夫积聚者。由阴阳不和。腑脏虚弱。受于风邪。搏于腑脏之气所为也。腑者阳也。脏者
阴也
聚
者阳气
乃成积
积名曰
脉来
脉出在
气逆。
之状。
身
累累如桃李。起见于外。腹满呕泄肠鸣。四肢重。足胫肿。 不能卧。脾主肌肉损。其色黄。
诊得肝积。其脉弦而细。两胁下痛。邪走心下。足胫寒。胁痛引小腹。男子积疝也。女
瘕聚也。身无膏泽。喜转筋。爪甲枯黑。春瘥秋剧。其色青。诊得肾积。脉沉而急。苦脊与
腰相引。饥则见。饱则减。病腰痛。小腹里急。口干咽肿。赤痛。目视茫茫。骨骨中寒。主
髓喜忘。其色黑。诊心腹积聚。其脉牢强急者生。虚弱急者死。又积聚之脉。实强者生。
沉小者死。
夫肝之积名曰肥气。在左胁下。如覆杯。有头足。久不愈。令人发 疟。连岁月不已。
以仲
肺。
治肥气在左胁下。似覆杯。咽酸吐水。面目萎黄。胸膈不利。宜服蓬 根散方。
蓬 根(二两锉) 牡丹(一两) 赤芍药(一两) 桂心(三分) 京三棱(一两炮
裂) 枳壳
〔二
上件药。捣粗罗为散。每服三钱。水一中盏。入生姜半分。煎至六分。去滓。食前稍热
服。
治肥气在左胁下。结聚成块。心腹妨实。不欲饮食。宜服防葵散方。
防葵(一两) 诃黎勒皮(三分) 白术(三分) 郁李仁(三分汤浸去皮微炒) 吴
茱萸(半
两汤
分)
上件药。捣筛为散。每服三钱。以水一中盏。入生姜半分。煎至六分。去滓。食前稍热
服。
治肥气在左胁下。按之坚。不能食。脉候弦而紧。肌体萎瘦。宜服鳖甲散方。
鳖甲(一两半涂醋炙令黄去裙 ) 当归(一两锉微炒) 京三棱(一两炮锉) 诃黎
勒皮
(一两)
焙干微
炒) 桃
上件药。捣筛为散。每服三钱。水一中盏。入生姜半分。煎至六分。去滓。食前稍热服。
治肥气结聚。在左胁下。坚牢疼痛。食少体瘦。宜服大黄丸方。
川大黄(二两锉碎微炒) 防葵(一两) 木香(三分) 川乌头(一两炮裂去皮脐) 鳖
甲
(一两
上件药。捣细罗为末。以陈米醋三升。熬令稠。入神曲末半两。煎成糊。溶和诸药末。
可丸
治肥气。在左胁下。如覆杯。有头足。令人羸瘦。发寒热。不能食。宜服三棱丸方
。
京三棱(一两) 川乌头(一两炮裂去皮脐) 雄黄(半两细研) 硼砂(一两不夹石
者细锉) 青橘皮(半两汤浸去白瓤焙) 干漆(半两捣碎炒令烟出) 鳖甲(一两涂酥炙
令黄去裙 )
防葵(一两) 麝香(一分研入)
上件药。捣细罗为末。入研了药令匀。以米醋一升。熬令稠。入少面作糊。和丸如绿豆
大。
治肥气。体瘦无力。少思饮食。鳖甲丸方。
鳖甲(一枚可重四两净洗以醋和黄泥固济背上浓三分令干) 京三棱(三两炮锉) 川
大黄
(三
去皮尖
双仁
上件药。除鳖甲外。捣罗为末。后泥一风炉子。上开口。可安得鳖甲。取前药末并桃仁
膏。
去
前
治肥气。结聚不散。腹胁胀满。呕逆酸水。饮食减少。宜服牵牛煎丸方。
牵牛子末(三两以生姜汁半升酒一升慢火熬如膏) 木香(一两) 附子(一两炮裂去
皮脐)
麸炒微黄研
入) 吴茱萸(半两汤浸七遍焙干微炒) 硼砂(一两不夹石者细研入)
上件药。捣细罗为末。入牵牛子。煎中和。溶为丸。如梧桐子大。每服食前。生姜汤下
二十
治肥气。结固不散。腹胁急疼。食少体瘦。宜服三棱煎丸方。
湿三棱(七斤净洗去泥土锉碎) 川大黄(三两) 芫花(一两醋拌炒令干) 鳖甲(三
两涂
醋炙
上件药。先以水二斗。煮三棱至三升。去滓。捣罗诸药为末。入前煎中。于铜器内慢火
