大意
积聚 瘕。皆太阴湿土之气。名虽不同。大要不出痰与食积死血而已。气则不能成形也。（玉册）
内因
积之始生。因起居不时。忧恚过度。饮食失节。脾胃亏损。邪正相搏。结于腹中。或因内伤外感气郁误补而
致。（汇补）
外候
或恶寒潮热。或痞满呕吐。或走注疼痛。或腹满泄泻。或眩晕嘈杂。胁肋攻冲。（吴球）
左右有别
旧说以积块在中为痰饮。在右为食积。在左为死血。此大概之论。不可拘执也。常有胃家食积而病发于
中者。亦有气与食积相假而积留于左者。（汇补）
积聚不同
积属阴。五脏所主。发有常处。痛不离部。聚属阳。六腑所成。发无定所。痛无常处。（难经）
瘕各别
者。征也。以其有所征验也。腹中坚硬。按之应手。不能移动。瘕者。假也。假物而成蠢动之形。如血鳖之类。
中虽硬而聚散无常。且有活性。故或上或下。或左或右。 因伤食。瘕是血生。二症多见于脐下。（汇补）
癖痞异
在腹内。贴近脐旁。左右一条。筋脉急痛。有时而见。癖居两肋。有时而痛。外不可见。痞居心下。满闷壅塞。
按之不痛。而无形迹。（汇补）
脉法
大率实大坚强者生。虚弱沉细者死。又沉而附骨者积脉也。
积聚分治
食积。气口紧盛。或弦急。或中或右。硬痛不移。呕吐饱胀。或作寒热身痛。痰积。脉来沉滑。忽时眩晕麻木。恶
心痞塞。嘈杂。虫积。口吐清水。或时吐虫。或偏嗜一物。脉来乍大乍小。面生白斑。唇红能食。时痛时止。血积。
因打扑闪肭。血瘀成块。或妇人产后不月。多有是症。盖月事正临产后虚弱。适感寒气。寒气客于子门。血
凝成块。多在小腹。发则痛楚万倍。面色不泽。（汇补）
五脏积名
肝积曰肥气。在右胁下。如覆杯。有头足。如龟鳖状。久不愈。令人呕逆。或胸胁痛引小腹。足寒转筋。肺积曰
息奔。在右胁下。大如覆杯。久不愈。令人洒洒寒热。呕逆喘咳。发肺痈。心积曰伏梁。起脐上。大如臂。上至心。
久不已。令人烦心。身体胫股皆肿。环脐而痛。脾积曰痞气。在胃脘。覆大如盘。久不愈。令人四肢不收。发黄
疸。饮食不为肌肤。心背彻痛。肾积曰奔豚。发于小腹。上至心。如豚奔走状。久不愈。令人喘逆骨痿少气。（汇补）
养正
壮实人无积。虚人则有之。皆因脾胃虚衰。气血俱伤。七情悒郁。痰挟血液凝结而成。若徒用磨坚破积之
药。只损真气。积虽去而体已备。虽或临时通快。药过依然。气愈耗而积愈大。惟当渐磨熔化。攻补兼施。若
去积及半。即宜纯与甘温调养。使脾土健运。则破残余积。不攻自走。所谓养正积自除之谓也。（汇补）
治法
大法。咸以软之。坚以削之。惟行气开郁为主。或以所恶者攻之。或以所喜者诱之。则易愈。（汇补）
治分国中末
初起正气尚强。邪气尚浅。则任受攻。中则受病渐久。邪气较深。正气较弱。任受且攻且补。末则邪气侵凌。
正气消残。则任受补。（洁古）又初起为寒。宜辛温消导。久则郁热。宜辛寒推荡。（汇补）
用药
主以二陈汤。随症加减。消痰。加南星、枳壳、海石。去食。加山楂、神曲、草果。追虫。加槟榔、使君子、楝树
根、花椒。破瘀。加桃仁、红花、赤芍、玄胡索、归尾。导饮。加茯苓、泽泻。顺气。加香附、砂仁。开郁。加木香、
白豆蔻。温散。加肉桂、沉香。削坚。加三棱、蓬术。滋阴。加鳖甲、知母。化热。加黄连、山栀。平胃。加苍术、浓
朴。疏肝。加青皮、柴胡。补气。加人参、白术。养血。加当归、川芎。又积属阴。参攻积丸。聚属阳。兼行气散结。
加麦芽、神曲、山楂、枳实、浓朴。瘕加川芎、当归、丹皮、乌药、玄胡、桃仁、红花、海石。痞加黄连、枳实、浓
朴、山楂、栝蒌。癖加肉桂、玄胡。若久病患虚。法须六君归脾理中等汤大补。若在皮里膜外者。用抚芎、香附等开之。
仍须断浓味。
积聚选方
新制阴阳攻积散 治积聚 瘕 癖蛊血痰食。不问阴阳。皆效。
吴茱萸（泡） 干姜（炒） 官桂 川乌（泡各一两） 黄连（炒） 半夏
橘红 茯苓 槟榔 浓朴 枳实 菖蒲
玄胡索 人参 沉香 琥珀（另研） 桔梗（各八钱） 巴霜（五钱另研）
末之。皂角水煎汁泛丸绿豆大。每服八分。渐加一钱五分。姜汤送下。
遇仙丹 治血积气积痰癖。肢节肿痛。一切有余湿热痰火。痰涎壅滞。脉滑实有力者。
白牵牛（头末四两半生牛炒） 白槟榔（一两） 茵陈（六钱） 蓬术 三棱（各五钱俱醋炒）
牙皂（五钱炙去皮弦）
一方。加沉香一两。末之。醋糊丸绿豆大。每服三钱。五更凉茶下。天明看所去之物。有积去积。
有虫去虫。小儿减半。孕妇勿服。
济阴丸 治经候不调。 癖积块刺痛。
香附（一斤醋浸炒） 莪术 当归（各四两俱酒浸）
末之。醋糊丸。醋汤下。
三圣膏 贴积。
用未化锻石十两。筛过极细。炒红。将好醋熬成膏。入大黄末一两。再入肉桂末五钱。略炒。
搅匀。浓摊烘。
热贴之。
琥珀膏
用大黄、朴硝各一两为末。以大蒜捣膏贴之。
黄蜀葵根煎汤 治小腹有块。曾服涩药止经。因而血滞成块。入人参、白术、青皮、陈皮、甘草、牛膝煎膏。入
研细桃仁、玄明粉少许。热饮之。二服当见块下。病重者。补接之后。加减调理。或再行一度。去块一二次。
去葵根、玄明粉。
积块 用海石、三棱、莪术、香附。俱醋炒。桃仁、红花、五灵脂之类为丸。石咸、白术汤下。
六君子汤 归脾汤（二方见中风） 理中汤（方见中寒）
[General Principle]
Ji (accumulation) and Xia (masses that gather and scatter) are both caused by the dysfunction of damp-earth qi in the Taiyin spleen meridian. Although their names differ, they essentially stem from phlegm, food stagnation, and dead blood (stasis). Qi itself cannot form a tangible solid mass. (From *Yu Ce*)
