即积，瘕即聚， 与癖则稍异其状，大略如是已，后世更立痞块之目，殊为无谓。至其治方，则积聚二证
鲜能区别者，要不过就消磨一途而分轻重，今之所纂亦此忘也。如妇人之病，其类不一，具列于彼门，兹仍不登
载。
源由总说 瘕癖结者，积聚之异名也，证状不一，原其病本大略相类，但从其所得或诊其证状以立
名尔。且 者为隐见腹内，按之形证可验也。瘕者为瘕聚，推之流移不定也。癖者僻侧在于胁肋（按∶三证详见
后）。结者沉伏结强于内（按，此亦积，不须别立名）。然有得之于食，有得之
于水，有得之于忧思，有得之于风寒，凡使血气沉滞留结而为病者，治须渐磨溃消，使气血流通，则病可愈矣。
（《圣济》）（按∶《中藏经》曰∶ 者系于气也，瘕者系于血也。）
积聚之病，凡饮食血气风寒之属，皆能致之，但曰积曰聚，当详辨也。盖积者积迭之谓，由渐而成者也；
聚者聚散之谓，作止不常者也。由此言之，是坚硬不移者，本有形也，故有形者曰积；或聚或散者，本无形也，
故无形者曰聚。诸有形者，或以饮食之滞，或以脓血之留，凡汁沫凝聚，旋成症块者，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。故《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，而治积治聚，自可得其梗概矣。（《景岳》）
病因腑脏受邪 积聚者，由阴阳不和，腑脏虚弱，受于风邪，搏于腑脏之气所为也。腑者阳也，脏者
阴也。阳浮而动，阴沉而伏。积者阴气，五脏所生，始发不离其部，故上下有所穷已。聚者阳气，六腑所成，
故无根本，上下无所留止，其痛无有常处。诸脏受邪，初未能为积聚，留滞不去，乃成积聚。（《病源论》）
六腑属于三阳，太阳利清气，阳明泄浊气，少阳化精气，有如都会之府，主转输以为常也。夫苟六腑失常，
则邪气聚而不散，始发既无根本，上下无所留止，其痛亦无常处，故在上则格，在下则胀，旁攻两胁，如有痞
块，易于转动，故非五积之比也。（《济生》）
风寒外感之邪，亦能成积。如经曰∶虚邪之中人也，留
而不去。传舍于肠胃之外，募原之间，留着于脉，息而成积。又曰∶病名伏梁，此风根也。由此观之，凡今人
以疟后成痞者，是即风寒之属，类可推矣。但疟由风寒，固易知也，而诸积于风，若不相干涉。不知饮食之滞，
非寒未必成积，而风寒之邪，非食未必成形。故必以食遇寒，以寒遇食，或表邪未清，过于饮食，邪食相搏，
而积斯成矣。经曰∶虚邪之风，与其身形，两虚相得，乃客其形。信乎致积之由，多由于此，即血症气痞之由，
亦无出于此。然积以寒留，留久则寒多为热；风以致积，积成则证已非风。故治此者，亦但当治其所留，不可
发散，以再伤其真气也。惟慎疾者，能知所由而虑之于始，则可为保脾之良策。（《景岳》）
病因饮食不消 症者，由寒温失节，致腑脏之气虚弱，而饮食不消，聚结在内，染渐生长块段，
盘牢不移动者，是 也，言其形状可征验也。若积引岁月，人即柴瘦，腹转大，遂致死。（《病源论》）
瘕病者，由寒温不适，饮食不消，与脏气相搏，积在腹内，结块瘕痛，随气移动是也，言其虚假不牢，故
谓之为瘕也。（同上）
夫积者，伤滞也，伤滞之久，停留不化，则成积矣。且人之脏腑，皆触冒以成疾病，惟脾胃最易受触。盖
日用饮食，稍或过多，停滞难化，或吐或呕，或泄或利。当是之时，法宜推荡，然后助养脾胃。所谓推荡者，
更宜斟量人之虚实，伤滞之轻重而推荡之，停滞一消，则不成积，克化失宜，久之必成积聚 瘕矣。（《济生
续方》）
病因气郁痰血 方书之五积六聚，证状不同，非谓食物所伤，留滞不去。盖五积者，因喜怒忧思失志，
以伤五脏，
遇传克不行而成病也。（《澹寮》）
诸书所载，皆以内为喜怒忧思七情之气，克制五脏，结而不散，乃成积聚之证（云云）。余忖度之，必是
因气结聚痰饮，或者积聚之物，而后能坚硬如此。发萌之初，早能辨其脉证，投以药饵，或以导引之法，犹云
庶几。若其见形于皮肤之下，药入肠胃，熏蒸之所不及，诚为难治之证。（《大成》）
