积者，有形之邪，或食、或痰、或血积滞成块，时常硬痛，始终不离故处者也。
在妇人则谓之 。 者，征也，有形可验也。聚者，无形之气，滞则聚，行则散，
聚则有形而硬痛，散则痛止形消，忽此忽彼，无有定处者也。在妇人谓之瘕。瘕者，
假也，假气为形，而实非有形也。形属阴，气属阳，故积属阴，聚属阳。古分积属
脏、在血分，聚属腑、在气分，即阴阳之义耳，不必泥也。至其病因，则《内经》
谓∶寒气入肠胃，则肠外汁沫凝聚不散，日以成积。又或饮食过饱，或用力过度，
伤其肠胃之络，则血溢肠外，与寒沫搏结成积。或外中于寒，而忧怒气逆，血凝液
留，皆成积。可见外感内伤，皆足以郁滞其气血痰液，以成积聚。而在妇人尤甚，
以妇人经产血行，或食生冷，或感风寒，且多恚怒忧郁，易致瘀滞也。
一食积（酒积附）
证见嗳腐吞酸，腹满恶食，宜秘方化滞丸，山楂、麦芽、枳实、神曲、阿魏、
礞石、牵牛、巴豆之类。倒仓法最佳。按食停肠内，必栖泊在隐曲之处，乃能久而
不下，隐曲之处，为地无几，必附益以肠外之涎沫，内外交结，乃成大块，须兼治
其痰饮乃效。酒积目黄口干，肚腹胀痛，少食，宜葛根、枳 、麦芽之类。（酒湿热伤
脾，痰血瘀滞成积，须兼清热利湿导滞之药。旧谓食积在右，血积在左，痰积在中，
大概如此，不可泥。）
一痰积（水积附）
证见麻木眩晕，痞闷嘈杂，其人平素多痰，宜控涎丹，（见痰饮。）朱砂、腻粉、瓜
蒂、甘遂之类。水积，足胫肿胀，（必有窠囊。）宜郁李、商陆、甘遂、芫花之类。
一血积
证见面色痿黄，有蟹爪纹路，（血不能上荣也。）多怒善忘，口燥便秘，骨热肢冷，宜
桃仁煎，地榆、虻虫、水蛭之类。
以上皆有形之积，阻碍正气，故痛也。而亦有不痛者，日久则正气另辟行径，
不复与邪相争，或邪另结窠囊，不碍气血隧道之故。此为难治，以药不易到也。又
食、痰、血数者，皆无知之物，不能移动，故常在其处。然有饮污井之水，吞蛟
蜃之精，因而假血气以成形，含有活性，时能蠢动游移者，须以意治之。如败
梳治虱瘕，铜屑治龙瘕之类。（七 八瘕，载《千金方》，有蛟、蛇、狐、鳖等名。）
又积久则成疳，
因经络壅滞郁成湿热，以致口糜龈烂，当兼用龙荟等丸，（见胁痛。）以清疳热。凡治积，
宜丸不宜汤，必兼用膏药熨贴及艾灸乃除，以其在肠胃之外也。
一气聚
证必肚腹膨胀，时痛时止，得嗳即宽，旋复痛，游走攻刺，宜木香、槟榔、枳
壳、牵牛之类，不可下。
上明积聚之理，至下文所举色目，不过随部位而异名，总不出积与聚二端。
心积名伏梁，起脐上，大如臂，上至心下，（心经气郁血滞所致。）久不已令人烦心，
宜大七气汤加石菖蒲、半夏，兼吞伏梁丸。
肝积名肥气，在左胁下，如覆杯，有头足，久不已令人呕逆，或胸胁痛引小腹，
足寒转筋，寒热如疟，（肝经血气郁滞所致。）宜大七气汤，煎熟待冷，淋烧红铁铁器，
乘热服，兼吞肥气丸。
肺积名息贲，在右胁下，大如覆杯，气逆背痛，或少气善忘，久不愈令人洒洒
寒热，喘咳，皮中时痛，如虱缘针刺，（肺热气壅所致。）宜大七气汤加桑白皮、杏仁，兼
吞息贲丸。（按《内经》谓∶胁不满，气逆，二三岁不已，病名息积。当是肥气之属，非即此证。）
脾积名痞气，在胃脘，大如复盘，痞塞不通，心背痛，饥减饱见，腹满吐
泄，久则四肢不收，发黄胆，饮食不为肌肤，足肿肉消，宜大七气汤下红丸子，（见
伤饮食。）兼吞痞气丸。
肾积曰奔豚，发于小腹，上冲至心如豚状，上下无时，少腹急，腰痛，久不已
令人喘逆骨痿，宜大七气汤倍桂，加茴香、炒楝子肉，兼吞奔豚丸。
，在腹内近脐，左右各有一条筋脉急痛，大者如臂，小者如指，有时而现，
如弦之状，故名 。
癖，偏僻也，僻居两肋，有时而痛。
石瘕，生胞中，因寒气客于子门，恶血留聚，日渐大，状如怀子。此气先病血
后病，月事不以时下。（此血分病。）
肠覃，寒客大肠外，结瘕，始如鸡卵，渐益大如怀孕。此气病血未病，故月水
不断。（此气分病。）
上二者皆女子病，似妊娠，治法可用辛热，如吴茱萸、桂心、附子，加入消块药。
Ji (Accumulation) refers to pathogenic factors with tangible form, which may result from food retention, phlegm turbidity, or blood stasis condensing into masses. These masses are often hard and painful, and remain fixed in their original location.
In women, this condition is termed "Zheng" (Mass). Zheng implies a visible sign, indicating a tangible pathogen that can be verified.
