先贤说五积六聚甚明，惟治法独隐。其言五积曰∶肝之积，名曰肥气，在左胁下
，如覆杯，有头足，久不已，令人发咳逆 疟，连岁不已者是也；心之积，名曰伏梁，起于
脐，大如臂，上至心下，久不已，令人病烦心；脾之积，名曰痞气，在胃脘，大如复盘，久不
已，令人四肢不收，发黄胆，饮食不为肌肤，俗呼为食劳黄也；肺之积，名曰息贲，在右胁
下，大如覆杯，久不愈，令人洒淅寒热，喘嗽，发肺痈；肾之积，名曰贲豚，发于少腹，
上至心下，若豚状，或上或下无时，久不已，令人喘逆，骨痿，少气。此五积之状，前贤言
之，岂不分明。遍访医门，人人能道。
及问治法，不过三棱、广术、干漆、 砂、陈皮、礞
石、巴豆之类。复有不明标本者，又从而补之。岂有病积之人，大邪不出，而可以补之乎。至于世之磨积
取积之药，余初学医时，亦曾用之，知其不效，遂为改辙。因考《内经》，骤然大悟。《内
经》曰∶木郁则达之，火郁发之，土郁夺之，金郁泄之，水郁折之。王太仆曰∶达谓吐，发谓汗，夺谓
下，泄为利小便，折谓折其冲逆。
此五者，五运为司天所制，故立此五法，与五积若不相似
然。盖五积者，因受胜己之邪，而传于己之所胜，适当旺时，拒而不受，复还于胜己者，胜
己者不肯受，因留结为积，故肝之积。得于季夏戊巳日；心之积，得于秋庚辛日；脾之积，
得于冬壬癸日；肺之积，得于春甲乙日；肾之积，得于夏丙丁日。此皆抑郁不伸而受其邪也
。岂待司天克运，然后为之郁哉？且积之成也，或因暴怒、喜、悲、思、恐之气，或伤酸、
苦、甘、辛、咸之
食，或停温、凉、热、寒之饮，或受风、暑、燥、寒、火、湿之邪。其初甚微，可呼吸按导
方寸大而去之。不
幸而遇庸医，强补而留之，留而不去，遂成五积。
夫肥气者，不独气有余也，其中亦有血矣
。盖肝藏血故也。伏梁者，火之郁也，以热药散之则益甚，以火灸之，则弥聚。况伏梁证有
二，名同而实异，不可不详焉。其一伏梁，上下左右皆有根，在肠胃之外，有大脓血，此伏梁
义同肚痈；其一伏梁，身体髀股 皆肿，环脐而痛，是
为风根，不可动，动则为水溺涩之病。此二者，《内经》虽言不可动，止谓不可大下，非谓
全不可下，恐病去而有害痞气者。举世皆言寒则痞，《内经》以为湿则痞。虽因饮冷而得，其阳
气为湿所蓄，以热攻之则不散，以寒攻之，则湿去而寒退矣。
息贲者，喘息愤而上行也。此旧说
也。余以谓贲者，贲门也。手太阴之筋，结胸里而贯贲，入贲，下抵季胁，其病支转筋，痛
甚则成息贲。手心主结于臂，其病胸痛息贲。又云∶肺下则居贲迫，肝善胁下痛，肝高则上支
贲，两胁 为息贲。若是言之，是积气于贲而不散。
此《灵枢》说五脏处，言此贲自是多，
故予发之。贲豚者，贲与奔同。《铜人》言或因读书得之，未必皆然也。肾主骨，此积最深难疗，大
忌吐涌，以其在下，止宜下之。故予尝以独圣散吐肥气，
疑
之以降火之药调之。又尝治痞气，万举万全，先以瓜蒂散，吐其酸苦黄胶腥腐之物三、二升
，次以导水、禹功，下二、三十行，末以五苓淡剂等药调之。又尝治息贲，用瓜蒂散，不计
四时，置之燠室中，更以火一炉，以助其汗，吐、汗二法齐行。此病不可逗留，久则伤人。又尝治贲豚
，以导水通经，三日一下之，一月十下，前后百行，次用治血化气磨积之药调之。此积虽不伤人
，亦与人偕老。
若六聚之物，在腑属阳而无形，亦无定法。故此而行之，何难之有？或言余
之治积太峻。予曰∶不然。积之在脏，如陈茎之在江河。且积之在脏，中
间多着脂膜曲折之处，区臼之中；陈
茎之在江河，不在中流，多在汀湾洄薄之地。遇江河之
溢，一漂而去。积之在脏，理亦如之。故予先以丸药驱逐新受之食，使无梗塞。其碎着之积，已离而未下。
次以散药满胃而下。横江之筏，一壅而尽。设未尽者，以药调之。惟坚积不可用此法，宜以
渐除。《内经》曰∶坚者削之。今人言块癖是也。因述九积图，附于篇末，以俟来
哲，知余用心独苦久矣，而世无知者。食积，酸心腹满，大黄、牵牛之类，甚者礞石、巴豆。
酒积，目黄口干，葛根、麦 之类，甚者甘遂、牵牛。
气积，噫气痞塞，木香、槟榔之类，甚者枳壳、牵牛。
涎积，咽如拽锯，朱砂、腻粉之类，甚者瓜蒂、甘遂。
痰积，涕唾稠粘，半夏、南星之类，甚者瓜蒂、藜芦。
癖积，两胁刺痛，三棱、广术之类，甚者甘遂、蝎梢。
水积，足胫胀满，郁李、商陆之类，甚者甘遂、芫花。
血积，打扑肭瘀，产后不月，桃仁、地榆之类，甚者虻虫、水蛭。
肉积， 瘤核疠，腻粉、白丁香，砭刺出血，甚者
九积皆以气为主，各据所属之状而对治之。今人总此诸药，并为一方，曰∶可治诸积，大谬
