积聚有余，宜消导，分新与久，新病为寒，宜辛温消
导，久则为热，宜辛寒推荡；不足，止宜缓治。盖阳虚有积易治，阴虚难以峻攻，痞积又忌滞药。（《士林余
业》）
攻下例 或言予之治积太峻，予曰∶不然。积之在脏，如陈 之在河江。且积之在脏中，间多着脂膜
曲折之处，区臼之中。陈 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，
一壅而尽。设未尽者，以药调之。惟坚积不可用此法，宜以渐除，《内经》曰坚者削之，今人言块癖是也。（《儒
门事亲》）（按∶《格致余论》曰∶积聚久则形质成，根据附肠胃回薄曲折处，以为栖泊之窠臼，阻碍津液气血，
熏蒸燔灼成病，自非剖肠刮骨之神妙，孰能去之，又岂合勺铢两之丸散，所能窃犯其藩墙户牖乎。此全本子和
之言。）
夫大积大聚，乃可攻之；积聚非大，则未可攻也，十去六七，即衰其半矣，止者不可复攻也。多毒之药，
以破积聚。毒有大小，大毒之性烈，其为伤也多；小毒之性和，其为伤也少。毒药之攻积聚，因其势不得已而用
之也，既衰其大半，势已去即止者，恐伤正气也，圣人之虑深矣。凡攻其积块者，以辛散之，以苦泻之，以咸
软之，以坚削之，未有不愈者也。（《保命歌括》）（按∶此系错综《六元正纪大论》、《五常政大论》之文。）
补养例 壮人无积，虚人则有之，皆由脾胃怯弱，气血两衰，四时有感，皆能成积。若遽以磨坚破结
之药治之，疾似衰而人已衰矣，干漆、 砂、三棱、牵牛、大黄之类，得药则暂快，药过则依然，气愈消，疾
愈大，竟何益哉。故善治者，当先补虚，使血气壮，积自消，如满座皆君子，则小
人自无容地也。不问何脏，先调其中，使能饮食，此是本也。（《纲目》引洁古）
真定王君用，年一十九岁，病积，脐左连胁如覆杯，腹胀如鼓，多青络脉，喘未能卧，时值暑雨，加之自
利完谷，日晡潮热，夜多盗汗，以危急来求冶。予往视之，脉得浮数，按之无力，谓病家曰∶凡治积，非有毒
之剂攻之则不可；今脉虚弱如此，岂能以常法治之。遂投分渗益胃之剂，数服而清便自调，杂以升降阴阳，进
食和气，而腹胀大减，胃气稍平，间以削之，不月余良愈。先师尝曰∶洁古老人有云∶养正积自除，譬之满座
皆君子，纵有一小人，自无容地而出。今令真气实，胃气强，积自除矣，洁古之言，岂欺我哉。《内经》云∶
大积大聚，衰其大半而止。满实中有积气，大毒之剂尚不可过，况虚中有积者乎。此亦冶积之一端也，邪正虚
实，宜精审焉。（《宝鉴》）
行死血块，块去须大补。（《丹溪》）
中洲吴仰泉夫人，年五旬，患腹中积块如盘大，腹胀年余，后渐卧不倒床，腹响如雷，嗳气不透，口干吐
白沫，下气通则腹中稍宽，五心烦热，不思饮食，肌瘦如柴。医更八人，并无寸效，一家哭泣，后事俱备，束手
待毙而已。召余至，诊六脉涩数，气口紧盛。余知是前医误以寒凉杀伐之过，使真气不运而瘀血不行。余以八
物汤，加半夏、陈皮、木香、浓朴、萝卜子、大腹皮、海金沙。服三剂后，小便下血块，如鸡肝状。服至十二
剂，打下黑血块盆许，腹中仍有数块。又以八物汤，加枳实、香附，五剂而痊。正是养正而积自除也，信哉不
诬。（《寿世保元》）
顾晋封夫人，患痞在胁下，或令用膏药，加阿魏一分，麝香半分贴之，五六日间，遂下鲜血血块甚多，二
三日方
止，是后每岁当贴膏时必发。近邻妪亦用阿魏膏贴痞，下血如前。世以阿魏、麝香为痞块必用之药，外用为患若
此，况服食乎。因为拈出，以为虚人漫用攻击之戒。（《医通》）
攻补节度 养正积除，此积之微者也。如脾胃失于健运，而气积食积之不疏导者，惟养脾胃之正气，而
滞积自疏矣。若夫大积大聚，如五积之久而成症病，坚固不移者，若非攻击悍利之剂，岂能推逐之乎。惟虚弱
之人，必用攻补兼施之法也。（《医统》）
人之有积，则皆为身中之邪气，若君子座中之有小人也，惟其正气盛，而真气营运不失其常，则积略攻之而散
溃，亦或自然消退矣。正气稍虚，则积日着，而恣其欺罔之势，正气日渐为之弱矣。凡积成而形渐悴，速补真气，
待荣卫充实，方可下之。或且攻且补，或先补后攻，或先攻后补，必至于邪去正复而后已。然除之不以渐，则必
致于颠覆之害矣。其积余之尚在者，若不亟下之，必将复起，恣害亡身者有矣。（同上）（按∶此删润《微义》
文者。）
治积之要，在知攻补之宜，而攻补之宜，当于孰缓孰急中辨之。凡积聚未久而元气未损者，治不宜缓，盖
缓之则养成其势，反以难制，此其所急在积，速攻可也。若积聚渐久，元气日虚，此而攻之，则积气本远，攻不
易及，胃气切近，先受其伤，愈攻愈虚，则不死于积而死于攻矣，此其所重在命，不在乎病，所当察也。故凡
治虚邪者，当从缓冶，只宜专培脾胃以固其本，或灸或膏以疏其经，但使元气日强，经气日通，则积痞自消。斯
缓急之机，即万全之策也。不独治积，诸病皆然。（《景岳》）
盖积之为义，日积月累，匪伊芳朝夕，所以去之亦当有渐，太亟则伤正气，正伤则不能运化而邪反固矣。余尝制阴
阳二积之剂，药品稍峻，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，则复攻之，
屡攻屡补，以平为期，此余独得之诀，百发百中者也。（《必读》）
理气为先 （说见前病因气滞条。）
消磨例 凡积病，若下亦不退者，当消积药融化开，则积自消矣。（《丹溪》）
如痰食之积，形虽坚而尚能移动者，其治犹易；如积气在阴，坚顽内伏，此等之候，阳气难行，药难遽及，
惟有仲师鳖甲煎丸，取飞潜动跃之物为用，借其体阴用阳之功，俾得入阴而转旋阳气，庶可冀入阴通阳，以消
解此坚顽深固之痼疾也。（《医级》）
病有当用从治 或问∶人有积块疝气心腹等证者，虽多服久服附子、姜、桂等热药，而不发药毒，不生
他病，然本病日深者，何也？曰∶诸积诸痛，喜温而恶寒，热药与病情相合，积久成郁而大邪深矣。郁热既深，
则见寒愈逆，见热愈喜，两热相从，故不生他病，所谓亢则害，承乃制，火极而似水者也。然真气被食，阴血干
枯，病日深痼而不可为矣。世人不识，但见投热不热，误认为沉寒痼冷而益投之，至死不悟，悲夫。然则治之当
如何？曰∶当用从治法。《内经》曰热因寒用，寒因热用，伏其所主，先其所因者是也。（《明医杂着》）
治积诸药 大抵治积，或以所恶者攻之，以所喜者诱之，则易愈。如 砂、水银治肉积，神曲、麦 治
酒积，水蛭，虻虫治血积，木香、槟榔治气积，牵牛、甘遂治水积，雄黄、腻粉治涎积，礞石、巴豆治食积，
各从其类也。若用群队之药分其势，则难取效。许嗣宗所谓譬犹猎不知兔，广罗原野，冀一人获之，术亦疏矣。
须是认得分明，是何积
聚，然后增加用药，不尔，反有所损，嗣宗自谓不着书，在临时变通也。（《本事》）
古方有用曲、 者，化水谷也。有用 砂、阿魏者，去肉食也。用陈皮、紫苏、生姜者，化鱼鳖也。用丁
香、桂心者、腐果菜也。用牵牛、芫花者，攻水饮也。用三棱、鳖甲者，去 瘕也。用附子、硫黄者，除痼冷
也。用水蛭、虻虫者，攻血块也。用木香、槟榔者，攻滞气也。用雄黄、腻粉者，攻涎积也。用礞石、巴豆者，
攻痰食也。甘遂、甘草并用者，假其相战以去积也。（《医方考》）
治有宜蜡匮药 有一等虚人沉积，不可直取，当以蜡匮其药。盖蜡能粘逐其病，而又久留肠胃间，又不
伤气，能消磨至尽也。（《鸡峰》）（按∶《本草衍义》论丸药用蜡投蜜相合，下咽易消化，非用蜡之本意，
宜考。）
药宜丸子 凡诸块不宜用煎剂，只宜用丸子。盖块至难消，若用煎剂，如过路之水而已，徒损元气，于
块无益。惟丸子入胃，徐徐而化，径至所患之处，潜消嘿夺，日渐损削，其块自小。亦不宜消尽其块，假如鹅
卵大者，消至如弹丸即止，不必再服。盖块既渐少，大势既杀，必无再大之理，如暖解冰，一解即不能合矣。若
必欲消尽，则人之元气亦消尽，反不可保，况块势既衰，久必自消矣。经曰∶衰其大半则止，过者死。医者所当
知也。（《医镜》）（按∶块不宜煎剂，固是概论，然论丸子之效颇当，仍存之。）
