经义
病胁下满，气逆，二、三岁不已，病名息积。○任脉为病，女子带下瘕聚。○病有少腹盛，上下左右皆有
根，病名伏梁。裹
大脓血，居肠胃之外，不可治，治之每切按之致死。○人有身体髀股 皆肿，环齐而痛，病名伏梁，此风根也。
其气溢于大肠而着于肓，肓之原在齐下，故环齐而痛，不可动之，动之为水溺涩之病。○大积大聚，其可犯也，
衰其大半而止，过者死。（《素问》）
积之始生，得寒乃生，厥乃成积也。寒气上入于肠胃则 胀， 胀则肠外之汁沫迫聚不得散，日以成
积。（《灵枢》）
病有积有聚，何以别之？然积者阴气也，聚者阳气也。故阴沉而伏，阳浮而动，气之所积名曰积，气之
所聚名曰聚。故积者五脏所生，聚者六腑所成。积者阴气也，其发有常处，其痛不离其部，上下有所终始，左
右有所穷处。聚者阳气也，其始发无根本，上下无所留止，其痛无常处。○肝之积，名曰肥气，在左胁下，如覆
杯，有头足。久不愈，令人发咳逆 疟，连岁不已。○心之积，名曰伏梁，起脐上，大如臂，上至心下。久不
愈，令人烦心。○脾之积，名曰痞气，在胃院，覆大如盘。久不愈，令人四肢不收，发黄胆，饮食不为肌肤。
○肺之积，名曰息贲，在右胁下，覆大如杯。久不已，令人洒淅寒热，喘咳肺壅。○肾之积，名曰奔豚，发于少
腹，上至心下，若豚状，或上或下无时。久不已，令人喘逆，骨痿少气。（《难经》）
哲言
问曰∶病有积、有聚、有谷气，何谓也？师曰∶积者脏病也，终不移；聚者腑病也，发作有时，辗转痛
移为可治。○谷气者胁下痛，按之则愈，复发，为谷气。（《金匮》）
凡人脾胃虚弱，或饮食过常，或生冷过度，不能克化，致成积聚结块，心腹胀满，噫气吞酸，面青肌瘦。
其名有十∶一曰食积，二曰酒积，三曰面积，四曰肉积，五曰鱼蟹积，六曰果菜积，
七曰茶积，八曰水积，九曰血积，十曰虫积。（《得效方》）
症名有七∶曰蛇、蛟、鳖、肉、发、虱、米是也。瘕名有八∶曰青、黄、燥、血、脂、狐、蛇、鳖是也。
病因食物相感而成，然瘕比 稍轻。又有肠覃、石瘕、血蛊，皆女子之疾，种种不同，乃痞块之异名耳。（《千金方》）
食积腹满酢心，酒积目黄口干，痰积涕唾稠粘，涎积咽如曳锯，水积足胫肿满，气积噫气痞塞，血积打扑
肭瘀。产后不月，少腹腰胁有形块癖积，两 刺痛。息贲在右肋下，大如覆杯，气逆背痛，已成形也。息积右
胁下满，气逆息难，未成形也。（《医学阶梯》）
者征也，以其腹中坚硬，按之应手，病形有可征验者也，多见于脐下。其原由于饮食失节，胃衰脾弱，
邪正相搏，牢固不动，故名曰 。有因脏腑虚弱，好食生冷粘滞之物，不能克化，与脏气相搏，结积成块，日
渐长大，坚固不移，谓之食 。有因跌仆挫闪，气凝血结，经络壅瘀成块，谓之血 。瘕者假也，腹中虽硬，
聚散无常亦多见于脐下。其原由于起居失宜，饮食失节。脏腑之气先虚，又复外感风寒，与食气停蓄于内，结
聚成块，推之而动，按之而走，故名曰瘕。八瘕有名可稽，有形可按。一青瘕，聚于左右胁下，苦腰下急痛，
腹中气冲，面黄肌肿，二便难，喜唾涎，不能食。二黄瘕，左胁下有气，牢结不可抑，苦腰背引痛，少腹常急，
下引阴中如刺，不得小便，或溺黄赤，时发寒热。三燥瘕，状如半杯，上下腹中不定，苦痛连两胁，引心而烦，
不得太息，腰背肿，足酸痛，遗尿失精，便难盗汗，妨食呕吐。四血瘕，留着肠胃之外，及少腹间，苦横骨下
有积气，坚牢如石，少腹急痛，阴中冷气，或背疼不可俯仰。五脂瘕，在脂膜间，猝难踪迹，苦腰背如刺，或
左右走，腹中切痛，少腹沉重，身体解 ，大小便血，此证妇人患之，男子无也。六狐瘕，出入少腹，或隐或
见，男为狐疝，女名狐瘕，苦阴酸涩，小便难，少腹 痛，胸膈腰背上冲而
痛，甚则有头足成形者不治。七蛇瘕，其形长大，在脐上下，或左右胁，上食心肝，苦不得吸气，腰背痛，难
以动作，少腹热，引阴挛急，小便黄赤，股胫时痛。八鳖瘕，形大如杯，若存若亡，苦少腹切痛，恶气左右走，
上下腹中痛，腰背亦痛，不可以息，面目黄黑，甚则亦有头足成形，此八瘕之属也。 者悬也，悬于腹内，近
脐左右，各有一条筋脉扛起，大者如臂、如筒，小者如指、如管。其原皆由阴阳不和，常多郁怒，或适当饮食
与气缠裹，或适受寒冷与气停留，合并成形，故名曰 。癖者匿也。潜匿两肋，寻摸不见，有时而痛，始觉有
物。其原皆由营卫失调，经络 隔，饮食无度，伤脾伤胃，或有所劳倦，强力入房，以致精伤血耗，邪结不散，
故名曰癖。痞者闭也，痞必有块，在皮里膜外。其原皆由脾胃亏损，食积痰血，阻塞气道，遂结成形，察其形
质，不能移动者类于 ，能移动者类于瘕。总之积、聚、 、瘕、 、癖、痞，分隶三焦，断难混视。痞、癖
见于膈间，是上焦病。 、积、聚见于腹内，是中焦病。 、瘕见于脐下，是下焦病。按证分部，方得头绪。
故积、聚、 、癖、痞多生于男子， 、瘕多生于女子。七病各有形证不同，治当分别。（沈金鳌）
积聚之病，凡饮食血气风寒皆能致之。但积聚当辨，积者积垒之谓，由渐而成；聚者聚散之谓，作止不
常。由此言之，是坚硬不移者，本有形也，故曰积。或聚或散者，本无形也，故曰聚。诸有形者，或饮食之滞，
或脓血之留，凡汁沫凝聚，旋成 块者，皆积之类。其病多在血分，血有形而静也。诸无形者，或胀或不胀，
或痛或不痛，凡随触随发，时来时往者，皆聚之类。其病多在气分，气无形而动也。《难经》以积为阴气，聚
为阳气，其义即此。凡无形之聚，其散易；有形之积，其破难。临此证者，但当辨其有形无形，在气在血，而
治法自可得其梗概矣！（张景岳）
心火居上，肾水居下，水能克火，以脾土居中，制住肾水，故不得凌上耳。若土虚不能制水，水无所畏，
自少腹上冲于心，
来克心火，如豚之奔而不可遏，故名奔豚。久则痛甚，日就 羸，不可救药。（周慎斋）
脐下有动气，名曰肾气，亦曰奔豚。奔豚，肾之积名也。五积中惟奔豚冲心最急。其人素有肾积，因伤寒
之邪，冲突下焦，致其发动，如江豚之奔冲也。大抵真气内虚，水结不散，气与之搏，即发奔豚。虽有表里之
证，汗下皆不可也。○抑尝论之，医为病所困者，惟阴虚之难补，久积之难除。玉山自倒，阴虚之谓也；养虎
遗患，久积之谓也。人之罹此二患者，可不俱哉！（朱丹溪）
凡人腹中有块，不问积聚 瘕，俱为恶候，切勿视为泛常。若胀满已成，胸腹鼓急，虽卢扁复生，亦莫能
救也。（《医学正传》）
补编
壮人无积，虚人则有之。由于脾胃怯弱，气血两衰，四时有感，皆能成积。若遽以磨坚破结之药治之，得
