经云。寒气客于小肠膜原之间。络血之中。血涩不得注于大经。血气稽留不得行。故宿昔而
成积矣。
有身体髀股 皆肿。环脐而痛。名曰伏梁。此风根也。其气溢于大肠而着于肓。肓之原在脐
下。故环脐而痛也。不可动之。动之为水溺涩之病。
病胁下满气逆。二三岁不已。名曰息积。此不妨于食。不可灸刺。积为导引服药。药不能独治也。
按息积乃气息痞于胁下。不在脏腑营卫之间。积久成形。气不干胃。故不妨于食。
妇人重身。大积大聚。毒可犯也。衰其大半而止。过乃死。
肠覃。寒气客于肠外。与卫气相搏。气不得营。因有所系。癖而内着。恶气乃起。 肉乃生。
其始生也。大如鸡卵。稍以益大。至其成如怀子之状。久者离岁。按之则坚。推之则移。月事以
时下。此其候也。
石瘕。生于胞中。寒气客于子门。子门闭塞。气不得通。恶血当泻不泻。 以留止。日以益
大。状如怀子。月事不以时下。皆生于女子。可导而下。
金匮云。奔豚病。从少腹起上冲咽喉。发作欲死。复还止。皆从惊恐得之。
惊则伤心。恐则伤肾。心伤气虚。而肾邪乘之。从少腹起上冲咽喉。肾脉所循之处也。其水
邪逆上凌心。故发作欲死。少顷邪退还止也。
奔豚。气上冲胸。腹痛。往来寒热。奔豚汤主之。
气上冲胸腹痛者。阴邪上逆也。往来寒热者。邪正交争也。奔豚虽曰肾积。而实冲脉为患。
冲主血。故以芎、归、芍、草、苓、半、生姜散其坚积之瘀。葛根以通津液。李根以降逆气。并
未尝用少阴药也。设泥奔豚为肾积而用伐肾之剂则谬矣。即使果有水气凌心。不过桂、苓之类。
千金成法可师。不必如东垣奔豚丸之用巴豆、乌、附等耗水伤津药也。
心胸中大寒。痛呕不能饮食。腹中寒。上冲皮起。出见有头足。上下痛而不可触近。大建中汤主之。
大寒填塞于胸膈之间。不能出纳。是以痛呕不能饮食也。腹中有寒。则汁沫溢于肠胃之外。
是以上冲皮起。出见有头足。痛不可触。乃有形之积。聚于空郭之间。故当大建其中。使邪不敢
内干于藏也。干姜、人参、胶饴大温补其中土。蜀椒补心气而散胸中之寒。又能消皮肤中之阴聚。
总取其辛散耳。
胁下偏痛发热。其脉紧弦。此寒也。以温药下之。宜大黄附子汤。
胁下偏痛发热。其脉紧弦。寒在厥阴少阴之分也。邪在下。当从下解。然寒邪之在阴分。故
当以温药下之。附子驱少阴之寒。细辛达厥阴之气。用大黄通泄其积。此寒热并施之妙用也。
寒气厥逆。赤丸主之。
寒气逆于上下。则阴阳之气不相顺接。是以厥逆而不知也。乌头驱上逆之寒。茯苓导心气下
降。细辛发肾气上升。半夏散寒饮结聚。真朱为色。有坎离相生之义。世俗以乌、半相反。殊失
此方之奥。
难经云。气之所积名曰积。气之所聚名曰聚。故积者五脏所生。其始发有常处。其痛不离其
部。上下有所终始。左右有所穷处。聚者六腑所成。其始发无根本。上下无所留止。其痛无常处。
肝之积。名曰肥气。在左胁下。心之积。名曰伏梁。在脐上。上至心下。脾之积。名曰痞气。在
胃脘。肺之积。名曰息贲。在右胁下。肾之积。名曰贲豚。发于少腹上至心下。若豚状。或上或
下无时。 者。按之应手。亦如五积之不移。瘕者。假物成形。如血鳖石瘕之类。 者。皮浓也。
在肌肉之间而可见者也。癖者。僻也。内结于隐僻。外不得见者也。
李士材曰。按积之成也。正气不足。而后邪气踞之。然攻之太急。正气转伤。国中末之三法。
不可不讲也。初者病邪初起。正气尚强。邪气尚浅。则任受攻。中者受病渐久。邪气较深。正气
较弱。任受且攻且补。末者病根经久。邪气侵凌。正气消残。则任受补。盖积之为义。日积月累。
匪朝伊芳夕。所以去之亦当有渐。太急则伤正气。正伤则不能运化。而邪反固矣。余尝用阴阳攻积
丸通治阴阳二积。药品虽峻。用之有度。补中数日。然后攻伐。不问其积去多少。又与补中。待
其神壮而复攻之。屡攻屡补。以平为期。经曰。大积大聚。毒可犯也。衰其大半而止。过者死。
故去积及半。纯与甘温调养。使脾土健运。则破残之余积。不攻自走。必欲攻之无余。其不遗人
夭殃者鲜矣。经曰。壮者气行则已。怯者则着而成病。洁古云。壮人无积。惟虚人则有之。皆由
脾胃怯弱。气血两衰。四气有感。皆能成积。若遽以磨坚破积之药治之。疾似去而人已衰。药过
则依然。气愈消。痞愈大。竟何益哉。善治者。当先补虚。使血气壮。积自消也。不问何藏。先
调其中。使能饮食。是其本也。虽然。此为轻浅者言耳。若夫大积大聚。不搜而逐之。日进补养。
无益也。审如何经受病。何物成积。见之既确。发直入之兵以讨之。何患其不愈。兵法曰。善攻
者。敌不知其所守。是亦医中之良将也夫。
五积六聚。随气上下。发作有时。心腹 痛。上气窒塞。小腹满大。小便不利。大七气汤用铁洛
饮煎服。形羸气弱者禁用。有饮癖结成块。在胁腹之间。病类积聚。用破块药多不效。此当行其
饮。六君子合五苓散最妙。更加旋复、前胡、枳实、白芍。即海藏五饮汤。若在膜外者。宜导痰
汤主之。何以知其饮。其人先曾病瘥。口吐涎沫清水。或素多痰者是也。又多饮人。结成酒癖。
肚腹积块。胀急疼痛。或全身肿满。肌黄食少。宜大七气汤红酒煎服。腹中似若瘕癖。随气上下。
未有定处。二陈加当归、杏仁、桂心、槟榔。名散聚汤。若气作痛。游走心腹间。攻刺上下如雷
鸣。或已成积。或未成积。宜木香通气散。肉积妨碍饮食。四味阿魏丸。石瘕。利血通经汤。不
应。见 丸。虚人。十全大补汤送下。肠覃。阿魏麝香散。伏梁环脐而痛。金匮三物大建中汤加
桂、苓。息积气逆而不妨于食。内服三因化气散。外用良方阿魏膏。此膏熨贴一切痞积并效。食
鱼鳖成痞。雌 丸。疟痞寒热。阿魏化痞散。乔氏阴阳攻积丸。可代东垣五积诸方。局方。治七
种癖块。五种癫病。十种疰忤。七种飞尸。十二种蛊毒。五种黄病。十二种疟疾。十种水病。八