[Internal Causes]
The onset of Ji and Ju begins with irregular daily routines, excessive worry and anger, and unregulated diet, leading to damage and deficiency of the spleen and stomach. At this point, pathogenic factors and healthy qi contend with each other, knotting in the abdomen. It may also result from internal injury combined with external contraction, qi stagnation, and erroneous use of tonifying medicines. (From *Zheng Zhi Hui Bu*)
[External Manifestations]
Symptoms include: aversion to cold alternating with fever, epigastric fullness and vomiting, wandering pain, abdominal distension and diarrhea, dizziness and gastric discomfort, or a sensation of attacking and rushing in the hypochondrium. (From Wu Qiu)
[Differences Between Left and Right]
Old theories state that masses in the center are phlegm-fluids, on the right are food stagnation, and on the left are dead blood. This is a general discussion and should not be rigidly adhered to. There are cases where food stagnation in the stomach manifests in the center, and cases where qi combines with food stagnation to accumulate on the left. (From *Zheng Zhi Hui Bu*)
[Differences Between Ji and Ju]
"Ji" (Accumulation) belongs to Yin, is governed by the Five Zang organs, has a fixed location of onset, and pain remains localized. "Ju" (Gathering) belongs to Yang, is formed by the Six Fu organs, has no fixed location of onset, and pain has no fixed place. (From *Nan Jing*)
[Differences Among Zheng, Xia, Pi, and Pi]
"Zheng" refers to accumulation because it has tangible signs. The abdomen feels hard, palpable upon pressure, and immovable. "Xia" means false; it takes shape artificially, resembling moving creatures like blood clots. Though hard inside, it gathers and scatters unpredictably and has mobility, so it may move up, down, left, or right. Zheng is often due to food injury, while Xia is often due to blood generation. Both symptoms are mostly seen below the umbilicus. (From *Zheng Zhi Hui Bu*)
"Pi" (specifically Pian Pi) is located inside the abdomen, close to the sides of the umbilicus, appearing as a strip on either side, causing urgent pain in the sinews and vessels, appearing intermittently. Pian Pi also resides in the hypochondrium, causing intermittent pain, invisible externally. "Pi" (Stagnation) is located in the heart region (epigastrium), feeling full and obstructed, painless upon pressure, and without visible form. (From *Zheng Zhi Hui Bu*)