药暂快，药过依然，疾未去而人已衰矣。气愈消，疾愈大，竟何益哉！故善治者，当先补虚，使气血旺，其积
自消。如满座皆君子，则小人自无容身之地。不问何脏，先调其中，使能饮食，是治其本也。（张洁古）
肠胃之络伤，则血溢肠外，与痰沫相搏，复遇外寒，凝聚而成积矣。居于皮里膜外，苟非剖腹割肠之技，
何能涤除？但不妨碍饮食，惟宜养胃补中。（刘河间）
大黄、巴豆迅利之药，亦必以仗中气营运。人至气绝之后，灌以巴、黄斤许，岂能通利？巴、黄峻利之最
者，若无人气以营运，则虽入腹，犹置于纸木器中，安然不动。如此一想，则痞聚之类，可不仗中气以营运乎？（冯楚瞻）
按积之成也，正气不足，而后邪气踞之。然攻之太急，正气伤。初、中、末之三法，不可不讲也。初者，
病邪初起，正气尚强，邪气尚浅，则任受攻。中者，受病渐久，邪气较深，正气较弱，任受且攻且补。末者，
病根经久，邪气侵凌，正气消残，则任受补。盖积之为义，日积月累，匪朝伊芳夕，所以去之亦当有
渐，太急则伤正气，正伤则不能运化而邪反固矣。余尝用阴阳攻积丸，通治阴、阳二积，药品虽峻，用之有度。
补中数日，然后攻伐，不问其积去多少，又与补中，待其神壮而复攻之，屡攻屡补，以平为期。《经》曰∶大
积大聚，其可犯也，衰其大半而止，过者死。故去积及半，纯与甘温调养，使脾土健运，则余积不攻自走，必
欲攻之无余，其不遗人夭殃者鲜矣！（李士材）
积之在脏，如陈 之在江河。积之在脏，多着脂膜曲折之处。陈 之在江河，多在汀湾洄薄之地，遇江河
之溢，一漂而去，积之在脏，理亦如之。予先以丸药驱逐新受之食，使无梗塞，其碎着之积已离而未下。次以
散药满胃而下，横江之筏，一拥而尽。设未尽者以药调之。惟坚积不可用此法，宜以渐除。《经》曰∶坚者削
之。今人言块癖是也。○《汉书艺文志》载五苦六辛之说，而颜师古辈皆无注解。夫五者，五脏也；脏者，里
也。六者，六腑也；腑者，表也。病在里者属阴分，宜以苦寒之药，涌之、泄之；病在表者属阳分，宜以辛温
之剂，发之、汗之，此五苦六辛之意也。思五积、六聚，用药亦不外于是。夫五积在脏有常形属里，宜以苦寒
之药涌之、泄之；六聚在腑无常形属表，宜以辛温之药发之、汗之，与前五苦六辛之义亦合。（《儒门事亲》）
《难经》分积者阴气也，五脏所生；聚者阳气也，六腑所成。后巢氏另立 瘕之名，以不动者为 ，动者
为瘕，亦即积聚之意也。前贤有云∶积聚者，就其肓膜结聚之处，以经脉所过部分，属脏者为阴，阴主静，静
则坚而不移，属腑者为阳，阳主动，动则移而不定。故着而不移，是为阴邪聚络，大旨以辛温入血络治之。可容
不移之阴邪者，自必无阳动之气以旋运之，而必有阴静之血以倚伏之，所以必藉体阴用阳之品，方能入阴出阳，
以施其辛散温通之力也。又云∶初为气结在经，久则血伤入络。辄仗蠕动之物，松透病根，化裁之妙，于古人
书引伸触类而得。昔贤于五积、九积治法颇多，大略消补兼施，并以所恶者攻，所喜者诱尔。
（《临证指南》）
诸积之成，莫不由痰食死血，人共知之。讵知痰食死血，乃成积之质，而非成积之本也。盖使痰伏其位，
食化其液，血顺其经，病何由作？积何由生？惟气郁而湿滞，湿郁而热生，热郁而痰结，痰郁而血凝，血郁而
食不化，食郁而积乃成，此六者相因致病。古人所以云∶六郁为诸积之本也。故当积之未成，必先有以解其郁，
而使当升者升，当降者降，当变化者变化，不致传化失常，治宜六郁汤、越鞠丸、保和丸，斯气血冲和，而百
疾不作。若积之既成，又当调营养卫，扶胃健脾，使元气旺，而间进以去病之剂，从容调理，俾其自化，然后
病去而人不伤。乃今之治积者，动议吐、下，不知吐、下只治病之暴者。若积之成，其所由来者渐，故积之治，
其所由去者不可不渐也。不然《内经》何但有化积、消积、磨积之文，而并无吐积、下积之说。盖直吐、直下，
皆足以伤胃气而损元气，积必不去也。凡病者、医者，其皆体念毋忽。○饮食误中蛇毒，致成蛇癖，腹内常饥，
食物即吐，宜赤蜈蚣散。好吃生米成癖，呕吐清水，宜鸡矢米煎。食发成癖，心腹作痛，咽间如有虫行，欲得
油饮，宜香泽油。平时嗜酒而成酒鳖；平时多气，血凝气滞而成气鳖；虚劳痼冷，败血挟痰而成血鳖，上侵人
咽，下蚀人肛，或附胁背，或隐胸腹，宜芜荑汤。老人小儿 癖，往来疼痛，宜星附丸。以上种种，皆积聚之
类。（沈金鳌）
白马尿治鳖瘕。○杏仁消狗肉积。○胡黄连消果子积。○糯米消杏积。○麝香治水果积。○穿山甲破血
积。○山楂肉治血积。○圣齑即牛倒草，治牛肉积。（《见闻录》）
脉候
寸口脉沉而横，曰胁下有积，腹中有横积痛。（《素问》）
诸积大法，脉来细而附骨者乃积也。寸口，积在胸中。微出寸口，积在喉中。关上，积在脐旁。上关上，
积在心下。微下关，
积在少腹。尺中，积在气冲。脉出左，积在左。脉出右，积在右。脉两出，积在中央。各以其部处之。（《金匮》）
驶紧浮牢，小而沉实，或结或伏，为聚为积。强实者生，沉小者死。（《脉诀》）
选案
一男子患一奇证，将一年矣。每夜交二更时，即有一股气，从小肚冲至脐上，渐至胸前。久又渐抵咽喉，
腹内有物跳动，即不能睡，直至五更方平，扪之无形，日间如常，医皆不知何病。予诊两关尺脉俱沉弦，谓曰∶
此奔豚证耳。每至二更而起者，二更乃亥时，亥属猪，豚即猪也，故至其时则阴气感动。五更阳气回，则阴气
潜伏，豚性本阴柔，然有时而奔，此气伏于肾脏至阴之中，毫无形影，突然上冲，不可架御，当以纯阳之药御
[Canonical Meaning]
The disease presents with fullness under the hypochondrium, rebellious Qi, persisting for two or three years without resolution; this condition is named Xi Ji (Breath Accumulation). ○ When the Ren Mai (Conception Vessel) is diseased, women may suffer from leukorrhea and Jia Ju (abdominal masses). ○ The disease manifests as distension and fullness in the lower abdomen, with roots extending up, down, left, and