诸有形而坚着不移者，为积。诸无形而留止不定者，为聚。积在五脏，主阴，病属血分。血有形而静者也。聚
在六腑，主阳，病在气分。气无形而动者也。《难经》既以积聚分属脏腑，经曰∶外中于寒，内伤忧怒，则
气上逆，六俞不通，凝血蕴裹不散，津
液涩渗，着而不去，积乃成已。《难经》曰∶积者五脏所生，始发无常处，痛不离其部，上下有终始，左右
有穷处。聚者六腑所成，始发无根本，上下无留止，痛无常处。《巢氏病源》，别立 瘕之名，以不动者为 ，
动者为瘕，亦犹《难经》之积聚而已。第无形之瘕聚，其散易；有形之 积，其破难。治之者先辨有形无形，
在气在血，可略得其概矣。其生于五脏者，肺之积曰息贲，在右胁下；肝之积曰肥气，在左胁下；心之积曰伏
梁，在脐上，上至心下；脾之积曰痞气，在胃脘；肾之积曰奔豚，发于少腹，上至心，上下无时。其见于脐下
为瘕， 者按之不移，即血 食 之属；瘕者假物成形，如血鳖石瘕之类。见于胸胁为痞癖，痞乃结块，
在肌肉而可见；癖由内着，结隐僻而难 。既分其部，必原所起。初由寒气瘀血痰沫，交结于肓膜，久而盘踞
坚牢，至元气日削，盘踞日深，攻补两难措手。惟先理其气，大七气汤、排气饮，气行则脉络通。或先调其中，
补中益气汤、参苓汤，脾运则积滞化，其药性宜辛散温通，方能入阴出阳，解散凝聚。然初为气结在经，久
则血伤入络，必理血分，如归尾、桃仁、苏木、延胡、郁金、琥珀、桂心。兼通络瘀，如归尾、韭根、鲮鲤甲、
桂枝尖、新绛、鸡血藤。搜逐之中，酌补元气。如五积等丸，用参、苓、桂、附之类。即邪深积锢，务令脾胃
气旺，乃可消磨坚结，否则专事攻削，正气益衰，积聚何由去乎？知养正则邪可除，而后结者散之，客者除之，
留者行之，坚者削之，强者夺之，咸者软之，苦者泻之。和其中外，可使必已。且经曰∶大积大聚，毒可犯也。
衰其大半而止，惧尽攻其邪，必伤其正也。今条列方治。有息积，病胁下满，气逆，不妨于食，化气汤、
木香调气散。有肠覃，寒客肠外，与卫气搏，因有所系，癖而内着， 肉乃生，始如鸡卵，稍以益大，状如怀
子，月事以时下。阿魏麝香散。有石瘕，生于胞中，寒气客于子门，气不得通，恶血留止，状如怀子，月事不
以时下。和血通经汤，若不应，见 丸，虚人十全大补汤送下。二症皆生于女子。有奔豚，病从少腹起，上
冲咽喉，得之惊恐，金匮奔豚汤。有伏梁，环脐而痛，金匮大建中汤加桂、苓。其息贲、肥气、痞气诸积，东
垣用五积丸分治。凡通治五积，
成形坚久，攻积丸、化积丸。通治六聚，随气上下，散聚汤。有血 ，沈氏血 丸。有食 ，大和中饮。
有疝瘕，导气汤。有蛇瘕，赤蜈蚣散。有鳖瘕，芜荑汤。有发瘕，香泽油。有痞块，连萝丸、溃坚汤。有痞积，
胁坚如石，大黄散、化痞膏。有胸痞，半夏泻心汤。有胁痞，右胁有形，推气散。有疟痞，左胁有形，属
血分。鳖甲丸。有饮癖，口吐清涎，六君子汤合五苓散。有酒癖，伤酒成积，保和丸。有茶癖，嗜茶成积，星
术丸。好食茶叶成癖，椒红、茶叶各一两，研末，炒飞面糊丸。茶清下。好食生米土灰成癖，大七气汤加槟榔、
使君子。有面积，阿魏丸，或莱菔子姜酒煎。有肉积，小阿魏丸。或狗肉积，杏仁、山楂、 砂、阿魏。
有菜果积，桂香丸。有鱼蟹积，紫苏、橘皮、芦根，姜汁。有蛋积，白蔻、豆豉、橘红、生姜。有小腹 积，
形如卵，攻痛时发，茴香丸。有虫积，雷丸、槟榔、榧子、使君子，妙应丸。有血积，跌扑蓄瘀，面黄粪黑。
桃仁承气汤。有寒积，附子理中汤。有痰积，导痰汤。有疳积，肥儿丸。脾胃虚者，六君子汤。肝脾虚者，
归脾汤。肝火郁者，芦荟丸。忧思郁者，六郁汤。肝肾亏者，肾气丸。量新久，酌虚实，或一补一攻，或
三补一攻，以积聚由渐而成，治必由渐而去，故缓攻通络，勿峻用吐下，致伤胃气，而损真元也。况坚顽之积，
多在肠胃以外，募原之间，非药所能猝及，宜用阿魏膏、琥珀膏、水红花膏、三圣膏以攻其外，用针法以攻
其内。且以艾火灸法消散固结为尤效。
仲景曰∶积聚 瘕，不转动者难治。五积中奔豚症，最难治。
《得效》曰∶宿血滞气，结为 瘕，腹中痞块，坚硬作痛。当以破气药治之，或以类从。如败梳治
虱瘕，铜屑治龙瘕，曲 治米瘕，锻石治发瘕。
叔微曰∶治积要法，大抵所恶者攻之，所喜者诱之，则易愈。
《入门》曰∶积初属寒，宜辛温消导。大七气汤、乌白丸。久则为热，宜辛寒推荡。木香槟榔丸、通
元二八丹。壮人无积，虚者有之，先补虚，使气血旺，则积消。木香枳壳丸。
士材曰∶尝制阴阳攻积丸，通治五积六聚，七 八瘕， 癖蛊血痰食，不问阴阳皆效。药品稍峻，
用之有度。补中数日，然
后攻伐，不问积去多少，又与补中，待其神壮，则复攻之，屡攻屡补，以平为期。此予独得之诀，百发百中者
也。
Those that are tangible, hard, and fixed in position are called *Ji* (Accumulation). Those that are intangible, lingering, and unstable in position are called *Ju* (Gathering). *Ji* resides in the Five Zang Organs, is governed by Yin, and belongs to the Blood aspect. Blood is tangible and static. *Ju* resides in the Six Fu Organs, is governed by Yang, and belongs to the Qi aspect. Qi is intangible and dynamic. The *Nan Jing* (Classic of Difficult Issues) has already assigned *Ji* and *Ju* to the Zang and Fu organs respectively. The classics state: External invasion by cold and internal injury from worry and anger cause Qi to rebel upward, leading to obstruction of the six Shu points. Coagulated blood becomes entangled and does not disperse; body fluids become astringent and seep abnormally, adhering and remaining undischarged, thus forming *Ji*. The *Nan Jing* states: *Ji* arises from the Five Zang Organs; its onset has no fixed location, pain remains within its sector, moving up and down with definite limits, and left and right with boundaries. *Ju* is formed by the Six Fu Organs; its onset has no