即积，瘕即聚， 与癖则稍异其状，大略如是已，后世更立痞块之目，殊为无谓。至其治方，则积聚二证
鲜能区别者，要不过就消磨一途而分轻重，今之所纂亦此忘也。如妇人之病，其类不一，具列于彼门，兹仍不登
载。
源由总说 瘕癖结者，积聚之异名也，证状不一，原其病本大略相类，但从其所得或诊其证状以立
名尔。且 者为隐见腹内，按之形证可验也。瘕者为瘕聚，推之流移不定也。癖者僻侧在于胁肋（按∶三证详见
后）。结者沉伏结强于内（按，此亦积，不须别立名）。然有得之于食，有得之
于水，有得之于忧思，有得之于风寒，凡使血气沉滞留结而为病者，治须渐磨溃消，使气血流通，则病可愈矣。
（《圣济》）（按∶《中藏经》曰∶ 者系于气也，瘕者系于血也。）
积聚之病，凡饮食血气风寒之属，皆能致之，但曰积曰聚，当详辨也。盖积者积迭之谓，由渐而成者也；
聚者聚散之谓，作止不常者也。由此言之，是坚硬不移者，本有形也，故有形者曰积；或聚或散者，本无形也，
故无形者曰聚。诸有形者，或以饮食之滞，或以脓血之留，凡汁沫凝聚，旋成症块者，皆积之类，其病多在血
分，血有形而静也；诸无形者，或胀或不胀，或痛或不痛，凡随触随发，时来时往者，皆聚之类，其病多在气
分，气无形而动也。故《难经》以积为阴气，聚为阳气，其义即此。凡无形之聚，其散易；有形之积，其破难。
临此证者，但当辨其有形无形，在气在血，而治积治聚，自可得其梗概矣。（《景岳》）
病因腑脏受邪 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。阳浮而动，阴沉而伏。积者阴气，五脏所生，始发不离其部，故上下有所穷已。聚者阳气，六腑所成，
故无根本，上下无所留止，其痛无有常处。诸脏受邪，初未能为积聚，留滞不去，乃成积聚。（《病源论》）
六腑属于三阳，太阳利清气，阳明泄浊气，少阳化精气，有如都会之府，主转输以为常也。夫苟六腑失常，
则邪气聚而不散，始发既无根本，上下无所留止，其痛亦无常处，故在上则格，在下则胀，旁攻两胁，如有痞
块，易于转动，故非五积之比也。（《济生》）
风寒外感之邪，亦能成积。如经曰∶虚邪之中人也，留
而不去。传舍于肠胃之外，募原之间，留着于脉，息而成积。又曰∶病名伏梁，此风根也。由此观之，凡今人
以疟后成痞者，是即风寒之属，类可推矣。但疟由风寒，固易知也，而诸积于风，若不相干涉。不知饮食之滞，
非寒未必成积，而风寒之邪，非食未必成形。故必以食遇寒，以寒遇食，或表邪未清，过于饮食，邪食相搏，
而积斯成矣。经曰∶虚邪之风，与其身形，两虚相得，乃客其形。信乎致积之由，多由于此，即血症气痞之由，
亦无出于此。然积以寒留，留久则寒多为热；风以致积，积成则证已非风。故治此者，亦但当治其所留，不可
发散，以再伤其真气也。惟慎疾者，能知所由而虑之于始，则可为保脾之良策。（《景岳》）
病因饮食不消 症者，由寒温失节，致腑脏之气虚弱，而饮食不消，聚结在内，染渐生长块段，
盘牢不移动者，是 也，言其形状可征验也。若积引岁月，人即柴瘦，腹转大，遂致死。（《病源论》）
瘕病者，由寒温不适，饮食不消，与脏气相搏，积在腹内，结块瘕痛，随气移动是也，言其虚假不牢，故
谓之为瘕也。（同上）
夫积者，伤滞也，伤滞之久，停留不化，则成积矣。且人之脏腑，皆触冒以成疾病，惟脾胃最易受触。盖
日用饮食，稍或过多，停滞难化，或吐或呕，或泄或利。当是之时，法宜推荡，然后助养脾胃。所谓推荡者，
更宜斟量人之虚实，伤滞之轻重而推荡之，停滞一消，则不成积，克化失宜，久之必成积聚 瘕矣。（《济生
续方》）
病因气郁痰血 方书之五积六聚，证状不同，非谓食物所伤，留滞不去。盖五积者，因喜怒忧思失志，
以伤五脏，
遇传克不行而成病也。（《澹寮》）
诸书所载，皆以内为喜怒忧思七情之气，克制五脏，结而不散，乃成积聚之证（云云）。余忖度之，必是
因气结聚痰饮，或者积聚之物，而后能坚硬如此。发萌之初，早能辨其脉证，投以药饵，或以导引之法，犹云
庶几。若其见形于皮肤之下，药入肠胃，熏蒸之所不及，诚为难治之证。（《大成》）
气无形故不成块，然痰与食积死血，多因气聚而成，是气虽不为块，而所以为块者实由乎气，故治积之法，
以行气为主。（《统旨》）（按∶丹溪曰∶气不能作块成聚，块乃有形之物也，痰与食积死血而成也。叶氏实
驳此说也。）
五积当从郁论，《难经》所谓因受胜己之邪，传于己之所胜，适当旺时，拒而不受，因留为积。此皆抑郁
不伸而受其邪，故五积六聚治同郁断。伏梁者，火之郁。肥气者，木之郁。痞气者，土之郁。息贲者，金之郁。奔
豚者，水之郁。（按∶以上系《儒门事亲》节文）郁者，气不舒而抑郁成积，不独聚可以气言也。故治积之法，
以理气为先，则津液流行，积聚何由而成。（《锦囊》）
上古穴居野处，无情欲之累，故病多外感，以故《素问》往往谓脏寒生满病，又谓用力过度则络脉伤，伤
则血外溢于肠外，有寒汁沫与血相搏，则并合凝聚不能散而成积。今人多情欲，痰血气郁凝滞者比比皆是，故不
敢引经以断也。（《六要》）
大抵积块者，皆因一物为之根，而血涎裹之，乃成形如杯如盘，按之坚硬也。食积败血，脾胃有之。痰涎
之积，左右皆有之。（《保命歌括》）
病有因热 经曰∶小肠移热于大肠，为 瘕，为沉（云
云）。然则经言瘕病，亦有热者也。或阳气郁结，怫热壅滞，而坚硬不消者，非寒 瘕也，当以脉证别之。（《原
病式》）
