积聚之症，《难经》分属脏腑。云∶气之所积，名曰积，五脏所生。其始发有常处，其痛不离其部。
肝之积曰肥气，在左胁下、如覆杯。曰肥气者，肥之为言盛也。肺之积曰息贲，在右胁下如覆杯。曰
息贲者，其气或息或贲也。心之积曰伏梁，起脐上大如臂，上至心下。曰伏梁者，伏而不动，如梁木然
也。脾之积，曰痞气，在胃脘，覆大如盘。曰痞气者，痞塞而不通也。肾之积、曰奔豚，发于少腹，上至
心，若豚状，上下无时。曰奔豚者，若江豚之奔走于水面，不常定也。气之所聚，名曰聚。聚者六腑所
成，其始发无根本，其痛无常处。所谓症者，按之有形可征。即积聚成块，不能移动者也。亦名痞块。皆
气滞痰凝，食积死血所为，病在肠胃之间，男女小儿咸有之。瘕者，假物成形，其块移易能动，如血鳖石
瘕之类，瘀血所成，多在少腹，隐辟而痛，独生于妇女。按积之成也，正气不足，而后邪气踞之。如小
人在朝，由君子之衰也。正气与邪气，势不两立，若大积大聚，不搜逐之，则邪气日昌，正气日削，而丧
亡从之矣。审如何经受病，何物成积。如因食者，大安丸和鸡金散，加三棱、莪术之属。因痰者，礞石丸
之属。因气者，聚宝丹之属。因瘀血者，大黄 虫丸之属。因虫者，槟黄万应丸之属。见之既确，发直入
之兵以讨之，自无不愈。经曰∶大积大聚，其可犯也，衰其大半而止。故去积及半，即当补气健
脾为主，脾能健运，则破残之余积，不攻自走。士材云∶积之为义，日积月累，匪伊芳朝夕。所以去
之，亦当有渐，太急则正气转伤，故宜分初、中、末三法治之。初病、邪气尚浅，正气尚强，则任
受攻；中则邪气渐深，正气渐衰，则任受且攻、且补∶末者，病久，邪气侵凌，正气消残，则任受
补。余制攻积丸一方，药品稍峻，用之有度，补中数日，然后攻伐，不问其积去多少，又与补中，
待其神壮，则复攻之。屡攻屡补，以平为期，百发百中者也。洁古云∶壮盛无积，虚人则有之，故
当养正则邪自除，譬之满座皆君子，一、二小人，自无容身之地。此论治轻浅之积，其法甚善，
学人均宜究心焉。
阴阳攻积丸〔重订。〕治积聚 瘕，一切皆效。
三棱 蓬术〔消积聚 瘕之要药。〕 香附〔漆渣制之，化气破瘀，且漆渣同槟榔，兼
能杀虫。烧酒、醋各浸三日，漆渣拌炒去之。只此二味，治痞块神效。〕 枳实 槟榔 青皮〔凡
积必由气结，气利而积消，故用枳、槟、青皮，破气散结滞之气。〕 桃仁 虫 海石 瓦
楞子〔凡积必假血根据痰，故用桃、 、海石，瓦楞子，消瘀化血。〕 黄连〔邪聚则热，用连之苦
寒以清之。〕巴豆霜〔荡涤一切有形之物，辛热大毒，性最猛烈，不可轻用，一钱，余各五钱。〕
人参〔恐专用克削。脾虚不运，积愈难去。故用参补助脾元。〕 皂荚〔五钱。〕 〔宣壅导滞，
性极尖利，无闭不开，无坚不破。〕煎汁。
同，蜜为丸，桐子大，每服二丸，一日三服。如积不去，每服再加一丸，渐加至积去暂停，服
补脾药数日，仍如上法再服，积去大半即止。凡治痞块，俱宜丸散，外用化痞膏贴之。
此利气清痰，破瘀削积攻下之剂。经曰∶坚者削之。故大积大聚，若不用峻厉之药，早为除去，
恐有养虎害身之患。按吴鹤皋云∶东垣治五积诸方，率以攻下温热之品，类聚为丸。夫五脏积气，在
肠胃之外，而用巴霜干漆等峻剂，以攻肠胃之内，非其治也。余直以为此非东垣之方，借曰为之，则无
脾胃论矣，明者辨之。又按仲淳论治五积，俱忌破气攻下，甚符鹤皋之论，附其治法于左，以俟临症参
酌用之。
