郁金 香附（醋炒） 丹参 茯苓 炒黑丹皮 苏梗 延胡索（醋炒）
韭菜根汁（一酒杯，冲） 童便（冲） 鲜藕
另∶用云南黑白棋子二枚，研细末。用白蜜调，徐徐咽下。
渊按∶血从惊恐而来，所谓惊则气乱，恐则气下。气乱血逆，必然之理，棋子治何病未详。
又 肝郁化火，胃寒化热，气满于腹，上攻脘胁，则血亦上出。前方疏理气血之壅，病情稍效。今以化肝
煎加减。盖肝胃之气，必以下降为顺，而瘀凝之血，亦以下行为安。气降而血不复升，
是知气降而火降，瘀化而血安，必相须为用也。
郁金 三棱（醋炒） 延胡索 川贝 青皮 桃仁 泽泻 焦山栀 茯苓 苏梗 丝瓜络 鲜藕 鲜苎麻（连根叶）
范 素有肝胃气痛，兼挟寒积。脘腹胀满，痛及于腰，咳不可忍，舌苔白腻，渴不欲饮，大便似利不利，
脉沉弦而紧。恐属脏结，颇为险候。非温不能通其阳，非下不能破其结，仿许学士温脾法。
制附子 干姜 肉桂 川朴（姜汁炒） 生大黄 枳实
渊按∶咳不可忍，上焦之气亦闭矣。所谓五实证非耶？
又 脘腹胀满，上至心下，下连少腹，中横一纹，如亚腰葫芦之状。中宫痞塞，阴阳结绝，上下不通，
势濒于危。勉进附子泻心一法，温阳以泄浊阴，冀其大便得通。否则恐致喘汗厥脱，难以挽回。
制附子 川连（姜汁炒） 川朴（姜汁炒） 生大黄（酒浸）
长流水煎。再服备急丸七粒，砂仁汤送下。
又 两投温下，大便仍然不通。胸腹高突，汤水下咽辄吐，肢渐冷，脉渐细，鼻煽额汗，厥脱可忧。
按结胸、脏结之分，在乎有寒热、无寒热为别。下之不通，胀满愈甚，乃太阴脾脏受
戕，清阳失于转运。崔行功有枳实理中一法，取其转运中阳，通便在是，挽回厥脱亦在是，惟高明裁酌之。
此证死。
仁渊曰∶五积六聚，积属脏而不移，聚属腑而无定。又曰 瘕， 者，真也，其块不散；瘕者，假也，
聚散不常。夫五积虽分属五脏，不过分其部位病形，使学人有所遵循耳。究在脏腑之
外，乃寒痰汁沫瘀血凝结于膜壑曲折之处，因脏气不能运化，积
年累月，受病非一途。先宜观其虚实，即形气实者，亦不可专于攻伐，况夫虚多实少！且痞气、肥气、多于奔
豚、伏梁。即今之癖块居脘胁之下，因久疟而生者十七八，又名疟母。由服药不
当，或早用堵截，或饮食不节，致湿热痰浊漫无出路，郁于膜原之分，中气不化，日久成积。初宜开化其邪，
兼调营卫。中虚者，先调其中，湿热化而块自消，中气和而块亦消，养正逐邪，
各有分寸。六聚较积轻浅，病在气分，营卫不和，气聚有形，必挟肝邪，疏肝和脾以调气机，自效。积聚之
证，大抵寒多热少，虚多实少，桂枝、肉桂、吴茱萸为积聚之要药，能温脾疏肝，使气机通畅故也。盖气温则
行，血寒则凝，营运其气，流通其血，为治积第一法。有热再佐连、柏之类，参以活变。若虫积乃由湿
热食滞而生，或寒邪郁其湿热，肠胃之气不化，而九虫生焉。《千金方》分属五脏，不过分病形以定治法耳，
未免凿空。盖无论何虫，不过伏在肠胃曲折之处。如果伏于五脏，必然五脏被咬，其人尚能生乎！虫积既从
湿热食滞而生，固多实证，治无补法。即久虚亦必先去其虫而后调补之，不可泥养正积除之说也。
郁金、香附（醋炒）、丹参、茯苓、炒黑牡丹皮、苏梗、延胡索（醋炒）。
韭菜根汁（一杯，冲服）、童便（冲服）、鲜藕。
另法：取云南黑白棋子各二枚，研成细末。用白蜜调和，慢慢咽下。
渊按：血液妄行源于惊恐，所谓“惊则气乱，恐则气下”。气机紊乱导致血行逆乱，这是必然的道理。至于棋子能治什么病，不详。
又案：肝气郁结化火，胃中寒气化为热邪，气滞充满腹部，向上攻冲脘部和胁肋，导致血液上溢而出。前方使用疏理气血壅滞的药物，病情稍有好转。现在改用化肝煎加减。因为肝和胃的气机，以下降为顺；而瘀凝的血液，也以下行为安。气机下降则血液不再上逆，由此可知，气降则火降，瘀血化解则血液安宁，这两者必须相互配合使用。