right; this condition is named Fu Liang (Hidden Beam). It contains large amounts of pus and blood, located outside the intestines and stomach; it is considered incurable. Treatment involving forceful palpation often leads to death. ○ Some individuals exhibit swelling of the body, thighs, and legs, along with pain encircling the navel; this condition is named Fu Liang, which is rooted in wind pathogens. The pathogenic Qi overflows into the large intestine and adheres to the Huang (the area between the heart and diaphragm). The source of the Huang is below the navel, hence the periumbilical pain. It must not be manipulated, as doing so induces disorders of water metabolism and difficult urination. ○ For massive accumulations, attack may be employed, but one should stop when the pathology has diminished by more than half; excessive treatment leads to death. (*Su Wen*)
Accumulations begin with the generation of Cold. Rebellious Qi leads to the formation of accumulations. When Cold Qi enters the stomach and intestines, it causes distension. Distension forces the juices and foam outside the intestines to gather and prevents them from dispersing, gradually forming an accumulation. (*Ling Shu*)
How to distinguish between Ji (Accumulation) and Ju (Gathering)? Ji belongs to Yin Qi, while Ju belongs to Yang Qi. Therefore, Yin is deep and latent, while Yang is floating and active. Where Qi accumulates, it is called Ji; where Qi gathers, it is called Ju. Thus, Ji arises from the Five Zang Organs, while Ju is formed by the Six Fu Organs. Ji is Yin; its onset occurs at fixed locations, pain remains within its region, and there are definite boundaries above/below and left/right. Ju is Yang; its onset lacks a root, there is no fixed stopping point above/below, and the pain has no fixed location. ○ The accumulation of the Liver is named Fei Qi (Fat Qi), located under the left hypochondrium, resembling an inverted cup with head and feet. If untreated for long, it causes cough, rebellious Qi, and malaria, persisting for years. ○ The accumulation of the Heart is named Fu Liang (Hidden Beam), starting above the umbilicus, as thick as an arm, extending up to the epigastrium. If untreated for long, it causes mental restlessness. ○ The accumulation of the Spleen is named Pi Qi (Stagnant Qi), located in the epigastrium, covering an area as large as a plate. If untreated for long, it causes weakness of the four limbs, jaundice, and failure of food to nourish the muscles. ○ The accumulation of the Lung is named Xi Ben (Panting Accumulation), located under the right hypochondrium, covering an area as large as a cup. If untreated for long, it causes chills and fever, wheezing, cough, and lung congestion. ○ The accumulation of the Kidney is named Ben Tun (Running Piglet), originating in the lower abdomen, ascending to the epigastrium, resembling a running piglet, moving up and down irregularly. If untreated for long, it causes wheezing and rebellion, bone萎 (weakness), and shortness of breath. (*Nan Jing*)