种大风。十二种 痹。及五脏滞气壅闭。心腹胀满。诸蛊积聚。时定时发。十年二十年不瘥者。
千金耆婆万病丸悉主之。好食茶叶成癖。面黄少力者。用椒红二两。茶叶一两为末。飞罗面炒香。
打糊为丸。茶清送下三十丸。又方。苦草二两。加茶叶一两。如好食米谷土炭纸布之类。即以其
物加入。并用其物煮汤送下。疟痞丹方。月明净雄黄。醋煮研细。神曲为丸。空心温酒送下四五
分。勿令间断。消尽乃止。血积。桃仁、穿山甲。干漆、大黄、虻虫。瘀血。蓬术、瓦垄子。痰
积。半夏、南星。白术、枳实、礞石、硝石、风化硝、白芥子。老痰。海石、蛤粉。水积。大戟、
甘遂、荛花、芫花。酒积。干葛、神曲、砂仁、豆蔻、黄连、干姜、甘遂、牵牛、茶积。姜黄、
茱萸、椒、姜。癖积。三棱、蓬术、巴霜、大黄。肉积。山楂、阿魏、硝石。
虫积。雄黄、锡灰、槟榔、雷丸、芜荑、使君子、鹤虱。疟积。桃仁、鳖甲、草果。
〔诊〕脉来细而附骨者。积也。积脉坚强者生。虚弱者死。沉而有力为积。沉紧者为寒积。脉
弦而牢积聚。弦而伏者。腹中有 。不可转也。不治。小沉而实者。胃中有积聚。不下食。食即
吐。脉沉重而中散者。因寒食成 。脉左转而沉重者。气 结在胸中。右转出不至寸口者。内有
肉也。
喻嘉言治一人。少腹脐傍三块。坚硬如石。以手拊之痛不可忍。其脉止两尺洪盛。余俱微细。
此由见块医块。不究其源而误治也。初起时块必不坚。以峻猛之药攻之。致真元内乱。转助邪为
害。故迸紧不散。其实全是空气聚成。非如女子月经。凝而不行。即成血块之比。观两尺脉洪盛。
明是肾气传于膀胱。姑用补中药一剂。以通中下之气。后用大剂药。内收肾气。外散膀胱。先以
理中汤加附子五分。块减十之三。再用桂、附大剂。腹中奔气响甚。三块一时顿没。更用补肾药
加桂、附调理而愈。
顾晋封夫人患痞在胁下。或令用膏药。加阿魏一分。麝香半分贴之。五六日间。遂下鲜血血
块甚多。二三日方止。是后每岁当贴膏时。必发。近邻妪亦用阿魏膏贴痞。下血如前。世以阿魏、
麝香为痞块必用之药。外用为患若此。况服食乎。因为拈出。以为虚人漫用攻击之戒。
《黄帝内经》说：寒气侵入小肠的膜原之间，络脉的血中，血液凝涩不能注入大经脉，气血停滞不能运行，所以经过很长时间就形成了积聚。
有的患者身体、大腿和股部都肿胀，围绕肚脐疼痛，名叫伏梁。这是风邪留下的病根。风气溢于大肠，并附着在肓膜上。肓膜的根源在脐下，所以会出现围绕肚脐疼痛的症状。这种病不可用攻下法治疗，如果误用攻下法，就会导致小便不利或排尿困难的病症。
有的患者胁下胀满，气机上逆，两三年不愈，名叫息积。这并不影响进食，不可用灸法和针刺治疗。对于积聚，应采用导引术配合服药的方法，因为药物不能单独治愈此病。
按语：息积是由于气息痞塞于胁下，不在脏腑营卫之间，积聚日久形成形体，但气机不干扰胃腑，所以不影响进食。
妇女怀孕时，如果有大的积聚，可以使用有毒的药物进行治疗。但要等到病势消退大半时就停止，如果过度攻伐会导致死亡。
肠覃（一种腹部肿块），寒气侵入肠外，与卫气相搏结，气机不能正常营运，因而有所羁绊，癖积内着，恶气于是产生，息肉于是生长。它刚开始生成时，大小如鸡蛋，逐渐增大，直到长成像怀孕一样的形状，病程长的可达数年，按压时感觉坚硬，推动时可以移动，月经仍然按时来潮，这就是它的征候。
石瘕（女性腹内肿块），生于胞宫之中。寒气侵入子门（子宫口），子门闭塞，气机不能通畅，恶血应当排出却未能排出，因而留滞体内，一天天增大，形状像怀孕一样，月经不能按时来潮。这些病都发生在女子身上，可以用导引及泻下的方法治疗。
《金匮要略》说：奔豚病，从少腹向上冲至咽喉，发作时痛苦欲死，过后又自行缓解停止。这都是由于惊恐引起的。
惊则伤心，恐则伤肾。心受伤导致气虚，而肾邪乘虚侵袭，从少腹向上冲至咽喉，这是肾经循行的部位。肾中的水邪逆上凌犯心火，所以发作时痛苦欲死，片刻后邪气退还便停止了。
气上冲胸、腹痛，是阴邪上逆的表现；往来寒热，是邪正交争的表现。奔豚虽然被称为肾积，但实际上是冲脉为患。冲脉主血，所以方中使用川芎、当归、白芍、甘草、茯苓、半夏、生姜来消散坚积之瘀血，葛根以通利津液，李根白皮以降逆气，并没有使用少阴经的药物。如果拘泥于奔豚是肾积而使用伐肾的药物，那就错了。即使确实有水气凌心的情况，也不过是用桂枝、茯苓之类的药物即可。千金方的成法值得效法，不必像李东垣奔豚丸那样使用巴豆、乌头、附子等耗伤津液的药物。
心胸中大寒，疼痛呕吐不能饮食，腹中寒冷，寒气上冲皮肤，突起如头足状，上下疼痛且不可触碰，用大建中汤主治。
大寒填塞于胸膈之间，不能出纳，所以出现疼痛、呕吐、不能饮食。腹中有寒，则津液沫溢出肠胃之外，所以上冲皮肤，突起如头足状，疼痛不可触碰。这是有形的积滞，聚于空郭（腹腔）之间，所以应当大补其中焦，使邪气不敢向内侵犯脏腑。干姜、人参、饴糖大温补中土，蜀椒补心气并散胸中之寒，又能消除皮肤中的阴聚，总体取其辛散的作用。
胁下偏侧疼痛伴发热，脉象紧弦，这是寒证，应用温药攻下，宜用大黄附子汤。
胁下偏侧疼痛伴发热，脉象紧弦，说明寒邪在厥阴、少阴之分。邪气在下，应当从下面解决。然而寒邪在阴分，所以应当用温药攻下。附子驱除少阴之寒，细辛通达厥阴之气，大黄通泄积滞，这是寒热并用的妙处。
寒气逆乱于上下，阴阳之气不相顺接，所以出现厥逆而不省人事。乌头驱散上逆之寒，茯苓引导心气下降，细辛激发肾气上升，半夏散寒饮之结聚，真朱（辰砂）有色泽，蕴含坎离相生之义。世俗认为乌头与半夏相反，特别误解了此方的奥妙。
