许学士云。大抵治积。或以所恶者攻之。或以所喜者诱之。则易愈。如 砂、阿魏治肉积。神
曲、麦 治酒积。
水蛭、虻虫治血积。木香、槟榔治气积。牵牛、甘遂治水积。雄黄、腻粉治涎积。礞石、巴豆治食
积。各从其类也。若用群队之药分其势。则难取效。须是认得分明是何积聚。兼见何证。然后增减
酌量用药。不尔反有所损。要在临时通变也。
真定王君用。年一十九岁。病积。脐左连胁如覆杯。腹胀如鼓。多青络脉。喘不能卧。时值暑
雨。加之自利完谷。日哺潮热。夜有盗汗。以危急来求。予往视之。脉得浮数。按之有力。谓病家
曰。凡治积非有毒之剂攻之则不可。今脉虚弱如此。岂敢以常法治之。遂投分渗益胃之剂。数服而
清便自调。杂以升降阴阳。进食和气。而腹大减。胃气稍平。间以削之。不月余良愈。先师尝曰。
洁古老人有云。养正积自除。犹之满坐皆君子。纵有一小人。自无容地而出。今令真气实、胃气强
、积自消矣。洁古之言。岂欺我哉。内经云。大积大聚。衰其大半而止。满实中有积气。大毒之剂
尚不可过。况虚中有积者乎。此亦治积之一端也。邪正虚实。宜精审焉。
【乌梅丸】治脏寒蛔虫动作。上入膈中。烦闷呕吐。时发时止。得食即呕。常自吐蛔。有
此证候。谓之蛔厥。此药主之。又治久痢。
乌梅（三百个） 黄柏（炙） 细辛（去苗） 肉桂（去粗皮）
附子（炮。去皮脐） 人参（去芦。各六两） 干姜（炮。十两） 当归（去芦。四两
）
蜀椒（去目及闭口者。微炒出汗用。四两） 黄连（去须。十六两）
上异捣筛。合治之。以酒浸乌梅一宿。去核。蒸之令熟。用米饭熟捣成泥。和药令相得。纳臼
中。与炼蜜杵二千下。丸如梧桐子大。每服十五丸。温米饮下。食前服。
【化虫丸】
鹤虱（去土） 槟榔 苦楝根（去浮皮） 胡粉（炒。各一两）
白矾（枯。二钱半）
上为末。水糊丸如麻子大。小儿疾病。多有诸虫。或因脏腑虚弱而动。或因食甘肥而动。其动
即腹中疼痛发作。积聚往来上下。痛有休止。亦攻心痛则哭不休。合眼仰身扑手。心神闷乱。呕哕
涎沫。或吐清水。四肢羸困。面色青黄。饮食虽进。不生肌肉。或寒或热。沉沉默默。不的知病之
处。其虫不疗。则子母相生。无有休止。长一尺则能害人。一岁儿服五丸。温浆水入生油一两点。
打匀下之。温米饮亦得。不拘时候。其虫细小者皆化为水。大者自下。
【补金散】治诸般虫。
鹤虱（生） 雷丸 定粉 锡灰（各等分）
上为末。每服三钱。空心食前。少油调下。又用猪肉一两。烧熟。糁药在上。细嚼亦得。每服
药时。用鸡翎、甘
遂末一钱。与前药一处服之。其虫自下矣。
【雷金散】治诸虫。
雷丸（末。八分） 郁金（末。七分） 黑牵牛（末。一钱半）
上三件末。和匀。以生油调下三两匙。饭压之。
【化虫散】取寸白虫。
黄丹（半两炒） 锡灰（一两罗） 定粉（二两）
上同研极细末。每服一钱。先烧猪肉五片。吃了后。以生油一口许调药服。至晚取下。妇人有
胎不可服。李副统女子菊花年十三。一服取虫一抄。终身不发。
许学士说：大抵治疗积聚，或用患者厌恶的药物来攻伐它，或用患者喜欢的药物来引诱它，这样容易治愈。比如用砂仁、阿魏治疗肉积；用神曲、麦芽治疗酒积；用水蛭、虻虫治疗血积；用木香、槟榔治疗气积；用牵牛子、甘遂治疗水积；用雄黄、腻粉治疗涎积；用礞石、巴豆治疗食积。这些都是根据病邪的性质同类相治。如果使用多种药物混合使用以分散病势，则难以见效。必须明确分辨是何种积聚，兼见什么证候，然后增减斟酌用药。否则反而会有损害，关键在于临证时灵活变通。
真定人王君用，年龄十九岁，患有积聚病，脐部左侧连及胁下，肿块形状像倒扣的杯子，腹部胀大如鼓，表面有很多青色脉络，气喘不能平卧。当时正值暑天多雨，加上他自泻完谷不化，下午定时潮热，夜间有盗汗，病情危急前来求医。我去诊视，脉象浮数，重按有力。我对病人家属说：凡是治疗积聚，非要用有毒的药物攻伐不可。现在脉象虚弱如此（注：此处原文逻辑似有矛盾，前文言按之有力，后文言虚弱，依原文直译），怎么敢用常规方法治疗呢？于是投予分渗益胃的方剂，服用几剂后，大小便自然调和。再配合升降阴阳、进食和气的方法，腹部明显缩小，胃气稍平。间歇性地使用消削之法，不到一个月就痊愈了。先师曾说：洁古老人说过：“保养正气，积聚自然消除。”这就像满座都是君子，纵然有一个小人，也没有容身之地而自行出去。现在让真气充实、胃气强健，积聚自然消散。洁古的话，难道会欺骗我吗？《内经》说：对于大的积聚，病邪消退大半就要停止。在满实之中有积气，尚且不可过度使用大毒药物，何况是虚中有积的情况呢？这也是治疗积聚的一个方面。邪正虚实，应当精心审察。
【乌梅丸】治疗脏寒导致蛔虫躁动，向上进入膈中，烦闷呕吐，时发时止，进食即呕，经常吐出蛔虫。有此证候，称为蛔厥。此药主治。又治疗久痢。
乌梅（三百个） 黄柏（炙） 细辛（去苗） 肉桂（去粗皮）
附子（炮制，去皮脐） 人参（去芦，各六两） 干姜（炮制，十两） 当归（去芦，四两）
蜀椒（去目及闭口者，微炒出汗用，四两） 黄连（去须，十六两）
以上药物分别捣碎过筛，混合在一起。用酒浸泡乌梅一夜，去核，蒸熟，用米饭一起捣成泥状，与药末混合均匀，放入臼中，与炼蜜杵打两千下，制成梧桐子大小的丸药。每次服用十五丸，温米饮送下，饭前服用。
【化虫丸】
鹤虱（去土） 槟榔 苦楝根（去浮皮） 胡粉（炒，各一两）
