Library

[Zhu Danxi] Qi cannot form tangible accumulations; accumulations are tangible entities formed by the aggregation of phlegm, food retention, and dead blood. It is appropriate to use sea coral (Hai Shi) boiled in vinegar, San Leng and E Zhu processed with vinegar, Tao Ren, Hong Hua, Wu Ling Zhi, Xiang Fu, and similar herbs, administered with Shi Jian Bai Zhu Tang. Va Le Zi (Argopecten irradians shell) can eliminate blood masses and also resolve phlegm. When treating accumulations, one should clear fire and resolve food retention. (Food retention is essentially phlegm.) To move dead blood, after the blood mass is removed, a substantial tonification is required.

Shi Jian (Stone Alkali) can be used for phlegm accumulations forming masses; it cleanses greasy filth and resolves food retention. If the mass is located between the skin and fascia, qi-tonifying and aromatic opening herbs must be used, combined with Er Chen Tang plus qi-tonifying herbs. First, rich and heavy flavors must be avoided. In cases of accumulation diseases, purgatives should not be used, as they merely damage true qi without resolving the disease. Instead, herbs that dissolve accumulations should be used to melt and disperse them until they vanish naturally.

[Li Dongyuan] The essential method for treating accumulations: Xu Xueshi stated that generally, accumulations are treated by attacking what the pathogen dislikes or enticing it with what it likes, making recovery easier. For example, Nao Sha (Sal Ammoniac) and Shui Yin (Mercury) treat flesh accumulations; Shen Qu (Medicated Leaven) and Mai Ya (Malt) treat wine accumulations; Shui Zhi (Leech) and Meng Chong (Blue Bottle Fly larva) treat blood accumulations; Mu Xiang (Aucklandia Root) and Bing Lang (Areca Seed) treat qi accumulations; Qian Niu Zi (Pharbitis Seed) and Gan Suan (Kansui Root) treat water accumulations; Xiong Huang (Realgar) and Ni Fen (Calomel) treat phlegm accumulations; Meng Shi (Quercus Galla) and Ba Dou (Croton Seed) treat food accumulations, each treating according to its category. Using large groups of medicines to scatter their momentum makes efficacy difficult to achieve. One must clearly identify the type of accumulation and accompanying syndromes before adding assistant and guiding herbs. Otherwise, harm may result; flexibility is key. When treating accumulations, observe the site of pain to determine excess or deficiency, knowing when to tonify or drain, without violating seasonal timing, and carefully distinguishing the location of zang-fu organs. Cold is treated with heat; stagnation is dispersed; external pathogens are eliminated; retained substances are moved; hardness is reduced; excess is depleted; salty substances soften hardness; bitter substances purge. Herbs that preserve true qi are used for tonification, moving according to the accumulated substance. Regulate diet, be cautious with daily activities, and harmonize interior and exterior to ensure cure. Otherwise, suddenly using highly toxic drugs to attack will fail to remove the accumulation and instead damage righteous qi, making recovery difficult. Can physicians not be cautious?

All accumulations originate from emotional injuries (anger and joy) damaging the zang organs leading to yin deficiency. Once yin is deficient, wind and rain invade this deficiency; pathology arising from above leads to accumulation; clear dampness invading yin deficiency leads to accumulation below. (See detailed acupuncture sections.)

[Zhang Jiegu] Robust individuals do not have accumulations; only deficient individuals do. This is due to weak spleen and stomach, dual deficiency of qi and blood, and seasonal pathogenic influences, all capable of forming accumulations. If one suddenly uses hard-resolving and knot-breaking drugs, the disease may seem to recede while the person becomes weakened. Drugs like Gan Xi (Dried Lacquer), Nao Sha, San Leng, Qian Niu Zi, and Da Huang provide temporary relief but leave the condition unchanged afterward, further depleting qi and enlarging the disease, yielding no benefit. Therefore, skilled practitioners first tonify deficiency to strengthen qi and blood, allowing the accumulation to dissipate naturally, just as if the room were full of gentlemen, there would be no place for villains. Regardless of the affected organ, first regulate the middle jiao to restore appetite, which is the root.

