分） 青皮（二分） 归尾（三分） 泽泻（五分） 茯苓 神曲 广术 昆布（各二分） 橘皮（去白，三分） 熟
地（二分） 人参（二分） 附子（三分） 甘草（炙） 巴豆霜 葛根（各二分）
上为末，蒸饼为丸，桐子大。初服二丸，一日加一丸，二日加二丸，渐加至大便微溏，再从二丸加服，淡
甘草汤送下。
肺之积，息奔丸 治左右胁下，覆大如杯，久不已，令人洒淅寒热，喘咳嗽，发肺痈。
浓朴（姜制，八钱） 黄连（炒，一两三钱） 干姜（炮，一钱半） 桂枝（去皮，一钱） 巴豆霜（四分） 白
茯（一钱半） 川乌（炮，去皮脐，一钱） 川椒（去汗，钱半） 人参（二钱） 桔梗（一钱） 紫菀（去苗，一钱
半） 青皮（五分） 陈皮 京三棱（炮） 天门冬 白豆蔻（各一钱）
上除茯苓、巴豆霜旋入外，余药为末，炼蜜丸，如桐子大。每服二丸，一日加一丸，二日加二丸，加至大
便微溏，再从二丸加服，煎淡生姜汤送下，食远，周而复始，积减大半，勿服。秋冬加浓朴五钱，通前一两
三钱，黄连减七钱，用六钱。
加减息奔丸 仲夏合此，其积为病，寒热喘咳，气上奔，脉涩，失精亡血，气滞则短气，血凝泣则寒热相参，
气分寒，血分热。治法宜益元气，泄阴火，破气削其坚也。
川乌（一钱） 干姜（一钱） 人参（二钱） 陈皮（八钱） 黄连（一两三钱） 紫菀（一钱半） 桂枝（二钱）
巴豆霜（四分） 浓朴（一钱半） 青皮（七分） 川椒（炒，去汗，钱半） 红花（少许） 茯苓（一钱半） 桔梗
（一钱） 白豆蔻（一钱） 京三棱（一钱半） 天门冬（去心，一钱半）
上件为末，汤泡蒸饼为丸，如桐子大。初服二丸，一日加一丸，二日加二丸，加至大便微溏为度，再从二
丸加服，煎生姜汤送下，食前。忌酒湿面辛辣生冷之物。
肾之积，奔豚丸 发于小腹，上至心下，若豚状，或上下无时，久不已，令人喘逆，骨痿少气，及治男子内经
七疝，女子瘕聚带下。
苦楝（酒煮，三钱） 黄连（炒，五钱） 白茯（二钱） 泽泻（二钱） 川乌（炮，五分） 菖蒲（二钱） 玄
胡索（一钱半） 全蝎（一钱） 附子（一钱） 巴豆霜（四分） 浓朴（姜制，七钱） 独活（一钱） 丁香（五分）
肉桂（三分）
上除巴豆霜、茯苓另为末旋入外，余药为细末，炼蜜丸，如梧子大。初服二丸，一日加一丸，二日加二丸，
渐加至大便微溏，再从二丸加服，淡盐汤送下，食远，周而复始，病减大半，勿服。秋冬，加浓朴半两，通
前用一两二钱。如积势坚大，先服前药不减，于一料中加存性牡蛎三钱，疝带勿加。如大积大聚，消其大半
乃止，药过剂则死。如积满腹或半腹，先治其所起是何积，当先服本脏积药，诸疾自愈，是治其本也，余积
皆然。如服药不觉热，加黄连。如服药人气短，加浓朴。如服药人闷乱，减桂。
〔洁〕肝之积伏梁，温白丸加柴胡、川芎治之。心之积肥气，温白丸加菖蒲、黄连、桃仁治之。脾之积痞
气，温白丸加吴茱萸、干姜治之。肺之积息奔，温白丸加人参、紫菀治之。肾之积奔豚，温白丸加丁香、茯苓、
远志治之。（温白丸方见前。）
〔丹〕贾福六舅子十余岁，左胁有块，能饮食。
青皮（细切，醋炒） 三棱 柴胡（三分） 桂枝 川芎 防风（各二钱） 白术（二钱半） 木通（一钱半）
海藻（一钱） 甘草（半钱）
上分七帖，煎取半盏，下保和丸十五粒，忌一切。
〔无〕肥气丸 治肝之积气在胁下，如覆杯，其脉弦而细。
青皮（炒） 当归 苍术（各一两半） 蛇含石（ 醋盛，三分） 蓬术 三棱 铁孕粉（各二两，与三棱、蓬
术同入醋煮一伏时）
上为末，醋煮米糊丸，绿豆大。每服四十丸，当归酒下。
〔海〕治伏梁在心下，结聚不散。用桃奴三两为末，空心温酒调下，桃奴是桃实着树不落者，正
月采树上干桃子是也。（出《圣惠方》）
〔《本》〕治肺喘久不愈为息贲，五灵丸。
五灵脂（二两半） 木香（半两） 马兜铃（去壳，炒，一两） 葶苈
上为细末，枣肉为丸，如桐子大。每服二十丸，生姜汤下，日三。
肺之积名曰息奔，在右胁下，大如杯，令人洒淅寒热，喘嗽发肺痈，枣膏丸。
葶苈 陈皮 桔梗（各等分）
上下二味为末，入葶苈研匀，煮肥枣肉和丸，如桐子大。每服五七丸，饮下。予尝患停饮，久渍肺经，食
已必嚏喘，觉肺系大急，服此良验。
定喘急肺积，葶苈丸。
苦葶苈（一两一分） 当归 肉桂 白蒺藜 鳖甲 川乌头 干姜 吴茱萸 大杏仁 茯苓
人参（各五钱） 槟榔（一两）
上为细末，煮枣肉和杵丸，如桐子大。每服二三十丸，姜枣汤下，日四服，不拘时候。
师曰∶奔豚病从小腹起，上冲咽喉，发作欲死，复还止，皆从惊恐得之。故越人曰∶惊者神上越也。
（仲景谓奔豚从惊恐得之，盖奔豚病上冲咽喉者，随神上越也。）奔豚气上冲，胸腹痛，往来寒热，
奔豚汤主之。
甘草 芎 当归（各二两） 半夏（四两） 黄芩（二两） 生姜（三两） 芍药（二两） 干葛（一两三钱）
甘李根（白皮，一升，焙干）
上九味，以水二斗，煮取五升，温服一升，日三夜一服。
茯苓 桂枝 甘草 大枣汤 治脐下悸，欲作奔豚。
桂枝加桂汤 治奔豚气从小腹上至心。（以上二方并见伤寒。）
〔无〕散聚汤 治有块痛无常处，展转动移。
半夏 槟榔 当归（各一两） 陈皮 杏仁（去皮尖） 桂心（各二两） 茯苓 甘草（炙） 附子（炮，去皮脐）
川芎 枳壳（麸炒） 吴茱萸（汤洗） 浓朴（姜制。各一两）
上锉散，每四钱，水一盏半，煎七分，去渣，食前服。
运气 积块皆从湿土。经云∶土太过曰敦阜。敦阜之化，其动濡积并蓄是也。
〔丹〕琥珀膏贴块。（方见痈疽门下。）
又，贴块三圣膏。用锻石十两，细筛过，炒红，急用好醋熬成膏，入大黄末一两，官桂末半两，搅匀，
以瓦器封贮，纸摊贴患处，火烘热贴。大黄须锦纹者。
〔世〕又贴块。
白鸽粪（二两） 白芷（三两） 硫黄 白蔹 木鳖子肉（各一两）
上为末，用面水调和，敷患处。
〔丹〕贴积聚块。
大黄 朴硝（各一两）
各为末，大蒜捣膏和匀贴之。
〔《外》〕集验熨症。吴茱萸三升，碎之，以酒和煮，热布裹熨症上，冷更炒，更番用之。症移走，逐熨
之，候消乃止。
〔《灵》〕黄帝曰∶人之善病肠中积聚者，何以候之？少俞答曰∶皮肤薄而不泽，肉不坚而淖泽，如此肠
胃恶，恶则邪气留止，积聚乃伤，脾胃之间。寒温不次，邪气稍至，蓄积留止，大聚乃起。（五变篇）
〔《脉》〕胃中有癖，食冷物者，痛不能食，食热则能推而外之，内者不外，心腹积也。（全文见诸脉诊病杂文。）
〔《难》〕人病有沉滞久积聚，可切脉而知之耶？然，诊病在右胁有积气，得肺脉结，脉结甚则积甚，结
微则气微，诊不得肺脉，而右胁有积气者，何也？然，肺脉虽不见，右手脉当沉伏。其外痼疾，同法耶？将异
也？然，结者，脉来去时一止无常数，名曰结也。伏者脉行筋下也。浮者脉在肉上行也，左右表里，法皆如此。
假令脉结伏者，内无积聚。脉浮结者，外无痼疾。有积聚脉不结伏，有痼疾脉不浮结，为脉不应病，病不应脉，
是为死病也。（十八难）
〔仲〕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，积在脐傍。
上关上，积在心下。微下关，积在少腹。尺中，积在气冲。脉出在左，积在左。脉出在右，积在右。脉两出，
积在中央。各以其部处之。
