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(This type of *pi* [obstruction] is located within the abdomen, differing from *pi* in the epigastrium.)

[Yang] "Pi" refers to obstruction/blockage, and "jie" [knotting/mass] refers to solidity/excess. When hot qi accumulates between the chest and diaphragm, and retained fluid gathers within the abdomen and hypochondrium, the Ying [Nutritive] and Wei [Defensive] qi cannot circulate freely, and the Zang-Fu organs cannot function smoothly. Consequently, distension and fullness progress to pi-jie, which is the inevitable course of the disease. This is a syndrome of heat and excess. Occasionally, it manifests as high fever; the Gansui San (Gansui Powder) from *Shenghui Fang* is indicated for this. This medicine treats pediatric pi-jie; although temporary relief may be achieved through bowel movement after taking the decoction, the internal stagnation and excess remain. The epigastrium feels hard and distended, and crying occurs upon palpation due to latent heat inside, with various symptoms appearing simultaneously. For this disease, it is appropriate to promote bowel movements to clear stagnation, break up knots, and dissipate qi. Subsequently, Shijin Wan (Digestion-Enhancing Pill) should be taken regularly.

Commentary: Shijin Wan contains Radix Crotonis Tiglii (Badou), which is unsuitable for long-term use. Kansui Radix (Gansui) has great toxicity; its water-draining power is like bursting a river dyke. It should not be used lightly unless three conditions are met simultaneously: the patient is extremely robust, the condition is extremely critical, and there is an excessive amount of water-dampness pathogen. Using it as the primary formula for pi-jie is erroneous.

[Xue] If pi-pi [masses] persist for a long time, leading to reduced appetite, the Spleen Qi must become deficient. If it remains uncured for a long time, the primary treatment must focus on consolidating Stomach Qi. Nourishing the righteous Qi will cause the accumulation to resolve spontaneously. If one attempts to directly attack the knot, not only will it fail to dissolve effectively, but it will also damage the Spleen Earth. Once the Spleen Earth is deficient, myriad complications will arise. One should refer to various categories and treat according to the specific manifestations.

Case 1: A child suffered from pi-pi and took medicines such as Areca Seed (Binglang), Turmeric Rhizome (Ezhu), Immature Bitter Orange (Zhishi), and Coptis Rhizome (Huanglian), causing the pi to worsen. I stated that this was pi due to Blood deficiency in the Spleen Meridian and advised against using harsh draining methods. I prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) added with Angelicae Sinensis Radix (Danggui). After several doses, Stomach Qi gradually recovered, and symptoms improved. Then, Yi Gong San (Yi Gong Powder) added with Cimicifugae Rhizoma (Shengma) and Bupleuri Radix (Chaihu) were administered in the morning, and Yi Gong San added with Danggui and Paeoniae Radix Alba (Shaoyao) in the evening, resulting in recovery.

Case 2: Another child suffered from pi-jie and took drugs that break stagnation. I considered this a case of both Form and Qi being deficient, requiring tonification of Middle Qi. The parents did not believe me and continued with draining attacks, leading to deficient fire flaming upward, erosion and ulceration of the gums, and tubercles under the jaw. I treated with Da Wuyi Tang (Major Worm-Expelling Decoction) and modified Yi Gong San, bringing stability to the condition.

Case 3: A child suffered from pi-jie for a long time, resulting in emaciated limbs and a gradually enlarging abdomen, accompanied by alternating chills and fever, lethargy, thirst, and desire to drink. Baizhu San (Atractylodis Macrocephalae Powder) was used as the main formula, assisted by Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill). After more than a month, symptoms gradually improved. Then, Yi Gong San added with Danggui, along with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), were used for another month until recovery.

Case 4: A child suffered from pi-jie with body heat like fire and numerous complex symptoms. Morning administration of Wuwei Yigong San (Five-Ingredient Yi Gong Powder) and evening administration of Siwei Fei'er Wan led to slight improvement after over a month. Assisted by Dihuang Wan, the child could walk and stand independently. Subsequently, Dihuang Wan was given in the morning, and Yi Gong San combined with Xama Wan (Toad Pill) in the evening. After several doses, recovery occurred.

Qianhu San (Peucedani Radix Powder) from *Shenghui Fang*: Treats pediatric abdominal pi-jie, high fever, emaciation, and excessive crying.
Peucedani Radix (Qianhu), Rhubarb (Chuan Dahuang) (each 3 fen, slightly stir-fried), Aurantium Fructus Immaturus (Zhike) (stir-fried until slightly yellow), Red Poria (Chi Fuling), Rhinoceros Horn (Xijiao) (crushed), Prunus Armeniaca Semen (Yuliren) (soaked in water, skin removed, slightly stir-fried), Turtle Shell (Biejia) (coated with vinegar, roasted until yellow, skirt removed) (each half liang).
Crush the above ingredients and sieve coarsely. Take 1 qian per dose, boil in one small cup of water until reduced to five parts, strain, and administer warm in divided doses according to the child's age/size. Stop when mild diarrhea occurs.

Gansui Po Jie San (Gansui Breaking-Knot Powder) from *Shenghui Fang*:
Kansui Radix (Gansui) (roasted, 2.5 qian, until yellow), Citri Reticulatae Pericarpium Viride (Qingpi) (soaked, white pith removed, dried), Scutellariae Radix (Huangqin), Rhubarb (Chuan Dahuang) (cut finely, roasted) (each half liang).
Make into coarse powder. Take 1 qian per dose, boil in one small cup of water until reduced to six parts, strain, and take warm. Adjust dosage based on size. Stop when bowel movement is achieved, then feed cold congee to support the stomach.