病属阴寒有留止聚散之别 脉之小也，微也，小急也，弦急也，沉也，沉伏也，迟也，涩也，实也，
数绝也，沉横也，结伏也，长而左右弹也（按∶此诸脉系经及《脉经》所见），是皆阴寒敛实之脉，则知积之
成也，亦多属阴寒。阴寒则不能温散，而易于凝着，始则毫厘之留，日以增益，如堆然，久久则小者大，软
者坚，虚者实，无形者有形。聚则不然，病发无根，痛无常处。夫无根无常，则气不留止，偶与气血相搏，则
邪正相干，气聚而痛，气散则解，非若积之留止不移不散也。如肠腹攻冲，疝 瘕热，胸腹胀满，切痛雷鸣等
证，皆聚之类也。古人论积聚分脏腑者，亦不过以沉伏留止不移者属阴，阴则为脏；浮动聚散不常者为阳，
阳则为腑耳。治之者，当于留止聚散上相机，不当于脏腑二字上作工夫也。（《续焰》）
脉候 寸口脉沉而紧，苦心下有寒，时痛，有积聚。关上脉 大而尺寸细者，其人必心腹冷积，
瘕结聚，欲热饮食。（《脉经》）
迟而涩，中寒有症结。快而紧，积聚有击痛。弦小者，寒癖。（同上）
寸口脉沉而横者，胁下及腹中有横积痛（按∶此《平人气象论》文）。其脉弦，腹中急痛（按∶此取小建
中汤条）。腰背痛相引，腹中有寒疝瘕。脉弦紧而微细者，症也。夫寒痹 瘕积聚之脉皆弦紧，若在心下即寸
弦紧，在胃管即关弦紧，在脐下即尺弦紧。（一曰关脉弦长，有积在脐左右上下也。）又脉症法∶左手脉横症
在左，右手脉横症在右，脉头
大者在上，头小者在下。又法∶横脉见左积在右，见右积在左，偏得洪实而滑亦为积，弦紧亦为积为寒痹为疝痛。
内有积不见脉难治，见一脉（一作胁）相应为易治，诸不相应为不治。左手脉大，右手脉小，上病在左胁，下
病在左足；右手脉大，左手脉小，上病在右胁，下病在右足。脉来细而沉时直者，身有痈肿，若腹中有伏梁。脉
来小沉而实者，胃中有积聚，不下食，食即吐。（同上）
脉沉重而中散者，因寒食成症，脉左转而沉重者，气症，阳在胸中。脉右转出不至寸口者，内有肉症。
（同上）
寸口脉细沉滑者，有积聚在胁下，左右皆满，与背相引痛。诊其脉来实，心腹积聚，饮食不消，胃中冷也。
（《病源论》）
脉来逆而牢者，为病症也。肾脉小急，肝脉小急，心脉若鼓，皆为症。寸口脉结者， 瘕。（同上）（按∶
《邪气脏腑病形篇》∶肾脉微急为沉厥奔豚，足不收，不得前后。又肝脉微急为肥气，在胁下，若覆杯。此巢氏
所本。又寸口脉结，本于《十八难》。）
诊决死生 诊人心腹积聚，其脉坚强急者生，虚弱（《病源》此有急字，衍）者死。又实强者生，沉（《济
生》此有小字）者死。其脉大，腹大胀，四肢逆冷，其人脉形长者死。腹胀满，便血，脉大时绝，极下血，脉
小疾者死。（《脉经》）
（按∶《病源》所举止沉者死。《中藏经》无其脉大三字，别为一条，据此或者腹胀诊法，姑录于兹。）
脉弦而伏者，腹中有症，不可转也（《病源》作不可转动），必死不治。（同上）
寸口脉紧而牢者，胁下腹中有横积。结痛而泄利，脉微细者生，浮者死。（《病源论》）
其脉实强者，阳脉也，一以征邪正之相搏，一以征元本之壮实，从腑从阳，故曰生；其脉沉细者，阴脉也，
一以征邪气之深久，一以征元本之衰微，从脏从阴，故曰死。（《续焰》）
五脏积 诊得肺积，脉浮而毛，按之辟易，胁下气逆，背相引痛，少气善忘，目瞑皮肤寒，秋瘥夏剧，
主皮中时痛，如虱缘之状，甚者如针刺，时痒，其色白。诊得心积，脉沉而芤，上下无常处，病胸满悸，腹中
热，面赤嗌干，心烦掌中热，甚即唾血，主身螈 ，主血厥，夏瘥冬剧（《病源》此下曰∶唾脓血者死），其色
赤。诊得脾积，脉浮大而长，饥则减，饱则见， 起与谷争减，心下累累如桃李，起见于外，腹满呕泄肠鸣，
四肢重，足胫肿，厥，不能卧，是主肌肉损，其色黄。诊得肝积，脉弦而细，两胁下痛，邪走心下，足肿寒，胁
痛引少腹，男子积疝，女子瘕淋，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
脊与腰相引痛，饥则见，饱则减，少腹里急，口干咽肿，伤烂，目 ，骨中寒，主髓厥善忘，其色黑。（《脉
经》）（按∶《要诀》错综《难经》及此条，拟以大七气汤加减，今不录。）
经论五脏积气，皆因五脏旺时，不受所传邪气而成（云云）。常究此说，亦未可必。夫肺病传肝、肝传脾
之类，自是胜其所胜，夫传所胜者死。若如所言，则五脏之积皆死候也，其实不然也。（《鸡峰》）
瘕形证 （暴症） 瘕者，此由寒温不调，饮食不化，与脏气相搏结所生也。其病不动者，直名为症。
若病虽有结瘕，而可推移者，名为 瘕（按∶此症字似衍）。瘕者假
也，谓虚假可动也。候其人，发语声嘶，中满浊而后语，乏气拖舌，语而不出，此人食结在腹，病寒，口里常
水出（按∶《圣惠》作候其人发语，声嘶挹舌，语而不出，此人食结在腹，其病寒，口中常有水出。《鸡峰》同，
舌作言），四体洒洒，常若发疟，饮食不能，常自闷闷而痛，此食症病也。（《病源论》）（宜参前病因饮
食不消条及脉候。）
暴症者，由腑脏虚弱，食生冷之物，脏既虚弱，不能消之，结聚成块，卒然而起，其生无渐，名曰暴症也。
本由脏弱，其症暴生，至于成病，死人则速。（同上）
戴云∶积聚 瘕，有积聚成块不移动者，是 ；或有或无，或上或下，或左或右者，是瘕。（《钩玄》）
癖形证 夫 癖者，本因邪冷之气积聚而生也。 者，在腹内近脐左右，各有一条筋脉急痛，大者如
臂，次者如指，因气而成，如弦之状，名曰 气也。癖者，侧在两肋之间，有时而僻（《鸡峰方》僻作痛），
