积者，有形之邪，或食、或痰、或血积滞成块，时常硬痛，始终不离故处者也。
在妇人则谓之 。 者，征也，有形可验也。聚者，无形之气，滞则聚，行则散，
聚则有形而硬痛，散则痛止形消，忽此忽彼，无有定处者也。在妇人谓之瘕。瘕者，
假也，假气为形，而实非有形也。形属阴，气属阳，故积属阴，聚属阳。古分积属
脏、在血分，聚属腑、在气分，即阴阳之义耳，不必泥也。至其病因，则《内经》
谓∶寒气入肠胃，则肠外汁沫凝聚不散，日以成积。又或饮食过饱，或用力过度，
伤其肠胃之络，则血溢肠外，与寒沫搏结成积。或外中于寒，而忧怒气逆，血凝液
留，皆成积。可见外感内伤，皆足以郁滞其气血痰液，以成积聚。而在妇人尤甚，
以妇人经产血行，或食生冷，或感风寒，且多恚怒忧郁，易致瘀滞也。
一食积（酒积附）
证见嗳腐吞酸，腹满恶食，宜秘方化滞丸，山楂、麦芽、枳实、神曲、阿魏、
礞石、牵牛、巴豆之类。倒仓法最佳。按食停肠内，必栖泊在隐曲之处，乃能久而
不下，隐曲之处，为地无几，必附益以肠外之涎沫，内外交结，乃成大块，须兼治
其痰饮乃效。酒积目黄口干，肚腹胀痛，少食，宜葛根、枳 、麦芽之类。（酒湿热伤
脾，痰血瘀滞成积，须兼清热利湿导滞之药。旧谓食积在右，血积在左，痰积在中，
大概如此，不可泥。）
一痰积（水积附）
证见麻木眩晕，痞闷嘈杂，其人平素多痰，宜控涎丹，（见痰饮。）朱砂、腻粉、瓜
蒂、甘遂之类。水积，足胫肿胀，（必有窠囊。）宜郁李、商陆、甘遂、芫花之类。
一血积
证见面色痿黄，有蟹爪纹路，（血不能上荣也。）多怒善忘，口燥便秘，骨热肢冷，宜
桃仁煎，地榆、虻虫、水蛭之类。
以上皆有形之积，阻碍正气，故痛也。而亦有不痛者，日久则正气另辟行径，
不复与邪相争，或邪另结窠囊，不碍气血隧道之故。此为难治，以药不易到也。又
食、痰、血数者，皆无知之物，不能移动，故常在其处。然有饮污井之水，吞蛟
蜃之精，因而假血气以成形，含有活性，时能蠢动游移者，须以意治之。如败
梳治虱瘕，铜屑治龙瘕之类。（七 八瘕，载《千金方》，有蛟、蛇、狐、鳖等名。）
又积久则成疳，
因经络壅滞郁成湿热，以致口糜龈烂，当兼用龙荟等丸，（见胁痛。）以清疳热。凡治积，
宜丸不宜汤，必兼用膏药熨贴及艾灸乃除，以其在肠胃之外也。
一气聚
证必肚腹膨胀，时痛时止，得嗳即宽，旋复痛，游走攻刺，宜木香、槟榔、枳
壳、牵牛之类，不可下。
上明积聚之理，至下文所举色目，不过随部位而异名，总不出积与聚二端。
心积名伏梁，起脐上，大如臂，上至心下，（心经气郁血滞所致。）久不已令人烦心，
宜大七气汤加石菖蒲、半夏，兼吞伏梁丸。
肝积名肥气，在左胁下，如覆杯，有头足，久不已令人呕逆，或胸胁痛引小腹，
足寒转筋，寒热如疟，（肝经血气郁滞所致。）宜大七气汤，煎熟待冷，淋烧红铁铁器，
乘热服，兼吞肥气丸。
肺积名息贲，在右胁下，大如覆杯，气逆背痛，或少气善忘，久不愈令人洒洒
寒热，喘咳，皮中时痛，如虱缘针刺，（肺热气壅所致。）宜大七气汤加桑白皮、杏仁，兼
吞息贲丸。（按《内经》谓∶胁不满，气逆，二三岁不已，病名息积。当是肥气之属，非即此证。）
脾积名痞气，在胃脘，大如复盘，痞塞不通，心背痛，饥减饱见，腹满吐
泄，久则四肢不收，发黄胆，饮食不为肌肤，足肿肉消，宜大七气汤下红丸子，（见
伤饮食。）兼吞痞气丸。
肾积曰奔豚，发于小腹，上冲至心如豚状，上下无时，少腹急，腰痛，久不已
令人喘逆骨痿，宜大七气汤倍桂，加茴香、炒楝子肉，兼吞奔豚丸。
，在腹内近脐，左右各有一条筋脉急痛，大者如臂，小者如指，有时而现，
如弦之状，故名 。
癖，偏僻也，僻居两肋，有时而痛。
石瘕，生胞中，因寒气客于子门，恶血留聚，日渐大，状如怀子。此气先病血
后病，月事不以时下。（此血分病。）
肠覃，寒客大肠外，结瘕，始如鸡卵，渐益大如怀孕。此气病血未病，故月水
不断。（此气分病。）
上二者皆女子病，似妊娠，治法可用辛热，如吴茱萸、桂心、附子，加入消块药。
积，是有形的病邪，或因食物、或因痰浊、或因瘀血停滞凝聚成块，时常坚硬疼痛，始终不离开原处的病证。
