness below the ear, alternating chills and fever, bitter taste, irregular menstruation, and a mass in the lower abdomen. This was Liver Fire with Qi stagnation and Blood coagulation. He treated with Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Shan Zhi (Gardenia Fruit, *Gardeniae Fructus*), Chuan Xiong (Ligusticum Rhizome, *Ligustici Chuanxiong Rhizoma*), and Dan Pi (Moutan Bark, *Paeoniae Moutan Cortex*). All symptoms receded.

A gentleman from Runzhou used Gui Ban (Tortoise Shell, *Testudinis Carapax et Plastrum)* extensively in tonics for nearly ten years, remaining quite healthy. In his later years, he suffered from Gu Ge (Gu Distension/Ascites). He visited Bai Feixia. Bai examined him for a long time and said, "This is a Jia (Mass). Did you take Tortoise Shell medicines? Now your abdomen is full of tortoises. My medicine can expel them. But those in bone joints and interstices are beyond my medicine's reach." He gave Chi Wan (Red Pills) the size of grains. More than a sheng of tortoise-shell-like particles were expelled. He felt slightly relieved but died within months. Upon changing clothes at death, examination of urine revealed tiny insects resembling tortoise shapes. Creatures transmitting via Qi in this manner—how careful one must be! (*Zhou Li Tu Shu Ying*.)

Mr. Bi of Huangshan took Asafoetida Umbilicus (Felimar Umbilicus, *Halichoeres margaritaceus umbilicus*). Initially effective, but after a long time, he developed Sha Lin (Sand Dysuria). The sand all resembled dog shapes, with heads and tails distinct. (Ibid.)

Chen Ziming treated a woman with an intra-abdominal mass that did not disappear for a long time. One pill of Shenxian Zhuidu Wan (Immortal Poison-Chasing Pill) cured her. (Formula seen in Gu section.)

Chen Ziming said: My clan's son's wife suffered from a large abdominal mass like a cup, with unbearable pain upon onset. By then, she was noble. Excellent physicians in the capital were invited, but none could cure her. I responded, "This is Xue Jia (Blood Mass)." I administered Hei Shen Wan (Black Divine Pill). After finishing three pills, the mass dissipated completely, never recurring in her lifetime. (*Liang Fang*, *Yi Shuo Xu Bian*.)

Sun Siju, a Ministry Official, suffered from a suspected Jia in the abdomen, unable to eat or sleep, with irritability and fever. Zhongchun prescribed Ren Shen (Ginseng Root, *Panacis Ginseng Radix*), Bai Shao (White Peony Root, *Paeoniae Radix Alba*), Fu Ling (Poria, *Poria*), Mai Dong (Ophiopogon Tuber, *Ophiopogonis Tuber*), Mu Tong (Akebia Stem, *Akebiae Caulis*), Suan Zao Ren (Ziziphus Seed, *Ziziphi Spinosae Semen*), and Shi Hu (Dendrobium Stem, *Dendrobii Caulis*). Just as the prescription was prepared, Shi Tingting, Grand Secretary, arrived. Seeing large-dose Ren Shen in the formula, he exclaimed, "Previously, administering Ren Shen worsened the condition severely. Could this be a mistake?" Zhongchun said, "The disease progression differs. Previously, Evil had not retreated, stagnation had not cleared, so it was unsuitable. Now, the disease is chronic. Fullness and irritability indicate Qi failing to return to its origin; inability to eat indicates Spleen Yuan deficiency; insomnia and irritability indicate internal heat and scanty fluids. Now, these medicines are urgently needed." After four doses, he improved. Later, he relapsed. Zhongchun diagnosed, "This is Yin Deficiency, not the previous condition." He prescribed Mai Dong (Ophiopogon Tuber, *Ophiopogonis Tuber*), Bai Shao (White Peony Root, *Paeoniae Radix Alba*), Gou Qi (Goji Berry, *Lycii Fructus*), Wu Wei Zi (Schisandra Fruit, *Schisandrae Chinensis Fructus*), Sheng Di (Rehmannia Root, *Rehmanniae Radix*), and Che Qian (Plantago Seed, *Plantaginis Semen*). The heat subsequently receded. (*Guang Biji*.)