此又阴虚似肝积也。推此，虽因部分名积，诊视之际，犹当详审，病病皆然，惟圆机者不昧此语。（《六要》）
症痞之积，凡或上或下，或左或右，本无定所。大都血积多在下，而气积食积，则上自胃脘，下至少腹，
凡有留停，无处不可停蓄。余尝治一食 结痛者，乃在小腹下右角尖处，自后屡见此证，方知食道之行，必自
小腹下右以入广肠，此实人所不知也。故凡治积聚者，必当详审所因，庶得其确。尝见丹溪之论（云云），愚
谓可聚可散者，此气聚无疑也。若以左为血积，右为食积，中为痰饮，则凿矣。即如小儿多有患痞者，必在
左肋之下，此无非纵食所致，岂因其在左即为血积而可攻其血乎。若为左血右食，则右岂无血而左岂无食乎。不
可以为法也。（《景岳》）
诸积概略 所谓积者，有气积肉积，酒积茶积，食积痰积，更有妇室月经不通，遂成血积。（《济生
续方》）（按∶《儒门事亲》有九积丸，系食、酒、气、涎、痰、癖、水、血、肉九证，《古今医统》更增益
数证，今排列于各类，宜参。）
有形之积，阻碍正气，故痛也。而亦有不痛者，日久则正气另辟行径，不复与邪相争，或邪另结窠囊，不碍
气血隧道之故，此为难治，以药不易到也。又食痰血数者，皆无知之物，不能移动，故常在其处。（《医碥》）
气积 气聚 气滞成积也，凡忧思郁怒，久不得解者，
多成此疾。故王宇泰云∶治积之法，理气为先，气既升降，津液流畅，积聚何由而生。丹溪乃谓气无形，不能作
聚成积，只一消痰破血为主，误矣。天地间有形之物，每自无中生，何止积聚也。戴复庵只以一味大七气汤治
一切积聚，其知此道欤。（《金匮翼》）
气积，噫气痞塞，木香、槟榔之类，甚者枳壳、牵牛。（《事亲》）
若腹中似若癖瘕，随气上下，未有定处，宜散聚汤。若气作痛，游走心腹间，攻刺上下，隐若雷鸣，或已成
积，或未成聚，以全蝎四个劈破煎汤，调苏合香丸。（《要诀》）
气聚证，必肚腹膨胀，时痛时止，得嗳即宽，旋复痛，游走攻刺。宜木香、槟榔、枳壳、牵牛之类，不可下。
（《医碥》）
血积 血积，痛有定处，遇夜则甚，其脉芤涩，妇人产后及跌扑努力者，多有此病。或忧怒伤其内，风
寒袭于外，气逆血寒，凝结成积。《内经》云∶卒然外中于寒，若内伤于忧怒，则气逆，六输不通，温气不行，
凝血蕴里而不散。此之谓也。（《金匮翼》）
血积，打扑血瘀，产后不月，桃仁、地丁之类，甚者虻虫、水蛭。（《事亲》）
血积瘀血，干漆、桃仁、牡丹皮、榆根皮之类，甚者大黄、虻虫、水蛭之类。瓦垄子能消瘀血，次消痰积。
花蕊石大消瘀血，兼气药能消血痞，人所不知。（《医统》）
血积，证见面色痿黄，有蟹爪纹路（血不能上荣也），多怒善忘，口燥便秘，骨热肢冷，宜桃仁煎、地榆、
虻虫、水蛭之类。（《医碥》）
食积 人有能食而不大便，初亦不觉为患，久乃腹内成
块结，推之可动，故名为谷瘕也。人有病常思肉，得肉食讫，又思之，为肉瘕。（《病源论》）（按∶此二
证与寻常食积不同，姑列于此。）
饮食之积，凡暂积者，不过以饮食偶伤，必在肠胃之内，故可行可逐，治无难也。惟饮食无节，以渐留滞
者，多成痞积于左胁隔膜之外。盖以胃之大络，名曰虚里，出于左乳下，其动应衣，此阳明宗气所出之道也。若
饥饱无论，饮食迭进，以致阳明胃气一有所逆，则阴寒之气得以乘之，而脾不及化，故余滞未消，乃并肠外汁
沫，抟聚不散，渐成症积矣。然其初起甚微，人多不觉，及其既久，则根深蒂固而药饵难及。今西北小儿多有
此疾，而尤于食面之乡为最，正以面性多滞，而留疾于皮里膜外，所以不易治也。即如妇人血症气痞或上或下
者，亦多在肠胃之外，募原之间，故当以渐消磨，求法治之，慎毋孟浪欲速，妄行攻击，徒致胃气受伤，而
积仍未及，反以速其危也。（《景岳》）
食积，酸心腹满，大黄、牵牛之类，甚者礞石、巴豆。（《事亲》）（更有肉积，是外病，不录。）
脾积食积，《简易》秘方胜红丸、金露丸、万病丸、顺气丸、秦川剪红丸、感应丸、脾积丸（胜红丸、感应
丸见于后，余不录）。米谷积，麦芽、神曲、砂仁、鸡内金。肉积， 砂、阿魏、山楂、硝石。五畜胎子积，连白
陈皮煎汁，豆豉汁、姜汁和服之。五菜积，丁香、桂末、麝香（按∶《得效》曰∶果菜积，平胃散加丁香麝香为
末。热盐汤调服。盖此所本。）笋蕨硬物，荸荠、砂仁、三棱、莪术。粉面积，萝卜子、姜，酒下（《得效》曰∶
粉片索粉积，紫苏浓煎汁，加杏泥，服即消。面积，阿魏丸，浓煎萝卜子汤下）。鱼鳖积，陈紫苏、橘皮煎汤，
姜汁磨木香服。（《得
效》曰∶鱼蟹积，参苏散多加生姜、陈皮煎。盖本于《鸡峰》，互出《饮食伤》中，宜参）。（《医统》）
食积，证见嗳腐吞酸，腹满恶食。按食停腹内，必栖泊在隐曲之处，乃能久而不下。隐曲之处，为地无几，
必附益以肠外之涎沫，内外交结，乃成大块，须兼治其痰饮乃效。（《医碥》）
酒积 （茶积）（治方并见后）人有性嗜酒，饮酒既多而食谷常少，积久渐瘦，其病遂常思酒，不得酒即
吐，多睡，不复能食，云是胃中有虫使之然，名为酒瘕也。（《病源论》）
酒积，目黄口干，葛根、麦 之类，甚者甘遂、牵牛。（《事亲》）
酒积，冷者，平胃散加丁香、缩砂、麦芽、神曲，或香苏散亦可加入，并用姜、枣、盐煎，空腹服（丁香、
缩砂、香附子、甘草，各少许为散，细嚼，名醉乡宝屑，效）。热者，曲 丸。（《得效》）（曲 丸出后酒
积丸方下。）
多饮人结成酒癖，腹胁积块，胀急疼痛，或全身肿满，肌黄少食，宜十味大七气汤，红酒煎服。（《六要》）
酒积，目黄口干，肚腹胀痛，少食，宜葛根、枳 、麦芽之类（酒湿热伤脾，痰血瘀滞成积，须兼清热利
湿导滞之药）。（《医碥》）
茶饮茶癖，干姜、吴茱萸、川椒、姜黄、芝麻之类。（《医统》）（有方见后）
痰积 （饮癖）涎积，咽如拽锯，朱砂、腻粉之类，甚者瓜蒂、甘遂。痰积，涕唾稠粘，半夏、南星之
类，甚者瓜蒂、藜芦。（《事亲》）（按∶又有水积，即是水肿，今不录。）
石碱去痰积，涤洗垢腻有效。痰癖胁痛，浓朴、枳实、青皮、芒硝、泽泻，甚者甘遂、芫花。水饮癖，治用
枳壳汤加茯苓，神保丸，生五苓散下小理中丸。痰积食积有块，锻石能消化之。（《医统》）