理气诸方 主五种积，膈气，三焦痞塞，胸膈满闷，呕吐痰逆，口苦吞酸。常服顺气宽中，消 癖积
聚，宜服枳壳散。
枳壳（去穣锉麸炒） 荆三棱 橘皮（去白） 益智仁 蓬莪术 槟榔（不见火各一两或各六两一钱）
干姜（炮） 浓朴（去粗皮姜汁炙） 甘草（炙） 青皮（去白） 肉豆蔻 木香（各半两或各三两）
上为细末，每服二钱重，水一盏，生姜三片，枣一个，同煎至七分，热服不拘时候，盐点亦得。（《本
事》）（按∶此本《和剂》膈气散，今去肉桂。）
大七气汤，治六聚，状如 瘕，随气上下，发作有时，心腹 痛，攻刺腰胁，上气窒塞，喘咳满闷，小腹
胀，大小便不利，或复泄泻淋沥无度。（《济生》）（方出《诸气》中）一方加大黄、槟榔，治诸般痞积，
面黄肌瘦，四肢无力，皆缘内有虫积，或好食生米、壁泥、茶、炭、咸、辣等物。用水煎，露一宿，空心温服。
不得些少饮食，则虫积不行矣。（《回春》）（按∶《济世全书》此下曰∶服后食顷，腹必痛，当下如鱼冻，
或长虫，或血鳖，至日午虫积下尽，方用温粥止之，后服绿矾丸一料而愈。）
开怀散（云林制），治心下积块，作痞闷或发热者。
青皮（去穣） 陈皮 半夏（姜炒） 白茯苓（去皮） 三棱（醋炒） 莪术（醋炒） 香附 槟榔
草豆蔻（倍用） 柴胡（倍用） 红花 枳实（麸炒） 甘草
上锉一剂，生姜煎服。口干，加干葛。（《医鉴》）（按∶此本东垣消痞汤，更加数味，宜参《痞满》门。
又《士林余业》治伏梁横架心下为心积，用枳实、白术、浓朴、茯苓、半夏、三棱、黄连，酒糊丸，是一类方。）
温中诸方 （治验）（熨法见后）散聚汤，治久气积聚，状如 瘕，随气上下，发作有时，心腹绞痛，
攻刺腰胁，上气窒塞，喘咳满闷，小腹 胀，大小便不利，或复泄泻淋沥无度，遗精白浊，状若虚劳。
半夏（汤洗七次） 槟榔 当归（各三分） 陈皮 杏仁（麸炒去皮尖） 桂心（各二两） 茯苓 甘草（炙） 附
子（炮去皮脐） 川芎 枳壳（麸炒去穣） 浓朴（姜汁制） 吴茱萸（汤洗各一两）
上锉散，每服四钱，水一盏半，煎七分去滓，食前服。大便不利，加大黄。（《三因》）
治寒癖气，腹胁满胀，短气呕逆，手足厥冷，不欲饮食，腰背疼痛，吴茱萸丸方。
吴茱萸（一两汤浸七遍焙干微炒） 浓朴（一两半去粗皮涂生姜汁炙令香熟） 附子（三分炮裂去皮脐）
桂心（三分） 人参（二分） 甘草（三分炙微赤锉） 半夏（三分汤洗七遍去滑） 枳实（一两麸炒微黄）
干姜（三分炮裂锉）
上件药捣罗为末，炼蜜和捣三二百杵，丸如梧桐子大，每服温酒下三十丸，日三四服。（《圣惠》）
昔有人病 癖，有人教令取数片大蒜，合皮截去两头吞之，名内灸，根据此大效。（《神巧万全方》）（按∶
此本出陈藏器《本草》。）
喻嘉言治一人，少腹脐旁三块，坚硬如石，以手拊之，痛不可忍，其脉止两尺洪盛，余俱微细，此由见块
医块，不究其源而误治也。初起时块不必坚，以峻猛之药攻之，致真元内乱，转助邪为害，故迸紧不散，其实
全是空气聚成，非如女子月经，凝而不行，即成血块之比，观两尺脉洪盛，明是肾气传于膀胱。姑用补中药一
剂，以通中下之气，后用大剂药，内收肾气，外散膀胱。先以理中汤加附子五分，块减十之三，再用桂、附大
剂，腹中奔气响甚，三块一时顿没，更用补肾药加桂、附调理而愈。（《医通》）（按∶此《寓意草》节文。）
消磨诸方 《延年》半夏汤，主腹内左肋 癖硬急，气满不能食，胸背痛者方。
半复（三两洗） 生姜（四两） 桔梗（二两） 吴茱萸（二两） 前胡（三两） 鳖甲（三两炙）
枳实（二两炙） 人参（一两） 槟榔子（十四枚）
上九味切，以水九升，煮取二升七合，去滓分温三服。（《外台》）《医心方》∶《医门方》疗 瘕，腹内
胁下小腹胀满痛，冷即发，其气上冲心，不能饮食，或呕逆气急烦满方。于本方去前胡、鳖甲、枳实，加大黄、
浓朴、茯苓、枳壳、干枣。
人有肝气甚郁，结成气块，在左胁之下，动则痛，静则宁，岁月既久，日渐壮大，面色黄槁，吞酸吐痰，时
[Background Information]
Book: Zabing Guangyao (Comprehensive Requirements for Miscellaneous Diseases)
Author: Danbo Yuanjian (Japan)
Dynasty: Qing
Chapter: Accumulation and Masses (3/5)
Category: Comprehensive
Accumulation and masses presenting with excess syndrome should be treated with resolution and guiding out. Differentiate between new-onset and chronic cases. New-onset cases are typically cold in nature, suitable for acrid-warm herbs to resolve and guide out; chronic cases tend to transform into heat, suitable for acrid-cold herbs to push and purge. If deficiency is present, only slow treatment is appropriate. Generally, accumulation associated with Yang deficiency is easy to treat, whereas that with Yin deficiency is difficult to treat with harsh attacking methods; moreover,痞 (pi - stuffiness/mass) accumulations contraindicate the use of cloying/stagnating herbs. (From *Shilin Yuye*)
Case of Purging: Some say my treatment of masses is too harsh. I reply: Not so. Accumulations in the zang organs are like silt deposited in rivers. Furthermore, accumulations within the viscera often adhere to the convoluted areas of fatty membranes, akin to furrows or mortars. Silt in rivers does not stay in the midstream but mostly settles in bays and eddies; when the river floods, it is washed away. The principle of accumulation in the viscera is similar. Therefore, I first use pill medicines to drive out newly ingested food, preventing obstruction. For fragmented adherent accumulations that have loosened but not yet passed, I then use powder medicines to fill the stomach and induce downward movement, like a raft