熬之
治肥气。经年不散。左胁下状如覆杯。天阴即疼痛。宜服硼砂煎丸方。
硼砂(二两不夹石者细研以酒醋各一升熬如膏) 干漆(一两捣碎炒令烟出) 防葵(一
两)
木
上件药。捣细罗为末。入硼砂煎中。入少蒸饼。和溶为丸。如绿豆大。每日空心。温酒
下十
治肥气积聚不散方。
川大黄(四两锉碎与鳖甲同煮焙干) 木香(二两) 鳖甲(四两以米醋二升与大黄同
煮令
醋尽
上件药。捣细罗为末。以酒煮面糊和丸。如梧桐子大。每日空心。生姜汤下二十丸。
积聚病,是由于阴阳失调、脏腑虚弱,感受风邪,邪气与脏腑之气相搏结而形成的。腑属阳,脏属阴。聚证是阳气运行不畅所致;积证则是阴气凝聚而成。
关于脉象表现:脉来急促者,为气逆之状;脉出在皮肤表面者,多为……(原文此处有脱漏或语意未完,依文意推测为表证或气浮)。
脾主肌肉,若脾受损,则面色发黄。身体出现累累如桃李大小的肿块,突起于体表,伴有腹部胀满、呕吐、腹泻、肠鸣、四肢沉重、足胫浮肿,不能平卧。
诊断肝积(肝脏的积块):脉象弦而细,两胁下疼痛,邪气走窜至心下部,足胫发冷,胁痛牵引小腹。男子患此称为疝气积块,女子患此称为瘕聚积块。身体失去光泽,容易抽筋,指甲枯黑。春季病情缓解,秋季加重,面色青。
诊断肾积(肾脏的积块):脉象沉而急,苦于脊柱与腰部相互牵引作痛,饥饿时症状显现,饱食后减轻。病症表现为腰痛,小腹部拘急,口干咽肿,目赤疼痛,视物模糊,骨髓中感到寒冷,记忆力减退喜忘事。面色黑。
诊断心腹部的积聚病:脉象牢强急有力的预后良好(生),脉象虚弱急迫的预后不良(死)。另外,积聚病的脉象,实而有力的预后良好,沉而细小的预后不良。
肝脏的积块名为“肥气”,位于左胁下,形状像倒扣的杯子,有头有足。久治不愈,会使人发作疟疾,连绵数月不止。
治疗肥气在左胁下,形状似倒扣的杯子,伴有咽酸吐水、面目萎黄、胸膈不利等症状,宜服用蓬根散方。
药材:蓬根(二两,锉碎)、牡丹(一两)、赤芍药(一两)、桂心(三分)、京三棱(一两,炮裂)、枳壳(二两,去瓤,麸炒微黄)。
上列药物,捣成粗散。每次服用三钱,加水一中盏,放入生姜半分,煎至六分,去渣滓。饭前稍热服。
治疗肥气在左胁下,结聚成块,心腹部痞塞充实感,不想饮食,宜服用防葵散方。
药材:防葵(一两)、诃黎勒皮(三分)、白术(三分)、郁李仁(三分,汤浸去皮微炒)、吴茱萸(半两,汤浸七遍焙干微炒)。
上列药物,捣筛为散。每次服用三钱,加水一中盏,放入生姜半分,煎至六分,去渣滓。饭前稍热服。
治疗肥气在左胁下,按之坚硬,不能进食,脉象弦而紧,肌体消瘦,宜服用鳖甲散方。
药材:鳖甲(一两半,涂醋炙令黄色,去裙边)、当归(一两,锉碎微炒)、京三棱(一两,炮裂锉碎)、诃黎勒皮(一两)、干姜(一两,焙干微炒)、桃仁(一两,汤浸去皮尖双仁,麸炒微黄)。
上列药物,捣筛为散。每次服用三钱,加水一中盏,放入生姜半分,煎至六分,去渣滓。饭前稍热服。
治疗肥气结聚,在左胁下,坚牢疼痛,食少体瘦,宜服用大黄丸方。
药材:川大黄(二两,锉碎微炒)、防葵(一两)、木香(三分)、川乌头(一两,炮裂去皮脐)、鳖甲(一两,涂醋炙令黄色,去裙边)。
上列药物,捣细罗为末,用陈米醋三升,熬至稠厚,加入神曲末半两,煎成糊状,溶和诸药末,制成梧桐子大的丸剂。