痰积，证见麻木眩晕，痞闷嘈杂，其人平素多痰，宜控涎丹。（《医碥》）
有饮癖结成块，在腹胁之间，病类积聚，用破块药多不效，此当行其饮（《医通》此下曰∶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）宜导痰汤。何以知为饮？
其人先曾病瘥（戴氏又曰∶心瘥有痰饮所致，俗名饮瘥。此瘥盖其义，《医通》作瘥，恐非），口吐涎沫清水，
或素来多痰者是也。（《要诀》）
虫积 九虫积，腹中不时作块痛，面青口吐清水，用雄黄、锡灰、芜荑、雷丸、石榴根、榧子实。
（《医统》）（宜参后大七气汤条、茶积治方及《蛔虫》门。）
异证
鳖 鳖 者，谓腹内 结如鳖之形状，有食鳖触冷不消生症者，有食诸杂物，得冷不消，变化而作者，此
皆脾胃气弱而遇冷，不能克消故也。 瘕结成，推之不动移是也。（《病源论》）
虱 人有多虱而性好啮之，所啮既多，腑脏虚弱，不能消之，不幸变化生症，而患者亦少。俗云虱症人，
见虱必啮之，不能禁止。虱生长在腹内，时从下部出，亦能毙人。
米 人有好哑米，转久弥嗜哑之，若不得米，则胸中清水出，得米水便止，米不消化，遂生 结。其人
常思米，不能饮食，久则毙人。（按∶据《回春》此即虫积，宜参后
大七气汤条。）
食 有人卒大能食，乖其常分，因饥值生葱，便大食之，乃生一肉块，绕畔有口，其病则难愈，故谓食
。特由不幸，致此妖异成症，非饮食生冷过度之病也。
发 有人因食饮内，误有头发，随食而入成症，胸喉间如有虫上下来去者是也。
鳖瘕（文与鳖症同，今省。）瘕言假也，谓其有形假而推移也。
鱼瘕 有人胃气虚弱者，食生鱼，因为冷气所搏，不能消之，结成鱼瘕，揣之有形状如鱼是也。亦有饮陂
糊之水，误有小鱼入人腹，不幸便即生长，亦有形状如鱼也。《养生方》云∶鱼赤目，作 食之生瘕。
蛇瘕 人有食蛇不消，因腹内生蛇瘕也。亦有蛇之精液，误入饮食内，亦令病之。其状常若饥，而食则不下，
喉噎塞，食至胸内即吐出，其病在腹摸揣，亦有蛇状，谓蛇瘕也。（按∶上诸证，《千金》、《外台》有治方，
宜考。）
腹内有毛 人有因饮食内误有毛，随食入腹，则令渐渐羸瘦，但此病不说别有证状，当以举因食毛以知之。
（并同上）
七 八瘕之名，经论亦不详出，虽有蛟龙、蛇、鳖、肉、发、虱、米等七证，初非定名，偶因食物相感而致
患耳。若妇人七 八瘕，则由内、外、不内外因，动伤五脏气血而成。古人将妇人病为痼疾，以蛟龙等为生瘕，
然亦不必如此执泥。妇人 瘕，并属血病；龙蛇鱼鳖等事，皆出偶然，但饮食间误中之，留聚腹脏，假血而成，
自有活性。亦犹永徽中僧病噎者，腹有一物，其状如鱼，即生瘕也。与夫宿食停凝，结为痞块，虽内外所感之不
同，治法当以类相
从，所谓医者意也。如以败梳治虱瘕，铜屑治龙瘕，曲 治米瘕，锻石治发瘕，如此等类，方论至多，不复繁
引，学人可以理解。（《三因》）
死证 大凡腹中有块，不问积聚 瘕，俱为恶候，切勿视为寻常等疾，而不求医早治。若待胀满已成，
胸腹鼓急，虽仓扁复生，亦莫能救其万一，遘斯疾者，可不惧乎。（《正传》）
积如大盘，形脱不食，呕吐肿胀者，不治。（《活人心统》）
治法总说 治之当察其所痛，以知其应有余不足，可补则补，可泻则泻，无逆天时。详脏腑之高下，如
寒者热之，结者散之，客者除之，留者行之，坚者削之消之，按之摩之，咸以软之，苦以泻之，全其真气以补
之，随其所利而行之，节饮食，慎起居，和其中外，可使必已。不然，遽以大毒之剂攻之，积不能除，反伤正气，
终难治也，医者不可不慎。（《试效方》）
经曰∶坚者削之，留者攻之，结者散之，客者除之，上之下之，摩之浴之，薄之劫之，开之发之，适事为
故。凡积聚之治，如经之云者，总其要不过四法，曰攻曰消曰散曰补四者而已，详列如下∶凡积坚气实者，非攻
不能去，如秘方化滞丸、化铁丹、遇仙丹、感应丸、大硝石丸、三花神 丸、赤金豆、百顺丸之类，皆攻剂之
峻者也。如三棱丸、胜红丸、阿魏丸、助气丸、红丸子、温白丸之属，皆攻剂之次者也。凡不堪攻击，止宜消
导渐磨者，如和中丸、草豆蔻丸、保和丸、大小和中饮之类是也。若积聚下之不退而元气未亏者，但当以行气
开滞等剂，融化而潜消之。无形气聚宜散而愈者，如排气饮、神香散、《指迷》七气汤、十香丸、
四磨饮之属是也。凡积痞势缓而攻补俱有未便者，当专以调理脾胃为主，如洁古之枳术丸，乃其宜也。凡脾肾
不足及虚弱失调之人，多有积聚之病，盖脾虚则中焦不运，肾虚则下焦不化，正气不行则邪滞得以居之，若此辈
者，无论其有形无形，但当察其缓急，皆以正气为主。凡虚在脾胃者，宜五味异功散或养中煎、温胃饮、归脾汤
之类主之。虚在肝肾者，宜理阴煎、肾气丸、暖肝煎之类酌而用之，此所谓养正积自除也。其或虚中有滞者，
则不妨少加佐使。（《景岳》）（按∶此所举诸方，大抵系其新方，宜参全书。又《病机汇论》曰∶欲总其要，
其法有三，曰攻曰消曰补而已。此本之景岳而去散一法者矣。）
诸积，有不因气动而成者，如偶有所食，或误吞钱物之类是也；因气动而成者，如七情所致，或饮食劳倦，
或五脏传受之类是也。故所积之物不一，气血之聚有殊，或成蛊疣生瘕之类难测。故须是认得分明，是何积聚，
用药宜各从其类。然亦要看元气虚实，或攻取峻削，或养正渐除可也。不尔，则岂但有损而已。（《微义》）
积有定形，聚无定处，不问何经，并宜十味大七气汤，吞下尊贵红丸子，须日数服。有正当积聚处，内热
如火，渐渐遍及四肢，一日数发，如此二三日又愈，此不当攻其热。又有元得热病，热留结不散，遂成 癖，
此却当兼用去热之剂。（《要诀》）
五积，通用二十四味沉香流气饮，加三棱、莪术，并胜红丸常服，仍灸上中脘。（《医统》）
大抵积之初固为寒，而积之久则为热矣。予今分辛温、辛平、辛凉三例，正欲人知新久之义尔。（《心法
附余》）
这又是阴虚表现出的类似肝积的证候。推究此理，虽然根据部位不同而命名为各种“积”，但在诊视时，仍然应当详细审察，每种疾病都是如此，只有圆通机变者才不会忽略这句话。（《六要》）
