总括 积常有处聚无常， 有明形瘕假肌；四病所生俱是积，身中气血各遭伤。
脉法 小儿脉伏结为物聚。
钱氏曰∶小儿脉沉细为癖积。
脉经曰∶脉来细而附骨者积也。
《内经》曰∶积聚留饮痞膈，中满湿积，霍乱吐下， 瘕坚硬腹满，皆太阳湿土，乃脾胃之气积聚之根也。
丹溪曰∶块乃有形之物，气不能成形，痰与食积死血也。在中为痰饮，在右为食积，在左为死血，治法行气开血为
主。按此大略之言不可大拘也。夫小儿热气蕴于胸膈之间，留饮聚于腰胁之内，由是荣卫不能流行，脏腑不得宣通，胀
满而致癖结，势使然耳！或时发壮热是也。故疟家中脘多蓄黄水，日久而后结癖，寒热不已者，以此大抵脏腑和平，荣
卫调畅则津液自然流通，纵使多饮水浆不能为病，惟乳食失节，三焦关膈，以致水浆停滞，肠胃不得宣行，冷气搏之，
乃结聚而成癖也。治疗之法实则水晶丸下之，候所作形症消尽，便可攻补兼施。《经》云∶大积大聚乃可攻也，衰其半
而止之是也。气弱者先调脾胃，如前下之，若虚甚用三棱散、化癖丸渐消之，顺适阴阳，以平为期，然先补后泻，行迎
夺之法，去其陈寒冷积，若面黄唇白，发竖肌瘦，乃为虚极不可轻下，徐徐用药消化调理为上，古人所谓养正则积自除
也。积症寒热似疟，肚腹疼痛，面黄肌瘦，其候未可作疟治，又不可峻取，亦不可太补。峻取则耗散元气，津液虚损；
太补则积温成热，转生他症。治先发散，调和中气，缓急次序下之，勿伤其胃。
（批∶久疟后腹中有块者宜服藿香正气散，用二陈汤加柴胡葛朴苏青槟果楂，先发散之，然后服鳖甲散治之，然亦
渐加人参之类以保其元气。）
〔附方〕
治疟癖 生地 白芍 陈皮 川芎 黄芩 半夏（以上各一钱） 甘草（五分） 酸炙鳖甲（二钱） 水姜煎
服。
水晶丸 南星 半夏 滑石 益智 巴豆霜
三棱散 见诸吐症内。
化癖丸 陈皮 莪术 三棱 青皮 枳壳 槟榔 白术 丁香 细辛 广木香
藿香正气散 见伤积症。
二陈汤 见诸吐症。
鳖甲散 见疟疾症内。
总括：积块常有固定位置，聚散无常；有的表现为明显的瘕块，有的则似假生于肌肉之中。这四种病症的产生，都是由于身体中的气血各自遭受损伤所致。
《脉经》说：脉搏来势细小且紧贴骨壁者，为积证。
《黄帝内经》说：积聚、留饮、痞膈、中满、湿积、霍乱吐泻、瘕块坚硬伴腹部胀满，这些病证都与太阳湿土有关，乃是脾胃之气积聚的根本原因。
朱丹溪说：肿块是有形的物体，气本身不能形成形状，（肿块）是由痰、食积和死血构成的。位于中焦的是痰饮，位于右侧的是食积，位于左侧的是死血，治疗方法以行气活血为主。按此说是大概之言，不可过分拘泥。小儿热气蕴结于胸膈之间，留饮聚集于腰胁之内，因此营卫之气不能流畅运行，脏腑不得宣通，导致胀满而形成癖结，这是形势使然！有时会出现壮热的症状。所以疟疾患者中脘部多蓄积黄水，日久之后结成癖块，寒热症状不止，大抵是因为脏腑功能平和，营卫调畅，则津液自然流通，即使大量饮水也不会致病；只有乳食失去节制，三焦关膈受阻，导致水浆停滞，肠胃不得宣通运行，冷气搏结，才结聚而成癖块。治疗的方法，实证可用水晶丸攻下，等待形成的形症完全消除后，便可攻补兼施。《内经》说：“大的积聚才可以攻伐”，即衰减到一半时就停止，就是这个道理。气虚者先调理脾胃，如前所述用下法；若虚损严重，用三棱散、化癖丸慢慢消散，顺应并调整阴阳，以平衡为准则。然而应先补后泻，运用迎夺之法，去除陈寒冷积。如果面色发黄、嘴唇苍白、毛发竖立、肌肉消瘦，这是极度虚弱的表现，不可轻易攻下，应徐徐用药消化调理为上策，正如古人所说“养护正气，积块自除”。积证寒热类似疟疾，肚腹疼痛，面色黄、肌肉消瘦，其征候不可当作疟疾治疗，也不可用峻猛之法攻取，同样不可过度进补。峻猛攻取会耗散元气，导致津液虚损；过度进补会使积滞郁而化热，转而产生其他病症。治疗应先发散，调和其中气，按照缓急次序给予下药，不要损伤胃气。