[Pulse Diagnosis]
Generally, a pulse that is large, excess, and strong indicates survival, while a weak, deep, and fine pulse indicates death. Furthermore, a pulse that is deep and felt only when pressing to the bone is the pulse of accumulation.
[Differentiated Treatment of Accumulations]
Food Stagnation: The Renying or Qikou pulse is tight and full, or wiry and urgent; the pulse position is central or right; the mass is hard and painful without moving; accompanied by vomiting, bloating, or alternating chills and fever with body pain.
Phlegm Stagnation: The pulse comes in a deep and slippery manner; sudden dizziness and numbness; nausea and obstruction; gastric discomfort.
Parasite Stagnation: Spitting clear saliva; occasional expulsion of parasites; craving for specific foods; pulse fluctuating between large and small; white spots on the face; red lips and good appetite; pain that comes and goes.
Blood Stagnation: Due to falls, bruises, or sprains, blood stasis forms a lump; or women experiencing amenorrhea postpartum often have this condition. Since menstruation has just ended and the body is weak postpartum, if exposed to cold pathogens, the cold lodges in the Zi Men (uterine opening), coagulating blood into a mass, mostly in the lower abdomen. Upon onset, the pain is extreme, and the complexion lacks luster. (From *Zheng Zhi Hui Bu*)
[Names of Five Zang Accumulations]
Liver Accumulation is called Fei Qi, located under the right hypochondrium, shaped like an inverted cup, with head and feet, resembling a turtle or crab. If untreated for long, it causes vomiting and regurgitation, or chest and hypochondriac pain radiating to the lower abdomen, cold feet, and muscle spasms.
Lung Accumulation is called Xi Ben, located under the right hypochondrium, large as an inverted cup. If untreated for long, it causes shivering chills and fever, vomiting, regurgitation, wheezing, coughing, and may develop into Lung Abscess.
Heart Accumulation is called Fu Liang, starting above the umbilicus, large as an arm, extending upward to the heart. If untreated, it causes mental restlessness, swelling of the legs and thighs, and pain circling the umbilicus.
Spleen Accumulation is called Pi Qi, located in the stomach region, covering an area large as a plate. If untreated, it causes weakness and inability to move the limbs, jaundice, failure of food to nourish muscles, and penetrating pain in the heart and back.