症痞之积，有的在上，有的在下，有的在左，有的在右，本来没有固定的位置。大体上血积多在下部，而气积、食积，则从上至胃脘，下至少腹，凡是停留之处，无处不可以蓄积。我曾经治疗过一个因食结导致疼痛的患者，痛点位于小腹右下方尖角处，此后多次见到此类证候，才知晓食道走向，必定从小腹右下进入广肠（直肠），这是人们所不知道的。所以凡治疗积聚者，必须详细审察病因，才能准确无误。曾见丹溪的论述（云云），我认为可聚可散的，这无疑是气聚。如果认为左边是血积，右边是食积，中间是痰饮，那就太牵强附会了。就像小儿多有患痞块的，一定在左肋之下，这无非是纵容饮食所致，难道因为其在左侧就认为是血积而可以攻伐其血吗？如果是左血右食，那么右侧难道没有血，左侧难道没有食吗？这不可以作为法则。（《景岳全书》）
各类积聚概略：所谓积，有气积、肉积，酒积、茶积，食积、痰积，更有妇女因月经不通，遂成血积。（《济生续方》）（按：《儒门事亲》有九积丸，包括食、酒、气、涎、痰、癖、水、血、肉九种证候，《古今医统》又增加了数种证候，现排列于各类中，宜参考。）
有形的积，阻碍正气，所以疼痛。但也有不痛的，日久之后正气另辟行径，不再与邪气相争，或者邪气另结巢穴，不妨碍气血运行的通道，这就难以治疗，因为药物不易到达。另外，食、痰、血等物，都是无知之物，不能移动，所以常停留在原处。（《医碥》）
气积：气聚、气滞而成积，凡是忧愁思虑、抑郁愤怒，长久不得解脱的人，多形成此病。所以王宇泰说：治疗积的方法，以理气为先，气既已升降通畅，津液流畅，积聚从何而生？丹溪却认为气无形，不能聚集成积，只以消痰破血为主，这是错误的。天地间有形的物体，往往从无中生有，何止积聚呢？戴复庵只用一味大七气汤治疗一切积聚，他真是懂得这个道理啊。（《金匮翼》）
气积，表现为嗳气痞塞，用木香、槟榔之类，严重的用枳壳、牵牛子。（《儒门事亲》）
如果腹中似有癖瘕，随气上下移动，没有固定位置，宜用散聚汤。如果气作痛，游走于心腹之间，攻刺上下，隐隐如雷鸣声，或已成积，或未成聚，可用全蝎四个劈开煎汤，调服苏合香丸。（《医学入门·要诀》）
气聚证，必然肚腹膨胀，时痛时止，得嗳气即宽舒，旋即又痛，游走攻刺。宜用木香、槟榔、枳壳、牵牛子之类，不可使用泻下药。（《医碥》）
血积：血积，疼痛有固定位置，夜间加重，脉象芤涩，妇女产后及跌打损伤用力过度者，多有此病。或因忧怒内伤，风寒外袭，气逆血寒，凝结成积。《内经》说：突然外受寒邪，若内伤于忧怒，则气逆，六输不通，温气不行，凝血蕴积体内而不散。说的就是这种情况。（《金匮翼》）
血积，由打扑导致的血瘀，产后经闭，用桃仁、地丁之类，严重的用虻虫、水蛭。（《儒门事亲》）
血积瘀血，用干漆、桃仁、牡丹皮、榆根皮之类，严重的用大黄、虻虫、水蛭之类。瓦垄子能消除瘀血，其次消除痰积。花蕊石大量消除瘀血，配合行气药能消除血痞，这是人们所不知道的。（《古今医统》）
血积，证见面色萎黄，有蟹爪纹路（血不能上行荣养所致），易怒健忘，口燥便秘，骨蒸潮热四肢冷，宜用桃仁煎、地榆、虻虫、水蛭之类。（《医碥》）
食积：人能吃但不大便，起初也不觉得是病，久了腹内结成块状，推之可动，所以名为谷瘕。有人病中常想吃肉，吃完肉食后还想吃，称为肉瘕。（《诸病源候论》）（按：这两种证候与寻常食积不同，暂列于此。）
饮食之积，凡是暂时积滞的，不过是饮食偶然受伤，必在肠胃之内，所以可行导逐除，治疗不难。唯有饮食无节制，逐渐留滞的，多成痞积于左胁隔膜之外。因为胃的大络名叫虚里，出于左乳下，跳动应衣，这是阳明宗气发出的道路。如果饥饱无常，饮食连续进食，导致阳明胃气一有所逆，阴寒之气得以乘虚而入，脾来不及运化，所以余滞未消，并与肠外的汁沫搏结不散，渐渐成症积了。然而初起很轻微，人多不觉，等到日久，则根深蒂固而药物难及。现在西北小儿多有此疾，尤其在吃面食的地方最严重，正是由于面性多滞，留滞于皮里膜外，所以不易治疗。就像妇人血症气痞或上或下的，也多在肠胃之外，募原之间，所以应当逐渐消磨，求法治之，切勿孟浪求速，妄行攻击，徒然损伤胃气，而积仍未除，反而加速危险。（《景岳全书》）
食积，表现为反酸心窝、腹部胀满，用大黄、牵牛子之类，严重的用礞石、巴豆。（《儒门事亲》）（另有肉积，属外病，不录。）
脾积食积，《简易方》中的秘方胜红丸、金露丸、万病丸、顺气丸、秦川剪红丸、感应丸、脾积丸（胜红丸、感应丸见于后文，其余不录）。米谷积，用麦芽、神曲、砂仁、鸡内金。肉积，用砂仁、阿魏、山楂、硝石。五畜胎子积，用连白陈皮煎汁，加豆豉汁、姜汁和服。五菜积，用丁香、桂末、麝香（按：《博济方》说：果菜积，平胃散加丁香麝香为末，热盐汤调服。大概以此为本）。笋蕨硬物，用荸荠、砂仁、三棱、莪术。粉面积，用萝卜子、姜，酒送下（《博济方》说：粉片索粉积，紫苏浓煎汁，加杏泥，服即消。面积，阿魏丸，浓煎萝卜子汤下）。鱼鳖积，用陈紫苏、橘皮煎汤，姜汁磨木香服。（《博济方》说：鱼蟹积，参苏散多加生姜、陈皮煎。大概本于《鸡峰普济方》，互出《饮食伤》中，宜参考）。（《古今医统》）
食积，证见嗳腐吞酸，腹部胀满厌恶食物。按食停腹内，必栖息在隐蔽曲折之处，才能久而不下。隐曲之处地方不多，必依附肠外的涎沫，内外交结，乃成大块，须兼治其痰饮才有效。（《医碥》）
酒积（茶积）（治方并见后文）有人嗜好饮酒，饮酒过多而吃饭常少，积久渐瘦，病遂常想喝酒，不得酒即呕吐，多睡，不能再吃，说是胃中有虫使之然，名为酒瘕。（《诸病源候论》）
酒积，目黄口干，用葛根、麦冬之类，严重的用甘遂、牵牛子。（《儒门事亲》）
酒积，属冷证的，用平胃散加丁香、缩砂、麦芽、神曲，或香苏散亦可加入，并用姜、枣、盐煎，空腹服（丁香、缩砂、香附子、甘草，各少许为散，细嚼，名醉乡宝屑，有效）。热证的，用曲蘖丸。（《博济方》）（曲蘖丸出后文酒积丸方下。）
多饮之人结成酒癖，腹胁积块，胀急疼痛，或全身肿满，肌肤发黄少食，宜用十味大七气汤，红酒煎服。（《六要》）
酒积，目黄口干，肚腹胀痛，少食，宜用葛根、枳实、麦芽之类（酒湿热伤脾，痰血瘀滞成积，须兼清热利湿导滞之药）。（《医碥》）
