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Qi disorders arise from the stagnation of Qi in the chest, causing a sensation of fullness and discomfort; relief is achieved only when the Qi flows freely. The *Classic of Internal Medicine* states: "When turbid Qi remains above, distension occurs." If this condition persists for a long time, it develops into Pi-Man (epigastric fullness and stuffiness). Treatment should primarily focus on diffusing and resolving formless Qi. Although fire pathogens and phlegm may be involved, the key to recovery lies in the smooth flow of Qi.

Pi-Man (epigastric fullness and stuffiness) results from the failure of Lung Qi to descend and Spleen Qi to transform, leading to dysfunction in the ascending and descending mechanisms. This causes a sensation of blockage and fullness in the epigastrium ("heart below"). It differs from Zhang-Man (distension). In Zhang-Man, there is internal distension accompanied by visible external swelling; in Pi-Man, there is an internal sensation of stuffiness without external signs of acute distension. Therefore, one should not exclusively use formulas that break Qi or promote downward purging, as this may damage Yuan Qi (Original Qi) and potentially transform into Gu-Zhang (drum-like distension). Scholar Xu stated: "Where pathogenic factors gather, Qi must be deficient; if they remain and do not depart, the disease manifests as excess." Thus, treating Pi-Man requires a method of tonification and reduction combined.

Xuanfu Daizhe Tang (Inula and Hematite Decoction) [See Ye Ge (Regurgitation)]. In the original formula, Sheng Jiang (Fresh Ginger Rhizome) and Ban Xia (Pinellia Tuber) should be used with discretion, while Gan Cao (Licorice Root) and Da Zao (Jujube Fruit) should be removed. It is advisable to refer to Chenxiang Jiangqi San (Agarwood Descending Qi Powder) and other herbs. This formula is suitable for patients with epigastric fullness and persistent belching; it can be used with modifications.

Chenxiang Jiangqi San (Agarwood Descending Qi Powder) [See Chuan (Asthma/Wheezing)]. Bai Shao (White Peony Root) and Li Zhi (Pear Juice) should be added. [Mai Dong (Ophiopogon Tuber), Su Zi (Perilla Seed), and Li Zhi clear and moisten, allowing Lung Qi to descend naturally; Fu Ling (Poria), Bai Shao, Chen Xiang (Agarwood), Sha Ren (Amomum Fruit), and Ju Hong (Tangerine Peel) tonify and awaken, allowing Spleen Qi to transform naturally.] This formula is suitable for patients with epigastric fullness and loss of appetite; it can be used with modifications.

Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) [See Xie Xie (Diarrhea)]. This formula is suitable for patients with epigastric fullness and can be modified according to symptoms; it embodies the method of simultaneous tonification and reduction.

A patient suffered from rebellious Qi rising, belching dozens of times after every one or two bites of food, occurring three or four times per meal. Zhang Zhunchun said: "This is due to Qi failing to return to its origin and the failure of the Middle Jiao to transform." Each dose required 2 qian of Ren Shen (Ginseng Root). The patient did not believe him. After taking Qi-moving drugs, the condition worsened. Three months later, Zhang Zhunchun said: "Now 4 qian of Ren Shen are needed." The patient still did not believe him. Another three months passed, and Zhang Zhunchun said: "Now 6 qian of Ren Shen are needed." The patient remained skeptical. Eventually, the patient could not swallow food, vomiting cold Qi in clumps, with upper and lower Qi failing to connect. Only then did he seek treatment from Zhang Zhunchun.

Zhang Zhunchun prescribed Ren Shen (6 qian) assisted by Chen Xiang (Agarwood), Sha Ren (Amomum Fruit), and Yi Zhi Ren (Alpinia Oxyphylla Fruit) (each 1 qian) to guide Qi back to its origin; Su Zi (Perilla Seed) and Mai Dong (Ophiopogon Tuber) (each 3 qian), Ju Hong (Tangerine Peel) (1 qian), Pi Pa Ye (Loquat Leaf) (3 slices), and Lu Gen Zhi (Reed Rhizome Juice) (1 cup) to descend rebellious Qi; and Bai Shao (White Peony Root), Wu Wei Zi (Schisandra Berry), and Yu Rou (Cornus Fruit) (each 2 qian) to astringe and consolidate dissipating Qi. The first decoction produced no effect; the second also produced no effect, though it did not cause vomiting like other decoctions. Upon taking the third decoction, there was suddenly a sound like an explosion below the heart, followed by belching upwards and uncontrollable urination downwards. The upper and lower pathways became clear, and the patient immediately requested porridge, eating three or four bowls without further rebellion of Qi. After five or six doses, the amount of Ren Shen was reduced by 2 qian. The remaining herbs were ground into powder ten times the original quantity, formed into pills using Shan Yao Paste (Chinese Yam Paste), and taken for half a year until the illness was cured.