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There are cases where Liver Qi is extremely stagnant, condensing into a Qi mass located below the left hypochondrium and above the left abdomen. It causes pain upon movement and relief upon rest. Over time, the mass gradually enlarges, the complexion becomes sallow and withered, accompanied by acid regurgitation and expectoration of phlegm, with symptoms persisting without cessation. People assume it to be a *Pi* mass (痞块, epigastric fullness/mass), but who would know that this is actually a *Jia* syndrome (瘕证, movable abdominal mass) formed due to the stagnation of Wood (Liver)? The nature of Liver Wood prefers to spread and rise freely, disliking closure and stagnation. Once Liver Qi stagnates, it inevitably attacks the Spleen and Stomach downward. When the Spleen and Stomach are attacked, Qi cannot circulate smoothly through the Zang-Fu organs. Upon encountering the Liver's region, obstruction occurs, preventing flow. Day by day and month by month, formless Qi transforms into a tangible accumulation. This is either blood stasis forming a *Jia*, or food retention forming a *Pi*. The treatment method is to soothe the stagnation in the Liver and assist the Qi of the Spleen and Stomach, so that the tangible accumulation transforms back into the formless. If one sees a tangible mass and mistakenly identifies it as food retention or blood stasis, recklessly using herbs to digest food or break blood will severely damage the Qi of the Spleen and Stomach, while the Liver's stagnation remains unresolved. Consequently, the mass will inevitably grow larger, often leading to death without realization. Is this not deeply tragic? Use Ping Gan Xiao Jia Tang (Calm the Liver and Dissolve Mass Decoction) for treatment.

Bai Shao (White Peony Root, 1 liang), Dang Gui (Angelica Sinensis, 5 qian), Bai Zhu (Atractylodes Macrocephala, 1 liang), Chai Hu (Bupleurum, 1 qian), Bie Jia (Turtle Shell, 3 qian), Shen Qu (Medicated Leaven, 1 qian), Shan Zha (Hawthorn, 1 qian), Zhi Ke (Immature Bitter Orange, 1 qian), Ban Xia (Pinellia, 1 qian). Decoct in water and take orally. After four doses, the mass shrinks; after another four doses, it shrinks further; after ten doses, the mass completely disappears.

This formula primarily calms the Liver to resolve stagnation. Once the stagnant Qi relaxes, it no longer attacks the Earth of the Spleen and Stomach, allowing the Qi of Earth to settle naturally. Adding Bai Zhu strengthens the Spleen and opens the stomach, making Spleen and Stomach Qi robust so they do not fear Liver Qi attack, allowing Qi to flow freely. What obstruction could the Liver cause then? Moreover, Bie Jia and Shan Zha are miraculous herbs for attacking hardness and removing filth. How could there be depression and discomfort?

For this condition, Hua Pi Gao (Dissolve Pi Paste) can also be used externally.

Da Huang (Rhubarb, 5 qian), Ren Shen (Ginseng, 3 qian), Bai Zhu (Atractylodes Macrocephala, 5 qian), Zhi Shi (Immature Bitter Orange, 3 qian), Dan Pi (Moutan Cortex, 2 qian), Bie Jia (Turtle Shell, 1 liang), Shen Qu (Medicated Leaven, 1 liang), Shan Zha (Hawthorn, 5 qian), Mai Ya (Barley Sprout, 5 qian), Hou Po (Magnolia Bark, 3 qian), Dang Gui (Angelica Sinensis, 1 liang), Bai Shao (White Peony Root, 1 liang), Shi Jun Zi Rou (Seed of Quisqualis, 3 qian), Liang Tou Jian (Rhizoma Typhonii, 2 qian), Pu Gong Ying (Dandelion, 1 liang), Jin Yin Hua (Honeysuckle, 1 liang), Sheng Gan Cao (Raw Licorice, 2 qian), Bing Lang (Areca Nut, 2 qian), Fang Feng (Saposhnikovia, 1 qian), Chuan Wu (Aconitum Carmichaelii, 1 piece), Xiang You (Sesame Oil, 3 jin). Boil the above herbs in sesame oil. After several boils, filter out the dregs with white cloth. Re-boil until the oil drops form pearls. Then add the following powdered herbs: Bo He Ye (Mint Leaf, 2 qian), Ru Xiang (Frankincense) and Mo Yao (Myrrh) (each 5 qian), She Xiang (Musk, 1 qian), Chi Shi Zhi (Red Halloysite, 2 liang), Bing Pian (Borneol, 2 qian), A Wei (Asafoetida, 3 qian), Xue Jie (Dragon's Blood, 3 qian). Grind each into powder, mix into the oil, and boil again. Add 1 jin of Huang Dan (Lead Monoxide, processed and levigated), and collect to form the paste. Apply to the Pi mass; applying it stops the growth of one mass. The paste must be applied thickly, not thinly.

