帝曰∶积之始生，至其已成，奈何？岐伯曰∶积之始生，得寒乃生，厥乃成积也。
寒性凝敛气血，故积因寒生，至气血与邪胶结，而厥逆不行，其积乃成也。
帝曰∶其成积奈何？岐伯曰∶厥气生足， 生胫寒，胫寒则血脉凝涩，血脉凝涩则寒气上入于肠胃，入
于肠胃则 胀， 胀则肠外之汁沫迫聚不得散，日以成
积。卒然多饮食，则肠满，起居不节，用力过度，则络脉伤，阳络伤则血外溢，血外溢则衄血，阴络伤则血内
溢，血内溢则后血，肠胃之络伤，则血溢于肠外，肠外有寒汁沫与血相搏，则并合凝聚不得散而积成矣。卒然
外中于寒，若内伤于忧怒，则气上逆，气上逆则六输不通，温气不行，凝血蕴裹而不散，津液涩渗，着而不
去，其积皆成矣。
此举外感、内伤皆能成积者也。厥气生于足， 生胫寒者，外邪受于足经也， ，犹闷闷也，因足
三阴经脉上行入腹者，由是而血脉凝涩，内传肠胃而成积。盖邪从外入内，从上而下者，前文已明，此又申说
邪从下受，及由内伤七情饮食者。若卒然多饮食，及起居不节，用力过度，以致络伤，血溢肠外，占寒汁沫凝
聚而成积。又有外中寒邪，内伤忧怒，则气上逆而六输不通，六输者，六腑转输之经脉也，腑为阳，输不通，
故温气不行，血凝不散，津液涩而不流，旁渗留着而皆成积，此由外感兼内伤者也。盖阳络浮浅而阳气上升，
故络伤则血外溢而吐衄，阴络深沉而阴气下降，故络伤则血内溢而便血，血既离经，则必与肠外汁沫相搏，及
其成积，或着于阴，或着于阳，或腑，或脏，皆有外证可验，如前后文之所明者，已详尽矣。
黄帝问道：积聚病从开始发生，到最终形成，是怎么回事？岐伯回答说：积聚病的产生，是由于感受寒邪才引发的，气机逆乱进而导致积聚的形成。
寒邪的性质具有凝滞收敛的特点，会使气血运行受阻，因此积聚因寒而生；等到气血与邪气相互胶结，气机厥逆不能正常运行，积聚这才真正形成。
黄帝问：积聚是如何形成的呢？岐伯说：厥逆之气产生于足部，向上蔓延至小腿引起寒冷，小腿寒冷则血脉凝滞涩缓，血脉凝滞涩缓则寒气上行侵入肠胃。寒气进入肠胃，就会使腹部胀满，腹部胀满则肠道外面的津液汁沫被迫聚集而不能消散，久而久之便形成了积聚。如果突然暴饮暴食，就会导致肠道充满；起居没有节制，用力过度，就会损伤络脉。阳络受损则血液向外溢出，血液外溢就会出现鼻衄或吐血等上部出血症状；阴络受损则血液向内溢出，血液内溢就会出现便血等下部出血症状。如果肠胃的络脉受损，血液就会溢出到肠外。肠外如果有寒邪和津液汁沫，并与溢出的血液相互搏结，就会融合凝聚而不能消散，从而形成积聚。如果突然外部遭受寒邪侵袭，或者内部因忧怒等情志受伤，就会导致气机上逆。气机上逆则六输经脉不通畅，温煦之气不能运行，凝血蕴积包裹而不能消散，津液渗涩停滞，附着不去，这样积聚就形成了。
这里列举了外感邪气和内伤因素都能导致积聚的情况。厥逆之气生于足部，向上导致小腿寒冷，这是外邪受于足部经脉所致。“䐜”（chēn），意思是闷闷不乐或胀满的样子，因为足三阴经脉上行进入腹部，由此导致血脉凝滞涩缓，病邪内传至肠胃而形成积聚。大概邪气从外部侵入内部，从上向下传变，前文已经阐明，这里又进一步说明邪气从下部受邪，以及由内伤七情、饮食不当导致的病变。如果是突然暴饮暴食，以及起居不节、用力过度，导致络脉损伤，血液溢出到肠外，结合寒邪和津液汁沫凝聚而成积聚。又有外部中受寒邪，内部因忧怒受伤，导致气机上逆而六输不通，六输指的是六腑转输的经脉，腑属阳，输注不通，所以温气不能运行，血液凝结不散，津液涩滞而不流动，旁渗留着而都形成积聚，这是由外感兼内伤引起的。大概阳络位置浮浅且阳气上升，所以络脉损伤则血液外溢而出现吐衄；阴络位置深沉且阴气下降，所以络脉损伤则血液内溢而出现便血。血液一旦离开经脉，就必然与肠外的津液汁沫相互搏结，等到积聚形成时，有的附着在阴分，有的附着在阳分，有的在腑，有的在脏，都有外在证候可以验证，如前后文所明确指出的那样，已经非常详尽完备了。
The Yellow Emperor asked, "How does the accumulation (Ji) begin to form, and how does it eventually become established?" Qibo replied, "The formation of accumulation begins with the invasion of cold pathogen. It is the reversal of Qi (Jue Qi) that leads to the establishment of accumulation."