〔《素》〕太阴涩则病积，心腹时满。厥阴涩则病少腹积气。少阴涩则病积溲血。阳明涩则病积时善惊。
太阳涩则病积时善巅疾。少阳涩则病积时筋急目痛。（四时刺逆从论）寸口脉沉而横，曰胁下有积，腹中有横积痛。
（平人气象论 即动脉之状，厥厥如豆，不升降也。）
〔《脉》〕左手脉横症在左，右手脉横症在右，脉头大者在上，头小者在下。脉迟而滑，中寒有 结，偏
得洪实而滑为积，弦紧亦为积，为寒痹，为疝痛。内有积，不见脉，难治。见一脉相应，为易治。诸不相应，
为不治。脉弦，腹中急痛，腰背痛相引，腹中有寒疝瘕。脉弦紧而微细者，症也。夫寒痹 瘕积聚之脉，皆弦
紧。苦在心下，即寸弦紧；在胃脘，即关弦紧；在脐下，即尺弦紧。脉弦小者，寒痹。
心肺有积痹，其脉皆喘数。经云∶赤脉之至也喘而坚。诊曰有积气在中，名曰心痹。白脉之至也喘而浮，
上虚下实，有积气在胸中，喘而虚，名曰肺痹是也。
肝有积，其脉弦长面青。经云∶青脉之至也长而左右弹，有积气在心下支 ，名曰肝痹是也。
脾肾有积痹，其脉皆大。经云∶黄脉之至也大而虚，有积气在腹中。黑脉之至也上坚而大，有积气在小腹
与阴，名曰肾痹。王注云∶上谓寸口是也。（全文见上脏腑条。）
〔《脉》〕诊人心腹积聚，其脉坚强急者生，虚弱者死。脉弦而伏者，腹中有症，不可转也，必死不治。
〔《灵》〕黄帝问曰∶夫百病之始生也，皆生于风雨寒暑，清湿喜怒。喜怒不节则伤脏，风雨则伤上，清
湿则伤下。三部之气，所伤异类，愿闻其会？岐伯曰∶三部之气各不同，或起于阴，或起于阳，请言其方。喜
怒不节则伤脏，脏伤则病起于阴也。清湿袭虚，则病起于下。风雨袭虚，则病起于上。是谓三部，至于其淫 ，
不可胜数。（百病始生篇 下同）是故虚邪之中人也，始于皮肤，皮肤缓则腠理开，开则邪从毛发入，入则抵深，深则
毛发立，毛发立则淅然，故皮肤痛。留而不去，则传舍于络脉，在络之时，痛于肌肉，其痛之时息，大经乃代。
留而不去，传舍于经，在经之时，洒淅善惊。留而不去，传舍于输，在输之时，六经不通四肢，则肢节痛，腰
脊乃强，留而不去，传舍于伏冲之脉，在伏冲之时，体重身痛。留而不去，传舍于肠胃，在肠胃之时，贲响腹
胀，多寒则肠鸣飧泄，食不化，多热则溏出麋。留而不去，传舍于肠胃之外，募原之间。
以上数端，皆邪气袭虚留而不解去，以次相传，未曾留着，无有定所。若留着而有定所，则不能传矣。
所谓留着者，当如下文法云。
留着于脉，稽留而不去，息而成积，或着孙脉，或着络脉，或着经脉，或着输脉，或着于伏冲之脉，或着
于膂筋，或着于肠胃之募原，上连于缓筋，邪气淫 ，不可胜论。其着孙络之脉而成积者，其积往来上下，臂
手孙络之居也，浮而缓不能拘积而止之，故往来移行肠胃之间，水凑渗注灌，濯濯有音，有寒则 满雷引，
故时切痛。其着于阳明之经，则挟脐而居，饱食则益大，饥则益小。其着于缓筋也，似阳明之积，饱食则痛，
饥则安。其着于肠胃之募原也，痛而外连于缓筋，饱食则安，饥则痛。其着于伏冲之脉者，揣之应手而动，发
手则热气下于两股，如汤沃之状。其着于膂筋，在肠后者，饥则积见，饱则积不见，按之不得。其着于输之脉
者，闭塞不通，津液不下，孔窍干壅，此邪气之在外入内，从上下也。（此谓风雨袭阴之虚，病起于上而积生也。）
黄帝曰∶积之始生，至其已成，奈何？岐伯曰∶积之始生，得寒乃生，厥乃成积也。黄帝曰∶其成积奈何？
岐伯曰∶厥气生足 ，足 生胫寒，胫寒则血脉凝涩，血脉凝涩则寒气上入于肠胃，入于肠胃则 胀， 胀则肠
外之汁沫迫聚不得散，日以成积。卒然多食饮则肠满，起居不节，用力过度，则络脉伤。阳络伤则血外溢，血
外溢则衄血。阴络伤则血内溢，血内溢则后血。肠胃之络伤则血溢于肠外，肠外有寒，汁沫与血相搏，则并合
凝聚不得散，而积成矣。卒然外中于寒，若内伤于忧怒，则气上逆，气上逆则六输不通，温气不行，凝血蕴里
而不散，津液涩渗，着而不去，而积皆成矣。（此谓清湿袭阴之虚，病起于下而成积也。）
黄帝曰∶其生于阴者，奈何？岐伯曰∶忧思伤心，重寒伤肺，忿怒伤肝，醉以入房，汗出当风伤脾，用力
过度若入房汗出浴则伤肾，（此谓喜怒伤脏病起于阴也，风雨袭阴之虚则病起于上而生积，清湿袭阴之虚则病
起于下而成积，此内外三部皆受病，其积方成矣。）此内外三部之所生病者也。黄帝曰∶善。治之奈何？岐伯
对曰∶察其所痛，以知其应，有余不足，当补则补，当泻则泻，毋逆天时，是谓至治。
手少阴筋病内急，心承伏梁，下为肘纲，治在燔针劫刺，以知为数，以痛为输，其成伏梁唾血脓者，死不治。
手太阴筋病甚成息奔，胁急吐血。手心主筋病，胸痛息奔，皆治在燔针劫刺，以知为数，以痛为输。（经文并
见经筋。）
〔桑〕 瘕积块，先于块上针之，甚者又于块首一针，块尾一针，立应。针讫，灸之。又，三里灸之。
（接上文）青皮（二分），当归尾（三分），泽泻（五分），茯苓，神曲，莪术，昆布（各二分），橘皮（去白，三分），熟地黄（二分），人参（二分），附子（三分），炙甘草，巴豆霜，葛根（各二分）。
以上药物研为细末，用蒸饼和药粉制成丸剂，大小如梧桐子。初次服用二丸，第一天加服一丸，第二天加服两丸，逐渐增加剂量直到大便轻微稀溏为止；之后又从二丸开始重新加服，用淡甘草汤送服。
肺的积块病，称为息奔丸。主治左右胁下肿块，覆盖面积大如杯口，久治不愈，使人出现忽冷忽热的症状，气喘咳嗽，甚至引发肺痈。
厚朴（姜制，八钱），黄连（炒，一两三钱），干姜（炮，一钱半），桂枝（去皮，一钱），巴豆霜（四分），白茯苓（一钱半），川乌（炮，去皮脐，一钱），川椒（去汗，一钱半），人参（二钱），桔梗（一钱），紫菀（去苗，一钱半），青皮（五分），陈皮，京三棱（炮），天门冬，白豆蔻（各一钱）。
除茯苓和巴豆霜外，其余药物研为细末，用炼蜜制成丸剂，大小如梧桐子。每次服用二丸，第一天加服一丸，第二天加服两丸，逐渐增加剂量直到大便轻微稀溏为止；之后又从二丸开始重新加服，煎淡生姜汤送服，饭后服用，循环往复。待积块减少大半后，停止服药。秋冬季节，加厚朴五钱，总计一两三钱，黄连减七钱，只用六钱。
加减息奔丸：仲夏时节合用此方。其积块病症表现为寒热、气喘咳嗽、气向上冲逆，脉象涩滞，遗精或失血，气滞则短气，血凝滞则寒热交错，气分偏寒，血分偏热。治疗方法应当补益元气，清泄阴火，破气以消除坚结。
川乌（一钱），干姜（一钱），人参（二钱），陈皮（八钱），黄连（一两三钱），紫菀（一钱半），桂枝（二钱），巴豆霜（四分），厚朴（一钱半），青皮（七分），川椒（炒，去汗，一钱半），红花（少许），茯苓（一钱半），桔梗（一钱），白豆蔻（一钱），京三棱（一钱半），天门冬（去心，一钱半）。
以上药物研为细末，用汤浸泡蒸饼和药粉制成丸剂，大小如梧桐子。初次服用二丸，第一天加服一丸，第二天加服两丸，逐渐增加剂量直到大便轻微稀溏为止；之后又从二丸开始重新加服，煎生姜汤送服，饭前服用。忌食酒、湿面、辛辣及生冷食物。
肾的积块病，称为奔豚丸。病发于小腹，向上冲到心下，形状像小猪奔跑，有时上下移动无定时，久治不愈，使人气喘逆乱，骨骼痿弱，气短无力，以及治疗男子内经所述的七种疝气，女子瘕聚带下病。