《难经》说：气停留不散叫作“积”，气聚集叫作“聚”。所以积是由五脏产生的，初发时有固定部位，疼痛不离其部位，上下有始有终，左右有尽头；聚是由六腑形成的，初发时无根本，上下无所停留止息，疼痛无常处。
肝之积，名叫肥气，在左胁下；心之积，名叫伏梁，在脐上，上至心下；脾之积，名叫痞气，在胃脘；肺之积，名叫息贲，在右胁下；肾之积，名叫贲豚，发于少腹，上至心下，像小猪奔跑的样子，有时上行有时下行，没有定时。廪者，按压时应手，也像五积一样不移位。瘕者，假借物成形，如血鳖、石瘕之类。廪者，皮厚也，在肌肉之间而可见。癖者，僻也，内结于隐僻之处，外表看不见。
李士材说：积聚的形成，是因为正气不足，然后邪气占据它。然而攻伐太急，正气反而受损。初、中、末三法，不可不讲。初期病邪刚起，正气尚强，邪气尚浅，则可以承受攻伐；中期患病渐久，邪气较深，正气较弱，可以边攻边补；末期病根经久，邪气侵凌，正气消残，则可以承受补益。积聚的意义在于日积月累，并非朝夕之间形成，所以去除它也应当循序渐进。太急则会损伤正气，正气受损则不能运化，邪气反而固结。我曾经用阴阳攻积丸通治阴阳二积，药品虽峻猛，但使用有度，先补中数日，然后攻伐，不问积聚去除了多少，再给予补益，等待其神气壮实后再行攻伐，屡攻屡补，以平和为准则。经文说：大积大聚，毒可犯也，衰其大半而止，过度会致死。所以去除积聚一半后，纯用甘温调养，使脾土健运，那么剩下的残余积聚，不攻自走。一定要攻尽无余，很少有不给人带来夭折祸殃的。经文说：壮者气行则已，怯者则着而成病。洁古说：壮人无积，只有虚人则有之，都是由脾胃怯弱，气血两衰，四气有感，都能成积。如果急于用磨坚破积的药治疗，疾病似乎去了，但人已衰弱，药过之后依然如故，气更消，痞更大，究竟有什么益处呢？善于治疗的人，应当先补虚，使血气壮实，积聚自然消除。不论何脏，先调和中焦，使其能饮食，这是根本。虽然如此，这是针对轻浅者而言。如果是大积大聚，不搜逐它，只每天进补养，也没有益处。审察是哪经受病，什么物质成了积聚，看得既确切，就直接出兵讨伐，还担心治不好吗？兵法说：善攻者，敌不知其所守，这也是医家中的良将啊。
五积六聚，随气上下，发作有时，心腹疼痛，上气窒塞，小腹满大，小便不利，用大七气汤，以铁落饮煎服。形体羸弱、气虚者禁用。有饮癖结成块，在胁腹之间，病类似积聚，用破块药多无效，这应当行其饮邪，六君子汤合五苓散最妙，再加旋覆花、前胡、枳实、白芍，就是海藏的五饮汤。如果在膜外的，宜用导痰汤主治。怎么知道是饮邪呢？此人先前曾生病痊愈，口吐涎沫清水，或者素来多痰的就是。又多饮酒的人，结成酒癖，肚腹积块，胀急疼痛，或全身肿满，肌肤发黄食少，宜用大七气汤加红酒煎服。腹中似若瘕癖，随气上下，未有定处，用二陈汤加当归、杏仁、桂心、槟榔，名叫散聚汤。如果气作痛，游走心腹间，攻刺上下如雷鸣，或已成积，或未成积，宜用木香通气散。肉积妨碍饮食，用四味阿魏丸。石瘕，用利血通经汤，不应验，见XX丸（原文此处可能有缺漏或指代前文某方，依原文保留语境）。虚人，用十全大补汤送下。肠覃，用阿魏麝香散。伏梁环脐而痛，用金匮三物大建中汤加桂枝、茯苓。息积气逆而不妨于食，内服三因化气散，外用良方阿魏膏。此膏熨贴一切痞积均有效。吃鱼鳖成痞，用雌XX丸（原文可能有缺字，依原文保留语境）。疟痞寒热，用阿魏化痞散。乔氏阴阳攻积丸，可代替东垣五积诸方。局方治七种癖块，五种癫病，十种疰忤，七种飞尸，十二种蛊毒，五种黄病，十二种疟疾，十种水病，八种大风，十二种XX痹（原文可能有缺字），及五脏滞气壅闭，心腹胀满，诸蛊积聚，时定时发，十年二十年不愈者，千金耆婆万病丸全都主治。好食茶叶成癖，面黄少力者，用椒红二两，茶叶一两为末，飞罗面炒香，打糊为丸，茶清送下三十丸。又一方，苦草二两，加茶叶一两，如果喜好食米谷土炭纸布之类，就用那些东西加入，并用那种东西煮汤送下。疟痞丹方，月明净雄黄，醋煮研细，神曲为丸，空心温酒送下四五分，勿令间断，消尽乃止。血积，用桃仁、穿山甲、干漆、大黄、虻虫。瘀血，用蓬术、瓦垄子。痰积，用半夏、南星、白术、枳实、礞石、硝石、风化硝、白芥子。老痰，用海浮石、蛤粉。水积，用大戟、甘遂、荛花、芫花。酒积，用干葛、神曲、砂仁、豆蔻、黄连、干姜、甘遂、牵牛。茶积，用姜黄、吴茱萸、椒、姜。癖积，用三棱、蓬术、巴霜、大黄。肉积，用山楂、阿魏、硝石。虫积，用雄黄、锡灰、槟榔、雷丸、芜荑、使君子、鹤虱。疟积，用桃仁、鳖甲、草果。
〔诊〕脉来细而附骨者，是积。积脉坚强者生，虚弱者死。沉而有力为积，沉紧者为寒积。脉弦而牢为积聚，弦而伏者，腹中有XX（原文可能有缺字，指有形之物），不可转也，不治。小沉而实者，胃中有积聚，不下食，食即吐。脉沉重而中散者，因寒食成XX（原文可能有缺字）。脉左转而沉重者，气结在胸中，右转出不至寸口者，内有肉也。
喻嘉言治疗一人，少腹脐旁有三块，坚硬如石，用手抚摸疼痛不可忍受。其脉仅两尺洪盛，其余皆微细。这是由于见块医块，不究其源而误治所致。初起时块必不坚硬，因用峻猛之药攻伐，导致真元内乱，反而助长邪气为害，所以迸紧不散。其实全是空气聚成，不像女子月经凝而不行，即成血块那样。观两尺脉洪盛，明是肾气传于膀胱，暂用补中药一剂，以通中下之气，后用大剂药，内收肾气，外散膀胱，先用理中汤加附子五分，块减十分之三，再用桂枝、附子大剂，腹中奔气响甚，三块一时顿没，更用补肾药加桂枝、附子调理而愈。