Ju (Gathering), on the other hand, refers to intangible Qi stagnation. When Qi stagnates, it gathers; when Qi moves, it disperses. When gathered, it presents as tangible and causes hardness and pain; when dispersed, the pain ceases and the tangible form disappears. Its location shifts unpredictably without a fixed site. In women, this is termed "Jia" (False Mass). Jia implies falseness, meaning it assumes a shape through Qi but is not truly tangible.
Form belongs to Yin, while Qi belongs to Yang. Therefore, Ji belongs to Yin, and Ju belongs to Yang. Ancient texts classified Ji as belonging to Zang organs and located in the Blood level, while Ju was classified as belonging to Fu organs and located in the Qi level. This distinction aligns with the principles of Yin and Yang and should not be rigidly adhered to.
Regarding etiology, *Neijing* states: When cold qi invades the intestines and stomach, the fluids outside the intestines condense and fail to disperse, gradually forming accumulation over time. Alternatively, excessive eating or overexertion may damage the collaterals of the intestines and stomach, causing blood to overflow into the extraintestinal space. There, it combats with cold fluids to form accumulation. External invasion by cold combined with internal emotional distress (worry and anger) leading to rebellious Qi, blood coagulation, and fluid retention also results in accumulation. Thus, both external pathogens and internal injuries can cause stagnation of Qi, blood, phlegm, and fluids, leading to Ji and Ju. This is particularly severe in women due to menstrual and postpartum blood dynamics, consumption of raw/cold foods, exposure to wind-cold, and frequent anger or depression, all of which predispose them to blood stasis and stagnation.
1. Food Accumulation (with Wine Accumulation as an appendix)
Symptoms include belching with a rotten odor, acid regurgitation, abdominal distension, and aversion to food. The secret formula Huazhi Wan (Stagnation-Resolving Pill) is indicated, composed of Hawthorn Fruit (*Crataegi Fructus*), Malt (*Hordei Fructus Germinatus*), Immature Bitter Orange (*Aurantii Fructus Immaturus*), Medicated Leaven (*Shenqu*), Asafoetida (*Ferulae Resina*), Nanshaishi (*Calcaris Ostrae*), and Radix Sennae (*Folium Sennae*), among others. The Dao Cang Fa (Stomach Purging Method) is optimal.
