Piji Wan for Treating Stomach Pain and Acid Regurgitation

In the Southern Song physician Yang Shiying's Renzai Zhifang Lun (Discriminating Treatments for Benevolent Companions), there is a formula called "Piji Wan" (Spleen Accumulation Pills). Its composition is as follows: Peng'ezhu (Rhizoma Curcumae, i.e., Ezhu) 3 liang (90 g), Jing Sanleng (Rhizoma Sparganii, i.e., Sanleng) 2 liang (60 g), Gaoliangjiang (Rhizoma Alpiniae Officinarum) 5 qian (15 g—boil dry with 1 sheng of vinegar in a porcelain bottle, cut up while hot, and bake dry), Qingpi (Pericarpium Citri Reticulatae Viride, white removed) 1 liang (30 g), Nanmuxiang (Radix Aucklandiae, i.e., Muxiang) 5 qian (15 g), 3 large uninflected Zaojiao (Fructus Gleditsiae, charred to retain nature), and Baicaoshuang (soot from the bottom of a rural stove, i.e., fine wood ash) 2 qian (10 g).

Powder all the above herbs finely. Take 5 qian (15 g) of Badou (Fructus Crotonis, shell removed) and grind into a paste; gradually mix in the herb powder until evenly blended, then make pills with a flour paste, the size of a hemp seed (about 3 mm in diameter). Take 5-10 pills each time, washed down with Chenpi (Pericarpium Citri Reticulatae) decoction, twice daily.

The main action of this formula is to resolve accumulation and move stagnation. It is indicated for stagnation of undigested food with abdominal distending pain and fullness, nausea and vomiting, acid regurgitation, and constipation. The above symptoms are mostly seen in hyperacidity. Hyperacidity has many causes; gastritis, gastric ulcer, and gastroesophageal reflux disease can all cause it.

Both Sanleng and Ezhu in this formula belong to the TCM category of herbs that break qi and move blood, dissipate accumulation and relieve pain; they are also commonly used antitumor herbs. TCM treatment of gastric pain generally does not use such harsh herbs, but refractory gastric distension and pain require these two. Gaoliangjiang warms the stomach and relieves pain, while also promoting digestion. Qingpi and Muxiang are qi-regulating, pain-relieving herbs. Zaojiao resolves phlegm and scatters nodules, but this herb has a strong hemolytic effect, so patients with bleeding tendency are strictly forbidden from using it. Badou is a laxative that helps expel gastrointestinal contents. Baicaoshuang mainly stops bleeding and resolves accumulation; here it both resolves accumulation and prevents gastric bleeding from excessive blood-activating herbs.

Piji Wan has no ready-made patent medicine for sale; patients can prepare it themselves according to the original formula. Piji Wan is best prepared as pills, because the side effects of Zaojiao and Badou in this formula are strong, and controlling the dosage is difficult when taken as a decoction. If the patient develops diarrhea after taking Piji Wan, it should be stopped, or the Badou should be removed.

This formula has some antitumor and gastric-pain-relieving effects and may be used as adjunctive therapy for esophageal, gastric, and liver cancers and other gastrointestinal tumors, with some effect in relieving corresponding symptoms.