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Miaoxiang Wan from *Liangfang* treats pediatric deficiency-type accumulation, characterized by tidal chills and fever (alternating chills and fever occurring at regular intervals), abdominal distension, fullness, and pain.
Ingredients: Cinnabar (Shachen, 1 liang), Calculus Bovis (Niuhuang), Borneolum Syntheticum (Sheng Longnao), Moschus (Shexiang) (each 2.5 qian), Folium Aureum (Jinbo, 14 pieces), Fen Shuang, Nifen (each 1 qian), Beeswax (Huangla, 2 liang), Fructus Crotonis Tiglii (Badou, selecting plump ones, 120 grains).
Preparation and Administration: Grind the above ingredients and make pills the size of a bullet. Adjust dosage according to the child's deficiency or excess condition. Administer with Borneol solution water, taking it after midnight. If the internal organs are deficient, administer with Borneol rice drink. Take three pills the size of a small bean per dose; to缓 (huan, slow/milden) the drug's effect, press the pill flat. For stubborn diseases, increase to ten pills. Puncture each pill with a needle to create several holes to facilitate the release of medicinal power. For removing accumulation in children, make pills the size of mung beans; this is especially effective for treating pediatric vomiting and reflux. This medicine is most effective in clearing chest烦 (fan, vexation/restlessness) and deficiency accumulation.

*Tingru Ji* records: Treating children who develop chills and fever after purgation, where blood coagulation forms Pi Qi (accumulation mass) in the left hypochondrium, or due to cold fluid retention or cold food accumulation causing qi movement, with residual heat in the chest and heart, inability to eat or drink, and emaciation with dark complexion. It is appropriate to first take a small amount of Yinzi San to move qi and descend food, then take Zishuang Wan to remove old accumulation, allowing the body to gradually fill out.
Yinzi Formula Ingredients: Radix Bupleuri (Chaihu), Poria (Fuling), Radix Ginseng (Renshen), Rhizoma Atractylodis Macrocephalae (Baizhu), Testudo Carapax et Plastrum (Biejia) (coated with vinegar, roasted until fragrant and cooked, each 0.5 liang).
Preparation and Administration: Cut into pieces the size of beans. Add two sheng of water, boil down to five he. Divide into three or four warm doses taken on an empty stomach. Re-administer after a time interval equivalent to walking one or two li. Consume congee for dietary care.

