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Someone asked: Which Zang organ does the Pi syndrome (epigastric fullness and stuffiness) belong to? Which Qi does the pathogen belong to? The answer is: I have examined the *Huangdi Neijing* (Yellow Emperor's Inner Canon), which mentions "Yangming Fui" (rebound of Yangming dryness-metal Qi), presenting with heart pain and Pi. The commentary explains this as internal excessive cold and external heat stagnation. It also mentions "Taiyang Fui" (rebound of Taiyang cold-water Qi), presenting with cold in the heart and stomach, heart pain, and Pi. The commentary explains this as heart Qi burning internally. In the "Bihua Ji" (year of balanced earth Qi), the disease is Pi. In the "Beijian Ji" (year of deficient earth Qi), there is retention, fullness, and Pi obstruction. When "Taiyin" (Taiyin damp-earth Qi) arrives, it manifests as fluid accumulation and obstruction. All these commentaries attribute it to Yin prevailing over Yang. From this, we can see that the affected organs are the Heart and Spleen. The pathogens causing Fu Yu (depression and obstruction) leading to Pi are Fire and Dampness. Discussing the causes of disease cannot be summarized in one sentence. External contraction of the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) from Heaven, mutual overcoming of the Five Pathogens (Deficiency, Excess, Thief, Minor, Proper) from Humanity, imbalance of Yin and Yang, excess in diet and Seven Emotions (Joy, Anger, Worry, Thought, Grief, Fear, Fright) all suffice to disturb the Fire (Heart) and Earth (Spleen) Qi. Generally, the Heart belongs to Yang Fire and governs Blood; the Spleen belongs to Yin Earth and governs Dampness. Any injury to Yang leads to Fire depression and Blood coagulation; any injury to Yin leads to Earth obstruction and Dampness accumulation. The diseases of these two organs are close to each other (within a square inch), but regarding the distinction of Yin and Yang, the treatment methods cannot be the same. Why? The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) chapter on Water Disease states: Hardness below the heart like a plate, with edges like an inverted cup, is caused by fluid retention. Although the descriptions in two clauses are similar, the first clause has the term "Qi Fen" (Qi division) above it, treated with Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Aconite, and Cinnabar Root Decoction). This treats water-cold pathogen closure, where the Yang of the Qi Sea cannot distribute, and Ying and Wei (Nutritive and Defensive Qi) do not circulate. The second clause uses Zhizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction) because of water retention and Earth obstruction in the Middle Jiao. Also, in the Chest Bi chapter: Chest Bi accompanied by Pi below the heart, retained Qi knotting in the chest, chest fullness, and Qi counterflow rushing to the heart, is primarily treated with Zhishi Yebai Guizhi Tang (Immature Bitter Orange, White Melon Seed, and Cinnamon Twig Decoction). Renshen Tang (Ginseng Decoction) is also indicated. One syndrome lists two formulas; inferring the intent, when retained Qi knotting in the chest is severe, tonifying the Middle Jiao is necessary. There is also Pi in the heart, various counterflows causing hanging pain in the heart, primarily treated with Guizhi Shengjiang Zhishi Tang (Cinnamon Twig, Ginger, and Immature Bitter Orange Decoction). In the *Shanghan Lun* (Treatise on Cold Damage), it is said that if patients have cold hands and feet, a tight pulse, and pathogen knotting in the chest, vomiting should be induced. If the pulse is floating and large, and the area below the heart is hard with heat belonging to the Zang, purging should be used. These two cases involve Pi and fullness without sweating or purging initially; depending on the high or low position of the pathogen, vomiting or purging is chosen differently. If Pi below the heart occurs after sweating or purging, various Xiexin Tangs (Drain the Epigastrium Decoctions) are used. Generally, Pi and Jie Xiong (Knotting in the Chest) both present with fullness and hardness, but Jie Xiong requires Yong Zhi (surge treatment/vomiting). Is it not that Zhang Zhongjing's treatment of Pi also focuses on the Heart and Spleen, treating according to the Yin-Yang