blocking a river, which is swept away entirely upon blockage. If anything remains, it is regulated by medication. Only firm, hard accumulations cannot be treated this way; they should be gradually eliminated. As the *Neijing* states, "Firmness is削 (scraped/reduced)." This refers to what people today call mass-like癖 (pi - fixed masses). (From *Rumen Shiqin*) [Note: *Gezhi Yulun* states: When accumulation and masses persist, physical forms develop, attaching to the convoluted and thin areas of the intestines and stomach, serving as nests for stagnation, obstructing fluids and qi-blood, causing disease through steaming and burning. Unless one possesses divine skills like dissecting intestines and scraping bones, who can remove them? How could mere spoonfuls or ounce-weights of pills and powders breach their walls and doors? This fully follows Zhang Hezi's words.]
Only major accumulations and masses may be attacked; if the accumulation is not major, it should not be attacked. If six or seven-tenths are removed, the condition has already halved; at this point, stop and do not attack again. Medicines with toxicity are used to break down accumulations. Toxicity varies; highly toxic medicines are fierce and cause much damage; mildly toxic medicines are gentle and cause less damage. The use of toxic medicines to attack accumulations is a necessity due to the situation. Once the majority is weakened and the momentum is gone, one must stop, fearing injury to healthy Qi. The wisdom of the sages is profound. In general, to attack mass blocks, use acrid herbs to disperse, bitter herbs to purge, salty herbs to soften, and firm substances to reduce. There is no case where such treatment fails to cure. (From *Baoming Gekuo*) [Note: This text combines passages from *Liuyuan Zhengji Dalun* and *Wuchangzheng Dalun*.]
Case of Tonification and Nourishment: Robust individuals do not suffer from accumulations; only deficient individuals do. This is all due to weak spleen and stomach, decline of both qi and blood, and susceptibility to seasonal pathogens, all of which can lead to accumulation. If one hastily uses herbs to grind hardness and break knots, the disease may seem to recede, but the person becomes depleted. Herbs like dry lacquer (Ganqi), nao sha (Niaoshan), san leng (Burreed Tuber), qianniu (Morning Glory Seed), and dahuang (Rhubarb Root and Rhizome) provide temporary relief, but after the medicine wears off, the condition returns. Qi diminishes further, and the disease grows larger. What good is this? Therefore, skilled practitioners should first tonify deficiency, strengthening qi and blood, so that accumulations eliminate themselves. It is like having a seat full of gentlemen; petty people will naturally have no place to stand. Regardless of which organ is affected, first regulate the middle jiao to enable eating; this is the root. (Cited in *Bencao Gangmu* from Zhang Jiegou)