气无形故不成块，然痰与食积死血，多因气聚而成，是气虽不为块，而所以为块者实由乎气，故治积之法，
以行气为主。（《统旨》）（按∶丹溪曰∶气不能作块成聚，块乃有形之物也，痰与食积死血而成也。叶氏实
驳此说也。）
五积当从郁论，《难经》所谓因受胜己之邪，传于己之所胜，适当旺时，拒而不受，因留为积。此皆抑郁
不伸而受其邪，故五积六聚治同郁断。伏梁者，火之郁。肥气者，木之郁。痞气者，土之郁。息贲者，金之郁。奔
豚者，水之郁。（按∶以上系《儒门事亲》节文）郁者，气不舒而抑郁成积，不独聚可以气言也。故治积之法，
以理气为先，则津液流行，积聚何由而成。（《锦囊》）
上古穴居野处，无情欲之累，故病多外感，以故《素问》往往谓脏寒生满病，又谓用力过度则络脉伤，伤
则血外溢于肠外，有寒汁沫与血相搏，则并合凝聚不能散而成积。今人多情欲，痰血气郁凝滞者比比皆是，故不
敢引经以断也。（《六要》）
大抵积块者，皆因一物为之根，而血涎裹之，乃成形如杯如盘，按之坚硬也。食积败血，脾胃有之。痰涎
之积，左右皆有之。（《保命歌括》）
病有因热 经曰∶小肠移热于大肠，为 瘕，为沉（云
云）。然则经言瘕病，亦有热者也。或阳气郁结，怫热壅滞，而坚硬不消者，非寒 瘕也，当以脉证别之。（《原
病式》）
病属阴寒有留止聚散之别 脉之小也，微也，小急也，弦急也，沉也，沉伏也，迟也，涩也，实也，
数绝也，沉横也，结伏也，长而左右弹也（按∶此诸脉系经及《脉经》所见），是皆阴寒敛实之脉，则知积之
成也，亦多属阴寒。阴寒则不能温散，而易于凝着，始则毫厘之留，日以增益，如堆然，久久则小者大，软
者坚，虚者实，无形者有形。聚则不然，病发无根，痛无常处。夫无根无常，则气不留止，偶与气血相搏，则
邪正相干，气聚而痛，气散则解，非若积之留止不移不散也。如肠腹攻冲，疝 瘕热，胸腹胀满，切痛雷鸣等
证，皆聚之类也。古人论积聚分脏腑者，亦不过以沉伏留止不移者属阴，阴则为脏；浮动聚散不常者为阳，
阳则为腑耳。治之者，当于留止聚散上相机，不当于脏腑二字上作工夫也。（《续焰》）
脉候 寸口脉沉而紧，苦心下有寒，时痛，有积聚。关上脉 大而尺寸细者，其人必心腹冷积，
瘕结聚，欲热饮食。（《脉经》）
迟而涩，中寒有症结。快而紧，积聚有击痛。弦小者，寒癖。（同上）
寸口脉沉而横者，胁下及腹中有横积痛（按∶此《平人气象论》文）。其脉弦，腹中急痛（按∶此取小建
中汤条）。腰背痛相引，腹中有寒疝瘕。脉弦紧而微细者，症也。夫寒痹 瘕积聚之脉皆弦紧，若在心下即寸
弦紧，在胃管即关弦紧，在脐下即尺弦紧。（一曰关脉弦长，有积在脐左右上下也。）又脉症法∶左手脉横症
在左，右手脉横症在右，脉头
大者在上，头小者在下。又法∶横脉见左积在右，见右积在左，偏得洪实而滑亦为积，弦紧亦为积为寒痹为疝痛。
内有积不见脉难治，见一脉（一作胁）相应为易治，诸不相应为不治。左手脉大，右手脉小，上病在左胁，下
病在左足；右手脉大，左手脉小，上病在右胁，下病在右足。脉来细而沉时直者，身有痈肿，若腹中有伏梁。脉
来小沉而实者，胃中有积聚，不下食，食即吐。（同上）
脉沉重而中散者，因寒食成症，脉左转而沉重者，气症，阳在胸中。脉右转出不至寸口者，内有肉症。
（同上）
寸口脉细沉滑者，有积聚在胁下，左右皆满，与背相引痛。诊其脉来实，心腹积聚，饮食不消，胃中冷也。
（《病源论》）
脉来逆而牢者，为病症也。肾脉小急，肝脉小急，心脉若鼓，皆为症。寸口脉结者， 瘕。（同上）（按∶
《邪气脏腑病形篇》∶肾脉微急为沉厥奔豚，足不收，不得前后。又肝脉微急为肥气，在胁下，若覆杯。此巢氏
所本。又寸口脉结，本于《十八难》。）
诊决死生 诊人心腹积聚，其脉坚强急者生，虚弱（《病源》此有急字，衍）者死。又实强者生，沉（《济
生》此有小字）者死。其脉大，腹大胀，四肢逆冷，其人脉形长者死。腹胀满，便血，脉大时绝，极下血，脉
小疾者死。（《脉经》）
（按∶《病源》所举止沉者死。《中藏经》无其脉大三字，别为一条，据此或者腹胀诊法，姑录于兹。）
