五脏为积，六腑为聚。实强者生，沉细者死。
《难经》五十五难曰∶积者，阴气也。聚者，阳气也。阴沉而伏，阳浮而动。又
曰∶积者，五脏所生。聚者，六腑所成。越人以阴阳分脏腑。既分脏腑，自有五六
之名。但历考《灵》、《素》积聚 瘕之类，亦不全以脏腑分也。如《灵枢·百病始生篇》
云∶积之初成，必先身形自虚，而后外邪中伤，始于皮肤、腠理、毛发，次络脉，
次经脉，次输，次伏冲，次肠胃，次肠胃之外，募原之间。此言邪气自浅入深之常
道也。然亦有不必传至极处。邪之所在，无论浅深，若有积留，即积于彼。故本篇
岐伯又曰∶或着孙脉，或着络脉，或着经脉，或着于膂筋，或着于肠胃之募原，上
连于缓筋。邪气淫 ，不可胜论。后复详言留着成积之病状，曰∶其着孙络之脉而
成积者，其积往来上下。臂手孙络之居也。浮而缓，不能句积而止之。故往来移行
肠胃之间。水凑渗注灌，濯濯有音。有寒则 胀满，雷引，故时切痛。其着于阳明
之经，则挟脐而居。饱食则益大，饥则益小。其着于缓筋也，似阳明之积，饮食则
痛，饥则安。其着于肠胃之募原也，痛而外连于缓筋。饱食则安，饥则痛。其着于
伏冲之脉者，揣之应手而动。发手，则热气下于两股，如汤沃之状。其着于膂筋在
肠后者，饥则积见，饱则积不见，按之不得。其着于输之脉者，闭塞不通，津液不
下，孔窍干壅。此邪气之从外入内，从上下也。又云∶积之始生，得寒乃生，厥乃
成积也。又云∶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。又云∶
卒然多食饮，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。又云∶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，凝血蕴里而不散，津液
涩渗，着而不去，而积皆成矣。最后黄帝始曰∶其生于阴者奈何？岐伯曰∶忧思伤
心；重寒伤肺；忿怒伤肝；醉以入房，汗出当风，伤脾；用力过度，若入房汗出浴，
则伤肾。此五脏之五伤也。虽不详言成积之状，谓之五脏所生可也。谓之即成肥气、
伏梁、痞气、息贲、贲豚，五积之因亦可也。据本篇全文，及《素问·脉要精微论》
云∶推而外之，内而不外，有心腹积也。又五脏生成论云∶赤，脉之至也，喘而坚。
诊曰有积气在中，时害于食，名曰心痹。（赤乃其色。色赤而脉喘坚，则知病为心痹。下文仿此。）白，
脉之至也，喘而浮，上虚下实，惊，有积气在胸中，喘而虚，名曰肺痹。青，脉之
至也，长而左右弹，有积气在心下支 ，名曰肝痹。得之寒湿，与疝同法。黄，脉
之至也，大而虚，有积气在腹中，有厥气，名曰厥疝。黑，脉之至也，上坚而大，
有积气在少腹与阴，名曰肾痹。又平人气象论云∶寸口脉沉而横，曰胁下有积，腹
中有横积痛。又云∶盛喘数绝者，则病在中。结而横，有积矣。又大奇论云∶肾脉
小急，心脉小急，不鼓，皆为瘕。又云∶三阳急，为瘕。又《灵枢》邪气脏腑病形
篇云∶心脉微缓，为伏梁，在心下。肝脉微急，为肥气，在胁下，若覆杯。肾脉微
急，为沉厥奔豚。又卫气篇云∶积痛可移者，易已也。积不痛，难已也。又《难经》
十八难云∶诊在右胁有积气，得肺脉结脉。结甚则积甚，结微则积微。诊不得肺脉
而右胁有积者何也？然肺脉虽不见，右手脉当沉伏。又《脉经》云∶脉迟而涩，中
寒有 结。又云∶弦急疝瘕，小腹痛，又为癖病。又云∶弦小者寒癖。由是观之，
则脉之小也、微也、小急也、弦急也、沉也、沉伏也、迟也、涩也、实也、数绝也、
沉横也、结伏也、长而左右弹也，是皆阴寒敛实之脉。则知积之成也，亦多属阴寒
阴寒则不能温散，而易于凝着。始则毫厘之留，日以增益，如堆然。久久则小者
大，软者坚，虚者实，无形者有形。越人言其始发也，有常处，其痛不离其部，上
下有所终始，左右有所穷处。又云∶积者，阴气也。又云∶阴沉而伏，皆中的之语。
