凡饮食留聚而为 痞者，或以生冷，或以风寒，或以忿怒气逆，或以劳倦饥馁，而
饮食叠进不用消化，则积而成 矣。然胃气强者必不致留聚饮食，而饮食之不能化者，
必由脾肾气弱而然。所以治此者，宜酌虚实而为攻补，庶乎得效也。诸治法详积聚门，宜参
而用之。
立斋曰∶前证若形气虚弱，须先调补脾胃为主，而佐以消导。若形气充实，当先疏导为
主，而佐以补脾胃。若气壅血滞而不行者，宜用乌药散，散而行之。若脾气虚而血不行者，
宜用四君、芎、归，补而行之。若脾气郁而血不行者，宜用归脾汤，解而行之。若肝肾血燥
而不行者，宜用加味逍遥散，清而行之。大抵食积痞块之证，皆以邪气盛则实，真气夺则虚
，但当养正辟邪，而积自除矣。虽曰坚者削之，客者除之，若胃气未虚，或可少用。若病久
虚乏者，不宜轻用。
瘕者，假也。所谓假者，谓其形虽若 ，而原无根窠，非若 痞之坚顽有形者
也。盖有形者，或因血积，或因食积，积有定形，所不可移易者也。无形者，病在气分，气
逆则甚，气散则缓，聚散无根者也。惟其无根，故能大能小，或左或右。或近胁肋而如臂如
指，则谓之 癖；或下脐腹而为胀为急，则谓之疝瘕。《难经》曰∶病有积聚，何以别之？
然，积者阴气也，阴沉而伏。聚者阳气也，阳浮而动。故积者五脏之所生，聚者六腑之所成
也。然则 由于积，积在阴分而有渊薮，故攻之非易；瘕由于聚，聚在阳分而犹乌合。
故散之非难，此 瘕之辨有如此。惟散之之法，最有因通因塞之妙用，而人多莫之知也
。
一、凡病在气分，而无停蓄形积者，皆不可下。盖凡用下者，可除有形，而不可以除无
形。若气因形滞者，去其积则气亦顺，自无不可。若全在无形气分，即下亦不去，而适足以
败正气也，宜切识之。
一、散气之法，止在行气，盖气行则散也。但行气之法，大有权宜。如气实则壅滞，宜
破而行之；气闭则留蓄，宜利而行之；气热则干涸，宜寒而行之；气寒则凝结，宜温而行之
。此散气治瘕之大法也。然瘕聚之证，使果气强力健，则流行不息，又何瘕聚之有？惟正气
不行，而后邪气得聚。经曰∶邪之所凑，其气必虚。故凡为此病，必气虚者多，虚不知补，
则正气不行，正气不行，则邪气不散，安望其有瘳乎？但实者有据，故显而易见，虚每似实
，故隐而难知，此所以当辨其真也。
一、破气行气之剂，凡气实气壅之甚而为胀为痛者，宜排气饮、木香顺气散、木香调气
散、四磨汤、诸七气汤之类主之。若血中之气滞而为瘀为痛者，宜失笑散、通瘀煎、调经饮
，甚者《良方》奇命丹。疝瘕气聚者，荔香散，甚者天台乌药散。气结膀胱，小水不利者，
小厘清饮、四苓散、五苓散。气结大肠，干秘不行者，搜风顺气丸、麻仁丸。水亏血虚而秘
滞者，济川煎；肝气逆而为聚者，解肝煎，兼火者，化肝煎。气聚兼热，火郁不行者，抽薪
饮、大厘清饮。寒滞不行，气结胀聚者，抑扶煎、和胃饮、丁香茯苓汤。三焦壅滞，气道不
清而中满肿胀者，廓清饮。痰饮水气停蓄胸胁，而为吞酸呕逆者，苓术二陈煎、六安煎、和
胃饮、括痰丸之类主之。以上诸法，惟气实瘕聚者宜之，凡元气不足者，皆不可用。
一、补气以行气之剂，如圣愈汤、参归汤、七福饮，皆能调心气之虚滞。五味异功散、
参术汤，能理心脾之气虚不行。独参汤、参附汤，能助肺以行五脏之治节。若脾胃气虚而滞
者，惟六君子汤、归脾汤为宜。脾胃虚寒而滞者，必温胃饮、理中汤、五君子煎最佳。若虚
在脾肾阴分，气有不行而或为痰饮，或为胀满，或为呕吐腹痛等证，非理阴煎不可。若虚在
血中之气而为滞为痛，微则四物汤，甚则五物煎、决津煎、大营煎方可。若肝肾寒滞，小腹
气逆而痛者，必暖肝煎以温之。若脾肾气虚，门户不要而为滞为痛者，必胃关煎以固之。若
元气下陷，滞而不升者，宜补中益气汤、举元煎以举之。若元气大虚，气化不行而滞者，必
五福饮、十全大补汤、大补丸煎，或六味回阳饮以培补之。以上皆补气行气之法也。亦不过
为之筌蹄云耳。而此中之用，诚有未可以言悉者。然常人之情，犹为气之滞者，惟破之散之
为宜；而反云补之，必不然也。不知客之强者，以主之弱；邪之胜者，惟正之虚。凡今人之
病虚者最多，而用补者最少，治与病违，而欲以药济人，盖亦罕矣。即余以多虚少实，谆谆
为言，而人亦未信，姑以人事喻之，其或可晓然乎。夫人之虚实，亦犹人之贫富。气实者若