There are cases where Spleen Qi is deficient and cold, combined with the consumption of cold foods, condensing in the lower abdomen. Unable to dissipate over time, it forms a hard mass that later moves. People assume it is a虫结 (worm knot) causing a *Jia*, but who would know this is due to the decline of Ming Men Fire (Gate of Life Fire) failing to transform substances? The Spleen is damp Earth, relying on Ming Men Fire to steam and warm. If Ming Men Fire declines, it is like having no fire under the pot; how can it cook and rot the water and grain? For example, in a warm place with sunlight, all things develop; in a cold, dark area, plants wither. How can sprouts emerge? Similarly, muddy wet fields require intense sun to dry; soil must receive fire to become dry. Is the human Spleen Earth any different? Without fire, ingested food accumulates internally, generating *Jia* masses. If one uses purging methods, Spleen Yin will inevitably be damaged. Why not instead tonify Ming Men Fire and support Spleen Earth? Robust Earth can naturally digest food; there is no need to purge, and the *Jia* will open itself. This gradual transformation is superior. Use Wen Tu Xiao Jia Tang (Warm Earth and Dissolve Mass Decoction):

Bai Zhu (Atractylodes Macrocephala, 1 liang), Fu Ling (Poria, 1 liang), Rou Gui (Cinnamon Bark, 2 qian), Zhi Shi (Immature Bitter Orange, 2 qian), Ren Shen (Ginseng, 5 qian), Ba Ji Tian (Morinda Officinalis, 5 qian), Shan Zha (Hawthorn, 1 qian). Decoct in water and take orally. After two doses, the mass reduces slightly; after two more doses, it reduces further; after ten doses, it digests into nothingness.

This formula uses Ba Ji Tian and Rou Gui to warm and tonify Ming Men Fire. When Fire is robust, Yin-Cold naturally extinguishes. Ren Shen, Bai Zhu, and Fu Ling strengthen the Spleen and promote diuresis. With dampness removed, the Earth becomes dry and warm, leaving no hiding place for cold worms or water monsters. Moreover, Zhi Shi and Shan Zha can naturally purge stagnation. This formula treats both the root and the branch.

For this condition, Hua Kuai Dan (Dissolve Mass Pill) can also be used.

Ren Shen (Ginseng, 5 qian), Bai Zhu (Atractylodes Macrocephala, 2 liang), Rou Gui (Cinnamon Bark) and Shen Qu (Medicated Leaven) (each 2 qian), Bi Qi (Water Chestnut, 1 liang), Bie Jia (Turtle Shell, 3 qian). Decoct in water and take orally.

