陈无择云 瘕属肝部积聚属肺部夫 者坚也瘕者假也假物而成形然七 八瘕之名经论亦
不详
出虽有蛟蛇鳖肉发虱米等七证初非定名偶因食物相感而致患尔若妇人 瘕则由内外不内外因
动伤五脏气血而成古人谓为痼疾以蛟蛇等为生瘕然亦不必泥此并属血病蛇发等事皆出偶然但
饮食间误中之留聚假血而成自有活性亦犹永微中僧病噎者腹中有一物其状如鱼即生瘕也
按此论积聚等属脏部盖分气血尔亦不必拘此然生瘕亦有外因而成者如昔之徐之才治取蛤
精疾生于足间者若此陈于三因何不之及
水胀篇曰石瘕何如岐伯曰石瘕生于胞中寒气客于子门子门闭塞气不通恶血当泻不泻 以
留
止日以盖大状如怀子月事不以时下皆生于女子可导而下宝鉴曰夫膀胱为津液之腑气化则能出
矣今寒客于子门则必气塞不通血壅不流而 以止之结硬如石是名石瘕也此气先病而血后病故
月事不来则可宣导而下出者也故难经云任之为病其内苦结男子为七疝女子为瘕聚此之谓也非
大辛之药不能已可服见 丹
肠覃何如岐伯曰寒气客于肠外与胃相搏不得荣因有所系瘕而内着恶气乃起 肉乃生其始
生者
大如鸡卵稍以益大至其成如怀子之状久者离岁按之则坚推之则移月事以时下此其候也夫肠者
大肠也覃者延也大肠以传道为事乃肺之腑肺主卫卫为气气得炅则泄寒则凝今寒客于大肠故卫
气不荣有所系止而结瘕在内贴者其延久不已是名肠覃也气散则清气聚则浊结为证聚所以恶气
发起 肉乃生小渐益大至期而鼓其腹则如怀子状也此气病而血未病故月水不断以时下本非妊
娠可以此为辨矣
按此谓石瘕为血壅不流故月事不来肠覃为清气
聚而浊结成瘕故血未病月水不断而知此二积之
异然亦有诸积所致或有病痈脓而似此二证者不可不察也
陈无择说：瘕属于肝部，积聚属于肺部。“积”是坚硬的，“瘕”是假性的，借助外物而形成形状。然而关于“七瘕”的名称，经典论述也不详细。虽然有蛟、蛇、鳖、肉、发、虱、米等七种证候，起初并非固定的名称，只是偶然因为食物相互作用而导致患病罢了。至于妇女的瘕，则是由于内因、外因及不内外因动伤五脏气血而成。古人称之为痼疾，认为蛟蛇等是形成生瘕的原因，但也不必拘泥于此，这些都归属于血病。蛇、发等事都是偶然的，只是在饮食间误食后留聚，假借血液而形成的，自有其活性。也就像永徽年间有个僧人患噎病，腹中有一物，形状像鱼，这就是生瘕。
按照这个理论，积聚等属于脏部，大概分为气分和血分罢了，也不必拘泥于此。然而生瘕也有由外因而成的，比如过去的徐之才治疗取蛤精疾，生于足间的。对此，陈无择在三因方中为何没有提及？
《水胀篇》说：石瘕怎么样？岐伯说：石瘕生于胞宫（子宫），寒气客居于子门（子宫口），子门闭塞，气不通畅，恶血应当排出却排不出，因此停留停止，一天天增大，形状像怀孕一样，月经不能按时来潮。这都是发生在女子身上的，可以用导引下行的方法治疗。《宝鉴》说：膀胱是津液之腑，气化后才能排出。现在寒气客居于子门，必然导致气塞不通，血壅滞不流而停留，结硬如石头，这就叫石瘕。这是气先生病而后血生病，所以月经不来，可以宣导而下出。所以《难经》说：任脉为病，内部苦于结聚，男子表现为七疝，女子表现为瘕聚，说的就是这个道理。如果不是大辛热的药物，不能治愈，可以服用见丹（注：原文可能有缺字或异体，此处保留原意）。
肠覃怎么样？岐伯说：寒气客居于肠外，与胃相搏，不得荣养，因为有所系连，瘕结在内附着，恶气于是兴起，息肉乃生。它刚开始生成时，大小如鸡卵，逐渐增大，等到长成时，形状像怀孕一样，病程久的超过一年，按压它则坚硬，推动它则移动，月经按时来潮。这是它的征候。所谓“肠”，是大肠；“覃”是延长之意。大肠以传导为功能，是肺的腑，肺主卫气，卫气得热则泄，得寒则凝。现在寒气客居于大肠，所以卫气不能荣养，有所系连停止而结瘕在内贴附，这种延长久治不愈，就叫肠覃。气散则清气聚，浊气结为证候聚，所以恶气发起，息肉乃生，小渐增大，到了时期鼓其腹部则像怀孕的样子。这是气病而血未病，所以月经不断且按时来潮，本非妊娠，可以此为辨别。
按此说法，石瘕是因为血壅滞不流，所以月经不来；肠覃是因为清气聚而浊结成瘕，所以血未病，月经不断。由此知道这两种积聚的不同。然而也有其他诸积所致，或者有病痈脓而类似这两种证候的，不可不仔细考察。
Chen Wuyue stated: Jia (masses with shifting shape) belongs to the Liver department, while Ji (fixed masses) belongs to the Lung department. "Ji" implies hardness; "Jia" implies falsity or provisionality, taking shape by borrowing external substances. However, the names of the "Seven Jias" are not detailed in classic treatises. Although there are seven syndromes named after jiao (water dragon), snake, soft-shelled turtle, meat, hair, lice, and rice, these were not originally fixed names but rather accidental occurrences caused by the interaction of food items leading to illness. As for Jia in women, it is formed when internal, external, or neither-internal-nor-external causes injure the Qi and Blood of the Zang organs. The ancients called it a stubborn disease, regarding creatures like jiao and snakes as causes of "living Jia," yet one need not be rigid about this; all belong to blood diseases. Matters involving snakes or hair are merely coincidental; they remain and gather during eating, forming through borrowed blood, possessing their own vitality. It is similar to the monk in the Yonghui era who suffered from dysphagia, having an object in his abdomen shaped like a fish, which was a living Jia.