Kidney Accumulation is called Ben Tun, originating in the lower abdomen, extending upward to the heart, resembling a pig running. If untreated, it causes wheezing and regurgitation, bone atrophy, and shortness of breath. (From *Zheng Zhi Hui Bu*)
[Nourishing Righteous Qi]
Robust individuals do not get accumulations; only deficient individuals do. This is all due to spleen and stomach deficiency, injury to both qi and blood, depression of the seven emotions, and condensation of phlegm mixed with blood. If one merely uses drugs to grind hardness and break accumulations, it only damages true qi. Although the accumulation may be removed, the body becomes extremely depleted. Although there may be temporary relief, relapse occurs after the medicine wears off; the more qi is consumed, the larger the accumulation becomes. One should gradually grind and dissolve, combining attack and tonification. Once half of the accumulation is removed, one should purely use sweet-warm tonics to strengthen the spleen earth. Then, the remaining accumulation will disperse without further attack. This is what is meant by "nourishing righteousness, and the accumulation will naturally eliminate." (From *Zheng Zhi Hui Bu*)
[Treatment Principles]
The general principle is: use salty substances to soften hardness, use harsh substances to reduce solidity, with the main focus on promoting qi circulation and relieving depression. Alternatively, attack it with what the patient dislikes, or lure it with what the patient likes, making it easier to cure. (From *Zheng Zhi Hui Bu*)
[Treatment Divided into Early, Middle, and Late Stages]
In the early stage, righteous qi is still strong, and pathogenic factors are shallow, so the patient can tolerate attack. In the middle stage, the disease has lasted longer, pathogenic factors are deeper, and righteous qi is weaker, so the patient can tolerate simultaneous attack and tonification. In the late stage, pathogenic factors invade severely, and righteous qi is nearly exhausted, so the patient can tolerate tonification only. (From Jie Gu/Li Dongyuan) Additionally, early stages involving cold should use acrid-warm substances for digestion and elimination; long-standing cases turning into depressed heat should use acrid-cold substances for pushing and clearing. (From *Zheng Zhi Hui Bu*)
[Medication]
Mainly use Er Chen Tang (Two-Cured Decoction), modified according to symptoms.
For eliminating phlegm: add Tian Nan Xing (Arisaema Rhizome), Zhi Ke (Bitter Orange), Hai Shi (Floating Limestone).
For eliminating food: add Shan Zha (Hawthorn), Shen Qu (Mass Medicamentum Fermentatum), Cao Guo (Black Cardamom).
For expelling parasites: add Bing Lang (Areca Nut), Shi Jun Zi (Quisqualis Fruit), Lian Shu Gen (Melia Root), Hua Jiao (Sichuan Pepper).
For breaking stasis: add Tao Ren (Peach Kernel), Hong Hua (Safflower), Chi Shao (Red Peony Root), Yuan Hu Suo (Corydalis Rhizome), Gui Wei (Angelica Sinensis Tail).
For guiding out fluids: add Fu Ling (Poria), Ze Xie (Alisma).
For smoothing qi: add Xiang Fu (Cyperus Rhizome), Sha Ren (Amomum Fruit).
For opening depression: add Mu Xiang (Aucklandia Root), Bai Dou Kou (White Cardamom).
For warming and dispersing: add Rou Gui (Cinnamon Bark), Chen Xiang (Aquilaria Wood).
For reducing hardness: add San Leng (Burreed Tuber), Peng Zhu (Curcuma Zedoaria).
For nourishing yin: add Bie Jia (Turtle Shell), Zhi Mu (Anemarrhena Rhizome).
For resolving heat: add Huang Lian (Coptis Rhizome), Shan Zhi (Gardenia Fruit).
For leveling the stomach: add Cang Zhu (Atractylodes Rhizome), Hou Po (Magnolia Bark).
For soothing the liver: add Qing Pi (Unripe Citrus Peel), Chai Hu (Bupleurum Root).
For tonifying qi: add Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome).
For nourishing blood: add Dang Gui (Angelica Sinensis Root), Chuan Xiong (Ligusticum Rhizome).
Additionally, Ji (Accumulation) belongs to Yin; refer to Gong Ji Wan. Ju (Gathering) belongs to Yang; combine with promoting qi circulation and dissipating nodules, adding Mai Ya (Barley Sprout), Shen Qu, Shan Zha, Zhi Shi (Immature Bitter Orange), Hou Po.
For Xia: add Chuan Xiong, Dang Gui, Dan Pi (Moutan Cortex), Wu Yao (Lindera Root), Yuan Hu, Tao Ren, Hong Hua, Hai Shi.
For Pi (Stagnation): add Huang Lian, Zhi Shi, Hou Po, Shan Zha, Gua Lou (Trichosanthes Fruit).
For Pian Pi: add Rou Gui, Yuan Hu.