苦楝（酒煮，三钱），黄连（炒，五钱），白茯苓（二钱），泽泻（二钱），川乌（炮，五分），石菖蒲（二钱），玄胡索（一钱半），全蝎（一钱），附子（一钱），巴豆霜（四分），厚朴（姜制，七钱），独活（一钱），丁香（五分），肉桂（三分）。
除巴豆霜和茯苓另研为细末备用外，其余药物研为细末，用炼蜜制成丸剂，大小如梧桐子。初次服用二丸，第一天加服一丸，第二天加服两丸，逐渐增加剂量直到大便轻微稀溏为止；之后又从二丸开始重新加服，用淡盐汤送服，饭后服用，循环往复。待病情减轻大半后，停止服药。秋冬季节，加厚朴半两，总计用一两二钱。如果积块势头坚硬巨大，先服用前面的药物效果不减，在一料药中加入煅存性的牡蛎三钱，治疗疝气和带下病时不加牡蛎。如果是大的积聚，消减到一半以上就停止，药物过量会导致死亡。如果积块充满腹部或半腹，先治疗其起始的积块是什么，应当先服用本脏的积块药物，其他疾病自然痊愈，这是治本的方法，其余积块也是如此。如果服药后不觉发热，加黄连。如果服药后人感到气短，加厚朴。如果服药后人感到烦闷混乱，减少桂枝用量。
〔李东垣〕肝的积块伏梁，用温白丸加柴胡、川芎治疗。心的积块肥气，用温白丸加石菖蒲、黄连、桃仁治疗。脾的积块痞气，用温白丸加吴茱萸、干姜治疗。肺的积块息奔，用温白丸加人参、紫菀治疗。肾的积块奔豚，用温白丸加丁香、茯苓、远志治疗。（温白丸方见前文。）
〔朱丹溪〕贾福的舅子十多岁，左胁下有肿块，但饮食正常。
青皮（细切，醋炒），三棱，柴胡（三分），桂枝，川芎，防风（各二钱），白术（二钱半），木通（一钱半），海藻（一钱），甘草（半钱）。
以上药物分成七帖，煎取半盏药液，送服保和丸十五粒，忌食一切刺激性食物。
〔滑寿〕肥气丸：治疗肝的积块，气在胁下，如倒扣的杯子，脉象弦而细。
青皮（炒），当归，苍术（各一两半），蛇含石（醋淬，三分），蓬莪术，三棱，铁孕粉（各二两，与三棱、蓬莪术同入醋中煮一个时辰）。
以上药物研为细末，用醋煮米糊制成丸剂，大小如绿豆。每次服用四十丸，用当归酒送服。
〔海藏〕治疗伏梁在心下，结聚不散。用桃奴三两研为细末，空腹时用温酒调服。桃奴是指挂在树上不落的桃子果实，正月采集树上干枯的桃子即是。 （出自《圣惠方》）
〔《本草纲目》〕治疗肺喘久治不愈成为息贲，用五灵丸。
五灵脂（二两半），木香（半两），马兜铃（去壳，炒，一两），葶苈子。
以上药物研为细末，用枣肉制成丸剂，大小如梧桐子。每次服用二十丸，用生姜汤送服，每日三次。
肺的积块名为息奔，位于右胁下，大如杯口，使人忽冷忽热，气喘咳嗽并发肺痈，用枣膏丸。
葶苈子，陈皮，桔梗（各等分）。
将上述两味药研为细末，加入葶苈子研匀，煮肥枣肉和药粉制成丸剂，大小如梧桐子。每次服用五至七丸，用水送服。我曾患停饮之症，久渍肺经，进食后必打喷嚏气喘，感觉肺系非常紧急，服用此方疗效很好。
定喘急肺积，用葶苈丸。
苦葶苈（一两一分），当归，肉桂，白蒺藜，鳖甲，川乌头，干姜，吴茱萸，大杏仁，茯苓，人参（各五钱），槟榔（一两）。
以上药物研为细末，煮枣肉和药粉捣杵制成丸剂，大小如梧桐子。每次服用二三十丸，用姜枣汤送服，每日四次，不拘时候。
老师说：奔豚病从小腹发起，向上冲至咽喉，发作时痛苦欲死，随后又停止回归，这都是因为惊恐所致。所以越人（扁鹊）说：惊则神气上越。（张仲景认为奔豚因惊恐得之，大概是因为奔豚病气上冲咽喉，随着神气上越的缘故。）奔豚气上冲，胸腹痛，往来寒热，用奔豚汤主治。
甘草，川芎，当归（各二两），半夏（四两），黄芩（二两），生姜（三两），芍药（二两），干葛（一两三钱），甘李根白皮（一升，焙干）。
以上九味药，用水二斗，煮取五升，温服一升，每日三次，夜间一次。
茯苓桂枝甘草大枣汤：治疗脐下悸动，想要发作奔豚。
桂枝加桂汤：治疗奔豚气从小腹上冲至心下。（以上两个方剂均见于《伤寒论》。）
〔滑寿〕散聚汤：治疗有肿块疼痛且位置不固定，辗转移动。
半夏，槟榔，当归（各一两），陈皮，杏仁（去皮尖），桂心（各二两），茯苓，炙甘草，附子（炮，去皮脐），川芎，枳壳（麸炒），吴茱萸（汤洗），厚朴（姜制，各一两）。
以上药物切碎成散剂，每次四钱，水一盏半，煎至七分，去渣，饭前服用。
运气学说：积块皆源于湿土。经文说：土太过称为敦阜。敦阜的变化，其动表现为濡湿积聚并蓄。
〔朱丹溪〕琥珀膏贴敷肿块。（方剂见痈疽门下。）
另外，贴敷肿块的三圣膏。用锻石十两，细筛过，炒红，立即用好醋熬成膏，加入大黄末一两，官桂末半两，搅匀，用瓦器密封储存，摊在纸上贴敷患处，用火烘热后贴敷。大黄须选用锦纹者。
〔世传〕又一种贴敷肿块的方法。
白鸽粪（二两），白芷（三两），硫黄，白蔹，木鳖子肉（各一两）。
以上药物研为细末，用面水调和，敷于患处。
〔朱丹溪〕贴敷积聚块。
大黄，朴硝（各一两）。
分别研为细末，用大蒜捣烂成膏调和均匀后贴敷。
〔《外科正宗》〕集验熨法。吴茱萸三升，捣碎，用酒调和煮热，用热布包裹熨烫肿块处，冷了再炒热，交替使用。肿块移动，就跟随熨烫，等到消散才停止。
〔《灵枢》〕黄帝问：人容易患肠中积聚病的，如何诊察？少俞回答说：皮肤薄而不润泽，肌肉不坚实而淖泽，这样肠胃功能恶劣，邪气停留止息，积聚便损伤脾胃之间。寒温失调，邪气稍至，蓄积停留，大聚便形成。（《五变篇》）
〔《脉诀》〕胃中有癖块，吃冷物的人，疼痛不能进食，吃热的则能推动邪气向外排出，邪气在内不外排，就是心腹积块。（全文见诸脉诊病杂文。）
〔《难经》〕人有沉滞已久的积聚病，可以通过切脉知道吗？回答是：诊察病在右胁有积气，得到肺脉结象，脉结甚则积甚，结微则气微，诊察不到肺脉，而右胁有积气的，为什么呢？回答是：肺脉虽然不见，右手脉应当沉伏。这种外部的顽固疾病，方法相同吗？还是不同呢？回答是：结脉，脉搏来去时偶尔停顿，没有固定规律，叫做结脉。伏脉，脉搏行于筋下。浮脉，脉搏行于肉上，左右表里，法则都是如此。假如脉象结伏，内部没有积聚。脉象浮结，外部没有顽疾。有积聚而脉不结伏，有顽疾而脉不浮结，这是脉不应病，病不应脉，是死证。（《十八难》）
〔张仲景〕各种积块的大法，脉象细而按之及骨的，乃是积块。寸口脉，积在胸中。微出寸口，积在喉中。关上脉，积在脐旁。上关上脉，积在心下。微下关脉，积在少腹。尺中脉，积在气冲。脉象出现在左手，积在左边。脉象出现在右手，积在右边。脉象两边都出现，积在中央。各自根据脉位判断积块所在。
〔《素问》〕太阴脉涩则病积，心腹时常胀满。厥阴脉涩则病少腹积气。少阴脉涩则病积尿血。阳明脉涩则病积时常惊恐。太阳脉涩则病积时常头顶疾病。少阳脉涩则病积时常筋急目痛。（《四时刺逆从论》）寸口脉沉而横，曰胁下有积，腹中有横积痛。（《平人气象论》 即动脉之状，厥厥如豆，不升降也。）
〔《脉诀》〕左手脉横症在左，右手脉横症在右，脉头大者在上，头小者在下。脉迟而滑，中寒有结，偏得洪实而滑为积，弦紧亦为积，为寒痹，为疝痛。内有积，不见相应脉象，难治。见到一脉相应，为易治。诸脉不相应，为不治。脉弦，腹中急痛，腰背痛相互牵引，腹中有寒疝瘕。脉弦紧而微细者，症也。夫寒痹瘕积聚之脉，皆弦紧。苦在心下，即寸脉弦紧；在胃脘，即关脉弦紧；在脐下，即尺脉弦紧。脉弦小者，寒痹。