富翁，气虚者若贫士，今人于千百中，而富者其几？舍富之外，尽贫人矣。其多其少，即此
类也。又有华其貌而罄其室者，人多难测，亦此类也。但贫人之情，可益不可损，增一分犹
然未足，削一分其窘何堪？使以潜消暗剥之术，而加之贫寒窘乏之士，阴移人祚而人不之觉
，亦甚堪怜矣。此道以仁为术，其可不以此为心乎？嗟乎！人生以气为主，得气则生，失气则
死。夫知者知人之命，不知者知人之病。若强不知以为知，而徒资便给，以人命为尝试者，
则其概可知矣。
凡因饮食停滞积聚而形成痞块的情况，可能是因为食用生冷食物，或者感受风寒邪气，或者因为愤怒导致气机逆乱，或者因为过度劳累、饥饿导致脾胃虚弱，使得饮食连续摄入却无法消化，从而积滞形成痞块。然而，胃气强健的人通常不会导致饮食留滞，而饮食不能消化的情况，必定是由于脾肾之气虚弱所致。因此，治疗这种情况，应当根据虚实情况进行攻补治疗，这样才能取得疗效。具体的治疗方法详见“积聚”章节，可以参考使用。
薛立斋说：上述病症如果形体和正气虚弱，必须先以调理补益脾胃为主，辅以消食导滞的药物。如果形体和正气充实，应当先以疏通疏导为主，辅以补益脾胃的药物。如果是气机壅滞、血液运行不畅的，适宜使用乌药散，通过发散来推动气血运行。如果是脾气虚弱导致血液不行的，适宜使用四君子汤加上川芎、当归，通过补益来推动运行。如果是脾气郁结导致血液不行的，适宜使用归脾汤，通过解郁来推动运行。如果是肝肾阴血枯燥导致血液不行的，适宜使用加味逍遥散，通过清热凉血来推动运行。大抵食积形成的痞块这类病症，都是由于邪气盛实或真气亏损导致的虚实证候，但主要原则是培养正气、驱除邪气，积滞自然就会消除。虽然古法说“坚硬的要用削法，外来的邪气要用除法”，但如果胃气尚未虚弱，或许可以少量使用这些峻猛药物。如果病程长久、身体虚弱的，就不宜轻易使用。
瘕，意思是假象。所谓假象，是指它的形状虽然好像有肿块，但原本没有固定的根基，不像痞块那样坚硬顽固且有固定形态。那些有形的肿块，可能是因为血积，也可能是因为食积，积滞有固定的形状，不可移动。无形的病变，病在气分，气机逆乱时症状加重，气机疏散时症状缓解，聚散无常，没有根基。正因为没有根基，所以它的大小可以变化，位置可以在左或在右。如果靠近胁肋部位，形状像手臂或手指大小的，就称为癖；如果位于脐腹下方，引起胀满急迫感的，就称为疝瘕。《难经》说：疾病有积和聚的区别，怎么辨别呢？回答说：积属于阴气，性质阴沉潜伏；聚属于阳气，性质轻浮流动。所以积是五脏产生的，聚是六腑形成的。那么，痞（此处指有形之积）源于积，积在阴分而有深厚的根源，所以攻伐它不容易；瘕源于聚，聚在阳分如同乌合之众，所以消散它并不难，这就是痞与瘕的区别所在。其中消散的方法中，最有妙用的是“通因通用”的原则，但人们大多不知道这一点。
第一，凡是病在气分，而没有停蓄有形积块的，都不可使用泻下法。因为凡是使用泻下法的，只能去除有形的积滞，而不能去除无形的气滞。如果是气机因为有形积滞而受阻，去除了积滞，气机自然顺畅，就没有什么不可以了。如果完全是在无形的气分，即使使用泻下法也去不掉，反而足以败坏正气，这一点必须深刻认识。
第二，消散气滞的方法，关键在于行气，因为气行则滞散。但是行气的方法，有很大的权变灵活性。比如气实则壅滞，适宜用破气的方法来推动；气闭则留蓄，适宜用利窍的方法来推动；气热则津液干涸，适宜用寒凉的方法来推动；气寒则凝结，适宜用温热的的方法来推动。这是消散气滞治疗瘕的大法。然而，瘕聚这类病症，如果果真气强体健，气血流行不息，又哪里会有瘕聚呢？只有正气不行，邪气才能聚集。《内经》说：邪气聚集的地方，正气必然虚弱。所以凡是患这种病的，大多是气虚的人。如果不了解补气，正气就不能运行；正气不运行，邪气就不能消散，怎么能希望痊愈呢？但是实证有依据，所以显而易见；虚证往往看似实证，所以隐蔽难知，这就是需要辨别真伪的原因。
