《准绳》曰∶大全方分 癖诸气、疝瘕、八瘕、腹中瘀血、痞 、食 、血 ，凡七门。 者在腹内，
近脐左右，各有一条筋脉急痛，大者如臂，次者如指，因气而成，如弦之状，故名曰弦。癖者僻在两胁之间
，有时而痛，故名曰癖。疝者痛也。瘕者假也，其积聚浮假而痛，推移乃动也。瘕有八症∶
黄、青、燥、血、脂、狐、蛇、鳖。积在腹内，或肠胃之间，与脏气结搏坚牢，虽推之不移。名曰 ，言其
病形可征验也。气壅塞为痞，言其气痞塞不宣畅也。伤食成块，坚而不移，名曰食 ，淤血成块者也。大抵
以推之不动为 ，动为瘕也。至
夫疝与 癖，则与痛俱见，不痛即隐。在腹左右为 ，在两胁之间为癖，在小腹而牵引腰胁为疝。
朱丹溪曰∶痞块在中为痰饮，在右为食痰积，在左为血块。气不能作块成聚。块乃有形之物，痰与
食积、死血而成也。用醋煮海石、三棱、蓬术、桃仁、红花、五灵脂、香附之类为丸，石碱、白术汤吞下。
瓦子能消血块，次消痰。石碱一物，有痰积、有块可用，洗涤垢腻，又能消食积。治块当降火，消食积，
即痰也。行死血块，去须大补。凡积不可用下药，徒损真气，病亦不去，当用消积药，使之融化，则
除根矣。
张子和曰∶积之在脏，如陈茎之在江河，中间多着脂膜曲折之处，区臼之中。如陈茎之在江河，不在中
流，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。故予先以丸药驱新受之食，使无梗塞
，其辟着之积，已离而未下。次以散药，满胃而下，横江之筏，一壅而尽。设未尽者，得以药调之。惟坚积
不可用此法，宜以渐除。《内经》曰坚者削之是也。
凡食积，酸心腹满，大黄、牵牛之类，甚者礞石、巴豆。
酒积，目黄口干，干葛、麦芽之类，甚者甘遂、牵牛。
气积，噫气痞塞，木香、槟榔之类，甚者枳壳、牵牛。
涎积，咽喉如曳锯，朱砂、腻粉之类，甚者瓜蒂、甘遂。
痰积，涕唾稠粘，半夏、南星之类，甚者瓜蒂、藜芦。
癖积，两胁刺痛，三棱、广术之类，甚者甘遂、蝎梢。
水积，足胫胀满，郁李、商陆之类，甚者甘遂。芫花。
血积，打扑肭淤，产后不月，桃仁、地榆之类，甚者虻虫、水蛭。
肉积，赘瘤核疠，腻粉、白丁香，砭刺出血，甚者 砂、
信石。
九积皆以气为主，各据所属之状而对治之。
方约之曰∶凡积聚痞块之症，人之气血营卫，一身上下周流，无时少息，一旦七情感动五志之火，火
性炎上，有升无降，以致气液水谷不能顺序，稽留而为积也必矣。
丹溪以为气不能成块成聚，块必痰与死血食积而成，在中为痰饮，在右为食积，在左为血块，诚哉言
也。夫左关肝胆之位，藏血液；右关脾胃之位，藏饮食。所以左边有积为血块，右边有积为食积。中间则
为水谷出入之道路，五志之火熏蒸水谷而为痰饮，所以中间有积，则为痰饮也。
治法，顺气破血，消食豁痰是已。如木香、槟榔去气积，三棱、莪术去血积，麦芽、神曲去酒积，香附、
枳实去食积，牵牛、甘遂去水积，山楂、阿魏去肉积，海粉、礞石去痰积，雄黄、白矾去涎积，干姜、巴豆
对寒积，黄连、大黄去热积，各从其类也。
大抵积之初，固为寒；而积之久，则为热矣。予分辛温、辛平、辛凉三例，正欲人知新久之义耳。然阴
虚难补，久积难除，诚节欲以养性，内观以养神，固可从容而治耳。
《治法纲》曰∶积有常所，痛有常处；聚无常所，痛无常处。盖阴伏而静，阳浮而动，故脏腑之气，
有积聚之别。然虽有积聚之脉，总皆气病，无二端也。其脉浮洪者易治，沉涩者难治。治宜审其所因∶倘
有风寒束于外，使气不宣通，当以驱邪为主；或忧思纳于内，使气不流畅，当以理气为本。丹溪治积法甚善。
又云若积于皮里膜外者，尤非药石所能治，必须针灸之，方能消散，甚得肯綮。洁古云养正则积自除，亦
有滋味。盖元气实，方可攻邪也。
今以通用药味，加减主之，各加引经之药，庶无差误。以
槟榔、木香、青皮、陈皮、枳壳、三棱、莪术之类，如因风寒外束，气滞不行，加麻黄、苏叶、干姜、官桂、
吴茱萸之类；因七情内伤，气郁不散，加香附、川芎、苍术、苏梗之类；如肝积左胁，呕逆，倍用青皮，加柴
胡、白芍、川芎，防风之类；如心积脐上至心，烦闷，加菖蒲、炒黄连、香附，川芎、当归之类；如脾积中
脘，其人黄瘦，加白术、苍术、神曲、麦芽、山楂之类；如肺积右胁，喘咳，加桔梗、葶苈、前胡、苏子之
类；如肾积脐下奔筑，加细辛、官桂、香附之类；如手足太阳经聚，加羌活；如手足少阳经聚，加柴胡；如
手足阳明经聚，加白芷。
若治痞块，以培养脾胃为主。而兼以消化之剂，以人参、白术、茯苓、黄 、陈皮、白芍、归身、
甘草之类。如痰块，加半夏、苍术、南星、海石、牡蛎。如血块，加三棱、莪术、香附、桃仁、红花、苏木、
干漆。如食积，加山楂、麦芽、神曲、枳实。如肉积，加生姜、黄连、阿魏。