心肺有积痹，其脉皆喘数。经文说：赤脉之至也喘而坚。诊曰有积气在中，名曰心痹。白脉之至也喘而浮，上虚下实，有积气在胸中，喘而虚，名曰肺痹是也。
肝有积，其脉弦长面青。经文说：青脉之至也长而左右弹，有积气在心下支 ，名曰肝痹是也。
脾肾有积痹，其脉皆大。经文说：黄脉之至也大而虚，有积气在腹中。黑脉之至也上坚而大，有积气在小腹与阴，名曰肾痹。王注云：上谓寸口是也。（全文见上脏腑条。）
〔《脉诀》〕诊察人心腹积聚，其脉坚强急者生，虚弱者死。脉弦而伏者，腹中有症，不可转也，必死不治。
〔《灵枢》〕黄帝问：百病之始生也，皆生于风雨寒暑，清湿喜怒。喜怒不节则伤脏，风雨则伤上，清湿则伤下。三部之气，所伤异类，愿闻其会？岐伯曰：三部之气各不同，或起于阴，或起于阳，请言其方。喜怒不节则伤脏，脏伤则病起于阴也。清湿袭虚，则病起于下。风雨袭虚，则病起于上。是谓三部，至于其淫 ，不可胜数。（《百病始生篇》 下同）是故虚邪之中人也，始于皮肤，皮肤缓则腠理开，开则邪从毛发入，入则抵深，深则毛发立，毛发立则淅然，故皮肤痛。留而不去，则传舍于络脉，在络之时，痛于肌肉，其痛之时息，大经乃代。留而不去，传舍于经，在经之时，洒淅善惊。留而不去，传舍于输，在输之时，六经不通四肢，则肢节痛，腰脊乃强，留而不去，传舍于伏冲之脉，在伏冲之时，体重身痛。留而不去，传舍于肠胃，在肠胃之时，贲响腹胀，多寒则肠鸣飧泄，食不化，多热则溏出麋。留而不去，传舍于肠胃之外，募原之间。
以上数端，皆邪气袭虚留而不解去，以次相传，未曾留着，无有定所。若留着而有定所，则不能传矣。所谓留着者，当如下文法云。
留着于脉，稽留而不去，息而成积，或着孙脉，或着络脉，或着经脉，或着输脉，或着于伏冲之脉，或着于膂筋，或着于肠胃之募原，上连于缓筋，邪气淫 ，不可胜论。其着孙络之脉而成积者，其积往来上下，臂手孙络之居也，浮而缓不能拘积而止之，故往来移行肠胃之间，水凑渗注灌，濯濯有音，有寒则 满雷引，故时切痛。其着于阳明之经，则挟脐而居，饱食则益大，饥则益小。其着于缓筋也，似阳明之积，饱食则痛，饥则安。其着于肠胃之募原也，痛而外连于缓筋，饱食则安，饥则痛。其着于伏冲之脉者，揣之应手而动，发手则热气下于两股，如汤沃之状。其着于膂筋，在肠后者，饥则积见，饱则积不见，按之不得。其着于输之脉者，闭塞不通，津液不下，孔窍干壅，此邪气之在外入内，从上下也。（此谓风雨袭阴之虚，病起于上而积生也。）
黄帝曰：积之始生，至其已成，奈何？岐伯曰：积之始生，得寒乃生，厥乃成积也。黄帝曰：其成积奈何？岐伯曰：厥气生足 ，足 生胫寒，胫寒则血脉凝涩，血脉凝涩则寒气上入于肠胃，入于肠胃则 胀， 胀则肠外之汁沫迫聚不得散，日以成积。卒然多食饮则肠满，起居不节，用力过度，则络脉伤。阳络伤则血外溢，血外溢则衄血。阴络伤则血内溢，血内溢则后血。肠胃之络伤则血溢于肠外，肠外有寒，汁沫与血相搏，则并合凝聚不得散，而积成矣。卒然外中于寒，若内伤于忧怒，则气上逆，气上逆则六输不通，温气不行，凝血蕴里而不散，津液涩渗，着而不去，而积皆成矣。（此谓清湿袭阴之虚，病起于下而成积也。）
黄帝曰：其生于阴者，奈何？岐伯曰：忧思伤心，重寒伤肺，忿怒伤肝，醉以入房，汗出当风伤脾，用力过度若入房汗出浴则伤肾，（此谓喜怒伤脏病起于阴也，风雨袭阴之虚则病起于上而生积，清湿袭阴之虚则病起于下而成积，此内外三部皆受病，其积方成矣。）此内外三部之所生病者也。黄帝曰：善。治之奈何？岐伯对曰：察其所痛，以知其应，有余不足，当补则补，当泻则泻，毋逆天时，是谓至治。
手少阴筋病内急，心承伏梁，下为肘纲，治在燔针劫刺，以知为数，以痛为输，其成伏梁唾血脓者，死不治。手太阴筋病甚成息奔，胁急吐血。手心主筋病，胸痛息奔，皆治在燔针劫刺，以知为数，以痛为输。（经文并见经筋。）
(Qingpi, 2 fen), Guizhi Tang (Cinnamon Twig Decoction) tail (3 fen), Zexie (5 fen), Fuling (Poria), Shenqu (Medicated Leaven), Ezhu (Curcuma zedoaria Rhizome), Kunbu (Laminariae Thallus) (each 2 fen), Jupi (Citri Reticulatae Pericarpium, peeled of white pith, 3 fen), Shudihuang (Rehmanniae Radix Praeparata, 2 fen), Renshen (Ginseng Radix et Rhizoma, 2 fen), Fuzi (Aconiti Lateralis Radix Praeparata, 3 fen), Zhigancao (Prepared Licorice Root), Badoushuang (Barbadensis Seed Frost), Gegen (Puerariae Lobatae Radix) (each 2 fen).
The above herbs are ground into fine powder, mixed with steamed bread dough to form pills the size of Sophora japonica seeds. Initially take two pills; on the first day add one pill, on the second day add two pills, gradually increasing the dose until the stool becomes slightly loose. Then restart from two pills and increase again, taken with a light licorice decoction.
The accumulation in the Lung is called Xiben Wan (Breath-Rush Pill). It treats masses under the hypochondrium on either side, covering an area as large as a cup, which if left untreated for long causes chills and fever, wheezing and coughing, and may develop into Lung Abscess (Fei Yong).
