各能积热。如胞之移热膀胱者。入则必自其窍出之。亦有不因下焦而溺血者。
如内经悲哀太过。阳气内动。发则心下崩数溲血之类。病名有标本。急治标。缓
治本。凡遇是证。未可独以下焦热一语。而更不求其所来。 溏者大肠寒。则阳
衰不能坚实糟粕。故屎薄少结。而中如 屎也。肠垢者。大肠属金主液。有热则
就燥。郁滞其液。涩而不行。积为肠垢。若脓若血。频并窘迫。故重下而不彻。亦有
垢不因大肠移热而生者。小肠后重下血。正与内经所谓结阴下血相类。小肠
属火。为心之腑。心主血。小肠寒。则阳不得越。因郁为下重。血亦不入于脉。随其
所郁而便下。然亦有便血因火热而溢者。不惟小肠而已。小肠有热痔者。小肠
从脐下入大肠肛门。由肛门总为大小肠出入之门户也。然大肠筋脉横解者
亦为痔。督脉生病者。亦作痔。仲景举小肠寒热病中。因心及之耳。
问曰。病有积。有聚。有 气。何谓也。师曰。积者。脏病也。终不移。聚者。腑病也。发作有
时。辗转痛移。为可治。 气者。胁下痛。按之则愈。复发为 气。诸积大法。脉来细而
附骨者。乃积也。寸口。积在胸中。微出寸口。积在喉中。关上。积在脐旁。上关上。积在
心下。微下关。积在少腹。尺中。积在气冲。脉出左。积在左。脉出右。积在右。脉两出。积
在中央。各以其部处之。
〔衍义〕仲景立积聚之名。盖以脏者阴也。腑者阳也。阳动而阴静。脏主血。脏病则
血凝。凝故不移。而名曰积。腑主气。腑病则气停。停则终必动而名曰聚。 气者。
即首章 之邪。从口入。宿食之气也。胁下脾之幕。章门穴是其处。凡饮食入
胃。输精于脾。脾若不胜其气之所宜者。则不布于三阴而积之于幕。故按之则
所积之气开。而痛暂愈。后集则又痛。是名 气。盖饮食之气味。各有所喜入之
脏。宁无从其所入之处而病者乎。故胁下痛。亦非独 气也。悬饮亦痛。寒邪泣
血在肝亦痛。但按之散与不散为异耳。虽然。寒气之客于小络者。按之暖。其痛
亦愈。及考内经灵枢。有积瘕而无聚。仲景去瘕而名聚。内经不分积瘕动静。仲
景分属之。灵枢有着筋经之动静。仲景不言及。巢氏又增之为四。曰积、曰聚、曰
、瘕。积聚。脏腑虚弱。受风邪搏气之所致也。 瘕由饮食不消。聚结渐长所致。
盘牢不移者 也。可以推移者瘕也。陈无择遂以积聚气结者属肺。 瘕血结
者属肝。更有五脏相传之积。此与仲景所名又不同矣。内经灵枢以风寒饮食
七情。俱为积瘕之邪。巢氏陈氏分之如此。仲景独以动静立名。又不关内经灵
枢。巢氏或因仲景不言其邪。遂有四者之名。陈氏又从而立肺肝之名。名愈分
而理愈不明。名以人立。固从时迁可也。邪可迁乎哉。内经灵枢。未常以风寒不
病血。饮食不病气。而乃纷纷若是。古之然耶。今之然耶。
各种邪气都能积聚化热。例如胞宫的热邪移注于膀胱，进入体内后必然从其窍道排出。也有不因为下焦病变而尿血的，如《内经》所说悲哀过度，导致阳气在内扰动，发病时出现心下部崩漏、频繁尿血等情况。疾病有标和本之分，急则治其标，缓则治其本。凡是遇到这类证候，不可仅仅用“下焦有热”一句话带过，而不进一步探求病邪的来源。
大便稀溏是因为大肠寒凉，阳气衰微不能使糟粕坚实，所以粪便稀薄且量少，中间夹杂未消化的食物残渣（飧泄）。肠垢是指大肠属金主津液，若有热邪则会趋向干燥，郁滞津液，使其涩滞不行，积结而成肠垢，状如脓或血，伴有频繁的里急后重感，所以即使多次排便也不能排尽。也有肠垢并非由大肠移热所生的情况。小肠后重下血，正与《内经》所说的“结阴下血”相似。小肠属火，为心之腑，心主血脉。若小肠受寒，则阳气不得宣越，因郁滞而导致肛门重坠感，血液也不入脉中，随着郁滞之气而下泄。然而也有便血是因火热迫血妄行所致，这不仅仅局限于小肠。小肠有热可致痔疮，小肠从脐下进入大肠肛门，肛门是大小肠出入的门户。但是大肠筋脉松弛横解也会形成痔疮，督脉生病也会引发痔疮。张仲景在论述小肠寒热病时，是因为关联到心脏才提及这些内容。
