详见痰饮门
许学士云大抵治积或以所恶者攻之或以所喜者诱之则易愈如 砂水银治肉积神曲麦 治
酒积
水蛭虻虫治血积木香槟榔治气积牵牛甘遂治水积雄黄腻粉治涎积礞石巴豆治食积各从其类也
若用群队之药分其药势则难取效须要认得分明是何积聚兼见何证然后增减斟量使之不尔反有
所损要在临时通变也
谨按诸积有不因气动而成者如偶有所食或误吞钱物之类是也因气动而成者如七情所致或
饮食
劳倦或五脏传受之类是也故所积之物不一气血之聚有殊或成蛊瘤生瘕之类难测故须是认得分
明是何积聚用药宜各从其类然亦要看元气虚实或攻取峻削或养正渐除可也不尔则岂但有损而
已
卫生宝鉴曰洁古云养正积自除譬如满座皆君子纵有一小人自无容地而出令其真气实胃气
强
积自消矣洁古之言岂欺我哉内经曰大积大聚衰其太半而止满实中有积气大毒之剂尚不可过况
虚中有积者乎此乃治积之一端也邪正虚实宜详审焉
按或云积非下之不可今言养正而后积除将以待正气而除乎将以待药力而除乎然人之有积
则皆
为身中之邪气若君子座中之有小人也惟其调正气则真气营运不失其常而积自除夫君子众而正
直在位其小人自然退避矣不然则正气虚而真气乖致积增膜膈胃乱真正气绝而死矣亦若小人得
志则政乱法坏而君子有所不能制焉且夫养正者非为饮食起居之间也盖积既成矣形渐悴矣必用
调养使荣卫充实而积自除余有坚而不去者方可亟下之此先补后攻期于邪去正复而后已然除之
不以渐则必有颠覆之害矣若昔之武氏斫丧唐宗几于改物尚赖狄张诸公匡扶之力渐除党与兴
复
丕祚惜乎中宗不鉴前辙之失而留三思至致韦氏之祸其犹积余之尚在者而不亟下之更不慎守禁
戒遂纵口嗜欲病证复起而不可制其有不丧身者未之有也
详见痰饮门。
许学士说：大抵治疗积证，或用患者厌恶的药物来攻伐它，或用患者喜欢的药物来诱导它，这样容易痊愈。例如，用硇砂、水银治疗肉积；用神曲、麦芽治疗酒积；用水蛭、虻虫治疗血积；用木香、槟榔治疗气积；用牵牛子、甘遂治疗水积；用雄黄、腻粉治疗涎积；用礞石、巴豆治疗食积。这都是各从其类的道理。如果使用大队药物分散药势，就难以取得疗效。必须辨认清楚是何种积聚，兼见什么证候，然后增减斟酌剂量，如果不这样做，反而会有所损害。关键在于临证时灵活变通。
谨按：各种积证有不因气机运动而形成的，如偶然吃了某些食物或误吞钱币异物之类；有因气机运动而形成的，如七情所致，或饮食劳倦，或五脏传变之类。所以所积之物不一，气血的聚结也有差异，有的形成蛊、瘤、瘕之类，难以预测。因此必须辨认清楚是何种积聚，用药应当各从其类。然而也要看元气虚实，或者使用峻猛的攻逐方法，或者通过扶正来逐渐消除。如果不这样做，岂止是有损害而已。
《卫生宝鉴》记载：洁古先生说：扶助正气，积证自然消除。譬如满座都是君子，纵然有一个小人，自然没有容身之地而离去，让他自己出去。使真气充实，胃气强健，积证自然消散。洁古先生的话，难道欺骗我吗？《内经》说：大的积聚，衰减其大半就要停止。在满实之中有积气，尚且不可过度使用大毒的药物，何况是虚中有积者呢？这是治疗积证的一个方面。邪正虚实应当详细审察。
按语：有人说积证非用下法不可，现在说扶助正气而后积证消除，是等待正气恢复来消除呢，还是等待药力来消除呢？然而人有了积证，都是身体中的邪气。如果像君子坐席中有小人一样，只有调补正气，使真气运行不失常态，积证自然消除。如果君子众多且正直在位，小人自然会退避。不这样的话，正气虚弱而真气乖逆，导致积证增加，隔膜混乱，真正的气绝而死。这也如同小人得志，则政令混乱、法度败坏，而君子有所不能控制。况且所谓“养正”，不仅仅是在饮食起居之间调养。既然积证已经形成，形体逐渐憔悴，必须用调养的方法使营卫充实，积证自然消除。其余有坚硬不去的，才可以紧急使用下法。这是先补后攻，期望邪去正复之后才这样。如果消除积证不循序渐进，必然有颠覆的危害。就像过去的武氏（武则天）斫丧唐宗，几乎改朝换代，还依赖狄仁杰、张柬之诸位公卿匡扶之力，逐渐清除党羽，复兴大唐国运。可惜中宗没有借鉴前辙的失误，留下张易之、张昌宗兄弟（注：原文“三思”指张昌宗/张易之或韦后相关势力，此处依文意理解为留患），以至于导致韦氏之祸。这就像积证残余尚在，不紧急攻下，又不谨慎遵守禁忌，放纵口腹嗜欲，病证复发而不可控制，能不丧身吗？这是必然的。
See the section on Phlegm-Fluids (Tan Yin).