也！吾无此病，焉用此药？吾无彼病，焉用彼药？十羊九牧，何所适从？非徒无益，而又害之。
先贤对五积六聚的描述非常明确，唯独治疗方法隐晦不明。他们所说的五积是：肝的积，名叫肥气，位于左胁下，形状像倒扣的杯子，有头有脚，如果长期不愈，会导致人咳嗽、呃逆、疟疾，多年不止；心的积，名叫伏梁，起于肚脐，大小如手臂，向上延伸至心窝下方，长期不愈，使人患心烦病；脾的积，名叫痞气，位于胃脘部，大小像圆形的盘子，长期不愈，使人四肢无力无法收持，面色发黄得黄疸病，饮食不能转化为肌肉营养，俗称“食劳黄”；肺的积，名叫息贲，位于右胁下，大小像倒扣的杯子，长期不愈，使人感到忽冷忽热，气喘咳嗽，引发肺痈；肾的积，名叫贲豚，发于小腹，向上延伸至心窝下方，状如小猪奔跑，有时上行有时下行没有定时，长期不愈，使人气喘逆乱，骨骼痿弱，气息短少。这五种积的症状，前代贤人已说得很清楚，难道还不分明吗？遍访医界人士，人人都能讲述。
但当问及治疗方法时，不过是用三棱、莪术（广术）、干漆、硇砂、陈皮、礞石、巴豆之类的药物。更有那些不明白标本关系的人，反而加以补益。哪里有邪气盛实的积证病人，大邪未去，就可以用补法呢？至于世间那些磨积、消积的药物，我初学医时也曾使用过，知道它们无效，于是改变了治法。因此考证《黄帝内经》，突然恍然大悟。《黄帝内经》说：木郁结则通达它，火郁结则发散它，土郁结则攻夺它，金郁结则泄利它，水郁结则折抑它。王冰（王太仆）注解说：达指吐法，发指汗法，夺指下法，泄指通利小便，折指折抑其冲逆之势。
这五种方法，是因为五运之气被司天之气所制约，所以设立这五种治法，这与五积虽然看似不相似，但道理相通。所谓五积，是因为受了克制自己的邪气，传到自己所能克制的脏腑，正当该脏腑旺盛之时，拒绝接受，又返还给克制自己的脏腑，而克制自己的脏腑不肯接受，因而停留凝结成为积块，所以肝之积，得于长夏戊己日；心之积，得于秋季庚辛日；脾之积，得于冬季壬癸日；肺之积，得于春季甲乙日；肾之积，得于夏季丙丁日。这些都是因抑郁不得伸展而受邪所致。哪里一定要等到司天之气克制岁运，才称为郁呢？况且积的形成，或因暴怒、喜、悲、思、恐等情志之气，或损伤酸、苦、甘、辛、咸等食物，或停饮温、凉、热、寒等饮品，或感受风、暑、燥、寒、火、湿等外邪。起初症状很轻微，可以通过呼吸导引等方法在方寸之地去除它。不幸遇到庸医，强行进补而留住了病邪，留滞不去，遂形成五积。
肥气这个病，不仅仅是气有余，其中也有血瘀。因为肝主藏血的缘故。伏梁这个病，是火的郁结，如果用热药散之则会更加严重，用火灸之，则积聚更甚。况且伏梁证有两种，名称相同而实质不同，不可不详察。其一伏梁，上下左右都有根，位于肠胃之外，有大脓血，这种伏梁的含义同于肠痈；其二伏梁，身体大腿和股部都肿胀，环绕肚脐疼痛，这是风根，不可触动，一动则会导致小便涩痛的疾病。这两种情况，《黄帝内经》虽然说不可触动，只是指不可峻下，并非完全不可下，恐怕的是病去之后会伤害正气导致痞气。举世的人都认为寒则致痞，《黄帝内经》认为是湿则致痞。虽然是因为喝冷饮而得的，但其阳气被湿气蓄积，用热药攻之则不散，用寒药攻之，则湿去而寒退。
息贲这个病，是指喘息愤懑而上行。这是旧时的说法。我认为贲指的是贲门。手太阴肺经的筋，结于胸内并贯穿贲门，进入贲门，向下抵至季胁，其病症为支转筋，痛甚则形成息贲。手厥阴心包经结于臂，其病症为胸痛息贲。又说：肺位置低下则居于贲门迫近处，肝容易胁下痛，肝位置高则向上支撑贲门，两胁胀满即为息贲。如果是这样说来，就是气积聚在贲门而不消散。
这是《灵枢》论述五脏位置时，提到这个“贲”字很多，所以我将其阐发出来。贲豚这个病，贲与奔同义。《铜人腧穴针灸图经》说有的因读书过度而得，未必都是如此。肾主骨，这个积最深难治，最忌用吐涌之法，因为它病位在下，只宜用下法。所以我曾用独圣散催吐肥气，并用降火的药物来调理。又曾治疗痞气，万无一失，先用瓜蒂散，吐出酸苦黄胶腥腐之物二三升，再用导水丸、禹功散，泻下二三十次，最后用五苓散等淡渗利湿的药物来调理。又曾治疗息贲，用瓜蒂散，不分四季，置于温暖室中，再燃一炉火以助出汗，吐法和汗法同时进行。这个病不可拖延，久了就会伤人。又曾治疗贲豚，用导水丸、通经散，每三天泻下一次，一个月泻十次，前后共泻百余次，然后用治血、化气、磨积的药物来调理。这个积虽然不致命，但也与人共存到老。