[Philosophical Discourse]
Question: What are Ji (Accumulation), Ju (Gathering), and Gu Qi (Grain Qi)? Master replies: Ji is a disease of the Zang organs and does not move; Ju is a disease of the Fu organs, occurs intermittently, and involves shifting pain, which is treatable. ○ Gu Qi refers to pain under the hypochondrium that relieves upon pressure but recurs; this is called Gu Qi. (*Jin Gui Yao Lue*)
In general, if the Spleen and Stomach are weak, or if one overeats or consumes excessive raw/cold foods, digestion fails, leading to the formation of accumulations and masses, causing abdominal distension, belching, acid regurgitation, cyanotic complexion, and emaciation. There are ten types: 1. Food Accumulation, 2. Wine Accumulation, 3. Flour/Noodle Accumulation, 4. Meat Accumulation, 5. Fish/Crab Accumulation, 6. Fruit/Vegetable Accumulation, 7. Tea Accumulation, 8. Water Accumulation, 9. Blood Accumulation, 10. Parasite Accumulation. (*De Xiao Fang*)
There are seven types of Zheng (masses): Snake, Jiao, Turtle, Meat, Hair, Louse, Rice. There are eight types of Jia (false masses): Green, Yellow, Dry, Blood, Fat, Fox, Snake, Turtle. These etiologies arise from interactions among foods, but Jia is slightly milder than Zheng. There are also Chang Tan (Intestinal Tuber), Shi Jia (Stone Jia), and Xue Gu (Blood Disturbance), all diseases of women, varying greatly, being alternative names for Pi Ku (obstructed masses). (*Qian Jin Fang*)
Food Accumulation presents with abdominal fullness and acid regurgitation; Wine Accumulation with yellow eyes and dry mouth; Phlegm Accumulation with thick sputum and saliva; Saliva Accumulation with a sensation of sawing in the throat; Water Accumulation with swollen calves and feet; Qi Accumulation with belching and chest obstruction; Blood Accumulation with bruising from trauma. Postpartum amenorrhea with fixed masses in the lower abdomen, waist, and hypochondrium, and stabbing pain in both flanks. Xi Ben is under the right hypochondrium, large as an inverted cup, with rebellious Qi and back pain, already formed. Xi Ji is fullness under the right hypochondrium with rebellious Qi and breathing difficulty, not yet formed. (*Yi Xue Ti Jie*)