[Zhu Danxi] A thirty-year-old woman, after weeping for her deceased son, developed chest oppression and a mass the size of a cup half a year later. Her appetite decreased significantly, her complexion was pale yellow and dark, she was emaciated, and her six pulses were wiry, thin, deficient, and choppy. She experienced chills and fever after dusk. Observing the urgency, I used both tonification and draining methods. I prescribed Bu Zhong Yi Qi Tang adjusted for weather changes, alternating with Dong Yuan's Pi Qi Wan (see Five Accumulations section). She took the decoction before meals and the pill after meals, ensuring slightly more decoction than pills. After nearly a month, chills and fever subsided, and appetite improved. Then, equal amounts of decoction and pills were taken. In the second month, she suddenly had severe chills and fever overnight, which resolved by dawn, and the chest mass seemed to disappear. However, by evening, her lower limbs swelled, so I stopped the medication. Three to five days later, the swelling vanished overnight, but by dawn, the chest mass reappeared, slightly smaller than before. I then used Er Chen Tang with Jie Geng, Bai Zhu, and Zhi Shi, regulating for half a month until she recovered. She gave birth to a son the following year.

Another woman, over forty, pale and thin with an irritable temperament, developed a mass under her breast adhering to the ribs three months after severe frustration. The mass grew gradually, causing mild pain under the heart and diaphragmatic oppression, reducing her appetite by three-quarters. She felt bitter taste in her mouth every morning, and her pulses were faint, short, and choppy. Knowing her menstruation had ceased for some time, I feared for her prognosis and initially declined treatment. However, realizing she still had stomach qi (evidenced by her ability to dress and speak normally), I prescribed Ren Shen, Bai Zhu, Dang Gui, and Chuan Xiong with qi-regulating herbs in large doses, four times a day, applying Da Hu Po Gao externally to prevent growth. After over a month and more than a hundred doses of tonics, her appetite reached half of normal. Continuing the same prescription for another month, her pulse became fuller. She then took Run Xia Wan with the tonic for over a hundred doses, and menstruation returned within two months, with the choppy pulse reducing by four-fifths. Due to hot weather, anticipating purple menstrual blood, I added Cu Zhi San Leng (Vinegar-processed San Leng) to the tonic and supplemented with Yi Qing Wan (15 pills). After another month, the mass reduced by more than half, menstruation arrived on schedule (half a day late), and appetite was normal, though meat caused discomfort. I advised stopping medication until spring when wood qi is prosperous. In June of the next year, the mass suddenly enlarged by half a finger width, with a slightly wiry pulse, weaker on the left. She reported slight fullness after eating, resolving with movement. I suspected emotional agitation, which was confirmed. I prescribed the previous tonic with Huang Qin and Chao Huang Lian, assisted by small amounts of Mu Tong and Sheng Jiang, removing San Leng, decocting to swallow Run Xia Wan, and applying Hu Po Gao externally for half a month. Menstruation occurred, and the mass dissipated. This was lung metal scorched by internal fire, wood overcoming earth, earth failing to transport, causing turbid and clear qi to mix. The residual mass remained because qi and blood had not fully recovered. Retained turbid qi caused the mass to recur. Tonifying qi and blood protected the lungs from pathogens, balanced wood, rectified earth, moved turbid qi, and dispersed the mass.

Fang Tiling, aged fifty-six, suffered left hypochondriac pain level with the umbilicus in winter of the Ding Chou year after drinking and anger. Gradually, a small mass formed, appearing with pain and disappearing when pain ceased. He had a sallow face, dry mouth, weakness, poor appetite, belching the smell of consumed food, and aversion to wind and cold. His left pulse was larger than the right, wiry, choppy, and long, predominantly on the left, becoming entirely wiry upon heavy pressure. This resulted from excessive sweating damaging stomach qi and lowering yin blood. I prescribed He Wei Tang to tonify stomach qi and nourish yin blood, along with Bao He Wan to aid digestion. Once stomach qi and yin blood were sufficient, I switched to Xiao Kuai He Wei Tang.

Ren Shen (3 qian), Bai Zhu (1.5 qian), Chen Pi (1 qian), Shao Yao, Dang Gui Shen (0.5 qian each), Ge Gen (0.3 qian), Hong Hua (bean-sized), Zhi Gan Cao (2 qian).
One dose, taken with 25 Bao He Wan and 15 Long Hui Wan.

The above three methods prioritize qi and blood tonification, using accumulation-resolving herbs as assistants, with tonification exceeding resolution. This is the method for accumulations due to severe qi and blood deficiency.

For the woman from Gan Cun with an abdominal mass: Administer 35 Bao He Wan with Bai Zhu Tang.

