诸有形而坚着不移者为积。诸无形而留止不定者为聚。积在五脏，主阴，病属血分。聚
在六
腑，主阳，病属气分。《难经》既以积聚分属脏腑，《巢氏病源》别立症瘕之病名，以不动
者为症，动者为瘕。亦犹是《难经》积聚之说也。第无形之瘕聚，其散易。有形之症积，其
破难。治之者，辨有形无形，在气在血，可得其概矣。
分阴阳，(二百遍。)推三关，(一百遍。)退六腑，(一百遍。)推补脾土，(二百遍。)掐
四横
纹，(三十遍。)运八卦，(八十遍。)掐大肠，(二十四遍。)揉版门，(八十遍。)推补肾水，
(一百遍。)天门入虎口，(一百遍。)掐小横纹。(二十遍。)发热腹痛，加水底捞明月，(五
十遍。)大便秘结，加推六腑，(一百遍。)掐小横纹，(二十四遍。)揉掐肾水。(各五十遍。
)腹痛泄泻，加揉掐一窝风，(三十六遍。)揉脐及龟尾。(各一百遍。)凡推用葱姜椒水，用
灸法。(见卷二，二十六页。)
按《难经》肺之积在右胁下，为息贲；肝之积在左胁下，为肥气；心之积在脐上，上至
心下
，为伏梁；脾之积在胃脘，为痞气；肾之积发于少腹，上至心，上下无时，为奔豚；其见于
脐下为症瘕，症者按之不移，有血症、食症之别；瘕者假物成形，如血鳖石瘕之类。见于胸
胁为痞癖，痞为结块，在肌肉而可见。癖由内着，结隐癖而难求。既分其部，必原所起，其
初由外感风寒，内伤气郁血瘀，食积痰滞，凝结于肓膜，久而盘踞坚牢，以至元气日衰，攻
补为难。如徒以按摩诸法治之，恐难奏效，所贵理其气，气行则脉络通，尤宜调其中，脾运
则积滞化。其药宜辛散温通，乃能入阴出阳，解散凝聚，李士材有阴阳攻积丸在，然搜逐之
中，酌补元气，务令脾胃气旺，乃可消磨坚结。但坚顽之积聚，多在肠胃以外募原之间，非
药力所能猝及。宜薄贴以攻其外，针法以攻其内，艾灸以消散固结，佐其所不逮也。(惕厉
子)
凡是形态可见且坚硬固定不移的称为“积”。凡是无形态且停留位置不固定的称为“聚”。“积”位于五脏，属阴，病在血分；“聚”位于六腑，属阳，病在气分。《难经》已经将积聚分别归属于脏腑，《诸病源候论》又单独设立了症瘕的病名，其中不动的称为“症”，移动的称为“瘕”。这也与《难经》中关于积聚的说法一致。只是无形的瘕和聚，容易消散；有形的症和积，难以攻破。治疗时，辨别是有形还是无形，病在气分还是血分，就能掌握大概原则了。
分阴阳（操作二百遍），推三关（一百遍），退六腑（一百遍），推补脾土（二百遍），掐四横纹（三十遍），运八卦（八十遍），掐大肠（二十四遍），揉板门（八十遍），推补肾水（一百遍），天门入虎口（一百遍），掐小横纹（二十遍）。若伴有发热腹痛，加用水底捞明月（五十遍）；大便秘结，加上推六腑（一百遍）、掐小横纹（二十四遍）、揉掐肾水（各五十遍）。若为腹痛泄泻，加上揉掐一窝风（三十六遍）、揉脐及龟尾（各一百遍）。凡是用推拿手法时，使用葱姜椒水，并配合艾灸法。（详见卷二，第二十六页。）
根据《难经》记载：肺之积在右胁下，名为息贲；肝之积在左胁下，名为肥气；心之积在脐上，向上延伸至心下，名为伏梁；脾之积在胃脘部，名为痞气；肾之积发于小腹，向上延伸至心，发作时间不定，名为奔豚；出现在脐下的称为症瘕，其中“症”是指按压后位置不移，分为血症和食症两种；“瘕”是假借物象而成形，如血鳖、石瘕之类。出现在胸胁部的称为痞癖，“痞”指结块，位于肌肉层且肉眼可见；“癖”由内部附着形成，结聚隐蔽而难以探寻。既然已经区分了部位，必须追溯其起因。初期多由外感风寒、内伤情志气郁或血瘀、饮食积滞痰湿停滞，凝结在肓膜（腹腔内脂肪组织及筋膜间隙），日久盘踞变得坚牢，导致元气日渐衰弱，此时攻邪与补虚都难以处理。如果仅仅依靠按摩等疗法，恐怕难以见效。可贵之处在于调理气机，气行则脉络通畅，尤其应当调和中焦，脾胃运化功能正常则积滞得以化解。药物宜用辛散温通之品，才能入阴出阳，解散凝聚。李士材著有阴阳攻积丸，但在搜逐邪气的同时，需酌情补益元气，务必使脾胃之气旺盛，才能消磨坚结。但是，顽固坚硬的积聚，多在肠胃以外的募原之间，非药力所能迅速到达。适宜用薄贴膏药从外部攻治，用针刺法从内部攻治，用艾灸来消散固结，以弥补其他疗法的不足。（惕厉子）
Those that are visible in form, hard, and fixed without movement are called "Ji" (accumulation). Those that are invisible in form and stay in uncertain locations are called "Ju" (gathering). "Ji" is located in the Zang organs (solid organs), belongs to Yin, and the disease pertains to the Blood aspect. "Ju" is located in the Fu organs (hollow organs), belongs to Yang, and the disease pertains to the Qi aspect. The *Nan Jing* (Classic of Difficult Issues) has already assigned Ji and Ju to specific Zang and Fu organs. The *Chao Shi Bing Yuan* (General Treatise on the Causes and Manifestations of Diseases by Chao Yuanfang) separately established the disease names "Zheng" (mass) and "Jia" (mobility), where immobile masses are called "Zheng" and mobile ones are called "Jia". This is consistent with the theory of Ji and Ju in the *Nan Jing*. However, the invisible Jia and Ju are easy to dissipate, while the visible Zheng and Ji are difficult to break down. In treatment, by distinguishing between visible and invisible forms, and whether the pathology lies in Qi or Blood, one can grasp the general principles.