root, it moves up and down without staying in one place, and pain occurs at varying locations. The *Chao Shi Bing Yuan* (Source of Diseases of Chao Yuan-fang) established the name *Xia* (Mass), distinguishing those that do not move as *Qin* and those that move as *Xia*, which is similar to the *Ji* and *Ju* of the *Nan Jing*. However, intangible *Xia* and *Ju* are easy to dissipate; tangible *Qin* and *Ji* are difficult to break. In treatment, one must first distinguish between tangible and intangible, and whether the pathology lies in Qi or Blood, thereby grasping the general principle. Those arising in the Five Zang Organs include: Lung *Ji* named *Xi Ben* (Breathful Accumulation), located under the right hypochondrium; Liver *Ji* named *Fei Qi* (Fat Qi), located under the left hypochondrium; Heart *Ji* named *Fu Liang* (Hidden Beam), located above the umbilicus extending to the epigastrium; Spleen *Ji* named *Pi Qi* (Stagnant Qi), located in the stomach region; Kidney *Ji* named *Ben Tun* (Rushing Pig), originating in the lower abdomen and rising to the heart, occurring at irregular intervals. Manifesting below the umbilicus as *Xia*, *Qin* refers to masses that do not shift upon pressure, belonging to categories such as Blood *Qin* or Food *Qin*; *Xia* takes shape provisionally, such as Blood Turtle *Xia* or Stone *Xia*. Manifesting in the chest and hypochondrium as *Pi Pi* (Stagnant Preference), *Pi* refers to nodules visible in the muscle layer; *Pi* adheres internally, knotting in hidden places and being difficult to treat. Having distinguished the location, one must trace the origin. Initially, cold qi, blood stasis, and phlegm mucus intertwine in the *Huang Mo* (Membranous Network), becoming entrenched and firm over time. As Yuan Qi (Primal Qi) declines daily and the entrenchment deepens, both attacking and tonifying methods become difficult to apply. One should first regulate Qi using *Da Qi Qi Tang* (Great Seven-Qi Decoction) or *Pai Qi Yin* (Qi-Discharging Drink); when Qi moves, the collaterals unblock. Alternatively, first harmonize the Middle Jiao using *Bu Zhong Yi Qi Tang* (Tonify the Middle and Augment the Qi Decoction) or *Shen Ling Tang* (Ginseng and Poria Decoction); when the Spleen transforms and transports, stagnation resolves. The medicinal properties should be pungent, dispersing, warm, and unblocking, so as to enter Yin and emerge into Yang, dissolving condensation. However, initially, Qi knots in the meridians; over time, Blood is injured and enters the collaterals. One must then regulate the Blood aspect, using herbs such as Dang Gui Wei (Radix Angelicae Sinensis Caulis), Tao Ren (Semen Persicae), Su Mu (Lignum Sappan), Yan Hu Suo (Rhizoma Corydalis), Yu Jin (Radix Curcumae), Hu Po (Electrum), and Gui Xin (Cortex Cinnamomi). To simultaneously unblock collateral stasis, use Dang Gui Wei, Jiu Gen (Radix Allii Tuberosi), Ling Li Jia (Carapax Manemys Sinensis), Gui Zhi Jian (Ramulus Cinnamomi Acumen), Xin Jiang (Fresh Dyestuff), and Ji Xue Teng (Caulis