在妇女身上则称为“癥”。癥，即征象的意思，是有形之邪可以验证的。
聚，是无形的病气，气机阻滞则聚集，气机运行则消散，
聚的时候表现为有形且坚硬疼痛，散的时候疼痛停止且形体消失，位置忽此忽彼，没有固定处所的病证。在妇女身上称为“瘕”。瘕，即假的意思，是假借气机形成形态，而实际上并非真正有形的病证。
形体属于阴，气机属于阳，所以积属于阴，聚属于阳。古代将积归属于脏、位于血分，将聚归属于腑、位于气分，这也就是阴阳的道理罢了，不必拘泥于此。
至于其病因，《内经》说：寒气侵入肠胃，则肠外的津液汁沫凝聚不散，日久便形成积。
或者饮食过饱，或者用力过度，损伤了肠胃的络脉，导致血液溢出到肠外，与寒性的津液汁沫搏结而形成积。
或者是外感寒邪，加上忧怒导致气机上逆，血液凝滞、津液留停，都会形成积。
由此可见，外感六淫和内伤七情，都足以导致气血痰液郁滞，从而形成积聚。而在妇女身上尤为严重，因为妇女经历月经和产后，血行变化较大，或者食用生冷食物，或者感受风寒，且多易产生愤怒和忧郁情绪，容易导致瘀血停滞。
一、食积（附酒积）
症状表现为嗳气带有腐臭味、吞酸、腹部胀满、厌恶进食，适宜使用秘方化滞丸，由山楂、麦芽、枳实、神曲、阿魏、礞石、牵牛子、巴豆等药物组成。倒仓法效果最佳。
按：食物停滞在肠道内，必定栖息在隐蔽曲折之处，才能长久不下行。隐蔽曲折之处，空间极少，必须依附于肠外的涎沫，内外相互交结，才能形成大块头，因此必须同时治疗其痰饮才能见效。
酒积表现为目黄、口干、肚腹胀痛、食欲减退，适宜使用葛根、枳壳、麦芽等药物。（酒湿热损伤脾脏，痰血瘀滞形成积，必须兼用清热利湿、导滞的药物。旧时说食积在右侧，血积在左侧，痰积在中部，大体如此，不可拘泥。）
二、痰积（附水积）
症状表现为麻木、眩晕、痞闷嘈杂，患者平素多痰，适宜使用控涎丹（见痰饮篇），由朱砂、腻粉、瓜蒂、甘遂等药物组成。
水积表现为足胫肿胀（必然有窠囊存在），适宜使用郁李仁、商陆、甘遂、芫花等药物。
三、血积
症状表现为面色萎黄，面部有蟹爪状纹路（因血液不能上行荣养所致），容易发怒、健忘，口燥便秘，骨蒸潮热、四肢寒冷，适宜使用桃仁煎，由地榆、虻虫、水蛭等药物组成。
以上这些都属于有形的积，阻碍正气，所以会疼痛。但也有不痛的，是因为日久之后正气另辟路径，不再与邪气相争，或者邪气另外结成窠囊，不妨碍气血通道的缘故。这种情况难以治疗，因为药物不容易到达病所。
又，食积、痰积、血积这几类，都是无知的物质，不能移动，所以常停留在原处。然而，如果饮用污井之水，吞食蛟蜃的精气，因而假借血气形成形态，含有活性，时常能够蠢动游移的，需要用意念来治疗。如败梳治疗虱瘕，铜屑治疗龙瘕之类。（七、八瘕，记载于《千金方》，有蛟、蛇、狐、鳖等名称。）
又，积久则会变成疳症，
因为经络壅滞郁结而成湿热，导致口腔糜烂、牙龈腐烂，应当兼用龙胆泻肝丸等（见胁痛篇），以清除疳热。
凡是治疗积证，适宜用丸剂而不适宜用汤剂，必须兼用膏药熨贴及艾灸才能去除，因为这些病位在肠胃之外。
四、气聚
症状必然是肚腹膨胀，时痛时止，打嗝后感到舒缓，随即又痛，疼痛游走攻刺，适宜使用木香、槟榔、枳壳、牵牛子等药物，不可使用泻下法。
上面阐明了积聚的原理，至于下文所列的各种色目，不过是随着部位不同而有不同的名称，总不出积与聚这两类。
心积名为伏梁，起于脐上，大如手臂，向上延伸至心下，（由心经气郁血滞所致。）日久不愈使人烦闷忧心，适宜使用大七气汤加石菖蒲、半夏，兼服伏梁丸。
肝积名为肥气，在左胁下，如倒扣的杯子，有头有足，日久不愈使人呕吐逆气，或胸胁痛牵引小腹，足部寒冷转筋，寒热往来如疟疾，（由肝经血气郁滞所致。）适宜使用大七气汤，煎熟待冷后，淋在烧红的铁器上，趁热气服用，兼服肥气丸。
肺积名为息贲，在右胁下，大如倒扣的杯子，气逆背痛，或少气健忘，日久不愈使人洒洒恶寒发热，喘咳，皮肤中时时疼痛，如虱子咬针刺一般，（由肺热气壅所致。）适宜使用大七气汤加桑白皮、杏仁，兼服息贲丸。（按：《内经》说：胁下不满，气逆，两三年不愈，病名息积。应当是肥气的一类，不是这个证候。）