Zheng (征) implies verification; the abdomen is hard, tender to touch, with observable signs, mostly below the umbilicus. Etiology: dietary irregularity, weak Stomach and Spleen, struggle between pathogen and healthy Qi, firm and immobile. Hence called Zheng. Due to organ deficiency, craving raw/cold/sticky foods, indigestion, interaction with organ Qi, forming masses that grow larger and remain immobile, called Shi Zheng (Food Zheng). Due to falls/trauma, Qi stagnation and Blood coagulation, meridian obstruction forming masses, called Xue Zheng (Blood Zheng). Jia (瘕) means false; the abdomen is hard, but the mass gathers and scatters irregularly, mostly below the umbilicus. Etiology: improper living habits, dietary irregularity. Organ Qi first deficient, then external Wind-Cold combines with retained food Qi internally, forming masses that move upon pushing and shift upon pressing, hence called Jia. The Eight Jias have specific names and forms. 1. Qing Jia (Green Jia): gathers under left/right hypochondrium, painful lower back, rushing Qi in abdomen, yellow face, swollen muscles, difficult urination/defecation, salivation, anorexia. 2. Huang Jia (Yellow Jia): Qi in left hypochondrium, firm and unyielding, radiating back pain, frequent lower abdominal urgency, piercing pain in yin, dysuria, or dark urine, intermittent chills/fever. 3. Zao Jia (Dry Jia): shape like half a cup, mobile in upper/lower abdomen, pain radiating to flanks and heart, inability to sigh deeply, swollen back/legs, enuresis/spermatorrhea, difficult stool, night sweats, vomiting. 4. Xue Jia (Blood Jia): lodged outside intestines/stomach and in lower abdomen, Qi accumulation below transverse bone, stone-hard, lower abdominal urgency, cold in yin, back pain preventing bending/straightening. 5. Zhi Jia (Fat Jia): between fatty membranes, elusive, stabbing back pain, migrating pain, severe abdominal pain, heavy lower abdomen, body lethargy, hematochezia/hematuria; affects women, not men. 6. Hu Jia (Fox Jia): moves in/out of lower abdomen, visible/invisible; male: Hu Han (Fox Hernia); female: Hu Jia; sour/astringent yin, dysuria, lower abdominal pain, rushing pain to chest/diaphragm/back; severe cases with head/foot formation are untreatable. 7. She Jia (Snake Jia): large shape, above/below umbilicus or flanks, affecting heart/liver, inability to inhale fully, back pain, limited mobility, hot lower abdomen, yin cramping, dark urine, leg/shin pain. 8. Bie Jia (Turtle Jia): large as a cup, fluctuating presence, severe lower abdominal pain, malicious Qi moving around, abdominal/back pain, dyspnea, yellow-black face; severe cases with head/foot formation belong to these Eight Jias.