of Fire and Earth, adapting to each situation? High positions are cleared by Yue (vomiting), low positions by Jie (purging); insufficient Upper Qi is pushed up, insufficient Lower Qi is warmed and circulated. High positions are suppressed, low positions are lifted, depression is opened, knots are resolved, cold is treated with heat, heat is treated with cold, deficiency is tonified, excess is drained, and treatment varies with circumstances. Li Dongyuan said: Pi refers to fullness below the heart without pain. Taiyin is Dampness, governing obstruction; it is Earth Qi rising to the heart causing Pi. Early purging in Shanghan can also cause Pi, as cold damages Ying (Blood); the Heart governs Blood, so pathogen entering the root causes Pi below the heart. Zhang Zhongjing established several Xiexin Tangs, all using Huanglian (Coptis Rhizome) to drain Earth pathogen in the heart, effective as quickly as a drumstick striking a gong. Thus, the *Renwu Shu* says: Once Pi is confirmed, use Jiegeng Zhike Tang (Platycodon and Aurantium Decoction) first, not specifically to treat Pi, but because premature purging inevitably leads to Pi, where pathogen is about to sink and pass through the chest. Using it first intercepts and disperses the pathogen, preventing Pi. "First" implies early use. If used after Pi is formed, it is too late, damaging Zheng Qi (Upright Qi) in the chest without resolving Pi; then Zhongjing's Pi medicines should be used. The classics say: Observe the location of the pathogen and regulate treatment accordingly. This applies not only to Shanghan but also to Jiuzhi (wine accumulation) and miscellaneous diseases where excessive purging causes Pi injury. Purging often destroys Yin, meaning the Yin of Spleen-Stomach food and fluids is lost. Thus, Qi in the chest sinks due to deficiency into the Heart's territory, causing Pi. One should raise Stomach Qi combined with Blood medicines. Using only Qi-moving drugs worsens Pi; further purging lowers Qi more, leading to Zhongman (middle fullness/bloating), which is incorrect treatment. There are also differences between excess and deficiency. Excess Pi with constipation is treated with Nongpu Zhishi Tang (Magnolia Bark and Immature Bitter Orange Decoction). Deficiency Pi with loose stools is treated with Baishao Chenpi Tang (White Peony Root and Tangerine Peel Decoction). Pi due to food injury requires digestion and guiding out, removing chest obstruction. If Qi rebels with nausea, induce vomiting ("Above, therefore vomit"). Zhang Yuansu (Haizang) said: Treating Pi solely benefits the Central Earth (Spleen), using Blood medicines; no method surpasses this. Shanghan Pi comes from Blood; miscellaneous disease Pi also comes from Blood. Both are Blood syndromes, but Shanghan moves from exterior to interior, from substantial to insubstantial. Therefore, insubstantial Qi syndromes are drained with bitter drugs; substantial Blood syndromes are dispersed with acrid-sweet drugs. Those with Zhongman should avoid sweet foods; those without can eat them. Zhongman means abdominal distension. Self-perceived fullness without external distension is not Zhongman, but "Bu Man" (not full). Bu Man refers to pathology, treatable with sweet drugs. Main formula: Huangqi Buzhong Tang (Astragalus Tonify the Middle Decoction) plus Chaihu (Bupleurum Root) and Shengma (Cimicifuga Rhizome). Since Pi results from Heaven and Earth not interacting, using Zhu Ling (Polyporus) and Zexie (Alisma Rhizome) descending from heaven, and Chaihu, Shengma ascending from earth, transforms Pi (obstruction) into Tai (peace). Insubstantial Qi syndromes are drained with bitter drugs, e.g., Zhishi (Immature Bitter Orange), Huanglian; formulas include Da Xiao Pi Wan (Great Eliminate Pi Pill), Huanglian Xiao Pi Wan, Shixiao Wan. Substantial Blood syndromes are dispersed with acrid-sweet drugs, e.g., Zhishi Lizhong Wan, Renshen Tang, Banxia Xiexin Tang. After 5-6 days of Shanghan, regardless of prior purging, for Pi below the heart, use Xiexin Tang or Xiaochaihu Tang (Minor Bupleurum Decoction) plus Zhishi and Jiegeng. Shaoyin syndrome with red face and diarrhea, Pi below the heart, use Xiexin Tang modifications; Yi Lao (Zhang Yuansu) uses Xiexin Tang alone, following Qian Shi's (Qian Yi) method, modifying based on symptoms. Add Zhizi (Gardenia