血之所积。因名曰积。积久而后发也。气之所聚。因名曰聚。聚散不常之意也。 者。坚也。坚则难破。
瘕者。假也。假血成形。 者。左右或有一条筋。脉拘急。大者。如臂。小者如指。如弦之状。故名曰 。
因气而成也。僻者。隐在两胁之间。时痛时止。故名曰癖。痰与气结也。名色虽多。而痞块二字。可以该之。
欲知治痞块之法。详察五积。其理自明。肝积居于左胁。大如覆杯。名曰肥气。久不愈令人发呃。 疟连岁不已。
心积居于脐下。上至心下。其大如臂。名曰伏梁。久不愈令人烦心。肺积居于右胁。大如覆杯。名曰息贲。久不愈
令人洒淅寒热。喘咳成痈。脾积在胃脘右侧。腹大如盘。名曰痞气。久不愈令人四肢不收。发为黄胆。斯四积者。
从何而生焉。盖因饮食不消。着于气怒。痰行过其处。必裹一层。血流过其处。必裹一层。痰血共裹之。则不能不
成块矣。但上部气多血少。不致活而成痞。治以化痰为主。而活血兼之。宜用消积二陈汤。若痛无形质。不时而发者。
非即癖。宜用柴胡疏肝散。至于肾积居于脐下。在女子多因血滞不行。男子多因食积所成。按之不移。
方为积病。因于血者。宜用加味柴物汤。因于食者。宜用二陈消食之剂。至
若活而成痞。千金保命丹。大有殊功。秦越人云。肾积居于脐下。上下无时。
有若江豚拜浪。名曰奔豚。久不愈令人喘急。骨痿少气。据此看来。又有积散不常之意。不可以积名也。此因下焦虚寒。
寒气从腰而入。自后冲前。所以小腹作痛。宜用桂枝独活汤。温经散邪为主。不用大补。内经云。凡治积
块。衰其大半而止。块去须大补。若必欲攻之无余。多致积散成臌。至于脾气大虚。神思倦怠者。当以大补元气为主。
正气盛则邪气自退。此不易之法也。内热不受补者。脉来弦数者。极为危笃难医。虽然积块固属实症。倘
按之无形。多因七情气滞。肠中汁沫。与气相抟。故作痛也。亦用加减柴物汤。
消积二陈汤
陈皮 半夏 白茯 甘草 杏仁 枳实 玄明粉 石菖蒲 归尾 赤芍
内热加黄芩。有滞加浓朴。痛甚加莪术。
柴胡疏肝散
柴胡 黄芩 半夏 甘草 陈皮 白茯 白芍 香附 枳壳 玄胡
内热。加山栀。
加味柴物汤
柴胡 黄芩 半夏 甘草 当归 川芎 白芍 熟地 香附 玄胡
桂枝茯苓汤
陈皮 半夏 白茯 甘草 香附 桂枝 细辛 独活
肾积奔豚。乃寒气从腰眼而入。肠中汁沫凝聚作痛。故用二陈以行汁沫。桂辛独活以散外邪。不可妄补。
Accumulation of blood is called "Ji" (Accumulation), referring to a condition that manifests after a long period of stagnation. Gathering of qi is called "Ju" (Gathering), referring to the irregular nature of gathering and dispersing. "Zheng" (Mass) implies hardness; being hard makes it difficult to break down.
"Jia" (Fluctuating Mass) implies something false or temporary, taking shape by borrowing blood. "Pi" (Nip) refers to a tendon on either side that may become spasmodic; when large, it resembles an arm, and when small, a finger, shaped like a string, hence named "Pi". This arises from qi stagnation. "Pi" (Hidden Mass) hides between the two hypochondria, causing intermittent pain, hence named "Pi". This is due to the knotting of phlegm and qi. Although there are many names, the term "Pi Ku" (Stagnant Masses) can encompass them all.