聚则不然。越人谓聚者，阳气也，六腑所成。又云∶阳浮而动，病发无根，痛无常
处。夫无根无常，则气不留止。偶与气血相搏，则邪正相干。气聚而痛，气散则解，
非若积之留止不移不散也。如肠腹攻冲，疝 瘕热，胸腹胀满，切痛雷鸣等证，皆
聚之类也。古人论积聚，分脏腑者，亦不过以沉伏留止不移者属阴，阴则为脏，浮
动聚散不常者属阳，阳则为腑耳。治之者，当于留止聚散上相机，不当于脏腑二字
上作工夫也。其脉实强者，阳脉也。一以征邪正之相搏，一以征元本之壮实。从腑
从阳，故曰生。其脉沉细者，阴脉也。一以征邪气之深入，一以征元本之衰微。从
脏从阴，故曰死。以上积聚二证，楫引灵素难经金匮诸书，其病因病状，可谓详且
悉矣。但言证处，不斩然，亦不全属一证。故虽有成方，不能插入。今历观积聚之
由，似宜温行，不宜寒敛，似宜运动枢机，不宜专尚攻克。是选名方十九首，以便择用焉。
五脏形成的病证称为“积”，六腑形成的病证称为“聚”。脉象实强者预后良好可生，脉象沉细者预后不良主死。
《难经》第五十五难说：“积，属于阴气；聚，属于阳气。”又说：“阴气性质沉静而潜伏，阳气性质轻浮而变动。”再如：“积，由五脏产生；聚，由六腑形成。”扁鹊（越人）用阴阳来区分脏腑。既然区分了脏腑，自然就有五和六的名称区别。但是，全面考察《灵枢》、《素问》中关于积聚、瘕等病证的论述，并不完全以脏腑来划分。例如《灵枢·百病始生篇》说：“积证初成时，必定先是因为身体自身虚弱，然后外邪乘虚侵入，始于皮肤、腠理、毛发，接着进入络脉，再进入经脉，接着到达输穴，再深入伏冲之脉，再至肠胃，再到肠胃之外、募原之间。这是说邪气由浅入深的常规途径。”然而，也有不一定传变到极深处的情况。邪气所在之处，无论深浅，只要有积滞停留，就会在那里形成积证。所以本篇岐伯又说：“有的停留在孙脉，有的停留在络脉，有的停留在经脉，有的停留在膂筋，有的停留在肠胃的募原，向上连接于缓筋。邪气淫溢，无法尽述。”随后详细描述了因邪气留着而形成积证的病状，说：“邪气停留在孙络而成积的，其积块往来上下移动。臂手部的孙络位置浅表且松弛，不能拘束积块使其停止。所以积块在肠胃之间往来移行。水液凑集渗透灌注，发出濯濯的声音。若有寒气，则出现胀满，雷鸣样牵引痛，所以时常剧烈疼痛。”邪气停留在阳明经的，则挟脐部居住。饱食后积块变大，饥饿时积块变小。邪气停留在缓筋的，症状类似阳明经的积证，进食后疼痛，饥饿时缓解。邪气停留在肠胃的募原的，疼痛并向外牵连缓筋。饱食后缓解，饥饿时疼痛。邪气停留在伏冲之脉的，触摸时感觉应手而动，抬手后，热气下行至两大腿，像热水浇淋的样子。邪气停留在肠后的膂筋的，饥饿时积块显现，饱食时积块不显，按压也摸不到。邪气停留在输之脉的，导致闭塞不通，津液不下行，孔窍干燥壅塞。这是邪气从外入内、从上往下的变化。又说道：“积证开始生成，得寒邪乃生，厥逆之气乃成积。”又说：“厥逆之气生于足胫，导致小腿寒冷。小腿寒冷，则血脉凝涩。血脉凝涩，则寒气上入于肠胃。进入肠胃，则发生胀满。胀满则迫使肠外的汁沫聚集而不能消散，日久形成积证。”又说道：“突然饮食过多，则肠道充满。起居无节制，用力过度，则络脉受伤。阳络受伤则血液外溢，血液外溢则出现鼻衄或肌衄。阴络受伤则血液内溢，血液内溢则出现便血或尿血。肠胃的络脉受伤，则血液溢出到肠外。肠外有寒邪和汁沫，与溢出的血液相互搏结，则并合凝聚不得消散，从而形成积证。”又说道：“突然外部受寒，或者内部因忧怒而受伤，则气机上逆。气机上逆，则六输不通，温煦之气不行，凝血蕴结在内而不散，津液渗涩，附着不去，于是积证就形成了。”最后黄帝问道：“那些生于阴分的积证是怎么回事？”岐伯回答说：“忧思伤心；重寒伤肺；忿怒伤肝；醉酒后行房事，汗出当风，伤脾；用力过度，或者行房后汗出洗澡，则伤肾。这是五脏的五种内伤。