【脉】 来细而附骨乃积。寸口，积在胸；关上，积在脐旁；尺中，积在气冲。
左
积左，右积右，脉两出，积在中央。浮而毛，按之辟易，胁下气逆，背相引痛，名肺积。
沉而芤，上下无常处，胸满悸，腹中热，名心积。
弦而细，两胁下痛，邪走心下，足肿寒，名肝积。
沉而急，若脊与腰相引痛，饥见饱减，名肾积。
浮大而长，饥减饱见，腹满泄呕，胫肿，名脾积。
寸口沉而结，快而紧，积聚有系痛。脉弦细微者，为 ，横胁下及腹中有横积。脉弦，
腹中
急痛为瘕。脉细而沉时直者，身有痈肿，若腹中有伏梁。脉沉小而实者，胃有积聚，不下食
，食则吐。脉沉而紧者，若心下有寒，时痛，有积聚。关上脉大而尺寸细者，必心腹冷积
；迟而滑，中寒有症。脉弦而伏，腹中有症，不可转也，死。脉紧，强急者生，虚弱者死，
沉者死。
【因】 胫寒厥气则血脉凝涩，寒气上入肠胃，所以腹胀。腹胀则肠外之汁沫，
迫聚不得散，日以成积。
又盛食多饮，起居过度，肠胃之络伤，则血溢于肠外，肠外有寒汁沫，与血相搏，则气
聚而成积。
又外中于寒，内伤于忧怒，气则上逆，上逆则六 不通，湿气不行，凝血蕴裹，津液凝
涩，渗着不去而成积。
又生于阴，盖忧思伤心，重寒伤肺，忿怒伤肝，醉以入房，汗出当风伤脾，用力过度入
房，汗出入浴伤肾，皆脏气不平，凝血不散，汁沫相搏，蕴结而成积矣。
又有食积、酒肉积、水积、涎积、血积、气积，皆因偏爱，停留不散，日久成积块。在
中为痰饮，在右为食积，在左为血积。
【证】 盖积、聚之源则一。其在脏者，始终不移为积；其在腑者，发痛转移，
随气退出为聚。积者，系于脏；聚者，系于腑。 者，系于气；瘕者，系于血。
肝之积名肥气。在左胁下如复盆，发咳逆 疟。连岁不已，其中有血，肝主血故也。
心之积名伏梁。起脐下，大如臂，上至心下，令人烦心，有大脓血，在于膈胃之外。
肺之积名息贲。在右胁下，大如杯，洒淅寒热，喘咳肺壅。贲者，贲门也，积在肺下有
贲门。
脾之积名痞气。在胃脘，大如盘，四肢不收，黄胆，饮食不为肌。痞者，湿也。食冷，
其人伤气，为湿所蓄。
肾之积名奔豚。发于小腹，上至心下，若豚状。上下喘息，骨痿。
病在六腑。太阳利清气，阳明泄浊气，少阳化精气，失常则壅聚不通。故实而不转，虚
则输
，属阳无形，随气往来，在上则格，在下则胀，旁攻两胁，如有泥块，易于转变，故名曰聚
。
又有息积者，乃气息癖滞于胁下，不在脏腑营卫之间，积久形成。气不干胃，故不妨食
，病者胁下满，气逆息难，频哕不已，名曰息积。
【治法】 寒者热之，结者散之，客者除之，留者行之，坚者削之；消者摩之，
咸以软
之，苦以泻之；全真气以补之，随其所利而行之；酒肉食等积，以所恶者攻之，以所喜者诱
之。
五积丸 治积块。
黄连（肝肾五钱，心肺一两半，脾七钱） 浓朴（肝心脾，五钱，肺胃八钱） 巴豆霜（五
分） 川乌（肝肺一钱，肾脾五钱） 干姜（心肝五分，肾一钱五分） 茯苓（一钱五分） 人参（
肝肺肾二钱，心五钱）
另研巴豆，旋入和匀，炼蜜丸，梧子大。微溏为度。
肝积，加柴胡二两、皂角二钱五分，川椒四钱、昆布二钱、莪术三钱五分。
心积，加茯苓三钱、肉桂一钱、茯神一钱、丹参一钱、菖蒲五钱。
肺积，加桔梗一钱、紫菀一钱五分、天门冬一钱、三棱一钱、青皮一钱、陈皮一钱、川