第三，破气行气的方剂，凡是气实、气壅严重而导致胀痛的，适宜使用排气饮、木香顺气散、木香调气散、四磨汤、各种七气汤等。如果是血中的气滞导致瘀血疼痛的，适宜使用失笑散、通瘀煎、调经饮，严重的用《良方》奇命丹。疝瘕气聚的，用荔香散，严重的用天台乌药散。气结于膀胱，小便不利的，用小厘清饮、四苓散、五苓散。气结于大肠，大便干结不通的，用搜风顺气丸、麻仁丸。水亏血虚导致便秘滞涩的，用济川煎；肝气上逆导致气聚的，用解肝煎，兼有火邪的，用化肝煎。气聚兼有热邪，火郁不行的，用抽薪饮、大厘清饮。寒滞不行，气结胀痛聚散的，用抑扶煎、和胃饮、丁香茯苓汤。三焦壅滞，气道不清导致中焦胀满肿胀的，用廓清饮。痰饮水气停蓄胸胁，导致吞酸呕吐逆气的，用苓术二陈煎、六安煎、和胃饮、括痰丸等。以上诸法，只适用于气实瘕聚的患者，凡是元气不足的，都不可使用。
第四，补气以行气的方剂，如圣愈汤、参归汤、七福饮，都能调补心气的虚滞。五味异功散、参术汤，能调理心脾气虚不行的状况。独参汤、参附汤，能助肺气以行使五脏的治节功能。如果脾胃气虚而滞涩的，只有六君子汤、归脾汤比较适宜。脾胃虚寒而滞涩的，必须用温胃饮、理中汤、五君子煎效果最佳。如果虚在脾肾阴分，气机不行而出现痰饮、胀满、呕吐腹痛等症状的，非理阴煎不可。如果虚在血中之气导致滞涩疼痛的，轻微的用四物汤，严重的用五物煎、决津煎、大营煎才可以。如果肝肾寒滞，小腹气逆疼痛的，必须用暖肝煎来温煦。如果脾肾气虚，固摄无力导致滞涩疼痛的，必须用胃关煎来固摄。如果元气下陷，滞涩不升的，适宜用补中益气汤、举元煎来提升。如果元气大虚，气化不行导致滞涩的，必须用五福饮、十全大补汤、大补丸煎，或者六味回阳饮来培补。以上都是补气行气的方法。也不过是作为达到目的的手段罢了。其中的奥妙，实在不是言语所能完全表达的。然而常人的心理，对于气滞的病，认为只有破气散气才合适；反而说要补气，一定不相信。他们不知道客邪强盛是因为主人虚弱；邪气胜是因为正气虚。现在人患虚证的最多，而使用补法的却最少，治疗与病情违背，想要靠药物救人，大概很少见了。就是我反复强调多虚少实，人们也不相信，姑且用人世间的道理来比喻，也许可以明白吧。人的虚实，就像人的贫富一样。气实的人像富翁，气虚的人像贫士，现在千百人中，富人有几个？除了富人之外，全是穷人。多多少少，就是这样的比例。还有外表华丽但内室空虚的人，人们很难推测，也是这一类。但是穷人的情况，只能增益不能损耗，增加一分还觉得不够，削减一分那窘迫怎么忍受？如果用暗中消剥的方法，施加在贫寒窘乏的人身上，暗中转移人的福气而本人还不知道，也是非常可怜的了。医学之道以仁爱为技术，怎能不以这个为心念呢？唉！人生以气为主，得气则生，失气则死。聪明的人知道保护人的命，不聪明的人只知道治病。如果强不知以为知，只是为了方便自己，拿人命当试验品的，那他们的结局大概也就知道了。
Whenever food stagnates and accumulates to form a *pi* mass (a sensation of fullness or obstruction, often without a palpable lump), it may be due to consuming raw or cold foods, contracting wind-cold pathogens, experiencing anger leading to rebellious Qi, or suffering from overexertion and hunger. These factors cause continuous intake of food that cannot be digested, resulting in accumulation. However, individuals with strong Stomach Qi will not typically experience such food retention; the inability to digest food is necessarily due to weak Spleen and Kidney Qi. Therefore, treatment should be adjusted according to deficiency or excess to apply purgative or tonifying methods, thereby achieving efficacy. Detailed treatment methods are described in the chapter on Accumulation and Gathering (*Ji Ju*), which should be consulted.