There are cases where Stomach Qi is weak, unable to digest food. Occasionally, hard objects are eaten and remain in the Stomach. Over time, they become tangible masses that move chaotically in the abdomen. Movement causes unbearable pain, relieved by eating. Later, the mass grows larger, causing pain even when eating. People assume it is a *Pi* mass resembling a turtle (*Bie*), but who knows it resembles a turtle but is not one? When painful, pressing it feels like the back of a turtle, with legs moving together. Turtles are animals; they would not stay in one place for long. Clearly, it is not a turtle. Why does it resemble one? The Stomach belongs to Earth. Things born from Earth are mostly four-legged. Things born from Earth prefer stillness over movement, settling firmly. Thus, it resembles a turtle and does not move. But since it dislikes movement, why does it move chaotically? Although its nature prefers stillness, seeking food to satisfy hunger makes it similar to moving things. Observe that it reduces activity when fed; this is proof of seeking food. Daily food nourishes its body, making it grow larger. As it grows, the food intake is insufficient. It naturally bites skin and flesh, causing pain. The treatment should focus on killing parasites. However, killing parasites is attacking evil, which damages righteous Qi. Tonifying righteousness to kill parasites—why doubt this? Use Gong Bu Liang Yi Tang (Attack and Tonify Both Benefiting Decoction):

Fei Zi (Torreya Seed, 10 pieces), Bai Wei (Cynanchum Atratum, 3 qian), Lei Wan (Polyporus Umbellatus, 3 qian), Shen Qu (Medicated Leaven, 3 qian), Bing Lang (Areca Nut, 2 qian), Shi Jun Zi (Quisqualis Fruit, 10 pieces), Bai Zhu (Atractylodes Macrocephala, 1 liang), Ren Shen (Ginseng, 5 qian). Decoct in water and take orally. After one dose, severe abdominal pain will occur. Do not drink tea or water. Endure for half a day. If thirsty, drink the second decoction. Soon, parasitic waste will be expelled, and recovery will occur. No need for a second dose.

This formula is miraculous. It contains many parasite-killing herbs, used within Ren Shen and Bai Zhu, with these two as the Sovereign herbs. Like a general charging into battle, he needs a benevolent ruler and wise minister to plan victory. If Ren Shen and Bai Zhu are omitted, and only parasite-killing herbs are used, there may be efficacy, but excessive killing harms oneself too. It is not a perfect army.

For this condition, Hua Bie Tang (Dissolve Turtle Decoction) is also effective.

Ren Shen (Ginseng, 3 qian), Bai Zhu (Atractylodes Macrocephala, 5 qian), Bai Wei (Cynanchum Atratum) and Bai Bu (Stemona Root) (each 3 qian), She Xiang (Musk) and Zhi Ke (Immature Bitter Orange) (each 1 qian), Bing Lang (Areca Nut, 2 qian). Mince Man Yu Gu (Eel Bone, stir-fried black) into powder, decoct in water, and take the juice.

There are cases where Qi deficiency leads to sinking, with food stagnating between the Spleen and Stomach forming a mass. Over time, the shape enlarges, feeling vague, neither painful nor moving clearly. People assume it is a *Pi* mass, but who knows this is due to Yang Qi failing to ascend? Spleen and Stomach Qi should move and ascend daily; it must not sink suddenly. If injury occurs from hunger/fullness or labor, or from sexual excess injuring the bones, plus indulgence in rich flavors and alcohol without restraint, how can Spleen and Stomach Qi ascend? Thus, Yang is closed within Yin, and Yin separates from Yang. Yin and Yang do not interact, making digestion difficult. Even if digested, Qi knotting prevents extension, yet it can still form shapes. However, the shape is large outside but empty inside, feeling hollow upon pressure, presenting a false appearance. Treatment need not target the mass directly; simply lift and raise Yang Qi. Then the Spleen and Stomach will not have sinking deficiency, and the Qi mass will dissolve spontaneously. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction):

Ren Shen (Ginseng, 3 qian), Huang Qi (Astragalus, 1 liang), Dang Gui (Angelica Sinensis, 3 qian), Chen Pi (Tangerine Peel, 1 qian), Gan Cao (Licorice, 1 qian), Bai Zhu (Atractylodes Macrocephala, 1 liang), Chai Hu (Bupleurum, 1 qian), Sheng Ma (Cimicifuga, 4 fen), Ban Xia (Pinellia, 1 qian). Decoct in water and take orally.