Fruit) for vexation, Douchi (Fermented Soybean) for restlessness, Banxia (Pinellia Tuber) for vomiting, Zhishi and Nongpu for fullness, Shaoyao for abdominal pain, Fuzi (Aconite Lateral Root) for slow pulse, Ganjiang (Dried Ginger) for lower Jiao cold, Dahuang (Rhubarb Root) for hard stool. If using Jiang (Ginger) and Fuzi, boil thoroughly first to prevent excessive heat, then add Huanglian. For Pi with unclear head and eyes, use Shangqing San (Upper Clearing Powder). For chest obstruction, benefit the exterior. For food-injury Pi, mild cases use Da Xiao Pi Wan, Zhizhu Wan, Huijin Wan. Severe cases require mild purging or vomiting. Purging uses Binglang Wan (Areca Seed Pill), Zhu Huang Wan. Vomiting uses Erchen Tang (Two-Cured Decoction) and Gouti San (Melon Spicule Powder) to induce vomiting. For wine-accumulation/miscellaneous disease Pi from excessive purging, raise Stomach Qi with Blood medicines. For Dampness with heavy limbs and scanty urine, use Pingwei San (Regulate the Stomach Powder) combined with Wuling San (Five-Ling Powder) to leach. For Depression, use Yueju Wan (Resolve Depression Pill). For Heat with vexation, thirst, and dark urine, drain with bitter-cold drugs, e.g., Da Xiao Pi Wan (boil with Huanglian, Gegen (Pueraria Root), and Shengma to release). For constipation, purge. For Cold with clear middle, disperse with acrid-sweet drugs, e.g., Zhishi Lizhong Wan, Zhuopi Tang plus Dingxiang (Caryophylli Flos), or Dingchen Touge Tang. Dai Funan stated that various Pi obstructions and Yige (dysphagia) are caused by Phlegm agitated by Qi rising, blocked by Phlegm stagnation, with Phlegm and Qi clashing. Treat all with Erchen Tang plus Zhishi, Sharen (Amomi Fructus), Muxiang (Aucklandiae Radix), or Muxiang Liuqi Yin plus Zhuli (Bamboo Juice) and Jiangzhi (Ginger Juice). For injuries from Seven Qi causing stagnation and Pi fullness, use Siqi Tang or Daotan Tang plus half a qian of Muxiang, or Xiailai Dan. For Pi due to weak Spleen-Stomach and poor transport, use Sijunzi Tang (Four Gentlemen Decoction). For Pi due to fatigue, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for Pi after major illness with unrecovered Yuan Qi, use the same. Right Guan pulse often wiry; wiry and slow indicates hardness below the heart, Liver Wood overcoming Spleen Earth, stagnation blocking viscera, Qi not smoothing causing Pi; use Muxiang Shunqi Tang. For attached dead blood, use much Mudanpi (Moutan Cortex), Jiangxi Hongqu (Red Yeast Rice), Maiya (Hordei Fructus Germinatus, fried and ground), Xiangfu (Cyperi Rhizoma, processed with child's urine), Jiegeng, Chuantongcao (Tetrapanacis Medulla), Chuanshanjia (Manis Squama), Fanjiangxiang (Dalbergiae Odoriferae Lignum), Honghua (Carthami Flos), Shanzha Rou (Crataegi Fructus), Sumu (Pterocarpus Indicus Lignum), each approx. 1 qian, decocted with wine and child's urine. Severe cases add Dahuang; add Leizhi juice and Taoren paste before administration. This formula is suitable for Pi arising after great anger.
[Chest Bi] Fullness below the heart without pain is Pi; fullness with pain is Chest Bi. In *Jingui*, for Chest Bi with chest Qi obstruction and shortness of breath, use Fuling Xingren Gancao Tang (Poria, Apricot Seed, and Licorice Decoction). Juqi Jiang Tang (Citrus, Immature Bitter Orange, and Ginger Decoction) is also indicated. For Chest Bi with alternating severity, use Yiyiren Fuzi San (Coix Seed and Aconite Powder). (These two clauses do not mention pain.) For Zhī Yin (branching fluid) causing chest fullness, use Zhipo Dahuang Tang (Immature Bitter Orange, Magnolia Bark, and Rhubarb Decoction). (Does not mention Bi pain.) For Chest Bi with wheezing, coughing, spitting, chest and back pain, shortness of breath, Cun Kou pulse sinking and slow, Guan pulse small, tight, and rapid, use Gualou Xiebai Baijiu Tang (Melon Seed, Macrostemon Stem, and White Wine Decoction). For Chest Bi unable to lie down, heart pain penetrating to the back, use Gualou Xiebai Banxia Tang (Melon Seed, Macrostemon Stem, and Pinellia Decoction). For Chest Bi with Pi in the heart, retained Qi knotting in the chest, chest fullness, and Qi counterflow rushing to the heart, use Zhishi Yebai Guizhi Tang. Renshen Tang is also indicated. Gualou seed, roasted熟, used with peel, decocted or made into pills, best at cleansing chest turbidity.