Spatholobi). While searching for and expelling pathogens,酌情 (appropriately) tonify Yuan Qi. For example, in pills like *Wu Ji Wan* (Five-Accumulations Pill), use Ren Shen (Radix Ginseng), Fu Ling (Poria), Gui Zhi (Ramulus Cinnamomi), and Fu Zi (Radix Aconiti Lateralis Preparata). Even if pathogens are deep and accumulations are firmly bound, one must ensure the Stomach and Spleen Qi are robust before attempting to dissolve hard knots; otherwise, solely engaging in attacking and scraping will further weaken Zheng Qi (Upright Qi), making it impossible to eliminate the accumulation. Understanding that nourishing Zheng Qi allows pathogens to be removed, one then applies: dissipation for knots, removal for invaders, movement for retention, reduction for hardness, seizure for strength, softening for saltiness, and purging for bitterness. Harmonizing the interior and exterior can ensure cure. Furthermore, the classics state: For large accumulations and gatherings, toxic drugs may be used. However, stop when the pathogen is reduced by more than half, fearing that complete attack on pathogens will inevitably damage Zheng Qi. Now, formulas and treatments are listed item by item. There is *Xi Ji* (Breathful Accumulation), characterized by fullness under the hypochondrium and rebellious Qi, without affecting food intake; treated with *Hua Qi Tang* (Qi-Transforming Decoction) or *Mu Xiang Tiao Qi San* (Costus Regulating Qi Powder). There is *Chang Tan* (Intestinal Polyp), where cold lodges outside the intestines, combats with Wei Qi (Defensive Qi), attaches internally due to binding, generates putrid flesh, starting the size of a chicken egg, gradually enlarging to resemble pregnancy, while menstruation proceeds on time; treated with *A Wei She Xiang San* (Asafoetida and Musk Powder). There is *Shi Xia* (Stone Mass), arising in the Bao Zhong (Uterus), where cold lodges in the Zi Men (Cervical Orifice), Qi fails to flow freely, evil blood remains stagnant, resembling pregnancy but menstruation is delayed; treated with *He Xue Tong Jing Tang* (Harmonize Blood and Unblock Menses Decoction). If ineffective, use *Qin Wan* (Accumulation Pill); for deficient persons, administer with *Shi Quan Da Bu Tang* (Complete Great Tonification Decoction). Both conditions occur in women. There is *Ben Tun* (Rushing Pig), where disease rises from the lower abdomen to the throat, caused by fright and fear; treated with *Jin Kui Ben Tun Tang* (Essential Prescriptions of the Golden Cabinet Rushing Pig Decoction). There is *Fu Liang* (Hidden Beam), with pain circling the umbilicus; treated with *Jin Kui Da Jian Zhong Tang* (Essential Prescriptions of the Golden Cabinet Great Middle-Tonifying Decoction) added with Gui Zhi and Fu Ling. For *Xi Ben*, *Fei Qi*, and *Pi Qi* accumulations, Dong Yuan used *Wu Ji Wan* (Five-Accumulations Pill) for separate treatment. For general treatment of Five *Ji* that have formed hard knots over a long period, use *Gong Ji Wan* (Attack-Accumulation Pill) or *Hua Ji Wan* (Resolve-Accumulation