脉弦而伏者，腹中有症，不可转也（《病源》作不可转动），必死不治。（同上）
寸口脉紧而牢者，胁下腹中有横积。结痛而泄利，脉微细者生，浮者死。（《病源论》）
其脉实强者，阳脉也，一以征邪正之相搏，一以征元本之壮实，从腑从阳，故曰生；其脉沉细者，阴脉也，
一以征邪气之深久，一以征元本之衰微，从脏从阴，故曰死。（《续焰》）
五脏积 诊得肺积，脉浮而毛，按之辟易，胁下气逆，背相引痛，少气善忘，目瞑皮肤寒，秋瘥夏剧，
主皮中时痛，如虱缘之状，甚者如针刺，时痒，其色白。诊得心积，脉沉而芤，上下无常处，病胸满悸，腹中
热，面赤嗌干，心烦掌中热，甚即唾血，主身螈 ，主血厥，夏瘥冬剧（《病源》此下曰∶唾脓血者死），其色
赤。诊得脾积，脉浮大而长，饥则减，饱则见， 起与谷争减，心下累累如桃李，起见于外，腹满呕泄肠鸣，
四肢重，足胫肿，厥，不能卧，是主肌肉损，其色黄。诊得肝积，脉弦而细，两胁下痛，邪走心下，足肿寒，胁
痛引少腹，男子积疝，女子瘕淋，身无膏泽，喜转筋，爪甲枯黑，春瘥秋剧，其色青。诊得肾积，脉沉而急，苦
脊与腰相引痛，饥则见，饱则减，少腹里急，口干咽肿，伤烂，目 ，骨中寒，主髓厥善忘，其色黑。（《脉
经》）（按∶《要诀》错综《难经》及此条，拟以大七气汤加减，今不录。）
经论五脏积气，皆因五脏旺时，不受所传邪气而成（云云）。常究此说，亦未可必。夫肺病传肝、肝传脾
之类，自是胜其所胜，夫传所胜者死。若如所言，则五脏之积皆死候也，其实不然也。（《鸡峰》）
瘕形证 （暴症） 瘕者，此由寒温不调，饮食不化，与脏气相搏结所生也。其病不动者，直名为症。
若病虽有结瘕，而可推移者，名为 瘕（按∶此症字似衍）。瘕者假
也，谓虚假可动也。候其人，发语声嘶，中满浊而后语，乏气拖舌，语而不出，此人食结在腹，病寒，口里常
水出（按∶《圣惠》作候其人发语，声嘶挹舌，语而不出，此人食结在腹，其病寒，口中常有水出。《鸡峰》同，
舌作言），四体洒洒，常若发疟，饮食不能，常自闷闷而痛，此食症病也。（《病源论》）（宜参前病因饮
食不消条及脉候。）
暴症者，由腑脏虚弱，食生冷之物，脏既虚弱，不能消之，结聚成块，卒然而起，其生无渐，名曰暴症也。
本由脏弱，其症暴生，至于成病，死人则速。（同上）
戴云∶积聚 瘕，有积聚成块不移动者，是 ；或有或无，或上或下，或左或右者，是瘕。（《钩玄》）
癖形证 夫 癖者，本因邪冷之气积聚而生也。 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，名曰 气也。癖者，侧在两肋之间，有时而僻（《鸡峰方》僻作痛），
故曰癖也。夫 之与癖，名号虽殊，针石汤丸主疗无别，此皆阴阳不和，经络痞隔，饮食停滞，不得宣流，邪冷
之气，搏结不散，故曰 癖也。（《圣惠》）
者悬也（按∶此说误），悬于腹内，近脐左右，各有一条筋脉扛起，大者如臂如筒，小者如指如笔管如
弦，其原皆由阴阳之气不和，常多郁塞，又时忿怒，动气偏胜，或适当饮食，与气缠裹，适受寒冷，与气停蓄，
且忿怒则肝火盛，而血随气结，痰亦缘火相附而升，遂合并而成形质，悬于脐之左右，故名曰 。（《尊生
书》）
癖积，两胁刺痛，三棱、广术之类，甚者甘遂、蝎梢。（《儒门事亲》）
部位 积在中为痰饮，在右为食积，在左为死血，乃丹溪确论也（按∶丹溪说，出《心法》）。然胃脘有食积而
病发在中者，亦有肝气与宿食相假而积在左者，又不可拘泥也。曾治一少年，体薄弱，且咳血，左边一块，不时上攻作
痛，左金、芦荟俱不应。诊其脉三部虽弦，而细涩不流利，因作阴虚治，四物加知、柏、玄参、牡丹皮，不六剂顿愈，