故曰癖也。夫 之与癖，名号虽殊，针石汤丸主疗无别，此皆阴阳不和，经络痞隔，饮食停滞，不得宣流，邪冷
之气，搏结不散，故曰 癖也。（《圣惠》）
者悬也（按∶此说误），悬于腹内，近脐左右，各有一条筋脉扛起，大者如臂如筒，小者如指如笔管如
弦，其原皆由阴阳之气不和，常多郁塞，又时忿怒，动气偏胜，或适当饮食，与气缠裹，适受寒冷，与气停蓄，
且忿怒则肝火盛，而血随气结，痰亦缘火相附而升，遂合并而成形质，悬于脐之左右，故名曰 。（《尊生
书》）
癖积，两胁刺痛，三棱、广术之类，甚者甘遂、蝎梢。（《儒门事亲》）
部位 积在中为痰饮，在右为食积，在左为死血，乃丹溪确论也（按∶丹溪说，出《心法》）。然胃脘有食积而
病发在中者，亦有肝气与宿食相假而积在左者，又不可拘泥也。曾治一少年，体薄弱，且咳血，左边一块，不时上攻作
痛，左金、芦荟俱不应。诊其脉三部虽弦，而细涩不流利，因作阴虚治，四物加知、柏、玄参、牡丹皮，不六剂顿愈，
这就是“积”，“瘕”就是“聚”，它们与“癖”在症状表现上略有不同，大致情况就是这样。后世又设立了“痞块”这一名称，实在没有意义。至于治疗方药，对于“积”和“聚”这两个证候，很少能严格区分，大体不过是在消食化积的方法上根据病情的轻重有所区别，现在编纂的这本书也是遵循这个原则。至于妇女的疾病，种类繁多，已在妇科门类中详细列出，这里不再赘述。
【源由总说】
“寢”、“癖”、“结”都是“积聚”的不同名称，虽然症状表现不一，但追溯其病因本源，大致是相似的，只是根据致病原因或诊察到的症状来命名罢了。“寢”是指在腹内隐约可见，按压时形态和症状可以验证；“瘕”是指假性聚集，推之移动不定；“癖”是指偏侧位于胁肋部（按：这三种证候详见后文）；“结”是指沉伏于体内，结实强硬（按：这也属于“积”，不必另立名称）。然而，有的因饮食所致，有的因水饮所致，有的因忧思所致，有的因风寒所致，凡是使气血沉滞留结而成为疾病的，治疗需要逐渐磨溃消散，使气血流通，疾病才能痊愈。（《圣济总录》）（按：《中藏经》说：“寢”系于气，“瘕”系于血。）
积聚的病，凡是饮食、血气、风寒等因素，都能导致，但称为“积”或“聚”，应当仔细辨别。所谓“积”，是累积重叠的意思，是由逐渐发展而成的；所谓“聚”，是聚散无常的意思，发作和停止没有固定规律。由此说来，坚硬不移的，本来就有形质，所以有形的称为“积”；有时聚集有时消散的，本来无形质，所以无形的称为“聚”。所有有形的病变，或者是饮食停滞，或者是脓血留滞，凡是汁沫凝聚，随即形成症块的，都属于“积”的范畴，这类病多在血分，因为血是有形且静止的；所有无形的病变，或者胀或不胀，或者痛或不痛，凡是随触动而发作，来时去时无常的，都属于“聚”的范畴，这类病多在气分，因为气是无形且运动的。所以《难经》认为“积”是阴气，“聚”是阳气，道理就在这里。凡是无形的“聚”，容易消散；有形的“积”，难以攻破。面对这些证候，只应当辨别其有形还是无形，在气还是在血，那么治疗“积”和治疗“聚”，自然就能掌握大概了。（张景岳《景岳全书》）
【病因腑脏受邪】
积聚，是由于阴阳不和，脏腑虚弱，受到风邪侵袭，与脏腑之气搏结而产生的。腑属阳，脏属阴。阳气轻浮而动，阴气沉静而伏。“积”是阴气，由五脏产生，发病时不离其部位，所以上下有固定的范围。“聚”是阳气，由六腑形成，所以没有根本，上下没有停留止息之处，疼痛也没有固定位置。各脏腑受到邪气，起初并不能形成积聚，只有当邪气留滞不去，才形成积聚。（《诸病源候论》）
六腑属于三阳经，太阳经利于清气，阳明经泄出浊气，少阳经化生精气，就像都会的府库，主要起转输作用以维持常态。如果六腑功能失常，则邪气聚集而不散，发病时既无根本，上下也没有停留之处，疼痛也没有固定位置，所以在上部则格拒，在下部则胀满，旁攻两胁，好像有痞块，易于转动，所以不能与五积相比。（《济生方》）
风寒外感之邪，也能形成积聚。如经典所说：“虚邪”侵入人体，停留不去，传舍于肠胃之外，募原之间，附着于脉道，呼吸之间形成积聚。又说：病名“伏梁”，这是风邪的根本。由此看来，如今人们疟疾后形成的痞块，也就是属于风寒一类，可以类推。但是疟疾由风寒引起，固然容易知晓，而各种积聚似乎与风邪无关。不知道饮食停滞，如果没有寒气未必形成积聚，而风寒之邪，如果没有食物依附未必形成有形之积。所以一定是饮食遇到寒气，或者寒气遇到饮食，或者表邪未清，饮食过量，邪气与食物相互搏结，积聚这才形成。经典说：“虚邪之风”，与人的身体，两虚相得，才客居形体。确实，导致积聚的原因，多由于此，即血症和气痞的原因，也不超出这个范围。然而积聚因寒而留滞，留滞久了则寒多转为热；风邪导致积聚，积聚形成后症状已不再是风邪的表现。所以治疗此类疾病，只应当治疗其所留滞之物，不可发散，以免再次损伤真气。只有谨慎对待疾病的人，能知道其原因并在初期加以考虑，这才是保养脾胃的良好策略。（张景岳《景岳全书》）
【病因饮食不消】
“寢”这种病，是由于寒温失调，导致脏腑之气虚弱，饮食不能消化，聚结在体内，逐渐生长成块段，盘踞牢固不移动的，就是“寢”，意思是其形状可以征验。如果积聚拖延岁月，人就会消瘦，腹部转而变大，最终致死。（《诸病源候论》）
“瘕”病，是由于寒温不适，饮食不消化，与脏气相互搏结，积聚在腹内，结成块状并疼痛，随气机移动，这就是“瘕”，意思是虚假不牢固，所以称为“瘕”。（同上）