According to *Zhunsheng* (Standard of Accuracy): The *Daquan Fang* (Complete Prescriptions) divides Pi (lump), various Qi disorders, Shan-Jia (hernia and lump), Ba-Jia (eight lumps), abdominal blood stasis, Pi (stagnation), Shi-Ji (food accumulation), and Xue-Ji (blood accumulation) into seven categories. Xian disease (String-like lump) is located within the abdomen, near the left and right sides of the umbilicus, where a single tendon or vessel feels tense and painful. The larger ones are as thick as an arm, the smaller ones as thick as a finger. It forms due to Qi stagnation and resembles the shape of a bowstring, hence the name "Xian" (String). Pi (Lateral Lump) dwells on the sides between the hypochondrium, causing intermittent pain, hence named "Pi" (Lateral/Hidden). Shan (Hernia/Pain) refers to pain. Jia (False Lump) implies falseness; its accumulation floats and is false in nature, causing pain that moves when pushed. There are eight types of Jia: Huang-Jia (Yellow), Qing-Jia (Green), Zao-Jia (Dry), Xue-Jia (Blood), Zhi-Jia (Fat), Hu-Jia (Fox), She-Jia (Snake), and Die-Jia (Turtle). Ji (Fixed Accumulation) is located within the abdomen, either between the intestines and stomach, knotting with the Zang-Qi, becoming hard and firm; even if pushed, it does not move. It is named "Ji" because its pathological form can be verified and confirmed. Qi obstruction and blockage is called "Pi" (Stagnation), indicating that Qi is stagnant and not flowing freely. Food injury forming a mass, hard and immovable, is named "Shi-Ji" (Food Accumulation); blood stasis forming a mass is also referred to similarly. Generally, what cannot be moved by pushing is "Ji", while what moves is "Jia". As for Shan and Pi, they appear together with pain; when there is no pain, they remain hidden. Those on the left and right of the abdomen are "Ji"; those between the two hypochondria are "Pi"; those in the lower abdomen radiating to the waist and hypochondrium are "Shan".