Pill). For general treatment of Six *Ju* that move up and down with Qi, use *San Ju Tang* (Dissipate-Gathering Decoction). For Blood *Qin*, use *Shen Shi Xue Qin Wan* (Shen's Blood-Accumulation Pill). For Food *Qin*, use *Da He Zhong Yin* (Great Harmonize-Middle Drink). For *Han Xia* (Hernia Mass), use *Dao Qi Tang* (Guide-Qi Decoction). For Snake *Xia*, use *Chi Wu Gong San* (Red Centipede Powder). For Turtle *Xia*, use *Wu Yi Tang* (Euodia Decoction). For Hair *Xia*, use *Xiang Ze You* (Fragrant泽 Oil). For *Pi Kuai* (Stagnant Lump), use *Lian Luo Wan* (Lotus Root Pill) or *Kui Jian Tang* (Collapse-Firmness Decoction). For *Pi Ji* (Stagnant Accumulation) with hypochondriac hardness like stone, use *Da Huang San* (Rhubarb Powder) or *Hua Pi Gao* (Resolve-Stagnation Plaster). For Chest *Pi*, use *Ban Xia Xie Xin Tang* (Pinellia Drain-Epigastric Decoction). For Hypochondriac *Pi* with tangible signs in the right hypochondrium, use *Tui Qi San* (Push-Qi Powder). For Malaria *Pi* with tangible signs in the left hypochondrium, belonging to the Blood aspect, use *Bie Jia Wan* (Turtle Shell Pill). For Fluid *Pi* with clear saliva vomiting, use *Liu Jun Zi Tang* (Six-Gentlemen Decoction) combined with *Wu Ling San* (Five-Ingredient Powder with Poria). For Wine *Pi* resulting from alcohol injury, use *Bao He Wan* (Preserve-Harmony Pill). For Tea *Pi* resulting from tea addiction, use *Xing Zhu Wan* (Apricot and Atractylodes Pill). For preference for tea leaves causing *Pi*, mix Jiao Hong (Pericarpium Zanthoxyli) and Cha Ye (Tea Leaf) each 1 liang, powder them, make pills with fried flour paste, and swallow with tea infusion. For preference for raw rice, soil, and ash causing *Pi*, use *Da Qi Qi Tang* added with Bing Lang (Areca Seed) and Shi Jun Zi (Quisqualis Fruit). For Grain Area (*Mian Ji*), use *A Wei Wan* (Asafoetida Pill) or Radish Seed decocted with ginger wine. For Meat *Ji*, use *Xiao A Wei Wan* (Small Asafoetida Pill). Or for Dog Meat *Ji*, use Xing Ren (Apricot Seed), Shan Zha (Crataegus Fruit), Sha Ren (Amomum Fruit), and A Wei. For Vegetable/Fruit *Ji*, use *Gui Xiang Wan* (Cinnamon and Citrus Pill). For Fish/Crab *Ji*, use Zi Su (Perilla Leaf), Ju Pi (Citrus Peel), Lu Gen (Reed Rhizome), and Ginger Juice. For Egg *Ji*, use Bai Kou (White Cardamom), Dou Chi (Prepared Soybean), Ju Hong (Red Tangerine Peel), and Sheng Jiang (Fresh Ginger). For Lower Abdomen *Qin Ji* resembling an egg with intermittent attacking pain, use *Hui Xiang Wan* (Fennel Pill). For Parasite *Ji*, use Lei Wan (Polyporus), Bing Lang, Fei Zi (Torreya Seed), and Shi Jun Zi, formulated as *Miao Ying Wan* (Miraculous Response Pill). For Blood *Ji* from trauma and blood stasis presenting with sallow complexion and black stool, use *Tao Ren Cheng Qi Tang* (Peach Kernel Purge-Qi Decoction). For Cold *Ji*, use *Fu Zi Li Zhong Tang* (Aconite Regulate-Middle Decoction). For Phlegm *Ji*, use *Dao Tan Tang* (Guide-Phlegm Decoction). For *Gan Ji* (Childhood Malnutrition Accumulation), use *Fei Er Wan* (Fatten-Infant Pill). For