茶饮茶癖，用干姜、吴茱萸、川椒、姜黄、芝麻之类。（《古今医统》）（有方见后文）
痰积（饮癖）涎积，咽喉如拽锯声，用朱砂、腻粉之类，严重的用瓜蒂、甘遂。痰积，鼻涕唾液稠粘，用半夏、南星之类，严重的用瓜蒂、藜芦。（《儒门事亲》）（按：又有水积，即是水肿，今不录。）
石碱去痰积，涤洗垢腻有效。痰癖胁痛，用厚朴、枳实、青皮、芒硝、泽泻，严重的用甘遂、芫花。水饮癖，治用枳壳汤加茯苓，神保丸，生五苓散下小理中丸。痰积食积有块，锻石能消化它。（《古今医统》）
痰积，证见麻木眩晕，痞闷嘈杂，其人平素多痰，宜用控涎丹。（《医碥》）
有饮癖结成块，在腹胁之间，病类积聚，用破块药多不效，此当行其饮（《医学入门·医通》此下曰：六君子合五苓散最妙，更加旋复花、前胡、枳实、白芍，即海藏五饮汤。若在膜外者，宜导痰汤主之）宜用导痰汤。何以知道是饮？其人先前曾病愈（戴氏又说：心瘥有痰饮所致，俗名饮瘥。此瘥盖取其义，《医通》作“瘥”，恐非），口吐涎沫清水，或素来多痰者是也。（《医学入门·要诀》）
虫积：九虫积，腹中不时作块痛，面色青，口吐清水，用雄黄、锡灰、芜荑、雷丸、石榴根、榧子实。（《古今医统》）（宜参考后文大七气汤条、茶积治方及《蛔虫》门。）
异证
鳖瘕：鳖瘕者，谓腹内结块如鳖之形状，有食鳖触冷不消生症者，有食诸杂物，得冷不消，变化而作者，此皆脾胃气弱而遇冷，不能克消故也。瘕结成，推之不动移是也。（《诸病源候论》）
虱瘕：人有多虱而性好啮之，所啮既多，腑脏虚弱，不能消之，不幸变化生症，而患者亦少。俗云虱瘕人，见虱必啮之，不能禁止。虱生长在腹内，时从下部出，亦能毙人。
米瘕：人有好哑米（指发霉变质之米），转久弥嗜哑之，若不得米，则胸中清水出，得米水便止，米不消化，遂生瘕结。其人常思米，不能饮食，久则毙人。（按：据《回春》此即虫积，宜参考后文大七气汤条。）
食瘕：有人卒然大能食，乖其常分，因饥值生葱，便大食之，乃生一肉块，绕畔有口，其病则难愈，故谓食瘕。特由不幸，致此妖异成症，非饮食生冷过度之病也。
发瘕：有人因食饮内，误有头发，随食而入成症，胸喉间如有虫上下来去者是也。
鳖瘕（文与鳖症同，今省。）瘕言假也，谓其有形假而推移也。
鱼瘕：有人胃气虚弱者，食生鱼，因为冷气所搏，不能消之，结成鱼瘕，揣之有形状如鱼是也。亦有饮陂糊之水，误有小鱼入人腹，不幸便即生长，亦有形状如鱼也。《养生方》云：鱼赤目，作羹食之生瘕。
蛇瘕：人有食蛇不消，因腹内生蛇瘕也。亦有蛇之精液，误入饮食内，亦令病之。其状常若饥，而食则不下，喉噎塞，食至胸内即吐出，其病在腹摸揣，亦有蛇状，谓蛇瘕也。（按：上诸证，《千金方》、《外台秘要》有治方，宜考。）
腹内有毛：人有因饮食内误有毛，随食入腹，则令渐渐羸瘦，但此病不说别有证状，当以举因食毛以知之。（并同上）
七瘕八瘕之名，经论亦不详出，虽有蛟龙、蛇、鳖、肉、发、虱、米等七证，初非定名，偶因食物相感而致患耳。若妇人七瘕八瘕，则由内、外、不内外因，动伤五脏气血而成。古人将妇人病为痼疾，以蛟龙等为生瘕，然亦不必如此执泥。妇人瘕，并属血病；龙蛇鱼鳖等事，皆出偶然，但饮食间误中之，留聚腹脏，假血而成，自有活性。亦犹永徽中僧病噎者，腹有一物，其状如鱼，即生瘕也。与夫宿食停凝，结为痞块，虽内外所感之不同，治法当以类相从，所谓医者意也。如以败梳治虱瘕，铜屑治龙瘕，曲蘖治米瘕，锻石治发瘕，如此等类，方论至多，不复繁引，学人可以理解。（《三因极一病证方论》）
死证：大凡腹中有块，不问积聚瘕，俱为恶候，切勿视为寻常等疾，而不求医早治。若待胀满已成，胸腹鼓急，虽仓扁复生，亦莫能救其万一，遘斯疾者，可不惧乎。（《医学正传》）
积如大盘，形脱不食，呕吐肿胀者，不治。（《活人心统》）
治法总说：治疗应当察其所痛，以知其应有余不足，可补则补，可泻则泻，无逆天时。详脏腑之高下，如寒者热之，结者散之，客者除之，留者行之，坚者削之消之，按之摩之，咸以软之，苦以泻之，全其真气以补之，随其所利而行之，节饮食，慎起居，和其中外，可使必已。不然，遽以大毒之剂攻之，积不能除，反伤正气，终难治也，医者不可不慎。（《卫生宝鉴》）
经书说：坚者削之，留者攻之，结者散之，客者除之，上之下之，摩之浴之，薄之劫之，开之发之，适事为故。凡积聚之治，如经之云者，总其要不过四法，曰攻曰消曰散曰补四者而已，详列如下：凡积坚气实者，非攻不能去，如秘方化滞丸、化铁丹、遇仙丹、感应丸、大硝石丸、三花神精丸、赤金豆、百顺丸之类，皆攻剂之峻者也。如三棱丸、胜红丸、阿魏丸、助气丸、红丸子、温白丸之属，皆攻剂之次者也。凡不堪攻击，止宜消导渐磨者，如和中丸、草豆蔻丸、保和丸、大小和中饮之类是也。若积聚下之不退而元气未亏者，但当以行气开滞等剂，融化而潜消之。无形气聚宜散而愈者，如排气饮、神香散、《指迷》七气汤、十香丸、四磨饮之属是也。凡积痞势缓而攻补俱有未便者，当专以调理脾胃为主，如洁古之枳术丸，乃其宜也。凡脾肾不足及虚弱失调之人，多有积聚之病，盖脾虚则中焦不运，肾虚则下焦不化，正气不行则邪滞得以居之，若此辈者，无论其有形无形，但当察其缓急，皆以正气为主。凡虚在脾胃者，宜五味异功散或养中煎、温胃饮、归脾汤之类主之。虚在肝肾者，宜理阴煎、肾气丸、暖肝煎之类酌而用之，此所谓养正积自除也。其或虚中有滞者，则不妨少加佐使。（《景岳全书》）（按：此所举诸方，大抵系其新方，宜参全书。又《病机汇论》曰：欲总其要，其法有三，曰攻曰消曰补而已。此本之景岳而去散一法者矣。）
各类积聚，有不因气动而成的，如偶有所食，或误吞钱物之类是也；因气动而成的，如七情所致，或饮食劳倦，或五脏传受之类是也。故所积之物不一，气血之聚有殊，或成蛊疣生瘕之类难测。故须是认得分明，是何积聚，用药宜各从其类。然亦要看元气虚实，或攻取峻削，或养正渐除可也。不尔，则岂但有损而已。（《医学微义》）
积有定形，聚无定处，不问何经，并宜十味大七气汤，吞下尊贵红丸子，须日数服。有正当积聚处，内热如火，渐渐遍及四肢，一日数发，如此二三日又愈，此不当攻其热。又有元得热病，热留结不散，遂成癖，此却当兼用去热之剂。（《医学入门·要诀》）