仲淳方 治肥气。〔属气血两虚，肝气不和，逆气与瘀血相并而成。〕
当归 抚芎〔和肝。〕郁金 香附 沉香 砂仁〔调气。〕红花 赤芍 玄胡 山楂 肉
桂〔活血化瘀。〕
此和肝调气，活血化瘀之剂。
仲淳方 治息贲。〔属肺经气虚，痰热壅结所致。〕
桑皮 紫菀 郁金〔降气。〕天冬〔清热。〕栝蒌 贝母 花粉 茯苓〔开痰。〕
桔梗〔入肺开发。〕 射干〔散结气，疗瘀血，消积痰，破 结。〕
此降气清热，开痰散结之剂。
仲淳方 治伏梁。〔属心经气血两虚，以致邪留不去。〕
茯神 远志 丹参 当归〔安神养血。〕 郁金 乳香
没药 赤芍 玄胡 五灵脂〔活血行滞。〕 菖蒲〔辛能四达，以散结邪。〕
此安神养血，活血行滞之剂。
仲淳方 治痞气。〔属脾经气虚，及气壅所致。〕
人参 白芍〔健脾。〕 木香 砂仁 橘红 香附〔理气。〕 神曲 麦芽〔消滞。〕
此健脾理气散滞之剂。
仲淳方 治奔豚。〔属肾火虚衰，阴凝结气，上攻所致。〕
附子 肉桂〔温肾。〕 沉香 砂仁 牛膝〔散结。〕 人参 山药 茯苓 泽泻〔扶脾
制邪。〕
此温肾散结，扶脾制邪之剂。
大安丸〔见肿胀，〕治食积。
本方合鸡金散，甚者加三棱、莪术。
礞石滚痰丸〔见痰。〕治痰积。
聚宝丹〔见胃脘痛。〕治气积。〔经言内伤于忧怒，则气逆不行，凝血成积，此性情乖戾者多
有之。〕
大黄 虫丸〔见虚劳。〕治血积。
万应丸〔见胃脘痛。〕治虫积。
此五方皆能去积，但宜审明何物致积，即发直入之兵以讨之。如虚弱者加人参以赞助之。
异功散 归脾汤 六君子汤〔俱见中风。〕
或再加香、砂、沉、蔻之属。热加黄连。〔平治会萃云∶治块当降火，消食，消痰是也。〕寒加
肉桂。〔辛以散之，热以行之也。〕
资生丸〔见虚劳。〕
此四方养正则邪自除，非大积大聚，或病久虚羸，不可
用克削之剂者，择而加减用之。
按立斋云∶若形气虚弱者，先调补脾胃为主，而佐以消积之品，若形气壮实者，当先疏导为主，而
佐以补脾之药；应补应攻，自在医者望、闻、问、切之明辨，则投剂不致有虚虚实实之误矣。又考刘氏
云∶ 瘕痞块，若久远无碍，不妨任其自然，切不可委外科治疗，及过服消导药。每见急于攻块，反增他
病，如痞散成鼓之类，遂至不救。
脉沉有力为积，坚强者生，虚弱者死。
A person suffered from jaundice, with an abdomen distended like a drum. Various medicines were ineffective. Xu Zhongke used Zhu Gao Fa Jian (Pig Fat and Hair Decoction), and the patient was cured after one dose.
Accumulation and mass disorders are classified by organ systems in the *Nan Jing* (Classic of Difficult Issues). It states: Accumulation refers to the stagnation of Qi, originating from the Zang organs. Its onset has a fixed location, and pain does not move away from that area.