Case of Mr. Wang Yongzhen of Zhending: Age 19, suffering from accumulation. A mass extended from the left of the umbilicus to the hypochondrium, resembling an inverted cup. Abdominal distension like a drum, prominent blue collateral vessels, wheezing unable to lie flat. At the time, it was hot and rainy season, compounded by spontaneous diarrhea with undigested food, tidal fever in the late afternoon, and night sweats. He sought urgent treatment. Upon examination, the pulse was floating and rapid, but forceless upon pressure. I told the family: Treating accumulation usually requires toxic agents to attack; however, given the current weak pulse, standard methods are unsuitable. I administered diuretic and stomach-benefiting formulas. After several doses, bowel movements normalized. I mixed in herbs to regulate yin and yang, promote appetite, and harmonize stomach qi. Abdominal distension decreased significantly, and stomach qi stabilized. Occasionally using reducing methods, he recovered well within a month. My predecessor once said: Old Master Jiegou stated, "Nourish the upright, and the accumulation will self-eliminate." Like a room full of gentlemen, even a petty person has nowhere to emerge. Now, with true qi solidified and stomach qi strong, the accumulation eliminates itself. Would Jiegou deceive us? The *Neijing* says: "For major accumulations, stop when half is reduced." Even in excess conditions with stagnant qi, highly toxic drugs should not be overused, let alone in deficiency with accumulation. This is another aspect of treating accumulation; one must carefully examine pathogenic vs. upright and excess vs. deficiency. (From *Baojian*)
Resolve dead blood clots; after the clot is gone, must strongly tonify. (From *Danxi*)
Case of Madam Wu Yangquan of Zhongzhou: Age 50, suffering from an abdominal mass the size of a plate. Abdominal distension for over a year, eventually bedridden. Abdomen rumbling like thunder, belching without relief, dry mouth with white foam salivation. Relief felt in abdomen after passing gas. Five-center heat, loss of appetite, emaciation like firewood. Eight doctors failed to produce any effect. The family wept, prepared funeral arrangements, and waited for death. Upon consultation, the six pulses were choppy and rapid, with a tight and full qi-kou pulse. I realized previous doctors had erred by using cold and purgative drugs, causing true qi stagnation and blood stasis. I prescribed Bawu Tang (Eight Substance Decoction) added with Banxia (Pinellia Tuber), Chenpi (Tangerine Peel), Muxiang (Aucklandiae Root), Houpo (Magnolia Bark), Luobozhong (Radish Seed), Dafupi (Areca Pericarp), and Haijinsha (Lygodium Spore). After three doses, bloody clots resembling chicken liver were passed in urine. After twelve doses, a basin-full of black bloody clots were expelled, though a few remained in the abdomen. I then used Bawu Tang added with Zhishi (Immature Bitter Orange) and Xiangfu (Cyperus Rhizome). After five doses, she recovered. This confirms that nourishing upright qi leads to self-elimination of masses. Truly reliable. (From *Shoushi Baoyuan*)
Case of Madam Gu Jinfeng: Suffering from a pi-mass under the hypochondrium. Someone advised applying a plaster with 1 fen of Asarum (Wei) and 0.5 fen of Musk (Shexiang). Within five to six days, she passed large amounts of fresh bloody clots, stopping after two to three days. Since then, every year when applying the plaster, bleeding occurred. A neighbor woman used the same Wei plaster for her mass and experienced similar bleeding. The world considers Wei and Shexiang essential for masses. If external application causes such harm, how much worse would internal ingestion be? I highlight this as a warning against blind use of attacking drugs in deficient persons. (From *Yitong*)