Note: Food stagnating in the intestines must lodge in hidden or tortuous areas to remain undigested for long periods. Since such spaces are limited, the food must adhere to salivary fluids from outside the intestines, forming large masses through internal-external interaction. Therefore, treatment must address phlegm-fluids concurrently to be effective.
Wine accumulation presents with yellow eyes, dry mouth, abdominal distension and pain, and reduced appetite. Ge Gen (*Puerariae Lobatae Radix*), Zhi Ke (*Aurantii Fructus*), and Mai Ya (*Hordei Fructus Germinatus*) are suitable. (Alcohol-damp-heat damages the Spleen, leading to phlegm-blood stasis and accumulation; clearing heat, draining dampness, and guiding out stagnation are required. Old theories suggest food accumulation is on the right, blood accumulation on the left, and phlegm accumulation in the center; this is generally true but should not be rigidly applied.)
2. Phlegm Accumulation (with Water Accumulation as an appendix)
Symptoms include numbness, vertigo, chest fullness, and嘈杂 (buzzing/irritability). Patients typically have chronic phlegm. Kongxian Dan (Phlegm-Draining Pill) is indicated (see Phlegm-Fluid section), containing Cinnabar (*Cinnabaris*), Calomel (*Hydrargyri Chloridum Mite*), Melon Peduncle (*Cucumeris Fructus*), and Kansui Radix (*Radix Kansui*).
Water accumulation presents with swelling of the lower legs and shins (indicating the presence of "ke nang" or reservoirs). Yuli Ren (*Prunus Semen*), Phytolacca Root (*Radix Phytolaccae*), Kansui Radix (*Radix Kansui*), and Genkwa Flower (*Flos Genkwa*) are suitable.
3. Blood Accumulation
Symptoms include sallow complexion, crab-claw-like vascular patterns on the face (due to blood failing to nourish the upper body), irritability, forgetfulness, dry mouth, constipation, bone-steaming fever, and cold limbs. Tao Ren Jian (Peach Kernel Decoction) is indicated, containing Di Yu (*Sanguisorbae Radix*), Blister Beetle (*Mylabris*), and Leech (*Hirudo*), among others.
The above are all tangible accumulations that obstruct healthy Qi, causing pain. However, some do not cause pain because, after a long duration, healthy Qi finds alternative pathways and no longer contends with the pathogen, or the pathogen forms isolated reservoirs that do not block the Qi-Blood channels. These cases are difficult to treat because medicines cannot easily reach the lesion.
Furthermore, food, phlegm, and blood accumulations consist of inert substances that do not move, hence they remain stationary. However, drinking water from polluted wells or swallowing essences of mythical creatures (like dragons or crocodiles) may create forms using Qi and Blood that possess activity, allowing them to move and shift. Such conditions require mental/spiritual intervention. For example, used combs treat louse-Jia, and copper filings treat dragon-Jia. (The Seven and Eight Jias are recorded in *Qianjin Fang*, with names like Dragon, Snake, Fox, and Turtle.)
Additionally, long-standing accumulation can transform into Gan syndrome (infantile malnutrition/wasting). Due to meridian obstruction and Qi stagnation transforming into damp-heat, symptoms include oral ulcers and gum rot. Longdan Xiegan Wan (Dragon Gallbladder Liver-Draining Pill) (see Hypochondriac Pain) should be used concurrently to clear Gan-heat.
Generally, treating accumulation favors pills over decoctions. Plaster application and moxibustion should be combined for removal, as these lesions are located outside the intestines and stomach.
4. Qi Gathering
Symptoms include abdominal distension, intermittent pain that resolves with belching but recurs shortly after, and wandering, stabbing pain. Mugher (*Costi Rhizoma*), Areca Seed (*Arecae Semen*), Aurantium (*Aurantii Fructus*), and Radix Sennae (*Folium Sennae*) are suitable. Purgatives should be avoided.
