越人谓五脏为积。六腑为聚。积属阴故静。聚属阳故动。静则易伏。而动则
易散也。然有所征验于外谓之 。假物而成谓之瘕。痞塞不快谓之痞。藏
于幽辟谓之癖。或云 主食而瘕主血。痞主气而癖主痰。四者分而言之
可。合而言之亦无不可。惟在疗之者。察其脏腑之阴阳。部分之高下。气血
之多寡。新久之浅深。元气之浓薄。或十攻而一补。或半攻而半补。或十补
而勿一攻。握一定之算。然后能取决于必胜也。近时士材立国中末三法。
未尝不善。而余则尤有商焉。积聚之生也以渐。匪朝伊芳夕之故。使苟元气
充。脏腑调。分布周列。何隙可容其蹯踞。令积聚实逼处此。妨碍于升降往
来。惟其萌于有渐。始尚不觉。日以益大。渐至猖狂而不可遏。斯时缓攻之
邪不去。峻攻之邪亦不去。即去矣。而邪之聚者。复散而变他症。盖攻积之
药。必由脏腑肠胃。而后达病所。其清纯之气。有不伤乎。余立一法。以攻积
丸累累加用。倍入人参汤监之。贫者以白术膏代之。必使元气胜乎邪气。
而邪自无容留地。否则专补元气。复其健运之常。则所积者。所聚者。将不
攻而自走。又必须其人。善自珍摄。爱护生命。而后可与施此术也。苟不然
者。亦终无如何矣。
攻积丸
人参 京三棱（醋煮） 蓬术（醋煮） 菟丝子（酒煮） 桃仁 当归 香附（醋煮） 黄连（土炒） 青皮（醋
炒） 枳实（麸炒） 茯苓 半夏（各一两） 炮姜（五钱） 泽泻（七钱） 肉桂（一两不见火）
上为末。神曲为丸。浓煎人参汤下。每服二钱。不拘时服。
一肝之积曰肥气。左胁下。如覆杯。呕逆。胁痛。引小腹。宜扶脾抑肝。
逍遥散
加连制吴茱萸醋制鳖甲青皮抚芎桃仁以破其血。
一肺之积曰息奔。右胁下。如覆杯。气逆。背痛。喘咳。宜人参茯苓广皮苏子
款冬花半夏旋复花桔梗炙甘草。兼脾弱。六君子以补其母。
一心之积曰伏梁。起脐上。大如臂。上至心下。烦心。用人参川连远志菖蒲
茯神肉桂柏子仁丹参干姜。
一脾之积曰痞气。在胃脘。大如覆杯。痞塞。吐泻。不为肌肤。用四君子汤加
麸炒枳实山楂炮姜藿香黄连蓬术神曲麦芽。
一肾之积曰奔豚。棱于少腹。上至心。若豚状。上下无时。久则骨痿少气。宜
安肾丸。地黄膏子丸。八味丸。或茯苓肉桂泽泻苦楝子杜仲玄胡索香附茴香桃仁。
安肾丸
肉桂 桃仁 乌头（各一分） 白蒺藜 巴戟 山药 茯苓 白术 石斛 肉苁蓉 萆 补骨脂（各三分）
蜜丸。每服三钱。盐汤下。
地黄膏子丸
血竭 沉香 木香 广术（泡） 玄胡索 人参 蛤蚧 当归 川芎 白术（土炒） 续断（酒炒）
川楝子（麸炒） 全蝎 茴香 柴胡 没药 青皮 吴茱萸 桂（以上分两无定数随症加减用）
为末。地黄膏子丸。如梧子大。空心温酒下二十丸。日加一丸至三十丸。
扁鹊认为，五脏的病证称为“积”，六腑的病证称为“聚”。积属于阴，所以性质静止；聚属于阳，所以性质变动。静止的病变容易潜伏，而变动的病变容易消散。然而，如果在体表有可征验的表现，就称为“癥”（zhēng）；假借物象而成形的称为“瘕”（jiǎ）。痞塞不通、感觉不适称为“痞”；藏匿于隐蔽部位的称为“癖”。有人说，“癥”主要与饮食有关，而“瘕”主要与血分有关；“痞”主要与气分有关，而“癖”主要与痰饮有关。这四种病证分开来说是可以的，合起来说也没有不可之处。关键在于治疗者，要观察患者脏腑的阴阳属性，病位的高低上下，气血的盛衰，病程的新久深浅，以及元气的强弱浓薄。或者采用十分攻邪、一分补益的方法，或者半攻半补，或者十分补益而不攻邪。掌握确定的策略，然后才能立于不败之地。
近代医家士材（李中梓）提出了初、中、末三期治法，未尝不好，但我对此仍有商榷之处。积聚的形成是逐渐产生的，并非一朝一夕的缘故。如果元气充足，脏腑调和，气血分布周遍，哪里有缝隙容许病邪盘踞？如今积聚确实逼近身体，妨碍了气机的升降往来。正因为它是逐渐萌发的，起初尚且不觉察，日复一日逐渐增大，渐渐发展到猖狂而不可遏制的地步。这时，缓和地攻邪，邪气不去；猛烈地攻邪，邪气也不去。即使暂时去除了，那些聚集的邪气，又会散开并转化为其他病症。大概攻伐积聚的药物，必须经过脏腑肠胃，才能到达病所，其中的清纯之气，能不受到损伤吗？
我确立一种方法：使用攻积丸，层层叠加服用，并用加倍剂量的人参汤来监制（制约药性）。贫穷的人可以用白术膏代替人参。必须使元气胜过邪气，那么邪气自然没有容留之地。否则，专门补益元气，恢复其健运的正常功能，那么所积聚的东西，将不攻自散。这也必须要求患者善于自我珍摄，爱护生命，之后才可以施行这种医术。如果不这样，最终也是无可奈何。
【方剂】攻积丸
组成：人参、京三棱（醋煮）、蓬术（醋煮）、菟丝子（酒煮）、桃仁、当归、香附（醋煮）、黄连（土炒）、青皮（醋炒）、枳实（麸炒）、茯苓、半夏（以上各一两）、炮姜（五钱）、泽泻（七钱）、肉桂（一两，忌见火）。
制法与用法：以上药物研为细末，用神曲糊丸。浓煎人参汤送服。每次服用二钱，不拘时间服用。
1. 肝脏的积证称为“肥气”。部位在左胁下，形状像倒扣的杯子，伴有呕吐逆气、胁痛，牵引小腹。适宜采用扶脾抑肝的方法。
【方剂】逍遥散
加减：加入连制吴茱萸、醋制鳖甲、青皮、抚芎（川芎的一种）、桃仁，以破血散结。
2. 肺脏的积证称为“息奔”。部位在右胁下，形状像倒扣的杯子，伴有气逆、背痛、喘咳。适宜用人参、茯苓、广皮（陈皮）、苏子、款冬花、半夏、旋复花、桔梗、炙甘草。兼有脾弱时，用六君子汤以补益脾土（培土生金）。