椒一钱五分、白豆蔻一钱。
肾积，加玄胡三钱、苦楝肉三钱、全蝎一钱、附子一钱、泽泻二钱、独活三钱、肉桂三
钱、菖蒲二钱、丁香五钱。
脾积，加吴萸二钱、泽泻一钱、茵陈二钱、缩砂二钱、川椒五钱。
秋冬，加制朴一倍，减芩、连服。人觉热，加连；觉闷乱，加桂；气短，减朴。又有虚
人，不可直攻，以蜡匮其药，又且久留磨积。
肉积， 砂、水银、阿魏；酒积，神曲、麦芽；血积，虻虫、水蛭、桃仁、大黄；气积
，槟
榔、木香；水积，甘遂、牵牛、芫花；涎积，雄黄、腻粉；食积，礞石、巴豆；癖积，三棱
、莪术；鱼鲜积，陈皮、紫苏、草果、丁香、桂心；寒冷成积，附、朴、硫黄。
化气汤 治息积癖于腹胁之下，胀满瘀痛，呕吐酸水。
缩砂 肉桂 木香（各一钱） 甘草（炙） 茴香（炒） 丁香 青皮（炒） 陈皮 生姜（炮
，各五钱） 沉香 胡椒（各一钱）
上为末，姜、紫苏汤、盐、酒调二钱一分。
散聚汤 治久气六聚，状如 瘕，随气上下，发作有时，心腹绞痛，攻刺胁腰，
喘咳满闷 胀。
半夏 槟榔 当归（各三钱） 陈皮 杏仁 肉桂（各二钱） 茯苓 甘草 炮附 川芎
枳壳 吴萸 浓朴（制，各一钱） 大黄（大便秘加之）
三圣膏 贴块。
锻石（末化者半斤，瓦器炒，令淡红出，候热稍减，研之） 大黄（一两，末之，就炉微
炒，候凉入桂） 桂心（半两，末，略炒，醋熬成膏，浓摊，贴患处）
又方 大黄 朴硝（各一两，末。） 大蒜捣膏，贴之亦佳。
张法 无忧散 治诸积不化。桂苓白术散调之。
茶调散 治沉积水气。木香槟榔丸调之。
千金硝石丸 止可磨块，不令困人，须量虚实。
硝石（六两） 大黄（半斤） 甘草 人参（各三两）
上为末，以三年苦酒（即好醋也）。三升，置筒中，以竹片作三片刻，先纳大黄搅，使微
沸尽一刻，乃下余药。又尽一刻，微火熬膏。丸梧子大，每服三十丸。
消块丸 此必审确可用。
三棱 莪术（削坚） 青皮 陈皮（破气） 香附（调气） 桃仁 红花（治血） 灵脂（破血）
甘
草牛膝（死血用） 石碱（破痰块） 二陈汤（皮里膜外多痰加之） 山楂（食块加之） 吴茱
萸（炒，一钱五分） 益智（炒，一钱五分） 葵根 白术（等分）
碱石汤下。
茶癖散 石膏 黄芩 升麻
砂糖调服。
治痰块 苦参 半夏 瓜蒂 姜
蜜丸。
破块验丸 吴茱萸 黄连 木香 槟榔 桃仁 郁李仁
又承气加连、芍、川芎。干葛汤下。
又栝蒌、半夏、黄连、贝母丸，果效。
[Pulse]
The pulse comes forth thin and adheres to the bone, indicating an accumulation (Ji). At the Cun position (distal radial pulse), the accumulation is in the chest; at the Guan position (mid-radial pulse), the accumulation is beside the umbilicus; at the Chi position (proximal radial pulse), the accumulation is near the Qichong point.