Zheng (症 - here referring to a suspended mass) means suspended; hanging inside the abdomen near the umbilicus on either side, with tendons lifting, large as arm/cylinder, small as finger/tube. Etiology: Yin-Yang disharmony, frequent anger, food/Qi entanglement, or Cold/Qi retention, merging to form shape. Pi (癖) means hidden; concealed in flanks, imperceptible to touch, painful occasionally, felt only when symptomatic. Etiology: Ying-Wei disharmony, meridian blockage, unregulated diet damaging Spleen/Stomach, fatigue, excessive intercourse damaging Essence/Blood, pathogen aggregation. Pi (痞) means obstruction; always has a mass, between skin and fascia. Etiology: Spleen/Stomach deficiency, food/phlegm/blood stasis blocking Qi pathway, forming masses. Immobile ones resemble Zheng; mobile ones resemble Jia. In summary, Ji, Ju, Zheng, Jia, Zheng, Pi, Pi are distributed across the Three Jiao and must not be confused. Pi and Pi appear in the Diaphragm region (Upper Jiao). Zheng, Ji, Ju appear in the abdomen (Middle Jiao). Zheng, Jia appear below the umbilicus (Lower Jiao). Differentiating by location clarifies the pattern. Thus, Ji, Ju, Zheng, Pi, Pi mostly affect men; Zheng, Jia mostly affect women. The seven diseases differ in form/symptoms and require distinct treatments. (Shen Jin'ao)
Accumulation diseases can be caused by food, blood, Qi, Wind, and Cold. However, distinction is crucial: Ji means piling up, occurring gradually; Ju means gathering/scattering, with irregular onset/remission. Thus, hard and immobile masses are有形 (have form), hence Ji. Gathering/scattering masses are无形 (formless), hence Ju. All有形 masses, whether food stagnation or pus/blood retention, where fluids/foam condense into blocks, belong to Ji. Their pathology is mostly in the Blood level (有形 and static). All无形 masses, whether distended or not, painful or not, appearing/disappearing upon contact, belong to Ju. Their pathology is mostly in the Qi level (无形 and active). *Nan Jing* states Ji is Yin Qi, Ju is Yang Qi, which aligns with this. Formless Ju dissipates easily;有形 Ji is hard to break. Clinically, one must distinguish formless/form and Qi/Blood to determine treatment principles. (Zhang Jingyue)
Heart Fire resides above, Kidney Water below. Water controls Fire, but Spleen Earth in the middle controls Kidney Water, preventing it from usurping upwards. If Earth is weak and cannot control Water, Water acts without fear, rushing from lower abdomen to Heart, attacking Heart Fire like a running piglet, hence named Ben Tun (Running Piglet). Prolonged severity leads to wasting and incurability. (Zhou Shenzhai)
Moving Qi below the umbilicus is named Kidney Qi, also Ben Tun. Ben Tun is the name for Kidney Accumulation. Among the Five Accumulations, only Ben Tun rushing to the Heart is most urgent. Patients with chronic Kidney Accumulation, triggered by Cold Damage pathogens conflicting in the Lower Jiao, experience sudden onset like a river porpoise charging. Generally, internal deficiency of True Qi and stagnant Water combined with Qi conflict triggers Ben Tun. Regardless of exterior/interior patterns, sweating and purging methods are contraindicated. ○ I have discussed that physicians are troubled by the difficulty of tonifying Yin Deficiency and removing chronic Accumulations. "Mount Tai collapsing" refers to Yin Deficiency; "Raising tigers leaving trouble" refers to chronic Accumulations. One should fear suffering from these two conditions. (Zhu Danxi)
Any mass in the abdomen, whether Ji, Ju, Zheng, or Jia, is a malignant sign; do not treat it casually. Once distension becomes severe with tight drum-like abdomen/chest, even Lu Bian (Lu Qiu and Bian Que) reborn could not save it. (*Yi Xue Zheng Chuan*)
[Supplement]
Robust people do not have accumulations; only deficient people do. This stems from weak Spleen/Stomach and dual deficiency of Qi and Blood, susceptible to seasonal pathogens. Using harsh breaking/piercing drugs temporarily relieves symptoms but leaves the disease intact while depleting the patient further. Qi diminishes, disease grows; what benefit is there? Good practitioners first tonify deficiency to strengthen Qi and Blood, allowing the accumulation to resolve naturally. Like having only gentlemen in a room, villains have no place to stand. Regulate the Middle Jiao regardless of the affected organ to restore appetite; this treats the root. (Zhang Jiegu)
