积聚 瘕。 者，有形可征，腹中坚硬，按之应手；瘕者，假气以成，中虽坚而或聚或
无常定位，故其病尚未及 。夫燥则脾健而消散，湿则脾困而积聚，血不流而滞，则血内凝
而，用醋煮海石、三棱、莪术、桃仁、红花、五灵脂、香附之类为丸，白术汤下。或曰瓦
垄子，能消血块痰积，可治 瘕。
凡积不可用下药，徒损真气，病亦不去，只宜消积，使之融化则积消矣，积去宜补之。
消积之法，三棱汤、延胡丸、保安丸、无忧散、鳖甲汤等，俱可选用。
三棱汤
三棱（二两） 白术（一两） 归身 莪术（各五钱） 槟榔 木香（各三钱）
共末，白汤调下三、四钱。
延胡丸
延胡索 青皮 陈皮 木香 当归 雄黄 生姜 三棱（各一两）
酒曲糊丸，生姜汤下。或加槟榔、黄 。
保安丸
炮姜（三钱） 大黄（三两） 附子（五钱，制） 鳖甲（一两，醋炙）
醋糊丸，米饮下二十丸，积如血肉腐下。
无忧散
黄 木通 桑皮 陈皮（各一两） 胡椒 白术 木香（各五钱） 白牵牛（四两，取头
共末，每服二钱，生姜汤下。快利后，白粥补之。
鳖甲汤
鳖甲（醋炙） 三棱 大腹皮 白芍 归身 柴胡 生地（各一两） 肉桂 生姜（各二钱）
空心服之。
丸方（治伏梁）
浓朴 人参 枳壳 半夏 山栀 白术 神曲
又方（治肥气）
青皮 苍术
煎方（治息贲、喘嗽）
半夏 吴萸（各一钱） 桑皮 葶苈（各二钱） 人参
又方（治奔豚）
干葛 甘草（各一钱） 白芍 归身 川芎（各钱半） 黄芩（一钱）
又丸方（治诸积）
白牵牛（四两） 槟榔（一两） 三棱（五枚） 莪术 茵陈（各五钱）
醋糊丸。
贴积块方
甘草 芫花 海藻
共末，醋调敷块上。
验案
一女心口有积如伏梁。人参、陈皮各五分，苡仁七分，茯苓一钱，草蔻三分，每发，一
一人年二十，腹中积聚，所服皆破血之药，脾胃已伤，不得已用理脾化气之法，人参，
白术、神曲各五分，茯苓七分，陈皮四分，砂仁三分，不拘时服。
积聚。瘕（腹内结块，推之可移，痛无定处），是那种有具体形态可以验证的，腹部坚硬，按压时有应手感；而瘕则是假借气机凝聚而成，中间虽然坚硬但有时聚集有时消散，没有固定的位置，所以它的病势尚未波及到脏。如果体内干燥，则脾脏功能健运而积聚消散；如果体内湿盛，则脾脏被困阻而导致积聚形成。血液不流动而停滞，就会在内部凝结成块。治疗时，使用醋煮的海浮石、三棱、莪术、桃仁、红花、五灵脂、香附等药物制成丸剂，用白术汤送服。或者有人说瓦垄子，能够消除血块和痰积，可以用来治疗瘕。
凡是积证不可轻易使用攻下药，只会徒然损伤真气，疾病也不会去除，只适宜采用消积的方法，使积块融化消散，积块去除后应当进行补益。
消除积块的方法，有三棱汤、延胡丸、保安丸、无忧散、鳖甲汤等，都可以酌情选用。
三棱汤
三棱（二两） 白术（一两） 当归身 莪术（各五钱） 槟榔 木香（各三钱）
以上药物共研为末，用温开水调服三至四钱。
延胡丸
延胡索 青皮 陈皮 木香 当归 雄黄 生姜 三棱（各一两）
用酒曲糊制作丸剂，用生姜汤送服。也可以加入槟榔、大黄。
保安丸
炮姜（三钱） 大黄（三两） 附子（五钱，经炮制） 鳖甲（一两，醋炙）
用醋糊制作丸剂，用米饮送服二十丸，积块如同血肉腐烂般排出。
无忧散
黄芪 木通 桑白皮 陈皮（各一两） 胡椒 白术 木香（各五钱） 白牵牛（四两，取头末）
以上药物共研为末，每次服用二钱，用生姜汤送服。大便通畅泻下后，喝白粥来补养脾胃。
鳖甲汤
鳖甲（醋炙） 三棱 大腹皮 白芍 当归身 柴胡 生地黄（各一两） 肉桂 生姜（各二钱）
空腹服用。
丸方（治疗伏梁——指心下至脐有硬块如臂状的积聚）
厚朴 人参 枳壳 半夏 山栀 白术 神曲
又一方（治疗肥气——指左胁下有肿块如覆杯状的积聚）
青皮 苍术
煎方（治疗息贲——指右胁下有肿块如复杯状的积聚，伴喘咳）
半夏 吴茱萸（各一钱） 桑白皮 葶苈子（各二钱） 人参
又一方（治疗奔豚——指气从少腹上冲心胸）
干葛 甘草（各一钱） 白芍 当归身 川芎（各一钱半） 黄芩（一钱）
又一方丸剂（治疗各种积聚）
白牵牛（四两） 槟榔（一两） 三棱（五枚） 莪术 茵陈（各五钱）
用醋糊制作丸剂。
贴积块方
甘草 芫花 海藻
以上药物共研为末，用醋调和敷在积块上。
验案
有一个女子心口部位有积块，状如伏梁。用人参、陈皮各五分，薏苡仁七分，茯苓一钱，草豆蔻三分，每次发作时服用。
又一案例：一个人年仅二十岁，腹中有积聚，之前所服用的都是破血逐瘀的药物，导致脾胃已经受损，不得已改用调理脾胃、化气行滞的方法，用人参、白术、神曲各五分，茯苓七分，陈皮四分，砂仁三分，不拘泥于固定时间服用。
Accumulation (Ji) and Mass (Jia). The term "Jia" refers to a mass that is formed by the temporary aggregation of Qi, characterized by hardness in the center but with shifting positions, sometimes gathering and sometimes dispersing, lacking a fixed location; thus, its pathological influence has not yet reached the Zang organs. In contrast, Accumulation (Ji) presents