If the pulse appears on the left, the accumulation is on the left side of the body; if on the right, it is on the right side; if appearing on both sides, the accumulation is in the center. A floating pulse that feels light like a feather upon superficial palpation and empty/hollow upon deep pressure, accompanied by rebellious Qi under the hypochondrium and pulling pain in the back, is named Lung Accumulation (Fei Ji).
A deep and hollow (Kou) pulse, with no fixed location, accompanied by chest fullness, palpitations, and heat in the abdomen, is named Heart Accumulation (Xin Ji).
A string-taut (Xian) and thin pulse, accompanied by pain in both hypochondria, pathogenic factors moving to the epigastrium, and swollen, cold feet, is named Liver Accumulation (Gan Ji).
A deep and rapid pulse, accompanied by pulling pain between the spine and waist, worsening when hungry and improving when full, is named Kidney Accumulation (Shen Ji).
A floating, large, and long pulse, improving when hungry and manifesting when full, accompanied by abdominal fullness, diarrhea, vomiting, and swelling of the lower legs, is named Spleen Accumulation (Pi Ji).
A deep and knotted (Jie) pulse at the Cun position, rapid and tight, indicates accumulations with fixed painful sites. A string-taut, fine, and weak pulse indicates Zhu disease (a chronic wasting condition or parasitic disease), characterized by transverse accumulations in the hypochondria and abdomen. A string-taut pulse with acute abdominal pain indicates Jia disease (mobile abdominal masses). A fine, deep, and straight/rigid pulse indicates carbuncles/swellings on the body, or Fuliang (a type of abdominal mass) in the abdomen. A deep, small, and solid pulse indicates gastric accumulation, inability to eat, and vomiting after eating. A deep and tight pulse, if associated with cold in the epigastrium and intermittent pain, indicates accumulation. A large pulse at the Guan position with fine pulses at the Cun and Chi positions indicates cold accumulation in the heart and abdomen; a slow and slippery pulse indicates cold and symptomatic accumulation. A string-taut and hidden (Fu) pulse with immobile abdominal accumulation indicates a fatal prognosis. A tight pulse indicates survival if the constitution is strong and urgent, but death if weak; a deep pulse indicates death.
[Etiology]
Cold in the lower legs and rebellious Qi cause blood vessels to coagulate and become stagnant. Cold Qi ascends into the stomach and intestines, causing abdominal distension. Abdominal distension forces the fluid foam outside the intestines to gather and not disperse, forming accumulations day by day.
Additionally, excessive food and drink intake, and overexertion in daily activities damage the collaterals of the stomach and intestines, causing blood to overflow outside the intestines. If there is cold and fluid foam outside the intestines, they contend with the spilled blood, causing Qi to gather and form accumulations.
Furthermore, external invasion of cold and internal injury from worry and anger cause Qi to rebel upward. Upward rebellion obstructs the Six Fu organs, preventing dampness from circulating. Coagulated blood becomes encapsulated, and body fluids become stagnant and viscous,渗着 (seeping and adhering) without dispersing, thus forming accumulations.
Moreover, diseases arising from Yin include: worry and thought injuring the Heart; double cold injuring the Lungs; anger injuring the Liver; sexual intercourse while drunk and sweating in the wind injuring the Spleen; overexertion and sexual intercourse followed by bathing while sweating injuring the Kidneys. All these lead to imbalance of Zang organ Qi, non-dispersion of coagulated blood, contention of fluid foam, and accumulation through entanglement.
There are also Food Accumulation, Wine/Meat Accumulation, Water Accumulation, Saliva Accumulation, Blood Accumulation, and Qi Accumulation, all caused by partiality or preference, leading to stagnation and eventual formation of mass over time. In the middle Jiao, it is Phlegm-Fluid; on the right, it is Food Accumulation; on the left, it is Blood Accumulation.
[Signs and Symptoms]
The origin of Accumulation (Ji) and Gathering (Ju) is the same. Those located in the Zang organs remain fixed and do not move, called "Ji"; those located in the Fu organs present with pain and shifting locations, moving with Qi, called "Ju". Ji is related to Zang; Ju is related to Fu. Zhu disease is related to Qi; Jia disease is related to Blood.