If the patient is chronic and deficient, the method requires major tonification using Liu Jun Zi Tang, Gui Pi Tang, or Li Zhong Tang. If the pathology is in the subcutaneous tissue or membrane exterior, use Fu Xiong (Chuan Xiong) and Xiang Fu to open it. One must still avoid rich and greasy foods.
[Selected Formulas for Accumulations]
Xin Zhi Yin Yang Gong Ji San (New Formula for Yin-Yang Attack Accumulation Powder): Treats Ji, Xia, Pian, Gu poison, blood accumulation, phlegm accumulation, and food accumulation. Effective regardless of yin or yang nature.
Ingredients: Wu Zhu Yu (soaked), Gan Jiang (fried), Guan Gui, Chuan Wu (soaked) [1 liang each]; Huang Lian (fried), Ban Xia, Ju Hong, Fu Ling, Bing Lang, Hou Po, Zhi Shi, Chang Pu, Yuan Hu Suo, Ren Shen, Chen Xiang, Hu Po (separately ground), Jie Geng [8 qian each]; Ba Dou Shuang (5 qian, separately ground).
Preparation: Grind into powder. Use soap pod water decoction to make pills the size of mung beans. Take 8 fen per dose, gradually increasing to 1.5 qian. Take with ginger soup.
Yu Xian Dan (Encounter Immortal Pill): Treats blood accumulation, qi accumulation, phlegm-pian, joint swelling and pain, all excess conditions of damp-heat, phlegm-fire, and phlegm-saliva obstruction, with a slippery, excess, and forceful pulse.
Ingredients: Bai Qian Niu (head powder 4.5 liang, half raw, half fried), Bai Bing Lang (1 liang), Yin Chen (6 qian), Peng Zhu, San Leng [5 qian each, all vinegar-fried]; Ya Zao (5 qian, roasted, skin and strings removed).
Alternative formula: Add Chen Xiang 1 liang.
Preparation: Grind into powder. Make pills with vinegar paste, size of mung beans. Take 3 qian per dose. Take with cool tea at the fifth watch (early morning). Observe excretions at dawn. Expel accumulation if present, expel parasites if present. Halve dose for children. Do not take during pregnancy.
Ji Yin Wan (Benefit Yin Pill): Treats irregular menstruation, pian accumulation masses with stabbing pain.
Ingredients: Xiang Fu (1 jin, soaked in vinegar and fried), E Zhu, Dang Gui [4 liang each, all soaked in wine].
Preparation: Grind into powder. Make pills with vinegar paste. Take with vinegar water.
San Sheng Gao (Three Sages Plaster): For applying to accumulations.
Ingredients: Use unmelted Duan Shi (calcined stone/mineral) 10 liang, sifted very fine, fried until red. Boil with good vinegar to form a paste. Add Da Huang powder 1 liang, then Rou Gui powder 5 qian, stir-fry briefly.
Preparation: Mix evenly, spread thickly, dry, and warm before application. Apply warm.
Hu Po Gao (Amber Plaster):
Ingredients: Da Huang, Po Xiao (Mirabilite) [1 liang each], ground into powder.
Preparation: Crush garlic into a paste, mix with the powder, and apply.
Huang Shu Kui Gen Decoction: Treats masses in the lower abdomen, resulting from blood stasis due to using astringent herbs to stop menstruation.
Ingredients: Add Ren Shen, Bai Zhu, Qing Pi, Chen Pi, Gan Cao, Niu Xi to decoct into a paste. Add finely ground Tao Ren and a small amount of Xuan Ming Fen.
Usage: Drink hot. After two doses, the mass should descend. For severe cases, after tonification and support, adjust and regulate. May repeat once or twice to remove the mass. Remove Huang Shu Kui Gen and Xuan Ming Fen subsequently.
Accumulation Masses:
Ingredients: Hai Shi, San Leng, E Zhu, Xiang Fu, all vinegar-fried. Tao Ren, Hong Hua, Wu Ling Zhi, etc., made into pills.
Usage: Take with Shi Xian (Salt/Saline mineral) and Bai Zhu decoction.
Liu Jun Zi Tang, Gui Pi Tang (see Stroke chapter for formulas), Li Zhong Tang (see Cold Damage chapter for formula).