《内经》曰∶病胁下满，气逆，二三岁不已，病名曰息积。夫消息者，阴阳之更事也。
今气
聚于胁下，息而不消，积而不散，故满逆而为病。然气不在胃，故不妨于食，特害于气而已
。治宜导引服药，药不可独治，善导引能行积气，药力亦藉导引而行故也。（《圣济》同下）
推气散 治右胁痛，胀满不食。
片姜黄 枳壳 桂心（各五钱） 炙草（二钱）
上为细末，每服二钱，姜、枣汤调下，食远服。
赤茯苓汤 治息积，胁下气逆满闷。
赤茯苓 桂心 陈皮（炒，半两） 高良姜（一两） 大腹皮（五钱） 吴茱萸（三分） 甘草
（一分）
水煎三钱，空心温服日二。
白术丸
白术（陈土炒） 枳实（麸炒） 桂心（各一两半） 人参 陈皮（去白，炒） 甘草（蜜炙）
桔梗（炒，各一两）
为末，蜜丸梧子大，空心酒下，三十丸，日二。
胸痛（附）
生地黄五斤绞取汁，微火煎三沸，投白蜜一升，再煎取三升，每服半升，日三。
经云∶结阳者，肿四肢。河间云∶四肢者，诸阳之本也。阳结故不得行于阴，阳脉不行
，故留结而为肿也。
犀角汤
犀角屑 元参 连翘 柴胡（各半两） 麦门冬 芒硝（各一两） 升麻 木通（各三钱）
沉香 射干（去毛） 甘草（炙，各一分）
上为末，每服三钱，水一盏，同煎至八分，食前去渣温服。
余曾治手十指独肿大者，与此药愈。有伤寒后手足肿而赤者，与此亦愈。但去柴胡、沉
香、芒硝不用，加枳壳一味。盖柴胡散气，沉香行气，皆所以通留结之阳，然升、柴不必并行，
而沉香之温燥，不如枳壳之和利也。芒硝泻阳明之阳，以其人便溏，故去之耳。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When there is fullness under the hypochondrium, with rebellious Qi, persisting for two or three years without resolution, the disease is named Xi Ji (Breathing Accumulation). The term "Xiao Xi" refers to the alternating processes of Yin and Yang. Currently, Qi gathers under the hypochondrium, stagnating in respiration without dissipating, accumulating without dispersing; thus, it causes disease through fullness and rebellion. However, since the pathogenic Qi is not in the Stomach, it does not hinder food intake, but only impairs the movement of Qi. Treatment should involve Daoyin (an ancient practice combining breathing exercises and physical movements for health and therapy) combined with herbal medicine. Medicine alone cannot cure effectively; skillful use of Daoyin can move accumulated Qi, and the efficacy of herbs also relies on Daoyin to circulate. (This view is consistent with that in *Shengji Zonglu*).
**Tui Qi San (Pushing Qi Powder)**: Treats pain in the right hypochondrium, distension, fullness, and loss of appetite.
* Pian Jianghuang (Curcumaae Radix), Zhike (Aurantii Fructus Immaturus), Guixin (Cinnamomi Ramulus) (each 5 qian);
* Zhi Caozhong (Prepared Glycyrrhizae Radix et Rhizoma) (2 qian).
Grind into a fine powder. Take 2 qian per dose, mixed with decoction of Ginger and Jujube, taken well after meals.
**Chi Fuling Tang (Red Poria Decoction)**: Treats Xi Ji (Breathing Accumulation), characterized by rebellious Qi, fullness, and oppression under the hypochondrium.
* Chi Fuling (Polyporus), Guixin (Cinnamomi Ramulus), Chenpi (Pericarpium Citri Reticulatae, stir-fried, 0.5 liang), Gaoliangjiang (Alpiniae Officinarum Rhizoma, 1 liang), Dafupi (Arecae Pericarpium, 5 qian), Wuzhuyu (Evodiae Fructus, 3 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 1 fen).
Decoct with water to obtain 3 qian of liquid. Take warm on an empty stomach, twice daily.
**Baizhu Wan (Atractylodis Macrocephalae Pill)**:
* Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with aged soil), Zhishi (Aurantii Fructus Immaturus, bran-fried), Guixin (Cinnamomi Ramulus) (each 1.5 liang);
* Renshen (Ginseng Radix), Chenpi (Pericarpium Citri Reticulatae, pith removed, stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Jiegeng (Platycodonis Radix, stir-fried) (each 1 liang).
Grind into powder, mix with honey to form pills the size of wutong seeds. Take 30 pills with wine on an empty stomach, twice daily.
**Chest Pain (Supplementary Formula)**:
Take 5 jin of Shengdihuang (Rehmanniae Radix), press to extract juice. Simmer over low heat until boiling three times. Add 1 sheng of Baimi (White Honey). Simmer again until reduced to 3 sheng. Take 0.5 sheng per dose, three times daily.
The Classic states: When Yang Qi is knotted, swelling occurs in the four limbs. Hejian (Liu Wansu) stated: The four limbs are the root of all Yang meridians. Because Yang is knotted, it cannot flow into Yin. Since the Yang meridians do not circulate, they remain knotted and cause swelling.
**Xijiao Tang (Rhinoceros Horn Decoction)**:
* Xijiaoxie (Rhinocerotis Cornu, now typically substituted with Water Buffalo Horn/Shuiniujia in modern practice), Xuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus), Chaihu (Bupleuri Radix) (each 0.5 liang);
* Maimendong (Ophiopogonis Radix), Mangxiao (Natrii Sulfas) (each 1 liang);
* Shengma (Cimicifugae Rhizoma), Mutong (Akebiae Caulis) (each 3 qian);
* Chenxiang (Aquilariae Lignum Resinatum), Shegan (Belamcandae Rhizoma, remove hairs), Gancao (Glycyrrhizae Radix et Rhizoma, prepared) (each 1 fen).
Grind into powder. Take 3 qian per dose with one cup of water. Decoct until reduced to 0.8 cup. Strain and take warm before meals.
I once treated a patient whose ten fingers were exclusively swollen, who recovered with this prescription. Another patient with red and swollen hands and feet following a Shanghan (Cold Damage) illness also recovered with this prescription. In these cases, I omitted Chaihu, Chenxiang, and Mangxiao, adding only Zhike. This is because Chaihu disperses Qi and Chenxiang moves Qi; both serve to unblock knotted Yang. However, Shengma and Chaihu need not be used together, and the warming-drying nature of Chenxiang is inferior to the harmonizing and promoting action of Zhike. Mangxiao purges Yang from the Yangming channel; it was omitted in that specific case because the patient had loose stools.