Injury to collateral vessels of intestines/stomach causes blood extravasation outside intestines, combining with phlegm foam, and encountering external Cold, condensing into accumulation. Located between skin and fascia, unless surgical excision is performed, how can it be cleared? As long as it does not hinder eating, nourishing Stomach and tonifying Middle is appropriate. (Liu Hejian)
Da Huang (Rhubarb Root and Rhizome) and Ba Dou (Croton Seed) are rapid and potent drugs, relying on Middle Qi for transport. After Qi ceases, pouring pounds of these drugs cannot promote movement. Without human Qi to transport them, even entering the abdomen, they remain inert like objects in paper/wood containers. Thus, treating Pi/Ju requires relying on Middle Qi for transport. (Feng Chuzhan)
Accumulations form due to insufficient Healthy Qi allowing Pathogenic Qi to occupy space. However, aggressive attack damages Healthy Qi. The three stages (Initial, Middle, Terminal) must be considered. Initial: Pathogen new, Healthy Qi strong, Pathogen shallow; attack is tolerated. Middle: Disease prolonged, Pathogen deep, Healthy Qi weaker; simultaneous attack and tonification tolerated. Terminal: Chronic root, Pathogen overwhelming, Healthy Qi depleted; only tonification tolerated. Accumulation implies daily/monthly accumulation, not overnight; thus removal must be gradual. Too fast damages Healthy Qi, impairing transformation and fixing the Pathogen. I used Yin-Yang Gong Ji Wan to treat both Yin/Yang accumulations. Though potent, dosage is controlled. Tonify Middle for days, then attack. Regardless of amount removed, tonify again. Wait for spirit/strength to recover, then attack again. Repeat attack/tonification until balance. *Classic* says: For major accumulations, attack is permissible, but stop when half is resolved; excess leads to death. Removing half the accumulation and using pure sweet/warm tonics to strengthen Spleen Earth allows remaining accumulation to resolve spontaneously. Insisting on total eradication rarely avoids premature death. (Li Shicai)
Accumulation in Zang organs is like old sediment in rivers. Sediment settles in bends/deep pools; similarly, accumulation adheres to folds of fatty membranes. River floods wash sediment away; similarly, accumulation can be moved. First, use pills to expel new food stagnation, preventing blockage, loosening fragmented accumulation. Then, use powders to fill the stomach and push downward, like rafts crossing a river. Residuals treated with medicine. Hard accumulations cannot use this method; remove gradually. *Classic* says: Hardeners are削 (reduced). Modern "blocks/pi" refer to this. ○ *Han Shu Yi Wen Zhi* mentions "Five Bitters and Six Pungents," but Yan Shigu lacked annotation. Five refers to Five Zang (Interior/Yin); Six refers to Six Fu (Exterior/Yang). Interior/Yang diseases suit Bitter-Cold drugs for vomiting/purging; Exterior/Yang diseases suit Pungent-Warm drugs for diffusing/sweating. This is the meaning of Five Bitters/Six Pungents. Thinking of Five Accumulations/Six Gatherings, medication follows this principle. Five Accumulations in Zang have fixed form (Interior), suited for Bitter-Cold vomiting/purging; Six Gatherings in Fu have variable form (Exterior), suited for Pungent-Warm diffusing/sweating. This aligns with the previous meaning. (*Ru Men Shi Qin*)
*Nan Jing* divides Ji as Yin Qi, generated by Five Zang; Ju as Yang Qi, formed by Six Fu. Later, Chao Shi established Zheng/Jia names: immobile is Zheng, mobile is Jia, equivalent to Ji/Ju. Ancients stated: Regarding Huang membrane aggregation, parts traversed by meridians belonging to Zang are Yin (static, hard, immobile); belonging to Fu are Yang (active, mobile, unstable). Thus, adhering/immobile indicates Yin Pathogen aggregating in collaterals, treated primarily with Pungent-Warm entering Blood collaterals. Accommodating immobile Yin Pathogens requires no Yang-moving Qi for rotation, but relies on Yin-static Blood for伏 (latent storage). Thus, substances with Yin substance/Yang function are needed to enter Yin and exit Yang, exerting Pungent-dispersing/Warming-unblocking power. Also: Initially Qi knot in meridians; later Blood injury enters collaterals. Use creeping creatures to loosen disease roots. Wisdom derived from expanding ancient texts. Ancients had many methods for Five/Nine Accumulations, generally combining elimination and tonification, attacking what the pathogen hates, enticing with what it likes. (*Lin Zheng Zhi Nan*)