The accumulation of the Liver is called Fei Qi (Fatty Gas), located under the left hypochondrium, shaped like an inverted cup. "Fei" implies abundance or prosperity. The accumulation of the Lung is called Xi Ben (Gasp Accumulation), located under the right hypochondrium, shaped like an inverted cup. "Xi Ben" refers to breath that sometimes stops and sometimes rushes. The accumulation of the Heart is called Fu Liang (Hidden Beam), starting above the umbilicus, as large as an arm, extending up to the epigastrium. "Fu Liang" means lying hidden and immobile, like a wooden beam. The accumulation of the Spleen is called Pi Qi (Stagnant Qi), located in the epigastrium, covering an area as large as a plate. "Pi Qi" refers to blockage and obstruction. The accumulation of the Kidney is called Ben Tun (Rushing Pig), originating in the lower abdomen, rising to the heart, resembling a piglet, moving up and down without fixed timing. "Ben Tun" resembles a river dolphin running on water, never staying still. Mass refers to the gathering of Qi, formed by the Fu organs. Its onset has no fixed root, and pain has no fixed location. The term "Zheng" refers to palpable masses. These are accumulations forming lumps that cannot be moved, also known as Pi Kuai (Stagnant Lumps). All are caused by Qi stagnation, Phlegm condensation, Food retention, and Dead Blood. The disease lies between the intestines and stomach, affecting men, women, and children alike. Jia (False Masses) take shape from borrowed substances; their lumps can shift and move, such as Xue Die Jia (Blood Turtle Mass) or Shi Jia (Stone Mass), formed by blood stasis, mostly in the lower abdomen, causing hidden pain, occurring exclusively in women. Examining the formation of Accumulation, it arises when Righteous Qi (Zheng Qi) is insufficient, allowing Pathogenic Qi (Xie Qi) to occupy the space. Like petty officials in court due to the decline of virtuous scholars, Righteous Qi and Pathogenic Qi are mutually exclusive. If major accumulations are not hunted and driven out, Pathogenic Qi will flourish daily while Righteous Qi declines, leading to demise. One must ascertain which meridian is diseased and what substance forms the accumulation. If caused by food, use Da An Wan (Great Peace Pill) combined with Ji Jin San (Chicken Gizzard Membrane Powder), adding San Leng (Rhizoma Sparganii) and E Zhu (Rhizoma Curcumae). If caused by Phlegm, use Meng Shi Wan (Calamine Pill). If caused by Qi, use Ju Bao Dan (Treasure Gathering Pellet). If caused by blood stasis, use Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill). If caused by parasites, use Bing Huang Wan Ying Wan (Areca Nut and Rhubarb Universal Pill). Once the diagnosis is clear, send troops directly into the pathogen to suppress it, ensuring recovery. The Classics state: For major accumulations, attack may be used, but stop when more than half of the pathogen is eliminated. Thus, after removing half the accumulation, tonifying Qi and strengthening the Spleen should become the main treatment. When the Spleen functions well, remaining residual accumulations will dissipate without direct attack. Shicai stated: The meaning of accumulation is day-by-day and month-by-month accumulation, not formed overnight. Therefore, its removal should be gradual; being too urgent damages Righteous Qi. Hence, treatment should be divided into early, middle, and late stages. In early disease, pathogen is shallow and Righteous Qi strong, so it can withstand attack. In the middle stage, pathogen deepens and Righteous Qi weakens, so both attack and tonification are tolerated. In the late stage, disease is chronic, pathogen invades, and Righteous Qi is depleted, so only tonification is tolerated. I formulated Gong Ji Wan (Accumulation-Attacking Pill). The drugs are slightly harsh; usage must be regulated. Tonify the Middle Jiao for several days, then attack. Regardless of how much accumulation is removed, tonify again. Wait for the spirit to strengthen, then attack again. Repeated attack and tonification until balance is achieved is a method that works perfectly every time. Jiegu stated: Robust people do not have accumulations; only weak people do. Therefore, nourish Righteous Qi, and Pathogenic Qi will remove itself. It is like having a room full of virtuous scholars; petty officials will have no place to stand. This theory treats mild accumulations well, and students should study it carefully.
Yin Yang Gong Ji Wan [Revised]. Treats accumulations and masses; effective for all types.
San Leng (Rhizoma Sparganii), Peng Zhen (Rhizoma Curcumae) [Essential herbs for eliminating accumulations and masses]. Xiang Fu (Rhizoma Cyperi) [Processed with lac residue to transform Qi and break stasis; lac residue combined with Bin Lang (Areca Seed) also kills parasites. Soak in rice wine and vinegar for three days each, stir-fry with lac residue and discard residue. These two alone are miraculous for treating stagnant lumps]. Zhi Shi (Fructus Aurantii Immaturus), Bin Lang (Areca Seed), Qing Pi (Pericarpium Citri Reticulatae Viride) [Accumulations always result from Qi knotting; when Qi flows, accumulation dissipates. Thus, Zhi Shi, Bin Lang, and Qing Pi are used to break Qi and scatter stagnation]. Tao Ren (Semen Persicae), Zhe Chong (Ground Beetle), Hai Shi (Lapis Aquamarina), Wa Leng Zi (Concha Arcae) [Accumulations rely on blood stasis and Phlegm. Thus, Tao Ren, Zhe Chong, Hai Shi, and Wa Leng Zi are used to resolve stasis and transform blood]. Huang Lian (Rhizoma Coptidis) [Pathogen gathering generates heat; Huang Lian's bitter cold clears it]. Ba Dou Shuang (Seed of Crotonis Tinctured) [Scours away all tangible objects. Pungent, hot, highly toxic, and most fierce. Do not use lightly. Dosage: 1 qian, others 5 qian each]. Ren Shen (Radix Ginseng) [Fear that using only draining drugs causes Spleen deficiency and poor transport, making accumulation harder to remove. Thus, Ren Shen is used to assist Spleen Yuan]. Zao Jiao (Fructus Gleditsiae Sinensis) [5 qian]. [Unblocks congestion and guides stagnation. Extremely sharp and potent, opening all closures and breaking all hardness.] Decoct juice.
