（附 瘕）
左 中脘聚形，形如覆碗，按之作酸，至卧则气从上逆。此痰气结聚，阳明太阴之滞，阻而难降，不易图治也。
制半夏 连皮苓 瓦楞子 橘红 九香虫 大腹皮
淡干姜 薤白头 枳壳 砂仁
某 左胁下聚形窒碍气机，甚则攻冲入脘，胀满不舒，似觉气自左升，不能右降，而仍还于左，冲入胸
中，则似觉火逆，所谓火而不泄为阳，抑而不舒为气也。
制香附 杭白芍 朱茯神 川石斛 青皮 金铃子 白归身 白蒺藜 香橼皮
马（左） 少腹偏左聚形，食入胀满，色夺形衰。脉迟苔白。此情志抑郁，木不条达也。致气湿瘀滞，酒积不
行，名曰积聚。恐元气耗损而入损门。
上官桂 制香附 金铃子 楂炭 延胡索 砂仁末 广陈皮 连皮苓 泽泻 猪苓
左 少腹结聚有形，按之坚硬。脉沉而弦。此气寒交阻，恐成胀病。
酒炒归须（二钱） 乌药（一钱五分） 楂炭（三钱） 酒炒赤苓（一钱五分） 制香附（二钱） 郁
金（一钱五分） 桂枝（五分） 酒炒延胡（一钱五分） 金铃子（一钱五分） 炒蓬术（一钱五分）
徐（右） 结块坚大如盘，推之不移。气寒血滞，与肠胃汁沫相抟，未可轻视。
川桂木 延胡 香附 白术 炒蓬术（一钱五分） 两头尖 归须 乌药 楂炭 野水红花子
二诊 结块稍软，而频咳气逆。此兼感新邪，药宜兼顾。
桂木 金铃子 延胡 苏梗 当归须 乌药
楂炭 两头尖 前胡 蓬术 荆三棱 杏仁 香附
某 中脘结块，按之不甚痛。脉象沉滑。此痰湿流入分肉之间。
制香附 制半夏 广皮 台白术 青葱管 白茯苓 旋复花 猩绛 指迷茯苓丸
郁（左） 时病之后，左胁下癖块胀大，腹满不舒。脉弦滑，苔白。脾土不运，胃络阻滞。拟宣通气血，参以运土。
川桂木（六分） 焦麦芽（四钱） 猪苓（二钱） 范志曲（二钱炒） 南楂炭（三钱） 广陈皮（一钱）
茯苓（三钱） 当归炭（一钱五分） 台白术（二钱） 延胡索（一钱五分）
二诊 癖积稍收，腹仍胀满。胃络不宣，生化因而不及。再宣通胃气，运土理湿。
川桂木（五分） 台白术（二钱） 范志曲（二钱炒） 猪苓（二钱） 泽泻（一钱五分） 南楂炭（三钱）
焦麦芽（四钱） 川郁金（一钱五分） 茯苓（三钱） 炒枳壳（一钱）
贾（右） 瘕聚有形，甚则上冲胸脘，寒热往来。恐延入损途。
醋炒柴胡（四分） 归尾（一钱五分） 延胡索（一钱五分酒炒） 制香附（二钱打） 白芍（一钱五分） 金
铃子（一钱五分切） 广皮（一钱） 柏子仁（三钱） 砂仁（七分） 台乌药（一钱五分）
右 腹中作痛，少腹聚形，经事当至不至，面色萎黄。脉形沉迟。此寒入胞门，与肠外之汁相抟，石瘕之
属也。须耐心善调，勿得急切攻夺。
当归须 川桂木 广郁金 台乌药 韭菜根（七钱） 南楂炭
金铃子 制香附 延胡索（醋炒） 两头尖（三钱） 野水红花子（三钱）
某 胁下结块。
香附（五钱） 吴萸（三钱） 青皮（五钱） 乌药（五钱） 木香（五钱）
上五味研粗末，麸皮一升姜三片葱三茎同炒，火起用陈酒喷，炒干，置洋布包内熨痛处，稍冷再炒，至焦而弃。
（附：瘕证）
左侧患者，中脘部位有聚成形块，形状像倒扣的碗，按压时感到酸楚，到了躺下时气机从上部上逆。这是痰气结聚，导致阳明、太阴经气滞涩，阻滞而难以降下，治疗比较困难。
处方：制半夏、连皮茯苓、瓦楞子、橘红、九香虫、大腹皮、淡干姜、薤白头、枳壳、砂仁。
某患者，左胁下有聚成形块阻碍气机运行，严重时攻冲进入胃脘，导致胀满不适，感觉气自左侧上升，不能向右下降，而是仍然返回左侧，冲入胸中，则感觉似有火气上逆，这就是所谓“火气不得宣泄则为阳热，气机压抑不得舒展则为气郁”。
处方：制香附、杭白芍、朱茯神、川石斛、青皮、金铃子、白归身、白蒺藜、香橼皮。
马姓患者（左侧），少腹偏左有聚成形块，进食后胀满，面色晦暗无华，形体衰瘦。脉象迟缓，舌苔白。这是由于情志抑郁，肝木之气不能条达舒畅。导致气滞湿阻血瘀，酒积不行，名为积聚。恐怕元气耗损而进入虚损病的范畴。
处方：上官桂、制香附、金铃子、山楂炭、延胡索、砂仁末、广陈皮、连皮茯苓、泽泻、猪苓。