治疗肥气,在左胁下,如倒扣的杯子,有头有足,使人羸瘦,发作寒热,不能进食,宜服用三棱丸方。
药材:京三棱(一两)、川乌头(一两,炮裂去皮脐)、雄黄(半两,细研)、硼砂(一两,不夹石者,细锉)、青橘皮(半两,汤浸去白瓤焙)、干漆(半两,捣碎炒令烟出)、鳖甲(一两,涂酥炙令黄色,去裙边)、防葵(一两)、麝香(一分,研入)。
上列药物,捣细罗为末,加入已研好的药令均匀,用米醋一升,熬至稠厚,加入少量面粉作糊,调和制成绿豆大的丸剂。
治疗肥气,身体瘦弱无力,思食减少,宜服用鳖甲丸方。
药材:鳖甲(一枚,重约四两,净洗,以醋和黄泥固济背上,厚三分,令干)、京三棱(三两,炮锉)、川大黄(三两,锉碎,酒浸,蒸从辰至酉,去皮尖)、桃仁(一两,汤浸去皮尖双仁,麸炒微黄)。
上列药物,除鳖甲外,捣罗为末。另取一个风炉子,上面开口,可安放鳖甲。将前药末并桃仁膏……(原文此处有脱漏,意指将药末填入处理过的鳖甲内或配合使用,具体制法略)。
治疗肥气,结聚不散,腹胁胀满,呕逆酸水,饮食减少,宜服用牵牛煎丸方。
药材:牵牛子末(三两,以生姜汁半升、酒一升慢火熬如膏)、木香(一两)、附子(一两,炮裂去皮脐,麸炒微黄研入)、吴茱萸(半两,汤浸七遍焙干微炒)、硼砂(一两,不夹石者细研入)。
上列药物,捣细罗为末,加入牵牛子煎膏中和,溶为丸,如梧桐子大。每次饭前,生姜汤送下二十丸。
治疗肥气,结固不散,腹胁急疼,食少体瘦,宜服用三棱煎丸方。
药材:湿三棱(七斤,净洗去泥土锉碎)、川大黄(三两)、芫花(一两,醋拌炒令干)、鳖甲(三两,涂醋炙令黄色,去裙边)。
上列药物,先以水二斗,煮三棱至三升,去渣滓,捣罗诸药为末,加入前面的煎液中,在铜器内慢火熬之……(原文此处有脱漏,意指熬制成丸)。
治疗肥气,经年不散,左胁下状如倒扣的杯子,天阴即疼痛,宜服用硼砂煎丸方。
药材:硼砂(二两,不夹石者细研,以酒醋各一升熬如膏)、干漆(一两,捣碎炒令烟出)、防葵(一两)、木香(一两)。
上列药物,捣细罗为末,加入硼砂煎膏中,加入少量蒸饼,和溶为丸,如绿豆大。每日空心,温酒送下十丸。
治疗肥气积聚不散方。
药材:川大黄(四两,锉碎与鳖甲同煮焙干)、木香(二两)、鳖甲(四两,以米醋二升与大黄同煮令醋尽)。
上列药物,捣细罗为末,以酒煮面糊和丸,如梧桐子大。每日空心,生姜汤送下二十丸。
Accumulation and mass disorders arise from the disharmony of Yin and Yang, weakness of the Zang-Fu organs, invasion by Wind pathogenic factors, and the contention between pathogenic factors and Qi within the Zang-Fu organs. Fu organs belong to Yang; Zang organs belong to Yin. Ju (Mass) disorders result from the dysfunction of Yang Qi; Ji (Accumulation) disorders result from the condensation of Yin Qi.