with tangible signs, hardness in the abdomen, and tenderness upon palpation. If the body is dry, the Spleen's function remains robust, leading to the dissipation of accumulations; if dampness prevails, the Spleen becomes encumbered, resulting in the formation of accumulations. When blood fails to circulate and stagnates, it coagulates internally into masses. Treatment involves using drugs such as Haishi (Fossilia Silicium), Sanleng (Rhizoma Sparganii), Ezhu (Rhizoma Curcumae), Taoren (Semen Persicae), Honghua (Flos Carthami), Wulingzhi (Resina Trogopterori), and Xiangfu (Rhizoma Cyperi), boiled in vinegar and processed into pills, taken with Baizhu Tang (Atractylodes Macrocephala Decoction). Alternatively, Walongzi (Concha Arcae) can be used, as it is capable of resolving blood stasis and phlegm accumulation, suitable for treating Jia.
Generally, Accumulation (Ji) should not be treated with purgative drugs, as this merely depletes True Qi without eliminating the disease. Instead, methods to resolve and dissolve the accumulation should be employed until the mass melts away. After the accumulation is removed, tonification is appropriate.
Methods for resolving accumulation include Sanleng Tang (Sparganium Decoction), Yanhu Wan (Corydalis Pill), Bao'an Wan (Security Pill), Wuyou San (Carefree Powder), and Biejia Tang (Turtle Shell Decoction), all of which may be selected according to the condition.
Sanleng Tang (Sparganium Decoction)
Sanleng (Rhizoma Sparganii, 2 liang), Baizhu (Radix Atractylodis Macrocephalae, 1 liang), Guishen (Radix Angelicae Sinensis, 5 qian each), Ezhu (Rhizoma Curcumae, 5 qian each), Binglang (Semen Arecae, 3 qian each), Muxiang (Radix Aucklandiae, 3 qian each).
Grind all ingredients into powder. Take 3-4 qian mixed with warm water.
Yanhu Wan (Corydalis Pill)
Yanhusuo (Rhizoma Corydzidis), Qingpi (Pericarpium Citri Reticulatae Viride), Chenpi (Pericarpium Citri Reticulatae), Muxiang (Radix Aucklandiae), Danggui (Radix Angelicae Sinensis), Xionghuang (Realgar), Shengjiang (Rhizoma Zingiberis Recens), Sanleng (Rhizoma Sparganii) (each 1 liang).
Process into pills using wine paste. Take with Shengjiang Tang (Fresh Ginger Decoction). One may also add Binglang (Semen Arecae) and Dahuang (Radix et Rhizoma Rhei).