3. 心脏的积证称为“伏梁”。起于脐上，大如手臂，向上延伸至心下，伴有心烦。适宜用人参、川连（黄连）、远志、石菖蒲、茯神、肉桂、柏子仁、丹参、干姜。
4. 脾脏的积证称为“痞气”。位于胃脘部，大如倒扣的杯子，伴有痞塞感、吐泻，导致形体消瘦（不为肌肤）。适宜用四君子汤加麸炒枳实、山楂、炮姜、藿香、黄连、蓬术、神曲、麦芽。
5. 肾脏的积证称为“奔豚”。结块在少腹部，向上延伸至心部，形状像小猪奔跑状，上下移动无定时。日久则导致骨痿、少气。适宜用安肾丸、地黄膏子丸、八味丸。或者选用茯苓、肉桂、泽泻、苦楝子、杜仲、玄胡索、香附、茴香、桃仁等药组方。
【方剂】安肾丸
组成：肉桂、桃仁、乌头（以上各一分）、白蒺藜、巴戟天、山药、茯苓、白术、石斛、肉苁蓉、萆薢、补骨脂（以上各三分）。
制法与用法：炼蜜为丸。每次服用三钱，盐汤送下。
【方剂】地黄膏子丸
组成：血竭、沉香、木香、广术（泡制）、玄胡索、人参、蛤蚧、当归、川芎、白术（土炒）、续断（酒炒）、川楝子（麸炒）、全蝎、茴香、柴胡、没药、青皮、吴茱萸、桂枝（以上药物分量不定，随症状加减使用）。
制法与用法：研为细末，用地黄膏制成丸药，大小如梧桐子。空腹时用温酒送服二十丸，每日增加一丸，直至三十丸。
Bian Que stated that pathological accumulations in the five Zang organs are termed "Ji" (Accumulation), while those in the six Fu organs are termed "Ju" (Gathering). Ji belongs to Yin, thus it is static; Ju belongs to Yang, thus it is dynamic. Static conditions are prone to concealment, whereas dynamic conditions are prone to dispersion. However, when there are external manifestations that can be verified, it is called "Zheng" (Mass); when formed by assuming a shape resembling an object, it is called "Jia" (Fluctuating Mass); when accompanied by a sensation of blockage and discomfort, it is called "Pi" (Stagnation/Fullness); and when hidden in obscure locations, it is called "Pi" (Hidden Accumulation). Some say that Zheng primarily relates to food retention, while Jia primarily relates to blood stasis; Pi primarily relates to Qi stagnation, while the hidden Pi primarily relates to Phlegm. It is acceptable to discuss these four conditions separately, and also acceptable to discuss them collectively. The key lies with the practitioner, who must observe the Yin-Yang status of the Zang-Fu organs, the high or low location of the disease, the abundance or scarcity of Qi and Blood, the depth and duration (new vs. old) of the condition, and the strength or weakness of Yuan Qi (Original Qi). Treatment may involve ten parts attacking pathogenic factors and one part tonifying, or half attacking and half tonifying, or ten parts tonifying without any attacking. By grasping a fixed strategy, one can ensure victory.