虽然未详细言明形成积证的具体形态，但称之为五脏所生是可以的。称之为即形成肥气、伏梁、痞气、息贲、贲豚这五种积证的成因也可以。”根据本篇全文，以及《素问·脉要精微论》说：“推按脉象向外，若内应而不外应，说明有心腹积证。”又《五脏生成论》说：“面色赤，脉象至时喘急而坚实。诊断为中有积气，时常妨碍饮食，名叫心痹。（赤是心之色。色赤而脉喘坚，可知病为心痹。下文仿此。）面色白，脉象至时喘急而浮，上部虚下部实，惊悸，有积气在胸中，喘促而虚，名叫肺痹。面色青，脉象至时长而左右弹指，有积气在心下支撑，名叫肝痹。得自寒湿，治疗同疝病法。面色黄，脉象至时大而虚，有积气在腹中，有厥逆之气，名叫厥疝。面色黑，脉象至上坚大，有积气在少腹与阴器，名叫肾痹。”又《平人气象论》说：“寸口脉沉而横，说明胁下有积，腹中有横向积痛。”又说：“脉盛喘且数绝者，病在中焦。脉结而横，说明有积证。”又《大奇论》说：“肾脉小急，心脉小急，不鼓动，皆为瘕证。”又说：“三阳脉急，为瘕证。”又《灵枢·邪气脏腑病形篇》说：“心脉微缓，为伏梁，位于心下。肝脉微急，为肥气，位于胁下，形状如覆杯。肾脉微急，为沉厥奔豚。”又《卫气篇》说：“积痛可以移动的，容易治愈；积痛不移的，难以治愈。”又《难经》第十八难说：“诊察右胁有积气，得到肺脉结脉。结脉甚则积证重，结脉微则积证轻。诊察没有肺脉而右胁有积证的是什么原因呢？回答是：虽然肺脉不见，右手脉应当沉伏。”又《脉经》说：“脉迟而涩，主中寒且有结聚。”又说：“弦急主疝瘕，小腹痛，又为癖病。”又说：“弦小主寒癖。”由此看来，脉象的小、微、小急、弦急、沉、沉伏、迟、涩、实、数绝、沉横、结伏、长而左右弹，这些都是阴寒敛实的脉象。由此可知，积证的形成，也多属于阴寒。阴寒则不能温散，而易于凝着。开始时只是毫厘的留滞，日日渐增，像堆积一样。久而久之则小的变大，软的变硬，虚的变实，无形的变成有形。扁鹊说它刚开始发作时，有固定的部位，疼痛不离其部位，上下有所终始，左右有所穷尽。又说：“积，属于阴气。”又说：“阴沉而伏”，都是切中要害的话。聚证则不然。扁鹊说聚属于阳气，由六腑形成。又说：“阳浮而动”，病发无根，疼痛无常处。因为没有根、无常处，所以气不留止。偶尔与气血相搏，则邪正相干。气聚则痛，气散则解，不像积证那样留止不移、不散去。如肠腹攻冲、疝瘕热、胸腹胀满、切痛雷鸣等证候，都属于聚的范畴。古人论述积聚，区分脏腑的，也不过是以沉伏留止不移的属阴，阴则为脏；浮动聚散不常的属阳，阳则为腑罢了。治疗时，应当在留止与聚散上相机行事，不应当在‘脏腑’二字上下功夫。脉象实强的，是阳脉。一方面征验邪正相搏，一方面征验元气根本的壮实。因为从腑、从阳，所以说生。脉象沉细的，是阴脉。一方面征验邪气之深入，一方面征验元气根本的衰微。因为从脏、从阴，所以说死。以上积聚二证，我潘楫引用《灵枢》、《素问》、《难经》、《金匮要略》等书，其病因病状，可以说详尽周悉了。但所述证候，并不截然分开，也不全属于单一证型。所以虽然有成方，不能直接插入。现在纵观积聚的成因，似乎适宜温通行散，不适宜寒凉收敛；似乎适宜运动枢机，不适宜专门崇尚攻伐克削。因此精选名方十九首，以便择用。
Accumulations (Ji, 积) are formed in the Zang organs (Zang organs), while Gatherings (Ju, 聚) are formed in the Fu organs (Fu organs). A pulse that is Excess and Strong (Shiqiang, 实强) indicates survival, whereas a pulse that is Deep and Fine (Chenxi, 沉细) indicates death.