Divide Yin and Yang (200 repetitions), push San Guan (Three Gates) (100 repetitions), retreat Liu Fu (Six Bowels) (100 repetitions), push and tonify Pi Tu (Spleen Earth) (200 repetitions), pinch Si Heng Wen (Four Transverse Creases) (30 repetitions), move Ba Gua (Eight Trigrams) (80 repetitions), pinch Da Chang (Large Intestine) (24 repetitions), rub Ban Men (Ban Gate) (80 repetitions), push and tonify Shen Shui (Kidney Water) (100 repetitions), Tian Men Ru Hu Kou (Heaven's Gate Entering Tiger's Mouth) (100 repetitions), pinch Xiao Heng Wen (Small Transverse Crease) (20 repetitions). If accompanied by fever and abdominal pain, add Shui Di Lao Ming Yue (Fishing for the Bright Moon at the Bottom of the Water) (50 repetitions); if constipated, add pushing Liu Fu (100 repetitions), pinching Xiao Heng Wen (24 repetitions), rubbing and pinching Shen Shui (each 50 repetitions). If there is abdominal pain with diarrhea, add rubbing and pinching Yi Wo Feng (One Nest Wind) (36 repetitions), rubbing the umbilicus and Gui Wei (Turtle Tail) (each 100 repetitions). Whenever using tuina techniques, use water infused with green onion, ginger, and pepper, and combine with moxibustion. (See Volume 2, page 26.)
According to the *Nan Jing*: The accumulation of the Lung is under the right hypochondrium, named Xi Ben (Breathful Surging); the accumulation of the Liver is under the left hypochondrium, named Fei Qi (Fat Qi); the accumulation of the Heart is above the umbilicus, extending up to below the heart, named Fu Liang (Hidden Beam); the accumulation of the Spleen is in the epigastrium, named Pi Qi (Stagnant Qi); the accumulation of the Kidney originates in the lower abdomen, extending up to the heart, occurring at irregular times, named Ben Tun (Running Piglet). Those appearing below the umbilicus are called Zheng Jia. "Zheng" refers to masses that do not move upon pressure, further divided into blood-type and food-type Zheng. "Jia" takes shape from temporary entities, such as Xue Die (Blood Turtle) or Shi Xia (Stone Jia). Those appearing in the chest and hypochondrium are called Pi Pi. "Pi" refers to palpable masses visible in the muscle layer. "Pi" (from the second character here referring to hidden accumulation) attaches internally, forming concealed knots that are hard to locate. Since the locations are distinguished, one must trace their origins. Initially, they arise from external contraction of wind-cold, internal injury from emotional qi stagnation or blood stasis, food retention, and phlegm-dampness stagnation, which coagulate in the Huang Mo (blind membrane/fascial spaces). Over time, they become entrenched and firm, causing the Yuan Qi (Original Qi) to decline daily, making it difficult to employ both attacking and tonifying methods. If one relies solely on massage therapies, it is feared that efficacy will be poor. The value lies in regulating Qi; when Qi moves, the meridians and collaterals become unobstructed. It is especially important to harmonize the Middle Jiao; when the Spleen transforms and transports, accumulations and stagnations dissolve. Medicinals should be pungent, dispersing, and warm-unblocking to enter Yin and emerge from Yang, dissolving coagulation. Li Shicai authored the Yin Yang Gong Ji Wan (Yin-Yang Attacking Accumulation Pill). However, amidst searching and purging, one must酌情 (discretionarily) tonify the Original Qi, ensuring the Spleen and Stomach Qi are robust so that hard accumulations can be metabolized. Nevertheless, stubborn and hard accumulations often reside in the Mu Yuan (originating source/fascial planes) outside the intestines and stomach, where medicinal power cannot reach suddenly. It is appropriate to use thin plasters to attack externally, acupuncture to attack internally, and moxibustion to dissipate solidified knots, supplementing what other methods cannot achieve. (Ti Li Zi)