This is "Ji" (Accumulation), "Jia" (Mass) is "Ju" (Gathering). Their symptoms differ slightly from "Pi" (Partiality), and the general situation is as described above. Later generations established the term "Pi Ku" (Obstructed Mass), which is truly meaningless. As for treatment prescriptions, there are few cases where the two syndromes of "Ji" and "Ju" can be strictly distinguished; generally, it merely involves differentiating severity within the approach of resolving stagnation. The compilation here also follows this principle. As for diseases in women, they are diverse and have been listed in detail in the gynecology section, so they are not recorded here again.
[General Discussion on Origins]
"Qin", "Pi", and "Jie" are alternative names for "Ji Ju" (Accumulations and Gatherings). Although their symptoms vary, tracing back to the root cause reveals they are largely similar; they are named based on the pathogenic factors or the observed symptoms. "Qin" refers to something faintly visible inside the abdomen, where pressing reveals its form and symptoms. "Jia" refers to a false gathering that moves when pushed. "Pi" refers to a condition located laterally in the hypochondrium (see later sections for details on these three syndromes). "Jie" refers to something deep-seated, firm, and hard inside (this is also considered "Ji" and does not need a separate name). However, some arise from food, some from water retention, some from worry and overthinking, and some from wind-cold. For any disease caused by blood and qi sinking, stagnating, and knotting, treatment requires gradual grinding and dissolving to restore the free flow of blood and qi, thereby curing the disease. (*Shengji Zonglu*) (Note: *Zhongzang Jing* states: "Qin" relates to Qi, while "Jia" relates to Blood.)