Houpo (Gardeniae Cortex, ginger-processed, 8 qian), Huanglian (Coptidis Rhizoma, stir-fried, 1 liang 3 qian), Ganjiang (Zingiberis Rhizoma, processed, 1.5 qian), Guizhi (Cinnamomi Ramulus, bark removed, 1 qian), Badoushuang (Euphorbiae Seminis Preparatum, 4 fen), Baifu (Poria Cocos, 1.5 qian), Chuanwu (Aconiti Radix, processed, skin and core removed, 1 qian), Chuanjiao (Sichuan Pepper, dried sweat removed, 1.5 qian), Renshen (Ginseng Radix et Rhizoma, 2 qian), Jiegeng (Platycodonis Radix, 1 qian), Ziwan (Asternis Radix, buds removed, 1.5 qian), Qingpi (Citri Reticulatae Pericarpium Viride, 5 fen), Chenpi (Citri Reticulatae Pericarpium), Sanleng (Sparganii Rhizoma, processed), Tiandong (Asparagi Radix), Baidoukou (Cardamomi Fructus Rotundus) (each 1 qian).
Except for Fuling and Badoushuang which are added separately later, the remaining herbs are ground into powder, mixed with refined honey to form pills the size of Sophora japonica seeds. Take two pills initially; on the first day add one pill, on the second day add two pills, gradually increasing until the stool becomes slightly loose. Then restart from two pills and increase again, taken with a light ginger decoction, after meals. Repeat this cycle. Stop taking the medicine when the accumulation has reduced by more than half. In autumn and winter, add Houpo (Magnoliae Officinalis Cortex) 5 qian, totaling 1 liang 3 qian; reduce Huanglian (Coptidis Rhizoma) by 7 qian, using only 6 qian.
Modified Xiben Wan: Use this formula in mid-summer. The accumulation disease presents with chills and fever, wheezing and coughing, qi rushing upward, a choppy pulse, seminal emission or blood loss. Qi stagnation causes shortness of breath; blood stasis causes alternating chills and fever; the qi aspect is cold, while the blood aspect is hot. The treatment method should tonify Yuan Qi (Primal Qi), drain Yin Fire, break Qi stagnation, and reduce hardness.
Chuanwu (Aconiti Radix, 1 qian), Ganjiang (Zingiberis Rhizoma, 1 qian), Renshen (Ginseng Radix et Rhizoma, 2 qian), Chenpi (Citri Reticulatae Pericarpium, 8 qian), Huanglian (Coptidis Rhizoma, 1 liang 3 qian), Ziwan (Asternis Radix, 1.5 qian), Guizhi (Cinnamomi Ramulus, 2 qian), Badoushuang (Euphorbiae Seminis Preparatum, 4 fen), Houpo (Magnoliae Officinalis Cortex, 1.5 qian), Qingpi (Citri Reticulatae Pericarpium Viride, 7 fen), Chuanjiao (Sichuan Pepper, stir-fried, dried sweat removed, 1.5 qian), Honghua (Carthami Flos, a small amount), Fuling (Poria, 1.5 qian), Jiegeng (Platycodonis Radix, 1 qian), Baidoukou (Cardamomi Fructus Rotundus, 1 qian), Sanleng (Sparganii Rhizoma, 1.5 qian), Tiandong (Asparagi Radix, heart removed, 1.5 qian).
The above ingredients are ground into fine powder, mixed with steamed bread dough soaked in water to form pills the size of Sophora japonica seeds. Initially take two pills; on the first day add one pill, on the second day add two pills, gradually increasing until the stool becomes slightly loose. Then restart from two pills and increase again, taken with a ginger decoction, before meals. Avoid alcohol, damp noodles, spicy, and raw/cold foods.