The *Nan Jing* (Classic of Difficult Issues), Chapter 55, states: "Accumulation belongs to Yin Qi (Yin energy); Gathering belongs to Yang Qi (Yang energy)." It further states: "Yin is quiet and latent; Yang is floating and active." It also says: "Accumulations arise from the Zang organs; Gatherings are completed by the Fu organs." Yue Ren (Bian Que) distinguished the Zang and Fu organs using Yin and Yang. Since the Zang and Fu were distinguished, there naturally arose the designations of Five and Six. However, a comprehensive examination of discussions on Accumulation, Gathering, and Jia (masses) in the *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions) does not strictly divide them by Zang and Fu organs. For instance, the *Ling Shu · Bai Bing Shi Sheng Pian* (Chapter on the Origin of Hundred Diseases) states: "When an accumulation first forms, it must begin with the body's own deficiency, after which external pathogenic factors invade. It starts at the skin, interstices (Couli, 腠理), and hair; then enters the Luo vessels (Collaterals, 络脉); then the Jing vessels (Main Channels, 经脉); then the Shu points (Transport points, 输); then the Fu Chong vessel (Hidden Rush vessel, 伏冲); then the intestines and stomach; and finally outside the intestines and stomach, between the Mu Yuan (Marrow Original/Epigastric region, 募原). This describes the normal pathway of pathogenic factors moving from shallow to deep." Nevertheless, there are cases where transmission does not reach the deepest levels. Wherever the pathogen resides, regardless of depth, if stagnation remains, an accumulation forms there. Therefore, in this chapter, Qi Bo further states: "Some remain in the Sun vessels (Branch Collaterals, 孙脉); some in the Luo vessels; some in the Jing vessels; some in the Lv Jin (Muscles of the back, 膂筋); some in the Mu Yuan of the intestines and stomach, connecting upwards to the Huan Jin (Relaxing Muscles, 缓筋). The proliferation of pathogenic factors is incalculable." Subsequently, the text details the pathological manifestations of accumulations formed by lingering pathogens, stating: "When pathogens remain in the Sun collaterals forming an accumulation, the mass moves up and down. The Sun collaterals of the arms and hands are superficial and lax, unable to contain or stop the accumulation. Thus, the accumulation migrates between the intestines and stomach. Fluids gather and permeate, producing a gurgling sound. If cold is present, distension and fullness occur, with thunder-like radiating pain, causing frequent sharp pain." When pathogens remain in the Yangming channel, the mass resides flanking the umbilicus. It enlarges after eating and shrinks when hungry. When pathogens remain in the Huan Jin, symptoms resemble those of a Yangming accumulation: pain occurs after eating and relieves when hungry. When pathogens remain in the Mu Yuan of the intestines and stomach, pain extends outward to the Huan Jin. It relieves after eating and hurts when hungry. When pathogens remain in the Fu Chong vessel, palpation reveals movement under the fingers; upon lifting the hand, heat flows down into both thighs, resembling the sensation of hot water being poured. When pathogens remain in the Lv Jin behind the intestines, the accumulation is visible when hungry but invisible when full, and cannot be felt upon pressure. When pathogens remain in the Shu vessels, obstruction occurs, fluids fail to descend, and orifices become dry and congested. This describes the entry of pathogens from the exterior to the interior, and from above downwards. It further states: "Accumulations originate from Cold; they are formed by rebellious Qi (Jue Qi, 厥气)." It also states: "Rebellious Qi originates in the feet, causing cold in the shins. Cold in the shins leads to coagulation and stagnation of blood vessels. Coagulated blood vessels allow cold qi to enter the intestines and stomach. Once in the intestines and stomach, distension occurs. Distension forces the fluid droplets outside the intestines to gather and prevents them from dispersing, gradually forming an accumulation." It also states: "Sudden overeating causes