白矾（枯，二钱半）
以上药物研为细末，用水糊制作成麻子大小的丸药。小儿患病，多有各种寄生虫。有的因脏腑虚弱而发动，有的因食用甘甜肥腻食物而发动。虫动则腹中疼痛发作，积聚往来上下，疼痛有休止时间，也会攻心导致心痛哭闹不止，合眼仰身扑手，心神烦乱，呕吐涎沫，或吐出清水，四肢瘦弱困倦，面色青黄，饮食虽然吃进，但不长肌肉，或寒或热，昏昏沉沉，不知道病的具体部位。如果不治疗这些虫子，它们就会子母相生，没有休止，长到一尺长就能害人。一岁儿童服用五丸，用温浆水加入生油一两点，搅匀送服。用温米饮也可以，不拘时候。细小的虫子都会化为水，大的虫子自然排出。
【补金散】治疗各种寄生虫。
鹤虱（生用） 雷丸 定粉 锡灰（各等分）
以上药物研为细末。每次服用三钱，空腹饭前，用少量油调服。另外用猪肉一两，烧熟，将药撒在上面，细细咀嚼吞服也可以。每次服药时，用鸡毛蘸取甘遂末一钱，与前药一起服用，虫子自然会排出。
【雷金散】治疗各种寄生虫。
雷丸（末，八分） 郁金（末，七分） 黑牵牛（末，一钱半）
以上三种药末，混合均匀，用生油调服三汤匙，饭后压住药力。
【化虫散】取出寸白虫（绦虫）。
黄丹（半两炒） 锡灰（一两罗筛） 定粉（二两）
以上药物共同研磨成极细末。每次服用一钱，先烧猪肉五片，吃完后，用生油约一口量调药服用。到了晚上虫子就会排出。妇女怀孕不可服用。李副统的女儿菊花，十三岁时，一次服药取出一抄勺的虫子，终身不再复发。
Xu Xueshi said: Generally, to treat accumulations (Ji), one may attack them with substances the patient dislikes, or lure them out with substances the patient likes, which makes them easier to cure. For example, Sha Ren (Amomi Fructus) and A Wei (Ferulae Resina) are used to treat meat accumulation; Shen Qu (Massa Medicata Fermentata) and Mai Ya (Hordei Fructus Germinatus) are used to treat alcohol accumulation; Shui Zhi (Hirudo) and Meng Chong (Ophiorrhizae Rhizoma) are used to treat blood accumulation; Mu Xiang (Aucklandiae Radix) and Bing Lang (Arecae Semen) are used to treat qi accumulation; Qian Niu Zi (Pharbitidis Semen) and Gan Sui (Kansui Radix) are used to treat water accumulation; Xiong Huang (Realgar) and Ni Fen (Calomelas) are used to treat phlegm-saliva accumulation; Meng Shi (Lepidocrocitum) and Ba Dou (Crotonis Fructus) are used to treat food accumulation. Each is treated according to its category. If a group of medicines is used to disperse the pathogenic factor's momentum, it will be difficult to achieve efficacy. One must clearly identify what kind of accumulation it is and what syndromes accompany it, then adjust and weigh the medications accordingly. Otherwise, harm may result. The key lies in flexible adaptation during clinical practice.
