痞块，肝积也，肝经湿热之气聚而成也。外以大蒜、皂角、阿魏胶敷之，内以地黄汤加
验案
一妇因丧子忧虑，饮食不思，有块在软肚内。用四君子加陈皮、肉桂、归身、沉香、半
夏；丸用茯苓、白术四、五两，藏猪肚内，煮烂，沉香为衣，久服全愈。
一妇素善怒，左胁下有块，身肥大，经将行，先一二日且吐且下。此肝木乘脾，脾虚生
痰，不生血也。善怒胁块，肝气亢也；吐下者，脾气虚也；身肥则多痰，痰盛则中焦多湿；每经
行时气血流通，冲动脾湿，且吐且下也。久而不治，必变中满。宜理脾燥湿。白术一两，半
夏五钱，生姜七钱，沉香二钱，共末。白糖和服。
一人左胁有块，右关脉豁大。用乌药一两，附子五钱制之。将乌药日磨二三分，酒送下
，俟积行动，乃以补中益气汤加附子服之，丸用六味丸。
一人左乳下有一块，此肾虚水不上升，肝火无制，郁而为块也。宜滋肾丸治之，知母、
一人小腹左边有块，宜戊己丸治之。白术补脾，白芍、肉桂以平肝。服之全愈。
一人当胸有一块，遇心有所用，即火动上燎其面，时吐痰，脉缓而有力，右手浮大。盖
胸为肺室，面属阳明。有块不宽，肺火郁也；火燎其面，大肠火炽也；脉浮大，火脉也。实则泻
之，宜养血以制之。四物汤各一钱，肉桂三分煎服。
一人因忧虑发寒热，三月后呕吐，食仓边有一块，痛直冲心，胸膈饱，便闭，背胀胁痛
。盖
不下也。脾不转运，故诸病生焉。方用二陈汤加苏梗、炮姜、吴萸，一服便通。
一人右脐旁有块作痛，移动不定，大便不通，诸药不效。左寸缓而有力，右寸微大，关
脉沉细无力。此肝气虚，脾土衰，土不受克，木无生发之气，肾元可纳矣。不可攻痞，宜益肝、
扶脾、安肾，使脾气输则痞运散。人参、熟地、小茴各五分，归身一钱，山药、茯苓各七分
痞块，是肝积的一种，由肝经的湿热之气聚集而成。外部可用大蒜、皂角、阿魏胶外敷，内部服用地黄汤。
验案：
一位妇女因为丧子而忧虑，不想饮食，腹部软处有肿块。使用四君子汤（补气基础方）加入陈皮、肉桂、当归身、沉香；制成丸药则用茯苓、白术各四五两，藏在猪肚内煮烂，以沉香粉为衣，长期服用可痊愈。
一位妇女平时容易发怒，左胁下有肿块，身体肥胖，月经将要来潮时，先在一两天内出现呕吐和腹泻。这是肝木乘脾（肝气过旺克制脾土），导致脾虚生痰，无法化生血液。经常发怒且有胁下肿块，是肝气亢盛的表现；呕吐和腹泻，是脾气虚弱的表现；身体肥胖说明多痰，痰盛则中焦湿气重；每次月经行经时气血流通，冲动脾湿，所以出现呕吐和腹泻。如果长久不治疗，必定变成中满证（腹部胀满）。适宜调理脾胃、燥湿。白术一两，半夏五钱，生姜七钱，沉香二钱，共研为末。用白糖调和服用。
一个人左胁下有肿块，右关脉豁大（浮大而空）。使用乌药一两，附子五钱炮制后使用。将乌药每天研磨二三分，用酒送服，等到积滞之气运行通畅后，再服用补中益气汤（升阳举陷方）加入附子，丸药服用六味地黄丸（滋补肾阴方）。
一个人左乳下有一个肿块，这是肾虚导致水液不能上承，肝火失去制约，郁结而形成肿块。适宜用滋肾丸治疗，包含知母、[黄柏等，原文此处似有缺漏，依语境推断]。
一个人小腹左边有肿块，适宜用戊己丸（调和肝脾方）治疗。白术补脾，白芍、肉桂以平抑肝气。服用后痊愈。
一个人胸口正中有一个肿块，每当用心思或情绪激动时，火气上炎烧灼面部，时常吐痰，脉象缓而有力，右手脉浮大。胸廓是肺之居所，面部属阳明经。有肿块导致气机不畅，是肺火郁结；火气烧灼面部，是大肠火炽盛；脉象浮大，是火盛的脉象。实证应当泻之，适宜养血以制约火气。四物汤（补血调血方）各一钱，肉桂三分，煎服。
一个人因为忧虑引发寒热往来，三个月后出现呕吐，胃脘部有一肿块，疼痛直冲心脏，胸膈饱闷，大便闭塞，背部胀满，胁肋疼痛。这是因为忧思伤脾，脾气不运，所以各种疾病产生。方剂使用二陈汤（燥湿化痰方）加入苏梗、炮姜、吴茱萸，服用一次大便即通。
一个人右脐旁有肿块并疼痛，位置移动不定，大便不通，各种药物无效。左寸脉缓而有力，右寸脉微大，关脉沉细无力。这是肝气虚弱，脾土衰败，土不受克（指脾虚不能制约肝木，或肝木反侮脾土，此处意指脏腑功能失调），木气没有生发的活力，肾元可以收纳了。不可攻伐痞块，适宜益肝、扶脾、安肾，使脾气输布则痞块运散。人参、熟地黄、小茴香各五分，当归身一钱，山药、茯苓各七分。
Pi Mass (Subcutaneous or Intraperitoneal Mass) is a type of Liver Accumulation (Liver Ji), formed by the aggregation of damp-heat qi in the Liver Meridian. Externally, it can be treated with applications of Garlic, Gleditsia Sinensis Fruit (Zaojiao), and Ferula Resin (Awei Jiao); internally, Dihuang Tang (Rehmannia Decoction) is used.