（批注：久疟后腹中有块者宜服用藿香正气散，用二陈汤加柴胡、葛根、厚朴、紫苏、青皮、槟榔、枳壳、山楂，先进行发散治疗，然后服用鳖甲散治疗，但也应逐渐加入人参之类药物以保护元气。）
〔附方〕
治疟癖方：生地、白芍、陈皮、川芎、黄芩、半夏（以上各一钱），甘草（五分），酸炙鳖甲（二钱），加水生姜煎服。
三棱散：见诸吐症篇内。
化癖丸：陈皮、莪术、三棱、青皮、枳壳、槟榔、白术、丁香、细辛、广木香。
二陈汤：见诸吐症篇。
General Principles: Accumulation (Ji) often has a fixed location, whereas Gathering (Ju) is irregular in its appearance and disappearance; some manifest as obvious masses (Jia), while others appear as if falsely generated within the muscles. The generation of these four types of diseases is due to the respective injury of Qi and Blood within the body.
Pulse Diagnosis: A deep, hidden, and knotted pulse in children indicates the presence of accumulated matter.
Qian Yi stated: A deep and fine pulse in children signifies Pi Ji (hidden accumulation).
The Pulse Classic states: A pulse that comes forth thin and adheres closely to the bone indicates an Accumulation (Ji).
The Huangdi Neijing states: Accumulation (Ji), Gathering (Ju), retained fluid (Liu Yin), chest fullness and diaphragm obstruction (Pi Ge), middle jiao fullness, damp accumulation, cholera with vomiting and diarrhea, hard masses (Jia) accompanied by abdominal fullness—all these conditions are related to the Taiyang Damp Earth, which constitutes the root of the accumulation of Spleen and Stomach Qi.
