（第十）
仁斋云∶痞者，塞也。结者，实也。热气蕴于胸膈之间，留饮聚于腰胁之内，于是荣卫不得
流行，脏腑不得宣通，腹满而致痞结，势使然耳。此实热之证也，或发为壮热是也。癖者，血膜
包水，癖侧于胁旁，时时作痛。惟癖为能发潮热，为能生寒热，故疟脉家中脘多蓄黄水，
日久而后结癖，寒热之起。小儿脏腑和平，荣卫
调畅，则津液自然流通，纵使多饮水浆，不能为病。惟乳哺失调，三焦关膈，以致水浆停
滞肠胃，不得宣行，冷热相搏，于是结聚而成癖也。
《脉诀》云∶小儿脉伏结为物聚。钱氏云∶小儿脉沉细为癖积。《脉经》云∶脉来细而附
骨来者积也。
钱氏曰∶腹中有癖不食，但饮乳是也。当渐用白饼子下之。小儿病癖由乳母乳食不消，
伏在腹中，乍凉乍热相类，不早治必成疳。以其有癖则令儿不食，致脾胃虚而发热，故引饮
过多，即涤荡肠胃，亡失津液，脾胃不能传化水谷，其脉沉细，益不食，脾胃虚衰，四肢不
举，诸邪遂生，而成疳矣。轻者，用仁斋木香丸，重用取癖丸，痞结甚者，用圣思甘露散主之。
罗谦甫云∶一小儿病癖积在左胁下，硬如覆手，肚大青筋，发热肌瘦，咳嗽自汗，日晡尤
甚，牙疳口臭恶，宣露出血，四肢困倦，饮食减少，病甚危笃。太医刘仲安先生治之，约百
日可愈，先与沉香海金沙丸一服，下秽物两三行，次日合塌气丸服之，十日，复以沉香海金
砂丸利之，又令服塌气丸。如此五换，服至月余，其癖减半，及百日良愈。近年多有此疾，
愈之者多，录之以救将来之病者也。
（第十节）
仁斋说：痞，就是阻塞的意思。结，就是结实的意思。热气蕴积在胸膈之间，停饮聚集在腰胁之内，于是营气和卫气不能正常运行，脏腑之气不能宣通，腹部胀满而导致痞结，这是形势使然。这属于实热证，有时表现为高热。癖，是指血膜包裹水液，癖块偏侧于胁肋旁边，时常发作疼痛。只有癖才能引起潮热，才能产生寒热往来，所以疟疾的脉象和家中脘部多蓄积黄水，日久之后结成癖块，从而引发寒热症状。小儿脏腑功能平和，营卫调畅，那么津液自然流通，即使喝很多水浆，也不会致病。只有哺乳喂养不当，导致三焦关膈不通，致使水浆停滞在肠胃中，不能宣散运行，冷热相互搏结，于是积聚而形成癖块。
《脉诀》说：小儿脉象伏而结滞，是有形之物积聚。钱乙说：小儿脉象沉细，是癖积的表现。《脉经》说：脉象来势细弱且紧贴骨面，是有积滞的表现。
钱乙说：腹中有癖块而不进食，只肯吃奶，就是这样。应当逐渐使用白饼子攻下它。小儿患癖病是因为乳母食物不消化，潜伏在腹中，忽冷忽热类似疟疾，如果不早治疗必定会发展成疳积。因为有癖块导致孩子不吃东西，致使脾胃虚弱而发热，所以引饮过多，进而涤荡肠胃，流失津液，脾胃不能传输化生水谷，其脉象沉细，更加不吃东西，脾胃虚衰，四肢无力抬举，各种邪气随之产生，从而形成疳积。轻症者，使用仁斋木香丸，重用取癖丸；痞结严重的，用圣思甘露散主治。
罗谦甫说：有一个小儿患癖积在左胁下，硬得像倒扣的手掌，肚子大且有青筋暴露，发热肌肉消瘦，咳嗽自汗，傍晚时分尤其严重，牙龈腐烂口臭恶臭，牙齿松动出血，四肢困倦，饮食减少，病情非常危重。太医刘仲安先生治疗他，预计一百天可以痊愈，先给予沉香海金沙丸服用一次，排出秽物两三行，第二天合服塌气丸，十天后，再用沉香海金沙丸利导，又令服用塌气丸。如此交替五次，服药一个多月，癖块减半，等到一百天时完全痊愈。近年来多有这种疾病，治愈的人很多，记录下来以救治未来的病患。
(Section 10)
Ren Zhai stated: "Pi" (epigastric fullness/stuffiness) refers to obstruction. "Jie" (knotting/mass) refers to solidity. When hot qi accumulates between the chest and diaphragm, and retained fluids gather within the waist and hypochondrium, Ying Qi (nutritive energy) and Wei Qi (defensive energy) cannot circulate smoothly, and the zang-fu organs cannot be unblocked. Abdominal distension leads to Pi-Jie (stuffiness and knotting), which is a natural consequence of the pathological situation. This is a syndrome of excess heat, which may manifest as high fever. "Pi" (mass in the hypochondrium) refers to water wrapped in blood membranes, located laterally in the hypochondrium, causing intermittent pain. Only Pi can cause tidal fever and alternating chills and fever; thus, in malaria, the pulse often indicates fluid retention in the upper abdomen, which over time forms masses, leading to chills and fever. In children, when the zang-fu organs are harmonious and Ying-Wei circulation is smooth, body fluids flow naturally. Even if they drink large amounts of water or milk, it will not cause disease. However, improper breastfeeding can obstruct the San Jiao (Triple Burner) and gateways, causing fluids to stagnate in the stomach and intestines without dispersing. The struggle between cold and heat leads to accumulation and the formation of Pi masses.