According to this theory, Ji and Jia belong to the Zang organs, roughly divided into Qi and Blood aspects, so one should not be overly constrained by this distinction. However, living Jia can also be caused by external factors, such as Xu Zhicai's treatment of a disease caused by consuming clam essence, which manifested on the foot. Why did Chen Wuyue omit this in his discussion of the Three Causes?
The *Shui Zhang* (Water Swelling) chapter asks: What is Shi Jia (Stone Jia)? Qibo replied: Shi Jia originates in the Baozhong (uterus). Cold pathogen lodges in the Zimen (os uteri), causing obstruction. Qi becomes blocked, and evil blood that should be discharged remains stagnant, accumulating day by day until the abdomen swells like pregnancy. Menstruation fails to arrive on time. This occurs only in women and can be treated by guiding the pathogenic factors downward. The *Baojian* states: The Bladder is the fu organ of body fluids; it functions through Qi transformation to excrete waste. Now, if cold lodges in the Zimen, Qi will surely become obstructed, and blood will stagnate and fail to flow, hardening like stone, hence named Shi Jia. Here, Qi pathology precedes Blood pathology; thus, since menstruation is absent, it can be guided out. Therefore, the *Nan Jing* states: When the Ren Mai is diseased, there is internal knottedness; in men, it manifests as Seven Hernias; in women, as Jia Ju (accumulations). This is what is meant. Unless potent acrid-hot medicines are used, the condition cannot be cured; Jian Dan may be taken.
What is Chang Qin (Intestinal Qin)? Qibo said: Cold pathogen lodges outside the intestines, contending with the Stomach, failing to receive nourishment. Due to adhesion, the Jia attaches internally, evil Qi arises, and polyps grow. Initially, it is the size of a chicken egg, gradually enlarging until it resembles pregnancy. If long-standing (over a year), it is hard upon pressure but movable upon pushing. Menstruation arrives on time. These are its signs. "Chang" refers to the Large Intestine; "Qin" means extension. The Large Intestine governs transmission and is the Fu organ of the Lung. The Lung governs Wei Qi (Defensive Qi). Wei Qi dissipates with heat and coagulates with cold. Now, cold lodges in the Large Intestine, so Wei Qi fails to nourish, adhering and stopping, forming Jia internally. This prolonged persistence is named Chang Qin. When Qi disperses, clear Qi gathers; when turbid Qi knots, pathological masses form. Thus, evil Qi arises, polyps grow, slowly increasing until the abdomen distends like pregnancy. Here, Qi is diseased but Blood is not, so menstruation continues regularly. It is not pregnancy, and this serves as the differentiation.
In analysis, Shi Jia is due to blood stagnation and obstruction, hence menstruation ceases; Chang Qin is due to the gathering of clear Qi and knotting of turbid Qi into Jia, hence Blood is unaffected and menstruation continues. From this, the difference between these two accumulations is known. However, other types of accumulations may cause similar presentations, or conditions like abscesses/pus may mimic these two syndromes; careful examination is indispensable.