顾晋封夫人患痞在胁下，有人建议用膏药，加阿魏一分，麝香半分贴之。五六日间，遂下鲜血血块甚多，二三日才止。此后每年当贴膏药时，必定发作。近邻老妇也用阿魏膏贴痞，下血如前。世人认为阿魏、麝香是痞块必用之药，外用为患若此，何况内服呢？因此特意提出，作为虚人漫用攻击之药的警戒。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When cold qi invades the membrane origins between the small intestine and the network vessels, blood becomes stagnant and cannot flow into the major meridians. Qi and blood stagnate and fail to circulate, thus forming accumulations over time.
Some patients present with swelling of the body, thighs, and legs, along with pain around the umbilicus, named *Fuliang* (Hidden Beam). This is rooted in wind pathogens. The pathogenic qi overflows into the large intestine and attaches to the *huang* (blind/epigastric region). The source of the *huang* is below the umbilicus, hence the pain around it. This condition must not be treated with purgatives; doing so will lead to difficulty in urination or dysuria.
Some patients present with fullness under the hypochondrium and rebellious qi for two or three years without resolution, named *Xi Ji* (Breathing Accumulation). This does not affect eating. Moxibustion and acupuncture are contraindicated. For accumulations, guided exercises (*Dao Yin*) combined with herbal medicine should be used, as herbs alone cannot cure this disease.
Commentary: *Xi Ji* occurs when breath becomes obstructed under the hypochondrium, not within the zang-fu organs or Ying-Wei (nutritive and defensive) systems. After long-standing accumulation takes form, the qi does not interfere with the stomach, hence eating is unaffected.
In pregnant women, if there are large accumulations, toxic drugs may be used. Treatment should cease when the pathogen has been reduced by more than half; excessive treatment can lead to death.
*Changtan* (Intestinal Polyp/Tumor): Cold qi invades outside the intestines and contends with Wei Qi (defensive qi). Qi fails to circulate properly due to some constraint, leading to localized adhesion. Evil qi arises, and flesh grows. Initially, it is the size of a chicken egg, gradually enlarging until it resembles pregnancy. It may last for years. It feels hard upon pressure but moves when pushed. Menstruation occurs on schedule. This is its characteristic presentation.
*Shijia* (Stone Fibroid): Arises in the uterus. Cold qi invades the cervical os, causing closure. Qi fails to flow freely. Evil blood should be discharged but remains stagnant, enlarging daily. It resembles pregnancy, but menstruation is irregular. These conditions occur only in women and can be treated with guiding methods and purgation.