Liver Accumulation is named Feiqi. It is located under the left hypochondrium, shaped like an inverted basin. Attacks involve coughing, rebellious Qi, and malaria. If unresolved for years, it contains blood, as the Liver governs Blood.
Heart Accumulation is named Fuliang. It starts below the umbilicus, size like an arm, extending up to the epigastrium. It causes vexation and anxiety, containing large amounts of pus and blood, located outside the diaphragm and stomach.
Lung Accumulation is named Xiben. It is located under the right hypochondrium, size like a cup. It presents with aversion to cold and fever, wheezing, coughing, and lung congestion. Ben refers to the cardia; the accumulation is below the lung at the cardia.
Spleen Accumulation is named Piqi. It is located in the epigastrium, size like a plate. It causes weakness of the four limbs, jaundice, and failure of diet to nourish muscles. Pi refers to dampness. Eating cold food damages Qi, which is then retained by dampness.
Kidney Accumulation is named Bentun. It arises in the lower abdomen, extending up to the epigastrium, resembling a running piglet. It causes panting and skeletal flaccidity.
Diseases in the Six Fu organs: The Taiyang channel benefits clear Qi, the Yangming channel drains turbid Qi, and the Shaoyang channel transforms essence Qi. Dysfunction leads to obstruction and gathering. Thus, excess conditions stagnate without turning, while deficiency conditions fail to transport. They belong to Yang, have no fixed form, and move with Qi. Above, they cause blockage; below, they cause distension; laterally attacking the hypochondria, they feel like mud clumps, easily changing, hence named "Ju".
Another type is Xiji, where breath becomes癖滞 (stagnant) under the hypochondria, not between Zang-Fu or Ying-Wei. Over time, it forms. Qi does not interfere with the Stomach, so appetite is unaffected. Patients experience hypochondriac fullness, rebellious Qi, difficulty breathing, and persistent hiccups, named Xiji.
[Therapeutic Methods]
Treat cold with heat; treat constriction with dispersion; eliminate exogenous pathogens; move stagnation; reduce hardness; massage for resolution; use salty flavors to soften; use bitter flavors to purge; preserve true Qi with tonification; act according to what is beneficial; attack wine/meat accumulations with substances they dislike, and lure them with substances they like.
Wuji Wan (Five Accumulations Pill): Treats accumulation masses.
Coptis Rhizome (Huanglian): 5 qian for Liver/Kidney, 1.5 liang for Heart/Lung, 7 qian for Spleen.
Magnolia Bark (N Hou): 5 qian for Liver/Heart/Spleen, 8 qian for Lung/Stomach.
Croton Seed Frost (Badou Shuang): 5 fen.
Aconite Root (Chuanwu): 1 qian for Liver/Lung, 5 qian for Kidney/Spleen.
Dried Ginger (Ganjiang): 5 fen for Heart/Liver, 1.5 qian for Kidney.
Poria (Fuling): 1.5 qian.
Ginseng (Renshen): 2 qian for Liver/Lung/Kidney, 5 qian for Heart.
Process Croton seed separately, mix evenly, honey-pelletize to wu zi size. Stop when mild diarrhea occurs.
For Liver Accumulation, add Bupleurum Root (Chaihu) 2 liang, Gleditsia Spine (Zaojiao) 2.5 qian, Sichuan Pepper (Chuanjiao) 4 qian, Kelp (Kunbu) 2 qian, Curcuma Zedoaria Rhizome (Ezhu) 3.5 qian.
For Heart Accumulation, add Poria (Fuling) 3 qian, Cinnamon Twig (Rougui) 1 qian, Poria with Hostwood (Fushen) 1 qian, Salvia Miltiorrhiza Root (Danshen) 1 qian, Acorus Tatarinowii Rhizome (Changpu) 5 qian.