For Wang Lang with heart pain and diaphragmatic mass:
Bai Zhu (2 qian), Qing Pi (1 qian), Shao Yao, Mu Tong, Chuan Xiong, Cang Zhu (1 qian each), Zhi Gan Cao (0.5 qian).
One dose, taken with 30 Bao He Wan.

Feng Shi Nu, aged thirty, thin with delicate skin, accustomed to rich flavors, once walked in snow and dried shoes with fire, leading to damp-heat ascending. At twenty-five, she frequently vomited clear fluid and acid regurgitation. Doctors used warm herbs like Ding Xiang, providing intermittent relief. By that year, she developed heart pain, chest oppression, and a mass, vomiting one-third of her food. I prescribed 24 Zuo Jin Wan with ginger juice. After more than thirty doses, she could eat nothing. I said, "The knot has opened." Advise stopping medication. If thirsty, give half a cup of boiled water, occasionally giving Qing Liu Wan. Although bedridden, abstaining from medicine is best. After nearly forty days, her pulse was slightly wiry, choppy on heavy pressure, and harmonious on light pressure, with the wiry quality increasing. I prescribed Ren Shen Jiu Shao Yao Tang to guide metal to drain wood. Appetite gradually returned, but constipation persisted. The family insisted on Da Huang, but I refused. I made pills with Sheng Shao Yao, Chen Pi, Tao Ren, and Ren Shen, using honey suppositories. Bowels moved, appetite increased, and she recovered after half a month of regulation.

Can Yu Wan is Zuo Jin Wan plus 1 qian Ren Shen.

Lu Zi Yu developed a mass in the left hypochondrium after malaria, consuming meat and alcohol.
Bai Zhu (1 qian), Cu Zhi Chai Hu (1 qian), Fu Ling (2 qian), Chao Zhi Ke (0.5 qian), Ren Shen (0.5 qian).
Decocted, taken with 5 Ai Wei, 20 Bao He, 10 Yi Qing, 10 Yu Dian, and 5 Gong Kuai.

Zhu Lang from Chang Yuan suffered from dampness due to years of drinking, with a mass on the hypochondrium, loose stools, and yellow urine.
Hua Shi (1 liang), Bai Zhu, San Leng (6 qian each), Chen Pi (5 qian), Huang Lian, Zhu Ling (3 qian each), Huang Qin, Mu Tong (2 qian each), Fang Feng (1.5 qian), Gan Jiang (1 qian), Zhi Gan Cao (0.5 qian).
Divided into seven doses, taken with 20 Bao He Wan.

A husband had a mass on the left abdomen extending to the hypochondrium, initially caused by gas pain from eating noodles and milk, then enlarged by meat and alcohol to the size of a peach, reducing appetite by one-third.
Hua Shi (0.5 liang), Bai Zhu (4 qian), Chen Pi, San Leng (3 qian each), Luo Bo Zi, Lian Qiao, Huang Lian (1 qian each), Ge Gen (2.5 qian), Tao Ren (20 pieces), Huang Qin (1 qian), Zhi Gan Cao (1.5 qian).
Divided into four doses, decocted in water.

A woman had a palm-sized mass in the hypochondrium, choppy pulse, and occasional fever. This is qi accumulation amidst deficiency. First tonify deficiency, then use accumulation-resolving drugs.
Bai Shao, Gui Xu (4 qian each), Chen Pi, Bai Zhu (3 qian), Qing Pi, Chuan Xiong, Mu Tong (1 qian each), Zhi Gan Cao (0.5 qian).
Decoct in plain water, take hot.

Accumulation-resolving drugs:
Cu Zhi San Leng (1 qian), Zhi Shi, Qing Pi, Tao Ren (5 qian each), Da Huang (5 qian), Gui Zhi (1.5 qian), Cu Zhi Hai Zao (3 qian).
Grind to fine powder, make pills with Shen Qu paste, size of sesame seeds. Take 40 pills per dose.

[World Physicians] A lady had an old mass in the left hypochondrium growing larger, with a wiry, large, slightly rapid pulse. She recently had fever, reduced appetite, and fatigue. First tonify, then attack the mass.
Chen Pi (5 qian), Bai Zhu (1.5 liang), Chai Hu, Dang Gui Tou, Qing Pi (5 qian each), Gan Cao (one piece), Mu Tong (3.5 qian).
Eight doses.

Next, attack the mass:
Cu Qing Pi (1.5 liang), Tao Ren (5 qian), Cu San Leng (1.5 liang), Gui Zhi (3.5 qian), Cu Xi Hai Zao (3 qian).
Grind, make pills with Shen Qu paste.