The *Jinkui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: In *Ben Tun* (Running Piglet) disease, qi rushes up from the lower abdomen to the throat. Attacks are agonizing, feeling like impending death, but then subside spontaneously. All cases originate from fright and fear.
Fright injures the Heart; fear injures the Kidney. Heart injury leads to qi deficiency, allowing Kidney pathogenic factors to invade. Qi rushes up from the lower abdomen to the throat, following the pathway of the Kidney meridian. Water evil rebels upward to harass the Heart, causing the agonizing sensation. After a moment, the evil retreats, and symptoms stop.
*Ben Tun* presents with qi rushing to the chest, abdominal pain, and alternating chills and fever. *Bentong Tang* (Panic Decoction) is the primary formula.
Qi rushing to the chest and abdominal pain indicate counterflow of yin evil. Alternating chills and fever indicate struggle between pathogen and healthy qi. Although *Ben Tun* is called a Kidney accumulation, it is actually a disorder of the Chong Mai (Penetrating Vessel). The Chong Mai governs blood. Therefore, the formula uses Chuanxiong (*Rhizoma Chuanxiong*), Danggui (*Radix Angelicae Sinensis*), Shaoyao (*Radix Paeoniae Alba*), Gancao (*Radix Glycyrrhizae*), Fuling (*Sclerotium Poriae Cocos*), Banxia (*Rhizoma Pinelliae Ternatae*), and Shengjiang (*Rhizoma Zingiberis Recens*) to dissipate stagnant blood in solid accumulations. Gegen (*Radix Puerariae Lobatae*) unblocks fluids. Ligen (*Cortex Pruni Spinosae*) directs rebellious qi downward. No Shaoyin (Kidney/Heart) specific herbs are used. If one rigidly adheres to the idea that *Ben Tun* is a Kidney accumulation and uses drugs to attack the Kidney, it would be erroneous. Even if water evil harasses the Heart, Guizhi (*Ramulus Cinnamomi Cassiae*) and Fuling suffice. The established methods of *Qianjin Fang* are worthy of emulation; there is no need to use harsh drugs like Badou (*Fructus Crotonis Tiglii*), Wutou (*Radix Aconiti Lateralis Preparata*), and Fuzi (*Radix Aconiti Lateralis Preparata*) which consume fluids, as seen in Li Dongyuan’s *Bentong Wan*.