The accumulation in the Kidney is called Bentun Wan (Running Piglet Pill). It originates in the lower abdomen, rises to the epigastrium, resembling a running piglet, moving up and down without fixed timing. If untreated for long, it causes wheezing and counterflow qi, bone萎 (weakness), and shortness of breath. It also treats the seven types of Hernia (Shan) in men described in the Inner Canon, and Giamass (accumulation) and leukorrhea in women.
Koulian (Meliae Cortex, wine-boiled, 3 qian), Huanglian (Coptidis Rhizoma, stir-fried, 5 qian), Baifu (Poria Cocos, 2 qian), Zexie (Alismatis Rhizoma, 2 qian), Chuanwu (Aconiti Radix, processed, 5 fen), Changpu (Acori Tatarinowii Rhizoma, 2 qian), Yanzhusu (Cyperi Rotundi Rhizoma, 1.5 qian), Quanxie (Scorpio, 1 qian), Fuzi (Aconiti Lateralis Radix Praeparata, 1 qian), Badoushuang (Euphorbiae Seminis Preparatum, 4 fen), Houpo (Magnoliae Officinalis Cortex, ginger-processed, 7 qian), Duhuo (Angelicae Pubescentis Radix, 1 qian), Dingxiang (Caryophylli Flos, 5 fen), Rougui (Cinnamomi Cortex, 3 fen).
Except for Badoushuang and Fuling which are ground separately and added later, the remaining herbs are ground into fine powder, mixed with refined honey to form pills the size of Sophora japonica seeds. Initially take two pills; on the first day add one pill, on the second day add two pills, gradually increasing until the stool becomes slightly loose. Then restart from two pills and increase again, taken with light salt water, after meals. Repeat this cycle. Stop taking the medicine when the condition improves by more than half. In autumn and winter, add Houpo (Magnoliae Officinalis Cortex) 0.5 liang, totaling 1 liang 2 qian. If the accumulation is hard and large, and the previous prescription is ineffective, add 3 qian of calcined Oyster Shell (Muli) to one dose; do not add Muli for treating hernia and leukorrhea. For major accumulations, stop when half is reduced; exceeding the dosage can be fatal. If the accumulation fills the whole or half abdomen, first determine the origin of the accumulation and treat with the herb specific to that Zang organ's accumulation; other diseases will resolve spontaneously, addressing the root cause. This applies to other accumulations as well. If no heat sensation occurs after taking the medicine, add Huanglian (Coptidis Rhizoma). If shortness of breath occurs, add Houpo (Magnoliae Officinalis Cortex). If restlessness and confusion occur, reduce the dosage of Guizhi (Cinnamomi Ramulus).
[Li Dongyuan] Liver accumulation Fuliang (Hidden Beam) is treated with Wenbai Wan (Warm White Pill) plus Chaihu (Bupleuri Radix) and Chuanxiong (Ligustici Chuanxiong Rhizoma). Heart accumulation Feiqi (Fat Qi) is treated with Wenbai Wan plus Changpu (Acori Tatarinowii Rhizoma), Huanglian (Coptidis Rhizoma), and Taoren (Persicae Semen). Spleen accumulation Piqi (Stagnant Qi) is treated with Wenbai Wan plus Wuzhuyu (Evodiae Fructus) and Ganjiang (Zingiberis Rhizoma). Lung accumulation Xiben (Breath Rush) is treated with Wenbai Wan plus Renshen (Ginseng Radix et Rhizoma) and Ziwan (Asternis Radix). Kidney accumulation Bentun (Running Piglet) is treated with Wenbai Wan plus Dingxiang (Caryophylli Flos), Fuling (Poria), and Yuanzhi (Polygalae Radix). (Wenbai Wan formula is seen earlier.)
[Zhu Danxi] Jia Fu's nephew, over ten years old, had a mass in the left hypochondrium but could eat normally.
Qingpi (Citri Reticulatae Pericarpium Viride, finely cut, vinegar-stir-fried), Sanleng (Sparganii Rhizoma), Chaihu (Bupleuri Radix, 3 fen), Guizhi (Cinnamomi Ramulus), Chuanxiong (Ligustici Chuanxiong Rhizoma), Fangfeng (Saposhnikoviae Radix) (each 2 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 2.5 qian), Mutong (Akebiae Caulis, 1.5 qian), Haizao (Sargassum Thallus, 1 qian), Gancao (Licorice Root, 0.5 qian).
Divide into seven doses, decoct to obtain half a cup, take with Baohe Wan (Harmonize and Preserve Pill) fifteen pills. Avoid all irritating foods.
[Hua Shou] Feiqi Wan (Fat Qi Pill): Treats liver accumulation where qi is under the hypochondrium, like an inverted cup, with a wiry and thin pulse.
Qingpi (Citri Reticulatae Pericarpium Viride, stir-fried), Danggui (Angelicae Sinensis Radix), Cangzhu (Atractylodis Rhizoma) (each 1.5 liang), Shehanshi (Ophicalcitum, quenched in vinegar, 3 fen), Pengzhu (Curcumae Longae Rhizoma), Sanleng (Sparganii Rhizoma), Tieyunfen (Ferrum Preparatum) (each 2 liang, boiled together with Sanleng and Pengzhu in vinegar for one shichen/2 hours).
Grind into fine powder, mix with rice paste boiled in vinegar to form pills the size of mung beans. Take forty pills each time, washed down with Danggui (Angelicae Sinensis Radix) wine.
[Hai Zang] Treats Fuliang (Hidden Beam) at the epigastrium, knotted and unresolved. Use Tao Nu (Peach Plumule) three liang ground into powder, taken with warm wine on an empty stomach. Tao Nu refers to peaches that remain on the tree and dry up, harvested in the first month. (From *Shenghui Fang*)
[*Ben Cao Gang Mu*] Treats chronic lung wheezing becoming Xiben (Breath Rush) with Wuling Wan (Five Spirit Pill).
Wulingzhi (Trogopterori Faeces, 2.5 liang), Muxiang (Aucklandiae Radix, 0.5 liang), Madouling (Aristolochiae Fructus, shell removed, stir-fried, 1 liang), Tingli (Descurainiae Semen seu Lepidii Semen).
Grind into fine powder, mix with jujube flesh to form pills the size of Sophora japonica seeds. Take twenty pills each time, washed down with ginger water, three times daily.
Lung accumulation named Xiben is located under the right hypochondrium, large as a cup, causing chills and fever, wheezing and coughing leading to Lung Abscess. Use Zaogao Wan (Jujube Paste Pill).
Tingli (Descurainiae Semen seu Lepidii Semen), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix) (equal parts).
Grind the above two ingredients into powder, mix evenly with Tingli, then combine with cooked thick jujube flesh to form pills the size of Sophora japonica seeds. Take five to seven pills each time, washed down with water. I once suffered from retained fluid infiltrating the Lung meridian; sneezing and wheezing always occurred after eating, with a feeling of tightness in the Lung system. Taking this formula yielded excellent results.
To calm wheezing urgency and Lung accumulation, use Tingli Wan (Descurainiae Seed Pill).
Ku Tingli (Descurainiae Semen seu Lepidii Semen, bitter, 1 liang 1 fen), Danggui (Angelicae Sinensis Radix), Rougui (Cinnamomi Cortex), Baijili (Tribuli Fructus), Biejia (Testudinis Carapax et Plastrum), Chuanwutou (Aconiti Radix), Ganjiang (Zingiberis Rhizoma), Wuzhuyu (Evodiae Fructus), Da Xingren (Armeniacae Semen Amarum), Fuling (Poria), Renshen (Ginseng Radix et Rhizoma) (each 5 qian), Binglang (Arecae Semen, 1 liang).
