（积聚 瘕）
心下为阳明之部分。乃心火宣布其化之地。君火之气。化血下行。随冲脉以藏于肝。即从心下而起。肾水
之阳。化气上行。随冲脉以交于肺。由肺散布以达肌肤。亦从心下而出。盖此地为阳明中土。乃水火血气。
上下往来之都会也。火降血下。气升水布。则此地廓然。设若火不降。则血不下。而滞于此矣。设若气不布。
则水不散。而结于此矣。观伤寒论。治心下痞满之证。用泻心汤以泻火。用十枣汤以泻水。甘草泻心汤。生
姜泻心汤。水火兼泻。五苓散解水结。柴胡汤解火结。可知此地须水升火降。斯为既济之形。设上火下水。
阻于中宫。遂成天地否象。故名曰痞。血家火浮于上。与水不交。往往见痞满之象。审系火气不得下降者。
泻心汤治之。或加生附子。以开其痞。审系膀胱水中之阳。逆于心下。不得外出者。以小柴胡汤。转其枢机。
而水火皆通达矣。如水火交结。轻者为结胸。小陷胸汤主之。重者为陷胸。大陷胸汤治之。若单是水气结
聚者。二陈汤。枳术丸治之。今医但知停食痞满。而不知痞满之证。不一而足。此外尚有胸痹等
证。皆未论列。兹所论者。乃失血家间有之证也。凡遇以上诸证。再能酌加当归地黄川芎赤芍丹皮等。以
照顾血证。斯为面面俱到。
又有积聚之证。或横亘心下。或盘踞腹中。此非凝痰。即是里血。通以化滞丸主之。凝痰用
清茶送下。里血用醋酒送下。无论脐上脐下。左右兼治。又凡在脐下。多是血积抵当丸治之。
又有 瘕见于脐下。或见或没。为瘕。常见不没为 。 宜肠下逐瘀汤。抵当丸。瘕宜橘核丸。
按痞满者。胸膈间病。积聚者大腹之病。 瘕者下焦之病。统以真人化铁汤。加吴萸治之。统以逍遥散和
之。另详瘀血门。
(Accumulation [Ji Ju] and Mass [Jia])
The area below the heart (Xin Xia) belongs to the jurisdiction of the Yangming channel. It is the place where the Heart Fire [Xin Huo] spreads and disseminates its transformative functions. The Qi of the Sovereign Fire [Jun Huo] transforms blood to descend, following the Chong Mai (Penetrating Vessel) to be stored in the Liver. This Qi originates from below the heart. The Yang of Kidney Water ascends as Qi, following the Chong Mai to interact with the Lungs. From the Lungs, it is dispersed to reach the skin and muscles. This Qi also emerges from below the heart. Generally, this location is the Central Earth of Yangming, a hub where Water, Fire, Blood, and Qi ascend and descend. If Fire descends and Blood goes down, while Qi rises and Water spreads, this area remains clear and unobstructed. However, if Fire fails to descend, Blood will not go down and will stagnate here. If Qi fails to spread, Water will not dissipate and will condense here. Observing the *Shanghan Lun* (Treatise on Cold Damage), which treats syndromes of fullness and obstruction below the heart (Xin Xia Pi Man) using Xiexin Tang (Drain the Epigastrium Decoction) to drain Fire, and Shizao Tang (Ten Jujube Decoction) to drain Water; Gancao Xiexin Tang (Licorice Drain the Epigastrium Decoction) and Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction) drain both Water and Fire; Wuling San (Five-Ingredient Powder with Poria) resolves Water accumulation; and Chaihu Tang (Bupleurum Decoction) resolves Fire accumulation. It can be seen that this region requires Water to rise and Fire to descend to achieve the state of Ji Ji (Mutual Completion). If Upper Fire and Lower Water are blocked in the Middle Palace, it forms the image of the Hexagram Pi (Standstill/Obstruction), hence named "Pi" (Fullness/Obstruction). Patients with blood disorders often have Floating Fire above that does not interact with Water, frequently presenting with signs of Pi Man. If diagnosed as Fire Qi failing to descend, treat with Xiexin Tang, or add Sheng Fuzi (Raw Aconite Root) to open the obstruction. If diagnosed as the Yang of Water in the Bladder reversing into Xin Xia and failing to exit outwardly, use Xiao Chaihu Tang (Minor Bupleurum Decoction) to turn the pivot mechanism, thereby allowing both Water and Fire to flow freely. If Water and Fire knot together, mild cases are called Jie Xiong (Chest Binding), treated primarily with Xiaoxianxiong Tang (Minor Intra-thoracic Decoction); severe cases are called Xian Xiong (Sinking Chest), treated with Daxianxiong Tang (Major Intra-thoracic Decoction). If it is merely Water Qi accumulating, treat with Erchen Tang (Two-Aged Decoction) or Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill). Modern physicians only know about Pi Man caused by food stagnation, but do not realize that Pi Man syndromes are numerous and varied. Furthermore, syndromes such as Xiong Bi (Chest Bi/Oppression) are not discussed here. The discussions herein concern syndromes occasionally seen in patients with hemorrhagic diseases. Whenever encountering the aforementioned syndromes, one should additionally consider adding Dang Gui (Angelica Sinensis), Di Huang (Rehmannia Root), Chuan Xiong (Ligusticum Rhizome), Chi Shao (Red Peony Root), and Dan Pi (Moutan Bark) to care for the blood condition, thus being comprehensive.
There are also syndromes of Accumulation (Ji Ju), which may lie horizontally across Xin Xia or dominate the abdomen. These are either congealed Phlegm [Ning Tan] or internal Blood stasis [Li Xue], primarily treated with Huazhi Wan (Resolve Stagnation Pill). For congealed Phlegm, take with clear tea; for internal Blood stasis, take with vinegar and wine. Regardless of whether the site is above or below the umbilicus, treat both sides comprehensively. Additionally, accumulations below the umbilicus are mostly Blood Accumulations, treated with Didang Wan (Attacking the Residence Pill).
Masses [Jia] appearing below the umbilicus, which appear and disappear intermittently, are termed Jia; those that are constantly present and do not disappear are termed [Zhen - implied fixed mass]. Treat with Changxia Zhuyu Tang (Lower Intestine Blood-Dispersing Decoction) or Didang Wan. Jia is treated with Juzhe Wan (Tangerine Seed Pill).
Note: Pi Man is a disease of the chest and diaphragm; Ji Ju is a disease of the large abdomen; Jia is a disease of the Lower Jiao. Collectively, they can be treated with Zhenren Huatie Tang (True Person Iron-Melting Decoction) added with Wu Zhu Yu (Evodia Fruit), or harmonized with Xiaoyao San (Free and Easy Wanderer Powder). See the Blood Stasis chapter for details.