Degree of Attack and Tonification: Nourishing upright qi to eliminate accumulation applies to mild cases. If spleen and stomach fail in transportation, leading to qi and food stagnation, nourishing spleen-stomach upright qi will naturally resolve the stagnation. However, for major accumulations, such as long-standing five accumulations forming fixed masses, unless fierce attacking agents are used, how can they be driven out? Only for weak persons must attack and tonification be combined. (From *Yitong*)
Accumulations in the body are pathogenic qi, like petty people among gentlemen. Only when upright qi is strong and true qi circulates normally can slight attacks disperse the accumulation, or it may resolve naturally. If upright qi is slightly weak, the accumulation attaches daily, acting deceitfully, weakening upright qi further. Once accumulation forms and the body deteriorates, quickly tonify true qi. Wait for Ying and Wei (nutritive and defensive qi) to be sufficient before purging. One may attack and tonify simultaneously, tonify then attack, or attack then tonify, until pathogen is gone and upright qi recovers. However, eliminating without gradual care leads to disaster. Residual accumulations, if not urgently purged, will recur and cause fatal harm. (Same source) [Note: Edited from *Weiyi*.]
The key to treating accumulation lies in knowing the appropriateness of attack and tonification, which must be distinguished by urgency. For recent accumulations with intact yuan qi, treatment should not be slow; slowness allows the pathogen to gain strength, becoming harder to control. The urgency here is the accumulation; rapid attack is acceptable. For long-standing accumulations with declining yuan qi, attacking now means the pathogen is deep and hard to reach, while stomach qi is close and easily injured. More attack leads to more deficiency; one dies from the attack rather than the accumulation. Here, life is paramount, not just the disease. Thus, for deficiency-pathogens, slow treatment is best: focus on cultivating spleen and stomach to secure the root, or use moxibustion/plasters to unblock meridians. As yuan qi strengthens and meridian qi flows, accumulations resolve. Grasping this balance of speed and slowness is the perfect strategy. This applies to all diseases, not just accumulations. (From *Jingyue*)
Accumulations imply daily accumulation over months, not a matter of days. Therefore, removal must be gradual. Too urgent injures upright qi; injured upright qi cannot transform, and pathogen becomes fixed. I once formulated agents for yin and yang accumulations. The drugs are slightly fierce but used with measure: tonify middle for several days, then attack. Regardless of how much is removed, tonify middle again. Wait for spirit to strengthen, then attack again. Repeated attack and tonification until balance is achieved. This is my unique secret, infallible. (From *Bidu*)
Regulating Qi First (See previous section on Qi Stasis Etiology).