Diseases of accumulation and gathering can be caused by food, blood, qi, wind, and cold. However, one must carefully distinguish between "Ji" and "Ju". "Ji" implies cumulative layering, developing gradually; "Ju" implies gathering and dispersing irregularly, with unpredictable onset and cessation. Therefore, those that are hard and immobile possess form and are called "Ji"; those that gather and disperse lack fixed form and are called "Ju". All forms-based lesions, whether due to food stagnation or retained pus and blood, where fluids and froth condense to form masses, belong to the category of "Ji". These diseases mostly reside in the blood level, as blood is tangible and static. All formless lesions, whether distended or not, painful or not, arising upon stimulation and coming and going unpredictably, belong to the category of "Ju". These diseases mostly reside in the qi level, as qi is intangible and dynamic. Thus, *Nan Jing* considers "Ji" as Yin Qi and "Ju" as Yang Qi, which aligns with this reasoning. Formless "Ju" is easy to disperse; formed "Ji" is difficult to break. When facing these syndromes, one only needs to differentiate between formless and formed, and between qi and blood levels; then, the principles for treating "Ji" and "Ju" will become clear. (Zhang Jingyue, *Jingyue Quanshu*)
[Etiology: Viscera Affected by Pathogens]
Accumulations and gatherings arise from disharmony of Yin and Yang, weakness of the viscera, invasion of wind pathogens, and contention with visceral qi. Fu organs belong to Yang, and Zang organs belong to Yin. Yang floats and moves; Yin sinks and rests. "Ji" is Yin Qi, generated by the Five Zang organs; its onset remains within its specific area, having definite upper and lower limits. "Ju" is Yang Qi, formed by the Six Fu organs; thus, it has no root, moves freely without staying in one place, and pain has no fixed location. When various viscera are affected by pathogens, it does not initially form an accumulation; only when the pathogen lingers and fails to dissipate does it become an accumulation. (*Zhubing Yuanhou Lun*)
The Six Fu organs belong to the Three Yang meridians. Taiyang facilitates clear qi, Yangming drains turbid qi, and Shaoyang transforms essence qi, acting like a central hub responsible for transportation and transformation. If the functions of the Six Fu organs fail, pathogens gather and do not dissipate. Onset lacks a root, movement is unrestricted, and pain is variable. In the upper body, it causes obstruction; in the lower body, distension; attacking both flanks, it resembles a mass but is easily movable, distinguishing it from the Five Accumulations. (*Jisheng Fang*)
External wind-cold pathogens can also form accumulations. As classics state: "Deficient pathogens" enter the body and linger, transmitting to the space outside the intestines and stomach, between the epigastric region and the membrane source, attaching to vessels, and forming accumulations through respiration. It is also said: The disease named "Fuliang" (Hidden Beam) is rooted in wind. From this, we can infer that post-malaria痞块 (obstructed masses) in modern people belong to the wind-cold category. While malaria caused by wind-cold is easily understood, various accumulations seem unrelated to wind. However, food stagnation may not form an accumulation without cold, and wind-cold pathogens may not take shape without food attachment. Thus, food encountering cold, or cold encountering food, or unresolved exterior pathogens combined with excessive diet, lead to the contention of pathogens and food, forming accumulations. Classics say: "When deficient wind pathogens meet a deficient body, they invade." Indeed, the cause of accumulations often stems from this, as do hemorrheal disorders and qi obstructions. Accumulations caused by cold, if lingering long, transform into heat; accumulations caused by wind, once formed, no longer present as wind symptoms. Therefore, treatment should focus on resolving the stagnation rather than using diaphoresis, which would further damage true qi. Only those who treat illness cautiously, understanding the cause and addressing it early, can preserve spleen and stomach health effectively. (Zhang Jingyue, *Jingyue Quanshu*)
[Etiology: Indigestion]
"Qin" arises from imbalance of cold and warmth, leading to weakened visceral qi and inability to digest food. Food gathers internally, gradually growing into solid, immovable masses. This is called "Qin," meaning its shape is verifiable. If the accumulation persists for years, the person becomes emaciated, the abdomen enlarges, and death ensues. (*Zhubing Yuanhou Lun*)
"Jia" disease arises from improper cold/warmth regulation and indigestion. Food contentions with visceral qi, accumulating in the abdomen to form movable, painful masses. It is called "Jia" because it is false and insecure. (Ibid.)
"Ji" refers to injury and stagnation. Prolonged stagnation that fails to transform becomes "Ji." The viscera are susceptible to external invasions, with the Spleen and Stomach being most vulnerable. Daily dietary excess leads to stagnation and difficulty in digestion, resulting in vomiting or diarrhea. At this stage, purgative methods ("Tui Dang") are appropriate, followed by nourishing the Spleen and Stomach. Purging must be calibrated to the patient's deficiency/excess and the severity of stagnation. Once stagnation clears, no accumulation forms; improper suppression leads to accumulations, Qin, and Jia over time. (*Jisheng Xufang*)
[Etiology: Qi Stagnation, Phlegm, and Blood Stasis]
The Five Accumulations and Six Gatherings in medical texts have different symptoms and are not solely caused by food injury and stagnation. The Five Accumulations result from emotional disturbances (joy, anger, worry, thought) damaging the Five Zang organs, leading to transmission and counter-restriction failures. (*Danliao Jiyan Fang*)
Various books attribute internal seven emotions to restraining the Five Zang organs, causing knotting and failure to disperse, resulting in accumulation syndromes. I speculate that hardness results from Qi knotting, phlegm-fluid retention, or existing accumulation matter. If identified early at the萌芽 (sprouting) stage, medication or Qigong guidance might help. However, if visible under the skin, where oral medications cannot reach via vaporization, it is indeed difficult to treat. (*Yixue Dacheng*)
Qi is formless and does not form masses itself, but phlegm, food stagnation, and dead blood often gather due to Qi. Although Qi itself is not a mass, the formation of masses relies on Qi. Therefore, treating accumulations prioritizes moving Qi. (*Danxi Xinfa Tongzhi*) (Note: Zhu Danxi stated: "Qi cannot form masses; masses are tangible entities formed by phlegm, food stagnation, and dead blood." Ye Tianshi actually refuted this view.)