For Lung Accumulation, add Platycodon Root (Jiegeng) 1 qian, Aster Root (Ziwan) 1.5 qian, Asparagus Fern Root (Tianmendong) 1 qian, Burreed Tuber (Sanleng) 1 qian, Green Tangerina Peel (Qingpi) 1 qian, Tangerina Peel (Chenpi) 1 qian, Sichuan Pepper (Chuanjiao) 1.5 qian, White Cardamom Seed (Baidoukou) 1 qian.
For Kidney Accumulation, add Corydalis Rhizome (Yanhusuo) 3 qian, Chinaberry Bark (Kelianrou) 3 qian, Whole Scorpion (Quanxie) 1 qian, Prepared Aconite Root (Fuzi) 1 qian, Alisma Rhizome (Zexie) 2 qian, Angelica Pubescens Root (Duhuo) 3 qian, Cinnamon Twig (Rougui) 3 qian, Acorus Tatarinowii Rhizome (Changpu) 2 qian, Clove (Dingxiang) 5 qian.
For Spleen Accumulation, add Evodia Fruit (Wuyu) 2 qian, Alisma Rhizome (Zexie) 1 qian, Capillaris Herb (Yinchen) 2 qian, Amomum Fruit (Suosha) 2 qian, Sichuan Pepper (Chuanjiao) 5 qian.
In autumn/winter, double the processed Magnolia Bark (N Hou) and reduce Scutellaria Root (Huangqin) and Coptis Rhizome (Huanglian). If feeling hot, add Coptis Rhizome (Huanglian); if feeling stifled/confused, add Cinnamon Twig (Rougui); if short of breath, reduce Magnolia Bark (N Hou). For deficient patients, direct attack is contraindicated; coat pills in wax and take long-term to grind down accumulations.
For Meat Accumulation, use Amomum Fruit (Sharen), Mercury (Shuiyin), Ferula Resin (awei); for Wine Accumulation, use Medicated Leaven (Shenqu), Barley Sprout (Maiya); for Blood Accumulation, use Blue Bottle Fly Larva (Mengchong), Leech (Shuizhi), Peach Kernel (Taoren), Rhubarb (Dahuang); for Qi Accumulation, use Areca Seed (Binglang), Aucklandia Root (Muxiang); for Water Accumulation, use Kansui Root (Gansui), Morning Glory Seed (Qianniu), Genkwa Flower (Yuanhua); for Saliva Accumulation, use Realgar (Xionghuang), Calomel (Nifen); for Food Accumulation, use Flue Stone (Mengshi), Croton Seed (Badou); for Pi Accumulation, use Burreed Tuber (Sanleng), Curcuma Zedoaria Rhizome (Ezhu); for Fish/Fresh Food Accumulation, use Tangerina Peel (Chenpi), Perilla Leaf (Zisu), Tsaoko Cardamom (Caoguo), Clove (Dingxiang), Cinnamon Bark (Guixin); for Cold-induced Accumulation, use Aconite Root (Fuzi), Magnolia Bark (N Hou), Sulfur (Liuhuang).
Huaji Tang: Treats Xiji stagnating in the abdomen and hypochondria, causing distension, stasis pain, and vomiting of sour water.
Amomum Fruit (Suosha), Cinnamon Twig (Rougui), Aucklandia Root (Muxiang) (each 1 qian); Roasted Licorice Root (Gancao), Stir-fried Fennel Seed (Huixiang), Clove (Dingxiang), Stir-fried Green Tangerina Peel (Qingpi), Tangerina Peel (Chenpi), Processed Ginger (Shengjiang) (each 5 qian); Agarwood (Chenxiang), Black Pepper (Hujiao) (each 1 qian).
Grind to powder, take 2.1 qian mixed with ginger, perilla decoction, salt, and wine.
Sanju Tang: Treats chronic Qi gathering in six places, resembling Zhu/Jia, moving up and down with Qi, occurring intermittently, with severe heart/abdominal pain radiating to hypochondria and waist, wheezing, coughing, fullness, and distension.