intestinal fullness. Irregular daily routines and excessive physical effort damage the Luo vessels. Damage to Yang Luo vessels causes external bleeding, resulting in epistaxis or subcutaneous bleeding. Damage to Yin Luo vessels causes internal bleeding, resulting in hematochezia or hematuria. Damage to the Luo vessels of the intestines and stomach causes blood to overflow outside the intestines. Cold fluid droplets outside the intestines contend with the spilled blood, coagulating together and failing to disperse, thus forming an accumulation." It also states: "Sudden external invasion by Cold, or internal injury from worry and anger, causes Qi to rebel upward. Upward rebellion of Qi obstructs the Six Transport points, preventing the circulation of warming Qi. Coagulated blood remains trapped inside without dispersing, and fluid permeation becomes sluggish, adhering and remaining, thereby forming accumulations." Finally, the Yellow Emperor asks: "How do accumulations arise from Yin?" Qi Bo replies: "Worry and thought injure the Heart; severe Cold injures the Lungs; anger injures the Liver; sexual intercourse while drunk with sweating exposed to wind injures the Spleen; excessive physical effort or bathing with sweat after intercourse injures the Kidney. These are the five injuries of the Zang organs. Although the specific forms of accumulated masses are not detailed, calling them 'generated by the Zang organs' is appropriate. Calling them the causes of the five accumulations—Fei Qi (Liver Mass, 肥气), Fu Liang (Gallbladder Mass, 伏梁), Pi Qi (Stomach Mass, 痞气), Xi Ben (Lung Mass, 息贲), and Ben Tun (Kidney Mass, 贲豚)—is also correct." Based on the full text of this chapter and the *Su Wen · Mai Yao Jing Wei Lun* (Chapter on Essential Refinement of Pulse Diagnosis), which states: "Pushing the pulse outward, if the response is inward rather than outward, it indicates heart and abdominal accumulations." And the *Wu Zang Sheng Cheng Lun* (Chapter on the Generation of the Five Zang): "If the complexion is red, and the pulse arrives rapid and firm, it is diagnosed as having Qi accumulation in the middle, occasionally hindering food intake, named Xin Bi (Heart Obstruction, 心痹). (Red corresponds to the Heart. Red complexion with rapid/firm pulse indicates Heart Bi. The following follows this pattern.) If the complexion is white, and the pulse arrives rapid and floating, with upper deficiency and lower excess, palpitations, and Qi accumulation in the chest, with panting and deficiency, it is named Fei Bi (Lung Obstruction, 肺痹). If the complexion is green, and the pulse arrives long and pulsates left and right, with Qi accumulation supporting below the heart, it is named Gan Bi (Liver Obstruction, 肝痹). Caused by Cold-Dampness, treated similarly to Hernia. If the complexion is yellow, and the pulse arrives large and deficient, with Qi accumulation in the abdomen and rebellious Qi, it is named Jue Shan (Rebellious Hernia, 厥疝). If the complexion is black, and the pulse arrives upper-firm and large, with Qi accumulation in the lower abdomen and genitals, it is named Shen Bi (Kidney Obstruction, 肾痹)." Also, the *Ping Ren Qi Xiang Lun* (Chapter on Normal Human Phenomena) states: "A Cun Kou pulse that is Deep and Horizontal indicates accumulation under the hypochondrium and horizontal accumulation pain in the abdomen." It also states: "A pulse that is Excessive, Panting, and frequently interrupted indicates disease in the Middle Jiao. A pulse that is Knotted and Horizontal indicates accumulation." The *Da Qi Lun* (Chapter on Great Anomalies) states: "A Small and Urgent Kidney pulse, and a Small and Urgent Heart pulse that does not drum/beat strongly, both indicate Jia (soft masses)." It also states: "An Urgent Taiyang/Taiyin/Yangming pulse indicates Jia." The *Ling Shu · Xie Qi Zang Fu Bing Xing Pian* (Chapter on Pathogenic Factors and Organ Disease Manifestations) states: "A slightly Slow Heart pulse indicates Fu Liang, located below the heart. A slightly Urgent Liver pulse indicates Fei Qi, located under the hypochondrium, shaped like an inverted cup. A slightly Urgent Kidney pulse indicates Chen