To understand the treatment of Pi Ku, one must examine the Five Accumulations in detail, and the principles will become clear. The Liver Accumulation is located in the left hypochondrium, as large as an inverted cup, named "Fei Qi" (Fat Qi). If not cured for a long time, it causes hiccups and malaria-like symptoms persisting for years. The Heart Accumulation is located below the umbilicus, extending up to the epigastrium, as large as an arm, named "Fu Liang" (Hidden Beam). If not cured for a long time, it causes mental restlessness. The Lung Accumulation is located in the right hypochondrium, as large as an inverted cup, named "Xi Ben" (Panting Burden). If not cured for a long time, it causes chills and fever, wheezing, coughing, and even lung abscesses. The Spleen Accumulation is located on the right side of the epigastrium, with the abdomen enlarged like a plate, named "Pi Qi" (Stagnant Qi). If not cured for a long time, it causes weakness of the four limbs and jaundice. How do these four accumulations arise? They generally stem from undigested food adhering to emotional anger. When phlegm flows through this area, it wraps around once; when blood flows through, it also wraps around once. The joint wrapping of phlegm and blood inevitably forms a mass. However, the upper body has more qi and less blood, so it does not easily form active masses. Treatment focuses on resolving phlegm while promoting blood circulation, suitable for using Xiao Ji Er Chen Tang (Eliminate Accumulation Two-Chen Decoction). If the pain lacks fixed form and occurs intermittently, it is not an immediate Pi mass; Chai Hu Shu Gan San (Bupleurum Powder to Soothe the Liver) is suitable. As for the Kidney Accumulation located below the umbilicus, in women it is often due to stagnant blood flow, and in men, due to food stagnation. If it cannot be moved upon palpation, it is considered an accumulation disease. If caused by blood, Jia Wei Chai Wu Tang (Modified Bupleurum and Magnolia Decoction) is suitable; if caused by food, Er Chen Tang modifications for digesting food are suitable. For masses formed by active blood stasis, Qianjin Baoming Dan (Thousand-Guard-Life Pill) has great efficacy. Qin Yueren stated: The Kidney Accumulation is located below the umbilicus, moving up and down without fixed timing, resembling a river porpoise leaping waves, named "Ben Tun" (Rushing Pig). If not cured for a long time, it causes rapid breathing, bone atrophy, and shortness of breath. Based on this, it also has the characteristic of irregular accumulation and dispersal, and should not be strictly called "Ji". This is due to deficiency-cold in the lower jiao, where cold qi enters from the waist and rushes forward from behind, causing lower abdominal pain. Gui Zhi Du Huo Tang (Cinnamon Twig and Angelica Pubescens Decoction) is suitable, focusing on warming meridians and dispelling pathogens, without heavy tonification. The Nei Jing states: In treating accumulation masses, stop attacking when half the disease is gone, and heavily tonify after the mass is removed. If one insists on eliminating everything, it often leads to the dispersion of the mass into drum distension. For those with severe Spleen qi deficiency and mental fatigue, the primary treatment should be heavily tonifying primordial qi; when righteous qi is strong, pathogenic qi naturally retreats. This is an unchangeable principle. Those with internal heat who cannot tolerate tonification, or whose pulse is wiry and rapid, are in a critical and difficult-to-treat state. Although accumulation masses are indeed excess conditions, if they feel formless upon palpation, it is often due to qi stagnation from seven emotions, where intestinal fluids and qi struggle against each other, causing pain. Jia Jian Chai Wu Tang (Modified Bupleurum and Magnolia Decoction) is also used.
Xiao Ji Er Chen Tang (Eliminate Accumulation Two-Chen Decoction)
Chen Pi (Aged Tangerine Peel), Ban Xia (Pinellia Rhizome), Bai Fu Ling (Poria), Gan Cao (Licorice Root), Xing Ren (Apricot Seed), Zhi Shi (Immature Bitter Orange), Xuan Ming Fen (Mirabilite), Shi Chang Pu (Acorus Rhizome), Gui Wei (Tangerine Root End), Chi Shao (Red Peony Root).
Add Huang Qin (Scutellaria Root) for internal heat; add Hou Po (Magnolia Bark) for stagnation; add E Zhu (Curcuma Zedoaria Rhizome) for severe pain.
Chai Hu Shu Gan San (Bupleurum Powder to Soothe the Liver)
Chai Hu (Bupleurum Root), Huang Qin (Scutellaria Root), Ban Xia (Pinellia Rhizome), Gan Cao (Licorice Root), Chen Pi (Aged Tangerine Peel), Bai Fu Ling (Poria), Bai Shao (White Peony Root), Xiang Fu (Cyperus Rhizome), Zhi Ke (Aurantium Fruit), Xuan Hu (Corydalis Rhizome).
For internal heat, add Shan Zhi (Gardenia Fruit).
Jia Wei Chai Wu Tang (Modified Bupleurum and Magnolia Decoction)
Chai Hu (Bupleurum Root), Huang Qin (Scutellaria Root), Ban Xia (Pinellia Rhizome), Gan Cao (Licorice Root), Dang Gui (Angelica Sinensis Root), Chuan Xiong (Ligusticum Rhizome), Bai Shao (White Peony Root), Shu Di (Prepared Rehmannia Root), Xiang Fu (Cyperus Rhizome), Xuan Hu (Corydalis Rhizome).
Gui Zhi Fu Ling Tang (Cinnamon Twig and Poria Pill Decoction - *Note: Formula composition listed differs from standard Gui Zhi Fu Ling Tang*)
Chen Pi (Aged Tangerine Peel), Ban Xia (Pinellia Rhizome), Bai Fu Ling (Poria), Gan Cao (Licorice Root), Xiang Fu (Cyperus Rhizome), Gui Zhi (Cinnamon Twig), Xi Xin (Asarum Root), Du Huo (Angelica Pubescens Root).
Kidney Accumulation Ben Tun arises from cold qi entering from the waist eyes, causing intestinal fluids to condense and produce pain. Therefore, Er Chen Tang is used to move the fluids, and Gui Zhi, Xi Xin, and Du Huo are used to disperse external pathogens. Blind tonification should be avoided.