Regarding pulse manifestations: A rapid pulse indicates rebellious Qi; a pulse emerging at the skin surface suggests... [text incomplete].
The Spleen governs muscles. If the Spleen is damaged, the complexion appears yellow. Lumps resembling peaches or plums appear on the body surface, accompanied by abdominal fullness, vomiting, diarrhea, borborygmus, heaviness of the four limbs, edema of the lower legs and shins, and an inability to lie flat.
Diagnosis of Liver Accumulation (Liver Mass): The pulse is wiry and thin. There is pain in both hypochondriac regions, with pathogenic factors radiating to the epigastrium. The lower legs and shins are cold. Hypochondriac pain radiates to the lower abdomen. In men, this is termed Hernia Accumulation; in women, it is termed Jia-Mass Accumulation. The body lacks luster, spasms are prone to occur, and the nails become dry and black. The condition improves in Spring and worsens in Autumn. The complexion is cyan.
Diagnosis of Kidney Accumulation (Kidney Mass): The pulse is deep and urgent. The patient suffers from牵引 (pulling) pain between the spine and waist. Symptoms manifest when hungry and subside when full. The disease presents as lower back pain, urgency and tightness in the lower abdomen, dry mouth, swollen throat, red and painful eyes, blurred vision, coldness in the bones and marrow, and forgetfulness. The complexion is black.
Diagnosis of Accumulations and Masses in the Heart and Abdomen: A firm, strong, and urgent pulse indicates survival (good prognosis); a weak and urgent pulse indicates death (poor prognosis). Furthermore, for accumulation and mass disorders, a solid and forceful pulse indicates survival, while a deep and small pulse indicates death.
The accumulation of the Liver is named "Fei Qi" (Fat Qi). It is located under the left hypochondrium, shaped like an inverted cup, with distinct head and foot structures. If not cured for a long time, it causes Malaria (Nue), persisting for months.
Treatment for Fei Qi located under the left hypochondrium, shaped like an inverted cup, accompanied by sour regurgitation, vomiting of water, sallow complexion, and chest/diaphragm discomfort, is appropriate with Peng Gen San Formula.
Ingredients: Radix Bupleuri (Penggen, 2 liang, crushed), Cortex Moutan (1 liang), Radix Paeoniae Rubra (1 liang), Ramulus Cinnamomi (3 fen), Rhizoma Sparganii (Jingsanleng, 1 liang, processed), Fructus Aurantii (Zhike, 2 liang, pith removed, stir-fried with bran until slightly yellow).
Process: The above ingredients are pounded into a coarse powder. Take 3 qian per dose, add one zhong of water and half a fen of fresh ginger, decoct until six parts remain, strain, and take warm before meals.
Treatment for Fei Qi located under the left hypochondrium, forming a lump, with epigastric/abdominal fullness and oppression, and loss of appetite, is appropriate with Fang Kui San Formula.