所谓“积”，就是伤滞。伤滞时间长久，停留不化，就形成了“积”。而且人的脏腑，都容易因触犯外邪而生病，其中脾胃最容易受触犯。因为日常饮食，稍微过多，停滞难以消化，就会出现呕吐、腹泻等症状。在这个时候，法度上适宜用推荡之法（泻下），然后辅助调养脾胃。所谓的推荡，更应斟酌病人的虚实，伤滞的轻重来进行推荡，一旦停滞消除，就不会形成积聚；如果克伐消化失宜，久而久之必然形成积聚、寢、瘕。（《济生续方》）
【病因气郁痰血】
医书中的五积六聚，症状不同，并非仅仅指食物受伤，留滞不去。所谓五积，是因为喜怒忧思失志，损伤五脏，遇到相克的情况无法运行而形成疾病。（《澹寮集验方》）
各种书籍所载，都认为内在的喜怒忧思等七情之气，克制五脏，结聚不散，从而形成积聚证候。我推测，必定是因为气结聚、痰饮，或者是积聚之物，之后才能变得如此坚硬。在萌芽之初，如果能早辨明脉证，投以药物，或者使用导引之法，还差不多。如果已经显现于皮肤之下，药物进入肠胃，熏蒸之力达不到，这确实是难治的证候。（《医学大成》）
气是无形的，所以不成块，但是痰、食积、死血，多因气聚而成，虽然气本身不为块，但形成块的原因确实在于气，所以治疗积聚的方法，以行气为主。（《丹溪心法统旨》）（按：朱丹溪说：“气不能作块成聚，块乃有形之物也，由痰与食积死血而成。”叶天士实际上驳斥了这个说法。）
五积应当从“郁”来论述，《难经》所说的因承受胜过自己的邪气，传给自己所胜的脏腑，正当旺盛之时，拒绝而不接受，因而留滞成为积。这都是因为抑郁不伸而受邪，所以五积六聚的治疗同于郁证的断案。伏梁，是火的郁结。肥气，是木的郁结。痞气，是土的郁结。息贲，是金的郁结。奔豚，是水的郁结。（按：以上系《儒门事亲》节选）郁，是气不舒展而抑郁形成积聚，不仅仅是聚可以用气来说明。所以治疗积聚的方法，以理气为先，这样津液流行，积聚从何而生呢？（《锦囊秘录》）
上古时期穴居野处，没有情欲的拖累，所以病多外感，因此《素问》往往说脏寒生满病，又说用力过度则络脉受伤，伤了则血外溢于肠外，有寒汁沫与血相搏，则并合凝聚不能散而成积。今人多有情欲，痰血气郁凝滞者比比皆是，所以不敢引用经典来断定。（《薛己医案六要》）
大抵积块，都是因为有一物作为根基，而血涎包裹它，才形成像杯像盘的形状，按压坚硬。食积败血，脾胃会有。痰涎之积，左右都有。（《保命歌括》）
【病有因热】
经典说：“小肠移热于大肠，为寢瘕，为沉……”既然如此，经典所说的瘕病，也有热的情况。或者是阳气郁结，怫热壅滞，而坚硬不消的，不是寒性的寢瘕，应当通过脉证来辨别。（刘完素《原病式》）
【病属阴寒有留止聚散之别】
脉象小、微、小急、弦急、沉、沉伏、迟、涩、实、数绝、沉横、结伏、长而左右弹（按：这些脉象见于经络及《脉经》），都是阴寒敛实的脉象，由此可知积聚的形成，也多属于阴寒。阴寒则不能温散，而易于凝着，开始时是毫厘的留滞，日以增益，像堆积一样，久久则小的变大，软的变硬，虚的变实，无形的变有形。聚则不然，病发无根，疼痛无常处。夫无根无常，则气不留止，偶尔与气血相搏，则邪正相干，气聚则痛，气散则解，不像积那样留止不移不散。如肠腹攻冲、疝瘕热、胸腹胀满、切痛雷鸣等证候，都属于聚的范畴。古人论述积聚分属脏腑，也不过是以沉伏留止不移者属阴，阴则为脏；浮动聚散不常者为阳，阳则为腑罢了。治疗者，应当在留止聚散上相机行事，不应当在脏腑二字上下功夫。（《续焰》）
【脉候】
寸口脉沉而紧，苦心下有寒，时常疼痛，有积聚。关上脉大而尺寸细的，其人必有心腹冷积，瘕结聚，想要热饮食。（《脉经》）
迟而涩，主中寒有症结。快而紧，主积聚有击痛。弦小的，主寒癖。（同上）
寸口脉沉而横的，胁下及腹中有横积痛（按：此出自《平人气象论》）。其脉弦，腹中急痛（按：此取小建中汤条）。腰背痛相互牵引，腹中有寒疝瘕。脉弦紧而微细的，是症。夫寒痹、寢瘕、积聚的脉皆弦紧，若在心下即寸脉弦紧，在胃管即关脉弦紧，在脐下即尺脉弦紧。（一说关脉弦长，有积在脐左右上下也。）又有脉症法则：左手脉横，症在左；右手脉横，症在右；脉头大的在上，头小的在下。又有法则：横脉见左，积在右；见右，积在左；偏得洪实而滑也为积，弦紧也为积、为寒痹、为疝痛。内有积而不见脉，难治；见一脉（一作胁）相应为易治，诸不相应为不治。左手脉大，右手脉小，上病在左胁，下病在左足；右手脉大，左手脉小，上病在右胁，下病在右足。脉来细而沉时直的，身有痈肿，若腹中有伏梁。脉来小沉而实的，胃中有积聚，不下食，食即吐。（同上）
脉沉重而中散的，因寒食成症，脉左转而沉重的，气症，阳在胸中。脉右转出不至寸口的，内有肉症。（同上）
寸口脉细沉滑的，有积聚在胁下，左右皆满，与背相引痛。诊其脉来实，心腹积聚，饮食不消，胃中冷也。（《诸病源候论》）
脉来逆而牢的，为病症。肾脉小急，肝脉小急，心脉若鼓，皆为症。寸口脉结的，为寢瘕。（同上）（按：《邪气脏腑病形篇》：肾脉微急为沉厥奔豚，足不收，不得前后。又肝脉微急为肥气，在胁下，若覆杯。此为巢氏所本。又寸口脉结，本于《十八难》。）
【诊决死生】
诊察人心腹积聚，其脉坚强急的为生，虚弱（《病源》此处有急字，衍文）的为死。又实强的为生，沉（《济生》此处有小字）的为死。其脉大，腹大胀，四肢逆冷，其人脉形长的为死。腹胀满，便血，脉大时绝，极下血，脉小疾的为死。（《脉经》）