Zhu Danxi stated: Masses are tangible objects; Qi itself cannot form shape. Masses consist of Phlegm, Food Retention, and Dead Blood. Located in the center is Phlegm-Fluid; on the right is Food Retention; on the left is Dead Blood. The treatment method primarily involves promoting Qi circulation and invigorating blood. This is a general statement and should not be rigidly adhered to. Children's heat qi accumulates between the chest and diaphragm, and retained fluids gather within the waist and hypochondrium. Consequently, Ying and Wei Qi cannot circulate freely, and the Zang-Fu organs fail to vent and unblock, leading to distension and the formation of Pi Jie (hidden nodules), which is dictated by the pathological trend! Sometimes, high fever occurs. Thus, in patients with malaria, yellow water often accumulates in the Zhongwan region, forming Pi Jie over time, resulting in persistent alternating chills and fever. Generally, when the Zang-Fu organs are harmonious and Ying and Wei Qi are smooth, body fluids flow naturally; even excessive drinking of water will not cause disease. Only when milk and food intake are irregular, obstructing the Sanjiao and diaphragm, causing stagnation of fluids, preventing the intestines and stomach from venting and circulating, and combined with cold qi clashing, does it coalesce into Pi Jie. For excess patterns, Shuijing Wan (Crystal Pill) can be used for purgation. Once the formed symptoms and signs have completely subsided, simultaneous attack and tonification can be employed. The Classics state: "Only major accumulations may be attacked," meaning one should stop when the pathogen has been reduced by half. For those with weak Qi, regulate the Spleen and Stomach first, using purgatives as previously described; for severe deficiency, use San Leng San (Curcuma Powder) or Hua Pi Wan (Resolve Pi Pill) to gradually dissipate the accumulation, adjusting Yin and Yang until balance is achieved. However, tonification should precede purgation, employing the methods of welcoming and seizing to eliminate chronic cold and stagnant accumulation. If the face is sallow, lips pale, hair stands erect, and muscles are emaciated, this indicates extreme deficiency, and gentle purgation is contraindicated; gradual medication for digestion and regulation is superior, as the ancients said: "Nourish the righteous Qi, and the accumulation will remove itself." Accumulation patterns present with chills and fever resembling malaria, abdominal pain, sallow complexion, and emaciation. These signs should not be treated as malaria, nor should harsh purgatives be used, nor should tonification be excessive. Harsh purgation depletes Yuan Qi and damages body fluids; excessive tonification causes stagnation to transform into heat, generating other syndromes. Treatment should first involve dispersal, then harmonizing the Middle Qi, followed by purgatives according to urgency, without damaging the Stomach Qi.
(Note: For abdominal masses following prolonged malaria, Huoxiang Zhengqi San (Agaric Powder to Rectify the Qi) is suitable. Use Erchen Tang (Two-Cured Decoction) added with Chai Hu (Bupleuri Radix), Ge Gen (Puerariae Radix), Hou Po (Magnoliae Officinalis Cortex), Zi Su Ye (Perillae Folium), Qing Pi (Citri Reticulatae Pericarpium Viride), Bing Lang (Arecae Semen), Zhi Ke (Aurantii Fructus), and Shan Zha (Crataegi Fructus) for initial dispersal, followed by Biejia San (Turtle Shell Powder). Ginseng or similar tonics should be gradually added to preserve Yuan Qi.)
[Attached Formulas]
Formula for Treating Malaria Pi: Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Chen Pi (Citri Reticulatae Pericarpium), Chuan Xiong (Chuanxiong Rhizoma), Huang Qin (Scutellariae Radix), Ban Xia (Pinelliae Rhizoma) (each 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma) (0.5 qian), Suan Zhi Bie Jia (Acid-processed Testudinis Carapax et Plastrum) (2 qian). Decoct with water and fresh ginger, and take orally.
Shuijing Wan (Crystal Pill): Nan Xing (Arisaematis Cum Bile), Ban Xia (Pinelliae Rhizoma), Hua Shi (Talcum), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Ba Dou Shuang (Crotonis Fructus Frost).
San Leng San (Curcuma Powder): See section on various vomiting syndromes.
Hua Pi Wan (Resolve Pi Pill): Chen Pi (Citri Reticulatae Pericarpium), E Zhu (Curcumae Rhizoma), San Leng (Sparganii Rhizoma), Qing Pi (Citri Reticulatae Pericarpium Viride), Zhi Ke (Aurantii Fructus), Bing Lang (Arecae Semen), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ding Xiang (Caryophylli Flos), Xi Xin (Asari Radix et Rhizoma), Guang Mu Xiang (Costi Radix).
Huoxiang Zhengqi San (Agaric Powder to Rectify the Qi): See section on food stagnation syndromes.
Erchen Tang (Two-Cured Decoction): See section on various vomiting syndromes.
Biejia San (Turtle Shell Powder): See section on malaria syndromes.