诸积皆属于脾。脾土果旺。则何物不化。至于成积。脾力之弱可知已。然积既已成。势不能不
用药以消。夫欲消困脾之积。必更伤受困之脾。愿治积者。必时时顾念脾土而后可。食积者。
肚腹必硬。膨胀拒按。吞酸嗳腐。不思饮食。保和丸、大和中饮等消之。脾虚者。六君子汤参用。
痞积者。或疟后痰结。或血裹肝气。伏于胁下。时痛时止。和中丸消之。外贴消痞膏。气虚者。六
君子汤参用。虫积者。湿热所化也。虫有九而血鳖最狠。蝤虫最驯。寸白虫上能蚀肺。柳叶虫
下能蚀肝。凡患虫症。则唇内起白点。若虫长一尺。贯胃则危。冲心则死。其人日渐消瘦。虫则
吸血自肥。当以化虫丸下之。腹痛则服花椒汤。虫闻椒则伏也。下后。仍以异功散养脾。痰积
者。饮食所积。脾不能化。则酿而为痰。其症初起时。两脉皆弦。腹渐胀大而软。急宜六君子汤
加浓朴、麦芽、莱菔子等以消之。若迁延日久。则痰积愈多。一旦上涌。发为厥逆。则吐之不能。
下之不得。无药可治也。水积者。即水肿之症。治法具详卷一。
疳者干也。久热伤阴。津液干涸之症。俗名童子痨。其症总因饮食不节。积滞化火。渐或生痞
生虫。致成骨蒸。内热销灼其阴。其症腹大青筋。发直毛焦。肌肤枯燥。唇舌绛红。而疳症成矣。
此症阴血既槁。势已难回。况又有热未清。积未去乎。善治者。必乘其阴血未槁之时。清其火。
消其积。育其阴。调其脾胃。尚克有济。初治宜清热导滞汤。有虫者。唇内起白点。以化虫丸间
服。若阴分既虚。则用理阴和中煎。胃口不开。则并用异功散调其胃。俾得阳生阴长。庶几有
救。大约此症腹软者。虽虚可治。为其能受补也。腹硬者难治。为其不可消也。
All accumulations (Ji, 积) belong to the Spleen. If the Earth element of the Spleen is robust, what food could fail to be digested? The fact that an accumulation has formed indicates that the Spleen's functional strength is evidently weak. However, once an accumulation has formed, it is imperative to use medication to dissipate it. To dissipate an accumulation caused by Spleen deficiency and stagnation, one inevitably risks further injuring the already compromised Spleen. Therefore, those treating accumulations must constantly attend to the Spleen Earth before proceeding with treatment.
Food accumulation (Shi Ji, 食积) presents with a hard abdomen, distension, and tenderness upon pressure, acid regurgitation, belching with a putrid odor, and loss of appetite. It should be treated with Baohe Wan (Preserve Harmony Pill) or Da He Zhong Yin (Greatly Harmonize the Middle Decoction) to promote digestion. In cases of Spleen deficiency, Liu Jun Zi Tang (Six Gentlemen Decoction) may be used in conjunction.
Stagnant accumulation (Pi Ji, 痞积) may result from phlegm condensation after malaria, or blood encasing Liver Qi latent beneath the hypochondrium, causing intermittent pain. It is treated with He Zhong Wan (Harmonize the Middle Pill), with external application of Xiao Pi Gao (Dissipate Stagnation Plaster). For patients with Qi deficiency, Liu Jun Zi Tang (Six Gentlemen Decoction) may be used in conjunction.
Parasitic accumulation (Chong Ji, 虫积) arises from the transformation of Damp-Heat. There are nine types of parasites; among them, Xue Die (Blood Leech/Parasite) is the most ferocious, while Qiu Chong (likely referring to a specific parasitic worm, literally "Crab Worm") is the most docile. Cun Bai Chong (Tapeworm) can erode the Lungs upwards, and Liu Ye Chong (Leaf-shaped Worm) can erode the Liver downwards. In any case of parasitic disease, white spots appear inside the lips. If a parasite grows to one chi (approx. 33 cm) long, penetrating the Stomach is critical, and striking the Heart leads to death. The patient becomes progressively emaciated as the parasites feed on blood and grow fat. Huachong Wan (Transform Parasites Pill) should be administered to expel them. If abdominal pain occurs, drink Sichuan Pepper Soup, as parasites subside upon smelling pepper. After expulsion, Yi Gong San (Benefit the Work Powder) should still be used to nourish the Spleen.
Phlegm accumulation (Tan Ji, 痰积) results from dietary stagnation that the Spleen fails to transform, thereby brewing into phlegm. Initially, both radial pulses are wiry (Xian, 弦), and the abdomen gradually becomes distended yet soft. Urgently treat with Liu Jun Zi Tang (Six Gentlemen Decoction) augmented with Hou Po (Magnolia Bark), Mai Ya (Barley Sprout), and Lai Fu Zi (Radish Seed) to dissipate the phlegm. If neglected for a long time, phlegm accumulates excessively. Once it surges upward, causing Jue Ni (Reversal Cold/Syncope), neither emesis nor purgation is applicable, rendering it untreatable.
Water accumulation (Shui Ji, 水积) refers to Edema (Shui Zhong, 水肿). The treatment methods are detailed in Volume One.
Gan Syndrome (Gan Zheng, 疳症) implies dryness. It is a condition where prolonged fever injures Yin fluids, leading to desiccation of body fluids. Commonly known as "Childhood Consumption" (Tong Zi Lao, 童子痨). This syndrome generally stems from irregular diet, where stagnation transforms into fire, gradually forming masses or parasites, resulting in Bone-steaming Fever (Gu Zheng, 骨蒸). Internal heat scorches the Yin. Symptoms include a distended abdomen with visible blue veins, straight and brittle hair, dry and rough skin, and crimson lips and tongue, marking the formation of Gan Syndrome. Since Yin and Blood are already exhausted, recovery is difficult, especially with lingering Heat and unresolved Accumulation. A skilled practitioner must act while Yin and Blood are not yet fully depleted: clear the Heat, dissipate the Accumulation, nourish the Yin, and regulate the Spleen and Stomach. Only then might there be hope. Initial treatment should employ Qing Re Dao Zhi Tang (Clear Heat and Guide Out Stagnation Decoction). If parasites are present, indicated by white spots inside the lips, Huachong Wan (Transform Parasites Pill) may be taken intermittently. If the Yin aspect is deficient, Li Yin He Zhong Jian (Regulate Yin and Harmonize the Middle Decoction) is used. If the appetite is poor, Yi Gong San (Benefit the Work Powder) is combined to harmonize the Stomach, allowing Yang to generate and Yin to grow, offering a chance of rescue. Generally, if the abdomen is soft, the condition, though deficient, is treatable because the body can tolerate tonification. If the abdomen is hard, it is difficult to treat because the accumulation cannot be dissipated.