处方：郁金、三棱（醋炒）、延胡索、川贝母、青皮、桃仁、泽泻、焦山栀、茯苓、苏梗、丝瓜络、鲜藕、鲜苎麻（连根叶）。
范姓患者：平素有肝胃气痛，兼夹寒积。脘腹胀满，疼痛波及腰部，咳嗽剧烈难以忍受，舌苔白腻，口渴但不想喝水，大便似通非通，脉象沉弦而紧。恐怕属于脏结证，是比较危险的候象。不用温药不能通达阳气，不用下药不能破除结聚，仿照许学士的温脾汤法。
处方：制附子、干姜、肉桂、川朴（姜汁炒）、生大黄、枳实。
渊按：咳嗽剧烈难以忍受，说明上焦气机闭塞。这难道不是五实证吗？
又案：脘腹胀满，向上延伸至心下部，向下连接少腹部，中间有一道横纹，形状像亚腰葫芦。中焦痞塞不通，阴阳之气隔绝，上下不通畅，形势濒临危险。勉强试用附子泻心汤一法，温补阳气以泄除浊阴，希望其大便能够通畅。否则恐怕会导致气喘、出汗、厥脱，难以挽回。
处方：制附子、川黄连（姜汁炒）、川朴（姜汁炒）、生大黄（酒浸）。
用长流水煎煮。再服用备急丸七粒，用砂仁汤送下。
又案：两次投用温下法后，大便仍然不通。胸腹部高高突起，汤水喝下去立即呕吐，四肢逐渐变冷，脉象逐渐细微，鼻翼煽动，额头出汗，出现厥脱之象令人担忧。
辨析结胸与脏结的区别，在于有无寒热表现。攻下后不通，胀满更加严重，这是太阴脾脏受到损伤，清阳之气失去转运功能。崔行功有枳实理中汤一法，取其转运中焦阳气，通便在此，挽回厥脱也在此，请高明者斟酌裁断。
此证最终死亡。
仁渊曰：五积六聚，积属于脏而不移动，聚属于腑而无定处。又说，“瘕”是假的意思（注：原文此处可能有误或特指，通常瘕为假，寢为真，但依原文翻译），“寢”是真，其肿块不散；“瘕”是假，聚散无常。虽然五积分别归属于五脏，不过是区分部位和病形，使学习者有所遵循罢了。究其实，病位在脏腑之外，是寒痰、津液、泡沫、瘀血凝结在膜原、沟壑、曲折之处，因为脏气不能运化，经年累月，致病途径不止一种。起初应当观察虚实，即使形体气力壮实的人，也不可专门使用攻伐之法，何况是虚多实少！而且痞气、肥气，多于奔豚、伏梁。就像现在的癖块位于脘胁之下，因长期疟疾而产生的占十分之七八，又名疟母。由于服药不当，或者过早使用堵截收敛之法，或者饮食不节制，导致湿热痰浊漫无出路，郁结于膜原之分，中气无法运化，日久形成积聚。初期宜开散化解邪气，兼调营卫。中焦虚弱者，先调理中焦，湿热化解则肿块自消，中气调和则肿块亦消，扶正祛邪，各有分寸。六聚比积轻浅，病在气分，营卫不和，气聚而成有形之物，必挟带肝邪，疏肝健脾以调畅气机，自然见效。积聚之证，大抵寒多热少，虚多实少，桂枝、肉桂、吴茱萸是治疗积聚的要药，能温脾疏肝，使气机通畅的缘故。大概气温则运行，血寒则凝滞，营运其气，流通其血，是治疗积聚的第一法则。如果有热，再佐以黄连、黄柏之类，参酌灵活变化。若虫积是由湿热食滞而生，或者寒邪郁闭湿热，肠胃之气不能运化，从而生出九虫。《千金方》将其分属五脏，不过是区分病形以确定治法罢了，未免有些牵强附会。大概无论何种虫子，不过是潜伏在肠胃曲折之处。如果真的潜伏在五脏，必然咬伤五脏，那人还能生存吗！虫积既然从湿热食滞而生，固然是多实证，治疗没有补法。即使久病体虚，也必须先去虫然后调理补益，不可拘泥于“养正积除”的说法。
Jinyin (Curcuma aromatica Rhizome), Xiangfu (Cyperi Rhizoma, stir-fried with vinegar), Danshen (Salvia miltiorrhiza Radix et Rhizoma), Fuling (Poria), Chaohei Danpi (Moutan Cortex, charred), Sugen (Perillae Caulis), Yanhusuo (Corydalis Rhizoma, stir-fried with vinegar).