Bu Zhong Yi Qi Tang is the sacred medicine for lifting Yang Qi. This disease originates from Qi deficiency, so Huang Qi is used as Sovereign to tonify Qi. Using 1 liang of Bai Zhu targets the mass in the abdomen, benefiting the waist and navel to connect upper and lower Qi. Ren Shen and Dang Gui assist Huang Qi and Bai Zhu to strengthen Spleen and Stomach Earth. Once Earth Qi is robust, Sheng Ma and Chai Hu lift it, making Qi rise easily. The *Jia* mass likely has Phlegm-fluid obstruction. Adding Ban Xia to Chen Pi and Gan Cao resolves Phlegm without consuming Qi. Working together, they promote the ascent of Yang Qi. Any evil knots will scatter. Since it is originally a Qi mass, not a Food mass, it will digest immediately. A few doses suffice for success.

For this condition, Jia Jian Liu Jun Zi Tang (Modified Six Gentlemen Decoction) can also be used.

Ren Shen (Ginseng, 3 qian), Bai Zhu (Atractylodes Macrocephala) and Fu Ling (Poria) (each 5 qian), Gan Cao (Licorice), Shan Zha (Hawthorn), Mai Ya (Barley Sprout), Hou Po (Magnolia Bark) (each 1 qian), Chen Pi (Tangerine Peel) and Zhi Shi (Immature Bitter Orange) (each 5 fen), Shen Qu (Medicated Leaven, 1 qian). Decoct in water and take orally.

There are cases where, during a meal, a sudden fright causes stagnation and indigestion, eventually forming a *Jia*. Doctors treating it as a *Pi* mass fail; treating it with tonics also fails because the Fright Qi has not settled. Shaoyang Gallbladder Qi governs generation. Upon fright, its Qi stagnates and fails to extend. The Gallbladder and Liver are interior-exterior partners; Gallbladder disease affects the Liver, which then attacks Spleen and Stomach Earth. The Spleen fears the robust Wood Qi and cannot digest residues. Thus, Wood and Earth Qi stagnate in the intestines and stomach, forming an intractable *Jia*. Treatment must first open Shaoyang stagnation, assisted by Liver-calming agents. Then the Spleen and Stomach will not fear Liver-Gallbladder attack and can naturally separate and digest water and grain. Why would the *Jia* not disperse? Use Xiao Yao San (Free and Easy Wanderer Powder):

Bai Zhu (Atractylodes Macrocephala, 2 qian), Bai Shao (White Peony Root, 5 qian), Dang Gui (Angelica Sinensis, 3 qian), Chai Hu (Bupleurum, 2 qian), Chen Pi (Tangerine Peel, 1 qian), Ban Xia (Pinellia, 1 qian), Bie Jia (Turtle Shell, 3 qian), Gan Cao (Licorice, 5 fen), Fu Ling (Poria, 3 qian). Decoct in water and take orally. One dose brings relief; two doses bring more relief; ten doses result in complete cure.

Xiao Yao San is the divine medicine for resolving stagnation. Once the stagnation in the Liver and Gallbladder meridians opens, the Spleen and Stomach *Jia* breaks down without attack.

For this condition, Xiao Jia Tang (Dissolve Mass Decoction) is also miraculous.

Bai Shao (White Peony Root, 1 liang), Bai Zhu (Atractylodes Macrocephala) and Bie Jia (Turtle Shell) (each 5 qian), Gan Cao (Licorice) and Yu Jin (Curcuma Longa Rhizome) (each 1 qian), Zhi Ke (Immature Bitter Orange, 5 fen), Tian Hua Fen (Trichosanthes Root), Dan Pi (Moutan Cortex), Xiang Fu (Cyperus Rotundus) (each 2 qian), Fu Ling (Poria), Ba Ji (Morinda Officinalis) (each 3 qian), Bai Dou Kou (Black Cardamom, 2 grains), Guang Mu Xiang (Vladimiria Root, 5 fen). Decoct in water and take orally.