脾积名为痞气，在胃脘部，大如翻过来的盘子，痞塞不通，心背疼痛，饥饿时减轻饱胀时显现，腹部胀满吐泄，日久则四肢无力不收，发黄疸，饮食不能化为肌肤，足肿肉消，适宜使用大七气汤送服红丸子（见伤饮食篇），兼服痞气丸。
肾积名为奔豚，发作于小腹，向上冲至心脏，状如小猪奔跑，上下无常，少腹急迫，腰痛，日久不愈使人喘逆骨痿，适宜使用大七气汤加倍桂枝，加小茴香、炒楝子肉，兼服奔豚丸。
弦，在腹内近脐处，左右各有一条筋脉紧急疼痛，大的如手臂，小的如手指，有时出现，像琴弦一样，所以命名为弦。
癖，意为偏僻，指病邪居于两肋偏僻之处，有时疼痛。
石瘕，生于胞宫之中，因寒气客居于子门，恶血留聚，日渐增大，状如怀孕。这是气先病而后血病，月经不能按时来潮。（这是血分病。）
肠覃，寒气客居于大肠之外，结为瘕块，开始如鸡卵大小，逐渐增大如怀孕。这是气病而血未病，所以月经不断。（这是气分病。）
上述两种都是女子的疾病，类似妊娠，治疗方法可用辛热药物，如吴茱萸、桂心、附子，加入消块药物。
Ji (Accumulation) refers to pathogenic factors with tangible form, which may result from food retention, phlegm turbidity, or blood stasis condensing into masses. These masses are often hard and painful, and remain fixed in their original location.
In women, this condition is termed "Zheng" (Mass). Zheng implies a visible sign, indicating a tangible pathogen that can be verified.
Ju (Gathering), on the other hand, refers to intangible Qi stagnation. When Qi stagnates, it gathers; when Qi moves, it disperses. When gathered, it presents as tangible and causes hardness and pain; when dispersed, the pain ceases and the tangible form disappears. Its location shifts unpredictably without a fixed site. In women, this is termed "Jia" (False Mass). Jia implies falseness, meaning it assumes a shape through Qi but is not truly tangible.
Form belongs to Yin, while Qi belongs to Yang. Therefore, Ji belongs to Yin, and Ju belongs to Yang. Ancient texts classified Ji as belonging to Zang organs and located in the Blood level, while Ju was classified as belonging to Fu organs and located in the Qi level. This distinction aligns with the principles of Yin and Yang and should not be rigidly adhered to.