Jiucai Gen Zhi (Juice of Allium tuberosum Root, one wine cup, taken by mixing), Tongbian (Child's urine, taken by mixing), Xian Ou (Fresh Lotus Rhizome).
Separately: Take two black and white chess pieces from Yunnan, grind into fine powder. Mix with white honey, and swallow slowly.
Yu An (Commentary by Yu): Hemorrhage arising from fright and fear; as the saying goes, "Fright causes Qi to become chaotic, Fear causes Qi to sink." Chaotic Qi leads to rebellious Blood flow, which is an inevitable principle. It is unclear what disease chess pieces treat.
Another case: Liver Qi stagnation transforms into Fire, Stomach Cold transforms into Heat. Qi fills the abdomen and attacks upward to the epigastrium and hypochondrium, causing Blood to erupt upwards. The previous formula, which regulated Qi and resolved Blood stasis obstruction, showed slight efficacy. Now, use a modified Huagans Decoction (Hua Gan Jian). The Qi of the Liver and Stomach must descend to be in harmony, and stagnant Blood finds peace when it descends. When Qi descends, Blood no longer rises. Thus, we know that descending Qi leads to descending Fire, and resolving stasis leads to stable Blood; these two methods must be used together.
Prescription: Jinyin, Sanleng (Sparganii Rhizoma, stir-fried with vinegar), Yanhusuo, Chuanbei (Fritillariae Cirrhosae Bulbus), Qingpi (Citri Reticulatae Pericarpium Viride), Taoren (Persicae Semen), Zexie (Alismatis Rhizoma), Jiao Shanzhi (Gardeniae Fructus, charred), Fuling, Sugen, Sigualuo (Luffae Reti Network), Xian Ou (Fresh Lotus Rhizome), Xian Zhuma ( Boehmeriae Niveae Herba, including roots and leaves).
Patient Fan: Suffers chronically from Liver-Stomach Qi pain, complicated by Cold accumulation. Epigastric and abdominal distension and fullness, pain radiating to the waist, unbearable coughing, white greasy tongue coating, thirst without desire to drink, stool appearing loose but not truly flowing, pulse is deep, wiry, and tight. This may belong to Zang-Jie (Organ Knotting), a rather dangerous condition. Without warming, Yang cannot be unblocked; without purging, the knot cannot be broken. I imitate Scholar Xu's Wenspi Method (Wen Pi Fa).
Prescription: Zhi Fuzi (Prepared Aconiti Lateralis Radix), Ganjiang (Zingiberis Rhizoma), Rougui (Cinnamomi Cortex), Chuanpu (Magnoliae Officinalis Cortex, stir-fried with ginger juice), Sheng Dahuang (Rhei Radix et Rhizoma, raw), Zhishi (Aurantii Fructus Immaturus).
Yu An: Unbearable coughing indicates closure of Upper Jiao Qi. Is this not the Five Excess Syndrome (Wu Shi Zheng)?
Another case: Epigastric and abdominal distension extends upward to the heart region and downward to the lower abdomen. There is a transverse line in the middle, resembling the shape of an hourglass gourd. The Central Palace is blocked, Yin and Yang are severed, upper and lower communication is obstructed, and the situation is critical. I tentatively administer the Fuzi Xiexin Method (Attitude of Fuzi and Bitter Drain), warming Yang to drain turbid Yin, hoping for bowel movement. Otherwise, panting, sweating, and collapse may occur, which would be difficult to reverse.
