者。大肠之头也。门为肛。小肠有热。则大肠传导其热而气结于肛门。故痔。
案为坚。沈及金鉴。为腹胀坚满。不可从也。肠垢。巢源云。肠垢者。肠间津汁垢腻也。由热痢蕴积。
肠间虚滑。所以因下痢而便肠垢也。下重者。后重也。伤寒论。四逆散泄利下重。下利篇。热利下重。
白头翁汤主之。刘熙释名云。泄利下重。而赤白曰HT 。是也。
问曰。病有积。有聚。有 气。何谓也。师曰。积者。脏病也。终不移。聚者。腑病也。发作有时。辗
转痛移。为可治。 气者。胁下痛。按之则愈复发。为 气。诸积大法。脉来细而附骨者。乃积也。寸口积在
胸中。微出寸口。积在喉中。关上积在脐六。上关上。积在心下。微下关。积在少
腹。尺中。积在气冲。脉出左。积在左。脉出右。积在右。脉两出。积在中央。各以其部处之。（ 。千金。
作谷。则愈之下。更有愈字。寸口积之口下。有结字。关上下。有结字。尺中下同。魏 作谷。云 之为字。本
如此。若夫谷。乃恶木也。后人改为 。遂并谷。亦改为KT 。又讹为 。皆误笔也。案通
雅云。 。即谷乃 也。山海经。百KT 生。荀子。五 蕃。是也。○诸积大法以下。徐沈尤。别提为一条。）
〔徐〕积。迹也。病气之属阴者也。脏属阴。两阴相得故不移。不移者。有专痛之处。而无迁改也。聚
则如市中之物。偶聚而已。病之属阳者也。腑属阳。故相比阳。则非如阴之凝。故寒气感则发。否则已。所谓
有时也。既无定着。则痛无常处。故曰辗转痛移。其根不深。故比积为可治。若 气。 者。谷也。乃食
气也。（案三因。立 气门载宿食论治。当并考。）食伤太阴。敦阜之气。抑遏肝气。故痛在胁下痛。不由
脏腑。故按之则气行而愈。然病气虽轻。按之不能绝其病原。故复发。中气强。不治自愈。
〔尤〕诸积。该气
血痰食而言。脉来细而附骨。谓细。而沉之至。诸积皆阴故也。又积而不移之处。
其气血荣卫。不复上行而外达。则其脉为之沉。细而不起。
故历举其脉出之所。以决其受积之处。而复益之曰。脉两出。积在中央。以中央有积。其气不能分布左右。
故脉之见于两手者。俱沉细而不起也。各以其部处之。谓各随其积所在之处。而分治之耳。
五十五难曰。积者。阴气也。聚者。阳气也。故阴沉而伏。阳浮而动。气之所积。名曰积。气之所聚。
名曰聚。故积者五脏所生。聚者六腑所成也。积者。阴气也。其始发有常处。其痛不离其部。上下有所终始。
左右有所穷处。聚者。阳气也。其始发无根本。上下无所留止。其痛无常处。谓之聚。故以是别知积聚。
邵氏明医指掌参补云。痞块多在皮里膜外。并不系肠胃间。而医者往往以峻剂下之。安能使此块入
肠胃。从大便而出哉。吾见病未必去。而元气已耗。经年累月。遂至不治者多矣。历代医家。皆曰在左为死
血。在右为食积。在中为痰饮。盖以左属肝。肝藏血。右属脾。脾化谷。而痰饮。则结聚于中焦也。殊不知肝
脾虽左右之分。而实无界限之隔。非谓肝偏于左。而无与于右。脾偏于右。而无与于左。在左为死血。而在右
独无死血乎。在中为痰饮。而左右独无痰饮乎。但在左在右在中。皆因虚之所在。而入之耳。不可以死血痰
饮食积分之也。然当诊之以察其病。弦滑为痰。芤涩为血。沉实为食。三脉并见。则当兼治也。
This is the head of the large intestine. The anus is referred to as the "gate." If there is heat in the small intestine, it transmits this heat to the large intestine, causing Qi stagnation at the anus, thus leading to hemorrhoids (zhì).
Regarding the phrase "an wei jian" (hardness like a case), Shen Mingzong and Jin Jian interpreted it as abdominal distension with hardness and fullness; this interpretation should not be followed. "Chang gou" (intestinal mucus) refers to what Chao Yuanfang stated: intestinal mucus is the turbid and greasy fluid within the intestines. This arises from the accumulation of heat-dysentery, causing the intestines to become weak and slippery, resulting in the passage of intestinal mucus during diarrhea. "Xia zhong" refers to tenesmus. In the *Shanghan Lun* (Treatise on Cold Damage), Si Ni San (Four Counterflow Powder) is mentioned for treating diarrhea accompanied by tenesmus; in the chapter on diarrhea, it is stated that heat-diarrhea with tenesmus is primarily treated with Bai Tou Weng Tang (Pulsatilla Decoction). Liu Xi in *Shi Ming* (Explaining Names) states that diarrhea with tenesmus and bloody-white stools describes this condition.