There are cases where one accidentally eats indigestible food, then hears something shocking. Qi knots and does not disperse; food is hard to digest. Phlegm wraps around to form a *Jia*. People assume it is a *Pi* mass, but who knows it is the closure of Fright Qi? Fright causes Qi to descend; one might suspect food descends with Qi. Why does fright cause retention? Qi is formless; food is tangible. Formless Qi descends with fright; tangible food rises with fright. Moreover, fright causes Qi to descend into the Liver, not the Spleen. Qi descending into the Liver prevents Liver Qi from dispersing, leading it to attack Spleen Earth downward. Even without intervening matter, undigested food remains. How much more so if there was already indigestible food consumed before the fright? This is why the *Jia* arises. Treatment must remove Fright Qi and greatly tonify Spleen and Stomach Earth. Then the *Jia* will disperse without attack. Use Pei Tu Hua Jia Tang (Nourish Earth and Dissolve Mass Decoction):

Bai Zhu (Atractylodes Macrocephala, 1 liang), Chai Hu (Bupleurum, 1 qian), Fu Ling (Poria, 3 qian), Shan Yao (Dioscorea Opposita, 4 qian), Shen Qu (Medicated Leaven, 2 qian), Shan Zha (Hawthorn, 1 qian), Zhi Ke (Immature Bitter Orange, 5 fen), Liang Tou Jian (Rhizoma Typhonii, 3 qian), Hou Po (Magnolia Bark, 1 qian), Bie Jia (Turtle Shell, 1.5 qian), Bai Wei (Cynanchum Atratum, 1 qian), He Shou Wu (Polygonum Multiflorum, raw, 2 qian), Bai Shao (White Peony Root, 5 qian), Bai Jie Zi (White Mustard Seed, 2 qian). Decoct in water and take orally. After ten doses, the *Jia* reduces by half; after another ten doses, it completely disappears.

This formula uses Bai Zhu to nourish Earth. Why use Bai Shao to calm the Liver? Spleen weakness is due to Liver-Gallbladder constraint. Using Bai Shao to calm Liver-Gallbladder is precisely to nourish Spleen-Stomach Earth. If the Liver does not attack Spleen Earth, Earth Qi ascends, transforming everything. Plus, adding herbs to dissolve *Jia* and break accumulation, what mass would not be removed? Furthermore, Chai Hu alone抒 (shu, soothes) Liver-Gallbladder Qi. When Gallbladder Qi rises and Liver Qi is happy, even if there is fright, where would it go? Would one worry about solidified *Jia*?

For this condition, Xiao Jia Tang (Dissolve Mass Decoction) can also be used.

There are cases where one sleeps in wind and dew after a full meal. Waking up, one feels abdominal fullness and discomfort, eventually forming a *Pi*. People assume it is undigested food causing *Pi*, but who knows it is Wind-Dew pathogens wrapping Phlegm in the Stomach? Wind pathogen is Yang; Dew pathogen is Yin. These two combine to create a Qi that is neither purely Yin nor Yang, which is hardest to transform. Thus, it often stagnates in the abdomen without dispersing. Treatment should harmonize Yin and Yang, allowing Yang pathogen to enter Yin and Yin pathogen to exit Yang. Then Yin-Yang righteous Qi will not harm each other, Phlegm-Qi will open, and evil will easily flee. Yang pathogen is easy to scatter; Yin pathogen is hard to scatter. However, when dispelling evil, why distinguish Yin and Yang? By tonifying Yin-Yang righteous Qi, the evil will dispel itself without direct attack. Use Liang Qu Dan (Two-Dispelling Elixir):

Bai Zhu (Atractylodes Macrocephala, 1 liang), Ren Shen (Ginseng, 3 qian), He Shou Wu (Polygonum Multiflorum, raw, 3 qian), Bie Jia Mo (Turtle Shell Powder, 3 qian), Di Li Fen (Water Chestnut Powder, 3 qian), Shen Qu (Medicated Leaven, 2 qian), Fu Ling (Poria, 2 qian), Dang Gui (Angelica Sinensis, 3 qian), Ban Xia (Pinellia, 1 qian), Bei Mu (Fritillaria, 1 qian). Decoct in water and take orally. Two doses bring relief; four doses bring more relief; ten doses result in complete disappearance of the *Pi* mass.