Mr. Mao discusses: From five months after birth up to seven years of age, children may have Jie Pi (knotting accumulation) forming lumps in the abdomen, coming and going like a plum pit or resembling an egg, often crying in pain. These are divided into categories: pain in the left hypochondrium is named "Qi," while pain in the right hypochondrium is named "Pi Qi." Administer Peng'ezhu San or Jia Jianpi Yin (for those refusing milk/food), which will lead to recovery. If the face turns black, eyes stare straight, stool contains black blood, nose and mouth feel cold, hands and feet are cold, and there is no intake of food, it is a death sign.
Qian Yi discusses: Pediatric Pi disease arises from undigested milk and food lying dormant in the abdomen, presenting with alternating cold and heat, drinking water, or wheezing/coughing, similar to tidal fever. If not treated early, it will inevitably develop into Gan syndrome (infantile malnutrition). Because of the Pi accumulation, the child loses appetite, leading to Spleen and Stomach deficiency and internal heat generation, causing excessive thirst. This washes out the intestines and stomach, depleting body fluids. The Stomach cannot transport and transform food and fluids. The pulse is deep and fine. With further loss of appetite, Spleen and Stomach deficiency worsens, limbs become weak, and various pathogens arise. Few escape becoming emaciated and developing Gan syndrome. Regarding Pi and tidal fever: Cao Xuande's son, aged three, had a yellow face and intermittent chills and fever, refused food, but drank water and milk incessantly. Other physicians diagnosed tidal fever and used Niuhuang Wan and Shexiang Wan without success. Administering Zhike Gansan caused vomiting. Qian Yi stated that Baibing Zi (see previous text) should be used to purge, followed by Spleen tonification, and then Xiaoji Wan to grind away accumulation (see previous text). This was indeed Pi disease, and the child recovered. Why? Refusing food but drinking only water indicates food stagnating in the gut unable to digest, causing cold sensations. Vomiting after taking thirst-quenching medicines is due to the medicine irritating the Spleen. Purging resolves it.
Ren Zhai states: Pi disease involves blood membranes wrapping water, located laterally in the hypochondrium, causing intermittent pain. Only Pi disease can trigger tidal fever and generate chills and heat. Therefore, in malaria patients, yellow fluid often accumulates in the Middle Jiao, and over time, Pi forms, causing persistent chills and heat. Those with this condition should use this method. When a child's internal organs are harmonious and Ying-Wei (Nutritive and Defensive Qi) flow smoothly, body fluids circulate naturally. Even if they drink much liquid, it does not cause disease. However, improper breastfeeding leads to blockage in the Three Jiao, causing water and fluid stagnation in the intestines and stomach, unable to diffuse and communicate. If attacked by cold qi, it aggregates to form Pi. Mild cases use Jizhi Muxiang Wan; severe cases use Qu Pi Wan.
Zeng Shirong states: Infants are born with incomplete constitution. Negligence in swaddling and unregulated breastfeeding, combined with external invasion by the Six Excesses and internal deficiency of the Five Zang Qi, cause cold accumulation to linger in the Spleen, unable to transform. This forms Pi, with "ghost qi" protruding in the hypochondrium, either left or right, commonly called Gui Zhu. These diseases result from accumulation stagnation fermenting, causing chills and fever, abdominal pain, or coolness by day and heat by night. Treatment: For excess Qi, first warm and rectify Stomach Qi, then use Wuxi Wan or Shuijing Dan to purge. After two or three times, stop slightly with thin congee. Wait until the formed manifestations disappear before administering tonifying agents. For deficiency Qi, first regulate Spleen and Stomach, consolidate True Yuan. Once spirit/color improves and food intake increases, purge as previously described. If extremely deficient, use Sanleng San or Huapi Wan to gradually eliminate, adjusting Yin and Yang until balance is achieved. However, tonifying first then purging follows the method of "meeting and seizing," removing old cold accumulation. If the face is yellow, lips white, hair erect, and muscles emaciated, this is extreme deficiency; do not lightly purge. Slowly using medicine to digest and regulate is superior. For young children, have the wet nurse frequently consume Huoxiang Yin so the medicine passes through breast milk, providing slight assistance.

[Mr. Mao] Peng'ezhu San: Mainly treats pediatric Qi Pi and all Qi disorders.
Ingredients: Rhizoma Curcumae (Peng'ezhu), Pericarpium Citri Reticulatae Viride (Qingjupi), Fructus Alpiniae Oxyphyllae (Yizhi) (each 0.5 liang), Radix Aucklandiae (Muxiang, 2.5 qian), Glutinose Rice (Nuomi, 1 liang).
Preparation and Administration: Grind into powder. Take one large qian per dose, mixed with aged rice drink. Take four times daily.

*Shenghui Fang* Biejia San:
Use Testudo Carapax et Plastrum (Biejia) (one piece, coated with vinegar, roasted until yellow, remove skirt edge).
Preparation and Administration: Crush, sift finely into powder. Take one qian per dose, decoct with one small cup of urine from an uncircumcised boy until reduced to five fen. Adjust dosage based on the child's size, divide and take. Three times daily. Divine efficacy.