All accumulations stem from Phlegm, Food, and Dead Blood, known to all. But Phlegm/Food/Dead Blood are the material basis, not the root cause. If Phlegm stays put, Food transforms, Blood flows smoothly, how would disease arise? Only Qi stagnation leads to Dampness stagnation; Dampness stagnation generates Heat; Heat stagnation knots Phlegm; Phlegm stagnation congeals Blood; Blood stagnation impedes Food digestion; Food stagnation forms Accumulation. These six factors causally lead to disease. Hence ancients said: Six Stagnations are the root of all accumulations. Before accumulation forms, resolve stagnation to ensure proper ascending/descending/transformation, preventing transmission disorders. Treat with Liu Yu Tang, Yue Ju Wan, Bao He Wan to harmonize Qi/Blood and prevent disease. Once formed, nourish Wei Qi, support Stomach/Spleen, strengthen Yuan Qi, and intermittently administer disease-removing agents for gentle regulation, allowing self-resolution, ensuring disease removal without harming the person. Today's practitioners rashly use vomiting/purging, unaware these only treat acute conditions. Accumulation develops gradually; thus removal must be gradual. Otherwise, why does *Nei Jing* mention dissolving/grinding accumulation but never vomiting/purging accumulation? Direct vomiting/purging damages Stomach Qi and Yuan Qi, failing to remove accumulation. Patients and doctors must reflect carefully. ○ Snake venom in food causes Snake Pi (constant hunger, vomiting food); use Chi Wu Gong San. Craving raw rice causes Pi (vomiting clear water); use Ji Shi Mi Jian. Eating hair causes Pi (abdominal pain, worm-sensation in throat, desire for oil); use Xiang Ze You. Chronic alcoholism causes Wine Bie; chronic anger/Qi stagnation causes Qi Bie; consumptive cold with Bad Blood/Phlegm causes Blood Bie (invading throat, eroding anus, attaching to flanks/back/chest/abdomen); use Wu Yi Tang. Elderly/children with Zheng/Pi (migratory pain); use Xing Fu Wan. All above are types of accumulation. (Shen Jin'ao)
White horse urine treats Bie Jia. ○ Apricot kernel eliminates Dog Meat Accumulation. ○ Picrorhiza Root eliminates Fruit Accumulation. ○ Glutinous rice eliminates Apricot Accumulation. ○ Musk treats Fruit Accumulation. ○ Pangolin Scales breaks Blood Accumulation. ○ Hawthorn Fruit treats Blood Accumulation. ○ Sheng Ji (Cow Grass) treats Beef Accumulation. (*Jian Wen Lu*)
[Pulse Diagnosis]
Cunkou pulse sunken and transverse indicates accumulation under hypochondrium and horizontal accumulation pain in abdomen. (*Su Wen*)
General rule for accumulations: Pulse fine and adhering to bone indicates accumulation. Cunkou: accumulation in chest. Slightly above Cunkou: accumulation in throat. Guan: accumulation beside umbilicus. Above Guan: accumulation below heart. Slightly below Guan: accumulation in lower abdomen. Chi: accumulation at Qichong. Pulse emerging on Left: accumulation on Left. Pulse emerging on Right: accumulation on Right. Pulse emerging on both: accumulation in center. Treat according to location. (*Jin Gui Yao Lue*)
Rapid, tight, floating, firm, small, sunken, solid, knotted, or hidden pulses indicate Ju or Ji. Strong/solid pulse indicates survival; sunken/small pulse indicates death. (*Mai Jue*)
[Selected Case]
A man suffered a strange symptom for nearly a year. Every night at the second watch (approx. 9-11 PM), a Qi rush starts from the lower abdomen, ascends to the umbilicus, gradually reaches the chest. Eventually reaching the throat, with pulsating sensation in abdomen, preventing sleep until the fifth watch (approx. 3-5 AM), when it subsides. Palpation reveals nothing; daytime normal. Physicians did not know the disease. I diagnosed both Guan and Chi pulses as sunken and wiry, stating: This is Ben Tun syndrome. Onset at second watch corresponds to Hai hour (Pig hour); Zhu (pig) corresponds to Ben Tun. Thus, Yin Qi is stimulated at this time. At fifth watch, Yang Qi returns, Yin Qi hides. Pig nature is Yin-soft, yet sometimes runs. This Qi hides in the extreme Yin of Kidneys, formless, suddenly rushing upward, uncontrollable. Must use Pure Yang herbs to counter...