Clinical Cases:
A woman, distressed by the loss of her child, lost her appetite and had a mass in the soft part of her abdomen. She was treated with Sijunzi Tang (Four Gentlemen Decoction) added with Chenpi (Tangerine Peel), Rougui (Cinnamon Bark), Dangguishen (Radix Angelicae Sinensis Stem), and Chenxiang (Aquilaria Wood). For pills, Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome), four to five liang each, were stewed inside a pig's stomach until soft, coated with Chenxiang powder, and taken over a long period for complete recovery.
Another woman, prone to anger, had a mass under her left hypochondrium, was obese, and experienced vomiting and diarrhea one or two days before her menstruation. This indicates Liver Wood overacting on Spleen Earth (Liver Qi invading the Spleen), causing Spleen deficiency to generate phlegm and fail to produce blood. Frequent anger and hypochondriac masses indicate hyperactive Liver Qi; vomiting and diarrhea indicate Spleen Qi deficiency; obesity suggests excessive phlegm, and excessive phlegm leads to dampness in the Middle Jiao. During menstruation, the flow of Qi and Blood stirs up Spleen dampness, causing vomiting and diarrhea. If untreated for a long time, it will inevitably transform into Zhongman (Abdominal Fullness). The treatment should focus on regulating the Spleen and drying dampness. Baizhu 1 liang, Banxia (Pinellia Tuber) 5 qian, Shengjiang (Fresh Ginger) 7 qian, Chenxiang 2 qian, all ground into powder and taken mixed with white sugar.
A man had a mass under his left hypochondrium, and his Right Guan pulse was hollow and large. He was treated with Wuyao (Lindera Root) 1 liang and prepared Fuzi (Prepared Aconite Lateralis Radix) 5 qian. The Wuyao was ground finely (2-3 fen daily) and taken with wine. Once the accumulated pathogen began to move, Buzhong Yiqi Tang (Decoction for Boosting the Middle and Augmenting Qi) with added Fuzi was administered, along with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) as pills.
A person had a mass below the left breast. This is due to Kidney deficiency failing to ascend water, allowing Liver Fire to go unchecked, leading to stagnation and mass formation. It should be treated with Zishen Wan (Kidney-Nourishing Pill), containing Zhimu (Anemarrhenae Rhizoma)... [text incomplete].
A person had a mass on the left side of the lower abdomen. It should be treated with Wuji Wan (Wuji Pill), which uses Baizhu to tonify the Spleen, and Baishao (White Peony Root) and Rougui to calm the Liver. Complete recovery was achieved.
A person had a mass in the center of the chest. Whenever mental exertion occurred, fire flared up, scorching the face, accompanied by frequent expectoration of phlegm. The pulse was slow yet forceful, and the Right hand pulse was floating and large. The chest is the residence of the Lung, and the face belongs to the Yangming channel. The presence of a mass obstructs free flow, indicating stagnant Lung Fire; the scorching of the face indicates blazing Large Intestine Fire; the floating and large pulse indicates Fire excess. For excess patterns, purging is indicated. Nourishing Blood to subdue the fire is appropriate. Siwu Tang (Four Substances Decoction), 1 qian of each ingredient, with Rougui 3 fen, decocted and taken.
A person developed alternating chills and fever due to worry. Three months later, vomiting occurred, with a mass at the edge of the stomach, pain shooting straight to the heart, chest and diaphragm fullness, constipation, back distension, and hypochondriac pain. This arises because worry injures the Spleen, impairing its transportation and transformation, giving rise to various diseases. The formula used was Erchen Tang (Two-Aged Decoction) added with Sugen (Perilla Stem), Paojiang (Prepared Ginger), and Wuyu (Evodia Fruit). One dose resulted in bowel movement.
A person had a painful mass beside the right umbilicus, moving unpredictably, with constipation, unresponsive to various medications. The Left Cun pulse was slow and forceful, the Right Cun pulse slightly large, and the Guan pulse deep, fine, and weak. This indicates Liver Qi deficiency and Spleen Earth decline. Since Earth is not controlled (or fails to control Wood appropriately), Wood lacks generating vitality, and Kidney Yuan can be secured. Attacking the Pi mass is contraindicated; instead, tonifying the Liver, supporting the Spleen, and calming the Kidney are required to allow Spleen Qi to distribute, thereby dispersing the mass. Renshen (Ginseng Radix), Shudi (Prepared Rehmanniae Radix), and Xiaohui (Fennel Fruit) each 5 fen, Dangguishen 1 qian, Shanyao (Dioscorea Rhizome) and Fuling each 7 fen... [text ends].