Regarding etiology, *Neijing* states: When cold qi invades the intestines and stomach, the fluids outside the intestines condense and fail to disperse, gradually forming accumulation over time. Alternatively, excessive eating or overexertion may damage the collaterals of the intestines and stomach, causing blood to overflow into the extraintestinal space. There, it combats with cold fluids to form accumulation. External invasion by cold combined with internal emotional distress (worry and anger) leading to rebellious Qi, blood coagulation, and fluid retention also results in accumulation. Thus, both external pathogens and internal injuries can cause stagnation of Qi, blood, phlegm, and fluids, leading to Ji and Ju. This is particularly severe in women due to menstrual and postpartum blood dynamics, consumption of raw/cold foods, exposure to wind-cold, and frequent anger or depression, all of which predispose them to blood stasis and stagnation.
1. Food Accumulation (with Wine Accumulation as an appendix)
Symptoms include belching with a rotten odor, acid regurgitation, abdominal distension, and aversion to food. The secret formula Huazhi Wan (Stagnation-Resolving Pill) is indicated, composed of Hawthorn Fruit (*Crataegi Fructus*), Malt (*Hordei Fructus Germinatus*), Immature Bitter Orange (*Aurantii Fructus Immaturus*), Medicated Leaven (*Shenqu*), Asafoetida (*Ferulae Resina*), Nanshaishi (*Calcaris Ostrae*), and Radix Sennae (*Folium Sennae*), among others. The Dao Cang Fa (Stomach Purging Method) is optimal.
Note: Food stagnating in the intestines must lodge in hidden or tortuous areas to remain undigested for long periods. Since such spaces are limited, the food must adhere to salivary fluids from outside the intestines, forming large masses through internal-external interaction. Therefore, treatment must address phlegm-fluids concurrently to be effective.
Wine accumulation presents with yellow eyes, dry mouth, abdominal distension and pain, and reduced appetite. Ge Gen (*Puerariae Lobatae Radix*), Zhi Ke (*Aurantii Fructus*), and Mai Ya (*Hordei Fructus Germinatus*) are suitable. (Alcohol-damp-heat damages the Spleen, leading to phlegm-blood stasis and accumulation; clearing heat, draining dampness, and guiding out stagnation are required. Old theories suggest food accumulation is on the right, blood accumulation on the left, and phlegm accumulation in the center; this is generally true but should not be rigidly applied.)
2. Phlegm Accumulation (with Water Accumulation as an appendix)
Symptoms include numbness, vertigo, chest fullness, and嘈杂 (buzzing/irritability). Patients typically have chronic phlegm. Kongxian Dan (Phlegm-Draining Pill) is indicated (see Phlegm-Fluid section), containing Cinnabar (*Cinnabaris*), Calomel (*Hydrargyri Chloridum Mite*), Melon Peduncle (*Cucumeris Fructus*), and Kansui Radix (*Radix Kansui*).
Water accumulation presents with swelling of the lower legs and shins (indicating the presence of "ke nang" or reservoirs). Yuli Ren (*Prunus Semen*), Phytolacca Root (*Radix Phytolaccae*), Kansui Radix (*Radix Kansui*), and Genkwa Flower (*Flos Genkwa*) are suitable.
3. Blood Accumulation
Symptoms include sallow complexion, crab-claw-like vascular patterns on the face (due to blood failing to nourish the upper body), irritability, forgetfulness, dry mouth, constipation, bone-steaming fever, and cold limbs. Tao Ren Jian (Peach Kernel Decoction) is indicated, containing Di Yu (*Sanguisorbae Radix*), Blister Beetle (*Mylabris*), and Leech (*Hirudo*), among others.
The above are all tangible accumulations that obstruct healthy Qi, causing pain. However, some do not cause pain because, after a long duration, healthy Qi finds alternative pathways and no longer contends with the pathogen, or the pathogen forms isolated reservoirs that do not block the Qi-Blood channels. These cases are difficult to treat because medicines cannot easily reach the lesion.
Furthermore, food, phlegm, and blood accumulations consist of inert substances that do not move, hence they remain stationary. However, drinking water from polluted wells or swallowing essences of mythical creatures (like dragons or crocodiles) may create forms using Qi and Blood that possess activity, allowing them to move and shift. Such conditions require mental/spiritual intervention. For example, used combs treat louse-Jia, and copper filings treat dragon-Jia. (The Seven and Eight Jias are recorded in *Qianjin Fang*, with names like Dragon, Snake, Fox, and Turtle.)
Additionally, long-standing accumulation can transform into Gan syndrome (infantile malnutrition/wasting). Due to meridian obstruction and Qi stagnation transforming into damp-heat, symptoms include oral ulcers and gum rot. Longdan Xiegan Wan (Dragon Gallbladder Liver-Draining Pill) (see Hypochondriac Pain) should be used concurrently to clear Gan-heat.
