积聚病形各不同，黄（大黄）加平胃（散）按经（五脏为积，六腑为聚，按各经加药）攻，理中（汤）妙
得中央运（执中央以运四旁，）桂附麻辛大气充（理中汤加桂枝、附子、麻黄、细辛等药，令大气
流行充满，则积聚不攻而自去。）
癫者，痴呆之状，其人常静，狂者，躁妄不堪，其人常动。痫者，忽倒无知，口角流涎
，或作五畜声，少顷即愈，作止有间断也。皆痰火为病。而痫症多由于胎中受惊，久伏而发
。三证虚者宜磁朱丸，实者宜滚痰丸，而风引汤加黄丹亦效。此证主痰火，故列于实证。
癫狂与痫本难医，痰火迷（其）神（明）四字规，风引汤为《金匮》法，磁朱（丸）缓步滚痰（丸为急
追（法）。
伤食症必有胸闷、嗳腐、腹胀等症，宜以平胃散加麦芽、山楂、神曲、莱菔子，炒紫研
末消之。《千金》取其余类，烧作末，酒服方寸匕，便吐其宿食，即瘥。若初伤，食尚在膈
，服此汤后，即以手探吐，或以瓜蒂散吐之。若伤之已久，肿满拒按，宜以三一承气汤下之
。若无胸闷、嗳腐等症，但见头痛、恶寒、发热，是外感之证，切不可用消导之品，致外邪
陷入，变证百出。伤寒不禁食，故用桂枝汤啜粥，是开章第一义，读仲景书自明。余见西北
之人，多有非食而疑食者，曰某日曾食某物，或某肉，或某面，某日即病，医者因其所言，
又见其胃口不开，必先治食。景岳云∶“无病之人，谁有不食，岂必预为停食以待病至者，
斯可信其无食乎”。凡一味胡猜，妄行剥削者，闻斯言而当知所返也。此证属内积，故列于
实证。
（经义）《经》云∶上部有脉，下部无脉，其人当吐，不吐者死，谓食塞于上，而脉绝于下
也。何者。阳火之根，本于地下，阴水之源，出于天上。食塞于上，是绝五脏之源，源绝则
水不下流。两尺脉绝，吐去上焦之物，而脉自通。如不能吐，则非食病，乃是根蒂之先拔，
故死。
积聚病的形态表现各不相同，大黄配合平胃散（燥湿健脾、行气和胃的方剂），根据病位在五脏还是六腑（五脏所成称为积，六腑所成称为聚）来加减药物进行攻伐；理中汤（温中祛寒、补气健脾的方剂）运用精妙在于能够运转中焦脾胃之气（通过调理中央脾胃以带动四周脏腑功能）。在理中汤基础上加入桂枝、附子、麻黄、细辛等药物，可以使人体胸中大气流行充满，这样积聚之邪不待强力攻伐也能自行消除。
癫证，表现为神情痴呆呆滞，患者通常喜欢安静；狂证，表现为烦躁狂妄难以忍受，患者通常好动不安；痫证，表现为突然昏倒失去知觉，口角流涎，或者发出类似五种牲畜的叫声，片刻之后即可苏醒，发作与停止之间有间歇期。这三种病症都是由痰火引起的。而痫证多由于胎儿时期受到惊吓，病邪潜伏体内日久才发作。对于这三种证候，属于虚证的适宜使用磁朱丸（镇心安神、益肾明目的方剂），属于实证的适宜使用滚痰丸（泻火逐痰的方剂），此外风引汤（清热熄风的方剂）加入黄丹也有疗效。此证主要病机为痰火，因此归类于实证。
癫证、狂证与痫证原本就难以医治，其治疗准则关键在于“痰火迷蒙神明”这六个字。风引汤是《金匮要略》中的治法，磁朱丸适用于病情较缓者，滚痰丸适用于病情急迫需急追痰火者。
伤食症必然伴有胸闷、嗳气带有腐臭味、腹胀等症状，适宜用平胃散加入麦芽、山楂、神曲、莱菔子，炒至紫黑后研成粉末服用以消导食积。《千金方》中取其他具有类似消食作用的药材，烧制成末，用酒送服一方寸匕，能使宿食吐出，病即痊愈。如果是刚受伤食，食物还在膈上，服用上述汤药后，可以用手指探喉催吐，或者使用瓜蒂散（涌吐痰食的方剂）来催吐。如果受伤时间已久，腹部肿胀满闷且拒按，适宜使用三一承气汤（峻下热结的方剂）来攻下。如果没有胸闷、嗳腐等症状，只见到头痛、恶寒、发热，这是外感表证，千万不可使用消导攻下的药物，以免导致外邪内陷，引发各种变证。伤寒病患者不宜急于进食，所以张仲景在桂枝汤服用后要喝热粥，这是开篇的第一要义，研读仲景的著作自然明白。我见到西北地区的人，有很多并不是真的伤食却怀疑是伤食的，说某一天吃了某种东西，或者是某肉、某面，当天就生病了。医生因为听信患者的话，又看到他们胃口不开，就先从治疗食积入手。张景岳说：“没有生病的人，谁有不吃饭的呢？难道一定是预先停滞了食物等待疾病到来吗？这可以相信他们没有伤食。”凡是那些胡乱猜测、妄行攻伐消导的医生，听到这番话应当知道回头反省。此证属于内部积滞，故列于实证。
（引用经典义理）《内经》说：上部有脉象，下部无脉象，病人应当呕吐，如果不呕吐就会死亡。这是指食物堵塞在上部，导致下部脉气断绝的原因。为什么呢？阳火的根本，源于地下；阴水的源头，出于天上。食物堵塞在上部，就是切断了五脏的源头，源头切断则水液不能向下流动。两手尺脉（反映肾与命门及下焦状况）断绝，通过呕吐去除上焦的积滞之物，脉气自然通畅。如果不能呕吐，那就不是单纯的食积病，而是生命根基先被拔除，所以会死亡。
The manifestations of accumulation and mass diseases (Ji Ju Bing) vary. Da Huang (Rhubarb Rhizome) combined with Pingwei San (Calm the Stomach Powder), according to the meridian involved (accumulation in the Zang organs, gathering in the Fu organs), is used to attack the pathogen; Lizhong Tang (Regulate the Middle Decoction) is effective because it facilitates the movement of the central Qi (by regulating the central Spleen and Stomach to influence the surrounding organs). Adding Gui Zhi (Cinnamon Twig), Fu Zi (Aconite Lateral Root), Ma Huang (Ephedra Stem), and Xi Xin (Asarum Root) to Lizhong Tang allows the Great Qi (vital energy circulating in the chest) to flow and fill the body, causing the accumulations to resolve spontaneously without aggressive treatment.
