积者，推之不移，成于五脏，多属血病；聚者，推之则移，成于六腑，多属气病。治积
聚者，当按初、中、末之三法焉。邪气初客，积聚未坚，宜直消之，而后和之。若积聚日久
邪盛正虚，法从中治，须以补泻相兼为用。若块消及半，便从末治，即住攻击之药，但和
中养胃，导达经脉，俾荣卫流通，而块自消矣。更有虚人患积者，必先补其虚，理其脾，增
其饮食，然后用药攻其积，斯为善治，此先补后攻之法也。初治，太无神功散主之；中治，
和中丸主之；末治，理中汤主之。予尝以此三法，互相为用，往往有功。
治痞积，不拘气血饮食，虫积痰水，皆效。
地 蓄 瞿麦穗 大麦芽（各五钱） 神曲（二钱五分） 沉香 木香（各一钱五分） 甘草（炙，五
钱） 大黄（酒蒸，二两
上为细末。每服二、三钱，灯心、竹叶煎汤，及无灰酒调服。女以灯心、红花、当归煎
汤，及无灰酒送下。忌油腻、动气之物，及房室一月。药须黄昏服，勿食晚饭，大小便见恶
和中丸 （见鼓胀）
书云∶肝之积，在左胁下，名曰肥气，加柴胡、鳖甲、青皮、莪术。
肺之积，在右胁下，名曰息贲，加白蔻仁、桑白皮、郁金。心之积，起脐上，上至心下，大
如臂，名曰伏梁，加石菖蒲、浓朴、红花、莪术。脾之积，在胃脘，腹大如盘，名曰痞气，
加浓朴。肾之积，在脐下，发于小腹，上冲心而痛，名曰奔豚，别用奔豚丸主之。热积，加
黄连、黄芩。寒积，加肉桂、干姜、附子。酒积、加葛根。痰积，加半夏。水积，加桑白皮
、赤小豆。血积，加桃仁、红花、干漆。肉积，加阿魏、山楂。
Accumulation (Ji) is characterized by a mass that cannot be moved by pushing, originates from the Zang organs, and mostly belongs to blood disorders; Gathering (Ju) is characterized by a mass that can be moved by pushing, originates from the Fu organs, and mostly belongs to Qi disorders. In treating Accumulation and Gathering, one should apply three methods corresponding to the initial, middle, and terminal stages. When pathogenic factors first invade and the accumulation/gathering has not yet become firm, it is appropriate to directly eliminate it, followed by harmonizing the body. If the accumulation/gathering has persisted for a long time, with excess pathogens and deficient healthy Qi, treatment should follow the middle-stage approach, requiring the combined use of tonification and purgation. If the mass has reduced by half, treatment should proceed to the terminal stage: cease using attacking drugs, focus only on harmonizing the Middle Jiao and nourishing the Stomach, and guide the meridians so that Ying and Wei Qi circulate freely, allowing the mass to dissolve naturally. Furthermore, in patients with deficiency who suffer from accumulation, one must first tonify their deficiency, regulate the Spleen, increase dietary intake, and then use medication to attack the accumulation; this constitutes good treatment, known as the method of tonifying first and attacking later. For the initial stage, Taiwu Shengong San is the primary formula; for the middle stage, Hezhong Wan is the primary formula; for the terminal stage, Lizhong Tang is the primary formula. I have often used these three methods in conjunction with each other, frequently achieving efficacy.
This prescription is effective for treating Pi accumulation (痞积), regardless of whether it is caused by Qi, Blood, food stagnation, parasitic accumulation, phlegm, or fluid retention.
Di Fu Zi (Kochia Scopariae Fructus), Xu Zhong (Polygoni Avicularis Herba), Qu Mai Sui (Dianthi Caulis et Flos), Da Mai Ya (Hordei Fructus Germinatus) (each 5 qian), Shen Qu (Medicated Leaven) (2.5 qian), Chen Xiang (Aquilariae Lignum Resinatum), Mu Xiang (Aucklandiae Radix) (each 1.5 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) (5 qian), Da Huang (Rhei Radix et Rhizoma, steamed with wine) (2 liang).
Grind the above ingredients into a fine powder. Take 2–3 qian per dose, mixed with decoction of Deng Xin Cao (Junci Medullia) and Zhu Ye (Bambusae Folium) and Wu Hui Jiu (unadulterated liquor). For female patients, take with decoction of Deng Xin Cao, Hong Hua (Carthami Flos), Dang Gui (Angelicae Sinensis Radix) and Wu Hui Jiu. Avoid greasy foods, Qi-aggravating substances, and sexual intercourse for one month. The medicine should be taken at dusk, without eating dinner, until foul matter is discharged via stool or urine.
Hezhong Wan (See Drum Distension chapter)
Medical texts state: The accumulation of the Liver is located under the left hypochondrium, named Fei Qi (肥气); add Chai Hu (Bupleuri Radix), Bie Jia (Testudinis Carapax et Plastrum), Qing Pi (Citri Reticulatae Pericarpium Viride), E Zhu (Curcumae Rhizoma).
The accumulation of the Lung is located under the right hypochondrium, named Xi Ben (息贲); add Bai Kou Ren (Amomi Fructus Rotundus), Sang Bai Pi (Mori Cortex), Yu Jin (Curcumae Longae Radix).
The accumulation of the Heart arises above the umbilicus, extending upward to below the heart, large as an arm, named Fu Liang (伏梁); add Shi Chang Pu (Acori Tatarinowii Rhizoma), Hou Po (Magnoliae Officinalis Cortex), Hong Hua (Carthami Flos), E Zhu (Curcumae Rhizoma).
The accumulation of the Spleen is in the epigastrium, with the abdomen distended like a plate, named Pi Qi (痞气); add Hou Po (Magnoliae Officinalis Cortex).
The accumulation of the Kidney is below the umbilicus, originating in the lower abdomen, rushing upward to the heart causing pain, named Ben Tun (奔豚); treat separately with Ben Tun Wan.
For Heat accumulation, add Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix).
For Cold accumulation, add Rou Gui (Cinnamomi Cortex), Gan Jiang (Zingiberis Rhizoma), Fu Zi (Aconiti Lateralis Radix Praeparata).
For Wine accumulation, add Ge Gen (Puerariae Lobatae Radix).
For Phlegm accumulation, add Ban Xia (Pinelliae Rhizoma).
For Water accumulation, add Sang Bai Pi (Mori Cortex), Chi Xiao Dou (Vigna Semen Rubrum).
For Blood accumulation, add Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Gan Qi (Meliloti Herba processed with lime? Note: Gan Qi usually refers to Dried Melilotus or similar, but contextually often implies specific blood-breaking agents; here kept as Gan Qi). *Correction*: Gan Qi (干漆) is Dry Lacquer.
For Meat accumulation, add A Wei (Asini Corii Colla), Shan Zha (Crataegi Fructus).