Cold has the nature of coagulation and contraction, causing Qi and Blood to stagnate. Therefore, accumulation arises from cold. When Qi and Blood become knotted with the pathogen, and the reversal of Qi prevents normal circulation, the accumulation is thereby formed.
The Yellow Emperor asked, "How exactly is the accumulation formed?" Qibo said, "Reversal Qi originates in the feet, ascending to cause coldness in the shins. Coldness in the shins causes the blood vessels to become coagulated and sluggish. When the blood vessels are coagulated and sluggish, cold Qi ascends into the stomach and intestines. Once inside the stomach and intestines, it causes distension. Distension forces the fluid droplets outside the intestines to gather and prevents them from dispersing, gradually forming an accumulation. If one suddenly over-eats, the intestines become full. If daily routines are irregular and physical exertion is excessive, the collaterals (Luo Mai) are injured. Injury to Yang collaterals causes blood to overflow externally, leading to epistaxis or hematemesis. Injury to Yin collaterals causes blood to overflow internally, leading to hematochezia or melena. If the collaterals of the stomach and intestines are injured, blood overflows into the space outside the intestines. If there is cold and fluid droplets in this space, they contend with the spilled blood, merging and coagulating without dispersing, thus forming an accumulation. If one is suddenly struck by external cold, or internally injured by sorrow and anger, Qi will reverse upward. Upward reversal of Qi obstructs the Six Transporting Meridians (Liu Shu), preventing the movement of warming Qi. Coagulated blood becomes trapped and does not disperse; body fluids become sluggish and stagnant, adhering and remaining in place, resulting in the formation of accumulation."
This passage illustrates that both external pathogens and internal injuries can lead to accumulation. Reversal Qi originating in the feet and causing shin coldness indicates that external pathogens invade via the foot meridians. The term "chen" refers to a state of stifling distension or depression. Since the three Yin meridities of the foot ascend into the abdomen, this pathway allows for the coagulation and sluggishness of blood vessels, transmitting the pathogen inward to the stomach and intestines to form accumulation. Generally, the transmission of pathogens from exterior to interior, and from upper to lower, was clarified in previous texts; here, it further elaborates on pathogens entering from the lower part, as well as lesions caused by internal injury from the Seven Emotions and improper diet. Sudden overeating, irregular living habits, and excessive exertion damage the collaterals, causing blood to spill outside the intestines, where it combines with cold and fluid droplets to form accumulation. Additionally, external cold invasion combined with internal emotional injury (sorrow and anger) causes Qi to reverse upward, obstructing the Six Transporting Meridians. The Six Transporting Meridians refer to the meridians responsible for the transport functions of the Six Fu Organs. Since Fu organs belong to Yang, obstruction of their transport prevents the movement of warming Qi, leading to coagulated blood that does not disperse and body fluids that do not flow. These fluids seep laterally and remain stagnant, all contributing to accumulation; this represents a combination of external infection and internal injury. Yang collaterals are superficial, and Yang Qi tends to rise; thus, injury to Yang collaterals causes blood to overflow externally, resulting in vomiting or nosebleeds. Yin collaterals are deep, and Yin Qi tends to descend; thus, injury to Yin collaterals causes blood to overflow internally, resulting in bloody stools. Once blood leaves its vessels, it inevitably contends with the fluid droplets outside the intestines. When the accumulation is fully formed, it may adhere to Yin or Yang, to Fu or Zang organs. In all cases, there are external signs for verification, as detailed in the preceding and following texts.