This formula treats both Spleen and Stomach. Spleen and Stomach both belong to Yin. Why ignore Yang? Knowing that Yang pathogen entering Yin becomes entirely Yin. Being entirely Yin, it forgets its Yang nature. Thus, treating Yin need not treat Yang. However, although this formula treats Yin, it contains herbs that treat Yang, allowing entry into Yin and exit from Yin, eliminating both Yin and Yang pathogens.

There are cases where one eats vegetables, feels chest oppression, suspects worms, and thus develops *Pi*. People assume worm activity causes it. Who knows it is mental suspicion preventing transformation? The Spleen and Stomach govern transformation. Whether vegetables or worms enter the Stomach and Spleen, they should transform. If worms digest, how can they form *Pi*? It is the suspicion that harms. The ability of Spleen and Stomach to transform relies on Pre-Heaven and Post-Heaven Fire Qi. Post-Heaven Fire is in the Pericardium; Pre-Heaven Fire is in the Ming Men. Pericardium Fire generates Stomach; Ming Men Fire generates Spleen. With Fire Qi in both meridians, Spleen and Stomach can transform residues and extract essence. Earth is born from Fire. Eating vegetables and harboring suspicion moves the Heart. The Pericardium acts for the Heart, governing movement, not stillness. Now the Heart moves, but the Pericardium dares not move. The Pericardium does not act for the Heart Sovereign, so Fire Qi does not enter the Stomach. The Stomach cannot transform, and the Spleen does not transport for the Stomach. How can ingested food transform? Naturally, it stagnates in the abdomen, forming *Pi*. If suspicion is not resolved, and only Spleen-strengthening and *Pi*-dissolving methods are used, how easily can the *Jia* be cleared? Use Shi Yi Tang (Resolve Doubt Decoction):

Ren Shen (Ginseng, 3 qian), Ba Ji Tian (Morinda Officinalis, 5 qian), Fu Ling (Poria, 3 qian), Bai Zhu (Atractylodes Macrocephala, 5 qian), Bai Wei (Cynanchum Atratum, 2 qian), Gan Cao (Licorice, 1 qian), Shi Jun Zi (Quisqualis Fruit, 3 pieces), Sha Ren (Amomum Villosum, 3 grains), Rou Gui (Cinnamon Bark, 1 qian), Guang Mu Xiang (Vladimiria Root, 3 fen), Chang Pu (Acorus Tatarinowii, 5 fen). Decoct in water and take orally. Two doses bring relief; four doses bring more relief; ten doses result in complete disappearance.

This formula entirely warms and tonifies Pericardium Qi. When Pericardium Qi is robust, Pericardium Fire naturally ascends. Would it remain inactive and not act for the Heart Sovereign to disseminate and transform? Pericardium Fire Qi disseminates in the Stomach, and Ming Men Fire follows suit. It is like husband and wife with one heart, internal and external forces combining. Attacking together, even if there is a *Jia*, I do not believe it will not digest immediately.

For this condition, Jia Wei Si Jun Zi Tang (Modified Four Gentlemen Decoction) can also be used.

Ren Shen (Ginseng), Yuan Zhi (Polygala Root), Shan Yao (Dioscorea Opposita) (each 3 qian), Bai Zhu (Atractylodes Macrocephala, 5 qian), Gan Cao (Licorice) and Zhi Ke (Immature Bitter Orange) (each 1 qian), Fu Ling (Poria, 5 qian), Chang Pu (Acorus Tatarinowii, 1 qian), Shan Zha (Hawthorn, 20 grains), Shen Qu (Medicated Leaven, 1 qian). Decoct in water and take orally.