Xue Lizhai stated: For the aforementioned conditions, if the physical constitution and Zheng Qi (Upright Qi) are deficient, one must first focus on regulating and tonifying the Spleen and Stem, assisting with digestive-promoting herbs. If the constitution and Zheng Qi are robust, one should first focus on unblocking and guiding, assisting with Spleen and Stomach tonification. If there is Qi congestion and blood stasis preventing flow, Wuyao San (Lindera Powder) should be used to disperse and promote movement. If Spleen Qi deficiency prevents blood circulation, Sijunzi Tang (Four Gentlemen Decoction) combined with Chuanxiong Rhizoma (Chuanxiong) and Angelicae Sinensis Radix (Danggui) should be used to tonify and promote movement. If Spleen Qi depression prevents blood circulation, Guipi Tang (Restore the Spleen Decoction) should be used to resolve depression and promote movement. If Liver and Kidney Yin-blood dryness prevents circulation, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) should be used to clear heat and promote movement. Generally, syndromes of food accumulation and pi masses involve excess due to pathogenic abundance or deficiency due to Zheng Qi depletion. The principle is to nourish the righteous Qi and repel pathogens, after which the accumulation will naturally dissipate. Although ancient texts state "firm masses should be pared away, and invading pathogens should be eliminated," these harsh methods may only be used in small doses if the Stomach Qi has not yet weakened. If the disease has been prolonged and the body is depleted, they should not be used lightly.