Pinellia Tuber (Banxia), Areca Seed (Binglang), Angelica Sinensis Root (Danggui) (each 3 qian); Tangerina Peel (Chenpi), Apricot Kernel (Xingren), Cinnamon Twig (Rougui) (each 2 qian); Poria (Fuling), Licorice Root (Gancao), Processed Aconite Root (Pao Fu), Ligusticum Chuanxiong Rhizome (Chuanxiong), Aurantium Fructus (Zhike), Evodia Fruit (Wuyu), Processed Magnolia Bark (N Hou) (each 1 qian); Rhubarb (Dahuang) (add if constipated).
Sansheng Gao: Apply to masses.
Calcined Litharge (Duanshi) (half jin, unrefined, stir-fried in clay pot until pale red, cool slightly, then grind); Rhubarb (Dahuang) (1 liang, powdered, lightly stir-fried in furnace, cool, then add Cinnamon Bark); Cinnamon Bark (Guixin) (0.5 liang, powdered, lightly stir-fried, boiled with vinegar to paste consistency, apply thickly to affected area).
Another prescription: Rhubarb (Dahuang), Mirabilite (Piaoxiao) (each 1 liang, powdered). Garlic paste applied externally is also good.
Zhang's Method: Wuyou San: Treats various unresolving accumulations. Administer with Guiling Baizhu San.
Chatiao San: Treats deep-seated water qi. Administer with Muxiang Binglang Wan.
Qianjin Xiaoshi Wan: Only grinds masses without exhausting the patient; must assess deficiency/excess.
Niter (Xiaoshi) (6 liang); Rhubarb (Dahuang) (0.5 jin); Licorice Root (Gancao), Ginseng (Renshen) (each 3 liang).
Grind to powder. Use three sheng of three-year-old vinegar (good vinegar). Place in a tube, mark bamboo slice for timing. First add Rhubarb, stir until slightly boiling for one ke (approx. 30 mins). Then add remaining herbs. Boil another ke on low fire to make paste. Pelletize to wu zi size. Take 30 pills each time.
Xiaokuai Wan: Must be carefully verified before use.
Burreed Tuber (Sanleng), Curcuma Zedoaria Rhizome (Ezhu) (for hard masses); Green Tangerina Peel (Qingpi), Tangerina Peel (Chenpi) (to break Qi stagnation); Cyperus Rhizome (Xiangfu) (to regulate Qi); Peach Kernel (Taoren), Safflower (Honghua) (to treat blood stasis); Trogopterorus Faeces (Wulingzhi) (to break blood stasis); Licorice Root (Gancao), Achyranthes Root (Niuxi) (for dead blood); Soda Ash (Shijian) (to break phlegm masses); Erchen Tang (add for phlegm in subcutaneous tissues); Hawthorn Fruit (Shanzha) (for food masses); Fried Evodia Fruit (Wuzhuyu) (1.5 qian); Fried Alpinia Oxyphylla Fruit (Yizhi) (1.5 qian); Hibiscus Root (Kuigen), Atractylodes Macrocephala Rhizome (Baizhu) (equal parts).
Take with Shijian Tang.
Cha Pi San: Gypsum (Shigao), Scutellaria Root (Huangqin), Cimicifuga Rhizome (Shengma).
Take with sugar water.
Treat Phlegm Masses: Sophora Root (Kushen), Pinellia Tuber (Banxia), Melon Seed (Gua Di), Ginger (Jiang).
Honey pelletize.
Po Kuai Yan Wan: Evodia Fruit (Wuzhuyu), Coptis Rhizome (Huanglian), Aucklandia Root (Muxiang), Areca Seed (Binglang), Peach Kernel (Taoren), Damson Plum Seed (Yuliren).
Also Chengqi Tang plus Coptis Rhizome (Lian), Peony Root (Shao), Ligusticum Chuanxiong Rhizome (Chuanxiong). Take with Kudzu Root (Gange) decoction.
Also, Trichosanthes Fruit (Gualou), Pinellia Tuber (Banxia), Coptis Rhizome (Huanglian), Fritillaria Bulb (Beimu) pill, effective.