Huapi Wan (Zeng Shi): Mainly treats Pi-jie Qi Kuai (accumulated Qi masses) between the ribs, persisting for a long time without resolving, alternating chills and heat, organ dysfunction, indigestion of rice and grain, choking, wheezing, shortness of breath, chest and abdominal fullness. Also treats Dingxi Bulu syndrome.
Ingredients: Radix Aucklandiae (Nanmuxiang), Pericarpium Citri Reticulatae (Chenpi, remove white pith), Rhizoma Curcumae (Ezhu, processed, crushed), Rhizoma Sparganii (Sanleng, processed, crushed), Pericarpium Citri Reticulatae Qingpi (Qingpi, with 9 grains of Fructus Crotonis Tiglii, remove skin and membrane core, lightly stir-fry, remove Badou), Fructus Aurantii (Zhike, remove pulp, bran-fried), Semen Arecae (Binglang) (these seven ingredients, each 0.5 liang), Rhizoma Atractylodis Macrocephalae (Baizhu), Flos Caryophylli (Dingxiang) (these two ingredients, each 2 qian), Radix Asari (Xixin, burned to retain nature, 4 qian).
Preparation and Administration: Except for Nanmuxiang, Binglang, and Dingxiang which are not overheated, bake the other seven ingredients. Grind together with the first three into powder. Make pills with yeast paste the size of hemp seeds. Take 15 to 21 pills per dose on an empty stomach with clear rice soup. If there are alternating chills and fever, take intermittently with Chaihu Yin. Avoid greasy and raw/cold foods.

Muxiang Wan: Treats vomiting milk and diarrhea of milk, with sour/foul odor, caused by incessant crying and forced feeding, leading to stagnation and indigestion, known as Milk Accumulation. Hard abdomen, heat, thirst, vomiting/diarrhea, caused by uncontrolled eating, sleeping immediately after overeating, known as Food Accumulation. Abdominal pain and crying, stool like crab foam, caused by disturbing Qi, disharmony of Ying-Wei, prolonged duration, known as Qi Accumulation. Post-malaria, Pi masses form in the abdomen.
Ingredients: Radix Aucklandiae (Muxiang), Rhizoma Curcumae (Pengshu), Fructus Amomi (Sharen), Pericarpium Citri Reticulatae Qingpi (Qingpi, remove white pith), Cinnabar (Zhusha, finely ground), Haematitum (Daizheshi, ground, each 2 qian), Flos Caryophylli (Dadingxiang), Semen Crotonis Tiglii (Chuan Badou Rou, pressed on paper to remove oil, each 1 qian).
Preparation and Administration: Grind into fine powder, mix evenly. Use refined white flour paste to make pills the size of sesame seeds. Take 2-3 pills per dose. For milk injury, take with breast milk; for food injury, take with rice drink.

Qu Pi Wan: A harsh agent, not used unless for severe excess accumulation.
Ingredients: Radix Kansui (Gansui, lightly stir-fried), Flos Genkwa (Yuanhua, stir-fried), Semen Plantaginis (Qianniu, half stir-fried half raw, ground to take powder), Ramulus Cinnamomi (Lagui), Rhizoma Curcumae (Pengshu), Pericarpium Citri Reticulatae Qingpi (Qingpi, remove pulp), Radix Aucklandiae (Muxiang), Semen Persicae (Taoren, soaked, peeled, stir-fried), Resina Trogopterori (Wulingzhi) (each 2 qian).
Preparation and Administration: Grind into fine powder. Add 1 qian of oil-free Fructus Crotonis Tiglii and grind together. Make pills the size of sesame seeds with very fine refined flour paste. Take 1-2 pills per dose,灌 (guan, force-feed) with ginger-honey decoction. After diarrhea, replenish with cold congee to harmonize the Stomach.

Ai Pi Wan: Treats Ru Pi Gu Jia (milk/grain accumulation masses), abdominal lump pain.
Ingredients: Radix Aucklandiae (Muxiang), Pericarpium Citri Reticulatae Qingpi (Qingpi, remove pulp), Rhizoma Curcumae (Pengshu), Haematitum (Daizheshi, fired, quenched in vinegar, finely ground), Radix Rehmanniae Recens (Sheng Dihuang) (each 3 qian), Fructus Crotonis Tiglii (Badou, pressed, oil completely removed, 1 qian).
Preparation and Administration: Grind into fine powder. Make pills the size of sesame seeds with vinegar-flour paste. Take 2 pills per dose after meals, with ginger-rubbed decoction.