"Jia" means false. A "false" condition refers to a shape that appears like a mass but originally lacks a fixed root, unlike "Pi" masses which are hard, stubborn, and have a tangible form. Tangible masses arise from blood accumulation or food accumulation; the accumulation has a fixed shape and cannot be moved. Intangible diseases reside in the Qi level; symptoms worsen when Qi rebels and ease when Qi disperses, gathering and scattering without a root. Because they lack a root, they can change size and location. If located near the hypochondrium and resembling an arm or finger, it is called "Pi" (specifically referring to a type of abdominal mass distinct from the general pi sensation). If located below the umbilicus causing distension and urgency, it is called "Shan Jia" (Hernia/Jia). The *Nan Jing* states: How to distinguish between Accumulation (*Ji*) and Gathering (*Ju*)? The answer is: Accumulation belongs to Yin Qi, which is dark and latent; Gathering belongs to Yang Qi, which is floating and active. Thus, Accumulation arises from the Five Zang Organs, while Gathering is formed by the Six Fu Organs. Therefore, Pi (here referring to tangible accumulation) stems from *Ji*; since *Ji* resides in the Yin aspect with deep roots, attacking it is difficult. Jia stems from *Ju*; since *Ju* resides in the Yang aspect like a hasty coalition, dispersing it is not difficult. This is the distinction between Pi and Jia. Among dispersal methods, the subtle application of "treating obstruction with unblocking agents" (Tong Yin Yong Tong) is most effective, though few understand this.
First, for any disease residing in the Qi level without stagnant tangible accumulation, purgative methods must not be used. Purgatives remove tangible forms but cannot remove intangible Qi stagnation. If Qi is obstructed by tangible forms, removing the accumulation allows Qi to flow smoothly. If the issue is entirely in the intangible Qi level, purgatives will fail to remove it and will instead damage Zheng Qi; this must be clearly understood.
Second, the method to dissipate Qi stagnation lies in moving Qi, as moving Qi leads to dispersion. However, the method of moving Qi requires flexibility. If Qi is excessive and congested, breaking Qi is appropriate; if Qi is closed and retained, promoting drainage is appropriate; if Qi is hot and drying, cooling is appropriate; if Qi is cold and coagulated, warming is appropriate. These are the general principles for dissipating Qi to treat Jia. However, if Qi strength and vitality were robust, circulation would be uninterrupted, and no Jia would exist. Only when Zheng Qi fails do pathogens gather. The Classics state: "Where pathogens gather, Qi must be deficient." Therefore, those suffering from this disease are mostly Qi-deficient. If deficiency is not addressed, Zheng Qi does not move; if Zheng Qi does not move, pathogens do not disperse, and recovery is impossible. Excess syndromes have evident signs, while deficiency syndromes often mimic excess, making them hidden and difficult to identify; thus, distinguishing true from false is crucial.