Prescription: Zhi Fuzi, Chuanlian (Coptidis Rhizoma, stir-fried with ginger juice), Chuanpu, Sheng Dahuang (soaked in wine).
Decoct with long-flowing water. Additionally, take seven pills of Beiji Wan (Emergency Rescue Pill), delivered with Amomum Villosum Seed Tea.
Another case: After two doses of warming purgatives, the bowels remain unopened. The chest and abdomen are bulging high; any soup swallowed is immediately vomited. Limbs gradually turn cold, pulse becomes thready, nasal flaring and forehead sweating appear, raising concern for collapse.
Regarding the distinction between Jie-Xiong (Chest Binding) and Zang-Jie: the difference lies in the presence or absence of Cold and Heat. If purgation fails to open the bowels and distension worsens, it indicates damage to the Taiyin Spleen organ, where Clear Yang loses its transformative transport function. Cui Xinggong has the Zhishi Lizhong Method (Zhishi Lizhong Tang), which aims to transform and transport Middle Yang; bowel unblocking and reversal of collapse both depend on this. Please, experts, exercise your judgment.
This patient died.
Ren Yuan said: Wu Ji (Five Accumulations) and Liu Ju (Six Gatherings); Ji belongs to the Zang organs and does not move; Ju belongs to the Fu organs and is indefinite. It is also said that "Jia" (False) implies irregular gathering and dispersal, while "Pin" (True/Solid) implies a mass that does not dissipate. Although Wu Ji are divided among the five Zang organs, this merely distinguishes their locations and morphological forms to guide learners. Ultimately, the pathology lies outside the Zang and Fu organs; it is Cold Phlegm, fluids, foam, and Blood stasis condensing in the membranes, fossae, and tortuous places. Because Zang Qi cannot transform them, over years and months, the pathogenesis is diverse. Initially, observe deficiency and excess. Even if the body and Qi are strong, one should not solely rely on attacking methods, especially when deficiency exceeds excess! Moreover, Pi Qi and Fei Qi are more common than Ben Tun (Running Piglet) and Fu Liang (Hidden Beam). Similarly, current masses located below the epigastrium and hypochondrium, arising from chronic malaria, account for 70-80%, also known as Nu Mu (Malaria Mother). Due to improper medication, such as premature use of astringents/blockers, or dietary indiscretion, Damp-Heat and Phlegm-Turbidity have no outlet, stagnating in the membrane source division. Middle Qi fails to transform, leading to accumulation over time. In the early stage, it is appropriate to open and resolve the pathogen, while simultaneously regulating Ying and Wei. For those with Middle Deficiency, first regulate the Middle; once Damp-Heat resolves, the mass disappears naturally; when Middle Qi harmonizes, the mass also subsides. Nourishing Righteousness and expelling Pathogens each require precise measurement. Liu Ju is lighter and shallower than Ji; the pathology is in the Qi level. With disharmony of Ying and Wei, Qi gathers into tangible form, inevitably involving Liver Pathogen. Soothing the Liver and harmonizing the Spleen to regulate Qi mechanism will be effective. Generally, Ji and Ju conditions involve more Cold than Heat, and more Deficiency than Excess. Guizhi (Cinnamon Twig), Rougui, and Wuzhuyu (Evodiae Fructus) are key herbs for treating accumulations because they warm the Spleen and soothe the Liver, ensuring smooth Qi mechanism. Essentially, warmth promotes movement, while Cold congeals Blood; circulating Qi and unblocking Blood is the primary method for treating accumulations. If Heat is present, assist with herbs like Lian (Coptidis Rhizoma) and Bo (Phellodendri Cortex), adapting flexibly. As for Worm Accumulation, it arises from Damp-Heat and Food Stagnation, or Cold Evil constraining Damp-Heat, causing intestinal Qi to fail in transformation, thereby generating Nine Worms. The *Qianjin Fang* assigns them to the five Zang organs, merely distinguishing morphological forms to determine treatment, which is somewhat far-fetched. Regardless of the worm type, they simply lurk in the tortuous parts of the intestines and stomach. If they truly lurked in the Zang organs, they would surely bite the Zang organs, and could the person still survive? Since Worm Accumulation arises from Damp-Heat and Food Stagnation, it is predominantly an Excess syndrome, and treatment involves no tonification. Even in cases of long-standing deficiency, one must first eliminate the worms before tonifying and regulating; one must not rigidly adhere to the theory of "Nourishing Righteousness to Remove Accumulation."