五积，通用二十四味沉香流气饮，加三棱、莪术，并胜红丸常服，仍灸上中脘。（《古今医统》）
大抵积之初固为寒，而积之久则为热矣。予今分辛温、辛平、辛凉三例，正欲人知新久之义尔。（《医宗必读·心法附余》）
This is again a condition where Yin deficiency presents as a syndrome resembling Liver Accumulation (Ji). Inferring from this, although named "Accumulation" based on location, during diagnosis and examination, one must still scrutinize carefully; this applies to all diseases. Only those with flexible and adaptable thinking will not overlook this statement. (*Liu Yao*)
The accumulation of Zheng and Pi may be located above or below, on the left or right, originally having no fixed position. Generally, Blood Accumulation (Xue Ji) is mostly in the lower part, while Qi Accumulation (Qi Ji) and Food Accumulation (Shi Ji) can occur from the stomach epigastrium down to the lower abdomen. Wherever stagnation occurs, it can accumulate anywhere. I once treated a patient with pain caused by food knotting, located at the lower right corner of the lower abdomen. Later, I frequently encountered this syndrome and realized that the pathway of the esophagus must enter the Large Intestine (Guochang) from the lower right of the lower abdomen. This is something people generally do not know. Therefore, when treating Accumulations, one must carefully investigate the cause to ensure accuracy. I have seen Danxi's discussion (etc.), and I believe that what can gather and disperse is undoubtedly Qi Gathering (Qi Ju). If one assumes the left is Blood Accumulation, the right is Food Accumulation, and the center is Phlegm-Fluid (Tan Yin), that would be overly rigid. For instance, many children suffer from Pi masses, which are invariably under the left hypochondrium. This is nothing but caused by indulging in food. Can we consider it Blood Accumulation simply because it is on the left and attack the blood? If left is blood and right is food, then does the right have no blood, and does the left have no food? This cannot serve as a rule. (*Jingyue Quanshu*)
General Overview of Various Accumulations: The so-called Accumulation includes Qi Accumulation, Flesh Accumulation, Wine Accumulation, Tea Accumulation, Food Accumulation, Phlegm Accumulation. Furthermore, women with amenorrhea may develop Blood Accumulation. (*Jisheng Xufang*) (Note: *Rumen Shiqin* has Nine Accumulations Pill, covering nine syndromes: Food, Wine, Qi, Saliva, Phlegm, Pi, Water, Blood, Flesh. *Gujin Yitong* added several more syndromes. They are arranged here by category for reference.)
