姜 左胁气逆攻胸，久而痞聚，妨食作胀。医用硝黄攻夺，无形元气受伤，腹鸣便泻，脘中坚聚成块，
诊脉左强右弱，食少不运，木旺土衰，必延吐逆之咎。议和肝通腑，降浊驱胀。白芍、牡蛎粉、枳壳、栝蒌仁（俱炒）、
青皮、砂仁壳、益智仁（煨）、茯苓、制半夏、煨姜。五服病减食加，块亦软小。去枳、蒌，加党参、生术扶
脾阳，而右脉亦振。
张 小腹积聚。自用大黄、郁金、枳实等，下瘀血数次，暂宽，恃气壮频年屡用。予谓积聚随元气为消长，
元气衰而后邪气踞之，屡行攻夺，终损脾元。经言大积大聚，其可去也。衰其半而止，宜扶脾兼消积为稳。方
用六君子料，加木香、青皮、归尾、延胡、白芍、官桂之属，水泛丸。庶痞积日渐消磨，不至损动真元耳。
房弟 少腹偏左瘕聚有形，感寒坠痛。昔用针刺原得痛缓，今宿 遇劳辄发，块肿不任峻攻，仿痛久伤
络之例，兼咸以软坚，主治宜效。特下焦深远之乡，乃厥阴宗筋所主，直达病所，良复
不易。舶茴香、橘核（俱酒焙）、当归、须、韭子（炒）、延胡、葫芦巴（俱酒炒）、牡蛎（醋 ），沉香（汁冲）服。
三剂痛定肿消，块亦渐软。
房侄 右胁上痞胀，按之肿满绷急，渐妨饱食。仿《石室秘录》软治法，用生术、茯苓、神曲、地栗粉、
鳖甲（炙）、白芍、制半夏、白芥子、浓朴 桂心、潞参。蜜丸服，以食物压之效。
姜某：左胁部气机逆乱，攻冲至胸部，日久形成痞块积聚，妨碍进食并引起腹胀。医生使用芒硝、大黄等峻下药物攻伐，导致无形之元气受损，出现肠鸣腹泻，胃脘部坚硬聚集成块。诊察脉象，左手脉强盛而右手脉虚弱，饮食减少且运化无力，此为肝木旺盛、脾土衰弱的表现，必然会导致呕吐反逆的后果。议定采用调和肝脏、疏通腑气的方法，以降泄浊气、驱除胀满。处方：白芍、牡蛎粉、枳壳、瓜蒌仁（均炒制）、青皮、砂仁壳、益智仁（煨制）、茯苓、法半夏、煨生姜。服用五剂后病情减轻，食欲增加，肿块也变软变小。去掉枳壳、瓜蒌，加入党参、生白术以扶持脾阳，随后右脉也随之振奋有力。
张某：小腹有积聚之症。自行服用大黄、郁金、枳实等药，多次泻下瘀血，症状暂时缓解，便倚仗身体强壮，多年频繁使用攻下之法。我认为积聚的消长随元气的盛衰而变化，元气衰弱后邪气便占据体内，屡次攻伐，最终损伤脾胃元气。医经说：“大积大聚，其可去也。”但应衰减半即止，宜采用扶持脾气兼消除积聚的方法较为稳妥。方剂选用六君子汤料，加入木香、青皮、当归尾、延胡索、白芍、官桂等，制成水泛丸。这样可使痞积日渐消磨，不至于损伤真元。
房某之弟：少腹左侧瘕聚有形，受寒后坠痛。过去曾用针刺原穴使疼痛缓解，如今宿疾遇劳累辄发作，肿块肿胀不能耐受峻猛攻伐，仿照久痛伤及络脉的先例，兼用咸味药物以软化坚结，主治应当见效。只是病位在下焦深远之处，乃厥阴肝经宗筋所主，直达病所确实不易。处方：舶茴香、橘核（均酒焙）、当归、须、韭子（炒制）、延胡索、葫芦巴（均酒炒）、牡蛎（醋制）、沉香（汁液冲服）。服用三剂后疼痛停止，肿胀消退，肿块也逐渐变软。
房某之侄：右胁上部痞闷胀满，按压时感觉肿胀紧绷急迫，逐渐妨碍饱食。仿照《石室秘录》中的“软治”法，使用生白术、茯苓、神曲、地栗粉、鳖甲（炙制）、白芍、法半夏、白芥子、厚朴、桂心、潞党参。制成蜜丸服用，服药后用食物压住腹部效果更佳。
Jiang (Left): Qi rebellion in the left hypochondrium attacks the chest, leading to stagnation and accumulation over time, obstructing food intake and causing distension. The physician used rhubarb (Rhei Radix et Rhizoma) and mirabilite (Natrii Sulfas) for purgation, injuring the formless primordial qi, resulting in borborygmus and diarrhea, with a hard mass forming in the epigastrium. Pulse diagnosis revealed a strong left pulse and a weak right pulse; decreased appetite and poor transport indicate hyperactive Liver Wood and deficient Spleen Earth, inevitably leading to vomiting and reflux. The proposed treatment is to harmonize the Liver and unblock the Fu organs, descending turbidity and dispelling distension. Prescription: White Peony Root (Paeoniae Radix Alba), Oyster Shell (Concha Ostreae), Aurantium Fructus Immaturus (Zhi Ke), Trichosanthes Seed (Gua Lou Ren) (all stir-fried), Green Tangerine Peel (Qing Pi), Amomum Fruit Husk (Sha Ren Qiao), Alpinia Officinarum Rhizome (Yi Zhi Ren) (roasted), Poria (Fu Ling), Prepared Pinellia Tuber (Zhi Ban Xia), Roasted Ginger (Wei Jiang). After five doses, symptoms improved, appetite increased, and the mass softened and shrank. Remove Zhi Ke and Gua Lou Ren; add Codonopsis Root (Dang Shen) and Raw Atractylodes Macrocephala Rhizome (Sheng Zhu) to support Spleen Yang, after which the right pulse also strengthened.