In recent times, Master Shicai (Li Zhongzi) established methods for the early, middle, and late stages, which are not without merit, but I have further considerations. The formation of Ji and Ju occurs gradually, not overnight. If Yuan Qi is sufficient and the Zang-Fu organs are harmonious, with Qi and Blood distributed evenly throughout, where would there be gaps for pathogens to lodge? Now, if Ji and Ju indeed press upon the body, obstructing the ascending and descending movements of Qi, it is precisely because they sprouted gradually. Initially, this is not felt; day by day, they grow larger, eventually becoming rampant and uncontrollable. At this stage, gentle attacking will not remove the pathogen, nor will aggressive attacking. Even if removed, the gathered pathogens may disperse and transform into other syndromes. Generally, medicines that attack accumulations must pass through the Zang-Fu organs and intestines/stomach to reach the site of the disease; their pure and clear nature inevitably causes some damage [to healthy Qi].
I establish a method: use Gongji Wan (Accumulation-Attacking Pill) repeatedly, supervised by a decoction of Ginseng at double the dose. For the poor, Baizhu Gao (Atractylodes Macrocephala Paste) can substitute for Ginseng. One must ensure that Yuan Qi surpasses the pathogenic factor, so that the pathogen has no place to remain. Otherwise, by exclusively tonifying Yuan Qi and restoring its normal transformative function, the accumulated and gathered masses will disperse without direct attacking. This requires the patient to carefully cherish themselves and protect their life, after which this technique can be applied. If not, ultimately, nothing can be done.
[Gongji Wan]
Ingredients: Renshen (Ginseng Root), Jing Sanleng (Vinegar-processed Rhizoma Sparganii), Pengzhu (Vinegar-processed Rhizoma Curcumae), Tusizi (Wine-processed Semen Cuscutae), Taoren (Peach Seed), Danggui (Angelica Sinensis Root), Xiangfu (Vinegar-processed Rhizoma Cyperi), Huanglian (Earth-fried Rhizoma Coptidis), Qingpi (Vinegar-processed Pericarpium Citri Reticulatae Viride), Zhishi (Bran-fried Fructus Aurantii), Fuling (Poria), Banxia (all 1 liang each), Paojiang (Prepared Ginger, 5 qian), Zexie (Alisma Rhizome, 7 qian), Rougui (Cinnamon Bark, 1 liang, avoid fire).