Severe cold in the heart and chest causes pain, vomiting, and inability to eat. Abdominal cold causes qi to rush upward against the skin, creating protrusions resembling heads and feet. Pain is severe and cannot be touched. *Dajianzhong Tang* (Great Construct the Middle Decoction) is indicated.
Severe cold fills the chest and diaphragm, blocking intake and output, causing pain, vomiting, and anorexia. Cold in the abdomen causes fluid droplets to overflow outside the intestines, rushing upward against the skin to create head-like and foot-like protrusions. The pain is untouchable. This is a tangible accumulation gathered in the hollow spaces of the abdomen. Therefore, one must greatly strengthen the middle jiao to prevent the pathogen from invading the zang organs internally. Ganjiang (*Rhizoma Zingiberis Officinalis*), Renshen (*Radix Ginseng*), and Jiaoyi (*Maltose*) greatly warm and tonify the central earth. Shujiao (*Fructus Zanthoxyli*) tonifies Heart qi and disperses cold in the chest, and also eliminates yin accumulation in the skin. The overall principle relies on acrid dispersion.
Oblique pain under the hypochondrium with fever and a tight, string-taut pulse indicates cold. It should be treated with warming purgatives. *Dahuang Fuzi Tang* (Rhubarb and Prepared Aconite Decoction) is appropriate.
Oblique pain under the hypochondrium with fever and a tight, string-taut pulse indicates cold in the Jueyin and Shaoyin levels. The pathogen is below, so it should be resolved from below. However, since cold evil resides in the yin levels, warming purgatives are required. Fuzi drives out Shaoyin cold; Xixin (*Herba Asari*) reaches Jueyin qi; Dahuang (*Radix et Rhizoma Rhei*) unblocks and drains the accumulation. This demonstrates the subtle application of combining cold and heat therapies.
Cold qi causing cold limbs is treated with *Chi Wan* (Red Pill).
When cold qi rebels up and down, yin and yang qi fail to connect smoothly, resulting in cold limbs and unconsciousness. Wutou (*Radix Aconiti Kusnezoffii*) dispels upward-rebelling cold; Fuling guides Heart qi downward; Xixin stimulates Kidney qi upward; Banxia disperses cold-fluid retention. Zhenzhu (*Margarita*) provides color, embodying the mutual generation of Kan and Li (Water and Fire). Secular views consider Wutou and Banxia incompatible, completely missing the profundity of this formula.
The *Nan Jing* (Classic of Difficult Issues) states: Stagnation of qi is called *Ji* (Accumulation); gathering of qi is called *Ju* (Gathering). Thus, *Ji* arises from the five zang organs; it starts at a fixed location, pain remains in that area, with definite upper/lower and left/right boundaries. *Ju* arises from the six fu organs; it has no root, moves up and down without stopping, and pain has no fixed location.
Liver *Ji* is named *Feiqi* (Fat Qi), located under the left hypochondrium. Heart *Ji* is named *Fuliang*, above the umbilicus extending to the epigastrium. Spleen *Ji* is named *Pi Qi* (Stagnant Qi), in the epigastrium. Lung *Ji* is named *Xiben* (Rebellant Breath), under the right hypochondrium. Kidney *Ji* is named *Ben Tun*, starting from the lower abdomen up to the epigastrium, resembling a running pig, moving up and down intermittently. *Lin* refers to masses felt upon pressure, similar to the five *Ji* types, immobile. *Jia* refers to masses formed artificially, such as blood clots or stone fibroids. *Lin* also refers to thickened skin visible between muscles. *Pi* means偏僻 (remote/secluded); it forms internally in hidden places and is not visible externally.