Case of Gradual Resolution: For accumulation diseases where purging fails, use resolving herbs to melt the accumulation, which will then self-resolve. (From *Danxi*)
For phlegm-food accumulations, although firm, if mobile, treatment is easier. For qi accumulation in the yin aspect, firmly embedded internally, yang qi struggles to move, and drugs struggle to reach. Only Zhang Zhongjing's Biejia Jian Wan (Turtle Shell Decoction) uses creatures that fly, swim, or leap, leveraging their yin-substance/yang-function properties to enter yin and rotate yang qi, hoping to penetrate yin and unblock yang to dissolve this stubborn, deep-seated chronic disease. (From *Yiji*)
Diseases Requiring Following Treatment: Question: Patients with mass blocks, hernia, or heart/abdominal pain take Fu Zi (Aconite Root), Jiang (Ginger), Gui (Cinnamon) for a long time without toxicity or other side effects, yet the primary disease worsens. Why? Answer: Various accumulations and pains prefer warmth and dislike cold. Hot drugs match the condition. Long-standing accumulation becomes depressed, and major pathogen deepens. Deep depression-heat makes cold symptoms appear contradictory and heat symptoms desirable. Two heats follow each other, so no other disease arises. This is "Excess causes harm, succession brings regulation"; extreme fire resembles water. However, true qi is consumed, yin blood dried up, disease becomes deep and incurable. People don't understand, seeing no heat reaction to hot drugs, mistakenly diagnosing deep cold and adding more heat, dying without realization. Sad! So how to treat? Use following treatment. *Neijing* says: "Use heat with cold method, cold with heat method," hiding the main pathogen, addressing the cause first. (From *Mingyi Zazhu*)
Herbs for Treating Accumulations: Generally, treat accumulation by attacking what it dislikes and inducing what it likes, making it easy to cure. E.g., Niao Sha (Realgar/Nitrum mix) and Mercury for meat accumulation; Shenqu (Medicated Leaven) and Maiya (Barley Sprout) for wine accumulation; Shizhi (Leech) and Mengchong (Horsefly) for blood accumulation; Muxiang (Aucklandia) and Binglang (Areca Nut) for qi accumulation; Qianniu (Morning Glory Seed) and Gansui (Kansui Root) for water accumulation; Xionghuang (Realgar) and Nifen (Calomel) for saliva/phlegm accumulation; Mengshi (Calamine) and Badou (Croton Seed) for food accumulation. Each follows its category. Using a group of drugs disperses the pathogen's momentum, making efficacy difficult. Xu Sizong said: Hunting without knowing where the rabbit is, searching broadly, hoping to catch one, is poor technique. Must clearly identify the type of accumulation, then add specific drugs. Otherwise, harm results. Xu Sizong claimed not to write books because of the need for flexible application. (From *Benshi*)
Ancient formulas: Qu (Medicated Leaven) and Maiya (Barley Sprout) digest grains/water. Niao Sha (Nitrum) and Awei (Asarum) remove meat. Chenpi (Tangerine Peel), Zisu (Perilla Leaf), Shengjiang (Ginger) resolve fish/crustaceans. Dingxiang (Clove), Guixin (Cinnamon Heart) resolve fruits/vegetables. Qianniu (Morning Glory Seed), Yuanhua (Genkwa Flower) attack water-fluids. Sanleng (Burreed Tuber), Biejia (Turtle Shell) remove zhija (masses). Fuzi (Aconite), Liuhuang (Sulfur) remove chronic cold. Shizhi (Leech), Mengchong (Horsefly) attack blood clots. Muxiang (Aucklandia), Binglang (Areca Nut) attack stagnant qi. Xionghuang (Realgar), Nifen (Calomel) attack phlegm-saliva. Mengshi (Calamine), Badou (Croton Seed) attack phlegm-food. Gansui (Kansui Root) and Gancao (Licorice Root) used together exploit their conflict to remove accumulation. (From *Yifang Kao*)
Treatment Suitable for Wax-Sealed Drugs: For certain deficient persons with deep accumulation, direct attack is impossible; drugs should be sealed in wax. Wax adheres to and drives out disease, stays long in intestines/stomach, does not injure qi, and grinds away accumulation completely. (From *Jifeng*) [Note: *Bencao Yan Yi* discusses wax mixed with honey for pills aiding digestion, which is not the original intent of using wax; this should be verified.]