Shijin Wan (Digestion-Enhancing Pill): Treats indigestion of milk and food, epigastric and abdominal distension/fullness, high fever, coarse breathing, vomiting with phlegm-reversal, borborygmus with diarrhea, undigested food in stool. Also treats dysentery with red and white mucus, abdominal pain with tenesmus. Additionally treats food accumulation, milk masses, Gan Qi [Childhood Malnutrition Syndrome], and pi-jie. For children with heat-excess in the chest/diaphragm and retained fluid in the abdomen, causing obstruction of Ying/Wei qi and blockage of Zang-Fu qi, manifesting as abdominal qi-knotting, distension, or high fever, the treatment principle is to promote bowel movements, break knots, and dissipate qi.
Crotonis Fructus Frost (Badoushuang) (1.2 qian), Angelicae Sinensis Radix (Danggui) (soaked overnight in rice wash water, stir-fried), Cinnabar (Zhusha), Hematitum (Daizheshi) (calcined, quenched in vinegar seven times), Aurantium Fructus Immaturus (Zhike) (stir-fried), Aucklandiae Radix (Muxiang) (each half liang), Moschus (Shexiang) (a small amount).
Grind into fine powder, mix with wheat paste to make pills the size of hemp seeds. One pill for a one-year-old, taken with warm rice broth. Adjust dosage based on deficiency/excess. Take after meals. Treats heat from food accumulation, emaciation with large abdomen, Qingjin Ganji [Green-Vein Childhood Malnutrition], abdominal pain with protruding ribs.

[Tang] The young daughter of Vice Minister Zhang of the Ministry of Revenue suffered from accumulated stagnation and knotting for a year. Her symptoms included abdominal fullness, high fever, closure of both upper and lower orifices (constipation and urinary retention), and inability to eat. Various physicians treated her as deficiency-heat or tidal fever, or as Stomach-cold causing anorexia. However, since she could not eat, her bowel and bladder movements naturally decreased. Others tried treating her as Gan-heat. All medicines failed to hit the mark, and her condition became desperate. I was invited to examine her. I asked what medicine she should take. I answered: "She should take Gansui and Dahuang." Zhang was shocked and said, "Previous doctors all used tonics. This girl hasn't eaten for a long time; it is inappropriate to use purgatives to move the intestines and stomach." I replied, "Trust me and she lives; defy me and she dies." Zhang asked, "Is there a substitute for Gansui that is slightly milder?" I ordered him to immediately give Dachengqi Tang (Major Order the Qi Decoction). After two doses, she recovered. On the next day, pulse diagnosis revealed residual stagnation and excess. The prognosis indicated that abdominal closure would recur in a few days, requiring the previous strong medicine to eradicate the root. Indeed, after a few days, recurrence occurred with abdominal fullness and pi-jie. Re-administering the medicine cured her in one dose.
Above is an example of promoting bowel movements. Suitable for cases where both Form and Qi are excess.

Zhizhu Wan (Aurantium and Atractylodes Pill):
Atractylodis Macrocephalae Rhizoma (Baizhu) (4 liang), Aurantium Fructus Immaturus (Zhishi) (2 liang).
Grind into powder. Wrap in Lotus Leaf and roast with cooked rice until soft, then make pills the size of Torreya Seeds. Take 40-50 pills per dose, fasting, with plain boiling water.

Zhishi Lizhong Wan (Aurantium Regulating Middle Pill):
Aurantium Fructus Immaturus (Zhishi) (16 slices, bran-stir-fried), Poria (Fuling), Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Zingiberis Rhizoma Recens (Ganjiang) (processed), Glycyrrhizae Radix et Rhizoma (Gancao) (roasted) (each 2 liang).
Grind into powder, mix with refined honey to make pills the size of Longan seeds. Take one pill per dose, dissolved in hot water. Continue for 2-3 doses. If the chest feels open but thirst persists, add Trichosanthis Radix (Gualougen) 1 liang. If spontaneous sweating occurs, add Oyster Shell (Muli) 2 liang. Also add if diarrhea is present.

Kuaise Tang (Quick Diaphragm Decoction): Regulates discomfort in the chest and diaphragm, poor appetite. Also promotes smooth Qi flow, harmonizes the middle, and resolves old stagnation.
Ginseng Radix et Rhizoma (Renshen) (rhizome removed), Citri Reticulatae Pericarpium Viride (Qingpi) (white pith removed), Amomi Fructus (Suosharen), Linderae Radix (Wuyao), Alpiniae Officinarum Rhizoma (Liangjiang), Cyperi Rhizoma (Xiangfu), Glycyrrhizae Radix et Rhizoma (Gancao) (roasted) (each 1 liang).
Grind into fine powder. Take 1 qian per dose, fasting, mixed with warm salted water.

Shenzhu Xiantang (Ginseng and Atractylodes Chest-Trap Decoction):
Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Tangerine Peel (Juhong), Pinelliae Rhizoma (Banxia) (each 1 qian), Trichosanthis Fructus (Gualou) (whole, cut finely, moist, 3 qian), Coptidis Rhizoma (Huanglian), Glycyrrhizae Radix et Rhizoma (Gancao) (each 5 fen).
Boil the above with 1.5 cups of water, 3 slices of Ginger, and 1 Jujube until reduced to 0.7 parts. Take warm.

Jiegugu stated: For loss of appetite, use Sijunzi Tang (Four Gentlemen Decoction) added with Ginger and Jujube, boiled and taken.