Grind into fine powder, mix with cooked jujube flesh and pound to form pills the size of Sophora japonica seeds. Take twenty to thirty pills each time, washed down with ginger-jujube decoction, four times daily, at any time.
The Master said: Bentun disease (Running Piglet) starts from the lower abdomen, rushes up to the throat, feels like death during attacks, then subsides. All cases arise from fright. Thus, Yue Ren (Bian Que) said: Fright causes the spirit to ascend. (Zhang Zhongjing stated Bentun arises from fright; roughly, the qi rushing up to the throat follows the ascending spirit.) Bentun qi rushing upward, with chest and abdominal pain, alternating chills and fever, is primarily treated with Bentun Tang (Running Piglet Decoction).
Gancao (Licorice Root), Xiong (Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix) (each 2 liang), Banxia (Pinelliae Rhizoma, 4 liang), Huangqin (Scutellariae Radix, 2 liang), Shengjiang (Zingiberis Rhizoma Recens, 3 liang), Shaoyao (Paeoniae Radix Alba, 2 liang), Gan Ge (Puerariae Lobatae Radix, 1 liang 3 qian), Gan Li Gen Bai Pi (Pruni Spinosae Cortex Albus, 1 sheng, baked dry).
Nine ingredients, decoct in two dou of water to yield five sheng. Take one sheng warm, three times daily and once at night.
Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction): Treats palpitations below the navel, indicating impending Bentun.
Guizhi Jia Guizhi Tang (Cinnamon Twig Decoction plus Cinnamon Twig): Treats Bentun qi rushing from the lower abdomen to the epigastrium. (Both formulas are found in *Shanghan Lun*.)
[Hua Shou] Sanju Tang (Disperse Accumulation Decoction): Treats painful masses with shifting locations.
Banxia (Pinelliae Rhizoma), Binglang (Arecae Semen), Danggui (Angelicae Sinensis Radix) (each 1 liang), Chenpi (Citri Reticulatae Pericarpium), Xingren (Armeniacae Semen Amarum, skin and tip removed), Guixin (Cinnamomi Ramulus) (each 2 liang), Fuling (Poria), Zhigancao (Prepared Licorice Root), Fuzi (Aconiti Lateralis Radix Praeparata, processed, skin and core removed), Chuanxiong (Ligustici Chuanxiong Rhizoma), Zhiqiao (Aurantii Fructus, bran-stir-fried), Wuzhuyu (Evodiae Fructus, soup-washed), Houpo (Magnoliae Officinalis Cortex, ginger-processed) (each 1 liang).
Cut into coarse pieces for decoction. Take four qian each time, with one and a half cups of water, decoct to seven-tenths, strain, and take before meals.
Qi Yun (Six Qi and Five Movements): Accumulations all stem from Damp Earth. The Classic states: Excess Earth is called Dunfu (High Mound). The transformation of Dunfu involves dampness, accumulation, and storage.
[Zhu Danxi] Hupo Gao (Amber Plaster) applied to masses. (Formula seen in the Carbuncle and Ulcer section.)
Also, San Sheng Gao (Three Holy Plasters) for applying to masses. Use Shigen (Calcined Iron Ore) ten liang, sifted fine, stir-fried red, immediately boiled with good vinegar into a paste. Add Dahuang (Rhei Radix et Rhizoma) powder one liang, Guigui (Cinnamomi Cortex) powder 0.5 liang, mix well. Seal in a pottery vessel. Spread on paper and apply to the affected area. Heat with fire before application. Dahuang must be of the "brocade pattern" variety.
[Worldly Transmission] Another plaster for masses.
Bai Ge Fen (White Pigeon Droppings, 2 liang), Baizhi (Angelicae Dahuricae Radix, 3 liang), Liuhuang (Sulfur), Bailian (Trichosanthis Radix), Muguezi Rou (Momordicae Semen Endospermum) (each 1 liang).
Grind into powder, mix with flour water, and apply to the affected area.
[Zhu Danxi] Plaster for accumulating masses.
Dahuang (Rhei Radix et Rhizoma), Xiaoning (Natrii Sulfas) (each 1 liang).
Grind separately into powder, mix evenly with garlic paste, and apply.
[*Waike Zhengzong*] Ji Yan Wet Compress. Wuzhuyu (Evodiae Fructus) three sheng, crushed, boiled with wine. Wrap in hot cloth and compress the mass. When cool, reheat and alternate. Follow the moving mass with compression until resolved.
[*Ling Shu*] Yellow Emperor asked: How can one diagnose those prone to intestinal accumulations? Shao Yu answered: Thin skin lacking luster, muscles not firm but soft/spongy indicate poor gastrointestinal function. Evil qi stays and accumulates, damaging the Spleen and Stomach. Irregular cold and warmth allow evil qi to enter, accumulate, and form major masses. (*Wu Bian Pian*)
[*Mai Jue*] Gastric Pi (partial accumulation): Those eating cold food experience pain and inability to eat; eating hot food pushes the pathogen outward. Internal retention without expulsion constitutes Heart-Abdominal Accumulation. (Full text in Pulse Diagnosis Miscellaneous Diseases.)
[*Nan Jing*] Can deep-seated, long-standing accumulations be known by pulse diagnosis? Yes. Diagnosing accumulation of qi in the right hypochondrium, if the Lung pulse is Knotted (Jie), severe knotting indicates severe accumulation, slight knotting indicates slight qi stagnation. If the Lung pulse is not felt but there is qi accumulation in the right hypochondrium, why? Because although the Lung pulse is absent, the Right Hand pulse should be Deep (Fu). Is the method for external stubborn diseases the same? No. A Knotted pulse stops intermittently without regularity. A Deep pulse runs beneath the tendons. A Floating pulse runs above the flesh. The principles apply to left/right and interior/exterior. If the pulse is Knotted and Deep, there is no internal accumulation. If the pulse is Floating and Knotted, there is no external stubborn disease. If there is accumulation but the pulse is not Knotted/Deep, or if there is stubborn disease but the pulse is not Floating/Knotted, the pulse does not match the disease, and the disease does not match the pulse; this is a fatal condition. (*Nan Jing 18*)
[Zhang Zhongjing] General rules for accumulations: A pulse that is thin and adheres to the bone indicates accumulation. At Cun Kou (Inch position), accumulation is in the chest. Slightly beyond Cun Kou, accumulation is in the throat. At Guan (Bar position), accumulation is beside the umbilicus. Above Guan, accumulation is at the epigastrium. Slightly below Guan, accumulation is in the lower abdomen. At Chi (Cubit position), accumulation is at Qichong. If the pulse emerges on the Left, accumulation is on the Left. If on the Right, accumulation is on the Right. If on both sides, accumulation is in the Center. Determine location based on the pulse site.
[*Su Wen*] Taiyin Choppy pulse indicates accumulation with occasional abdominal fullness. Jueyin Choppy pulse indicates lower abdominal qi accumulation. Shaoyin Choppy pulse indicates accumulation with hematuria. Yangming Choppy pulse indicates accumulation with frequent fright. Taiyang Choppy pulse indicates accumulation with frequent head disorders. Shaoyang Chopping pulse indicates accumulation with frequent tendon stiffness and eye pain. (*Si Shi Ci Ni Cong Lun*) Cun Kou pulse Deep and Horizontal indicates hypochondriac accumulation and horizontal abdominal pain. (*Ping Ren Qi Xiang Lun*)
[*Mai Jue*] Left Hand Horizontal pulse indicates syndrome on the Left; Right Hand Horizontal pulse indicates syndrome on the Right. Large pulse head indicates upper location; small pulse head indicates lower location. Slow and Slippery pulse indicates Cold with Knotting. Surprisingly Full, Real, and Slippery indicates accumulation. Wiry and Tight also indicates accumulation, Cold Bi, or Hernia Pain. Internal accumulation without corresponding pulse is difficult to treat. One corresponding pulse makes it easy to treat. Non-corresponding pulses are untreatable. Wiry pulse with acute abdominal pain, radiating backache, indicates Cold Hernia/Giamass in the abdomen. Wiry, Tight, and slightly thin pulse indicates syndrome. Cold Bi and Giamass accumulations all have Wiry-Tight pulses. Pain at the epigastrium corresponds to Wiry-Tight at Cun; pain at the Stomach region corresponds to Wiry-Tight at Guan; pain below the umbilicus corresponds to Wiry-Tight at Chi. Wiry and Small pulse indicates Cold Bi.