A husband had an accumulation in the hypochondrium with internal phlegm-heat, inability to sweat, and large, scattered, soft pulses, indicating body deficiency.
San Leng (5 qian), Bai Zhu, Huang Lian (3 qian each), Ren Shen (2.5 qian), Zhi Gan Cao (0.5 qian), Lian Qiao, Mu Tong (3 qian each), Chuan Xiong, Gui (1 qian).
Decoct, take with Bao He Wan.

Fu Xiao Niang had a left hypochondriac mass after malaria with scanty urination.
Hou Po, Chai Hu (2 qian each), San Leng (1.5 qian), Zhi Gan Cao (0.5 qian), Mu Tong (5 qian), Bai Zhu (6.5 qian), Qing Pi (5 qian), Sheng Jiang (one slice).
Take hot before meals.

Qian Lang from Xiapi developed sand-rash in January, resulting in two masses near the umbilicus, painful when raised, painless when flat, sometimes dull pain. He moxibusted the umbilicus. Pulse was very wiry, hidden on the right, slightly rapid on heavy pressure. This was latent heat wanting to resolve via sweat in spring, but weak qi prevented spontaneous sweating, leading to stagnation. Combined with irregular diet, pathogens clung to retained food, forming masses. Use 20 Bao He, 20 Wen Zhong, 10 Yi Qing, taken with Bai Zhu, Mu Tong, San Leng decoction.

The above eleven methods combine tonics and accumulation-resolving drugs equally. The first seven treat accumulations from diet, wine, and meat; the last three treat accumulations from body deficiency and heat.

[Zhu Danxi] Chen Lizhang's son, aged twenty-seven, previously vomited after overeating beef and tofu, continued irregular diet, and developed a mass in the right hypochondrium growing to palm size. Painful when active, painless when resting, pulse wiry and rapid. He is likely impatient; pressing the mass increases pain, leading to vomiting of yellow, sour, bitter fluid. Confirmed. Some treated it as Kidney Qi disorder. I said: No, this is food retention and damp-phlegm in the Foot Taiyin.

Shao Li Zhi He (roasted, 2), Chao Shan Zhi (shelled, 5), Chao Zhi Shi (15), Shan Zha (9), Chao Zhu Yu (9).
Some formulas include Ren Shen.
Grind finely, boil in fast-flowing water, add ginger juice until spicy, take hot before meals. Six doses. Vomiting occurred after two doses. Continue for four doses to stop pain, then switch to mass-dissolving drugs:
Ban Xia Mo (6 qian, mixed with juice from 6 Ze Xie boiled in water, dried), Chao Huang Lian (5 qian), Shi Jian (2 qian, ground separately).
Mix into fine powder, make pills with sugar paste, size of peppercorns.

[Zhu Danxi] A maid, slightly fat with purple complexion, melancholic, nearly forty, had amenorrhea for three months. A qi mass in the lower abdomen started like a chestnut and grew like a steamed bun. Pulses were choppy on both hands, slightly harmonious on heavy pressure. Pressing the mass caused severe pain; it was palpable 1.5 cun high. I prescribed Qian Jin Xiao Shi Wan. After four or five doses, she claimed her nipples were black and secreted fluid, fearing pregnancy. I said: Impossible; choppy pulses do not indicate pregnancy. After three or five more doses, pulses felt slightly hollow. I realized menstruation had been blocked for a long time. Stop previous drugs, prescribe Si Wu Tang with doubled Bai Zhu, assisted by Chen Pi and Zhi Gan Cao for thirty doses. After finishing, resume Xiao Shi Wan several times. She reported the mass shrank slightly, so I stopped medication. Half a month later, menstruation occurred with severe pain, passing half a sheng of black blood containing dozens of pepper-seed-like clots, and the mass reduced by half. She sought medicine to remove the rest. I advised: Do not be impatient; it seems to be opening, do not attack again. Next month's menstruation should clear it. Next month, she passed less black blood clots, and the mass shrank slightly more. She asked for medicine again. I said: Observe taboos, next month it will clear. It did. Generally, attacking drugs affect the disease; if pathogenic evil is light but drug force is heavy, stomach qi is injured. Stomach qi is pure, neutral, and harmonious, suitable for grains, meats, vegetables, and fruits. Medicines possess biased properties; even Ren Shen and Huang Qi are biased, let alone attacking drugs. This woman had weak stomach qi and little blood. If waiting for the mass to completely disappear before stopping drugs, her remaining stomach qi would be scarce.