Li Shicai stated: The formation of *Ji* occurs because righteous qi is deficient, allowing pathogenic qi to occupy the space. However, overly aggressive attack damages righteous qi further. The methods for early, middle, and late stages must be understood. In the early stage, the pathogen is new, righteous qi is strong, and the pathogen is shallow; aggressive treatment is tolerated. In the middle stage, the disease has persisted, the pathogen is deeper, and righteous qi is weaker; simultaneous attack and tonification are used. In the late stage, the root is old, the pathogen is invasive, and righteous qi is depleted; tonification is tolerated. *Ji* implies accumulation over days and months, not overnight. Therefore, removal must be gradual. Too rapid an approach damages righteous qi; once damaged, transformation fails, and the pathogen becomes entrenched. I once used *Yinyang Gongji Wan* to treat both yin and yang accumulations. Although the herbs are potent, dosage is controlled. Tonify the middle for several days, then attack. Regardless of how much accumulation is removed, tonify again. Wait for spirit and strength to return before attacking again. Repeat attack and tonification until balance is achieved. The Classic says: For large accumulations, toxic drugs may be used, but stop when half is gone; excess leads to death. Thus, after removing half the accumulation, use purely sweet and warm tonics to strengthen spleen earth. The remaining residual accumulation will disappear without direct attack. Insisting on total eradication rarely avoids causing premature death. The Classic says: Those with strong qi resolve it by movement; those with weak qi develop disease. Jiegu said: Strong people do not have accumulations; only weak people do. This is due to weak spleen and stomach, dual deficiency of qi and blood, and invasion of the four climatic evils. If one hastily uses drugs to grind hardness and break accumulations, the disease may seem to leave, but the person becomes weak. After the drug passes, the condition returns, qi diminishes further, and stagnation increases. What benefit is there? A skilled healer first tonifies deficiency, strengthening qi and blood, so the accumulation dissolves naturally. Regardless of the affected organ, first regulate the middle jiao to restore appetite; this is the foundation. However, this applies only to mild cases. For large accumulations, merely tonifying daily without searching and expelling is useless. Determine which meridian is diseased and what substance formed the accumulation. Once clearly identified, launch a direct attack. Why worry about non-healing? Military strategy says: The good attacker makes the enemy unaware of their defense. Such a physician is a general among healers.
Five *Ji* and six *Ju* move with qi, occurring at specific times, causing heart and abdominal pain, rebellious qi obstruction, lower abdominal fullness, and dysuria. Use *Daqi Qi Tang* (Great Seven Qi Decoction) decocted with Iron Drop Drink (*Tieli Yin*). Contraindicated in emaciated and qi-deficient individuals. If phlegm-fluid retention forms a mass in the hypochondrium/abdomen, resembling accumulation, blood-breaking drugs often fail. Here, one must promote fluid metabolism. *Liu Junzi Tang* combined with *Wuling San* is best, adding Xuanfuhua (*Floretus Inulae*), Qianhu (*Radix Peucedani*), Zhishi (*Fructus Aurantii Immaturus*), and Baishao (*Radix Paeoniae Alba*). This is Haizang’s *Wuyin Tang* (Five Fluid Decoction). If located outside the membranes, *Daotan Tang* (Great Phlegm Decoction) is indicated. How to identify fluid retention? The patient previously recovered from illness, spits saliva/clear fluid, or is prone to phlegm. Heavy drinkers may develop alcohol-related *pi* (adhesions), abdominal masses, distension, pain, generalized edema, jaundice, and anorexia. Use *Daqi Qi Tang* decocted with red wine. If abdominal masses resemble *jia/pi*, moving with qi without fixed location, use *Erchen Tang* plus Danggui (*Radix Angelicae Sinensis*), Xingren (*Semen Armeniacae Amarum*), Guixin (*Cortex Cinnamomi*), and Binglang (*Fructus Arecae*). Named *Sanju Tang* (Disperse Gathering Decoction). If qi causes pain, wandering in the heart/abdomen, stabbing up and down like thunder rumbling, whether accumulated or not, use *Muxiang Tongqi San* (Costus Regulating Qi Powder). Meat accumulation hindering diet is treated with *Siweiawei Wan* (Four-Ingredient Elaeocarpi Pill). *Shijia* is treated with *Lixue Tongjing Tang* (Promote Blood Unblock Meridian Decoction); if ineffective, refer to [missing text] pill. For weak persons, take with *Shiquan Dabu Tang* (Ten Complete Great Tonifying Decoction). *Changtan* is treated with *Awei Shexiang San* (Elaeocarpi and Musk Powder). *Fuliang* with periumbilical pain uses *Jinkui Sanwu Dajianzhong Tang* plus Guizhi and Fuling. *Xi Ji* with rebellious qi but unaffected eating uses internal *Sanyin Huqi San* and external *Liangfang Awei Gao* (Good Formula Elaeocarpi Plaster). This plaster is effective for all stagnations and accumulations via warming application. Fish/shellfish-induced stagnation uses [missing text] pill. Malaria-related stagnation/chills-fever uses *Awei Huapi San*. *Qiaoshi Yinyang Gongji Wan* can replace Dongyuan’s