脉经曰脉来细而附骨者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
下关积在少腹尺积在气街脉出在右积在右脉出在左积在左脉两出积在中央各以其部处之 脉
来小沉而实者胃中有积聚不食食即吐 肺积脉浮而毛按之辟易 心积脉沉而芤上下无常处
肝积脉弦而细 肾积脉沉而急 脉沉重而中散者因寒食成 脉左转而沉重者气 阳在胸中
右转出不至寸口者内有肉 也
难经曰积者阴气也聚者阳气也故阴沉而伏阳浮而动气之所积名曰积气之所聚名曰聚故积
者五脏所生聚者六腑所成也积者阴气也其始发有常处其痛不离其部上下在所
终始左右有所穷处聚者阳气也其始发无根本上下无所
留止其痛无常处谓之聚故以是别知积聚也
原病式曰证者腹中坚硬按之应手然水体柔顺而今反坚硬如地者亢则害承乃制也瘕者中虽
硬而
忽聚忽散无其常故其病未及 也经曰血不流而滞故血内凝而为瘕也小肠移热于大肠乃为虑瘕
大肠移热于小肠谓两热相搏则血溢而为伏瘕血涩不利月事沉滞而不行故云为虑瘕为虑与伏同
传写误尔
谨按积者实停蓄之总名 者有所成而名之亦皆积尔瘕者血病也似不可言为聚聚者阳气也
然大
小肠移热为瘕如此则亦聚尔但前人施治亦未见有分其异同者唯丹溪先生曰积块在中为痰饮在
左为血积在右为食积气不能作块成聚块乃有形之物痰与食积死血尔此深得病情之旨学人可因
此例而求诸
《脉经》说：脉搏来细弱且深按至骨才能触及的，是积证。脉象在寸口部位显现的，积在胸中；微微超出寸口的，积在喉中；在关部显现的，积在脐旁；略微超过关部的，积在心下；略微低于关部的，积在少腹；在尺部显现的，积在气街。脉象出现在右侧的，积在右侧；脉象出现在左侧的，积在左侧；脉象两侧都出现的，积在中央。分别根据脉象所在的部位来判断积证的位置。
脉搏来细小、沉取而坚实的，是胃中有积聚，不能进食，一吃就吐。肺积的脉象浮而如毛，轻按即散；心积的脉象沉而中空（芤脉），位置上下不定；肝积的脉象弦而细；肾积的脉象沉而急迫。脉象沉重而中间散乱的，是因为寒邪和饮食停滞所致。脉象向左转且沉重的，是气滞；阳气在胸中；向右转且出而不达寸口的，内有肉瘕。
《难经》说：积证属于阴气，聚证属于阳气。所以阴气沉潜而潜伏，阳气浮越而变动。气所积聚的地方叫作“积”，气所聚集的地方叫作“聚”。因此，积证是由五脏产生的，聚证是由六腑形成的。积证属于阴气，它开始发作时有固定的部位，疼痛不离开其所在部位，上下有始终，左右有穷尽之处。聚证属于阳气，它开始发作时没有根本，上下没有停留止息之处，疼痛没有固定位置，这叫做“聚”。因此通过这一点来辨别积和聚。
《原病式》说：证候表现为腹中坚硬，按压时有应手之感。水本柔顺，现在反而坚硬如地，这是亢盛则受害，承制才平衡的道理。瘕证虽然中间坚硬，但忽聚忽散，没有常态，所以病情较轻，未及深入。经文说：血液不流动而停滞，所以在内凝结成为瘕证。小肠的热邪移注于大肠，就成为虑瘕；大肠的热邪移注于小肠，称为两热相搏，导致血液溢出而成为伏瘕。血液涩滞不利，月经沉滞不行，所以说成为虑瘕。“虑”与“伏”同义，是传抄错误罢了。
谨按：积证是实邪停蓄的总称。瘕有所成形而得名，也都属于积类。瘕是血分病变，似乎不可以说是聚。聚属于阳气。但是像大小肠移热形成瘕这样，也属于聚类。只是前人治疗时，也没有见得分清异同的人。只有丹溪先生说：积块在中间的为痰饮，在左侧的为血积，在右侧的为食积。气不能形成块状或聚结，块乃是有形的物体，即痰、食积和死血罢了。这深得病情的旨意，学习的人可以由此类推去探求。
The *Mai Jing* (Pulse Classic) states: When the pulse is fine and adheres to the bone upon deep palpation, it indicates a *Ji* syndrome (accumulation mass). If the pulse manifests at the *Cunkou* (inch position), the accumulation is in the chest; if it slightly extends beyond the *Cunkou*, the accumulation is in the throat; if it manifests at the *Guan* (bar position), the accumulation is beside the navel; if it slightly exceeds the *Guan* position, the accumulation is below the heart; if it slightly descends from the *Guan* position, the accumulation is in the lower abdomen; if it manifests at the *Chi* (cubit position), the accumulation is at the *Qijie* (gas street/acupoint area). If the pulse appears on the right side, the accumulation is on the right; if on the left, the accumulation is on the left; if appearing on both sides, the accumulation is in the center. One should determine the location of the accumulation according to these respective positions.