The Five Accumulations should be discussed from the perspective of "Yu" (Depression/Stagnation). *Nan Jing* describes receiving pathogens stronger than oneself, transmitting to what one controls, and rejecting them during peak times, leading to stagnation. This is due to depression preventing the expulsion of pathogens. Thus, treatments for Five Accumulations and Six Gatherings are similar to those for Depression. Fuliang is Fire Depression; Feiqi is Wood Depression; Piqi is Earth Depression; Xiben is Metal Depression; Ben Tun is Water Depression. (Excerpt from *Rumen Shiqin*). Depression is Qi failing to unblock, leading to stagnation and accumulation. Treatment prioritizes regulating Qi to promote fluid circulation, preventing accumulation. (*Jinnang Milu*)
In ancient times, living in caves and wild places, people lacked emotional burdens, so diseases were mostly external. Hence, *Suwen* states that cold in viscera causes fullness, and excessive effort damages collaterals, causing blood to overflow outside intestines. Cold fluids and blood contend and condense, forming accumulations. Modern people have many desires, leading to frequent phlegm, blood, and Qi stagnation. Thus, I dare not rigidly apply classics to diagnose. (*Xue Ji Yi An Liuyao*)
Generally, masses are rooted in one substance, wrapped in blood and phlegm, forming cup- or plate-like shapes that are hard to touch. Food stagnation and bad blood affect the Spleen and Stomach; phlegm-fluid accumulations occur on both sides. (*Baoming Gekuo*)
[Etiology: Heat]
Classics state: "Small Intestine transferring heat to Large Intestine causes Qin Jia and Chen..." Thus, Jia diseases can also involve heat. Yang Qi knotting, stifling heat, and stagnation causing hardness are not cold-type Qin Jia; they must be differentiated by pulse and symptoms. (Liu Wansu, *Yuanbing Shi*)
[Differentiation of Yin-Cold: Lingering vs. Gathering/Dispersing]
Pulses that are small, minute, small-rapid, string-taut, deep, hidden, slow, choppy, excess, rapid-interrupted, deep-horizontal, knotted-hidden, or long-and-pulsing laterally (seen in classics and *Maijing*) indicate Yin-cold constriction and excess. Thus, accumulations often stem from Yin-cold. Yin-cold cannot warm and disperse, favoring condensation. Initially slight, it grows daily like a pile, eventually becoming large, hard, solid, and tangible. Conversely, "Ju" has no root, pain is variable. Without root or constancy, Qi does not linger. Occasionally contending with blood and Qi, evil and righteous Qi clash; Qi gathering causes pain, Qi dispersing resolves it. This differs from "Ji" which lingers and does not disperse. Symptoms like intestinal attack, hernia-jia heat, chest/abdominal fullness, and loud rumbling belong to "Ju". Ancient differentiation of accumulation by Zang/Fu attributed lingering/deep pulses to Yin/Zang, and floating/moving pulses to Yang/Fu. Treatment should focus on lingering vs. dispersing, not rigidly on Zang/Fu labels. (*Xu Yan*)
[Pulse Diagnosis]
Cunkou pulse deep and tight indicates cold in the epigastrium, periodic pain, and accumulation. Guan pulse large with Cun and Chi fine indicates cold accumulation in heart/abdomen, Jia knotting, and desire for hot drinks. (*Maijing*)
Slow and choppy indicates middle-cold with nodules. Rapid and tight indicates accumulation with striking pain. String-small indicates cold Pi. (Ibid.)