Form accumulations obstruct righteous Qi, causing pain. However, there are also cases without pain. After a long time, righteous Qi finds another path and no longer contends with the pathogenic factor, or the pathogenic factor forms a separate nest without obstructing the channels of Qi and Blood. These are difficult to treat because medicines cannot easily reach them. Additionally, food, phlegm, and blood are insensible substances that cannot move, so they often remain in their original locations. (*Yi Que*)
Qi Accumulation: Qi gathering and Qi stagnation lead to accumulation. Those who suffer from worry, thought, depression, and anger for a long time without relief often develop this disease. Thus, Wang Yutai said: The method for treating accumulation prioritizes regulating Qi. Once Qi ascends and descends freely, and body fluids flow smoothly, how can accumulation arise? Danxi claimed that Qi is formless and cannot gather into an accumulation, advocating primarily for resolving phlegm and breaking blood stasis. This was a mistake. Formed things in the world often arise from the formless; why only accumulation? Dai Fuan used only Da Qi Qi Tang to treat all accumulations; he truly understood this principle. (*Jinkui Yi*)
For Qi Accumulation manifesting as belching and chest fullness, use Mugher (Costus Root) and Binglang (Areca Seed). In severe cases, use Zhike (Aurantium Fruit) and Qianniu (Pharbitis Seed). (*Rumen Shiqin*)
If there seems to be a Pi mass in the abdomen moving up and down with Qi, without a fixed location, use San Ju Tang. If Qi causes pain, wandering between the heart and abdomen, stabbing up and down, with sounds like thunder, whether an accumulation has formed or not, use four Scorpions (Quanxie) split open and decocted in water, mixed with Suhe Xiang Wan. (*Yaojue*)
Qi Gathering Syndrome manifests as abdominal distension, intermittent pain relieved by belching, followed by recurrence, with wandering stabbing sensations. Use Mugher, Binglang, Zhike, Qianniu, etc. Do not use purgatives. (*Yi Que*)
Blood Accumulation: Pain is fixed in location and worsens at night. The pulse is Kou (Hollow) and Se (Choppy). Women postpartum or those suffering from falls and strain often have this disease. It may result from internal injury due to worry and anger, or external invasion of Wind-Cold, leading to Qi reversal and Cold Blood coagulating into an accumulation. *Neijing* states: Sudden external cold invasion, combined with internal emotional injury, leads to Qi reversal, blockage of the six transmission points, failure of Warm Qi to circulate, and congealed blood accumulating internally. This is what is meant. (*Jinkui Yi*)
For Blood Accumulation due to trauma and blood stasis, or postpartum amenorrhea, use Taoren (Peach Kernel) and Diding (Clematis Root). In severe cases, use Mengchong (Leech) and Shuizhi (Hirudo). (*Rumen Shiqin*)
For Blood Accumulation and Stasis, use Ganqi (Dry Lacquer), Taoren, Mudanpi (Moutan Bark), Yugenpi (Elm Bark). In severe cases, use Dahuang (Rhubarb), Mengchong, Shuizhi. Walongzi (Venericor Planorbis) eliminates blood stasis and secondarily phlegm accumulation. Huaruishi (Corallium Rubrum) greatly eliminates blood stasis; combined with Qi-moving herbs, it eliminates Blood Pi, which is unknown to many. (*Gujin Yitong*)
Blood Accumulation manifests with sallow complexion, crab-claw-like vascular patterns (due to Blood failing to nourish upwards), irritability, forgetfulness, dry mouth, constipation, bone-steaming fever, and cold limbs. Use Tao Ren Jian, Diyu (Sanguisorba Root), Mengchong, Shuizhi, etc. (*Yi Que*)
Food Accumulation: Some individuals eat well but do not defecate. Initially, they feel no harm, but over time, a movable mass forms in the abdomen, hence called Gu Jia (Grain Jia). Some patients constantly crave meat; after eating meat, they crave it again, called Rou Jia (Flesh Jia). (*Bingyuan Lun*) (Note: These two syndromes differ from common Food Accumulation and are listed here tentatively.)
Dietary accumulation resulting from temporary injury is merely accidental dietary damage within the intestines and stomach, so it can be guided out and purged, making treatment easy. However, unregulated diet leading to gradual stagnation often forms Pi accumulation outside the left hypochondrium and diaphragm. The great collateral of the Stomach is named Xuli, emerging below the left breast, pulsating against clothing; this is the pathway where Yangming Zong Qi emerges. Regardless of hunger or fullness, continuous eating causes Yangming Stomach Qi to reverse, allowing Yin-Cold to invade. The Spleen fails to transform, leaving residual stagnation that binds with intestinal juices and foam, gradually forming accumulation. Initially subtle and unnoticed, it becomes deeply rooted and resistant to medicine over time. Children in the northwest often suffer this, especially in areas consuming wheat, as wheat nature is stagnant, lingering in the subcutaneous and membranous spaces, making it hard to treat. Similarly, women with Blood Pi or Qi Pi moving up or down are often outside the intestines and stomach, in the Mouyuan (Miao Membrane). Treatment requires gradual dissipation. Do not act rashly or seek quick results with aggressive attacks, which only injure Stomach Qi without removing the accumulation, accelerating danger. (*Jingyue Quanshu*)
Food Accumulation manifesting as acid regurgitation and abdominal fullness uses Dahuang and Qianniu. In severe cases, use Mengshi (Fluorite) and Badou (Croton Seed). (*Rumen Shiqin*) (Meat Accumulation is considered an external pathology and is not recorded.)