If the pulse is small, deep, and solid, there is an accumulation in the stomach, leading to an inability to eat and vomiting immediately after eating. The pulse of lung *Ji* is floating and feathery, scattering upon light pressure; the pulse of heart *Ji* is deep and hollow (*Kou* pulse), with no fixed upper or lower location; the pulse of liver *Ji* is wiry and fine; the pulse of kidney *Ji* is deep and rapid. A pulse that is heavy and scattered in the middle indicates formation due to cold and food stagnation. A pulse turning leftward and heavy indicates Qi stagnation; Yang Qi in the chest; a pulse turning rightward and failing to reach the *Cunkou* indicates the presence of a fleshy mass (*Rou Jia*).
The *Nan Jing* (Classic of Difficult Issues) states: *Ji* syndromes belong to Yin Qi, while *Ju* syndromes belong to Yang Qi. Therefore, Yin is sunken and latent, while Yang is floating and active. Where Qi accumates, it is called *Ji*; where Qi gathers, it is called *Ju*. Thus, *Ji* syndromes are generated by the five Zang organs, and *Ju* syndromes are formed by the six Fu organs. *Ji* belongs to Yin Qi; its initial onset has a constant location, its pain does not leave its sector, having definite beginnings and endings above and below, and limits on the left and right. *Ju* belongs to Yang Qi; its initial onset has no root, moving up and down without staying or stopping, and its pain has no fixed location, which is why it is called *Ju*. Thus, one distinguishes between *Ji* and *Ju* based on this.
The *Yuan Bing Shi* (Manual of Original Causes of Disease) states: The manifestation involves hardness in the abdomen, yielding to touch. Water is naturally soft and smooth, but now it is hard like earth; this is because when things become excessive, they cause harm, and only through subordination/control is balance restored. *Jia* syndromes are hard in the middle but gather and scatter intermittently without constancy, so the disease does not penetrate deeply. The classic states: Blood fails to flow and stagnates, thus coagulating internally to form *Jia*. Heat transferring from the Small Intestine to the Large Intestine results in *Lv Jia* (worry *Jia*); heat transferring from the Large Intestine to the Small Intestine implies two heats clashing, causing blood to overflow and form *Fu Jia* (hidden *Jia*). Blood becomes涩 (astringent/stagnant) and unsmooth, menstrual flow becomes stagnant and ceases, hence it is called *Lv Jia*. "Lv" and "Fu" are synonymous, resulting from transcription errors.
Respectfully noting: *Ji* is the general term for the actual retention and storage of pathogens. *Jia* is named because it has formed a shape, yet all belong to the category of *Ji*. *Jia* is a blood pathology and seemingly cannot be termed *Ju*. *Ju* belongs to Yang Qi. However, since heat transfer between the large and small intestines forms *Jia*, this too falls under *Ju*. Nevertheless, predecessors in treatment did not see the need to distinguish their differences. Only Master Danxi stated: Accumulations in the center are Phlegm-Fluids; those on the left are Blood Accumulations; those on the right are Food Accumulations. Qi cannot form masses or gatherings; masses are tangible objects, namely Phlegm, Food Stagnation, and Dead Blood. This deeply grasps the essence of pathology. Students may use this as an example to seek further understanding.