Spleen/Stomach deficiency, use *Liu Jun Zi Tang*. For Liver/Spleen deficiency, use *Gui Pi Tang* (Restore-Spleen Decoction). For Liver Fire depression, use *Lu Hui Wan* (Aloe Pill). For Worry/Thought depression, use *Liu Yu Tang* (Six-Stagnations Decoction). For Liver/Kidney deficiency, use *Shen Qi Wan* (Kidney-Qi Pill). Assess the newness or chronicity, and evaluate deficiency or excess; employ either one tonification and one attack, or three tonifications and one attack. Since accumulations form gradually, treatment must proceed gradually; therefore, use mild attacks to unblock collaterals, avoiding harsh emetics and purgatives that would damage Stomach Qi and deplete True Yuan. Moreover, stubborn accumulations often lie outside the intestines and stomach, in the *Mu Yuan* (Sea of Origins), beyond the immediate reach of oral medicines. It is appropriate to use external applications such as *A Wei Gao* (Asafoetida Plaster), *Hu Po Gao* (Amber Plaster), *Shui Hong Hua Gao* (Water Red Flower Plaster), and *San Sheng Gao* (Three-Sages Plaster) to attack externally, and acupuncture to attack internally. Additionally, moxibustion with mugwort fire is particularly effective in dissipating solid knots.
Zhang Zhongjing stated: *Ji*, *Ju*, *Qin*, and *Xia* that do not move are difficult to treat. Among the Five *Ji*, *Ben Tun* is the most difficult.
The *De Xiao Fang* (Efficacious Formulas) stated: Old blood and stagnant Qi knot to form *Qin* and *Xia*, creating abdominal lumps that are hard and painful. One should treat with Qi-breaking herbs or follow the law of similarity. For instance, use broken combs to treat Lice *Xia*, copper filings for Dragon *Xia*, fermented grain starter for Rice *Xia*, and forged iron scales for Hair *Xia*.
Shu Wei stated: The essential method for treating *Ji* is generally to attack what the patient dislikes and lure what the patient likes, facilitating recovery.
The *Ru Men* (Introduction to Medicine) stated: *Ji* initially belongs to Cold, suitable for pungent-warm digestion and guidance using *Da Qi Qi Tang* or *Wu Bai Wan*. Over time, it transforms into Heat, suitable for pungent-cold pushing and washing using *Mu Xiang Bing Lang Wan* or *Tong Yuan Er Ba Dan*. Robust individuals do not suffer from *Ji*; only the deficient do. First tonify deficiency to make Qi and Blood robust, then the *Ji* will dissipate, using *Mu Xiang Zhi Ke Wan*.
Shi Cai stated: I once prepared *Yin Yang Gong Ji Wan* (Yin-Yang Attack-Accumulation Pill) for general treatment of Five *Ji* and Six *Ju*, Seven *Qin* and Eight *Xia*, as well as *Pi*, *Gu*, Blood, Phlegm, and Food *Ji*, effective regardless of Yin or Yang nature. The ingredients are slightly harsh, so dosage must be controlled. Tonify the Middle for several days, then attack. Regardless of how much accumulation is removed, resume tonification. Wait until the spirit and vitality are strong, then attack again. Repeatedly attack and tonify until equilibrium is reached. This is my unique secret, a method that never fails.