Five Accumulation formulas. The Bureau Formulary treats seven types of *pi* masses, five types of epilepsy, ten types of *zhu* transmission, seven types of *feishi* flying corpse, twelve types of gu poison, five types of jaundice, twelve types of malaria, ten types of water disease, eight types of great wind, twelve types of [missing text] bi, and five zang obstructions, heart/abdominal fullness, various gu accumulations, intermittent attacks lasting 10-20 years. *Qianjin Qipo Wanbing Wan* (Thousand Years Qibo Ten-Thousand Disease Pill) addresses all these. Tea addiction causing *pi*, yellow face, and weakness: use 2 liang of Jiaohong (*Pericarpium Zanthoxyli*) and 1 liang of tea leaves, powdered, fried with fine flour, bound with paste, taken as pills with tea infusion, 30 pills each time. Another formula: 2 liang Kucacao (*Radix Sophorae Flavescentis*) plus 1 liang tea leaves. If addicted to rice, grain, soil, charcoal, paper, or cloth, add those substances and decoct them to take with the pills. Malaria *pi* prescription: Pure realgar during a clear moon, boiled in vinegar, ground fine, bound with fermented dough, taken on an empty stomach with warm wine, 4-5 fen, continuously until dissolved. Blood accumulation: Taoren (*Semen Persicae*), Chuanshanjia (*Squama Manis*), Ganqi (*Resina Drynariae*), Dahuang, Mengchong (*Asio/Otis/Bombyx - specifically fly larvae here usually implies insect related to blood stasis, often interpreted as specific insect or metaphorically, WHO term: Fly Larva or similar depending on context, strictly: Mengchong*). Stasis: Pengzhu (*Rhizoma Curcumae), Walongzi (*Concha Arcae*). Phlegm accumulation: Banxia, Nanxing (*Rhizoma Arisaematis Cum Bile*), Baizhu (*Rhizoma Atractylodis Macrocephalae*), Zhishi, Mengshi (*Calcareous Concretion of Dragon Bone*), Xiaoshi (*Natrii Sulfas*), Fenghua Xiao (*Effloresced Natrii Sulfas*), Baijiezi (*Semen Sinapis Albae*). Old phlegm: Haishi (*Lapides Calcitae*), Ge Fen (*Concha Meretricis et Cyclinae*). Water accumulation: Daji (*Radix Euphorbiae Humifusae*), Gansui (*Radix Kansui*), Yaohua (*Radix Adonidis Ramosa*), Yuanhua (*Flos Genkwa*). Alcohol accumulation: Gange (*Radix Puerariae*), Shenqu (*Massa Medicata Fermentata*), Sharen (*Fructus Amomi Rotundus*), Doukou (*Fructus Cardamomi*), Huanglian (*Rhizoma Coptidis*), Ganjiang, Gansui, Qianniu (*Semen Pharbitidis*). Tea accumulation: Jianghuang (*Rhizoma Curcumae Longae*), Zhuyu (*Fructus Corni*), Jiao (*Zanthoxylum*), Jiang. Pi accumulation: Sanleng (*Rhizoma Sparganii*), Pengzhu, Bashuang (*Emunctio Crotonis*), Dahuang. Meat accumulation: Shanzha (*Fructus Crataegi*), Awei (*Resina Elaeocarpi*), Xiaoshi. Worm accumulation: Xionghuang (*Realgar*), Xihui (*Cinerii Stannum*), Binglang, Leiwan (*Fructus Tetraspermae*), Wuyi (*Fructus Chromolepis*), Shijunzi (*Fructus Quarandinae*), Leshe (*Herba Pyrethri*). Malaria accumulation: Taoren, Biejia (*Carapax et Plastrum Testudinis*), Caoguo (*Fructus Tsaoko*).
[Diagnosis] A pulse that is thin and adheres to the bone indicates accumulation. A firm and strong accumulation pulse indicates survival; a weak pulse indicates death. Deep and forceful indicates accumulation; deep and tight indicates cold accumulation. String-taut and firm pulse indicates accumulation; string-taut and hidden pulse indicates abdominal [mass], immovable, incurable. Slightly deep and solid indicates gastric accumulation, inability to eat, vomiting immediately after eating. Heavy and scattered pulse indicates [mass] from cold food. Pulse turning left and heavy indicates qi knot in the chest; turning right and failing to reach the cun position indicates internal flesh [mass].
Yu Jiayan treated a patient with three hard, stone-like masses beside the lower abdomen and umbilicus, extremely painful to touch. The pulse was only vigorous and full at both Chi (Kidney) positions, while others were faint and thin. This resulted from treating the mass without investigating the source. Initially, the mass was not hard; aggressive drugs disrupted the primordial yuan, aiding the pathogen, causing it to become tight and persistent. It was actually air accumulation, unlike menstrual blood stasis forming clots. The vigorous Chi pulse indicated Kidney qi transmitting to the Bladder. Initially, one dose of middle-tonifying herbs was used to unblock middle and lower qi. Then, a large dose was used to gather Kidney qi internally and disperse Bladder qi externally. First, *Lizhong Tang* plus 5 fen Fuzi reduced the mass by 30%. Then, large doses of Guizhi and Fuzi caused loud rushing qi sounds in the abdomen, and the three masses disappeared instantly. Finally, Kidney-tonifying herbs plus Guizhi and Fuzi restored health.
Madam Gu Jin Feng had a stagnation under the hypochondrium. Someone suggested using a plaster with 1 fen Awei and 0.5 fen Shexiang. After 5-6 days, she passed large amounts of fresh blood and clots, stopping after 2-3 days. Since then, every year when applying the plaster, bleeding recurs. A neighbor woman used the same plaster and experienced similar bleeding. People believe Awei and Shexiang are essential for stagnation masses. External use causes such harm, let alone internal ingestion. This is noted as a warning against blind aggressive treatment in weak persons.