（按：《病源》所举止沉者为死。《中藏经》无其脉大三字，别为一条，据此或许是腹胀诊法，姑录于此。）
脉弦而伏的，腹中有症，不可转也（《病源》作不可转动），必死不治。（同上）
寸口脉紧而牢的，胁下腹中有横积。结痛而泄利，脉微细的为生，浮的为死。（《诸病源候论》）
其脉实强的，是阳脉，一以征验邪正之相搏，一以征验元本之壮实，从腑从阳，所以说生；其脉沉细的，是阴脉，一以征验邪气之深久，一以征验元本之衰微，从脏从阴，所以说死。（《续焰》）
【五脏积】
诊得肺积，脉浮而毛，按之辟易，胁下气逆，背相引痛，少气善忘，目瞑皮肤寒，秋瘥夏剧，主皮中时痛，如虱缘之状，甚者如针刺，时痒，其色白。诊得心积，脉沉而芤，上下无常处，病胸满悸，腹中热，面赤嗌干，心烦掌中热，甚即唾血，主身螈 ，主血厥，夏瘥冬剧（《病源》此下曰：唾脓血者死），其色赤。诊得脾积，脉浮大而长，饥则减，饱则见， 起与谷争减，心下累累如桃李，起见于外，腹满呕泄肠鸣，四肢重，足胫肿，厥，不能卧，是主肌肉损，其色黄。诊得肝积，脉弦而细，两胁下痛，邪走心下，足肿寒，胁痛引少腹，男子积疝，女子瘕淋，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，苦脊与腰相引痛，饥则见，饱则减，少腹里急，口干咽肿，伤烂，目 ，骨中寒，主髓厥善忘，其色黑。（《脉经》）（按：《要诀》错综《难经》及此条，拟以大七气汤加减，今不录。）
经典论述五脏积气，皆因五脏旺时，不受所传邪气而成（云云）。常常探究此说，也未必一定如此。夫肺病传肝、肝传脾之类，自然是胜其所胜，夫传所胜者死。如果像所言，则五脏之积皆死候也，其实不然也。（《鸡峰普济方》）
【寢瘕形证】
（暴寢） 寢者，此由寒温不调，饮食不化，与脏气相搏结所生也。其病不动者，直名为寢。若病虽有结瘕，而可推移者，名为寢瘕（按：此寢字似衍文）。瘕者假也，谓虚假可动也。候其人，发语声嘶，中满浊而后语，乏气拖舌，语而不出，此人食结在腹，病寒，口里常水出（按：《圣惠》作候其人发语，声嘶挹舌，语而不出，此人食结在腹，其病寒，口中常有水出。《鸡峰》同，舌作言），四体洒洒，常若发疟，饮食不能，常自闷闷而痛，此食寢病也。（《诸病源候论》）（宜参前病因饮食不消条及脉候。）
暴寢者，由腑脏虚弱，食生冷之物，脏既虚弱，不能消之，结聚成块，卒然而起，其生无渐，名曰暴寢也。本由脏弱，其症暴生，至于成病，死人则速。（同上）
戴云：积聚寢瘕，有积聚成块不移动者，是寢；或有或无，或上或下，或左或右者，是瘕。（《医学钩玄》）
【癖形证】
夫 癖者，本因邪冷之气积聚而生也。 者，在腹内近脐左右，各有一条筋脉急痛，大者如臂，次者如指，因气而成，如弦之状，名曰 气也。癖者，侧在两肋之间，有时而僻（《鸡峰方》僻作痛），故曰癖也。夫 之与癖，名号虽殊，针石汤丸主疗无别，此皆阴阳不和，经络痞隔，饮食停滞，不得宣流，邪冷之气，搏结不散，故曰 癖也。（《太平圣惠方》）
者悬也（按：此说误），悬于腹内，近脐左右，各有一条筋脉扛起，大者如臂如筒，小者如指如笔管如弦，其原皆由阴阳之气不和，常多郁塞，又时忿怒，动气偏胜，或适当饮食，与气缠裹，适受寒冷，与气停蓄，且忿怒则肝火盛，而血随气结，痰亦缘火相附而升，遂合并而成形质，悬于脐之左右，故名曰 。（《尊生书》）
癖积，两胁刺痛，三棱、广术之类，甚者甘遂、蝎梢。（《儒门事亲》）
【部位】
积在中为痰饮，在右为食积，在左为死血，乃丹溪确论也（按：丹溪说，出《心法》）。然胃脘有食积而病发在中者，亦有肝气与宿食相假而积在左者，又不可拘泥也。曾治一少年，体薄弱，且咳血，左边一块，不时上攻作痛，左金、芦荟俱不应。诊其脉三部虽弦，而细涩不流利，因作阴虚治，四物加知、柏、玄参、牡丹皮，不六剂顿愈，
This is "Ji" (Accumulation), "Jia" (Mass) is "Ju" (Gathering). Their symptoms differ slightly from "Pi" (Partiality), and the general situation is as described above. Later generations established the term "Pi Ku" (Obstructed Mass), which is truly meaningless. As for treatment prescriptions, there are few cases where the two syndromes of "Ji" and "Ju" can be strictly distinguished; generally, it merely involves differentiating severity within the approach of resolving stagnation. The compilation here also follows this principle. As for diseases in women, they are diverse and have been listed in detail in the gynecology section, so they are not recorded here again.