Jue Ben Tun (Deep Rebellious Running Piglet, 沉厥奔豚)." The *Wei Qi Pian* (Chapter on Defensive Qi) states: "Accumulation pain that can move is easy to cure; accumulation pain that does not move is difficult to cure." The *Nan Jing*, Chapter 18, states: "Diagnosing Qi accumulation in the right hypochondrium, one obtains a Knotted Lung pulse. A severe knot indicates a severe accumulation; a slight knot indicates a slight accumulation. What is the cause of right hypochondriac Qi accumulation without a Lung pulse? The answer is: although the Lung pulse is not visible, the Right Hand pulse should be Deep and Hidden." The *Mai Jing* (Pulse Classic) states: "A Slow and Choppy pulse indicates Interior Cold with Knotting." It also states: "Urgent and Wiry pulses indicate Hernia and Jia, with lower abdominal pain, also known as Pi disease (parasitic mass, 癖病)." It also states: "Wiry and Small pulses indicate Cold Pi." From this, we see that pulses that are Small, Micro, Small-Urgent, Wiry-Urgent, Deep, Deep-Hidden, Slow, Choppy, Excess, Interrupted, Deep-Horizontal, Knotted-Hidden, Long and Pulsating Left-Right are all pulses of Yin-Cold contraction and solidity. Thus, we know that the formation of accumulations mostly belongs to Yin-Cold. Yin-Cold cannot warm and dissipate, making it prone to coagulation and adhesion. Initially, it is merely a trace of retention, increasing day by day, like a pile. Over time, small becomes large, soft becomes hard, deficient becomes excess, and formless becomes formed. Yue Ren stated that at its onset, it has a fixed location; pain does not leave its area, with definite beginnings and endings above and below, and limits to the left and right. He also said: "Accumulation belongs to Yin Qi." And "Yin is quiet and latent," which are accurate statements. Gatherings are different. Yue Ren stated that Gatherings belong to Yang Qi and are formed by the Fu organs. He also said: "Yang is floating and active"; the disease arises without a root, and pain has no fixed location. Because there is no root and no fixed location, Qi does not stay. Occasionally contending with Blood and Qi, pathogenic and healthy factors interfere. Qi gathers causing pain; Qi scatters resolving pain. This is unlike Accumulations, which remain stationary and do not disperse. Conditions such as attacking and rushing in the intestines and abdomen, Hernia-Jia heat, chest and abdominal distension/fullness, sharp pain, and thunder-like sounds all belong to the category of Gatherings. Ancients discussing Accumulations and Gatherings, distinguishing by Zang and Fu, essentially categorized those that are Deep, Latent, Stationary, and Unmoving as Yin, which corresponds to Zang; and those that are Floating, Active, Gathering, and Scattering irregularly as Yang, which corresponds to Fu. In treatment, one should act according to whether the pathology involves stasis/stationarity or gathering/scattering, rather than focusing solely on the terms 'Zang' and 'Fu'. A pulse that is Excess and Strong is a Yang pulse. It reflects both the contention between pathogenic and healthy factors and the robustness of the patient's original constitution. Because it relates to Fu and Yang, it indicates survival. A pulse that is Deep and Fine is a Yin pulse. It reflects both the depth of the pathogen and the depletion of the patient's original constitution. Because it relates to Zang and Yin, it indicates death. Regarding these two conditions, Accumulation and Gathering, I, Pan Ji, have cited the *Ling Shu*, *Su Wen*, *Nan Jing*, and *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet, 金匮要略). The etiology and symptoms are described in detail. However, the descriptions of syndromes are not mutually exclusive nor exclusively singular. Therefore, although there are established formulas, they cannot be directly inserted. Observing the causes of Accumulation and Gathering, it seems appropriate to use Warmth and Movement, rather than Cold and Contraction; appropriate to move the pivot mechanisms, rather than relying solely on aggressive purgation. Therefore, I have selected nineteen famous formulas for selection and use.