Spleen Accumulation and Food Accumulation: Secret recipes from *Jianyi* include Shenghong Wan, Jinlu Wan, Wanbing Wan, Shunqi Wan, Qinchuan Jianhong Wan, Yinggan Wan, Pi Ji Wan (Shenghong Wan and Yinggan Wan appear later; others omitted). Grain/Grocery Accumulation uses Maiya (Barley Sprout), Shenqu (Medicated Leaven), Sharen (Amomum Fruit), Jineijin (Chicken Gizzard Lining). Meat Accumulation uses Sharen, Awei (Asafoetida), Shanzha (Hawthorn Fruit), Xiaoshi (Niter). Five Livestock/Fetus Accumulation uses Chenpi (Tangerine Peel) boiled in water, mixed with Douchi (Fermented Soybean) juice and Jiangzhi (Ginger Juice). Five Vegetables Accumulation uses Dingxiang (Clove), Guilmo (Cinnamon Bark powder), Shexiang (Musk) (Note: *Degong* says: Fruit/Vegetable Accumulation uses Pingwei San plus Dingxiang and Shexiang powder, taken with hot salt water. This likely originates from there). Bamboo shoots, ferns, hard objects use Biqi (Water Chestnut), Sharen, Sanleng (Sparganium Rhizome), Ezhu (Curcuma Rhizome). Powder/Noodle Accumulation uses Luobozhong (Radish Seed) and Ginger, taken with wine (*Degong* says: Noodle accumulation uses dense Zijie decoction with Apricot Paste; Flour accumulation uses Awei Wan taken with strong Radish Seed decoction). Fish/Turtle Accumulation uses aged Zijie (Perilla Leaf) and Jupi (Tangerine Peel) decocted, with Muxiang (Aucklandia Root) ground in Ginger Juice (*Degong* says: Fish/Crab accumulation uses Rensu San with extra Ginger and Chenpi. Originates from *Jifeng*, cross-reference with Dietary Injury*). (*Gujin Yitong*)
Food Accumulation manifests as rotten belching, acid regurgitation, abdominal fullness, and aversion to food. Food retained in the abdomen lodges in hidden/cramped places, persisting long-term. These places are limited, so it must attach to intestinal saliva/phlegm, intertwining internally and externally to form large masses. Treating Phlegm-Fluid concurrently is necessary for efficacy. (*Yi Que*)
Wine Accumulation (Tea Accumulation) (Prescriptions see later): Individuals addicted to drinking consume much wine but little grain. Over time, they become thin, crave wine intensely, vomit if deprived, sleep excessively, and lose appetite. It is said worms in the stomach cause this, named Jiu Jia (Wine Jia). (*Bingyuan Lun*)
Wine Accumulation manifesting with yellow eyes and dry mouth uses Gegen (Kudzu Root) and Maidong (Ophiopogon Tuber). In severe cases, use Gansui (Kansui Root) and Qianniu. (*Rumen Shiqin*)
Wine Accumulation, Cold type: Pingwei San plus Dingxiang, Suosha (Black Cardamom), Maiya, Shenqu. Or add to Xiangsu San. Decoct with Ginger, Jujube, Salt. Take on an empty stomach (Dingxiang, Suosha, Xiangfu, Gancao, finely powdered, chewed slowly, named Zuixiang Baoxier, effective). Heat type: Qu Bi Wan. (*Degong*) (Qu Bi Wan appears under Wine Accumulation Pill later).
Excessive drinkers developing Wine Pi present with abdominal/hypochondriac masses, distension, urgency, pain, generalized edema, jaundice, and poor appetite. Use Shiwei Da Qi Qi Tang decocted in Red Wine. (*Liu Yao*)
Wine Accumulation manifesting with yellow eyes, dry mouth, abdominal distension/pain, and poor appetite uses Gegen, Zhishi (Immature Aurantium), Maiya, etc. (Alcohol-damp-heat injures Spleen, Phlegm-Blood stasis forms accumulation; clear heat, drain dampness, guide stagnation concurrently). (*Yi Que*)
Tea Drinking/Tea Pi uses Ganjiang (Dried Ginger), Wuzhuyu (Evodia Fruit), Chuanjiao (Sichuan Pepper), Jianghuang (Turmeric), Zhima (Sesame) (*Gujin Yitong*) (Prescription see later).
Phlegm Accumulation (Fluid Pi) Saliva Accumulation: Throat sounds like sawing wood. Use Zhusha (Cinnabar), Ninfen (Calomel). Severe: Guali (Throatwort Root), Gansui. Phlegm Accumulation: Thick sticky sputum/nasal discharge. Use Banxia (Pinellia Tuber), Nanxing (Arisaema Rhizome). Severe: Guali, Lilü (Veratrum Rhizome). (*Rumen Shiqin*) (Note: Water Accumulation is Edema, not recorded here.)
Shijian (Stone Alkali) removes Phlegm Accumulation, effective for washing off greasy filth. Phlegm-Pi hypochondriac pain uses Houpo (Magnolia Bark), Zhishi, Qingpi (Green Tangerine Peel), Mangxiao (Mirabilite), Zexie (Alisma Rhizome). Severe: Gansui, Yuanhua (Genkwa Flower). Water-Fluid Pi uses Zhike Tang plus Fuling (Poria), Shenbao Wan, Sheng Wuling San descending Xiao Lizhong Wan. Phlegm/Food Accumulation with masses: Duanshi (Calcined Iron Ore) digests it. (*Gujin Yitong*)
Phlegm Accumulation manifests with numbness, vertigo, chest stuffiness, and rumbling. Patients usually have excessive phlegm. Use Kongyan Dan. (*Yi Que*)
Fluid Pi forming a mass between abdomen and hypochondrium resembles accumulation; breaking-mass drugs are ineffective. One must promote fluid metabolism (*Yitong* adds: Liujunzi Tang combined with Wuling San is best, plus Xuanfuhua, Qianhu, Zhishi, Baishao, i.e., Haizang Wu Yin Tang. If outside the membrane, Dao Tan Tang is primary). Why identify as Fluid? The patient previously recovered from illness (Dai says: Heart recovery involves Phlegm-Fluid, commonly called Yin Chu. This 'Chu' implies meaning. *Yitong* writes 'Chai', likely incorrect), spits saliva/clear water, or has chronic phlegm. (*Yaojue*)
Parasite Accumulation: Nine Parasites Accumulation. Abdominal intermittent mass-pain, blue face, spitting clear water. Use Xionghuang (Realgar), Xihui (Tin Ash), Wuyi (Chrysanthemum Seed), Leiwan (Vermifuge), Shiliugen (Pomegranate Root), Feizi (Torreya Seed). (*Gujin Yitong*) (Refer to Da Qi Qi Tang section, Tea Accumulation prescription, and Roundworm section).
Abnormal Syndromes
Bie Jia (Turtle Jia): Refers to intra-abdominal knots shaped like a turtle. Caused by eating turtle meat exposed to cold without digestion, or ingesting miscellaneous items that fail to digest due to cold and transform. All result from weak Spleen/Stomach Qi unable to digest upon cold exposure. The Jia mass is fixed and immovable. (*Bingyuan Lun*)
Li Jia (Louse Jia): People with many lice who enjoy biting them ingest many. Viscera become weak and unable to digest. Unfortunately, transformation creates a syndrome, though rare. Commonly called "Louse Jia person," they cannot stop biting lice. Lice grow inside the abdomen, occasionally exit from below, and can be fatal.
Mi Jia (Rice Jia): People addicted to moldy rice continue to crave it. Without rice, clear water issues from the chest; with rice water, it stops. Undigested rice forms a Jia knot. The patient craves rice, cannot eat other foods, and eventually dies. (Note: According to *Huichun*, this is Parasite Accumulation; refer to Da Qi Qi Tang section.)
Shi Jia (Food Jia): Someone suddenly eats excessively beyond normal limits. Due to hunger, they ate raw green onions, generating a flesh mass with a mouth around the edge. The disease is hard to cure, hence Shi Jia. Specifically due to misfortune causing this bizarre syndrome, not merely excessive raw/cold food intake.