Generally, treating accumulation favors pills over decoctions. Plaster application and moxibustion should be combined for removal, as these lesions are located outside the intestines and stomach.
4. Qi Gathering
Symptoms include abdominal distension, intermittent pain that resolves with belching but recurs shortly after, and wandering, stabbing pain. Mugher (*Costi Rhizoma*), Areca Seed (*Arecae Semen*), Aurantium (*Aurantii Fructus*), and Radix Sennae (*Folium Sennae*) are suitable. Purgatives should be avoided.
The above clarifies the principles of Ji and Ju. The subsequent descriptions of various named masses differ only by location but fall under the two categories of Ji and Ju.
Heart Ji is named Fuliang (Hidden Beam). It starts above the umbilicus, is arm-sized, and extends up to below the heart. Caused by Heart Meridian Qi stagnation and blood stasis, if untreated, it causes mental restlessness. Daqi Qi Tang (Great Seven-Qi Decoction) plus Chang Pu (*Acori Tatarinowii Rhizoma*) and Ban Xia (*Pinelliae Rhizoma*) is indicated, along with Fuliang Wan.
Liver Ji is named Feiqi (Fat Qi). Located under the left hypochondrium, it resembles an inverted cup with head and tail. If untreated, it causes vomiting and rebellious Qi, or hypochondriac pain radiating to the lower abdomen, cold feet with cramps, and chills/fever resembling malaria. Caused by Liver Meridian Qi-Blood stagnation, Daqi Qi Tang is indicated. The decoction should be cooled, then poured onto red-hot iron tools, and drunk while hot, along with Feiqi Wan.
Lung Ji is named Xiben (Breath Burping). Located under the right hypochondrium, it resembles an inverted cup. Symptoms include rebellious Qi, back pain, shortness of breath, forgetfulness, chills/fever, cough, and skin pain like insect bites or needle pricks. Caused by Lung heat and Qi congestion, Daqi Qi Tang plus Bai Pi (*Morus Cortex*) and Xing Ren (*Armeniacae Semen Amarum*) is indicated, along with Xiben Wan. (Note: *Neijing* mentions "Xi Ji" for hypochondriac fullness and rebellious Qi lasting years, which likely belongs to Feiqi, not this specific syndrome.)
Spleen Ji is named Pi Qi (Obstruction Qi). Located in the epigastrium, it resembles an overturned plate, causing obstruction, heart/back pain, relief when hungry but worsening when full, abdominal distension, vomiting, and diarrhea. Long-term effects include limb weakness, jaundice, failure of nutrition to build flesh, leg swelling, and muscle wasting. Daqi Qi Tang administered with Hong Wan Zi (Red Pill) is indicated, along with Pi Qi Wan.
Kidney Ji is named Bentun (Rushing Pig). It originates in the lower abdomen and rushes upward toward the heart like a running pig, occurring at irregular intervals. Symptoms include lower abdominal urgency, lower back pain, and if untreated, wheezing, rebellious Qi, and bone weakness. Daqi Qi Tang with doubled Gui Zhi (*Ramulus Cinnamomi*) plus Huixiang (*Foeniculi Fructus*) and fried Li Zi Rou (*Toosendan Fructus Mesocarp*) is indicated, along with Bentun Wan.
Xian (String) is located near the umbilicus inside the abdomen. On either side, there is a tendon-like structure with urgent pain, size ranging from arm to finger, appearing intermittently like a string, hence the name.
Pi (Partiality) means偏僻 (remote/partial). It resides in the remote areas of the hypochondrium and causes intermittent pain.
Shi Jia (Stone Jia) arises in the uterus. Cold qi invades the cervical os, causing evil blood to accumulate and enlarge daily, resembling pregnancy. This is a Qi disorder preceding Blood disorder, resulting in irregular menstruation. (This is a Blood-level disease.)
Chang Tan (Intestinal Polyp/Tumor) occurs when cold qi lodges outside the large intestine, forming a mass starting the size of a chicken egg and growing to resemble pregnancy. This is a Qi disorder where Blood is unaffected, so menstruation continues. (This is a Qi-level disease.)
Both of the above are female diseases resembling pregnancy. Treatment should use acrid-warm herbs like Evodia Fruit (*Evodiae Fructus*), Cinnamon Heart (*Cinnamomi Cortex*), and Prepared Aconite Root (*Aconiti Lateralis Radix Praeparata*) added to mass-resolving medicines.