左侧患者，少腹结聚有形之块，按压质地坚硬。脉象沉而弦。这是气与寒邪交相阻隔，恐怕发展成胀病。
处方：酒炒当归须（二钱）、乌药（一钱五分）、山楂炭（三钱）、酒炒赤茯苓（一钱五分）、制香附（二钱）、郁金（一钱五分）、桂枝（五分）、酒炒延胡索（一钱五分）、金铃子（一钱五分）、炒蓬术（一钱五分）。
徐姓患者（右侧），结块坚硬巨大如盘，推之不移位。这是气寒血滞，与肠胃间的汁沫相互搏结，不可轻视。
处方：川桂木、延胡索、香附、白术、炒蓬术（一钱五分）、两头尖、当归须、乌药、山楂炭、野水红花子。
二诊：结块稍微变软，但频繁咳嗽且气机上逆。这是兼感新近的外邪，用药应当兼顾。
处方：桂木、金铃子、延胡索、苏梗、当归须、乌药、山楂炭、两头尖、前胡、蓬术、荆三棱、杏仁、香附。
某患者，中脘部结块，按压时疼痛不明显。脉象沉滑。这是痰湿流入肌肉腠理之间。
处方：制香附、制半夏、广陈皮、台白术、青葱管、白茯苓、旋复花、猩绛、指迷茯苓丸。
郁姓患者（左侧），在患外感病之后，左胁下有癖块胀大，腹部胀满不适。脉象弦滑，舌苔白。脾土运化失职，胃络阻滞。拟定宣通气血，参以运脾土的方法。
处方：川桂木（六分）、焦麦芽（四钱）、猪苓（二钱）、范志曲（二钱炒）、南楂炭（三钱）、广陈皮（一钱）、茯苓（三钱）、当归炭（一钱五分）、台白术（二钱）、延胡索（一钱五分）。
二诊：癖积稍微收敛，腹部仍然胀满。胃络不通畅，生化之源因而不足。再宣通胃气，运脾土以理湿。
处方：川桂木（五分）、台白术（二钱）、范志曲（二钱炒）、猪苓（二钱）、泽泻（一钱五分）、南楂炭（三钱）、焦麦芽（四钱）、川郁金（一钱五分）、茯苓（三钱）、炒枳壳（一钱）。
贾姓患者（右侧），瘕聚成形，严重时上冲胸脘，出现寒热往来。恐怕拖延进入虚损的途径。
处方：醋炒柴胡（四分）、归尾（一钱五分）、延胡索（一钱五分酒炒）、制香附（二钱捣碎）、白芍（一钱五分）、金铃子（一钱五分切片）、广陈皮（一钱）、柏子仁（三钱）、砂仁（七分）、台乌药（一钱五分）。
右侧患者，腹中疼痛，少腹有聚成形块，月经应当来潮却未来，面色萎黄。脉象沉迟。这是寒邪侵入胞宫，与肠外的汁液相互搏结，属于石瘕一类。需要耐心妥善调治，不得急切使用攻伐之法。
处方：当归须、川桂木、广郁金、台乌药、韭菜根（七钱）、南楂炭、金铃子、制香附、延胡索（醋炒）、两头尖（三钱）、野水红花子（三钱）。
某患者，胁下有结块。
处方：香附（五钱）、吴茱萸（三钱）、青皮（五钱）、乌药（五钱）、木香（五钱）。
以上五味药研成粗末，用麸皮一升、生姜三片、葱三茎同炒，见火起时用陈酒喷洒，炒干后，装入洋布包内熨烫疼痛处，稍冷后再炒，直到炒焦为止并丢弃。
(Attachment: Jia Syndrome)
Left-sided patient: There is a Ju (mass) in the Zhongwan (CV12) region, shaped like an inverted bowl. Pressing it causes sourness. When lying down, Qi rebels upwards from above. This is due to the accumulation of Phlegm and Qi, causing stagnation in the Yangming and Taiyin meridians. The obstruction makes descent difficult, making treatment challenging.
Prescription: Zhi Banxia (Prepared Pinellia Rhizome), Lian Pi Ling (Poria with Peel), Wa Leng Zi (Arca Shell), Ju Hong (Tangerine Peel), Jiu Xiang Chong (Stink Bug), Da Fu Pi (Areca Peel), Dan Gan Jiang (Dried Ginger), Xie Bai Tou (Allium Macrostemum Bulb), Zhi Qiao (Bitter Orange Fruit), Sha Ren (Amomum Fruit).