*Waitai Bi Xiao* prescription for adult and pediatric Pi:
Take Li Ren (Prunus salicina kernel) from under the cart, blanch slightly to remove skin and double kernels. Mix equally with dry wheat flour. Pound into cakes. If too dry, add plain water and knead like dough. Size should match the patient's palm. Make two cakes. Lightly roast until yellow, do not cook thoroughly. Eat one cake on an empty stomach. Should result in rapid diarrhea. If no diarrhea, eat another. Or drink hot congee juice to induce diarrhea. Stop when rapid diarrhea is achieved. If diarrhea continues past noon, stop with vinegar-cooked rice. After diarrhea, the body will be deficient. If the disease is not fully cleared, take another dose within one to two days according to strength, until the disease is gone. Children adjust accordingly. Do not consume dairy or beef/horse meat. Invariably effective. For severe disease, equal parts Li Ren and flour. For mild cases, reduce according to judgment. Subsequent doses also depend on strength. Frequent trials show divine efficacy.

*Shenghui Fang* Qianhu Wan: Treats pediatric Pi Qi, abdominal pain.
Ingredients: Radix Peucedani (Qianhu), Radix Platycodonis (Jiegeng) (remove rhizomes each), Radix Paeoniae Rubra (Chishaoyao), Polyporus (Chifuling), Fructus Aurantii (Zhike), Radix Rhei Palmati (Chuan Dahuang), Radix Angelicae Sinensis (Danggui), Semen Pruni Armeniacae (Yuli Ren, peel, lightly stir-fry, each 0.5 liang), Testudo Carapax et Plastrum (Biejia, 1 liang, roasted until yellow).
Preparation and Administration: Crush, sift into powder. Mix with refined honey to make pills the size of mung beans. For three-year-olds, take five pills dissolved in congee drink on an empty stomach. Adjust dosage based on child's size.

*Tingru Ji* prescription for pediatric Shan Pi, high fever, frequent use of cold medicines causing cold Qi to flood the Heart forming Pi, lower Jiao cold, intestinal constipation and difficult defecation:
Ingredients: Poria (Fuling), Radix Ligustici Chuanxiong (Chuanxiong), Testudo Carapax et Plastrum (Biejia, roasted), Fructus Aurantii (Zhike, roasted), Radix Paeoniae Alba (Shaoyao) (each 2 fen), Radix Bupleuri (Chaihu, 4 fen).
Preparation and Administration: Cut into pieces. Decoct in one da sheng and three he of water until reduced to three he. Divide into two doses on an empty stomach. Re-administer after a time interval equivalent to walking five or six li. Avoid Amaranth seeds.

[Zhu Shi] Zhimu Wan: Treats pediatric abdominal pain and irregularity, combined with Pi Qi.
Ingredients: Radix Anemarrhenae (Zhimu, 6 fen), Testudo Carapax et Plastrum (Biejia, roasted, 4 fen), Concha Ostreae (Muli), Fructus Aurantii (Zhike, bran-fried, each 3 fen), Radix Rhei Palmati (Dahuang, 12 fen, wrapped in paper, baked熟).
Preparation and Administration: Grind into powder. Mix with honey to make pills the size of mung beans. Take five pills with rice drink. Adults adjust dosage accordingly.

Treating seven-to-eight-year-old children who sleep excessively or have periodic high fever, progressively wasting away, body not painful, sometimes dysentery with pus, vomiting/reflux, refusal to eat. This is a sign of Pi Qi. The disease resembles malaria, often unrecognized by people. Prescription:
Ingredients: Radix Bupleuri (Chaihu), Radix Scutellariae (Huangqin) (each 1 fen), Fructus Aurantii (Zhike, stir-fried, two slices), Radix Glycyrrhizae (Gancao), Radix Anemarrhenae (Zhimu), Radix Paeoniae Alba (Shaoyao) (each 2 fen), Fructus Terminaliae Chebulae (Da Helile, baked, take peel, one piece; small ones use two).
Preparation and Administration: Grind into powder. Decoct in one zhan of water and take.