Accumulation-Bi in Heart and Lung both present with rapid, panting pulses. The Classic says: Red pulse arriving panting and firm indicates accumulation qi in the middle, named Heart Bi. White pulse arriving panting and floating, Upper Deficient Lower Excess, with accumulation qi in the chest, panting and deficient, is named Lung Bi.
Liver accumulation presents with Wiry-Long pulse and blue complexion. The Classic says: Long Green pulse arriving with lateral vibration indicates accumulation qi supporting below the heart, named Liver Bi.
Spleen and Kidney accumulation-Bi both present with Large pulses. The Classic says: Large and Deficient Yellow pulse indicates accumulation qi in the abdomen. Firm and Large Black pulse arriving upwards indicates accumulation qi in the lower abdomen and genitals, named Kidney Bi. Wang Bing notes: "Upwards" refers to Cun Kou. (Full text in Zang-Fu sections.)
[*Mai Jue*] Diagnosing Heart-Abdominal accumulation: Strong, tense, urgent pulse indicates survival; Weak pulse indicates death. Wiry and Deep pulse indicates abdominal syndrome unable to move, inevitably fatal and untreatable.
[*Ling Shu*] Yellow Emperor asked: The onset of hundred diseases stems from Wind, Rain, Cold, Summer Heat, Clear-Damp, Joy, and Anger. Unregulated Joy/Anger damages Zang organs; Wind/Rain damages the Upper; Clear-Damp damages the Lower. The Three Regions' pathogens damage differently; I wish to hear their convergence. Qibo replied: The Three Regions' pathogens differ, originating from Yin or Yang. Unregulated Joy/Anger damages Zang, so disease originates from Yin. Clear-Damp attacks deficiency, so disease originates from Below. Wind/Rain attacks deficiency, so disease originates from Upper. These are the Three Regions; their excesses are countless. (*Bai Bing Shi Sheng Pian*) Thus, Empty Pathogens entering humans start at the Skin. Loose skin opens pores, allowing evil to enter via hair follicles, penetrating deep. Deep penetration causes hair to stand erect, chilliness, and skin pain. If lingering, it transmits to Collateral Vessels (Luo Mai); pain in muscles, intermittent, then Major Meridians take over. If lingering, it transmits to Meridians; chills and fright occur. If lingering, it transmits to Transport points; Six Meridians block limbs, causing joint pain and stiff waist/spine. If lingering, it transmits to Deep-Chong vessels; heavy body and pain occur. If lingering, it transmits to Intestines/Stomach; rumbling and distension occur. Excess Cold causes borborygmus and undigested stool diarrhea; Excess Heat causes loose, mushy discharge. If lingering, it transmits outside intestines/stomach, between Mou-Yuan (epigastric/mesenteric membranes).
These stages show evil attacking deficiency, lingering without resolving, transmitting sequentially without fixed residence. If it lingers with a fixed residence, transmission stops. Lingering is described below.
Lingering in vessels, staying and forming accumulation, attaching to Sun vessels, Luo vessels, Jing meridians, Shu points, Fu-Chong vessels, Lv-Jin (back muscles), or Mou-Yuan of intestines/stomach, connecting to Huan-Jin. Evil excesses are incalculable. Accumulation in Sun-Luo vessels moves up and down; because Sun-Luo in arms/hands are superficial and loose, they cannot confine the accumulation, so it migrates between intestines/stomach, with fluid seeping and gurgling sounds. Cold causes fullness, thunder-like noises, and sharp pain. Attaching to Yangming Meridian, it resides beside the umbilicus; larger after eating, smaller when hungry. Attaching to Huan-Jin, similar to Yangming accumulation; painful after eating, comfortable when hungry. Attaching to Mou-Yuan of intestines/stomach, pain connects externally to Huan-Jin; comfortable after eating, painful when hungry. Attaching to Fu-Chong vessels, pressing yields movement; releasing hand sends heat down thighs like boiling water. Attaching to Lv-Jin behind intestines, visible when hungry, invisible when full, impalpable. Attaching to Shu vessels, blockage prevents fluid descent, orifices dry and obstructed. This is evil entering from exterior to interior, from top to bottom. (This describes Wind/Rain attacking Yin deficiency, disease starting Upper, accumulation forming.)
Yellow Emperor asked: How does accumulation begin and become established? Qibo replied: Accumulation begins with Cold, then Jue Qi forms accumulation. Yellow Emperor asked: How is accumulation formed? Qibo replied: Jue Qi generates foot numbness/cold; foot cold generates calf cold; calf cold causes blood vessel coagulation and stagnation; stagnant cold qi enters intestines/stomach; enters intestines/stomach causes distension; distension forces external intestinal juices to gather and condense, forming accumulation daily. Sudden overeating/fullness, irregular lifestyle, excessive effort damage Collateral vessels. Yang Luo damage causes external bleeding (epistaxis); Yin Luo damage causes internal bleeding (hematochezia). Intestinal/Stomach Luo damage causes bleeding outside intestines; external Cold causes juices and blood to fight and condense, forming accumulation. Sudden external Cold or internal Injury from Worry/Anger causes Qi counterflow; counterflow blocks Six Transport points, Warm Qi fails to circulate, congealed blood gathers internally without dispersing, fluids seep and stick, forming accumulation. (This describes Clear-Damp attacking Yin deficiency, disease starting Below, accumulation forming.)
Yellow Emperor asked: How does disease originate from Yin? Qibo replied: Worry/Thought damages Heart; Heavy Cold damages Lung; Anger damages Liver; Drunken intercourse damages Spleen (sweating exposed to wind); Excessive effort or intercourse with sweating/bathing damages Kidney. (This describes Joy/Anger damaging Zang, disease originating from Yin. Wind/Rain attacking Yin deficiency starts Upper; Clear-Damp attacking Yin deficiency starts Below. Internal/External Three Regions all diseased, accumulation forms.) These are diseases of the Internal/External Three Regions. Yellow Emperor asked: Good. How to treat? Qibo replied: Observe pain to know response; Tonify Excess, Drain Deficiency; Do not defy Heaven's Time; this is Supreme Treatment.
Hand-Shaoyin Meridian tendon disease: Internal tension, Heart bears Fuliang, lower becomes Elbow Net. Treat with burning needle sudden puncture, frequency based on sensation, pain point as Shu point. If Fuliang produces bloody/purulent sputum, death is untreatable. Hand-Taiyin Meridian tendon disease severe becomes Xiben, hypochondriac tension with vomiting blood. Hand-Xinmai Meridian tendon disease: Chest pain, Xiben. All treated with burning needle sudden puncture, frequency based on sensation, pain point as Shu point. (Text from Jingjin chapter.)
[Sang] For Giamass accumulations, first needle the mass itself. Severe cases: one needle at the head, one at the tail of the mass; immediate effect. After needling, moxa. Also, moxa Zusanli (ST36).