至于六聚之物，在腑属阳而无定形，也没有固定的治法。所以按此理施行，有什么难的？有人说我治疗积证过于峻猛。我说：不是这样的。积在脏，就像枯枝败叶在江河中。而且积在脏，中间多附着在脂膜曲折之处，如同臼槽之中；枯枝败叶在江河中，不在中流，多在岸边回水浅薄之地。遇到江河泛滥，一漂而去。积在脏，道理也是如此。所以我先用丸药驱逐新受的食积，使其无梗塞。那些碎裂附着的积，已经松动但未排出。再用散药充满胃部以下行。就像横江的筏子，一旦壅塞便全部冲走。如果有未尽者，再用药物调理。只有坚硬的积块不可用此法，宜逐渐消除。《黄帝内经》说：坚硬的要削伐。现在人说的块癖就是这样。因此叙述九积图，附在篇末，以等待后来的智者，知道我的用心良苦已久，而世上无人理解。
食积，表现为心中泛酸、腹部胀满，用大黄、牵牛子之类，严重的用礞石、巴豆。
酒积，表现为目黄、口干，用葛根、麦芽之类，严重的用甘遂、牵牛子。
气积，表现为嗳气、痞塞，用木香、槟榔之类，严重的用枳壳、牵牛子。
涎积，表现为咽喉如有拽锯声，用朱砂、腻粉之类，严重的用瓜蒂、甘遂。
痰积，表现为鼻涕唾沫稠粘，用半夏、南星之类，严重的用瓜蒂、藜芦。
癖积，表现为两胁刺痛，用三棱、莪术（广术）之类，严重的用甘遂、蝎梢。
水积，表现为足胫胀满，用郁李仁、商陆之类，严重的用甘遂、芫花。
血积，表现为跌打损伤瘀血、产后闭经，用桃仁、地榆之类，严重的用虻虫、水蛭。
肉积，表现为瘤核疠疮，用腻粉、白丁香，砭刺出血，严重的用……（原文此处似有缺漏，依语境推测为更强力的破积药，但根据指令不增添内容，故略去具体药名或保留原文空缺意涵，此处原文为“甚者”，后接下一段开头，实为排版错误，通常此类列表应有对应药物，但依据原文仅提取可见部分）。
以上九种积都以气为主，各自根据其所属的症状进行对治。现在的人将这些药合并为一一方，说：可以治疗各种积证，这是极大的谬误！我没有这个病，为什么要用这个药？我没有那个病，为什么要用那个药？十个羊九个牧人，该听谁的？不仅无益，反而有害。
The sages described the Five Accumulations (Wu Ji) and Six Gatherings (Liu Ju) very clearly, but their treatment methods were uniquely obscure. They stated regarding the Five Accumulations: The accumulation of the Liver is named Feiqi (Fatty Qi), located under the left hypochondrium, shaped like an inverted cup, with a head and feet; if not cured for a long time, it causes coughing, regurgitation, malaria, persisting for years; the accumulation of the Heart is named Fuliang (Hidden Beam), arising from the umbilicus, as large as an arm, extending upward to below the heart, and if not cured for a long time, causes irritability and heart distress; the accumulation of the Spleen is named Piqi (Stagnant Qi), located in the epigastrium, as large as a round plate, and if not cured for a long time, causes weakness of the four limbs, jaundice, and failure of diet to nourish muscles, commonly known as "Food-Labor Jaundice"; the accumulation of the Lung is named Xiben (Panting Burden), located under the right hypochondrium, as large as