Academician Xu stated: Generally, to treat accumulations (Ji), one may either attack them with substances the patient dislikes or lure them out with substances the patient likes, which makes recovery easier. For example, Nao Sha (Sal Ammoniac) and Shui Yin (Mercury) are used for Rou Ji (Meat Accumulation); Shen Qu (Medicated Leaven) and Mai Ya (Germinated Hordeum) are used for Jiu Ji (Alcohol Accumulation); Shui Zhi (Leech) and Meng Chong (Blue Bottle Fly Larva) are used for Xue Ji (Blood Accumulation); Mu Xiang (Aucklandia Root) and Bing Lang (Areca Seed) are used for Qi Ji (Qi Accumulation); Qian Niu Zi (Pharbitis Seed) and Gan Sui (Kansui Root) are used for Shui Ji (Water Accumulation); Xiong Huang (Realgar) and Ni Fen (Calomel) are used for Xian Ji (Saliva/Phlegm Accumulation); Meng Shi (Lodestone) and Ba Dou (Croton Seed) are used for Shi Ji (Food Accumulation). This follows the principle of treating each according to its nature. If a large group of medicines is used, dispersing their therapeutic power, it will be difficult to achieve efficacy. One must clearly identify what kind of accumulation it is and what accompanying syndromes exist, then adjust and weigh the dosage accordingly. Otherwise, there will be damage. The key lies in flexible adaptation during clinical practice.
It is noted that some accumulations do not form due to the movement of Qi, such as those caused by occasional improper diet or accidentally swallowing coins and foreign objects. Others form due to the movement of Qi, such as those caused by Seven Emotions, improper diet and overwork, or transmission among the Five Zang Organs. Therefore, the accumulated materials vary, and the aggregation of Qi and Blood differs; some form complex conditions like Gu (Parasitic Disease/Tumor), Liu (Tumor), or Jia (Mass), which are hard to predict. Thus, one must clearly identify the type of accumulation, and medication should follow the nature of the accumulation. However, one must also assess the deficiency or excess of Yuan Qi (Primal Qi). One may use harsh purgative methods or gradually eliminate the accumulation by supporting Zheng Qi (Upright Qi). If not done this way, the harm would go beyond mere injury.
*Weisheng Baojian* records: Jiegu said, "Support the upright Qi, and the accumulation will naturally disappear." It is like having a room full of gentlemen; even if there is one villain, he will have no place to stay and will leave on his own. By making the True Qi substantial and the Stomach Qi strong, the accumulation will dissipate naturally. Would Jiegu’s words deceive us? *Neijing* states: "For large accumulations and aggregations, reduce them by more than half and stop." Even when there is Qi stagnation within fullness and excess, one must not excessively use highly toxic medicines, let alone when there is an accumulation within deficiency. This is but one aspect of treating accumulations. One must carefully examine the pathogenic factors, upright Qi, deficiency, and excess.
Commentary: Some say that accumulations must be treated with purgatives. Now it is said that after supporting the upright Qi, the accumulation is removed. Is this waiting for the restoration of upright Qi to remove it, or waiting for the medicinal power to remove it? However, any accumulation in the human body is pathogenic Qi. Just as a gentleman's seat contains a villain, only by regulating and tonifying the upright Qi can the True Qi operate normally, causing the accumulation to disappear naturally. If many gentlemen are upright and in position, the villains will naturally retreat. Otherwise, if the upright Qi is deficient and the True Qi is disordered, the accumulation will increase, the diaphragm will become chaotic, the true Qi will cease, and death will ensue. This is similar to when villains gain power, leading to chaotic governance and broken laws, where gentlemen cannot control the situation. Furthermore, "supporting the upright Qi" is not merely about adjusting diet and daily life. Since the accumulation has already formed and the physique has gradually emaciated, one must use nourishing methods to make Ying Wei (Nutritive and Defensive Qi) substantial, so that the accumulation disappears naturally. Only for those that remain hard and undissolved should one urgently apply purgation. This is "tonify first, purge later," aiming for the elimination of pathogenic factors and the restoration of upright Qi. If the removal of accumulation is not gradual, there will inevitably be catastrophic consequences. Consider Wu Zetian, who devastated the Tang dynasty and nearly changed the ruling house; she relied on the efforts of ministers like Di Renjie and Zhang Jianzhi to gradually eliminate her faction and restore the Tang throne. Unfortunately, Emperor Zhongzong did not learn from past mistakes, leaving behind figures like Zhang Yizhi and Zhang Changzong (referred to as "San Si" in context of treacherous favorites), which led to the disaster of Consort Wei. This is like residual accumulation remaining; if not urgently purged, and if one does not strictly observe dietary and lifestyle prohibitions, indulging in sensual desires, the disease will recur uncontrollably, leading inevitably to loss of life.