Third, for formulas that break and move Qi, suitable for severe Qi excess and congestion causing distension and pain, include Paiqi Yin, Muxiang Shunqi San, Muxiang Tiaoqi San, Simo Tang, and various Qi Qi Tangs. For Qi stagnation within Blood causing stasis and pain, Shixiao San, Tongyu Jian, and Tiaojing Yin are suitable; for severe cases, Qiming Dan from *Liang Fang*. For Qi gathering in Shan Jia, Lixiang San is used; for severe cases, Tiantai Wuyao San. For Qi knotting in the Bladder causing difficult urination, Xiao Li Qing Yin, Siling San, and Wuling San are used. For Qi knotting in the Large Intestine causing dry constipation, Soufeng Shunqi Wan and Mahuang Wan are used. For constipation due to Water and Blood deficiency, Jichuan Jian is used. For Liver Qi rebellion causing gathering, Jiegan Jian is used; if accompanied by Fire, Huagan Jian is used. For Qi gathering with Heat and suppressed Fire, Chouxin Yin and Da Li Qing Yin are used. For Cold stagnation preventing movement and Qi knotting causing distension, Yifu Jian, Hewei Yin, and Dingxiang Fuling Tang are used. For Triple Burner congestion, unclear Qi pathways, and middle-jiao distension/swelling, Kuqing Yin is used. For Phlegm-fluid and Water-Qi stagnation in the chest and hypochondrium causing acid regurgitation and vomiting, Lingzhu Erchen Jian, Liu'an Jian, Hewei Yin, and Kutan Wan are used. All the above methods are suitable only for Qi-excess Jia gathering; they must not be used for those with insufficient Yuan Qi.
Fourth, for formulas that tonify Qi to move Qi, such as Shengyu Tang, Shen Gui Tang, and Qifu Yin, they regulate Heart Qi deficiency and stagnation. Wuwei Yigong San and Shen Zhu Tang regulate Heart-Spleen Qi deficiency and non-movement. Dushen Tang and Shenfu Tang assist Lung Qi to govern the regulation of the Five Zang Organs. For Spleen-Stomach Qi deficiency with stagnation, Liujunzi Tang and Guipi Tang are suitable. For Spleen-Stomach deficiency-cold with stagnation, Wenwei Yin, Lizhong Tang, and Wu Junzi Jian are best. For deficiency in the Yin aspect of Spleen-Kidney, where Qi non-movement leads to phlegm-fluid, distension, vomiting, or abdominal pain, Liyin Jian is indispensable. For deficiency in Qi within Blood causing stagnation and pain, mild cases use Siwu Tang; severe cases require Wuwu Jian,iejing Jian, or Daying Jian. For Liver-Kidney cold stagnation with rebellious Qi and pain in the lower abdomen, Nuangan Jian is required for warming. For Spleen-Kidney Qi deficiency leading to loss of control and stagnation/pain, Weiguan Jian is required for securing. For Yuan Qi sinking with stagnation and failure to ascend, Buzhong Yiqi Tang and Juyuan Jian are used to lift. For severe Yuan Qi deficiency with failed Qi transformation and stagnation, Wufu Yin, Shiquan Dabu Tang, Dabu Wan Jian, or Liuwei Huiyang Yin are required for tonification. All the above are methods of tonifying Qi to move Qi. They are merely tools to achieve the goal; their subtleties cannot be fully expressed in words. However, common sentiment holds that for Qi stagnation, breaking and dispersing is best; claiming tonification is met with disbelief. They do not know that pathogenic strength stems from host weakness; pathogenic victory stems from Zheng Qi deficiency. Most modern illnesses are deficiency-based, yet tonification is rarely used. Treatment contradicts the disease, making successful healing rare. I repeatedly emphasize that most diseases are deficiency with little excess, but people do not believe me. Let me use a human analogy to clarify. Human deficiency/excess is like wealth/poverty. Qi-excess is like a rich man; Qi-deficiency is like a poor scholar. How many rich men are there among thousands? Aside from the rich, all are poor. This ratio applies similarly. There are also those who appear wealthy but are internally bankrupt, hard to discern, fitting this category. But the nature of the poor is that they can be increased but not diminished; adding a bit is still insufficient, subtracting a bit makes their distress unbearable. Applying subtle draining techniques to the poor and destitute secretly transfers their fortune without their knowledge, which is pitiful. Medicine uses benevolence as its technique; how can one not hold this heart? Alas! Life depends on Qi; gaining Qi brings life, losing Qi brings death. The wise know how to preserve life; the unwise only treat disease. To pretend to know what one does not know, merely for convenience, using human lives as experiments—such people's outcomes are predictable.