an inverted cup, and if not cured for a long time, causes chills and fever, panting and coughing, leading to lung abscess; the accumulation of the Kidney is named Bentun (Rushing Pig), originating in the lower abdomen, extending upward to below the heart, resembling a pig running, moving up or down without fixed timing, and if not cured for a long time, causes panting and counterflow, bone萎 (bone atrophy/weakness), and shortness of breath. These are the manifestations of the Five Accumulations, which the former sages explained clearly; is this not distinct? Visiting all medical circles, everyone can recite them.
However, when asked about treatment methods, they merely used herbs such as Sanleng (Rhizoma Sparganii), Guangzhu (Rhizoma Curcumae), Ganqi (Dry Resin of Toxicodendron vernicifluum), Naosha (Nuo Sha), Chenpi (Pericarpium Citri Reticulatae), Mengshi (Calamine), and Badou (Seed of Croton tiglium). Furthermore, those who did not understand the root and branch relationships would add tonifying treatments. How can one use tonification on a patient with excess pathogenic accumulations where major pathogens have not been expelled? As for the world's medicines for grinding and removing accumulations, I also used them when I first studied medicine, knowing they were ineffective, so I changed my approach. Thus, I consulted the *Neijing* (Yellow Emperor's Inner Canon) and suddenly had a great realization. The *Neijing* states: For Wood stagnation, promote its flow; for Fire stagnation, disperse it; for Earth stagnation, purge it; for Metal stagnation, drain it; for Water stagnation, restrain it. Wang Bing (Grand Master Wang) commented: "Promote" refers to emesis, "Disperse" refers to sweating, "Purge" refers to purgation, "Drain" refers to promoting urination, and "Restrain" refers to checking its counterflow and rebellion.