Drugs Should Be Pills: Masses are unsuitable for decoctions; pills are best. Masses are hard to dissolve. Decoctions pass through like water, wasting yuan qi without helping the mass. Pills enter the stomach, melt slowly, reach the diseased site directly, secretly dissolving and reducing the mass day by day. Do not aim to completely eliminate the mass. E.g., if goose-egg sized, reduce to bullet-sized and stop. No need to continue. As mass decreases and major trend subsides, it won't grow again, like ice melting. If one insists on complete elimination, yuan qi is exhausted, endangering life. Moreover, as mass trend subsides, it will self-resolve over time. Classic says: "Stop when half is reduced; excess leads to death." Doctors must know this. (From *Yijing*) [Note: While decoctions are generally unsuitable for masses, the discussion on pill efficacy is valid; retained.]
Formulas for Regulating Qi: Mainly treats five types of accumulation, ge-qi (diaphragmatic qi), sanjiao (Triple Burner) obstruction, chest/diaphragm fullness, vomiting with reverse phlegm, bitter taste with acid regurgitation. Regularly taking herbs to smooth qi, broaden middle, and resolve pi-masses is suitable. Take Zhike San (Citrus Aurantium Powder).
Zhike (Citrus Aurantium Fruit, pulp removed, sliced, bran-fried), Sanleng (Burreed Tuber), Chendi (Tangerine Peel, white pith removed), Yizhiren (Alpinia Oxyphylla Fruit), Ezhu (Curcuma Zedoaria Rhizome), Binglang (Areca Nut, not roasted, each 1 liang or 6 qian 1 fen), Ganjiang (Dried Ginger, processed), Houpo (Magnolia Bark, bark removed, ginger juice fried), Gancao (Licorice Root, fried), Qingpi (Green Tangerine Peel, white pith removed), Roudoukou (Nutmeg), Muxiang (Aucklandia Root, each 0.5 liang or 3 qian).
Grind to fine powder. Take 2 qian weight per dose. With 1 cup water, 3 slices ginger, 1 date. Decoct to 70%, drink hot anytime. Salt seasoning is also acceptable. (From *Benshi*) [Note: Originally *Heji* Geqi San, now without Rougui (Cinnamon Bark).]
Da Qi Qi Tang (Great Seven Qi Decoction): Treats six types of ju (gathering), resembling zhija (masses), moving up and down with qi, occurring at specific times. Heart/abdominal pain radiating to waist/hypochondrium, upper qi obstruction, wheezing/cough/fullness, lower abdominal distension, difficulty urinating/defecating, or recurrent diarrhea/dribbling. (From *Jisheng*) [Formula from *Zhuqi* chapter]. Another version adds Dahuang (Rhubarb) and Binglang (Areca Nut) to treat various pi-accumulations, yellow face, emaciation, limb weakness, caused by internal worm accumulation or craving raw rice, wall mud, tea, charcoal, salt, spice. Decoct in water, leave overnight outdoors, take warm on empty stomach. No food intake allowed, otherwise worms won't move. (From *Huichun*) [Note: *Jishi Quan Shu* adds: After eating, abdominal pain occurs, passing jelly-like substance, long worms, or blood clots. By noon, worms clear. Stop with warm porridge. Then take Lvfan Wan (Green Vitriol Pills) for one course to cure.]
Kai Huai San (Open Heart Powder) (Made by Yunlin): Treats subcardiac mass causing stuffiness or fever.
Qingpi (Green Tangerine Peel, pulp removed), Chenpi (Tangerine Peel), Banxia (Pinellia Tuber, ginger-fried), Baifuling (Poria, peeled), Sanleng (Burreed Tuber, vinegar-fried), Ezhu (Curcuma Zedoaria Rhizome, vinegar-fried), Xiangfu (Cyperus Rhizome), Binglang (Areca Nut), Caodoukou (Cardamom, double dose), Chaihu (Bupleurum Root, double dose), Honghua (Safflower), Zhishi (Immature Bitter Orange, bran-fried), Gancao (Licorice Root).
Cut one dose, decoct with ginger. Add Gegen (Kudzu Root) if dry mouth. (From *Yijian*) [Note: Based on Dongyuan's Xiaopi Tang, added ingredients. Refer to *Piman* section. Also, *Shilin Yuye* treats Fuliang (lying beam) crossing subcardiac area as Xinji (Heart Accumulation) using Zhishi, Baizhu, Houpo, Fuling, Banxia, Sanleng, Huanglian, made into pills with wheat paste; similar formula.]
Warm Middle Formulas (Treatment Verification) (Warming method see later): Sanju Tang (Disperse Gathering Decoction): Treats long-standing qi accumulation resembling zhija, moving with qi, occurring at times. Heart/abdominal colic radiating to waist/hypochondrium, upper qi obstruction, wheezing/cough/fullness, lower abdominal distension, urinary/fecal difficulty, or recurrent diarrhea/dribbling, spermatorrhea/white turbidity, resembling consumptive disease.