Zhu Danxi said: Stagnant masses in the center are Phlegm-Fluids; on the right, they are Food-Phlegm accumulations; on the left, they are Blood masses. Qi alone cannot form a mass or aggregation. A mass is a tangible entity, formed by Phlegm, Food Accumulation, and Dead Blood (Stasis). Use Hai-Shi (Sea Stone/Floating Stone) boiled in vinegar, San-Leng (Sparganium Rhizome), E-Zhu (Curcuma Rhizome), Tao-Ren (Peach Kernel), Hong-Hua (Safflower), Wu-Ling-Zhi (Trogopterus Dung), and Xiang-Fu (Cyperus Rhizome) to make pills, taken down with Shi-Jian (Stone Alkali) and Bai-Zhu (Atractylodes Macrocephala Decoction). Wa-Leng-Zi (Arca Shell) can dissolve blood masses, and secondarily phlegm accumulations. Shi-Jian (Stone Alkali) is useful for conditions involving phlegm accumulations and masses; it cleanses dirt and grease, and can also digest food accumulations. To treat masses, one must descend Fire, digest food accumulations, which essentially resolves Phlegm. To move dead blood masses, after removal, one must strongly tonify. For all accumulations, purgative drugs should not be used, as they merely damage True Qi without removing the disease. One should use drugs that resolve accumulations, allowing them to melt and dissipate, thereby eliminating the root.
Zhang Zihe said: Accumulations in the Zang organs are like old stems in a river; they often attach to places with fatty membranes and curves, such as ditches and basins. Just as old stems in a river do not stay in the mid-stream but rather in bays and eddies, washed away when the river floods, so too is the principle of accumulations in the Zang organs. Therefore, I first use pill medicines to drive out newly acquired food stagnation, preventing blockage, so that attached accumulations loosen but have not yet descended. Next, I use powder medicines to fill the stomach and descend, like rafts across the river, blocking and clearing everything at once. If anything remains, it can be regulated by medicine. Only hard accumulations cannot be treated this way; they should be gradually removed. As stated in the *Neijing*: "For hardness, pare it down."
Regarding Food Accumulation: Symptoms include acid regurgitation and abdominal fullness. Use Da-Huang (Rhubarb Root), Qian-Niu (Morning Glory Seed), etc. In severe cases, Meng-Shi (Fluorite), Ba-Dou (Croton Seed).
Regarding Wine Accumulation: Symptoms include yellow eyes and dry mouth. Use Gan-Ge (Kudzu Root), Mai-Ya (Barley Sprout), etc. In severe cases, Gan-Sui (Euphorbia Root), Qian-Niu (Morning Glory Seed).
Regarding Qi Accumulation: Symptoms include belching and chest/stomach stuffiness. Use Mu-Xiang (Costus Root), Bing-Lang (Areca Nut), etc. In severe cases, Zhi-Qiao (Bitter Orange Peel), Qian-Niu (Morning Glory Seed).
Regarding Saliva Accumulation: Symptoms include a sensation in the throat like sawing. Use Zhu-Sha (Cinnabar), Ni-Fen (Calomel), etc. In severe cases, Gua-Di (Melon Peduncle), Gan-Sui (Euphorbia Root).
Regarding Phlegm Accumulation: Symptoms include thick and sticky sputum/nasal discharge. Use Ban-Xia (Pinellia Tuber), Nan-Xing (Arisaema Rhizome), etc. In severe cases, Gua-Di (Melon Peduncle), Li-Lu (Veratrum Rhizome).
Regarding Pi Accumulation: Symptoms include stabbing pain in both hypochondria. Use San-Leng (Sparganium Rhizome), Guang-Zhu (Curcuma Rhizome), etc. In severe cases, Gan-Sui (Euphorbia Root), Xie-Shao (Scorpion Tail).
Regarding Water Accumulation: Symptoms include distension and fullness in the calves. Use Yu-Li (Dried Plum Seed), Shang-Lu (Phytolacca Root), etc. In severe cases, Gan-Sui (Euphorbia Root), Yuan-Hua (Genkwa Flower).
Regarding Blood Accumulation: Symptoms include bruising from trauma or amenorrhea postpartum. Use Tao-Ren (Peach Kernel), Di-Yu (Sanguisorba Root), etc. In severe cases, Meng-Chong (Leech-like insect/Mansonia), Shui-Zhi (Leech).
Regarding Meat Accumulation: Symptoms include tumors and nodules. Use Ni-Fen (Calomel), Bai-Ding-Xiang (White Magpie Droppings), scarification to bleed. In severe cases, Niao-Sha (Sal Ammoniac), Xin-Shi (Realgar/Arsenic).