Mix with honey to make pills, size of paulownia seeds. Take 2 pills per dose, three times a day. If accumulation persists, add one pill per dose gradually until accumulation resolves, then pause. Take Spleen-tonifying medicine for several days, then resume as above. Stop when more than half of the accumulation is gone. For treating stagnant lumps, pills and powders are suitable; externally apply Hua Pi Gao (Stagnant Lump Dissolving Plaster).
This is a formula for promoting Qi flow, clearing Phlegm, breaking stasis, reducing accumulation, and purging downward. The Classics state: Hardness must be reduced. Therefore, for major accumulations, if harsh drugs are not used early to remove them, there is a risk of nurturing a tiger that harms oneself. Wu Hegao noted: Dongyuan's formulas for Five Accumulations generally gather attacking and warming drugs into pills. Five Zang organ Qi accumulations are outside the intestines and stomach, yet using harsh drugs like Ba Dou Shuang and Gan Qi (Dried Lac) attacks inside the intestines and stomach. This is incorrect treatment. I firmly believe this is not Dongyuan's formula; even if he made it, it contradicts his *Treatise on the Spleen and Stomach*. Discerning minds will judge. Also, Zhongchun's discussion on treating Five Accumulations avoids breaking Qi and purging, aligning with Hegao's view. His methods are attached below for clinical reference.
Zhongchun Formula for Fei Qi [Belongs to dual deficiency of Qi and Blood, Liver Qi disharmony, where rebellious Qi and blood stasis combine].
Dang Gui (Radix Angelicae Sinensis), Fu Xiong (Radix Chuanxiong) [Harmonize Liver]. Yu Jin (Radix Curcumae Longae), Xiang Fu (Rhizoma Cyperi), Chen Xiang (Lignum Aquilariae Resinatum), Sha Ren (Fructus Amomi Rotundus) [Regulate Qi]. Hong Hua (Flos Carthami), Chi Shao (Radix Paeoniae Rubra), Yan Hu Suo (Rhizoma Corydalis), Shan Zha (Fructus Crataegi), Rou Gui (Cortex Cinnamomi) [Invigorate blood and resolve stasis].
This is a formula for harmonizing Liver, regulating Qi, and invigorating blood resolving stasis.
Zhongchun Formula for Xi Ben [Belongs to Lung Qi deficiency with Phlegm-Heat congestion].
Sang Bai Pi (Cortex Mori Radicis), Zi Wan (Herba Asteris Tatarici), Yu Jin (Radix Curcumae Longae) [Descend Qi]. Tian Dong (Radix Asparagi) [Clear Heat]. Gua Lou (Fructus Trichosanthis), Bei Mu (Bulbus Fritillariae Cirrhosae), Hua Fen (Radix Trichosanthis), Fu Ling (Sclerotium Poriae) [Open Phlegm].
Jie Geng (Radix Platycconi) [Enters Lung to open]. She Gan (Rhizoma Belamcandae) [Scatters nodulated Qi, treats blood stasis, eliminates phlegmic accumulation, breaks knots].
This is a formula for descending Qi, clearing Heat, opening Phlegm, and scattering nodules.
Zhongchun Formula for Fu Liang [Belongs to dual deficiency of Heart Qi and Blood, causing pathogen to linger].