The above clarifies the principles of Ji and Ju. The subsequent descriptions of various named masses differ only by location but fall under the two categories of Ji and Ju.
Heart Ji is named Fuliang (Hidden Beam). It starts above the umbilicus, is arm-sized, and extends up to below the heart. Caused by Heart Meridian Qi stagnation and blood stasis, if untreated, it causes mental restlessness. Daqi Qi Tang (Great Seven-Qi Decoction) plus Chang Pu (*Acori Tatarinowii Rhizoma*) and Ban Xia (*Pinelliae Rhizoma*) is indicated, along with Fuliang Wan.
Liver Ji is named Feiqi (Fat Qi). Located under the left hypochondrium, it resembles an inverted cup with head and tail. If untreated, it causes vomiting and rebellious Qi, or hypochondriac pain radiating to the lower abdomen, cold feet with cramps, and chills/fever resembling malaria. Caused by Liver Meridian Qi-Blood stagnation, Daqi Qi Tang is indicated. The decoction should be cooled, then poured onto red-hot iron tools, and drunk while hot, along with Feiqi Wan.
Lung Ji is named Xiben (Breath Burping). Located under the right hypochondrium, it resembles an inverted cup. Symptoms include rebellious Qi, back pain, shortness of breath, forgetfulness, chills/fever, cough, and skin pain like insect bites or needle pricks. Caused by Lung heat and Qi congestion, Daqi Qi Tang plus Bai Pi (*Morus Cortex*) and Xing Ren (*Armeniacae Semen Amarum*) is indicated, along with Xiben Wan. (Note: *Neijing* mentions "Xi Ji" for hypochondriac fullness and rebellious Qi lasting years, which likely belongs to Feiqi, not this specific syndrome.)
Spleen Ji is named Pi Qi (Obstruction Qi). Located in the epigastrium, it resembles an overturned plate, causing obstruction, heart/back pain, relief when hungry but worsening when full, abdominal distension, vomiting, and diarrhea. Long-term effects include limb weakness, jaundice, failure of nutrition to build flesh, leg swelling, and muscle wasting. Daqi Qi Tang administered with Hong Wan Zi (Red Pill) is indicated, along with Pi Qi Wan.
Kidney Ji is named Bentun (Rushing Pig). It originates in the lower abdomen and rushes upward toward the heart like a running pig, occurring at irregular intervals. Symptoms include lower abdominal urgency, lower back pain, and if untreated, wheezing, rebellious Qi, and bone weakness. Daqi Qi Tang with doubled Gui Zhi (*Ramulus Cinnamomi*) plus Huixiang (*Foeniculi Fructus*) and fried Li Zi Rou (*Toosendan Fructus Mesocarp*) is indicated, along with Bentun Wan.
Xian (String) is located near the umbilicus inside the abdomen. On either side, there is a tendon-like structure with urgent pain, size ranging from arm to finger, appearing intermittently like a string, hence the name.
Pi (Partiality) means偏僻 (remote/partial). It resides in the remote areas of the hypochondrium and causes intermittent pain.
Shi Jia (Stone Jia) arises in the uterus. Cold qi invades the cervical os, causing evil blood to accumulate and enlarge daily, resembling pregnancy. This is a Qi disorder preceding Blood disorder, resulting in irregular menstruation. (This is a Blood-level disease.)
Chang Tan (Intestinal Polyp/Tumor) occurs when cold qi lodges outside the large intestine, forming a mass starting the size of a chicken egg and growing to resemble pregnancy. This is a Qi disorder where Blood is unaffected, so menstruation continues. (This is a Qi-level disease.)
Both of the above are female diseases resembling pregnancy. Treatment should use acrid-warm herbs like Evodia Fruit (*Evodiae Fructus*), Cinnamon Heart (*Cinnamomi Cortex*), and Prepared Aconite Root (*Aconiti Lateralis Radix Praeparata*) added to mass-resolving medicines.