Cunkou pulse deep and horizontal indicates horizontal accumulation pain in hypochondrium and abdomen (from *Pingren Qixiang Lun*). String pulse indicates acute abdominal pain (refer to Xiao Jianzhong Tang). Lower back pain radiating to abdomen indicates cold hernia and Jia. String-tight and micro-fine pulse indicates Nodules. Cold Bi, Qin Jia, and Accumulation pulses are all string-tight. Epigastric location corresponds to Guan string-tight; umbilical to Chi string-tight. (One theory: Guan pulse string-long indicates accumulation around the umbilicus.) Pulse-symptom rules: Left-hand horizontal pulse indicates left-sided accumulation; right-hand indicates right-sided. Pulse head large indicates upper location; small indicates lower. Horizontal pulse on left indicates right-sided accumulation; on right indicates left-sided. Surplus-excess-slippery or string-tight pulses also indicate accumulation, cold Bi, or hernia pain. Internal accumulation without corresponding pulse is hard to treat; one corresponding pulse makes it easier; no correspondence means untreatable. Large left/small right pulse: upper disease in left hypochondrium, lower in left foot. Large right/small left pulse: upper in right hypochondrium, lower in right foot. Fine-deep-straight pulse indicates abscess or Fuliang in abdomen. Small-deep-excess pulse indicates gastric accumulation, anorexia, and vomiting after eating. (Ibid.)
Heavy-deep-middle-scattered pulse indicates food-cold nodule. Left-turning heavy pulse indicates Qi nodule, Yang in chest. Right-turning pulse not reaching Cunkou indicates meat nodule internally. (Ibid.)
Cunkou pulse fine-deep-slippy indicates accumulation in hypochondrium, bilateral fullness, and back radiation pain. Excess pulse indicates heart/abdominal accumulation, indigestion, and cold stomach. (*Zhubing Yuanhou Lun*)
Rebellious-steadfast pulse indicates Nodule disease. Kidney pulse small-rapid, Liver pulse small-rapid, Heart pulse drum-like all indicate Nodules. Knotted Cunkou pulse indicates Qin Jia. (Ibid.) (Note: *Xieqi Zangfu Bingxing Pian*: Kidney micro-rapid indicates deep厥 Ben Tun, leg paralysis, urinary/fecal retention. Liver micro-rapid indicates Feiqi in hypochondrium like an inverted cup. These originate from Chao Yuanfang. Knotted Cunkou originates from *Nan Jing* Chapter 18.)
[Prognosis]
Heart/abdominal accumulation with strong-tight pulse indicates survival; weak pulse indicates death. Excess-strong pulse indicates survival; deep pulse indicates death. Large pulse with abdominal distension, cold limbs, and long pulse shape indicates death. Abdominal fullness, bloody stool, large-intermittent pulse, severe bleeding, and small-rapid pulse indicate death. (*Maijing*)
(Note: *Zhubing Yuanhou Lun* mentions only deep pulse indicates death. *Zhongzang Jing* omits "pulse large," listing it separately; this may be a specific abdominal distension diagnostic method.)
String-vaulted pulse indicates abdominal nodule, immobility, and certain death. (Ibid.)