All nine accumulations are primarily governed by Qi; each is treated according to its specific manifestations.
Fang Yuezhi said: In cases of accumulation, stagnation, and masses, the body's Qi, Blood, Ying, and Wei circulate continuously up and down without pause. Once the Seven Emotions stir the Fire of the Five Wills, and since Fire flares upward, rising without descending, the Qi, fluids, and food grains cannot flow in order, leading inevitably to retention and accumulation.
Danxi believed that Qi cannot form masses or aggregations alone; masses must be formed by Phlegm, Dead Blood, and Food Accumulation. Those in the center are Phlegm-Fluids; on the right, Food Accumulation; on the left, Blood Masses. This is indeed true. The Left Guan position corresponds to the Liver and Gallbladder, storing Blood; the Right Guan position corresponds to the Spleen and Stomach, storing Food and Drink. Therefore, accumulation on the left is a Blood Mass, and on the right is a Food Accumulation. The middle is the pathway for the entry and exit of water and grain. The Fire of the Five Wills steams and transforms water and grain into Phlegm-Fluids; thus, accumulation in the center is Phlegm-Fluid.
The treatment method involves smoothing Qi, breaking Blood, digesting Food, and resolving Phlegm. For example: Mu-Xiang (Costus Root) and Bing-Lang (Areca Nut) for Qi Accumulation; San-Leng (Sparganium Rhizome) and E-Zhu (Curcuma Rhizome) for Blood Accumulation; Mai-Ya (Barley Sprout) and Shen-Qu (Medicated Leaven) for Wine Accumulation; Xiang-Fu (Cyperus Rhizome) and Zhi-Shi (Immature Bitter Orange) for Food Accumulation; Qian-Niu (Morning Glory Seed) and Gan-Sui (Euphorbia Root) for Water Accumulation; Shan-Zha (Hawthorn Fruit) and A-Wei (Asafoetida) for Meat Accumulation; Hai-Fen (Sea Flour/Glasswort) and Meng-Shi (Fluorite) for Phlegm Accumulation; Xiong-Huang (Realgar) and Bai-Fan (Alum) for Saliva Accumulation; Gan-Jiang (Dried Ginger) and Ba-Dou (Croton Seed) for Cold Accumulation; Huang-Lian (Coptis Rhizome) and Da-Huang (Rhubarb Root) for Heat Accumulation. Each treats its corresponding category.
Generally, accumulations initially present as Cold; however, long-standing accumulations transform into Heat. I categorize them into Acrid-Warm, Acrid-Ping, and Acrid-Cold examples precisely to distinguish between new and chronic conditions. However, Yin Deficiency is difficult to tonify, and long-standing accumulations are difficult to eliminate. It is truly necessary to restrain desires to nourish nature, and practice introspection to nourish the Spirit, thereby allowing for calm and gradual treatment.
*Zhifa Gang* states: Accumulations have fixed locations, and pain has fixed sites; Aggregations have no fixed location, and pain has no fixed site. This is because Yin is latent and still, while Yang is floating and active, hence the distinction between Accumulation and Aggregation in Zang-Fu Qi. Although there are pulse signs for Accumulation and Aggregation, they are fundamentally all Qi disorders, with no other basis. Pulses that are Floating and Surging are easy to treat; those that are Deep and Choppy are difficult. Treatment should examine the cause: If Wind-Cold binds externally, obstructing Qi circulation, the primary approach should be expelling pathogens. If Worry and Thought enter internally, obstructing smooth Qi flow, the primary approach should be regulating Qi. Danxi’s methods for treating accumulations are excellent. He also stated that if accumulation occurs in the subcutaneous membrane layers, it is particularly beyond the reach of herbal medicine and requires acupuncture to dissipate, which hits the mark accurately. Jiegu said, "Nourish the righteous, and the pathogenic will remove itself," which is also meaningful. Only when Yuan-Qi (Primal Qi) is solid can one attack the pathogen.
