（积聚 瘕）
心下为阳明之部分。乃心火宣布其化之地。君火之气。化血下行。随冲脉以藏于肝。即从心下而起。肾水
之阳。化气上行。随冲脉以交于肺。由肺散布以达肌肤。亦从心下而出。盖此地为阳明中土。乃水火血气。
上下往来之都会也。火降血下。气升水布。则此地廓然。设若火不降。则血不下。而滞于此矣。设若气不布。
则水不散。而结于此矣。观伤寒论。治心下痞满之证。用泻心汤以泻火。用十枣汤以泻水。甘草泻心汤。生
姜泻心汤。水火兼泻。五苓散解水结。柴胡汤解火结。可知此地须水升火降。斯为既济之形。设上火下水。
阻于中宫。遂成天地否象。故名曰痞。血家火浮于上。与水不交。往往见痞满之象。审系火气不得下降者。
泻心汤治之。或加生附子。以开其痞。审系膀胱水中之阳。逆于心下。不得外出者。以小柴胡汤。转其枢机。
而水火皆通达矣。如水火交结。轻者为结胸。小陷胸汤主之。重者为陷胸。大陷胸汤治之。若单是水气结
聚者。二陈汤。枳术丸治之。今医但知停食痞满。而不知痞满之证。不一而足。此外尚有胸痹等
证。皆未论列。兹所论者。乃失血家间有之证也。凡遇以上诸证。再能酌加当归地黄川芎赤芍丹皮等。以
照顾血证。斯为面面俱到。
又有积聚之证。或横亘心下。或盘踞腹中。此非凝痰。即是里血。通以化滞丸主之。凝痰用
清茶送下。里血用醋酒送下。无论脐上脐下。左右兼治。又凡在脐下。多是血积抵当丸治之。
又有 瘕见于脐下。或见或没。为瘕。常见不没为 。 宜肠下逐瘀汤。抵当丸。瘕宜橘核丸。
按痞满者。胸膈间病。积聚者大腹之病。 瘕者下焦之病。统以真人化铁汤。加吴萸治之。统以逍遥散和
之。另详瘀血门。
心下部位属于阳明经的管辖范围，是心火宣通布散其化生的场所。君火之气，将血液转化为下行趋势，随着冲脉运行而藏于肝脏，这股气机即从心下发起。肾水中的阳气，化为气化功能向上运行，随着冲脉运行而与肺金相交，由肺脏散布到达肌肤，这股气机也从心下发出。大概因为这里是阳明中土之地，是水、火、血、气上下往来的交汇中心。如果火能下降、血能下行，气能上升、水能布散，那么这里就会空旷通畅。假如火不能下降，血就不能下行，从而停滞在这里；假如气不能布散，水就不能消散，从而凝结在这里。观察《伤寒论》中治疗心下痞满证候的方法，使用泻心汤来清泻火热，使用十枣汤来攻逐水饮，甘草泻心汤和生姜泻心汤则是水火同泻，五苓散解除水结，柴胡汤解除火结。由此可知，这个部位必须做到水升火降，这才是阴阳既济的状态。假如上焦之火与下焦之水阻隔在中宫，就形成了天地不交的“否”卦之象，所以命名为“痞”。失血患者往往火气浮越于上，与水不相交，常常出现痞满的症状。如果辨证属于火气不能下降的，用泻心汤治疗，或者加入生附子，以开通痞塞。如果辨证属于膀胱水中的阳气逆乱于心下，不能向外排出的，用小柴胡汤转枢机，从而使水火都能通达。如果水火相互交结，轻症称为结胸，以小陷胸汤主治；重症称为陷胸，以大陷胸汤治疗。如果是单纯的水气结聚，用二陈汤或枳术丸治疗。现在的医生只知道因停食导致的痞满，却不知道痞满这一证候种类繁多，不胜枚举。此外还有胸痹等证候，都没有在此论述。这里所讨论的，是失血患者间或出现的证候。凡是遇到以上各种证候，再能酌情加入当归、地黄、川芎、赤芍、丹皮等药物，以顾护血证，这样才算面面俱到。
又有积聚的证候，有的横亘在心下，有的盘踞在腹中，这要么是凝滞的痰浊，要么是体内的瘀血，通用化滞丸主治。如果是凝痰，用清茶送服；如果是里血（瘀血），用醋酒送服。无论病位在脐上还是脐下，左右兼顾治疗。另外，凡是在脐下的积聚，多是血积，用抵当丸治疗。
又有瘕见于脐下，时隐时现的，称为瘕；经常存在而不消失的，称为（注：原文此处似有缺字或异体字，指固定不移的肿块）。适宜用肠下逐瘀汤或抵当丸治疗。瘕适宜用橘核丸治疗。
按语：痞满是胸膈间的疾病，积聚是大腹部的疾病，瘕是下焦的疾病。统括起来可用真人化铁汤加吴茱萸治疗，或用逍遥散调和。另详参瘀血门。
(Accumulation [Ji Ju] and Mass [Jia])
The area below the heart (Xin Xia) belongs to the jurisdiction of the Yangming channel. It is the place where the Heart Fire [Xin Huo] spreads and disseminates its transformative functions. The Qi of the Sovereign Fire [Jun Huo] transforms blood to descend, following the Chong Mai (Penetrating Vessel) to be stored in the Liver. This Qi originates from below the heart. The Yang of Kidney Water ascends as Qi, following the Chong Mai to interact with the Lungs. From the Lungs, it is dispersed to reach the skin and muscles. This Qi also emerges from below the heart. Generally, this location is the Central Earth of Yangming, a hub where Water, Fire, Blood, and Qi ascend and descend. If Fire descends and Blood goes down, while Qi rises and Water spreads, this area remains clear and unobstructed. However, if Fire fails to descend, Blood will not go down and will stagnate here. If Qi fails to spread, Water will not dissipate and will condense here. Observing the *Shanghan Lun* (Treatise on Cold Damage), which treats syndromes of fullness and obstruction below the heart (Xin Xia Pi Man) using Xiexin Tang (Drain the Epigastrium Decoction) to drain Fire, and Shizao Tang (Ten Jujube Decoction) to drain Water; Gancao Xiexin Tang (Licorice Drain the Epigastrium Decoction) and Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction) drain both Water and Fire; Wuling San (Five-Ingredient Powder with Poria) resolves Water accumulation; and Chaihu Tang (Bupleurum Decoction) resolves