Zhang: Accumulation in the lower abdomen. Self-medicated with rhubarb (Rhei Radix et Rhizoma), Curcuma Longa Rhizome (Yu Jin), and Aurantium Fructus (Zhi Shi), expelling stasis multiple times, providing temporary relief. Relying on robust constitution, he used these aggressively for years. I stated that accumulations wax and wane with primordial qi; when primordial qi declines, pathogenic factors occupy the space. Repeated purgation ultimately damages Spleen primordial qi. The Classics state: "For large accumulations, they may be removed." However, stop when half the accumulation is reduced; supporting the Spleen while eliminating accumulation is the stable approach. Formula: Six Gentlemen Decoction (Liujunzi Tang) base, added with Costus Root (Mu Xiang), Green Tangerine Peel (Qing Pi), Angelica Sinensis Root Tail (Gui Wei), Corydalis Rhizome (Yan Hu Suo), White Peony Root (Bai Shao), and Cinnamon Bark (Guan Gui), made into water-pillets. This will gradually dissipate the stagnation without damaging true Yuan Qi.
Brother of Fang: A palpable mass (Lei accumulation) in the lower left abdomen, suffering from dragging pain upon cold exposure. Previously, needle pricking at the Yuan-source point relieved pain. Now, the chronic condition recurs with fatigue. The swollen mass cannot withstand harsh purgation. Following the precedent of long-standing pain injuring collaterals, combined with salty substances to soften hardness, the main treatment should be effective. However, the lower Jiao is deep, governed by the Liver Meridian of Foot-Jueyin and its sinews, making direct access difficult. Prescription: Fennel Fruit (Bo Hui Xiang), Tangerine Seed (Ju He) (both wine-roasted), Angelica Sinensis Root (Dang Gui), Mustard Seed (Xu), Chives Seed (Jiu Zi) (stir-fried), Corydalis Rhizome (Yan Hu Suo), Fenugreek Seed (Hu Lu Ba) (both wine-fried), Oyster Shell (Mu Li) (vinegar-processed), Agarwood (Chen Xiang) (decocted juice taken). After three doses, pain ceased, swelling subsided, and the mass softened.
Nephew of Fang: Stagnation and distension in the upper right hypochondrium, feeling swollen and tense upon pressure, gradually interfering with full meals. Following the "softening" method from *Shishi Milu*, use Raw Atractylodes Macrocephala Rhizome (Sheng Zhu), Poria (Fu Ling), Medicated Leaven (Shen Qu), Dioscorea Hypoglauca Tuber (Di Li Fen), Turtle Carapace (Bie Jia) (roasted), White Peony Root (Bai Shao), Prepared Pinellia Tuber (Zhi Ban Xia), White Mustard Seed (Bai Jie Zi), Magnolia Bark (Hou Po), Cinnamon Heart (Gui Xin), and Codonopsis Root (Lu Shen). Made into honey pills; taking them followed by food enhances efficacy.