Engin CAN 张恩勤&Ming Zhao CHENG程明钊

（Everwell Chinese Medical Centre & Middlesex University）

Pi syndrome痞证 is an old medical term in ancient China. Basically there are 2 kinds of Pi syndrome  in TCM （Traditional Chinese Medicine）: The first category is termed as “Spleen Ji 脾积”which refers to one of the 5 kinds of Ji syndrome and manifests as hepatomegaly or splenomegaly, or lump or tumor or cancer  in the abdomen caused by pathogenic accumulation due to deficiency of the spleen, recorded in the chapter - Problem 56 of the book “Nanjing ” ( Classic on Medical Problems, an important TCM classic which appeared around the Qin and Han Dynasties ,with its authorship ascribed to Dr Qin Yueren) ; The second category that we are talking about today is Pi syndrome 痞证, described in the book “ Shanghan Lun” ( Treatise on Febrile Diseases Caused by Cold, originally it was a part of the  book “Shanghan Zabing Lun” /Treatise on Febrile and Miscellaneous Diseases, written by Dr Zhang Ji in the Han Dynasty). 

However, in “Shanghan Lun” the etiology and characteristic of Pi syndrome is quite different from those in “Nanjing”, it refers to a syndrome marked by stuffiness, fullness and discomfort in the epigastrium, and painlessness and softness by pressing. For example, in Clause 151of “Shanghan Lun”, it says that “after the adoption of purgative to the case with a pulse of floating and tense, the pulse changes to deep and tense, and stuffiness and fullness is taking shape in the epigastrium. When it is pressed, the stuffiness is soft. Therefore it is kind of Qi(gaseous) Pi syndrome”. From the above clause 151, we can understand that the cause of Pi syndrome in “Shanghan Lun” is mostly caused by incorrect application of purgative; and main symptoms and signs are stuffiness, fullness and discomfort in the epigastrium, marked by painlessness and softness if pressing. Furthermore, in “Shanghan Lun” there are 4 main kinds of gaseous Pi syndrome:

1. Heat Pi Syndrome

It is described in Clause 154, “Symptoms and signs of stuffiness & fullness in the epigastrium, softness if pressing, and floating pulse up the Guan position, Dahuang Huanglian Xiexin Decoction should be chiefly used.” It is also recorded in Clause 164 that says “After a purgative has been used, diaphoresis is adopted again to the Shanghan syndrome .Consequently the patient gets chills and has stuffiness & fullness in the epigastrium. This indicates that the exterior syndrome is not over. Before the exterior is over, Pi syndrome should not be treated. To dispel the exterior syndrome with Guizhi Decoction; and then treat Pi syndrome with Dahuang Huanglian Xiexin Decoction”. The Dahuang Huanglian Xiexin Decoction consists of 3 herbs, including Dahuang (Radix et Rhizoma Rhei)6g, Huanglian (Rhizoma Coptidis)3g, Huangqin (Radix Scutellariae)3g.All the above herbs, bitter in taste, and cold in nature, put together, are good at clearing and purging pathogenic heat from the epigastrium to relieve stuffiness &fullness in the upper abdomen. Here we should also mention of that 3 herbs in the Dahuang Huanglian Xiexin Decoction are not to be decocted, just soaked in the boiling water for a while, then remove dregs and drink the “tea”. According to our experiences, this formula is really effective for treatments of stuffiness and fullness in the upper abdomen caused by IBS ,superficial gastritis, gastrotympanites, gastroparesis, etc.

2. Pi Syndrome due to Coexistence of Deficiency and Excess

This syndrome is detailed in Clause 149, saying that “Febrile disease for 5-6 days, symptoms of nausea, vomit and fever will be adequate proof，which suitable for Chaihu Decoction. When a dose of purgative is adopted, if Chaihu Decoction syndrome still exists, it is not an adverse case. The therapy will be dose of Chaihu Decoction. After taking the decoction, the patient will recover after he has had a fever and perspiration after shivering .In case the patient has fullness, pain and tenderness at the epigastrium, it is “Jie Xiong Syndrome” (obstruction in the chest syndrome) ,and Big Xian Xiong Decoction will be a remedy. If there is only stuffiness &fullness without pain at the epigastrium ,it is a Pi Syndrome ,Chaihu Decoction is not convenient for the case, and Banxia Xiexin Decoction will serve as a remedy ”; This type of Pi syndrome is also recorded in the Chapter 17 On Vomit, Nausea and Diarrhea in the book “ Jin Kui Yao Lue ” (Synopsis of Prescriptions of the Golden Chamber , originally another part of the  book “Shanghan Zabing Lun”/Treatise of Febrile and Miscellaneous Diseases ), saying that “ Vomiting and borborygmus, accompanied by Pi Syndrome, Banxia Xiexin Decoction should be used”. The Banxia Xiexin Decoction consists of Banxia ( Rhizoma Pinelliae) 12g., Huangqin ( Radix Scutellariae) 9g., Ganjiang (Rhizoma Zingiberis)9g., Renshen (Radix Ginseng)9g., Huanglian ( Rhizoma Coptidis) 3g., Dazao (Fructus Ziziphi Jujubae)4 pcs., and Zhigancao (Radix Glycyrrhizae)9g. All the above herbs should be  decocted in water for oral use .Clinically we often use Banxia Xiexin Decoction to treat acute and chronic gastritis, duodenal stasis, IBS , gastroneurosis, vomiting of pregnancy and other conditions marked by the Pi syndrome . Additionally, there are other 2 kinds of Pi syndrome similar to the Banxia Xiexin Decoction syndrome, one of them is “Shengjiang Xiexin Decoction Syndrome”, described in Clause 157, i.e. to reduce the dosage of Ganjiang (Rhizoma Zingiberis) to 3g. and add 12 gram of Shengjiang(Rhizoma Zingiberis Recens) into the Banxia Xiexin Decoction , it will be  renamed “ Shengjiang Xiexin Decoction” that  is for Pi syndrome marked by belching with a smell of indigestion, diarrhea and borborygmus duo to water –fluid accumulation” ; and there is another one called “Gancao Xiexin Decoction syndrome ” , recorded  in Clause 158 ,i.e. to increase the dosage of Gancao(Radix Glycyrrhizae) in the Banxia Xiexin Decoction to 12g., it will be renamed “Gancao Xiexin Decoction” that is for the treatment of Pi syndrome marked by stuffiness and fullness in the epigastrium, nausea , vomiting, hiccup and belching with acid regurgitation ,dyspepsia, diarrhea and increased gurgling sound due to severe damage of the stomach-qi.