[General Discussion on Origins]
"Qin", "Pi", and "Jie" are alternative names for "Ji Ju" (Accumulations and Gatherings). Although their symptoms vary, tracing back to the root cause reveals they are largely similar; they are named based on the pathogenic factors or the observed symptoms. "Qin" refers to something faintly visible inside the abdomen, where pressing reveals its form and symptoms. "Jia" refers to a false gathering that moves when pushed. "Pi" refers to a condition located laterally in the hypochondrium (see later sections for details on these three syndromes). "Jie" refers to something deep-seated, firm, and hard inside (this is also considered "Ji" and does not need a separate name). However, some arise from food, some from water retention, some from worry and overthinking, and some from wind-cold. For any disease caused by blood and qi sinking, stagnating, and knotting, treatment requires gradual grinding and dissolving to restore the free flow of blood and qi, thereby curing the disease. (*Shengji Zonglu*) (Note: *Zhongzang Jing* states: "Qin" relates to Qi, while "Jia" relates to Blood.)
Diseases of accumulation and gathering can be caused by food, blood, qi, wind, and cold. However, one must carefully distinguish between "Ji" and "Ju". "Ji" implies cumulative layering, developing gradually; "Ju" implies gathering and dispersing irregularly, with unpredictable onset and cessation. Therefore, those that are hard and immobile possess form and are called "Ji"; those that gather and disperse lack fixed form and are called "Ju". All forms-based lesions, whether due to food stagnation or retained pus and blood, where fluids and froth condense to form masses, belong to the category of "Ji". These diseases mostly reside in the blood level, as blood is tangible and static. All formless lesions, whether distended or not, painful or not, arising upon stimulation and coming and going unpredictably, belong to the category of "Ju". These diseases mostly reside in the qi level, as qi is intangible and dynamic. Thus, *Nan Jing* considers "Ji" as Yin Qi and "Ju" as Yang Qi, which aligns with this reasoning. Formless "Ju" is easy to disperse; formed "Ji" is difficult to break. When facing these syndromes, one only needs to differentiate between formless and formed, and between qi and blood levels; then, the principles for treating "Ji" and "Ju" will become clear. (Zhang Jingyue, *Jingyue Quanshu*)
[Etiology: Viscera Affected by Pathogens]
Accumulations and gatherings arise from disharmony of Yin and Yang, weakness of the viscera, invasion of wind pathogens, and contention with visceral qi. Fu organs belong to Yang, and Zang organs belong to Yin. Yang floats and moves; Yin sinks and rests. "Ji" is Yin Qi, generated by the Five Zang organs; its onset remains within its specific area, having definite upper and lower limits. "Ju" is Yang Qi, formed by the Six Fu organs; thus, it has no root, moves freely without staying in one place, and pain has no fixed location. When various viscera are affected by pathogens, it does not initially form an accumulation; only when the pathogen lingers and fails to dissipate does it become an accumulation. (*Zhubing Yuanhou Lun*)
The Six Fu organs belong to the Three Yang meridians. Taiyang facilitates clear qi, Yangming drains turbid qi, and Shaoyang transforms essence qi, acting like a central hub responsible for transportation and transformation. If the functions of the Six Fu organs fail, pathogens gather and do not dissipate. Onset lacks a root, movement is unrestricted, and pain is variable. In the upper body, it causes obstruction; in the lower body, distension; attacking both flanks, it resembles a mass but is easily movable, distinguishing it from the Five Accumulations. (*Jisheng Fang*)
External wind-cold pathogens can also form accumulations. As classics state: "Deficient pathogens" enter the body and linger, transmitting to the space outside the intestines and stomach, between the epigastric region and the membrane source, attaching to vessels, and forming accumulations through respiration. It is also said: The disease named "Fuliang" (Hidden Beam) is rooted in wind. From this, we can infer that post-malaria痞块 (obstructed masses) in modern people belong to the wind-cold category. While malaria caused by wind-cold is easily understood, various accumulations seem unrelated to wind. However, food stagnation may not form an accumulation without cold, and wind-cold pathogens may not take shape without food attachment. Thus, food encountering cold, or cold encountering food, or unresolved exterior pathogens combined with excessive diet, lead to the contention of pathogens and food, forming accumulations. Classics say: "When deficient wind pathogens meet a deficient body, they invade." Indeed, the cause of accumulations often stems from this, as do hemorrheal disorders and qi obstructions. Accumulations caused by cold, if lingering long, transform into heat; accumulations caused by wind, once formed, no longer present as wind symptoms. Therefore, treatment should focus on resolving the stagnation rather than using diaphoresis, which would further damage true qi. Only those who treat illness cautiously, understanding the cause and addressing it early, can preserve spleen and stomach health effectively. (Zhang Jingyue, *Jingyue Quanshu*)
[Etiology: Indigestion]
"Qin" arises from imbalance of cold and warmth, leading to weakened visceral qi and inability to digest food. Food gathers internally, gradually growing into solid, immovable masses. This is called "Qin," meaning its shape is verifiable. If the accumulation persists for years, the person becomes emaciated, the abdomen enlarges, and death ensues. (*Zhubing Yuanhou Lun*)
"Jia" disease arises from improper cold/warmth regulation and indigestion. Food contentions with visceral qi, accumulating in the abdomen to form movable, painful masses. It is called "Jia" because it is false and insecure. (Ibid.)
"Ji" refers to injury and stagnation. Prolonged stagnation that fails to transform becomes "Ji." The viscera are susceptible to external invasions, with the Spleen and Stomach being most vulnerable. Daily dietary excess leads to stagnation and difficulty in digestion, resulting in vomiting or diarrhea. At this stage, purgative methods ("Tui Dang") are appropriate, followed by nourishing the Spleen and Stomach. Purging must be calibrated to the patient's deficiency/excess and the severity of stagnation. Once stagnation clears, no accumulation forms; improper suppression leads to accumulations, Qin, and Jia over time. (*Jisheng Xufang*)
[Etiology: Qi Stagnation, Phlegm, and Blood Stasis]
The Five Accumulations and Six Gatherings in medical texts have different symptoms and are not solely caused by food injury and stagnation. The Five Accumulations result from emotional disturbances (joy, anger, worry, thought) damaging the Five Zang organs, leading to transmission and counter-restriction failures. (*Danliao Jiyan Fang*)
Various books attribute internal seven emotions to restraining the Five Zang organs, causing knotting and failure to disperse, resulting in accumulation syndromes. I speculate that hardness results from Qi knotting, phlegm-fluid retention, or existing accumulation matter. If identified early at the萌芽 (sprouting) stage, medication or Qigong guidance might help. However, if visible under the skin, where oral medications cannot reach via vaporization, it is indeed difficult to treat. (*Yixue Dacheng*)
Qi is formless and does not form masses itself, but phlegm, food stagnation, and dead blood often gather due to Qi. Although Qi itself is not a mass, the formation of masses relies on Qi. Therefore, treating accumulations prioritizes moving Qi. (*Danxi Xinfa Tongzhi*) (Note: Zhu Danxi stated: "Qi cannot form masses; masses are tangible entities formed by phlegm, food stagnation, and dead blood." Ye Tianshi actually refuted this view.)