Certain patient: A mass in the left hypochondrium obstructs Qi mechanism. Severe cases involve attacking pain rushing into the epigastrium, causing distension and discomfort. It feels as if Qi rises from the left but fails to descend to the right, instead returning to the left and rushing into the chest, creating a sensation of Fire rebellion. This illustrates that "Fire not vented becomes Yang heat, Qi suppressed and unrelieved becomes Qi stagnation."
Prescription: Zhi Xiang Fu (Prepared Cyperus Rhizome), Hang Bai Shao (White Peony Root), Zhu Fu Shen (Poria with Hostwood), Chuan Shi Hu (Dendrobium Stem), Qing Pi (Green Tangerine Peel), Jin Ling Zi (Chimonanthus Fruit), Bai Gui Shen (Angelica Sinensis Root), Bai Ji Li (Tribulus Fruit), Xiang Yuan Pi (Citron Peel).
Patient Ma (Left): A mass in the lower abdomen on the left side. Distension after eating. Complexion is dull, physique is emaciated. Pulse is slow, coating is white. This results from emotional depression causing Liver Wood Qi to fail in its free flow. Consequently, Qi, Dampness, and Blood stasis accumulate, and wine retention fails to move. Named Accumulation and Mass (Ji Ju). Fears that Yuan Qi depletion will lead to Consumption disease.
Prescription: Shang Guan Gui (Cinnamon Twig), Zhi Xiang Fu (Prepared Cyperus Rhizome), Jin Ling Zi (Chimonanthus Fruit), Zha Tan (Charred Hawthorn Fruit), Yan Hu Suo (Corydalis Rhizome), Sha Ren Fen (Amomum Fruit Powder), Guang Chen Pi (Tangerine Peel), Lian Pi Ling (Poria with Peel), Ze Xie (Alisma Rhizome), Zhu Ling (Poria).