The Mai Jue (Pulse Classic) states: "In children, a deep and knotted pulse indicates the aggregation of pathogenic matter." Qian Yi stated: "A deep and fine pulse in children indicates Pi Ji (accumulation due to Pi)." The Mai Jing (Classic of Pulse Diagnosis) states: "A pulse that is thin and adheres closely to the bone indicates an accumulation."
Qian Yi said: "When there is a Pi mass in the abdomen, the child refuses food but only accepts breast milk." One should gradually administer Bai Bing Zi (White Pill) to purge it. Children develop Pi because undigested food from the mother's diet lingers in the infant's abdomen, causing alternating chills and heat resembling malaria. If not treated early, it will inevitably develop into Gan Syndrome (infantile malnutrition). Because the Pi mass prevents eating, the Spleen and Stomach become deficient and generate fever, leading to excessive drinking. This purges the intestines and stomach, depletes body fluids, and impairs the Spleen and Stomach's ability to transform and transport food and fluids. The pulse becomes deep and fine, appetite decreases further, Spleen-Stomach deficiency worsens, limbs become weak and immobile, various pathogens arise, and Gan Syndrome ensues. For mild cases, Ren Zhai's Muxiang Wan (Costus Pill) is used; for severe cases, heavy doses of Qu Pi Wan (Remove Pi Pill) are employed. For severe Pi-Jie, Shengsi Ganlu San (Holy Thought Sweet Dew Powder) is the primary treatment.
Luo Qianfu recorded: A child suffered from Pi accumulation under the left hypochondrium, hard like an inverted hand, with a distended abdomen and visible blue veins, fever, emaciation, cough, spontaneous sweating, worsening in the late afternoon, foul breath, rotting gums, bleeding loose teeth, limb fatigue, and reduced appetite. The condition was critical. Imperial Physician Liu Zhong'an treated him, predicting recovery in about 100 days. First, he administered one dose of Chenxiang Haijinsha Wan (Agarwood and Lygodium Spore Pill), resulting in the passage of two or three stools of foul matter. The next day, he prescribed Taqi Wan (Collapse Qi Pill). After ten days, he again used Chenxiang Haijinsha Wan to promote drainage, followed by Taqi Wan. This regimen was alternated five times over more than a month, reducing the mass by half. By the hundredth day, the child had fully recovered. This disease has been common in recent years, with many cures achieved. It is recorded here to aid future practitioners.