bubble_chart Concept

Pediatric stuffiness mass refers to a palpable mass under the ribs, which may sometimes cause local pain.

In ancient medical texts, it is often referred to as "accumulation of pǐ." The "Zhubing Yuanhou Lun" calls it "pǐ," the "Youyou Jicheng" refers to it as "accumulation of pǐ," and the "Yizong Jinjian" calls it "pǐ disease." It is generally referred to as "stuffiness mass" or "stuffiness accumulation."

Stuffiness mass is a symptom of dysfunction in the spleen and stomach of children, similar to infantile malnutrition with accumulation in children and abdominal mass in adults. This article only discusses pediatric stuffiness mass; for masses caused by other diseases, please refer to the relevant entries.

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1. Spleen-Stomach Qi Deficiency︰There is stuffiness and lumps under the ribs, initially soft but gradually growing larger and harder, occasionally causing pain. There is reduced appetite and loose stools, or undigested food in the stool. The complexion is greenish-yellow, the tongue texture is pale and swollen with a white, slippery coating, and the pulse is deep, soggy, and weak. This is due to qi deficiency, often caused by excessive consumption of cold and cooling foods, which injures middle qi, leading to impaired water-dampness metabolism and the accumulation of phlegm-dampness. It manifests as signs of qi deficiency, such as reduced appetite, loose stools, fatigue, lack of strength, cold hands and feet, a swollen and pale tongue texture, and a deep, weak pulse.
2. Spleen-stomach Yin Deficiency︰Stuffy lumps under the armpits with intermittent pain, afternoon tidal fever, flushed cheeks, feverish feeling in palms and soles, irritability and startled crying, poor appetite and slow digestion, emaciation, dry stool and yellow urine, red tongue with scant coating, thready and rapid yet forceful pulse. This is due to yin deficiency, caused by Rebing damaging yin, where yin fluids are scorched by pathogenic heat, accumulating without dispersing. The key diagnostic points are: manifestations of yin deficiency with internal heat, such as feverish feeling in palms and soles, flushed cheeks, dry skin, red tongue with scant coating, thready and rapid pulse, etc. Therefore, in treatment, for qi deficiency, it is appropriate to tonify the spleen and stomach, eliminate dampness, and resolve stuffiness, using Extraordinary Efficacy Powder with modifications; for yin deficiency, it is appropriate to nourish the spleen and stomach, resolve stuffiness, and soften hardness, using Adenophora and Ophiopogon Decoction with additions such as prepared turtle carapace, Salvia, and oyster shell.
3. Chronic Malaria︰alternating chills and fever, vomiting yellow fluid, dizziness and physical fatigue, sallow complexion, abdominal distension and fullness, stuffiness and masses in the hypochondrium, tongue body pale and tender with red-crimson tip and edges, thin yellow greasy coating, wiry-slippery and rapid pulse. Due to stagnation of food and water congealing with dampness, impaired transportation and transformation of triple energizer qi movement, leading to binding of dampness with qi and blood. Youyou Jicheng stated: "Pi syndrome refers to water wrapped by blood membrane forming masses, with frequent hypochondriac pain, occasional tidal fever, or alternating chills and fever resembling malaria, hence malaria patients often exhibit this condition." The key diagnostic features are: alternating chills and fever, vomiting yellow fluid, dizziness, abdominal distension and fullness, wiry-slippery-rapid pulse. For debilitated patients, Xiaopi Wan should be selected to tonify spleen-stomach, regulating qi and resolving stasis; for robust patients, Hematite Aipi Wan should be used to soften hardness and dissipate masses, regulating qi and resolving stasis.

Stuffy masses are often caused by deficiency. Ancient prescriptions for treating masses often used Croton Fruit, nitre, and rhubarb for purgation, but this is not a common method. It may be used briefly at the onset for those with strong bodies and robust qi, but excessive purgation can damage spleen yang, leading to yang deficiency and qi sinking, which are difficult to treat. For stuffy masses caused by diet, it is advisable to regulate the spleen and stomach, supplemented by regulating qi and resolving stasis to eliminate the masses, or combined with Carthamus paste to invigorate blood, resolve stasis, soften hardness, and disperse the masses.

bubble_chart Documentation

1. 《Wai Zhi Mi Yao, Volume 12》: "When the five zang-organs are harmonized, the defense qi is regulated. When the defense qi is regulated, the body fluids flow smoothly. Even if one drinks a lot of water, it will not cause illness. If the nourishment is improper, the triple energizer becomes blocked. When the triple energizer is blocked, the intestines and stomach cannot function properly, and drinking water will cause stagnation and dispersion, leading to abdominal mass when encountering cold. A mass refers to a lump on the side between the two ribs, which sometimes causes pain."
2. Yizong Jinjian．Pediatrics Zabing Xinfa Yaojue．Mass Disease: "Mass disease results from overeating, causing the intestines and stomach to be full, with turbid fluids overflowing and being congealed by cold, leading to tidal fever, drinking cold, muscle wasting, thinness, abdominal distension and fullness, hard lumps, and a yellow-green complexion."