Question: There are diseases characterized by Ji (accumulation), Ju (gathering), and Xia qi (wandering mass). What do these mean? The Master said: Ji is a disease of the Zang organs, fixed and unmovable. Ju is a disease of the Fu organs, occurring at specific times, with pain shifting around; it is treatable. Xia qi presents as pain under the hypochondrium, which alleviates upon pressure but recurs; this is Xia qi. The general principle for diagnosing various Ji diseases is: if the pulse is fine and deep, palpable only when pressed to the bone, it indicates Ji. If the pulse is felt at Cun Kou (radial artery location corresponding to Lung channel), the accumulation is in the chest. If slightly beyond Cun Kou, the accumulation is in the throat. At Guan position, the accumulation is near the navel. Slightly above Guan, the accumulation is in the epigastrium. Slightly below Guan, the accumulation is in the lower abdomen. At Chi position, the accumulation is at Qichong point. If the pulse appears on the left hand, the accumulation is on the left side of the body; if on the right hand, on the right side; if on both hands, in the center. Treatment should be directed according to the location indicated by the pulse. (Note: In *Qianjin Fang*, the character "gu" is written as such; an extra "yu" character appears after "ze yu"; extra "jie" characters appear after "cun kou ji", above and below "guan", and similarly at "chi". Wei Liting writes "gu", stating that the character for "xia" originally looked like this. As for "gu", it refers to an evil tree. Later scribes changed it to "xia", and consequently altered related characters, eventually corrupting them into other forms; these are all scribal errors. Reference *Tong Ya*: "Xia" implies the meaning of "gu nai". *Shan Hai Jing* mentions "bai KT sheng", and *Xun Zi* mentions "wu fan", referring to this. ○ From "The general principle for various Ji diseases" onwards, Xu Lingtai, Shen Mingzong, and You Zaijing treated it as a separate paragraph.)
Xu Lingtai's commentary: Ji means trace or mark; it belongs to Yin pathogenic Qi. Zang organs belong to Yin; two Yins combining results in immobility. Immobility means there is a specific site of pain without migration. Ju is like goods in a market, gathering temporarily; it belongs to Yang pathogenic Qi. Fu organs belong to Yang; therefore, compared to Yin, Yang does not coagulate. Thus, it manifests upon exposure to cold Qi and subsides otherwise, hence "occurring at specific times." Since it has no fixed abode, pain has no fixed location, hence "pain shifting around." Its root is shallow, making it more treatable than Ji. Regarding Xia qi, "Xia" means "gu," referring to food Qi. (Reference *San Yin Fang*: It establishes a section on Xia qi containing discussions on retained food treatment; this should be cross-referenced.) Dietary injury to Taiyin Spleen Earth leads to excessive abundance, suppressing Liver Qi, causing pain in the hypochondrium. This is not due to intrinsic Zang-Fu pathology, so pressing promotes Qi flow and relieves pain. However, although the pathogenic Qi is mild, pressing cannot eliminate the root cause, so it recurs. If Middle Qi is strong, it may heal spontaneously without treatment.
You Zaijing's commentary: Various Ji diseases, including Xia qi, involve Blood, Qi, Phlegm, and Food. A pulse that is fine and deep, palpable to the bone, indicates that fine pulses become prominent only upon deep pressure because all Ji diseases are Yin in nature. Furthermore, where Ji accumulates and remains fixed, the Ying-Wei (Nutritive-Defensive) Qi of Blood and Qi no longer ascends or reaches the exterior, causing the pulse to sink, remain fine, and fail to rise. Therefore, listing the locations where the pulse emerges helps determine the site of accumulation. It adds: if the pulse appears on both hands, the accumulation is in the center. Because accumulation in the center prevents Qi distribution to the left and right, the pulse on both hands sinks, becomes fine, and fails to rise. "Treating each according to its part" means directing treatment based on the specific location of the accumulation.
*Nan Jing* Chapter 55 states: Ji is Yin Qi; Ju is Yang Qi. Therefore, Yin sinks and hides, while Yang floats and moves. Where Qi accumulates, it is called Ji; where Qi gathers, it is called Ju. Thus, Ji originates from the Five Zang organs, and Ju is formed by the Six Fu organs. Ji is Yin Qi; its onset has a fixed location, pain stays within its region, moving up and down with definite limits, and left/right boundaries. Ju is Yang Qi; its onset has no root, no fixed stopping point up or down, and pain has no fixed location; this is called Ju. Thus, one distinguishes Ji and Ju by these characteristics.
Shao Shi, in his supplementary notes to *Ming Yi Zhi Zhang*, stated: Pi masses (痞块) are mostly located between the skin and fascia, not within the intestines or stomach. Yet physicians often use harsh purgatives. How can such masses enter the intestines and be expelled via stool? I have seen cases where the disease remained, but the Original Qi was depleted, leading to untreatable conditions over years. Past physicians claimed that masses on the left indicate dead blood (stasis), on the right indicate food retention, and in the center indicate Phlegm-fluids. This is because the Left corresponds to the Liver (which stores Blood), the Right to the Spleen (which transforms grains), and Phlegm-fluids accumulate in the Middle Jiao. However, although Liver and Spleen correspond to left and right respectively, they are not strictly separated. It is incorrect to say the Liver is exclusively left and unrelated to the right, or the Spleen exclusively right and unrelated to the left. If the left has dead blood, why would the right lack it? If the center has Phlegm-fluids, why would the left and right lack them? Masses in the left, right, or center occur because pathogens invade areas of deficiency. One should not rigidly categorize them as dead blood, Phlegm, or food retention. Diagnosis is essential: wiry and slippery pulses indicate Phlegm; choppy and hollow pulses indicate Blood stasis; deep and forceful pulses indicate Food retention. If all three pulses appear simultaneously, combined treatment is necessary.