These five methods were established because the Five Movements (Wu Yun) were constrained by the Si Tian (Annual Climate) Qi, thus establishing these five methods. Although they seem dissimilar to the Five Accumulations, the principle is connected. The Five Accumulations occur because one receives the pathogen that overcomes oneself, transmits it to what one overcomes, and when that organ is at its peak, it refuses to accept it, returning it to the overcoming organ, which also refuses it, causing it to stay and knot into an accumulation. Therefore, the Liver accumulation is acquired on Wu and Ji days of late summer; the Heart accumulation on Geng and Xin days of autumn; the Spleen accumulation on Ren and Gui days of winter; the Lung accumulation on Jia and Yi days of spring; the Kidney accumulation on Bing and Ding days of summer. All these result from depression and lack of extension leading to pathogen reception. Why must one wait for the Si Tian to overcome the Yun (Movement) before calling it stagnation? Moreover, the formation of accumulations may be due to sudden anger, joy, sorrow, thought, or fear; injury from sour, bitter, sweet, pungent, or salty foods; retention of warm, cool, hot, or cold drinks; or exposure to wind, summer-heat, dryness, cold, fire, or dampness. Initially, the symptoms are slight and can be removed through breathing exercises and guidance within a square inch area. Unfortunately, encountering mediocre physicians who forcibly tonify and retain the pathogen, leaving it unresolved, leads to the formation of the Five Accumulations.
Feiqi involves not only excess Qi but also blood stasis, because the Liver stores blood. Fuliang is a stagnation of Fire; using hot herbs to scatter it will worsen it, and moxibustion will increase the aggregation. Furthermore, there are two types of Fuliang with the same name but different realities, which must be distinguished carefully. One type of Fuliang has roots above, below, left, and right, located outside the intestines and stomach, containing large amounts of pus and blood; this Fuliang is similar to intestinal abscess. The other type presents with swelling of the body, thighs, and legs, and pain around the umbilicus, known as Wind Root; it should not be disturbed, as disturbing it leads to difficult urination. Although the *Neijing* says these should not be disturbed, it means not to use severe purgation, not that purgation is completely forbidden, fearing that after the disease leaves, it might harm the body leading to Pi (stagnation). The world generally believes cold causes Pi, but the *Neijing* holds that dampness causes Pi. Although caused by drinking cold liquids, the Yang Qi is retained by dampness; attacking with heat will not disperse it, but attacking with cold will remove the dampness and retreat the cold.
Xiben refers to panting rising angrily. This is the old theory. I believe Ben refers to the cardiac orifice (Benmen). The sinews of the Hand-Taiyin Lung Meridian knot inside the chest and penetrate the Benmen, entering it and descending to the costal margin; their disease involves twisting spasms, and severe pain forms Xiben. The sinews of the Hand-Jueyin Pericardium Meridian knot in the arm; their disease involves chest pain and Xiben. It is also said: When the Lung is low, it resides near the Benmen; the Liver easily causes hypochondriac pain; when the Liver is high, it supports the Benmen upward, causing distension in both hypochondria known as Xiben. If spoken of this way, it is Qi accumulating in the Benmen and not dispersing.
This explanation of "Ben" appears frequently in the *Lingshu* (Spiritual Pivot) discussions on the locations of the Five Zang organs, so I elucidated it. Bentun means Ben is synonymous with Ben (running). The *Tongren* (Bronze Man) states it may be caused by excessive reading, but this is not always the case. The Kidney governs bones; this accumulation is deep and difficult to treat. Emesis is strictly contraindicated because the pathology is in the lower part; only purgation is suitable. Thus, I once used Dusheng San to induce vomiting for Feiqi, and regulated it with fire-descending herbs. I once treated Piqi with complete success: first using Genti San to vomit out three or two sheng of sour, bitter, yellow, gelatinous, fishy, and foul substances; then using Daoshui Wan and Yugong San to purge twenty or thirty times; finally regulating with Wuling San and other mild diuretic herbs. I once treated Xiben using Genti San, regardless of the season, placing the patient in a warm room, adding a stove to assist sweating, performing emesis and sweating simultaneously. This disease must not be delayed, as prolongation harms the person. I once treated Bentun using Daoshui Wan and Tongjing San, purging every three days, ten times in a month, totaling over a hundred purgations, then regulating with herbs for treating blood, transforming Qi, and grinding accumulations. Although this accumulation does not kill, it accompanies the person until old age.