Fa Jia (Hair Jia): Hair accidentally ingested with food/drink enters the body, forming a syndrome. Sensation of insects moving up and down in the chest/throat.
Bie Jia (Text same as Bie Zheng, abbreviated). Jia means false/provisional, referring to tangible yet shifting forms.
Yu Jia (Fish Jia): Individuals with weak Stomach Qi eating raw fish are attacked by Cold Qi, unable to digest, forming Yu Jia. Palpation reveals fish-like shape. Also, drinking stagnant pond water with small fish entering the abdomen can cause growth, appearing fish-shaped. *Yangsheng Fang* states: Eating red-eyed fish cooked as soup generates Jia.
She Jia (Snake Jia): Undigested snake meat causes She Jia in the abdomen. Snake essence accidentally ingested also causes disease. Symptoms resemble hunger but inability to swallow; throat blocked; food vomited upon reaching chest. Abdominal palpation reveals snake-like shape. (Note: *Qianjin* and *Waitai* have prescriptions for these; consult them.)
Hair in Abdomen: Hair accidentally ingested causes gradual emaciation. No specific symptoms described other than history of hair ingestion. (*Same source*)
Names of Qi Ba Jia (Seven and Eight Jias) are not detailed in classics. Although Dragon, Snake, Turtle, Flesh, Hair, Louse, Rice are seven syndromes, they were not fixed names but accidental reactions to food. Women's Qi Ba Jia result from internal, external, and non-internal/external factors injuring Zang-Fu Qi and Blood. Ancients viewed women's diseases as stubborn, naming dragons etc. as living Jias, but one need not be so rigid. Women's Jias belong to Blood diseases; Dragon/Snake/Fish/Turtle matters are accidental, mistakenly ingested, lingering in viscera, assuming blood form, possessing vitality. Similar to a monk in Yonghui era with a fish-like object in the abdomen causing Jia. Though causes differ (internal/external vs. retained food), treatment should follow categories. "Physician's intent." E.g., broken comb treats Li Jia, copper filings treat Long Jia, yeast treats Mi Jia, calcined ore treats Fa Jia. Many such formulas exist; scholars can infer. (*Sanyan*)
Death Syndromes: Any abdominal mass, regardless of Accumulation/Jia/Pi, is a malignant sign. Do not treat as ordinary disease delaying medical care. If distension becomes severe, chest/abdomen tense and drum-like, even Cang/Bian reborn cannot save. Those contracting this disease, should they not fear it? (*Zhengchuan*)
Accumulation like a large plate, physical depletion, anorexia, vomiting, swelling: Incurable. (*Huoxin Tong*)
General Treatment Principles: Treat by observing pain to determine excess/deficiency. Tonify if deficient, purge if excess. Do not defy seasonal timing. Detail Zang-Fu location. Cold treated with Heat; Knots dispersed; Invaders removed; Retained moved; Hardness shaved/reduced; Pressed/massed; Salty softened; Bitter purged. Preserve True Qi to tonify. Act according to benefit. Regulate diet, guard lifestyle, harmonize interior/exterior. Cure assured. Otherwise, sudden attack with toxic agents fails to remove accumulation, injures Righteous Qi, and remains incurable. Physicians must be cautious. (*Shixiao Fang*)
Classic says: Hardness shaved, Retained attacked, Knots dispersed, Invaders removed, Upper/Lower manipulated, Massaged/Bathed, Thin/Robbed, Opened/Released. Suit the matter. General treatment of Accumulation summarizes to four methods: Attack, Dissolve, Disperse, Tonify. Listed below: Hard/Accumulation with solid Qi requires Attack. E.g., Huazhi Wan, Huatie Dan, Yuxian Dan, Yinggan Wan, Da Xiaoshi Wan, Sanhua Shenjing Wan, Chijin Dou, Baishun Wan are harsh attacking agents. Sanleng Wan, Shenghong Wan, Awei Wan, Zhuqi Wan, Hong Wan, Wenbai Wan are secondary attacking agents. Those unfit for attack require gentle dissolution/grinding: Hezhong Wan, Caodoukou Wan, Baohe Wan, Da/Xiao Hezhong Yin. If purgation fails but Yuan Qi is intact, use Qi-moving/stagnation-resolving agents to melt and secretly dissolve. Formless Qi Gathering heals by dispersing: Paiqi Yin, Shenxiang San, *Zhimi* Qi Qi Tang, Shixiang San, Simo Yin. Slow-progress Pi/Accumulation unsuitable for attack/tonification focuses on regulating Spleen/Stomach: Ji Zhu Wan (Jiegu) is suitable. Spleen/Kidney deficiency and weakness often cause accumulation. Spleen deficiency fails middle jiao transport; Kidney deficiency fails lower jiao transformation. Lack of Righteous Qi allows Pathogenic Stagnation. Regardless of form, observe urgency, prioritize Righteous Qi. Deficiency in Spleen/Stomach: Siwu Yigong San, Yangzhong Jian, Wenyin Yin, Guipi Tang. Deficiency in Liver/Kidney: Liyin Jian, Shenqi Wan, Nuangan Jian. This is "Nourish Righteous, Accumulation Self-Removes." If deficiency with stagnation, add minor assistants. (*Jingyue Quanshu*) (Note: These are Jingyue's new formulas; consult full book. *Bingji Huilun* says three methods: Attack, Dissolve, Tonify. Based on Jingyue minus Disperse.)
Various Accumulations: Not caused by Qi movement, e.g., accidental ingestion, swallowing coins. Caused by Qi movement, e.g., Seven Emotions, Diet/Fatigue, Zang-Fu transmission. Accumulated substances vary, Qi/Blood gathering differs, possibly forming Gu/Wart/Jia. Identify clearly which accumulation, match medication to category. Observe Yuan Qi deficiency/excess. Harsh attack or gradual removal by nourishing Righteous Qi. Otherwise, only harm results. (*Weiyi*)
Accumulation has fixed shape; Gathering has no fixed place. Regardless of meridian, use Shiwei Da Qi Qi Tang, swallow Zun Gui Hong Wan, multiple doses daily. If accumulation site feels internal heat like fire spreading to limbs, occurring several times daily, resolving in 2-3 days: Do not attack heat. If original Heat Disease leaves residual heat knotting into Pi: Use heat-clearing agents concurrently. (*Yaojue*)
Five Accumulations: Universal Ershisi Wei Chenxiang Liuqi Yin, plus Sanleng, Ezhu, Shenghong Wan regularly. Moxibustion Shang/Zhong Wan. (*Gujin Yitong*)
Generally, early Accumulation is Cold; long-standing Accumulation becomes Heat. I divide into Pungent-Warm, Pungent-Neutral, Pungent-Cold examples to clarify new vs. old meanings. (*Xinfa Fuyu*)