Now, using common medicinal ingredients with modifications as the main formula, adding channel-guiding herbs to avoid errors: Use Bing-Lang (Areca Nut), Mu-Xiang (Costus Root), Qing-Pi (Green Tangerine Peel), Chen-Pi (Aged Tangerine Peel), Zhi-Qiao (Bitter Orange Peel), San-Leng (Sparganium Rhizome), E-Zhu (Curcuma Rhizome), etc. If caused by external Wind-Cold binding and Qi stagnation, add Ma-Huang (Ephedra Herb), Su-Ye (Perilla Leaf), Gan-Jiang (Dried Ginger), Guan-Gui (Cinnamon Twig), Wu-Zhu-Yu (Evodia Fruit), etc. If caused by internal injury from Seven Emotions and Qi depression, add Xiang-Fu (Cyperus Rhizome), Chuan-Xiong (Sichuan Lovage Rhizome), Cang-Zhu (Atractylodes Lancea Rhizome), Su-Geng (Perilla Stem), etc. If Liver Accumulation is in the left hypochondrium with vomiting and reverse flow, double the dose of Qing-Pi (Green Tangerine Peel) and add Chai-Hu (Bupleurum Root), Bai-Shao (White Peony Root), Chuan-Xiong (Sichuan Lovage Rhizome), Fang-Feng (Saposhnikovia Root), etc. If Heart Accumulation extends from the umbilicus to the heart region with irritability and oppression, add Shi-Chang-Pu (Acorus Rhizome), Chao Huang-Lian (Fried Coptis Rhizome), Xiang-Fu (Cyperus Rhizome), Chuan-Xiong (Sichuan Lovage Rhizome), Dang-Gui (Angelica Sinensis Root), etc. If Spleen Accumulation is at Zhong-Wan (CV12), with the person appearing jaundiced and emaciated, add Bai-Zhu (Atractylodes Macrocephala Rhizome), Cang-Zhu (Atractylodes Lancea Rhizome), Shen-Qu (Medicated Leaven), Mai-Ya (Barley Sprout), Shan-Zha (Hawthorn Fruit), etc. If Lung Accumulation is in the right hypochondrium with wheezing and cough, add Jie-Geng (Platycodon Root), Ting-Li (Lepidium Seed), Qian-Hu (Peucedanum Root), Su-Zi (Perilla Seed), etc. If Kidney Accumulation is below the umbilicus with rushing sensations, add Xi-Xin (Asarum Root), Guan-Gui (Cinnamon Twig), Xiang-Fu (Cyperus Rhizome), etc. If Hand-Foot Taiyang Channel Aggregation occurs, add Qiang-Huo (Notopterygium Rhizome). If Hand-Foot Shaoyang Channel Aggregation occurs, add Chai-Hu (Bupleurum Root). If Hand-Foot Yangming Channel Aggregation occurs, add Bai-Zhi (Angelica Dahurica Root).
When treating Pi-Masses (Stagnant Lumps), focus primarily on cultivating the Spleen and Stomach, supplemented with digestive agents. Use Ren-Shen (Ginseng Root), Bai-Zhu (Atractylodes Macrocephala Rhizome), Fu-Ling (Poria), Huang-Qi (Astragalus Root), Chen-Pi (Aged Tangerine Peel), Bai-Shao (White Peony Root), Gui-Shen (Angelica Sinensis Root tip), Gan-Cao (Licorice Root), etc. For Phlegm Masses, add Ban-Xia (Pinellia Tuber), Cang-Zhu (Atractylodes Lancea Rhizome), Nan-Xing (Arisaema Rhizome), Hai-Shi (Sea Stone), Mu-Li (Oyster Shell). For Blood Masses, add San-Leng (Sparganium Rhizome), E-Zhu (Curcuma Rhizome), Xiang-Fu (Cyperus Rhizome), Tao-Ren (Peach Kernel), Hong-Hua (Safflower), Su-Mu (Red Sandalwood), Gan-Qi (Drylac Resin). For Food Accumulation, add Shan-Zha (Hawthorn Fruit), Mai-Ya (Barley Sprout), Shen-Qu (Medicated Leaven), Zhi-Shi (Immature Bitter Orange). For Meat Accumulation, add Sheng-Jiang (Fresh Ginger), Huang-Lian (Coptis Rhizome), A-Wei (Asafoetida).