Wang Junyong from Zhengding, aged nineteen, suffered from an accumulation. There was a mass on the left side of the umbilicus extending to the hypochondrium, shaped like an inverted cup. His abdomen was distended like a drum, with many blue collateral vessels visible. He wheezed and could not lie flat. At that time, it was the rainy season with summer heat. Additionally, he had spontaneous diarrhea with undigested food, tidal fever in the late afternoon, and night sweats. He came seeking medical help in a critical condition. I examined him and found his pulse floating and rapid, but forceful upon deep pressure. I told the family: "Generally, treating accumulations requires toxic agents to attack them. However, given that the pulse is now weak [Note: Textual inconsistency noted], how dare I use standard methods?" Thus, I administered a formula for separating turbidity and benefiting the stomach (Fen Shen Yi Wei). After several doses, his urination and defecation naturally regulated. I then combined this with methods to ascend and descend yin and yang, promote appetite, and harmonize qi. His abdominal distension significantly decreased, and his stomach qi slightly stabilized. Intermittently using draining and reducing methods, he recovered well in less than a month. My former teacher once said: "The Elder Jieguo stated: 'Nourish the righteous qi, and the accumulation will remove itself.' This is like having a room full of gentlemen; even if there is one villain, he will have no place to stay and will leave on his own." Now, with righteous qi solidified and stomach qi strong, the accumulation naturally dissipates. Would Jieguo's words deceive us? The *Neijing* states: "For large accumulations, stop when more than half has been reduced." Even in cases of excess with accumulated qi, one should not overuse highly toxic drugs, let alone in cases where deficiency coexists with accumulation. This is also one aspect of treating accumulations. One must carefully examine the interplay of pathogenic factors, righteous qi, excess, and deficiency.
[Wumei Wan] Treats ascariasis caused by cold in the zang organs, where roundworms move restlessly, enter the epigastrium, causing irritability, vomiting, intermittent attacks, vomiting immediately after eating, and frequent expulsion of worms. When these symptoms occur, it is called "twirling jue" (Hui Jue). This medicine is indicated. It also treats chronic dysentery.