A fifty-five-year-old woman, robust in form and qi, wealthy but mentally taxed, accustomed to rich flavors and irritable, often had menorrhagia. Doctors used astringents to stop it. Later, she developed qi pain with thirteen masses of varying sizes in the chest and abdomen, severe night pain, bedridden for months, reduced appetite but managing household affairs. Pulses were choppy and weak on both hands. This was due to repeated use of astringents causing stagnant blood accumulation. In March, I used Shu Kui Gen decoction, then added Ren Shen, Bai Zhu, Chen Pi, Qing Pi, Gan Cao Shao, and Niu Xi. Added a little Xuan Ming Fen and ground Tao Ren, taken hot. After two doses, abdominal pain passed one mass. Decocting dregs again passed another mass. Due to prolonged illness and blood loss, I dared not extract more masses and withdrew. Later, I realized although the disease was severe, her constitution could tolerate drugs, provided Shu Kui Gen and Xuan Ming Fen were removed. Subsequently, the mass gradually dissolved, and she recovered.

A twenty-one-year-old woman, repeatedly injured by food, had a mass in the epigastrium rising to block the throat due to qi. She also ate salt-roasted porridge. Prescribed:
Bai Zhu (1.5 qian), Chen Pi, Ban Xia (1 qian each), Jie Geng, Qing Pi, Mu Tong (5 qian each), Zhi Gan Cao (some), Sheng Jiang (2 slices).
Decoct and take one or two times; condition stabilized. Repeat prescription. Add Jie Geng after half a month, induce vomiting to expel phlegm-food retention, cured.

[Zhang Zihe] The Magistrate of Xicheng heard his father died by bandits, grieved deeply. After crying, he felt heart pain increasing daily, forming a mass like an inverted cup after a month, unbearable pain, ineffective drugs. Discussed burning needles and moxa, but the patient disliked them, seeking Dai Ren. Dai Ren found a shaman nearby, imitated the shaman mixing madness with words to tease the patient, causing uncontrollable laughter. Turning away for one or two days, the internal hardness dispersed. Dai Ren said: *Nei Jing* states sorrow knots qi, joy relaxes meridians. Joy overcomes sorrow; *Nei Jing* has this method.

[Zhu Danxi] Lv Zongxin, aged sixty, loved wine, fell ill in August due to summer heat. Feet cold past knees, palm-sized mass in upper epigastrium pulling to hypochondrium, unable to sleep, halved appetite, no thirst. Self-administered Sheng Liao Wu Ji San for three doses. Pulses were deep, choppy, small, not weak on pressure, rapid, especially on the right. Bowels normal, urine red. Used Da Cheng Qi Tang with half Da Huang roasted, plus Huang Lian, Shao Yao, Chuan Xiong, Ge Gen, Gan Cao as decoction, taken with Gua Lou Ren, Ban Xia, Huang Lian, Bei Mu pills. After twelve doses, foot cold retreated to calves, mass halved, stopped medication. Half a month later, appetite restored, symptoms cleared.

[Tang] Liu Zongyuan compiled Rescue Dead Form. In February of the 12th year of Yuanhe, he suffered from gout, sudden obstruction at midnight, stone-hard mass in hypochondrium, near death. Unconscious for three days due to severe cold, family wailed. Zheng Xunmei of Xingyang transmitted Shan Mu Tang. After half a meal time, profuse diarrhea three times, qi flowed, mass dispersed. Formula: Shan Mu Jie (1 sheng), Ju Ye (1 sheng, substitute bark if no leaves), Da Fu Bing Lang (7), crushed together, Tong Bian (3 sheng), boil to 1.5 sheng, divide into two doses. If one dose causes rapid relief, stop the second.

*[Zhou Hou]* Treats sudden acute masses, stone-like stabbing pain in abdomen. Niu Xi (large bunch) with leaves, decoct in wine and drink.

*[Wai Tai]* Treats sudden acute masses, hard as stone in abdomen, painful to death. Take a small bundle of Shuo Bi Gen, wash, drain water, tear finely, soak in 2 sheng wine for three nights. Warm and take 5 ge to 1 sheng, three times daily. For faster effect, warm in hot ashes until aroma emerges, then drink. This formula is non-toxic and miraculous.

The above four formulas for urgent removal of sudden accumulations. After masses are removed, tonics must be used to rescue injury from attack.