Bao'an Wan (Security Pill)
Paojiang (Rhizoma Zingiberis Preparatum, 3 qian), Dahuang (Radix et Rhizoma Rhei, 3 liang), Fuzi (Radix Aconiti Lateralis Preparata, 5 qian, processed), Biejia (Carapax et Plastrum Testudinis, 1 liang, vinegar-fried).
Process into pills using vinegar paste. Take 20 pills with rice water. The accumulation will pass out like rotting flesh and blood.
Wuyou San (Carefree Powder)
Huangqi (Radix Astragali), Mutong (Caulis Akebiae), Sangpi (Cortex Mori), Chenpi (Pericarpium Citri Reticulatae) (each 1 liang), Hujiao (Fructus Piperis NigrI), Baizhu (Radix Atractylodis Macrocephalae), Muxiang (Radix Aucklandiae) (each 5 qian), Baiqianniu (Semen Pharbitidis, 4 liang, head end only).
Grind all ingredients into powder. Take 2 qian per dose with Shengjiang Tang (Fresh Ginger Decoction). After effective bowel movement, replenish with white congee.
Biejia Tang (Turtle Shell Decoction)
Biejia (Carapax et Plastrum Testudinis, vinegar-fried), Sanleng (Rhizoma Sparganii), Dafupi (Pericarpium Arecae), Baishao (Radix Paeoniae Alba), Guishen (Radix Angelicae Sinensis), Chaihu (Radix Bupleuri), Shengdi (Radix Rehmanniae Preparata) (each 1 liang), Rougui (Cortex Cinnamomi), Shengjiang (Rhizoma Zingiberis Recens) (each 2 qian).
Take on an empty stomach.
Pill Formula (for Fuliang - Accumulation resembling a beam under the heart)
Houpo (Cortex Magnoliae Officinalis), Renshen (Radix Ginseng), Zhike (Fructus Aurantii Immaturus), Banxia (Rhizoma Pinelliae), Shanzhi (Fructus Gardeniae), Baizhu (Radix Atractylodis Macrocephalae), Shenqu (Massa Medicata Fermentata).
Another Formula (for Feiqi - Accumulation resembling an overturned cup in the left hypochondrium)
Qingpi (Pericarpium Citri Reticulatae Viride), Cangzhu (Rhizoma Atractylodis).
Decoction Formula (for Xiben - Accumulation resembling an overturned cup in the right hypochondrium with wheezing and cough)
Banxia (Rhizoma Pinelliae), Wuyu (Fructus Evodiae) (each 1 qian), Sangpi (Cortex Mori), Tingli (Semen Lepidii/Descurainiae) (each 2 qian), Renshen (Radix Ginseng).
Another Formula (for Ben Tun - Rushing Pig syndrome, Qi rushing from lower abdomen to chest)
Gange (Radix Puerariae Lobatae), Gancao (Radix Glycyrrhizae) (each 1 qian), Baishao (Radix Paeoniae Alba), Guishen (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong) (each 1.5 qian), Huangqin (Radix Scutellariae) (1 qian).
Another Pill Formula (for various accumulations)
Baiqianniu (Semen Pharbitidis, 4 liang), Binglang (Semen Arecae, 1 liang), Sanleng (Rhizoma Sparganii, 5 pieces), Ezhu (Rhizoma Curcumae), Yinchen (Herba Artemisiae Scopariae) (each 5 qian).
Process into pills using vinegar paste.
External Application Formula for Accumulation Masses
Gancao (Radix Glycyrrhizae), Yuanhua (Flos Genkwa), Haizao (Thallus Sargassii).
Grind into powder, mix with vinegar, and apply topically to the mass.
Clinical Case
A young woman had an accumulation in her epigastrium resembling Fuliang. Prescription: Renshen (Radix Ginseng) and Chenpi (Pericarpium Citri Reticulatae) 5 fen each, Yiren (Semen Coicis) 7 fen, Fuling (Poria) 1 qian, Cao Kou (Fructus Cardamomi) 3 fen. Administer at the onset of symptoms.
Another Case: A twenty-year-old man had abdominal accumulation. He had previously taken blood-breaking herbs, damaging his Spleen and Stomach. Consequently, a method regulating the Spleen and transforming Qi was adopted: Renshen (Radix Ginseng), Baizhu (Radix Atractylodis Macrocephalae), Shenqu (Massa Medicata Fermentata) 5 fen each; Fuling (Poria) 7 fen; Chenpi (Pericarpium Citri Reticulatae) 4 fen; Sharen (Fructus Amomi Rotundus) 3 fen. Taken at any time.