Preparation and Administration: Grind the above ingredients into powder, form pills using Shenqu (Medicated Leaven). Take with a strong decoction of Renshen. Dosage: 2 qian per time, taken at any time.
1. The accumulation of the Liver is called "Feiqi". Location: Under the left hypochondrium, shaped like an inverted cup. Symptoms: Vomiting and regurgitation, hypochondriac pain radiating to the lower abdomen. Treatment Principle: Support Spleen and suppress Liver.
Formula: Xiaoyao San (Free and Easy Wanderer Powder).
Modifications: Add Lianzhi Wuzhuyu (Processed Evodia Fruit), CuZhi Biejia (Vinegar-processed Carapax Testudinis), Qingpi, Fuxiong (Chuanxiong), and Taoren to break blood stasis.
2. The accumulation of the Lung is called "Xiben". Location: Under the right hypochondrium, shaped like an inverted cup. Symptoms: Reverse flow of Qi, back pain, wheezing and cough. Treatment: Use Renshen, Fuling, Guangpi (Chenpi), Su Zi, Kuandonghua, Banxia, Xuanfuhua, Jiegeng, and Zhi Gancao. If accompanied by Spleen deficiency, use Liujunzi Tang (Six Gentlemen Decoction) to tonify the mother organ (Spleen).
3. The accumulation of the Heart is called "Fuliang". Origin: Above the umbilicus, size like an arm, extending up to below the heart. Symptoms: Vexation and irritability. Treatment: Use Renshen, Chuanlian (Huanglian), Yuanzhi, Changpu, Fushen, Rougui, Baiziren, Danshen, and Jiangtang (Shengjiang/Shenggan).
4. The accumulation of the Spleen is called "Piqi". Location: In the epigastrium, size like an inverted cup. Symptoms: Fullness and blockage, vomiting and diarrhea, leading to emaciation. Treatment: Use Sijunzi Tang (Four Gentlemen Decoction) plus Fuchao Zhishi, Shanzha, Paojiang, Huoxiang, Huanglian, Pengzhu, Shenqu, and Maiya.
5. The accumulation of the Kidney is called "Ben Tun". Location: Knots in the lower abdomen, extending up to the heart, resembling a pig running. Movement: Up and down without fixed timing. Long-term effects: Bone萎 (weakness) and shortness of breath. Treatment: Use Anshen Wan, Dihuang Gaozi Wan, or Bawei Wan. Alternatively, use Fuling, Rougui, Zexie, Koushenzi, Duzhong, Xuanshen (Yanhusuo), Xiangfu, Huixiang, and Taoren.
[Anshen Wan]
Ingredients: Rougui, Taoren, Wutou (all 1 fen), Baijili, Bajitian, Shanyao, Fuling, Baizhu, Shihu, Rongzhu, Bibo, Buguzhi (all 3 fen).
Preparation and Administration: Honey pills. Dosage: 3 qian per time, taken with salt water.
[Dihuang Gaozi Wan]
Ingredients: Xuejie, Chenxiang, Muxiang, Guangzhu (Soaked), Xuanshen, Renshen, Gejie, Danggui, Chuanxiong, Baizhu (Earth-fried), Xuduan (Wine-fried), Chuanlianzi (Bran-fried), Quanxie, Huixiang, Chaihu, Moyao, Qingpi, Wuzhuyu, Guizhi (Dosages indefinite, adjust according to symptoms).
Preparation and Administration: Grind into powder, make pills using Dihuang paste (Rehmannia Glutinosa Paste), size similar to wutong seeds. Dosage: Take 20 pills on an empty stomach with warm wine. Increase by one pill daily until reaching 30 pills.