Fire accumulation. It can be seen that this region requires Water to rise and Fire to descend to achieve the state of Ji Ji (Mutual Completion). If Upper Fire and Lower Water are blocked in the Middle Palace, it forms the image of the Hexagram Pi (Standstill/Obstruction), hence named "Pi" (Fullness/Obstruction). Patients with blood disorders often have Floating Fire above that does not interact with Water, frequently presenting with signs of Pi Man. If diagnosed as Fire Qi failing to descend, treat with Xiexin Tang, or add Sheng Fuzi (Raw Aconite Root) to open the obstruction. If diagnosed as the Yang of Water in the Bladder reversing into Xin Xia and failing to exit outwardly, use Xiao Chaihu Tang (Minor Bupleurum Decoction) to turn the pivot mechanism, thereby allowing both Water and Fire to flow freely. If Water and Fire knot together, mild cases are called Jie Xiong (Chest Binding), treated primarily with Xiaoxianxiong Tang (Minor Intra-thoracic Decoction); severe cases are called Xian Xiong (Sinking Chest), treated with Daxianxiong Tang (Major Intra-thoracic Decoction). If it is merely Water Qi accumulating, treat with Erchen Tang (Two-Aged Decoction) or Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill). Modern physicians only know about Pi Man caused by food stagnation, but do not realize that Pi Man syndromes are numerous and varied. Furthermore, syndromes such as Xiong Bi (Chest Bi/Oppression) are not discussed here. The discussions herein concern syndromes occasionally seen in patients with hemorrhagic diseases. Whenever encountering the aforementioned syndromes, one should additionally consider adding Dang Gui (Angelica Sinensis), Di Huang (Rehmannia Root), Chuan Xiong (Ligusticum Rhizome), Chi Shao (Red Peony Root), and Dan Pi (Moutan Bark) to care for the blood condition, thus being comprehensive.
There are also syndromes of Accumulation (Ji Ju), which may lie horizontally across Xin Xia or dominate the abdomen. These are either congealed Phlegm [Ning Tan] or internal Blood stasis [Li Xue], primarily treated with Huazhi Wan (Resolve Stagnation Pill). For congealed Phlegm, take with clear tea; for internal Blood stasis, take with vinegar and wine. Regardless of whether the site is above or below the umbilicus, treat both sides comprehensively. Additionally, accumulations below the umbilicus are mostly Blood Accumulations, treated with Didang Wan (Attacking the Residence Pill).
Masses [Jia] appearing below the umbilicus, which appear and disappear intermittently, are termed Jia; those that are constantly present and do not disappear are termed [Zhen - implied fixed mass]. Treat with Changxia Zhuyu Tang (Lower Intestine Blood-Dispersing Decoction) or Didang Wan. Jia is treated with Juzhe Wan (Tangerine Seed Pill).
Note: Pi Man is a disease of the chest and diaphragm; Ji Ju is a disease of the large abdomen; Jia is a disease of the Lower Jiao. Collectively, they can be treated with Zhenren Huatie Tang (True Person Iron-Melting Decoction) added with Wu Zhu Yu (Evodia Fruit), or harmonized with Xiaoyao San (Free and Easy Wanderer Powder). See the Blood Stasis chapter for details.