问：疾病有积、聚、奔豚气（此处原文缺字，根据上下文及《金匮要略》应为“奔豚气”或类似气病，结合下文“胁下痛...复发为...气”，通常指“奔豚”或“肝积”等，但原文此处似有脱漏，依《金匮》原文多为“奔豚气”或泛指气病，此处依文意译为气机逆乱之病），这是什么意思？老师说：积证，是脏的病，位置固定不移；聚证，是腑的病，发作有时，疼痛辗转移动，是可以治疗的。奔豚气（或气病），表现为胁下疼痛，按压后疼痛缓解，但之后又会复发。治疗各种积证的总原则是：脉象细弱而按至骨方得的，乃是积证。脉见于寸口，积在胸中；脉象微超出寸口，积在喉中；脉见于关上，积在脐旁；脉象微高于关上，积在心下；脉象微低于关上，积在少腹；脉见于尺中，积在气冲部位。脉象出现在左手，积在身体左侧；脉象出现在右手，积在身体右侧；脉象左右手均出现，积在身体中央。分别根据其脉象出现的部位来判断积证的位置。
〔衍义〕张仲景确立“积”和“聚”的名称，大概是因为脏属阴，腑属阳。阳主动，阴主静。脏主血，脏病则血凝，凝固故位置不移，所以称为“积”。腑主气，腑病则气停，停滞最终必动，所以称为“聚”。奔豚气（或气病），即首章提到的邪气，从口而入，是宿食之气。胁下是脾的幕布所在，章门穴是其处所。凡饮食进入胃，精微输布于脾，如果脾不能承受适宜的气机，就不能将精气布散于三阴经，而是积聚在脾的幕布之处，所以按压时积聚之气得以疏散，疼痛暂时缓解，后来气再次聚集又发生疼痛，这就叫奔豚气（或气病）。大概饮食的气味，各有其喜好进入的脏腑，哪有不从其所入之处而发病的呢？所以胁下疼痛，也不仅仅是奔豚气（或气病），悬饮也会痛，寒邪使肝血泣滞也会痛，只是按压后气血是否消散有所不同。虽然如此，寒气客居于小络脉，按压后感觉温暖，疼痛也会痊愈。等到考察《内经·灵枢》，只有积瘕而没有聚证。张仲景去掉“瘕”而命名为“聚”。《内经》不分积瘕的动静，张仲景将其区分归属。《灵枢》有关于筋经动静的记载，张仲景没有提及。巢元方又增加为四种，叫做积、聚、奔豚、瘕。积聚是由于脏腑虚弱，受风邪搏结气机所致。瘕是由饮食不消化，聚结逐渐长大所致。盘踞牢固不移的是积，可以推移的是瘕。陈无择于是将积聚气结者归属于肺，奔豚瘕血结者归属于肝，更有五脏相传的积证，这与张仲景的命名又不同。《内经·灵枢》认为风寒、饮食、七情都是积瘕的致病邪气，巢元方和陈氏这样分类，张仲景唯独以动静来立名，又不关乎《内经·灵枢》。巢元方或许因为张仲景没有说明致病邪气，于是有了这四种名称，陈无择又进而确立肺、肝的名称，名称分得越细，道理反而越不明白。名称是人立的，固然可以随时代变迁，但邪气能随之变迁吗？《内经·灵枢》从未说过风寒不伤血、饮食不伤气，却纷纷如此分类，这是古人的做法呢，还是今人的做法呢？
Various pathogens can accumulate and transform into heat. For instance, when heat from the Bao Palace (Uterus) transfers to the Bladder, it must exit through its orifices once inside. There are also cases of hematuria not caused by lower Jiao pathology, such as described in the *Nei Jing*: excessive grief causes internal movement of Yang Qi, leading to symptoms like submental collapse and frequent bleeding from urination. Diseases have a root (Ben) and a branch (Biao); in acute conditions, treat the branch; in chronic conditions, treat the root. Whenever encountering such syndromes, one cannot simply attribute them to "heat in the lower Jiao" without seeking their origin.