3. Pi Syndrome due to Accumulation of Phlegm

This kind of Pi syndrome manifests as stuffy and blocked sensation in epigastrium, continuous belching, nausea or vomit , detailed in Clause 161, saying that “ After the adoption of a diaphoretic, emetic or purgative to Shanghan syndrome , the patient will suffer stuffiness and blocked sensation at epigastrium and continuous belching when exterior syndrome has already gone. Xuanfu Daizhe Decoction should be used as a remedy”. Xuanfu Daizhe Decoction consists of Xuanfuhua (Flos Inulae) 9g. (wrapped with a piece of close while decocted), Daizheshi (Ochra Haematitum)3g., Renshen ( Radix Ginseng)6g,. Shengjiang ( Rhizoma Zingiberis Recens) 15g., Zhigancao(Radix Glycyrrhizae Praeparatae)9g.,Banxia ( Rhizoma Pinelliae) 9g., Dazao ( Fructus Ziziphi Jujubae)4 pcs. All the herbs should be decocted in water for oral use. Today we often apply this formula to treat belching or hiccup due to deficiency of stomach and phlegm retention caused by IBS, gastritis, gastric dilatation, incomplete pylorochesis and neurotic hiccup.

4. Pi Syndrome due to Accumulation of Water-fluid

This kind of syndrome manifests as stuffiness & fullness in the epigastrium, dysuria, restlessness and thirst caused by accumulation of pathogenic water-fluid due to dysfunction of the urinary bladder and “Sanjiao”, described in Clause 156, saying that “ When the stuffiness &fullness in the epigastrium is caused by the adoption of purgative, Xiexin Decoction will no longer be convenient. It is suitable for Wuling Powder to treat following symptoms and signs such as restlessness, thirst, a parched throat and dysuria. Wuling Powder consists of Zhuling ( Polyporus) 9g., Zexie ( Rhizoma Alismatis) 15g., Baizhu ( Rhizoma Atractylodis) 9g., Fuling ( Poria) 9g., Guizhi ( Ramulus Cinnamomi) 6g.. All the above ingredients should be ground into fine powder, to be taken 6 g. each time, 3 times a day; or decocted in water for oral use. Clinically it is applicable to many conditions today, such as retention of gastric juice, or edema caused by nephritis, cirrhosis, or uroschesis, hydrocephalus, hey fever, etc.

Summery:

Basically there are 4 kinds of Pi syndrome in “Shanghan Lun”. The main formulas for treating Pi syndromes are Dahuang Huanglian Xiexin Decoction, Banxia Xiexin Decoction and other 2 modified formulas (Shengjiang Xiexin Decoction and Gancao Xiexin Decoction) , and Wuling  Powder .Today we use the above formulas not only for Pi syndromes ,but also for many  different conditions such as IBS, gastritis, etc.

About Authors:

Prof Engin CAN (Enqin Zhang), a senior specialist & professor in Chinese Medicine &“Shanghan Lun” and the full member of ATCM, the UK. From 1985-1991 he was director of Advanced Studies Dept of Shangdong TCM University as well as chief editor & author of the first English-Chinese TCM textbooks in the world-“A Practical English-Chinese Library of TCM”, composed of 14 books, published by Shanghai TCM University Press in 1990.Today he is the manager & chief doctor of Everwell Chinese Medical Centre London Branch 7. For further information, please check Google “Enqin Zhang”; E-mail: prof.engincan@hotmail.co.uk

Dr Ming Zhao Cheng is a senior lecture and postgraduate program leader on Chinese Medicine in the Middlesex University as well as Deputy President of ATCM, the UK. Today he is a leading TCM educationist and practitioner in the UK and Europe.

References:

1. Li P and Liu D 1985 Textbook  of Shanghan Lun伤寒论讲义 Shanghai Science and Technology Press

2. Huang H 2005 Introduction To Treatise on Exogenous Febrile Diseases 伤寒论入门 Shanghai TCM University Press

3. Ruan J and Zhang G 2003 Chinese –English Textbook –Synopsis of Prescriptions of the Golden Chamber 汉英对照金匮要略 Shanghai Science and Technology Press