Cunkou pulse tight-steadfast indicates horizontal accumulation in hypochondrium/abdomen. Knotting pain with diarrhea, micro-fine pulse indicates survival; floating pulse indicates death. (*Zhubing Yuanhou Lun*)
Excess-strong pulse is Yang, indicating struggle between evil and righteous Qi and robust constitution; following Fu/Yang suggests survival. Deep-fine pulse is Yin, indicating deep/long-standing evil and depleted constitution; following Zang/Yin suggests death. (*Xu Yan*)
[Five Zang Accumulations]
Lung Accumulation: Floating-hairy pulse, yielding to pressure. Reverse Qi in hypochondrium, radiating back pain, shortness of breath, forgetfulness, closed eyes, cold skin. Improves in autumn, worsens in summer. Skin pain like insects crawling, needle-like sensation, itching, white complexion. Heart Accumulation: Deep-empty pulse, wandering location. Chest fullness, palpitations, abdominal heat, red face, dry throat, vexation, hot palms, spitting blood (severe), convulsions, blood厥, improves in summer, worsens in winter. Red complexion. (*Zhubing Yuanhou Lun* adds: spitting pus-blood indicates death.) Spleen Accumulation: Floating-large-long pulse, weaker when hungry, prominent when full. Lumps under epigastrium like peaches/plums, visible externally. Abdominal fullness, vomiting, diarrhea, borborygmus, heavy limbs, swollen calves,厥, inability to lie down. Damages muscles, yellow complexion. Liver Accumulation: String-fine pulse. Hypochondriac pain radiating to epigastrium, swollen/cold feet, hypochondriac pain radiating to lower abdomen. Men: hernia accumulations; Women: Jia strangury. Lack of luster, cramps, black brittle nails. Improves in spring, worsens in autumn. Blue complexion. Kidney Accumulation: Deep-rapid pulse. Spine/lower back pain, visible when hungry, reduced when full. Lower abdominal urgency, dry mouth, swollen/throat erosion, eye issues, cold bones, marrow厥, forgetfulness. Black complexion. (*Maijing*) (Note: *Yaojue* combines *Nan Jing* and this section, suggesting Da Qi Qi Tang modifications; omitted here.)
Classics state Five Zang Accumulations form when Zang organs are at peak strength and reject transmitted pathogens. However, this is not always absolute. Transmission from Lung to Liver, etc., follows controlling relationships; transmitting to what one controls leads to death. If all accumulations were fatal, it would contradict reality. (*Jifeng Puji Fang*)
[Qin Jia Morphology]
(Bao Qin) Qin arises from cold/warmth imbalance, indigestion, and contention with visceral qi. Immobile masses are directly called Qin. Movable masses are called Qin Jia. "Jia" means false/movable. Signs: hoarse voice, abdominal fullness/turbidity before speaking, weak air dragging tongue, speech inhibition, food knot in abdomen, cold disease, constant salivation, shivering limbs, malaria-like sensations, inability to eat, dull pain. This is Food Qin disease. (*Zhubing Yuanhou Lun*) (Refer to Etiology: Indigestion and Pulse Diagnosis sections.)
Bao Qin (Sudden Qin) arises from visceral weakness and consumption of raw/cold food. Weak viscera cannot digest, leading to sudden mass formation without gradual development. Due to weak viscera, onset is sudden, and death occurs quickly. (Ibid.)
Dai Yun: Accumulations/Qin/Jia with immovable masses are Qin; those appearing/disappearing or moving up/down/left/right are Jia. (*Yixue Gouxuan*)
[Pi Morphology]
Pi arises from accumulation of evil cold Qi. "Qixi" (often associated with Pi) refers to tendons near the umbilicus on either side, painful and taut like strings, varying in size from arm to finger, formed by Qi. "Pi" refers to lateral locations between ribs, sometimes偏僻 (remote/painful), hence the name. Although names differ, treatments (acupuncture, herbs, pills) are similar. Both result from Yin-Yang disharmony, meridian obstruction, food stagnation, and cold Qi contention. (*Taiping Shenghui Fang*)
"Qixi" implies hanging (note: this explanation is erroneous). Hanging inside abdomen near umbilicus, tendons rise like arms/tubes or fingers/brushes/strings. Root cause: Yin-Yang disharmony, frequent depression, anger causing Qi hyperactivity, food wrapping Qi, cold exposure causing Qi stagnation. Anger increases Liver Fire, binding Blood with Qi, Phlegm rising with Fire, merging into tangible forms hanging left/right of umbilicus. (*Zunsheng Shu*)
Pi accumulation with stabbing hypochondriac pain: Sanleng, Ezhu; severe cases: Kansui, Scorpion tail. (*Rumen Shiqin*)
[Location]
Accumulation in center: Phlegm-fluid; Right: Food stagnation; Left: Dead blood. This is Zhu Danxi's definitive view (*Xinfa*). However, gastric food stagnation can manifest centrally, and Liver Qi with old food can accumulate on the left. Do not be dogmatic. Case: Young man, weak, hemoptysis, left-sided mass attacking intermittently. Zuojin and Lu Hui failed. Pulses string-like but fine-choppy-unsmooth. Diagnosed as Yin Deficiency. Si Wu Tang plus Zhimu, Huangbai, Xuanshen, Mudanpi cured him in six doses.