五脏之积曰五积。六腑之积曰六聚。积有定形聚无定处。不问何经。并宜十味大七气汤
吞下
去食积。牵牛甘遂去水积。雄黄腻粉去涎积。HT 砂水银去肉积。各从其类也。
有饮癖结成块。在腹胁之间。病类积聚。用破块药。多不效。此当行其饮。宜导痰汤。
何以知为饮。其人先曾病瘥。口吐涎沫。渍水。或素来多痰者。是也。
又多饮人。结成酒癖。腹肚积块。胀急疼痛。或全身肿满。肌黄少食。宜十味大七气汤
肝积在左胁下。状如覆杯。或如鳖。或呕逆。或痛。在两胁。牵引小腹。足寒转筋。久
疟。名曰肥气。宜大七气汤煎熟。待冷。却以铁器烧通红。以药淋之。乘熟服。肺积在右胁下
大如覆杯。气逆背痛。或少气喜忘。目瞑肤寒。皮中时痛。如风缘针刺。久则咳喘。名曰息
贲。宜大七气汤。如桑白皮半夏杏仁各半钱。
心积起脐下。直至心。大如臂。腹热咽干。心烦甚。则吐血。名曰伏梁宜大七气汤。加
蒲。半夏各半钱。脾积在胃脘。大如覆杯。痞塞不通。背痛心疼。饥减饱见。腹满吐泄足肿肉
消。久则四肢不收。名曰痞气。宜大七气汤。下红丸子。
肾积发于小腹。奔上至心。上下无时。如奔豚走。饥见饱减。小腹急。腰痛口干。目昏
骨冷。久则骨痿。名曰奔豚。宜大七气汤。倍桂。加茴香炒楝子肉。各半钱。
若腹中似若癖瘕。随气上下。未有定处。宜散聚汤。
若气作痛。游走心腹间。攻刺上下。隐若雷鸣。或已成积。或未成聚。以全蝎一个。劈
煎汤。调苏合香丸。有正当积聚处。内热如火。渐渐遍及四肢。一日数发。如此二三日又愈
此不当攻其热。
又有元得热病。热留结不散。遂成 癖。此却当兼用去热之剂。
有病 瘕腹胀。纯用三棱莪术。以酒煨服。下一物如黑鱼状而愈。或加入香附子用水煎
多服取效。又有病此者。用姜苏汤。吞六味丸。六味者。乃小七香丸。红丸子。小安肾丸。连
翘丸。三棱煎。理中丸。六件等也。
诸饱气。并见诸痛门腹痛证。
The accumulations of the five Zang organs are called "Five Accumulations" (Wu Ji). The accumulations of the six Fu organs are called "Six Gatherings" (Liu Ju). Among these, accumulation (Ji) has a fixed shape, whereas gathering (Ju) has no fixed location. Regardless of which meridian is involved, it is appropriate to take Shiwei Da Qi Qi Tang (Ten-Ingredient Major Seven-Qi Decoction) by swallowing. For food stagnation, Qian Niu Zi (Pharbitis Seed) and Gan Sui (Kansui Root) are used to remove water stagnation; Xiong Huang (Realgar) and Ni Fen (White Lead Powder) are used to remove phlegm-saliva stagnation; Sha (Borax) and Shui Yin (Mercury) are used to remove meat stagnation, each targeting its corresponding pathogen type.
If fluid retention forms a mass, located between the abdomen and hypochondrium, resembling accumulation but often unresponsive to drugs that break up masses, treatment should focus on promoting diuresis and resolving phlegm-fluid, making Dao Tan Tang (Guiding Phlegm Decoction) appropriate. How to identify this as fluid retention? The patient previously recovered from an illness, spits saliva and foam, retains water in the body, or has a constitution prone to excessive phlegm.
Furthermore, excessive drinking may lead to alcohol-related stagnation (Jiu Pi), forming abdominal masses with distending, urgent pain, or generalized edema, yellowish skin, and poor appetite; Shiwei Da Qi Qi Tang is indicated.
Liver accumulation is located under the left hypochondrium, shaped like an inverted cup or a turtle, possibly accompanied by vomiting and rebellious qi, pain radiating to both hypochondria, pulling into the lower abdomen, cold feet with muscle cramps, and chronic malaria; this is named Fei Qi (Fat Qi). It is treated with Da Qi Qi Tang (Major Seven-Qi Decoction) decocted, cooled, then poured over a red-hot iron vessel, and taken while warm. Lung accumulation is located under the right hypochondrium, size of an inverted cup, with rebellious qi and back pain, shortness of breath, forgetfulness, aversion to light, cold skin, intermittent stinging pain in the skin like insect bites, progressing to cough and asthma; this is named Xi Ben (Breathing Pant). It is treated with Da Qi Qi Tang plus Sang Bai Pi (Morus Bark), Ban Xia (Pinellia Rhizome), and Xing Ren (Apricot Seed), each half qian.
Heart accumulation starts below the umbilicus extending to the heart, size of an arm, with abdominal heat, dry throat, severe restlessness, and hematemesis if severe; this is named Fu Liang (Hidden Beam). It is treated with Da Qi Qi Tang plus Pu Huang (Typha Pollen) and Ban Xia, each half qian. Spleen accumulation is in the epigastrium, size of an inverted cup, causing obstruction, back pain with heart pain, relief when hungry and worsening when full, abdominal distension, vomiting and diarrhea, swollen feet, muscle wasting, and eventually inability to move limbs; this is named Pi Qi (Stagnant Qi). It is treated with Da Qi Qi Tang combined with Hong Wan Zi (Red Pill).
Kidney accumulation originates in the lower abdomen, rushing upward to the heart without fixed timing, moving like Ben Tun (Running Piglet), appearing when hungry and subsiding when full, with lower abdominal urgency, lower back pain, dry mouth, blurred vision, cold bones, and eventually bone atrophy; this is named Ben Tun. It is treated with Da Qi Qi Tang, doubling Gui Zhi (Cinnamon Twig), adding Chao Hui Xiang (Fennel Seed) and Chao Lian Zi Rou (Toosendan Fruit Flesh), each half qian.
If there seems to be a mass in the abdomen moving up and down with qi flow without a fixed location, San Ju Tang (Dispersing Gathering Decoction) is appropriate.
If qi stagnation causes pain wandering between the heart and abdomen, stabbing up and down, sounding like thunder, whether an accumulation has formed or not, one whole Quan Xie (Scorpion) can be split and decocted to mix with Su He Xiang Wan (Styrax Pill). If there is a specific accumulation site with internal heat like fire spreading to the limbs, occurring several times a day for two to three days before self-resolution, heat-clearing attacks are not indicated.
If a previous febrile disease leaves residual heat condensing to form stagnation, heat-clearing agents should be used concurrently.
For cases of abdominal distension due to stagnation-masses, using only San Leng (Curcuma Zedoaria Rhizome) and E Zhu (Curcuma Phaeocaulis Rhizome), roasted in wine, may result in expelling a black fish-like object and cure. Alternatively, adding Xiang Fu Zi (Cyperus Rhizome) and decocting in water, taken frequently, is effective. Another method uses Jiang Su Tang (Ginger and Perilla Decoction) to swallow Liu Wei Wan (Six-Ingredient Pill), where "Liu Wei" refers to seven small fragrant pills, Red Pills, Small Kidney-Supporting Pills, Lian Qiao Pills, San Leng Decoction, and Li Zhong Pills, totaling six types.
Various conditions of fullness and qi stagnation are also discussed in the Abdominal Pain section under Various Pains.