The Five Accumulations should be discussed from the perspective of "Yu" (Depression/Stagnation). *Nan Jing* describes receiving pathogens stronger than oneself, transmitting to what one controls, and rejecting them during peak times, leading to stagnation. This is due to depression preventing the expulsion of pathogens. Thus, treatments for Five Accumulations and Six Gatherings are similar to those for Depression. Fuliang is Fire Depression; Feiqi is Wood Depression; Piqi is Earth Depression; Xiben is Metal Depression; Ben Tun is Water Depression. (Excerpt from *Rumen Shiqin*). Depression is Qi failing to unblock, leading to stagnation and accumulation. Treatment prioritizes regulating Qi to promote fluid circulation, preventing accumulation. (*Jinnang Milu*)
In ancient times, living in caves and wild places, people lacked emotional burdens, so diseases were mostly external. Hence, *Suwen* states that cold in viscera causes fullness, and excessive effort damages collaterals, causing blood to overflow outside intestines. Cold fluids and blood contend and condense, forming accumulations. Modern people have many desires, leading to frequent phlegm, blood, and Qi stagnation. Thus, I dare not rigidly apply classics to diagnose. (*Xue Ji Yi An Liuyao*)
Generally, masses are rooted in one substance, wrapped in blood and phlegm, forming cup- or plate-like shapes that are hard to touch. Food stagnation and bad blood affect the Spleen and Stomach; phlegm-fluid accumulations occur on both sides. (*Baoming Gekuo*)
[Etiology: Heat]
Classics state: "Small Intestine transferring heat to Large Intestine causes Qin Jia and Chen..." Thus, Jia diseases can also involve heat. Yang Qi knotting, stifling heat, and stagnation causing hardness are not cold-type Qin Jia; they must be differentiated by pulse and symptoms. (Liu Wansu, *Yuanbing Shi*)
[Differentiation of Yin-Cold: Lingering vs. Gathering/Dispersing]
Pulses that are small, minute, small-rapid, string-taut, deep, hidden, slow, choppy, excess, rapid-interrupted, deep-horizontal, knotted-hidden, or long-and-pulsing laterally (seen in classics and *Maijing*) indicate Yin-cold constriction and excess. Thus, accumulations often stem from Yin-cold. Yin-cold cannot warm and disperse, favoring condensation. Initially slight, it grows daily like a pile, eventually becoming large, hard, solid, and tangible. Conversely, "Ju" has no root, pain is variable. Without root or constancy, Qi does not linger. Occasionally contending with blood and Qi, evil and righteous Qi clash; Qi gathering causes pain, Qi dispersing resolves it. This differs from "Ji" which lingers and does not disperse. Symptoms like intestinal attack, hernia-jia heat, chest/abdominal fullness, and loud rumbling belong to "Ju". Ancient differentiation of accumulation by Zang/Fu attributed lingering/deep pulses to Yin/Zang, and floating/moving pulses to Yang/Fu. Treatment should focus on lingering vs. dispersing, not rigidly on Zang/Fu labels. (*Xu Yan*)
[Pulse Diagnosis]
Cunkou pulse deep and tight indicates cold in the epigastrium, periodic pain, and accumulation. Guan pulse large with Cun and Chi fine indicates cold accumulation in heart/abdomen, Jia knotting, and desire for hot drinks. (*Maijing*)
Slow and choppy indicates middle-cold with nodules. Rapid and tight indicates accumulation with striking pain. String-small indicates cold Pi. (Ibid.)
Cunkou pulse deep and horizontal indicates horizontal accumulation pain in hypochondrium and abdomen (from *Pingren Qixiang Lun*). String pulse indicates acute abdominal pain (refer to Xiao Jianzhong Tang). Lower back pain radiating to abdomen indicates cold hernia and Jia. String-tight and micro-fine pulse indicates Nodules. Cold Bi, Qin Jia, and Accumulation pulses are all string-tight. Epigastric location corresponds to Guan string-tight; umbilical to Chi string-tight. (One theory: Guan pulse string-long indicates accumulation around the umbilicus.) Pulse-symptom rules: Left-hand horizontal pulse indicates left-sided accumulation; right-hand indicates right-sided. Pulse head large indicates upper location; small indicates lower. Horizontal pulse on left indicates right-sided accumulation; on right indicates left-sided. Surplus-excess-slippery or string-tight pulses also indicate accumulation, cold Bi, or hernia pain. Internal accumulation without corresponding pulse is hard to treat; one corresponding pulse makes it easier; no correspondence means untreatable. Large left/small right pulse: upper disease in left hypochondrium, lower in left foot. Large right/small left pulse: upper in right hypochondrium, lower in right foot. Fine-deep-straight pulse indicates abscess or Fuliang in abdomen. Small-deep-excess pulse indicates gastric accumulation, anorexia, and vomiting after eating. (Ibid.)
Heavy-deep-middle-scattered pulse indicates food-cold nodule. Left-turning heavy pulse indicates Qi nodule, Yang in chest. Right-turning pulse not reaching Cunkou indicates meat nodule internally. (Ibid.)
Cunkou pulse fine-deep-slippy indicates accumulation in hypochondrium, bilateral fullness, and back radiation pain. Excess pulse indicates heart/abdominal accumulation, indigestion, and cold stomach. (*Zhubing Yuanhou Lun*)
Rebellious-steadfast pulse indicates Nodule disease. Kidney pulse small-rapid, Liver pulse small-rapid, Heart pulse drum-like all indicate Nodules. Knotted Cunkou pulse indicates Qin Jia. (Ibid.) (Note: *Xieqi Zangfu Bingxing Pian*: Kidney micro-rapid indicates deep厥 Ben Tun, leg paralysis, urinary/fecal retention. Liver micro-rapid indicates Feiqi in hypochondrium like an inverted cup. These originate from Chao Yuanfang. Knotted Cunkou originates from *Nan Jing* Chapter 18.)