Left-sided patient: A tangible mass binds in the lower abdomen, hard upon pressure. Pulse is deep and wiry. This is obstruction by Qi and Cold. Fears progression to Abdominal Distension disease.
Prescription: Jiu Chao Gui Xu (Wine-fried Angelica Sinensis Rootlets, 2 qian), Wu Yao (Lindera Root, 1.5 qian), Zha Tan (Charred Hawthorn Fruit, 3 qian), Jiu Chao Chi Ling (Wine-fried Red Poria, 1.5 qian), Zhi Xiang Fu (Prepared Cyperus Rhizome, 2 qian), Yu Jin (Turmeric Tuber, 1.5 qian), Gui Zhi (Cinnamon Twig, 0.5 qian), Jiu Chao Yan Hu (Wine-fried Corydalis Rhizome, 1.5 qian), Jin Ling Zi (Chimonanthus Fruit, 1.5 qian), Chao Peng Zhu (Stir-fried Curcuma Zedoaria Rhizome, 1.5 qian).
Patient Xu (Right): A mass is hard, large like a plate, and immovable upon pushing. This is Cold Qi and Stagnant Blood, clashing with intestinal fluids and froth. It must not be taken lightly.
Prescription: Chuan Gui Mu (Cinnamon Twig), Yan Hu Suo (Corydalis Rhizome), Xiang Fu (Cyperus Rhizome), Bai Zhu (Atractylodes Macrocephala Rhizome), Chao Peng Zhu (Stir-fried Curcuma Zedoaria Rhizome, 1.5 qian), Liang Tou Jian (Asparagus Fern Tubers), Gui Xu (Angelica Sinensis Rootlets), Wu Yao (Lindera Root), Zha Tan (Charred Hawthorn Fruit), Ye Shui Hong Hua Zi (Wild Safflower Seed).
Second visit: The mass has softened slightly, but frequent coughing and rebellious Qi occur. This indicates a concurrent new pathogenic factor; medication should address both.
Prescription: Gui Mu (Cinnamon Twig), Jin Ling Zi (Chimonanthus Fruit), Yan Hu Suo (Corydalis Rhizome), Su Geng (Perilla Stem), Dang Gui Xu (Angelica Sinensis Rootlets), Wu Yao (Lindera Root), Zha Tan (Charred Hawthorn Fruit), Liang Tou Jian (Asparagus Fern Tubers), Qian Hu (Peucedanum Root), Peng Zhu (Curcuma Zedoaria Rhizome), Jing San Leng (Sparganium Rhizome), Xing Ren (Apricot Seed), Xiang Fu (Cyperus Rhizome).
Certain patient: A mass in the Zhongwan region, not very painful upon pressure. Pulse is deep and slippery. This is Phlegm-Dampness flowing into the intermuscular spaces.
Prescription: Zhi Xiang Fu (Prepared Cyperus Rhizome), Zhi Banxia (Prepared Pinellia Rhizome), Guang Pi (Tangerine Peel), Tai Bai Zhu (Atractylodes Macrocephala Rhizome), Qing Cong Guan (Scallion Stem), Bai Fu Ling (White Poria), Xuan Fu Hua (Inula Flower), Xing Jiang (Safflower), Zhi Mi Fu Ling Wan (Zhi Mi Poria Pill).
Patient Yu (Left): After an exogenous disease, a Pi (mass) under the left hypochondrium has enlarged, causing abdominal fullness and discomfort. Pulse is wiry and slippery, coating is white. Spleen Earth fails to transport, Stomach collaterals are obstructed. Plan to promote circulation of Qi and Blood, assisted by strengthening Spleen Earth.