Ingredients: Radix Saposhnikoviae (Fang Kui, 1 liang), Pericarpium Terminaliae Chebulae (Helilepi, 3 fen), Rhizoma Atractylodis Macrocephalae (Baizhu, 3 fen), Semen Pruni Persicae (Yuliren, 3 fen, soaked in water, skin removed, stir-fried slightly), Fructus Evodiae (Wuzhuyu, 0.5 liang, soaked in water seven times, dried, stir-fried slightly).
Process: The above ingredients are pounded and sifted into a powder. Take 3 qian per dose, add one zhong of water and half a fen of fresh ginger, decoct until six parts remain, strain, and take warm before meals.
Treatment for Fei Qi located under the left hypochondrium, hard upon palpation, inability to eat, wiry and tight pulse, and emaciation, is appropriate with Bie Jia San Formula.
Ingredients: Carapax et Plastrum Testudinis (Biejia, 1.5 liang, coated with vinegar, roasted until yellow, skirt removed), Radix Angelicae Sinensis (Danggui, 1 liang, crushed, stir-fried slightly), Rhizoma Sparganii (Jingsanleng, 1 liang, processed and crushed), Pericarpium Terminaliae Chebulae (Helilepi, 1 liang), Rhizoma Zingiberis Preparatum (Ganjiang, 1 liang, dried and stir-fried slightly), Semen Pruni Persicae (Taoren, 1 liang, soaked in water, skin and tip removed, double kernels, stir-fried slightly with bran).
Process: The above ingredients are pounded and sifted into a powder. Take 3 qian per dose, add one zhong of water and half a fen of fresh ginger, decoct until six parts remain, strain, and take warm before meals.
Treatment for Fei Qi accumulation, located under the left hypochondrium, hard and painful, with reduced food intake and emaciation, is appropriate with Da Huang Wan Formula.
Ingredients: Radix et Rhizoma Rhei (Chuan Dahuang, 2 liang, crushed, stir-fried slightly), Radix Saposhnikoviae (Fang Kui, 1 liang), Radix Aucklandiae (Muxiang, 3 fen), Radix Aconiti Lateralis Preparata (Chuan Wutou, 1 liang, processed, skin and umbilicus removed), Carapax et Plastrum Testudinis (Biejia, 1 liang, coated with vinegar, roasted until yellow, skirt removed).
Process: The above ingredients are pounded into fine powder. Add three sheng of aged rice vinegar, boil until thick. Add half a liang of endophytum powder (Shenqu), boil into a paste, mix with the herbal powders, and form pills the size of paulownia seeds.
Treatment for Fei Qi, located under the left hypochondrium, like an inverted cup with head and foot, causing emaciation, alternating chills and fever, and inability to eat, is appropriate with Sanleng Wan Formula.
Ingredients: Rhizoma Sparganii (Jingsanleng, 1 liang), Radix Aconiti Lateralis Preparata (Chuan Wutou, 1 liang, processed, skin and umbilicus removed), Realgar (Xionghuang, 0.5 liang, finely ground), Borax (Pengsha, 1 liang, pure, finely crushed), Exocarpium Citri Reticulatae Viride (Qingjupi, 0.5 liang, soaked in water, white pith removed, dried), Resina Draconis (Ganqi, 0.5 liang, crushed, stir-fried until smoke emerges), Carapax et Plastrum Testudinis (Biejia, 1 liang, coated with butter, roasted until yellow, skirt removed), Radix Saposhnikoviae (Fang Kui, 1 liang), Moschus (Shexiang, 1 fen, ground and added).
Process: The above ingredients are pounded into fine powder, mixed evenly with the ground substances. Add one sheng of rice vinegar, boil until thick. Add a little flour to make a paste, mix, and form pills the size of mung beans.
Treatment for Fei Qi, characterized by physical weakness and fatigue, and poor appetite, is appropriate with Bie Jia Wan Formula.