Banxia (Pinellia Tuber, washed 7 times in hot water), Binglang (Areca Nut), Danggui (Angelica Sinensis Root, each 3 fen), Chenpi (Tangerine Peel), Xingren (Apricot Seed, bran-fried, skin/spirit removed), Guixin (Cinnamon Heart, each 2 liang), Fuling (Poria), Gancao (Licorice Root, fried), Fuzi (Aconite Root, processed, skin/navel removed), Chuanxiong (Ligusticum Rhizome), Zhike (Citrus Aurantium Fruit, bran-fried, pulp removed), Houpo (Magnolia Bark, ginger juice processed), Wuzhuyu (Evodia Fruit, washed in hot water, each 1 liang).
Cut into pieces. Take 4 qian per dose. With 1.5 cups water, decoct to 70%, strain, take before meals. If constipated, add Dahuang (Rhubarb). (From *Sanyin*)
Wuzhuyu Wan (Evodia Pill) for Cold Pi-Qi: Abdominal/hypochondrial fullness/distension, shortness of breath, vomiting/reverse, cold hands/feet, anorexia, back pain.
Wuzhuyu (Evodia Fruit, 1 liang, soaked 7 times, dried, lightly fried), Houpo (Magnolia Bark, 1.5 liang, bark removed, coated with ginger juice, fried fragrant), Fuzi (Aconite Root, 3 fen, processed, skin/navel removed), Guixin (Cinnamon Heart, 3 fen), Renshen (Ginseng Root, 2 fen), Gancao (Licorice Root, 3 fen, fried reddish-brown, cut), Banxia (Pinellia Tuber, 3 fen, washed 7 times to remove slipperiness), Zhishi (Immature Bitter Orange, 1 liang, bran-fried yellowish), Ganjiang (Dried Ginger, 3 fen, processed, cut).
Grind to powder, mix with refined honey, pound 300-200 times. Make pills like paulownia seeds. Take 30 pills with warm wine, 3-4 times daily. (From *Shenghui*)
In the past, someone with pi-accumulation was taught to take several slices of garlic, with skin, ends cut off, swallowed whole. Named "Internal Moxibustion." Highly effective based on this. (From *Shenqiao Wanquan Fang*) [Note: Originates from Chen Cangqi's *Bencao*.]
Yu Jiayan treated a man with three hard, stone-like masses beside the umbilicus in the lower abdomen. Touching caused unbearable pain. Pulse was only full and surging at both Chi (Kidney) positions; others were faint and fine. This resulted from treating the mass without investigating the source. Initially, masses aren't necessarily hard; harsh attacks disrupted true yuan, aiding pathogen, causing tightening. Actually, it was purely air/qi gathering, unlike female menstrual blood stasis. Surging Chi pulses indicate Kidney qi transmitting to Bladder. Temporarily used a tonifying middle agent to unblock middle/lower qi. Later used large-dose drugs to internally collect Kidney qi and externally scatter Bladder qi. First, Lizhong Tang (Regulate Middle Decoction) plus 5 fen Fuzi (Aconite); mass reduced by 30%. Then large dose of Guizhi (Cinnamon Twig) and Fuzi; rushing qi in abdomen sounded loudly; three masses disappeared instantly. Finally, tonifying kidney drugs plus Guizhi/Fuzi for regulation and cure. (From *Yitong*) [Note: Excerpt from *Yuyi Cao*.]
Formulas for Gradual Resolution: *Yannian* Banxia Tang (Longevity Pinellia Decoction): Mainly treats left hypochondriac pi-hardness/tightness, abdominal fullness inability to eat, chest/back pain.
Banxia (Pinellia Tuber, 3 liang, washed), Shengjiang (Fresh Ginger, 4 liang), Jiegeng (Platycodon Root, 2 liang), Wuzhuyu (Evodia Fruit, 2 liang), Qianhu (Peucedanum Root, 3 liang), Biejia (Turtle Shell, 3 liang, fried), Zhishi (Immature Bitter Orange, 2 liang, fried), Renshen (Ginseng Root, 1 liang), Binglangzi (Areca Seed, 14 pieces).
Nine ingredients chopped. Decoct in 9 sheng water to 2.7 sheng. Strain, divide into 3 warm doses. (From *Waitai*) *Yixin Fang*: *Yimen Fang* treats zhija, lower abdominal/hypochondrial fullness/pain, triggered by cold, qi rushing to heart, anorexia, vomiting/shortness of breath/irritability. Remove Qianhu, Biejia, Zhishi from base formula; add Dahuang (Rhubarb), Houpo (Magnolia Bark), Fuling (Poria), Zhike (Citrus Aurantium Fruit), Ganzao (Jujube).
Someone with severe Liver Qi depression formed a qi mass under the left hypochondrium. Pain on movement, relief on rest. Over years, it grew daily. Yellow, withered complexion, acid regurgitation, phlegm vomiting, occasional...