Loose stools indicate Cold in the Large Intestine, where Yang Qi is deficient and unable to solidify feces, resulting in thin, scanty stools with undigested food particles (Sun Xie). "Intestinal mucus" refers to the Large Intestine, which belongs to Metal and governs fluids. When Heat is present, it tends toward dryness, stagnating the fluids and causing涩 (astringency/stagnation), accumulating into intestinal mucus resembling pus or blood, accompanied by frequent tenesmus. Thus, even after repeated defecation, relief is incomplete. There are also cases where intestinal mucus arises not from heat transfer from the Large Intestine. Tenesmus and bloody stool from the Small Intestine resemble the "Jie Yin Bloody Stool" mentioned in the *Nei Jing*. The Small Intestine belongs to Fire and is the Fu organ of the Heart; the Heart governs Blood. If the Small Intestine is Cold, Yang Qi cannot diffuse freely, leading to stagnation and a sensation of heaviness in the anus. Blood does not enter the vessels but flows out following the stagnant Qi. However, bloody stool can also result from Fire-Heat forcing blood to overflow, which is not limited to the Small Intestine. Heat in the Small Intestine can cause hemorrhoids; the Small Intestine enters the Large Intestine and anus below the umbilicus, and the anus serves as the gateway for both intestines. Nevertheless, laxity of the Large Intestine's tendons and vessels can also cause hemorrhoids, and diseases of the Du Mai (Governing Vessel) can also manifest as hemorrhoids. Zhang Zhongjing mentions these in the context of Small Intestine Cold-Heat disorders because they relate to the Heart.
Q: What are Ji (Accumulation), Ju (Mass), and Ben Tun Qi (Rushing Pig Qi)?
A: Ji is a Zang organ disease, fixed in location and immobile. Ju is a Fu organ disease, occurring intermittently with migrating pain, and is treatable. Ben Tun Qi presents as pain under the hypochondrium, relieved by pressure but recurring later. The general principle for diagnosing Ji is: a pulse that is fine and deep, felt only upon pressing to the bone, indicates Ji. If the pulse appears at Cun Kou (Radial Artery at wrist), the accumulation is in the chest; if slightly beyond Cun Kou, in the throat; at Guan position, beside the umbilicus; slightly above Guan, below the heart; slightly below Guan, in the lower abdomen; at Chi position, at the Qi Chong point. If the pulse is prominent on the left hand, the accumulation is on the left side of the body; if on the right hand, on the right side; if on both hands, in the center. The location of the accumulation is determined by the pulse's position.
[Commentary] Zhang Zhongjing established the terms "Ji" and "Ju" likely because Zang organs belong to Yin and Fu organs to Yang. Yang moves, Yin is still. Zang governs Blood; Zang disease leads to Blood coagulation, which remains fixed, hence named "Ji". Fu governs Qi; Fu disease leads to Qi stagnation, which eventually moves, hence named "Ju". Ben Tun Qi refers to the pathogenic qi mentioned in the first chapter, entering via the mouth, consisting of retained food qi. The hypochondrium is the area of the Spleen's membrane, specifically the Zhangmen acupoint. When food enters the Stomach, essence is transported to the Spleen. If the Spleen cannot handle the appropriate Qi flow, it fails to distribute essence to the Three Yin channels, instead accumulating it in the Spleen's membrane. Pressure disperses this accumulated Qi, temporarily relieving pain, but recurrence causes pain again, termed Ben Tun Qi. Food flavors have specific affinities for certain Zang organs; thus, disease often arises from where the pathogen enters. Therefore, hypochondriac pain is not exclusive to Ben Tun Qi; Xuan Yin (Suspension Fluid) also causes pain, and Cold pathogen causing Liver Blood stasis also causes pain. The difference lies in whether the condition disperses upon pressure. Although Cold pathogen in small collaterals warms upon pressure and relieves pain, examining the *Nei Jing · Ling Shu*, there are only Ji and Jia (Firm Mass), no Ju. Zhang Zhongjing replaced Jia with Ju. The *Nei Jing* did not distinguish the mobility of Ji/Jia, whereas Zhang Zhongjing did. The *Ling Shu* discusses tendon channel dynamics, which Zhang Zhongjing omitted. Chao Yuanfang later expanded this into four categories: Ji, Ju, Ben Tun, and Jia. Ji and Ju result from Zang-Fu deficiency and Wind-Pathogen interacting with Qi. Jia results from undigested food accumulating and growing. Fixed and immovable masses are Ji; movable masses are Jia. Chen Wuyue attributed Qi-stagnation accumulations to the Lung and Blood-stagnation Jia to the Liver, and described Five Zang transmitted accumulations, differing from Zhang Zhongjing's nomenclature. The *Nei Jing · Ling Shu* considers Wind-Cold, diet, and Seven Emotions as causes of Ji/Jia. Chao and Chen categorized them differently. Zhang Zhongjing solely used mobility for classification, ignoring the *Ling Shu*. Chao may have added four names because Zhang didn't specify pathogens, and Chen further assigned Lung and Liver, making the theory more obscure despite finer distinctions. Names are human constructs and can change with times, but do pathogens change? The *Nei Jing · Ling Shu* never stated that Wind-Cold doesn't affect Blood or Diet doesn't affect Qi, yet classifications vary wildly. Is this the way of the ancients or the moderns?