[Prognosis]
Heart/abdominal accumulation with strong-tight pulse indicates survival; weak pulse indicates death. Excess-strong pulse indicates survival; deep pulse indicates death. Large pulse with abdominal distension, cold limbs, and long pulse shape indicates death. Abdominal fullness, bloody stool, large-intermittent pulse, severe bleeding, and small-rapid pulse indicate death. (*Maijing*)
(Note: *Zhubing Yuanhou Lun* mentions only deep pulse indicates death. *Zhongzang Jing* omits "pulse large," listing it separately; this may be a specific abdominal distension diagnostic method.)
String-vaulted pulse indicates abdominal nodule, immobility, and certain death. (Ibid.)
Cunkou pulse tight-steadfast indicates horizontal accumulation in hypochondrium/abdomen. Knotting pain with diarrhea, micro-fine pulse indicates survival; floating pulse indicates death. (*Zhubing Yuanhou Lun*)
Excess-strong pulse is Yang, indicating struggle between evil and righteous Qi and robust constitution; following Fu/Yang suggests survival. Deep-fine pulse is Yin, indicating deep/long-standing evil and depleted constitution; following Zang/Yin suggests death. (*Xu Yan*)
[Five Zang Accumulations]
Lung Accumulation: Floating-hairy pulse, yielding to pressure. Reverse Qi in hypochondrium, radiating back pain, shortness of breath, forgetfulness, closed eyes, cold skin. Improves in autumn, worsens in summer. Skin pain like insects crawling, needle-like sensation, itching, white complexion. Heart Accumulation: Deep-empty pulse, wandering location. Chest fullness, palpitations, abdominal heat, red face, dry throat, vexation, hot palms, spitting blood (severe), convulsions, blood厥, improves in summer, worsens in winter. Red complexion. (*Zhubing Yuanhou Lun* adds: spitting pus-blood indicates death.) Spleen Accumulation: Floating-large-long pulse, weaker when hungry, prominent when full. Lumps under epigastrium like peaches/plums, visible externally. Abdominal fullness, vomiting, diarrhea, borborygmus, heavy limbs, swollen calves,厥, inability to lie down. Damages muscles, yellow complexion. Liver Accumulation: String-fine pulse. Hypochondriac pain radiating to epigastrium, swollen/cold feet, hypochondriac pain radiating to lower abdomen. Men: hernia accumulations; Women: Jia strangury. Lack of luster, cramps, black brittle nails. Improves in spring, worsens in autumn. Blue complexion. Kidney Accumulation: Deep-rapid pulse. Spine/lower back pain, visible when hungry, reduced when full. Lower abdominal urgency, dry mouth, swollen/throat erosion, eye issues, cold bones, marrow厥, forgetfulness. Black complexion. (*Maijing*) (Note: *Yaojue* combines *Nan Jing* and this section, suggesting Da Qi Qi Tang modifications; omitted here.)
Classics state Five Zang Accumulations form when Zang organs are at peak strength and reject transmitted pathogens. However, this is not always absolute. Transmission from Lung to Liver, etc., follows controlling relationships; transmitting to what one controls leads to death. If all accumulations were fatal, it would contradict reality. (*Jifeng Puji Fang*)
[Qin Jia Morphology]
(Bao Qin) Qin arises from cold/warmth imbalance, indigestion, and contention with visceral qi. Immobile masses are directly called Qin. Movable masses are called Qin Jia. "Jia" means false/movable. Signs: hoarse voice, abdominal fullness/turbidity before speaking, weak air dragging tongue, speech inhibition, food knot in abdomen, cold disease, constant salivation, shivering limbs, malaria-like sensations, inability to eat, dull pain. This is Food Qin disease. (*Zhubing Yuanhou Lun*) (Refer to Etiology: Indigestion and Pulse Diagnosis sections.)
Bao Qin (Sudden Qin) arises from visceral weakness and consumption of raw/cold food. Weak viscera cannot digest, leading to sudden mass formation without gradual development. Due to weak viscera, onset is sudden, and death occurs quickly. (Ibid.)
Dai Yun: Accumulations/Qin/Jia with immovable masses are Qin; those appearing/disappearing or moving up/down/left/right are Jia. (*Yixue Gouxuan*)
[Pi Morphology]
Pi arises from accumulation of evil cold Qi. "Qixi" (often associated with Pi) refers to tendons near the umbilicus on either side, painful and taut like strings, varying in size from arm to finger, formed by Qi. "Pi" refers to lateral locations between ribs, sometimes偏僻 (remote/painful), hence the name. Although names differ, treatments (acupuncture, herbs, pills) are similar. Both result from Yin-Yang disharmony, meridian obstruction, food stagnation, and cold Qi contention. (*Taiping Shenghui Fang*)
"Qixi" implies hanging (note: this explanation is erroneous). Hanging inside abdomen near umbilicus, tendons rise like arms/tubes or fingers/brushes/strings. Root cause: Yin-Yang disharmony, frequent depression, anger causing Qi hyperactivity, food wrapping Qi, cold exposure causing Qi stagnation. Anger increases Liver Fire, binding Blood with Qi, Phlegm rising with Fire, merging into tangible forms hanging left/right of umbilicus. (*Zunsheng Shu*)
Pi accumulation with stabbing hypochondriac pain: Sanleng, Ezhu; severe cases: Kansui, Scorpion tail. (*Rumen Shiqin*)
[Location]
Accumulation in center: Phlegm-fluid; Right: Food stagnation; Left: Dead blood. This is Zhu Danxi's definitive view (*Xinfa*). However, gastric food stagnation can manifest centrally, and Liver Qi with old food can accumulate on the left. Do not be dogmatic. Case: Young man, weak, hemoptysis, left-sided mass attacking intermittently. Zuojin and Lu Hui failed. Pulses string-like but fine-choppy-unsmooth. Diagnosed as Yin Deficiency. Si Wu Tang plus Zhimu, Huangbai, Xuanshen, Mudanpi cured him in six doses.