Dian syndrome (Manic-Depressive Psychosis - Depressive Phase) is characterized by a dull and stupid demeanor, with patients tending to remain still. Kuang syndrome (Manic-Depressive Psychosis - Manic Phase) is characterized by unbearable restlessness and delirium, with patients tending to be active. Xian syndrome (Epilepsy) is characterized by sudden collapse and loss of consciousness, drooling from the corners of the mouth, or making sounds resembling five domestic animals, recovering after a short while, with intervals between attacks. All these conditions are caused by Phlegm-Fire. Xian syndrome often results from fright received in utero, lying dormant for a long time before manifesting. For these three syndromes, deficiency patterns are suitable for Ci Zhu Wan (Magnetite and Cinnabar Pill), while excess patterns are suitable for Gun Tan Wan (Rolling Phlegm Pill); Feng Yin Tang (Wind-Guiding Decoction) added with Huang Dan (Lead Oxide) is also effective. Since this condition is primarily due to Phlegm-Fire, it is classified under Excess Syndromes.
Dian, Kuang, and Xian are inherently difficult to treat; the guiding principle lies in the four characters "Phlegm-Fire confusing the Shen (Spirit/Mind)." Feng Yin Tang is a method from *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet); Ci Zhu Wan is for gradual treatment of slow-progressing cases, while Gun Tan Wan is for urgent pursuit of phlegm-fire in acute cases.
Food stagnation syndrome must present with symptoms such as chest tightness, belching with a putrid odor, and abdominal distension. It is suitable to use Pingwei San added with Mai Ya (Barley Sprout), Shan Zha (Hawthorn Fruit), Shen Qu (Medicated Leaven), and Lai Fu Zi (Radish Seed), stir-fried until purple, ground into powder, and taken to digest the stagnation. *Qian Jin Fang* (Prescriptions Worth a Thousand Gold) takes other herbs of similar nature, burns them to ash, administers one cun bi (a measure of volume) with wine, inducing vomiting of the retained food, leading to recovery. If the injury is recent and food remains in the diaphragm region, after taking the aforementioned decoction, induce vomiting by probing the throat with fingers, or use Gua Di San (Melon Pedicle Powder) to induce vomiting. If the injury has persisted for a long time, resulting in swelling, fullness, and tenderness upon pressure, it is suitable to purge using San Yi Cheng Qi Tang (Three-One Purging Decoction). If there are no symptoms of chest tightness or putrid belching, but only headache, aversion to cold, and fever, this is an external contraction syndrome. One must absolutely avoid using digestive/purgative agents, lest the external pathogen sink inward, causing myriad complications. In Taiyang Cold Damage (Shang Han), food intake is restricted; thus, drinking hot porridge after taking Guizhi Tang (Cinnamon Twig Decoction) is the primary principle at the beginning of the text, which becomes clear upon studying Zhang Zhongjing's works. I have observed that people in the northwest often suspect food stagnation when they are not actually suffering from it, claiming that eating certain foods, meats, or noodles on a specific day caused their illness. Doctors, trusting the patient's account and seeing poor appetite, prioritize treating food stagnation. Zhang Jingyue stated: "Who does not eat when healthy? Could it necessarily be that food stagnates beforehand waiting for disease to arrive? One can believe they do not have food stagnation." Any doctor who guesses blindly and recklessly uses purgatives should reflect upon these words. This condition belongs to internal accumulation, so it is listed under Excess Syndromes.
(Classical Meaning) The *Classic* states: "If there is pulse in the upper part but no pulse in the lower part, the person should vomit; if they do not vomit, they will die." This refers to food blocking the upper jiao, causing the pulse to vanish in the lower jiao. Why? The root of Yang Fire originates from below (earth), and the source of Yin Water comes from above (heaven/sky). Food blocking the upper part cuts off the source of the Five Zang organs; once the source is cut, water fluids cannot flow downward. When the two Chi pulses (reflecting Kidney and Lower Jiao) vanish, vomiting removes the material obstructing the Upper Jiao, and the pulse naturally reconnects. If vomiting is impossible, it is not merely a food disease, but rather the uprooting of the vital foundation, hence death ensues.