Nov 15 2008
痞
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Whether you call it epigastic focal distention, glomus, an indistinct feeling of discomfort in the chest, or any of the other various ways that we try to translate 痞 in English, this term seems to have a slippery and elusive meaning.
Often doctors in China will say this is a feeling on the part of the patient, while Japanese practitioners with their habit of abdominal palpation will say it is a feeling the hands of the practitioner can discern.
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In the Ban Xia Xie Xin Tang chapter of The Ten Major Formula Families, Doctor Huang has this to say:
Epigastric focal distention is a subjective feeling on the part of the patient where there is a feeling of discomfort or pain in the upper abdominal region; epigastric focal distention with firmness includes the afore mentioned subjective feelings on the part of the patient, plus a palpable feeling of firmness on the part of the practitioner.
I suspect that 痞 (pi) is one of those terms, that much like phlegm itself, that can be slippery and the cause of all kinds of distortion. There are terms in Chinese medicine which are more like puzzles, than answers. While I would not suggest that Doctor Huang has the definative answer to this particular question, his point of view does give us some guidelines to pay attention to in our own clinical practice. From that we can form our own ideas about what constitutes 痞, and how to treat it.
5 responses so far
I have follow Master Huanghuang 黄煌教授 for some years, and he always stress that pi 痞，is a subjective feeling of the patients epigastria, as the Meiheqi 梅核气 this feeling of discomfort is emotional related, the only one difference is that one is up in the throat and the other is in the epigastria, so this is why you use banxia 半夏( banxia , commands the pharynx and larynx; the central part of the chest, the esophagus，and trachea 咽喉). From the 痞 character we can see, that it is form by 3 parts, the root that means disease, bu 不 that is a negation，and kou 口 that means mouth, so this is about someone who maybe don’t want to eat, or don’t want to speak, someone that have maybe some emotional troubles and he reflects it in the epigastria, it’s meaning can’t be clear because every patient emotion reaction is different and the subjective feeling in the epigastria will be different also, so this is why Pi 痞 is a not clear concept, chinese will call it mohugainian 模糊概念 .
Hi Tino
痞 (pi) is one of those really tricky concepts, and I always enjoy hearing other people’s idea about this as it is one of those things in Chinese medicine that it seems almost everyone disagrees on. Many Japanese practitioners think that pi is something the practitioner feels when they palpate. In Huang’s book The 10 Key Formulas in Chinese Medicine (中醫十大類方) he says it could be a feeling on either the part of the practitioner or patient.
Lately I have been reading 傷寒論求是, by Chen Yi Ren (陳亦人). He has some excellent discussions about pi, and goes into how it can be a cold presentation, a hot presentation, that it can be due to both deficiency and excess. Good stuff there. In fact, watch for an update here on classicformulas.com in the near future that will go into more depth on the issue.
In Nanjing TCM University we use that book as a text book for some classes they called Shanghanlun II, is was Chenyiren himself who teaches this classes till 1998 . Chenyiren’s 陳亦人 book talks about cold or heat, deficiency or excess, you can find that in many books, since they discusses this from the formula point of view, you get huanglian, ganjiang, renshen 黃連 乾薑 人參 in a formula, something that Zhangji 张机 use a lot, some of the Xiexintang group 瀉心湯證 have this combination, or huanglian banxia黃連 半夏, that is another combination that he use, in Xiexintang group, or in Xiaoxianxiongtang 小陷胸湯.
About the Meiheqi 梅核氣and Xinxiapi心下痞, relation, everyone knows about the function of Banxia 半夏 of treating any disturbance in the throat in Banxiahouputang 半夏厚朴湯，but banxia半夏effect goes till the epigastric zone, in fact in Shennongbencaojing《神农本草经》says that banxia 半夏 “主…心下坚” that I think means “treat hardness in the epigastric zone”, something that looks like pi syndrome 痞证. So this is why I think that Meiheqi and Pi syndrome is related with emotional issues, two zones, same origin 异位同因.
My English is not very good(My mother language is spanish), I’m truly very sorry for that.
tino
149,150,151,152,153,154, 155,156, 157,158,159,161,163,166
this are the shanghanlun chapters related to Pi syndrome.
tino
huanglian黄连 ， is the other herb that is use often in the Pi syndrome
. Master Huanghuang 黄煌老师, in the syndrome of the herb 药证, includes Pi syndrome as a syndrome of huanglian, ban xia and huanglian are a very beauty combination, both can be use for pathologies due to emotional syndromes, use for heat restless, and pi syndrome with epigastrical pain. I used a lot Xiaoxianxiongtang, with good results in patients that suffer from chronic fatigue syndrome, most of this patients feels dry eyes, restless, Pi syndrome, feels tired, insomnia etc.