Wu Mei (300 fruits) Huang Bo (Zanthoxyli Cortex, processed with honey/fire) Xi Xin (Asari Radix et Rhizoma, removed roots) Rou Gui (Cinnamomi Cortex, removed rough bark)
Fu Zi (Aconiti Lateralis Radix Praeparata, processed, removed skin and navel) Ren Shen (Ginseng Radix, removed rhizome, each 6 liang) Gan Jiang (Zingiberis Rhizoma, processed, 10 liang) Dang Gui (Angelicae Sinensis Radix, removed rhizome, 4 liang)
Shu Jiao (Sichuan Pepper, removed eyes and closed ones, lightly fried until moisture evaporates, 4 liang) Huang Lian (Coptidis Rhizoma, removed roots, 16 liang)
Process each herb separately by pounding and sieving, then mix them together. Soak Wu Mei in wine overnight, remove pits, steam until cooked, mash with rice flour into a paste, and blend with the herbal powders. Place in a mortar, pound with refined honey two thousand times, and form pills the size of paulownia seeds. Take fifteen pills per dose, washed down with warm rice drink, before meals.
[Hua Chong Wan]
He Shi (Datiscae Caulis) Bing Lang (Arecae Semen) Ku Lian Gen (Meliae Cortex) Hu Fen (Cerussa, fried, each 1 liang)
Bai Fan (Alumen, calcined, 2 qian 5 fen)
Grind all ingredients into fine powder. Use water paste to form pills the size of sesame seeds. Children's illnesses often involve various parasites. These may arise due to weakness of the zang-fu organs or due to consumption of sweet and fatty foods. When the parasites move, abdominal pain occurs, and masses move up and down, with pain having intervals. They may attack the heart, causing crying without cessation, closing eyes, arching the back, flailing hands, mental confusion, vomiting saliva, or clear fluid. Limbs become emaciated and weak, complexion turns greenish-yellow. Although food intake continues, muscles do not grow. Symptoms may include alternating chills and fever, lethargy, and uncertainty about the disease location. If these parasites are not treated, they will reproduce endlessly. Those reaching one chi in length can harm the body. For a one-year-old child, administer five pills, mixed with warm grain water and one or two drops of raw oil, stirred evenly and given orally. Warm rice drink is also acceptable. Time of administration is unrestricted. Fine parasites will dissolve into water, while larger ones will be expelled naturally.
[Bu Jin San] Treats various types of parasites.
He Shi (Datiscae Caulis, raw) Lei Wan (Polyporus Umbellatus) Ding Fen (Cerussa) Xi Hui (Stannum Ash, equal parts)
Grind all ingredients into fine powder. Take three qian per dose, on an empty stomach before meals, mixed with a little oil. Alternatively, roast one liang of pork, sprinkle the medicine on top, and chew thoroughly. When taking the medicine, use a chicken feather to apply one qian of Gan Sui powder, and take it together with the main medicine. The parasites will be expelled.
[Lei Jin San] Treats various parasites.
Lei Wan (Polyporus Umbellatus, powdered, 8 fen) Yu Jin (Curcumae Longae Rhizoma, powdered, 7 fen) Hei Qian Niu (Pharbitidis Semen Nigrum, powdered, 1 qian 5 fen)
Mix the three powders evenly. Take three tablespoons mixed with raw oil, followed by a meal to suppress the drug's action.
[Hua Chong San] Expels Taenia saginata (Beef Tapeworm/Cun Bai Chong).
Huang Dan (Minii Oxidum Rubrum, half liang, fried) Xi Hui (Stannum Ash, one liang, sieved) Ding Fen (Cerussa, two liang)
Grind all ingredients together into an extremely fine powder. Take one qian per dose. First, roast five slices of pork, eat them, then take the medicine mixed with about one mouthful of raw oil. The worms will be expelled by evening. Pregnant women must not take this. Li Futong's daughter, Ju Hua, aged thirteen, expelled a handful of worms after a single dose and never suffered recurrence again.