Fu Shen (Sclerotium Poriae cum Radice), Yuan Zhi (Radix Polygalae Tenuifoliae), Dan Shen (Radix Salviae Miltiorrhizae), Dang Gui (Radix Angelicae Sinensis) [Calm Spirit and nourish Blood]. Yu Jin (Radix Curcumae Longae), Ru Xiang (Resina Acaciae Cathartae), Mo Yao (Resina Myrrhae), Chi Shao (Radix Paeoniae Rubra), Yan Hu Suo (Rhizoma Corydalis), Wu Ling Zhi (Faeces Trogopterori) [Invigorate blood and promote circulation]. Chang Pu (Rhizoma Acori Tatarinowii) [Pungent nature reaches all directions to scatter nodulated pathogen].
This is a formula for calming Spirit, nourishing Blood, invigorating blood, and promoting circulation.
Zhongchun Formula for Pi Qi [Belongs to Spleen Qi deficiency and Qi congestion].
Ren Shen (Radix Ginseng), Bai Shao (Radix Paeoniae Alba) [Strengthen Spleen]. Mu Xiang (Radix Aucklandiae), Sha Ren (Fructus Amomi Rotundus), Ju Hong (Exocarpium Citri Reticulatae), Xiang Fu (Rhizoma Cyperi) [Regulate Qi]. Shen Qu (Massa Medicata Fermentata), Mai Ya (Fructus Hordei Germinatus) [Resolve stagnation].
This is a formula for strengthening Spleen, regulating Qi, and resolving stagnation.
Zhongchun Formula for Ben Tun [Belongs to Kidney Fire deficiency, Yin condensing Qi, attacking upward].
Fu Zi (Radix Aconiti Lateralis Preparata), Rou Gui (Cortex Cinnamomi) [Warm Kidney]. Chen Xiang (Lignum Aquilariae Resinatum), Sha Ren (Fructus Amomi Rotundus), Niu Xi (Radix Achyranthis Bidentatae) [Scatter nodules]. Ren Shen (Radix Ginseng), Shan Yao (Rhizoma Dioscoreae), Fu Ling (Sclerotium Poriae), Ze Xie (Rhizoma Alismatis) [Support Spleen and control pathogen].
This is a formula for warming Kidney, scattering nodules, supporting Spleen, and controlling pathogen.
Da An Wan [See Swelling chapter], treats Food Retention.
Combine this formula with Ji Jin San; for severe cases, add San Leng and E Zhu.
Meng Shi Gun Tan Wan [See Phlegm chapter], treats Phlegm Accumulation.
Ju Bao Dan [See Epigastric Pain chapter], treats Qi Accumulation. [Classics say internal injury from sorrow and anger causes Qi rebellion and stagnation, coagulating blood into accumulation; those with erratic temperaments often suffer this.]
Da Huang Zhe Chong Wan [See Consumption chapter], treats Blood Accumulation.
Wan Ying Wan [See Epigastric Pain chapter], treats Parasite Accumulation.
These five formulas can all remove accumulation, but one must ascertain the cause of accumulation and send direct troops to suppress it. Add Ren Shen to support if the patient is weak.
Yi Gong San, Gui Pi Tang, Liu Jun Zi Tang [All see Stroke chapter]
Or add Xiang Fu, Sha Ren, Chen Xiang, Kou Ren (Fructus Cardamomi). For Heat, add Huang Lian. [Pingzhi Huihui says: Treating masses requires reducing Fire, digesting food, and resolving Phlegm]. For Cold, add Rou Gui. [Pungency disperses, Heat promotes movement].
Zi Sheng Wan [See Consumption chapter]
These four formulas nourish Righteous Qi so Pathogenic Qi removes itself. They are chosen and modified for cases that are not major accumulations, or for chronic diseases with emaciation, where draining drugs are contraindicated.
Li Zhai stated: For those with weak constitution, first regulate and tonify Spleen and Stomach, assisting with accumulation-resolving drugs. For those with robust constitution, first focus on dredging, assisting with Spleen-tonifying drugs. Whether to tonify or attack depends on the physician's clear differentiation through Observation, Auscultation/Olfaction, Inquiry, and Palpation, avoiding errors of reinforcing excess or depleting deficiency. Liu also stated: For long-standing Jia masses that cause no hindrance, allow nature to take its course. Do not entrust to surgery or overuse digestive drugs. Often, rushing to attack masses creates other diseases, such as Pi turning into Gu (Drum Distension), leading to untreatable conditions.
Pulse sinking and forceful indicates Accumulation. Strong pulse suggests survival; weak pulse suggests death.