As for the Six Gatherings, being in the Fu organs, they belong to Yang and have no fixed form, nor fixed methods. Therefore, applying this logic, what difficulty is there? Some say my treatment of accumulations is too harsh. I say: Not so. An accumulation in the Zang organs is like dead branches in a river. Accumulations in the Zang often adhere to fatty membranes and tortuous places, like areas in a mortar; dead branches in rivers are not in the midstream but mostly in shallow backwaters. When the river floods, they are washed away. The principle for accumulations in the Zang is similar. Thus, I first use pill medicines to drive out newly ingested food stagnation to prevent blockage. The fragmented adhering accumulations have loosened but not passed. Then I use powder medicines to fill the stomach and induce downward movement. Like a raft across a river, once blocked, it is all swept away. If any remains, I regulate with medicine. Only hard accumulations cannot use this method; they should be gradually eliminated. The *Neijing* states: Harden things must be pared down. This is what people call Kuaipi (masses and癖). Therefore, I describe the Nine Accumulations diagram, attached at the end of the chapter, awaiting future wise men to know that my efforts have been arduous for a long time, yet unknown to the world.
Food Stagnation: Sour taste in the heart, abdominal fullness. Use Dahuang (Radix et Rhizoma Rhei), Qianniu (Semen Pharbitidis); severe cases use Mengshi (Calamine), Badou (Seed of Croton tiglium).
Wine Stagnation: Yellow eyes, dry mouth. Use Gegen (Radix Puerariae Lobatae), Maiya (Fructus Hordei Germinatus); severe cases use Gansui (Radix Euphorbiae Kansui), Qianniu.
Qi Stagnation: Belching, obstruction. Use Muxiang (Radix Aucklandiae), Binglang (Semen Arecae); severe cases use Zhike (Fructus Aurantii), Qianniu.
Saliva Stagnation: Throat feeling like being sawed. Use Zhusha (Cinnabar), Nifen (Mercurius Sublimatus Corrosivus); severe cases use Gadi (Fructus Gardeniae Jasminoidis - note: usually Genti San uses Gadi fruit, here likely referring to the herb itself or preparation), Gansui.
Phlegm Stagnation: Thick and sticky sputum. Use Banxia (Rhizoma Pinelliae), Nanxing (Rhizoma Arisaematis Cum Bile); severe cases use Gadi, Lilü (Radix Veratri).
Pi Stagnation: Piercing pain in both hypochondria. Use Sanleng (Rhizoma Sparganii), Guangzhu (Rhizoma Curcumae); severe cases use Gansui, Xieshao (Cauda Scorpii).
Water Stagnation: Swelling and fullness of calves. Use Yuziren (Semen Pruni Armeniacae), Shanglu (Radix Phytolaccae); severe cases use Gansui, Yuanhua (Flos Genkwa).
Blood Stagnation: Bruising from falls, postpartum amenorrhea. Taoren (Semen Persicae), Diyu (Radix Sanguisorbae); severe cases use Mengchong (Hirudo), Shuizhi (Whitmania pigra).
Meat Stagnation: Tumors and nodules. Use Nifen, Baidingxiang (Avis Excrementum); scarification to bleed; severe cases use... [Text implies strong agents, but original text cuts off or merges].
All nine accumulations are primarily governed by Qi, and each is treated according to its specific manifestations. Today's physicians mix all these herbs into one prescription, claiming it treats all accumulations; this is a great error! If I do not have this disease, why use this medicine? If I do not have that disease, why use that medicine? With ten sheep and nine shepherds, whom should one follow? It is not only useless but harmful.