Prescription: Chuan Gui Mu (Cinnamon Twig, 6 fen), Jiao Mai Ya (Burnt Malt, 4 qian), Zhu Ling (Poria, 2 qian), Fan Zhi Qu (Fan's Medicated Leaven, 2 qian stir-fried), Nan Zha Tan (Southern Charred Hawthorn Fruit, 3 qian), Guang Chen Pi (Tangerine Peel, 1 qian), Fu Ling (Poria, 3 qian), Dang Gui Tan (Charred Angelica Sinensis Root, 1.5 qian), Tai Bai Zhu (Atractylodes Macrocephala Rhizome, 2 qian), Yan Hu Suo (Corydalis Rhizome, 1.5 qian).
Second visit: The Pi accumulation has slightly receded, but abdominal distension remains. Stomach collaterals are not unobstructed, so transformation and production are inadequate. Again promote Stomach Qi, strengthen Spleen Earth to resolve Dampness.
Prescription: Chuan Gui Mu (Cinnamon Twig, 5 fen), Tai Bai Zhu (Atractylodes Macrocephala Rhizome, 2 qian), Fan Zhi Qu (Fan's Medicated Leaven, 2 qian stir-fried), Zhu Ling (Poria, 2 qian), Ze Xie (Alisma Rhizome, 1.5 qian), Nan Zha Tan (Southern Charred Hawthorn Fruit, 3 qian), Jiao Mai Ya (Burnt Malt, 4 qian), Chuan Yu Jin (Turmeric Tuber, 1.5 qian), Fu Ling (Poria, 3 qian), Chao Zhi Qiao (Stir-fried Bitter Orange Fruit, 1 qian).
Patient Jia (Right): A Jia (mass) is tangible, sometimes rushing up to the chest and epigastrium, accompanied by alternating chills and fever. Fears progression to Consumption.
Prescription: Cu Chao Chai Hu (Vinegar-fried Bupleurum Root, 4 fen), Gui Wei (Angelica Sinensis Tail, 1.5 qian), Yan Hu Suo (Corydalis Rhizome, 1.5 qian wine-fried), Zhi Xiang Fu (Prepared Cyperus Rhizome, 2 qian crushed), Bai Shao (White Peony Root, 1.5 qian), Jin Ling Zi (Chimonanthus Fruit, 1.5 qian sliced), Guang Pi (Tangerine Peel, 1 qian), Bai Zi Ren (Biota Seed, 3 qian), Sha Ren (Amomum Fruit, 7 fen), Tai Wu Yao (Lindera Root, 1.5 qian).
Right-sided patient: Abdominal pain, a mass in the lower abdomen. Menstruation is due but absent. Complexion is sallow. Pulse is deep and slow. This is Cold entering the Uterus (Bao Men), clashing with fluids outside the intestines, belonging to the category of Shi Jia (Stone Jia). Must be treated patiently and properly; do not use aggressive purgatives hastily.
Prescription: Dang Gui Xu (Angelica Sinensis Rootlets), Chuan Gui Mu (Cinnamon Twig), Guang Yu Jin (Turmeric Tuber), Tai Wu Yao (Lindera Root), Jiu Cai Gen (Chinese Chive Root, 7 qian), Nan Zha Tan (Southern Charred Hawthorn Fruit), Jin Ling Zi (Chimonanthus Fruit), Zhi Xiang Fu (Prepared Cyperus Rhizome), Yan Hu Suo (Corydalis Rhizome vinegar-fried), Liang Tou Jian (Asparagus Fern Tubers, 3 qian), Ye Shui Hong Hua Zi (Wild Safflower Seed, 3 qian).
Certain patient: A mass under the hypochondrium.
Prescription: Xiang Fu (Cyperus Rhizome, 5 qian), Wu Zhu Yu (Evodia Fruit, 3 qian), Qing Pi (Green Tangerine Peel, 5 qian), Wu Yao (Lindera Root, 5 qian), Mu Xiang (Aucklandia Root, 5 qian).
The above five herbs are ground into coarse powder. Stir-fry with one sheng of bran, three slices of ginger, and three stalks of scallion. When fire appears, spray with aged rice wine. Stir-fry until dry. Place in a cotton cloth bag and apply hot compress to the painful area. Reheat when cool, until charred, then discard.