Ingredients: Carapax et Plastrum Testudinis (Biejia, one piece, approx. 4 liang, cleaned, sealed with vinegar and yellow mud on the back, thickness 3 fen, dried), Rhizoma Sparganii (Jingsanleng, 3 liang, processed and crushed), Radix et Rhizoma Rhei (Chuan Dahuang, 3 liang, crushed, soaked in wine, steamed from Chen hour to You hour, skin and tip removed), Semen Pruni Persicae (Taoren, 1 liang, soaked in water, skin and tip removed, double kernels, stir-fried slightly with bran).
Process: Except for Biejia, pound and sieve the other ingredients into powder. Prepare a wind stove with an opening on top to place the Biejia. Combine the herbal powders with Tao Ren paste... [text incomplete regarding specific preparation method].
Treatment for Fei Qi, accumulated and not dispersing, with abdominal and hypochondriac distension, acid regurgitation, and reduced diet, is appropriate with Qianniu Jian Wan Formula.
Ingredients: Pulvis Semen Kochiae (Qianniuzi Mo, 3 liang, boiled with half a sheng of fresh ginger juice and one sheng of wine over slow fire until paste-like), Radix Aucklandiae (Muxiang, 1 liang), Radix Aconiti Lateralis Preparata (Fuzi, 1 liang, processed, skin and umbilicus removed, stir-fried with bran until slightly yellow, ground and added), Fructus Evodiae (Wuzhuyu, 0.5 liang, soaked in water seven times, dried, stir-fried slightly), Borax (Pengsha, 1 liang, pure, finely ground and added).
Process: Pound the ingredients into fine powder, mix with the Qianniu paste, melt, and form pills the size of paulownia seeds. Take 20 pills before meals, washed down with ginger soup.
Treatment for Fei Qi, firmly accumulated and not dispersing, with acute abdominal and hypochondriac pain, reduced food intake, and emaciation, is appropriate with Sanleng Jian Wan Formula.
Ingredients: Fresh Rhizoma Sparganii (Shi Sanleng, 7 jin, cleaned, dirt removed, crushed), Radix et Rhizoma Rhei (Chuan Dahuang, 3 liang), Flos Genkwaniae (Yuanhua, 1 liang, mixed with vinegar, stir-fried until dry), Carapax et Plastrum Testudinis (Biejia, 3 liang, coated with vinegar, roasted until yellow, skirt removed).
Process: First, boil the Sanleng in two dou of water until reduced to three sheng. Strain. Pound the remaining herbs into powder, add to the previous decoction, and slowly boil in a copper vessel... [text incomplete regarding final pill formation].
Treatment for Fei Qi, persisting for years without dispersing, located under the left hypochondrium like an inverted cup, painful during cloudy weather, is appropriate with Pengsha Jian Wan Formula.
Ingredients: Borax (Pengsha, 2 liang, pure, finely ground, boiled with one sheng of wine and one sheng of vinegar until paste-like), Resina Draconis (Ganqi, 1 liang, crushed, stir-fried until smoke emerges), Radix Saposhnikoviae (Fang Kui, 1 liang), Radix Aucklandiae (Muxiang, 1 liang).
Process: Pound the ingredients into fine powder, add to the Pengsha paste, add a little steamed dough, mix, melt, and form pills the size of mung beans. Take 10 pills daily on an empty stomach, washed down with warm wine.
Treatment for Fei Qi accumulation and mass not dispersing.
Ingredients: Radix et Rhizoma Rhei (Chuan Dahuang, 4 liang, crushed, boiled together with Biejia and dried), Radix Aucklandiae (Muxiang, 2 liang), Carapax et Plastrum Testudinis (Biejia, 4 liang, boiled with two sheng of rice vinegar together with Dahuang until vinegar is exhausted).
Process: Pound the ingredients into fine powder. Use wine-boiled wheat gluten paste to form pills the size of paulownia seeds. Take 20 pills daily on an empty stomach, washed down with ginger soup.